Sameer Chadha

Complete heart block in takotsubo cardiomyopathy.

Tako-tsubo cardiomyopathy is a relatively recently recognized clinical entity, which presents similar to an acute myocardial infarction but there is no evidence of obstructive coronary artery disease on cardiac catheterization. It mostly affects postmenopausal women and an episode of acute illness or stress can often be identified preceding the presentation. Tako-tsubo cardiomyopathy (TCM) usually has a favorable outcome and an excellent prognosis but, in rare instances, it can be associated with life threatening complications. We report a unique case of TCM where the patient presented with a transient complete heart block.

Sinus of Valsalva aneurysm: a rare presentation with ventricular tachycardia.

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] An 82-year-old male with of a history of hypertension presented to the emergency department with complaints of intermittent palpitations. Electrocardiogram results showed monomorphic ventricular

Osborn waves in a patient with hypothermia due to severe hypothyroidism

An 88-year-old female with history of hypothyroidism was brought to our emergency department with acute change in mental status. Her vital signs were significant for a core body temperature of 88°F (31°C). She was found to be severely hypothyroid (serum TSH—7.14 mU/l, Free T4—0.5 ng/dl) …

Acute pulmonary edema secondary to hyperbaric oxygen therapy.

Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of diabetic ulcers, air embolism, carbon monoxide poisoning and gas gangrene with minimal adverse effects. Very few cases of HBOT causing acute pulmonary edema (PE) has been described; with a study on dogs suggesting that a complication of this therapy could be PE. We describe the case of an 80-year-old man with a history of stable systolic heart failure and diabetes mellitus presenting with acute PE following treatment with HBOT for diabetic foot.

Anomalous Origin of Left Main Coronary Artery from Right Sinus of Valsalva

A 46-year-old man emergently presented after developing chest pain while running for a taxi. He reported no associated shortness of breath, palpitations, or dizziness. His vital signs were stable, and the results of respiratory and cardiovascular examination were normal. An electrocardiogram showed ST-segment elevation in leads V2 through V6 (Fig. 1). An urgent coronary angiogram revealed narrowing at the origin of the left main coronary artery (LMCA) that did not resolve after intracoronary nitroglycerin was administered (Fig. 2). However, there was no evident atherosclerotic disease.

Heart block and Lyme carditis

A 19-year-old male with no past medical history presented to our emergency department with an episode of syncope while walking. The patient denied any history of chest pain, shortness of breath or previous similar episodes. The physical examination was significant for a heart rate of 33 and an erythema migrans rash on the abdomen (Figure 1 …

Troponins in Tako-tsubo Cardiomyopathy

Tako-tsubo cardiomyopathy was first described in Japan in 1990. The clinical presentation of Tako-tsubo cardiomyopathy (TCM) is similar to an acute myocardial infarction with patients having chest pain, ST segment elevations on EKG and elevated cardiac biomarkers. In TCM, however, the elevation in cardiac enzymes is usually mild. We report a case of TCM where the patient had Troponin I elevation up to 42.3 ng/ml. To the best of our knowledge, this is the first case in which such high troponins have been reported in a patient with Tako-tsubo cardiomyopathy.

Penoscrotal haematoma after cardiac catheterisation

Scrotal haematoma is an extremely rare complication after cardiac catheterisation (CC) with only few cases reported in literature. We report a 56-year-old patient who developed large scrotal haematoma after CC via transfemoral approach requiring blood transfusion due to haemodynamic instability. After an uneventful elective procedure, he was discharged with a collagen plug-based vascular closure device (Angio-Seal). He developed sudden onset, excruciating groin pain with scrotal swelling and shock. Bleeding was stopped with manual compression over the femoral artery and 2 units of packed red blood cells were transfused. CT angiogram revealed scrotal haematoma without active bleeding. Testicular blood supply remained intact. Scrotal swelling improved with conservative management and patient got discharged 3 days later in a stable condition. The review of literature suggests that penoscrotal haematoma is unusual after CC but may result from arterial injury or bleeding into the fascial planes. Majority of patients require observation but surgery is indicated in selected cases for vascular complications.

Refractory atrioventricular nodal re-entrant tachycardia: A rare manifestation of acute massive pulmonary embolism

With a wide array of manifestations ranging from mild dyspnea to fatal cardiogenic shock, acute pulmonary embolism (PE) remains an enigmatic clinical entity. Vivid electrocardiography (ECG) patterns portrayed in different clinical instances of acute PE have always remained an interesting, yet debatable subject since the classic S1Q3T3 pattern on ECG secondary to PE was first described in 1935. Atrial fibrillation, atrial flutter and atrial tachycardia are commonly described supraventricular tachycardias in association with PE; however, there is scant description of PE in the literature presenting as atrioventricular nodal re-entrant tachycardia (AVNRT). The present report describes the clinical course of an elderly woman presenting with refractory typical AVNRT who was subsequently found to have bilateral multilobar acute PE. To the authors’ knowledge, the present report is the first to describe a case involving acute PE presenting as hemodynamically unstable AVNRT requiring cardioversion.

Addison's disease masking a potentially life-threatening condition

Addisons disease (AD) is a metabolic disorder that affects the metabolism of potassium. The hyperkalemia that results from this condition can be reflected in the electrocardiogram, which could confound the diagnosis of other cardiac conditions. Such a challenging situation was encountered when a 73-year-old male with history of AD presented to the emergency department with chest pain.