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There are no established guidelines for the management of concurrent ischemic cardiomyopathy and cardiac amyloidosis due to the rarity of this phenomenon. We present the case of an African American woman in her 70s who was found to be in acute decompensated heart failure after she presented with progressive dyspnea. Initial workup revealed severe left ventricular systolic dysfunction with an ejection fraction of 20% and severe multivessel coronary artery disease, including severe left main disease. Multimodality imaging with cardiac MRI and technetium-99m pyrophosphate scintigraphy (PYP) during this hospital course revealed concurrent cardiac amyloidosis. Her systolic dysfunction was attributed to a combination of cardiac amyloidosis and ischemic cardiomyopathy. A multidisciplinary team comprised of interventional cardiology, cardiac surgery, and advanced heart failure amyloid specialists worked collaboratively to formulate an optimal treatment plan based on their collective clinical experiences and the limited literature, which ultimately resulted in a positive clinical outcome. Further investigation is needed to define treatment strategies specific to this patient population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bosah et al.)

Introduction: Acute purulent pericarditis is an exceedingly rare entity most often caused by direct intrathoracic contamination or hematogenous spread of a bacterial infection. Mortality nears 100% when left untreated. We present here a rare case of idiopathic bacterial pericarditis caused by methicillin-sensitive Staphylococcus aureus (MSSA)., Case: A 69-year-old male presented with chest pain and abdominal pain. He was found to have a pericardial effusion and tamponade and underwent emergent pericardiocentesis. Pericardial fluid culture grew methicillin-sensitive Staphylococcus aureus . The patient required multiple pericardial washouts and was then treated with four weeks of intravenous antibiotics., Conclusion: While uncommon, clinical suspicion for purulent pericarditis should remain high due to the associated high mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Huffman et al.)

The frequency of advanced cardiopulmonary imaging has increased the incidence of diagnosis of coronary artery anomalies, but this poses an interesting management dilemma of what to do with them once these anomalies are found. We present the case of a 57-year-old female with a past medical history of postpartum cardiomyopathy, recovered heart failure with reduced ejection fraction (EF), and alcohol use disorder who presented with chest pain, shortness of breath, nausea, vomiting, and palpitations. A CT angiogram was performed to rule out pulmonary embolism. No pulmonary embolism was found; however, the CT scan revealed an anomalous right coronary artery originating from the left coronary cusp, which had a malignant interarterial course (ARCA-LCC-IA) with a right dominant pattern of myocardial circulation. Subsequent nuclear stress testing did not show evidence of ischemia. Echocardiogram revealed a recurrently reduced EF of 40%. Our patient poses a management dilemma since she presented with possible angina and was found to have an anomalous right coronary artery (ARCA) with a malignant course, but subsequently she had a negative exercise stress test with nuclear perfusion imaging. We will review the literature on ARCA-LCC-IA and its clinical manifestations both generally and with its connection to this case as well as its management. We discuss the incidence, diagnosis, and management of ARCA-LCC-IA, with a focus on incidentally found lesions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Gajjar et al.)

We describe the case report of a patient with euglycemic diabetic ketoacidosis (euDKA), in the setting of sodium-glucose cotransporter-2 (SGLT2) inhibitor use, complicated by hypertriglyceridemia (HTG). A 28-year-old female with a history of gestational diabetes mellitus and subsequent type 2 diabetes mellitus (T2DM) on dapagliflozin and metformin presented with a one-week history of polyuria, poor appetite, and vomiting. On admission, serum glucose was 111 mg/dl, bicarbonate 18 mmol/l, anion gap 20, triglycerides 508 mg/dL, and venous pH 7.27. Serum ketone levels could not be assessed, as blood samples kept hemolyzing due to significant lipemia. The patient was initially admitted for starvation ketosis. However, serum chemistry obtained six hours after presentation revealed no change in the anion gap and a rise in triglycerides. She was treated with an insulin drip for euDKA and HTG with the resolution of the clinical picture. We performed a literature review of this topic and discuss the pathophysiology, diagnosis, management, and prevention of SGLT2-inhibitor-induced euDKA., Competing Interests: The authors have declared that no competing interests exist.

Pazopanib is a tyrosine kinase inhibitor used for the treatment of advanced renal cell carcinoma and advanced soft tissue sarcoma. We describe a case report of a patient with spindle cell sarcoma who developed severe left ventricular systolic dysfunction after starting pazopanib therapy with subsequent recovery of left ventricular ejection fraction upon stopping therapy., Competing Interests: The authors have declared that no competing interests exist.