Vijay Shetty

Chemotherapy induced Takotsubo cardiomyopathy

Chemotherapy has been linked with Takotsubo cardiomyopathy. Most of the literature on chemotherapy associated Takotsubo cardiomyopathy is on the drug 5-fluorouracil. In this report, we describe the case of a 55-year-old Asian male who developed Takotsubo cardiomyopathy while receiving dual chemotherapy with cytarabine and daunorubicin for acute myeloid leukemia. To our knowledge, it is the first case of Takotsubo cardiomyopathy associated with daunorubicin and/or cytarabine.

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.

Radiation induced cardiac valve disease in a man from Chernobyl.

A young man presented with a new heart murmur. History revealed that the patient was from Ukraine, which was affected by the Chernobyl nuclear plant explosion in 1986. Physical examination revealed murmurs of mitral regurgitation and aortic stenosis. Transesophageal echocardiography revealed severely calcified mitral and calcified tricuspid aortic valves with mitral and aortic regurgitation and aortic stenosis. Following valve replacement surgery, pathologic examination of the valves showed severe dystrophic calcifications and changes suggestive of a chronic inflammatory process such as radiation-induced valve disease. In the absence of another etiology explaining such severe valve disease in a young man, it can only be surmised that heavy radiation exposure from the nuclear plant caused this significant valve damage.

Role of Vasodilator Testing in Pulmonary Hypertension.

Pulmonary hypertension is clinically defined by a mean pulmonary artery (PA) pressure of 25mm Hg or more at rest, as measured by right heart catheterization. To identify patients who are likely to have a beneficial response to calcium channel blockers (CCBs) and therefore a better prognosis, acute vasodilator testing should be performed in patients in certain subsets of pulmonary arterial hypertension (PAH). A near normalization of pulmonary hemodynamics is needed before patients can be considered for therapy with CCBs. Intravenous adenosine, intravenous epoprostenol, inhaled nitric oxide, or inhaled iloprost are the standard agents used for vasoreactivity testing in patients with idiopathic PAH. In this review we describe the various aspects of vasodilator testing including the rationale, pathophysiology and agents used in the procedure.

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) …

Systolic aortic regurgitation: A rare phenomenon

We describe a case of an elderly man admitted to our hospital with syncope and a slow pulse rate. An echocardiogram showed both diastolic as well as systolic aortic regurgitation. Careful analysis of the clinical data, electrocardiogram and echocardiogram revealed that systolic aortic regurgitation was related to syncope in a very interesting fashion.

Nanomedicine in coronary artery disease

Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10–9 m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization.

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.

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.