The coronary sinus (CS) normally drains into the right atrium (RA). We report a rare case of anomalous CS drainage into the left atrium (LA). A middle-aged lady underwent coronary computed tomography angiography (CCTA) for evaluation of dyspnea. An earlier transthoracic echocardiogram showed normal chamber sizes and function. The CCTA revealed severe left anterior artery stenosis as well as an anomalous drainage of a normal sized CS into the LA. A small fistula from the CS also communicated with RA. These findings were confirmed during invasive angiography. No further intervention was offered as this was unlikely to be of hemodynamic significance. Nevertheless, understanding of this unusual anatomy will be of importance when planning for electrophysiological or pacing procedures.

A 43-year-old male with no past medical history presented with acute onset palpitations, chest pain and diaphoresis. Electrocardiogram showed atrial fibrillation with rapid ventricular response. High-sensitivity cardiac troponin I was elevated at 87 ng/L at presentation and rose further to 1874 ng/L 8 hours later. Invasive coronary angiography revealed significant stenosis of the left circumflex artery, which was treated with percutaneous coronary intervention. Transthoracic echocardiography showed severe left ventricular hypertrophy with mild systolic anterior motion of the anterior mitral leaflet. Cardiac magnetic resonance demonstrated features consistent with hypertrophic cardiomyopathy with regional fibrosis. Of note, focal delayed enhancement was seen in the anterolateral papillary muscle.

INTRODUCTION: Normal stress myocardial perfusion imaging (MPI) carries a favourable prognosis. Conversely, elevated coronary artery calcium (CAC) is associated with increased major adverse cardiovascular events (MACE). There is limited information on the prognosis and management of patients with elevated CAC and normal MPI. We aimed to assess the outcomes of patients with elevated CAC and normal MPI in relation to post-MPI statin use. METHODS: A retrospective review of normal MPI with CAC score >300 was performed between 1 March 2016 and 31 January 2017 in a Singapore tertiary hospital. Patients with known atherosclerotic cardiovascular disease or left ventricular ejection fraction <50% on MPI were excluded. Patient demographics, prescriptions and MACE (cardiac death, nonfatal myocardial infarction and/or ischaemic stroke) at 24 months after MPI were traced using electronic records. Binary logistic regression was used to evaluate for independent predictors of MACE. RESULTS: We included 311 patients (median age 71 years, 56.3% male), of whom 65.0% were on moderate to high-intensity statins (MHIS) after MPI. MACE was significantly lower in the post-MPI MHIS group (3.5% vs. 9.2%, P = 0.035). On univariate binary logistic regression, post-MPI MHIS use was the only significant predictor for MACE (odds ratio [OR] 0.355 [95% confidence interval (CI) 0.131-0.962], P = 0.042), even after multivariate adjustment (adjusted OR 0.363, 95% confidence interval 0.134-0.984, P = 0.046). CONCLUSION Post-MPI MHIS use is associated with lower MACE and is an independent negative predictor for 24-month MACE among patients with normal MPI and CAC >300.
Humans ; Male ; Aged ; Female ; Coronary Artery Disease ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Myocardial Perfusion Imaging/methods* ; Calcium ; Stroke Volume ; Brain Ischemia ; Risk Factors ; Ventricular Function, Left ; Stroke ; Prognosis

Humans ; COVID-19/complications* ; Pericarditis/complications*

COVID-19 ; Child ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver ; Liver Transplantation ; Living Donors ; SARS-CoV-2