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A 68-year-old Caucasian man with a history of Waldenstrom macroglobulinemia (WM) on treatment with ibrutinib for 2 years presented with syncope. He had no prior cardiovascular history or risk factors. On the day of presentation, he had an episode of dizziness followed by a sudden loss of

Thyrotoxic periodic paralysis (TPP) is characterized by a classic triad of muscle paralysis, hypokalemia, and hyperthyroidism. The underlying thyroid disorder is often very subtle making it challenging to recognize TPP. It is a completely reversible condition if diagnosed early; however, it is associated with fatal outcomes if delayed.

Introduction: Sodium-glucose Cotransporter-2 (SGLT-2) inhibitors are drugs with profound interest because of their beneficial effect on multiple organ systems, including the cardiovascular and renal systems. Their interplay with these systems could prove beneficial in managing complex conditions like heart failure with preserved ejection fraction. We sought to compare cardiac diastolic function in patients on SGLT-2 inhibitors with those on metformin. Methods: Data were collected retrospectively after approval from our institutional review board. The study group included patients on SGLT-2 inhibitors (n=75), and the control group had patients on metformin (n=82), primarily for diabetes mellitus. Patients with ejection fraction less than 50% were excluded from the study. Data collected included age, systolic blood pressure (SBP), left ventricular (LV) ejection fraction, LV and left atrial dimensions, and diastolic parameters. Mean values, along with standard deviation, were calculated. Multivariate regression analysis for diastolic function was performed while adjusting for confounders, including age, body mass index, and SBP. Results: Study group showed better diastolic function as evidenced by significantly higher e’ medial (6.8 v/s 6.16 cm/s; p = 0.03) and e’ lateral (9.8 v/s 7.9 cm/s; p=0.008) when compared to the control group. E/e’, a marker of pulmonary capillary wedge pressure, was lower in the study group (12.87 v/s 14.36; p=0.08); however, it did not reach statistical significance. LA volume index was significantly lower in the study group, suggestive of favorable hemodynamic status (26.5 v/s 29.6 mL/m 2 ; p=0.03). SBP was significantly lower in the study group (127 v/s 135 mm Hg; p=0.01). Multivariate regression model demonstrated SBP as a significant confounder that contributed to e’ (average) difference between the two groups. Conclusions: SGLT-2 inhibitors favored better diastolic measurements when compared with metformin alone. The mechanism may be attributed to its BP-lowering effect. A larger prospective study is required to determine the role of SGLT-2 inhibitors.

Hyperthyroidism is associated with multiple cardiac pathologies including dilated cardiomyopathy, isolated right ventricular heart failure, and atrial fibrillation (AF). Long standing untreated hyperthyroidism in conjunction with AF can cause severe dilated cardiomyopathy with reduced ejection fraction that is completely reversible with treatment. We present the case of a previously healthy male who presented with florid congestive heart failure (CHF) as an initial presentation for hyperthyroidism. A 37-year-old male presented to the emergency department with progressively worsening dyspnea on exertion and lower extremity edema for one month. His heart rate was noted to be 172 bpm and an EKG was done that showed AF. He was clinically noted to be in heart failure and was admitted for further management. He was started on metoprolol with good heart rate control and was started on furosemide for diuresis. A transthoracic echocardiogram was done and showed severe global hypokinesis with left ventricular ejection fraction reduced to 20% along with bi-atrial enlargement and dilated left ventricular cavity. Ischemic cardiomyopathy was ruled out with left heart catheterization. A TSH level was checked as a part of workup for non-ischemic cardiomyopathy and atrial fibrillation and was markedly reduced to

Statin-associated myopathy comprises of a spectrum of conditions ranging from benign myalgias to statin-induced immune-mediated necrotizing myopathy. Statin-induced immune-mediated necrotizing myopathy is an autoimmune condition wherein there is a destruction of normal skeletal muscular architecture that can be severely debilitating if not recognized promptly. Given its rarity, management is a challenge. We present one such case that was managed with aggressive immunosuppression.

Talaromycosis is a fungal infection caused by Talaromyces sp. that is predominantly prevalent in patients with acquired immunodeficiency syndrome in the United States. It is also rarely seen in other individuals who are otherwise immunosuppressed. With the advent of immunotherapy and increasing usage of these novel agents in treating several conditions, the prevalence of talaromycosis may increase, especially in people from endemic regions who might harbor a dormant infection. Clinical presentation is non-specific with respiratory symptoms such as shortness of breath, cough, or even fever that can delay the diagnosis. Little is known about the exact pathogenesis of the condition, and management is largely based on anecdotal evidence and small-sized studies. We present the case of an individual on nintedanib, a tyrosine kinase inhibitor that blocks fibroblast growth factor receptor and used for the treatment of interstitial lung disease, who was diagnosed with talaromycosis.

Non-small cell lung carcinoma (NSCLC) is a leading cause of cancer-related death, and some patients can present with advanced metastatic disease mostly involving the brain, bones, liver, or adrenal glands. Eye is an extremely rare site of metastasis. We present a case of a patient with NSCLC with rare vitreal metastasis. A 70-year-old female was admitted to the hospital with hypertensive crisis and on further imaging, was found to have a 4.5 cm spiculated nodule in the upper lobe of the right lung. Outpatient bronchoscopy and biopsy confirmed lung adenocarcinoma and she underwent right upper lobe wedge resection and mediastinal lymph node dissection. The surgical staging for the cancer was pT1a pN0, placing her in stage IA. The cells from the tumor were positive for epidermal growth factor receptor (EGFR) mutations: G719X and S768I. Unfortunately, six months later, she started to experience decreased visual acuity and floaters. Vitrectomy was done, and cytology showed atypical cells concerning for malignancy. These malignant cells were also positive for the same mutations as the lung adenocarcinoma. She was then treated with EGFR inhibitor afatinib to prevent relapse. She currently remains asymptomatic.

Ebstein's anomaly (EA) accounts for 1% of congenital heart disease and is characterized by failure of tricuspid valve (TV) delamination, highly variable TV morphology and right ventricle (RV) myopathy. The heart's conduction system can be affected in EA, with issues ranging from first-degree AV

Coronary artery ectasia (CAE) is a rare entity with an incidence of 0.3-5%. Atherosclerosis and vasculitis are the most common causes. A 47-year-old male with history of type-2 diabetes mellitus and dyslipidemia presented to our hospital with left sided chest pain for ten continuous hours. EKG