BACKGROUND

This case report describes a rare presentation of double-vessel Spontaneous Coronary Artery Dissection (SCAD) in a 54-year-old male. One dissection occurred in a coronary artery with atherosclerotic plaque deposition, while the second vessel exhibited dissection without evidence of plaque deposition, trauma or iatrogenic manipulation such as percutaneous coronary intervention. The patient, a known hypertensive and dyslipidemic, had a prior diagnosis of heart failure with reduced ejection fraction (HFrEF). He presented with progressively worsening shortness of breath and orthopnea (two-pillow orthopnea for three years. An initial coronary angiogram was recommended due to a high suspicion of underlying coronary artery disease (CAD).Subsequent diagnostic workup revealed multisegmental wall motion abnormalities on 2D echocardiography with Doppler imaging. Laboratory tests, including electrolytes, were unremarkable. A follow-up coronary angiogram revealed mild to moderate CAD in the left anterior descending (LAD) artery and spontaneous coronary artery dissection involving both the LAD and the right coronary artery (RCA). The patient was managed conservatively with aspirin and discharged on a regimen of sacubitril/valsartan, ivabradine, trimetazidine, and rosuvastatin. As typically seen in SCAD cases, conservative medical management was preferred over invasive procedures such as PCI or coronary artery bypass grafting (CABG), which are reserved for select clinical situations.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Arteries ; Dissection ; Hospitals ; Male ; Patients ; Research Report ; Tertiary Care Centers

Science ; Heart

BACKGROUND

Persistent left superior vena cava (PLSVC) is a rare but clinically relevant congenital vascular anomaly, occurring in 0.3% of the general population and up to 4.3% in those with congenital heart disease. It is usually asymptomatic and incidentally discovered during imaging, catheterization, or surgery.

CASE SUMMARY

We present the case of a 38-year-old hypertensive female who was evaluated for acute chest discomfort, palpitations and near-syncope. Transthoracic echocardiography revealed a dilated coronary sinus, prompting a contrast echocardiography study that demonstrated early opacification of the coronary sinus upon left arm injection confirming the diagnosis of PLSVC.

CONCLUSION

This case underscores the importance of recognizing coronary sinus dilatation as a potential marker of venous anomalies such as PLSVC. Contrast echocardiography with bilateral injections remains a practical, non-invasive tool in its diagnosis, with significant implications for future invasive procedures.

Human ; Vena Cava, Superior ; Population ; Heart Diseases ; Heart Defects, Congenital ; Echocardiography ; Catheterization

Suicide left ventricle describes the development of dynamic intraventricular gradients after aortic valve replacement due to acute hemodynamic changes that happen after relieving the obstruction leading to hemodynamic collapse. This is a rare complication in transcatheter aortic valve replacement and is underreported in surgical aortic valve replacement (SAVR). We present the case of a male patient who presented with suicide left ventricle after SAVR.

World Health Organization ; Transcatheter Aortic Valve Replacement ; Suicide ; Research Report ; Hemodynamics ; Heart Ventricles ; Aortic Valve

BACKGROUND

Carney complex (CNC) is a rare multiple endocrine neoplasia syndrome caused by PRKAR1A gene mutation and  characterized by lentigines, myxomatous tumors and various endocrine neoplasms.

CASE PRESENTATION

This is a case of a 52-year-old male patient who underwent echocardiogram for intermittent palpitations and near-syncopal attack, which revealed a left atrial myxoma. The patient also exhibited multiple lentigines and had a history of histologicallyconfirmed papillary thyroid carcinoma. Surgical excision and subsequent histopathologic examination confirmed cardiac myxoma, fulfilling three major Stratakis criteria for CNC.

DISCUSSION

This case highlights the importance of a thorough history and physical examination with a strong understanding of the syndrome’s features being key to recognizing the disease. Increasing awareness and reinforcing knowledge of CNC are crucial for preventing misdiagnosis and ensuring effective management of this rare condition. To our knowledge, this is the first published case report of CNC in the Philippines, emphasizing the need for heightened regional awareness.

CONCLUSION

CNC may present with subtle or nonspecific symptoms and atypical tumor locations. Early recognition through a high index of suspicion, targeted imaging and a multidisciplinary approach is critical to optimize outcomes and guide family screening in this rare syndrome.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Multiple Endocrine Neoplasia ; Carney Complex ; Myxoma ; Syndrome ; Neoplasms ; Mutation ; Lentigo ; Genes

This is the case of a 62-year-old male with prior modified Bentall’s procedure using a 23-mm bioprosthetic valve last 2013 who came in with progressive heart failure symptoms. On physical examination, vital signs are stable. Physical exam revealed rhonchi on both lung fields and irregular rhythm with a grade 3 systolic ejection murmur at the aortic area. A 2-dimensional transthoracic echocardiogram showed an ejection fraction of 25%, aortic valve area of 1.0 cm2 and mean gradient of 21 mmHg consistent with severe low-flow, low-gradient aortic stenosis (AS). Options for re-do surgical aortic valve replacement (SAVR) were discussed. Since the patient was deemed high risk for another surgery, the option for transcatheter aortic valve in surgical aortic valve (TAV-in-SAV) was considered. The patient underwent successful TAV-in-SAV using a 26-mm self-expanding bioprosthetic valve. Post-procedure, there was significant improvement of functional capacity from class IV to class I.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; World Health Organization ; Vital Signs ; Respiratory Sounds ; Research Report ; Physical Examination ; Constriction, Pathologic ; Aortic Valve Stenosis

BACKGROUND

Perimyocarditis due to inflammation of the pericardium and myocardium results in myocellular damage. Myocarditis, or myocardial inflammation, occurs after cardiac injury. Gallbladder edema, in the absence of cholecystitis, may occur in numerous conditions including cardiac inflammation.

CASE PRESENTATION

A 28-year-old previously healthy female presented with chest pain, orthopnea, exertional dyspnea and a history of fever. She also reported intermittent right upper quadrant pain. Physical exam revealed a pericardial friction rub. Electrocardiogram (ECG) showed sinus rhythm with nonspecific ST-T changes; troponin I was elevated. Echocardiography demonstrated segmental wall motion abnormalities, pericardial thickening and preserved systolic function. Initially managed as acute coronary syndrome, she was later diagnosed with perimyocarditis. On the second hospital day, she developed recurrence of right upper quadrant abdominal pain. Abdominal ultrasound revealed gallbladder edema with pericholecystic fluid, but no stones. Liver enzymes were elevated. Acalculous cholecystitis was considered and cholecystostomy offered instead due to aspirin therapy. However, repeat imaging showed resolution of cardiac and gallbladder findings, and surgery was deferred. Cardiac MRI postdischarge was unremarkable.

CONCLUSION

Perimyocarditis may present with gallbladder edema mimicking acalculous cholecystitis, potentially leading to unnecessary surgical intervention. This case emphasizes the importance of considering cardiac etiologies in atypical abdominal presentations.

Human ; Female ; Adult: 25-44 Yrs Old ; Acalculous Cholecystitis ; Research Report ; Pericardium ; Myocardium ; Myocarditis ; Inflammation

Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, Viridans streptococci, Haemophilus influenzae and anaerobic bacteria with Streptococcus pyogenes (S.pyogenes) being a possible, though very uncommon etiology. This case represents an occurrence of S. pyogenes pericarditis in an apparently healthy female with no known immunocompromising condition. A 37-year-old female, married, real estate agent with no comorbidities came in for chest pain radiating to the upper back, relieved with leaning forward. Cardiac biomarker was normal, ECG demonstrated diffuse ST-segment elevation and PR segment depression, while imaging showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance and workup for immunocompromised state was negative. The 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done. Cultures grew Streptococcus pyogenes confirming the diagnosis of acute purulent pericarditis. Daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics and the patient had resolution of pericardial effusion. Acute pyogenic pericarditis with cardiac tamponade is a rare but serious condition that requires prompt recognition and intervention. Early diagnosis, through a combination of clinical suspicion, ECG and echocardiography is crucial for initiating timely treatment.

Human ; Female ; Adult: 25-44 Yrs Old ; Viridans Streptococci ; Streptococcus Pyogenes ; Streptococcus Pneumoniae ; Staphylococcus Aureus ; Streptococcal Infections ; Electrocardiography ; Echocardiography ; Early Diagnosis

INTRODUCTION

Secondary hypertension should be suspected among young individuals and patients with recent onset of hypertension or drug-resistant hypertension. Among the causes of secondary hypertension, renovascular hypertension is well-established and correctible if diagnosed appropriately. We report the case of a young female with an unusual cause of renovascular hypertension.

CLINICAL PRESENTATION:

A 29-year-old female was admitted for elevated blood pressure and headache, unresponsive to multiple antihypertensives. The workup for secondary hypertension was mostly unremarkable. However, renal Doppler ultrasound showed elevated peak systolic velocity in the left renal artery. CT angiogram revealed an outpouching between the left gonadal and renal veins. No renal artery stenosis was found on renal angiography, but venography revealed an aneurysm between the left gonadal and renal veins. An aberrant vein draining into the inferior vena cava (IVC) and severe reflux into a dilated left gonadal vein were also noted.

MANAGEMENTCONCLUSION

This case highlights a rare cause of renovascular hypertension due to renal vein congestion from severe left gonadal vein reflux and a renal/gonadal vein aneurysm. Additional mechanisms may include external compression of the renal artery or a suction effect caused by multiple venous outflows. Regardless of the exact pathophysiology, coiling of the aneurysm and gonadal vein successfully restored normal venous return and resolved hypertension.

Human ; Female ; Adult: 25-44 Yrs Old ; Veins ; Research Report ; Renal Veins ; Pharmaceutical Preparations ; Patients ; Hypertension, Renovascular ; Hypertension ; Female ; Aneurysm

INTRODUCTION

Takayasu arteritis (TA) is a rare chronic large vessel vasculitis that affects the aorta and its major branches with a median age of onset of 25 years. The disease has a worldwide incidence of 1-2 per million, primarily affecting females with a 9:1 ratio. It is considered as an autoimmune disease that leads to progressive vessel thickening and stenosis, or aneurysmal dilatation. Coronary artery involvement is observed in 5.9%-58.2% of TA cases. We present a case of TA in a Filipino male presenting concurrently with myocardial infarction (MI) and ischemic stroke.

CASE REPORT

A 41-year-old Filipino male smoker with hypertension presented with chest pain, left-sided paresthesia and hemiparesis. Initial assessment revealed differential blood pressure between the arms, sensory and motor deficits, and abnormal ABI. Electrocardiogram confirmed anteroseptal ST-elevation MI and cranial computed tomography (CT) showed ischemic stroke. Arterial duplex scan had findings suggestive of hemodynamically significant lower extremity stenosis. A CT aortogram revealed multiple occlusions, including in the left subclavian artery, suggesting TA. Coronary angiography was attempted but was deferred due to peripheral arterial occlusion. A CT coronary angiogram revealed severe stenosis of the left anterior descending artery and moderate stenosis of the other coronaries. The patient was treated with dual antiplatelet therapy, statins, anticoagulation, corticosteroids and methotrexate. He experienced significant improvement in neurological symptoms and was chest pain-free upon discharge. At the 1-month follow-up, the patient remained asymptomatic.

DISCUSSION

Coronary involvement in TA can manifest as angina, MI, or other coronary lesions. The coexistence of MI and ischemic stroke in the same event is rare. Traditional risk factors for ischemic heart disease (IHD) in this patient such as hypertension and smoking may have contributed to the presentation, though TA itself is known to accelerate atherosclerosis. Limited vascular access hindered coronary intervention in this case and revascularization strategies remain challenging in active TA. The formation of extensive collateral arteries, along with early initiation of immunosuppressive therapy, likely contributed to the patient’s survival.

CONCLUSION

This case illustrates a rare and complex case of TA in a male patient with concurrent MI and ischemic stroke. Although coronary revascularization was not pursued due to occluded access, immunosuppressive therapy successfully managed the patient’s condition. Extensive collateral artery formation and early therapeutic intervention were key factors in the patient’s favorable outcome.

Human ; Male ; Adult: 25-44 Yrs Old ; Takayasu Arteritis ; Myocardial Infarction ; Ischemic Stroke ; Vasculitis ; Constriction, Pathologic