Pooja Sethi

Feature tracking cardiac magnetic resonance imaging: A review of a novel non-invasive cardiac imaging technique

Cardiovascular disease is a leading cause of morbidity and mortality globally. Early diagnostic markers are gaining popularity for better patient care disease outcomes. There is an increasing interest in noninvasive cardiac imaging biomarkers to diagnose subclinical cardiac disease. Feature tracking cardiac magnetic resonance imaging is a novel post-processing technique that is increasingly being employed to assess global and regional myocardial function. This technique has numerous applications in structural and functional diagnostics. It has been validated in multiple studies, although there is still a long way to go for it to become routine standard of care.

Breathless at the point of a sword

Context: Scimitar syndrome is a congenital anomaly of pulmonary venous return where right pulmonary artery drains into right side other heart, instead of the left side, causing pulmonary hypertension resulting in shortness of breath, recurrent lower respiratory tract infections, chest pain, and fatigue. Early diagnosis and surgical intervention would correct this congenital anomaly reducing morbidity and complications in otherwise healthy young patients. Case Report: We present a case of an 18-year-old female who presented with exertional shortness of breath, fatigue, and recurrent lower respiratory tract infections. She had unremarkable physical examination but chest x-ray showed an abnormal opacity next to right heart border. Computed tomography (CT) chest was performed that showed possible scimitar syndrome. Transesophageal echocardiogram (TEE) and right heart catheterization (RHC) confirmed the diagnosis. Conclusion: Scimitar syndrome is a very rare congenital anomaly of pulmonary venous return. It is usually diagnosed in early childhood but the diagnosis may be delayed until later in adulthood. The consequences are pulmonary hypertension, right-sided heart failure, and frequent pulmonary infections resulting in increased morbidity, mortality, and frequent doctor visits for otherwise healthy young patients.

ST Segment Elevation with Normal Coronaries

Noncardiac causes should be kept in the differential while evaluating ST elevation on EKG. Rarely abdominal pathologies like acute pancreatitis can present with ST elevation in the inferior leads. Once acute coronary syndrome is ruled out by emergent cardiac catheterization alternative diagnosis should be sorted. Abdominal pathologies, like acute pancreatitis and acute cholecystitis, can present with ST elevation in the inferior leads. Treating the underlying condition would result in resolution of these EKG changes.

Diagnostic Value of Noninvasive Computed Tomography Perfusion Imaging and Coronary Computed Tomography Angiography for Assessing Hemodynamically Significant Native Coronary Artery Lesions

Background: The objective of this study is to determine the diagnostic performance of computed tomography perfusion (CTP) with and without computed tomography angiography (CTA) in assessment of hemodynamically significant coronary artery lesions in comparison to invasive fractional flow reserve (FFR). Materials and Methods: PubMed and Cochrane Center Register of Controlled Trials from January 2010 searched through December 2014. Nine original studies were selected evaluating the diagnostic performance of CTP with and without CTA to invasive coronary angiography in evaluation of hemodynamic significance of coronary lesions (n = 951). Results: The sensitivity, specificity, LR+ and LR‐ and DOR of CTA+CTP were 0.85 [95% confidence interval (CI: 0.79‐0.89)] 0.94 (CI: 0.91‐0.97), 15.8 (CI: 7.99‐31.39), 0.146 (CI: 0.08‐0.26), and 147.2 (CI: 69.77‐310.66). Summary Receiver Operating Characteristics (SROC) results showed area under the curve (AUC) of 0.97 indicating that CTA+CTP may detect hemodynamically significant coronary artery lesions with high accuracy. The sensitivity, specificity, LR+ and LR‐ and DOR of CTP were 0.83 (CI: 0.78‐0.87), 0.84 (CI: 0.80‐0.87) 5.26 (CI: 2.93‐9.43), 0.209 (CI: 0.12‐0.36), and 31.97 (CI: 11.59‐88.20). Conclusions: This result suggests that CTP with CTA significantly improves diagnostic performance of coronary artery lesions compared to CTA alone and closely comparable with invasive FFR.

Valvular Hemolysis Masquerading as Prosthetic Valve Stenosis

The evaluation of prosthetic valves can provide a unique challenge, and a thoughtful approach is required. High output states like anemia should be kept in the differential when evaluating elevated gradients across prosthetic valves. We present the case of a 69-year-old man with a Starr-Edwards prosthetic aortic valve who presented with symptoms of congestive heart failure and high transvalvular pressure gradients. These symptoms indicate a potential prosthetic valve stenosis. His laboratory evaluation results were consistent with valve-related hemolysis. Resolving his anemia led to a resolution of the symptoms and lowered the pressure gradient on follow-up.

Deglutition Syncope: Two Case Reports Attributed to Vagal Hyperactivity

Deglutition syncope is a relatively rare cause of syncope that belongs to the category of neurally mediated reflex syncopal syndromes. The phenomenon is related to vagal reflex in context to deglutition causing atrioventricular block and acute reduction in cardiac output leading to dizziness or syncope. We present case series of two cases of deglutition syncope, of which first was managed medically and second with pacemaker implantation.

COMPLETE HEART BLOCK ASSOCIATED WITH DENGUE HEMORRHAGIC FEVER

Dengue is the most prevalent viral disease transmitted by mosquitoes, producing clinical illness in 96 million cases annually. It is not uncommon for cardiovascular system to be affected with mosquito-borne dengue virus. Clinical manifestations of cardiac complications have a spectrum from self-

Cardiac Arrest as a Consequence of Air Embolism: A Case Report and Literature Review.

Air embolism is an infrequent but potentially catastrophic complication. It could be a complication of invasive procedures including surgery, central line placement, positive pressure ventilation, trauma, hemodialysis, pacemaker placement, cardiac ablation, and decompression sickness. Usually, it does not cause any hemodynamic complication. In rare cases, it could lodge in the heart and cause cardiac arrest. We present a case of an 82-year-old white female who underwent computed tomography (CT) guided biopsy of right lung pulmonary nodule. When she was turned over after the lung biopsy, she became unresponsive and developed cardiopulmonary arrest. She underwent successful resuscitation and ultimately was intubated. CT chest was performed immediately after resuscitation which showed frothy air dense material in the left atrium and one of the right pulmonary veins suggesting a Broncho venous fistula with air embolism. Although very rare, air embolism could be catastrophic resulting in cardiac arrest. Supportive care including mechanical ventilation, vasopressors, volume resuscitation, and supplemental oxygen is the initial management. Patients with cardiac, neurological, or respiratory complications benefit from hyperbaric oxygen therapy.