Mazen Shaheen

The Important Role of Inflammatory Biomarkers Pre and Post Bare–Metal and Drug–Eluting Stent Implantation

In-stent restenosis and stent thrombosis are major complications after percutaneous coronary intervention and coronary stent placement. The inflammatory status of an individual, as reflected by biomarkers and genetic polymorphisms, is a strong predictor of the risk of in-stent restenosis and stent thrombosis. Identifying biomarkers and studying their values are crucial for a more efficient personalized intervention. General inflammatory biomarkers, evidence of inflammation, and the difference between inflammatory biomarkers after bare-metal stent and drug-eluting stent placement are discussed. Clinical implications and the use of antiplatelet and anti-inflammatory medications, as well as future directions in coronary intervention, in reducing the occurrence of these complications, are also discussed.

Spontaneous dissection of all 3 coronary arteries in a postpartum woman.

Forty-one thousand people aged 29 to 44 years are diagnosed with acute myocardial infarction each year in the United States. The etiology of acute coronary syndrome among patients younger than 45 years can be atheromatous or nonatheromatous coronary heart disease, hypercoagulable states, or related to substance abuse. Spontaneous coronary artery dissection (SCAD) falls under the nonatheromatous category, and unfortunately the diagnosis is often made at autopsy.

ST-segment elevation and ventricular tachycardia after ingestion of a common ornamental plant—a case report

Japanese yew is a widely used ornamental plant. However, most people are unaware that it is also a poisonous plant. It has potent cardiac toxicities that can lead to sudden cardiac death. A 37-year-old female patient presented to the emergency room with altered mental status and sustained ventricular tachycardia (VT). Electrocardiogram (ECG) after cardioversion showed profound QRS prolongation and ST-segment elevation suggestive of either hyperkalaemia, acute myocardial ischaemia, or Brugada syndrome. Her electrolytes and coronary angiography were normal. After improvement of the patients mental status, she admitted that she has been consuming Japanese yew from her yard for several months. Few hours later, QRS duration normalised, but mild ST-segment elevation persisted in the right pre-cordial leads, making it more suspicious for Brugada syndrome. However, a procainamide challenge test and electrophysiology study failed to induce typical Brugada pattern ECG and VT. The absence of coronary artery disease and electrolytes disturbances points toward the fact that her arrhythmia and ECG changes are secondary to yew intoxication. The patient was monitored for a few days. She was haemodynamically stable and has not had any arrhythmia. This case highlights the importance of public awareness of severe toxicity from Japanese yew or other yew plants. Yews contain taxines that are responsible for the ECG abnormalities due to its inhibitory effect on the cardiac sodium and calcium channels. They cause conduction abnormalities, VT, and ST-segment elevation that can resemble acute myocardial infarction, hyperkalaemia, and Brugada syndrome.

Non-healing skin ulcers secondary to calciphylaxis with Candida tropicalis fungemia in an end-stage renal disease patient.

Calciphylaxis is an uncommon necrotizing skin condition characterized by excessive calcification of soft tissue and small arteries, leading to ischemic ulceration of the skin. It mainly affects patients with chronic renal failure and often leads to fatal consequences. Chronic renal failure, hyperparathyroidism, hypercalcemia, and hyper-phosphatemia often trigger the precipitation of calcium-phosphate crystals in the arterioles of the dermis and soft tissues, leading to ischemia and skin ulcerations. The diagnosis of calciphylaxis is mainly clinical and skin biopsy is infrequently done because of the risk of poor healing and secondary infections. Despite aggressive treatment regimens, mortality is high. Here, we report the case of a 44-year-old female end-stage renal disease patient with multiple non-healing skin ulcers secondary to calciphylaxis complicated with refractory infections including Candida tropicalis fungemia, vancomycin-resistant enterococcus and Acinetobacter baumannii wound infections.