Dominika M Zoltowska

Association between hypothyroidism and Takotsubo Cardiomyopathy: Analysis of Nationwide Inpatient Sample Database.

BACKGROUNDnTakotsubo Cardiomyopathy (TC), also called transient left ventricular (LV) ballooning syndrome, resembles myocardial infarction and is characterized by LV dysfunction in the absence of coronary artery disease. Hypothesis described for TC has been an intense social stressor, pheochromocytoma, thyrotoxicosis among others. We performed this study to analyze the association of hypothyroidism with TC.nnnMETHODSnWe queried the Nationwide Inpatient Sample which represents 20% of all the United States hospital data for our study. We identified TC and hypothyroidism through their respective ICD9. Codes for years 2006-2012. SAS 9.4 was used to perform a chi-square analysis to find any statistical significance and p < 0.05 used to determine statistical significance. Significant differences were identified using odds ratio (OR) estimates.nnnRESULTSnA total of 19,713 cases with TC were identified of which 17,340 (87.96%) were females and 2,373 (12.04%) were males. 3,272 patients with TC had diagnosis of hypothyroidism. There is statistically significant evidence of an association between TC and hypothyroidism (OR 2.21 (95% CI: 2.11- 2.31); p<0.0001). There is evidence of increased statistical significance of females having TC 5.24 (95% CI: 4.96-5.53; (p<0.0001)) compared to males, with an increased statistically significance of females with hypothyroidism having TC, OR 6.65 (95% CI: 5.57-7.93; p< 0.001) compared to males.nnnCONCLUSIONnThere is an increased association of hypothyroidism, especially hypothyroidism for females with TC.

A Port-A-Cath in aorta

Totally implantable venous access ports are valuable invention for oncological patients. Erroneous arterial malposition rate is estimated from 1.1% to 3.7% (Bowen et al. Am. J. Surg., 2014, 208, 937). Early recognition and management are crucial to prevent further complications.

A rare cause of heart failure

Noncompaction cardiomyopathy (NCCM) is a rare but important cause of heart failure. The reported prevalence of left ventricle NCCM based on echocardiographic criteria varies between 0.014% and 1.3%, while the biventricular involvement is extremely rare with only few cases reported.

Cor triatriatum dexter

Cor triatriatum dexter (CTD) is an extremely rare finding (<0.01%), resulting from the persistence of the right valve of sinus venosus. Echocardiography with color Doppler is the first‐line tool for diagnosis and decision making.

May-Thurner Syndrome as a Rare Cause of Paradoxical Embolism in a Patient with Patent Foramen Ovale

May-Thurner syndrome is an underrecognized anatomical variant that can lead to increased propensity for venous thrombosis in the lower extremities. We present a case of a 67-year-old female who presented with transient ischemic attack. Initial workup including CT scan of the head, MRI scan of the head, and magnetic resonance angiogram of the head and neck was unremarkable. A transthoracic echocardiogram with bubble study was also normal. Subsequently, a transesophageal echocardiogram was performed that revealed a patent foramen ovale with right-to-left shunt. Lower extremity duplex venous ultrasound showed no evidence of deep vein thrombosis. However, magnetic resonance venogram of the pelvis showed compression of the left common iliac vein just after its origin suggestive of May-Thurner syndrome. Hence, May-Thurner syndrome was recognized as the probable source of paradoxical embolism causing transient ischemic attack in this patient.

Can aldosterone break your heart? Takotsubo cardiomyopathy in a patient with newly diagnosed primary aldosteronism

We report a case of a 47-year-old Caucasian woman with medical history of hypertension and hypokalemia, who presented to Emergency Room with symptoms resembling acute coronary syndrome ST-segment elevation myocardial infarction. Coronary angiogram revealed clear coronary arteries and left ventriculogram confirmed the diagnosis of Takotsubo cardiomyopathy. She was treated conservatively with good clinical outcome. Subsequent testing revealed underlying primary aldosteronism.

Nail to the heart: no big deal. A rare case of post-traumatic pericarditis

This is a unique case report of a 32-year-old man who presented with pneumatic nail gun injury to his right chest at work. He removed the nail and continued to work through the day. With continued chest pain, he presented to the emergency room and an echocardiogram revealed moderate-size pericardial effusion. He was managed conservatively as he was haemodynamically stable. Serial echocardiograms revealed slow resolution of the effusion over 3 days. At his 3-month follow-up appointment, there was complete resolution of his effusion. This case highlights the importance of obtaining imaging studies in penetrating chest wall injuries and utilisation of medications to prevent expected complications.

Mid-ventricular takotsubo cardiomyopathy triggered by major depressive disorder after abortion

Axa028-year-old gravida 7 para 5 woman presented from an outlying facility with non-radiating, crushing, severe left-sided chest pain. She was initially treated for a non-ST elevation myocardial infarction with ECG evidence of Txa0wave inversions in leads II, III, aVF, V5, V6 and an abnormal troponin level at 0.56u2009ng/mL. Accordingly, left heart catheterisation was performed emergently and revealed normal coronary arteries without any obstruction (figure 1). Left ventriculography showed mid-ventricular hypokinesis with hyperdynamic apical and basal wall contraction, consistent with a mid-ventricular takotsubo cardiomyopathyxa0(TCM) (video 1). The ejection fraction was estimated at 30%–35%.nnnnFigure 1 nCoronary angiogram showing normal coronary arteries. (A) Left anterior oblique 30 view. (B) Right anterior oblique 10 cranial 40 view. (C)xa0Left anterior oblique 45 caudal 25 view.nnnnnnVideo 1 nLeft ventriculogram.nnnnMedical history was significant for an elective abortion …

Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva

A 77-year-old woman with multiple risk factors for coronary artery disease, was referred for left heart catheterisation after abnormal dobutamine stress test, revealing anterior and anterolateral hypokineses. Coronary angiogram revealed a large, dominant right coronary artery (figure 1A), originating from the right coronary cusp along with underdeveloped anomalous left coronary system. Left main artery was absent. Left anterior descending artery (LAD) was originating from right coronary cusp posteriorly (figure 1B), while the left circumflex artery (LCx) from the same cusp anteriorly (figure 1C). Probably the small calibre …

Serpentine thrombus in the heart: a rare case of trapped thrombus in patent foramen ovale

A 77-year-old Caucasian woman with recent abdominal surgery was diagnosed with multiple paradoxical systemic emboli in the mesenteric and renal circulation. Diagnosis was made by direct visualisation of a serpentine thrombus traversing both atria through patent foramen ovale (PFO) by transesophageal echocardiogram (TEE). Concomitantly, the patient was found to have deep venous thrombosis and pulmonary embolism. A decision was made to pursue cardiothoracic surgery preceded by inferior vena cava filter placement. She was started on intravenous anticoagulation. Repeat TEE was negative for thrombus and the patient did not present any new clinical signs of embolisation by this time. Consequently, the treatment plan was modified and the patient received oral systemic anticoagulation followed by PFO closure with the use of St. Jude Amplatzer Cribriform septal occluder device. During the outpatient follow-up the patient was asymptomatic and there was no significant flow through the device on transthoracic echocardiogram.