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BACKGROUND We report a patient who was diagnosed with toxic myopericarditis secondary to hydrocarbon abuse using cardiac magnetic resonance imaging (CMR). CASE SUMMARY A 25-year-old male presented to emergency department with chest pain for 3 d. Patient also reported sniffing hydrocarbon containing inhalant for the last 1 year. Labs showed elevated troponin and electrocardiography was suggestive of acute pericarditis. Echocardiogram showed left ventricular (LV) ejection fraction (EF) of 40%. Given patient’s troponin elevation and reduced EF, cardiac catheterization was performed which showed normal coronaries. CMR was performed for myocardial infarction with non-obstructive coronary arteries evaluation. CMR showed borderline LV function with edema in mid and apical LV suggestive of myocarditis. CONCLUSION CMR can be used to diagnose toxic myopericarditis secondary to hydrocarbon abuse.

Background We report a patient with COVID 19 who presented with STEMI and high thrombus burden, needing intracoronary (IC) alteplase infusion and subsequent PCI Case 55 year old female with past history of diabetes, CVA (8 years back), recently diagnosed COVID 19 who presented to ED with chest pain for 18 hours She was noted to have ST elevation in anterolateral leads and was taken for emergent angiogram Angiogram showed large ostial LAD thrombus with thrombotic occlusion of distal LAD1 Decision-making Considering thrombus burden, several runs of aspiration thrombectomy was performed followed by balloon dilation No distal flow was noted Subsequently, 2 mg IC alteplase was infused twice, followed by thrombectomy Repeat angiogram showed TIMI 0 flow Intracoronary ultrasound (IVUS) was performed which showed heavy thrombus burden with no plaque rupture PTCA of ostial LAD was performed afterwards with 4 0 x 15 mm compliant balloon Thrombus was persistently noted in ostial LAD with TIMI 0 flow distally She was started on aspirin, ticagrelor, heparin drip and 12 hour tirofiban infusion 24 hours later she was taken back to the cath lab due to on and off chest pain and persistent ST elevation on EKG Repeat angiogram showed persistent ostial LAD thrombus with TIMI 2 distal flow PCI of ostial LAD was subsequently performed with excellent final result2 Conclusion IC alteplase can be considered in COVID patients with STEMI who have high burden burden when conventional measures fail to establish adequate flow [Formula presented]

Heart failure (HF) is characterized by maladaptive neurohormonal activation of the cardiovascular and renal systems resulting in circulatory inadequacy and frequent acute exacerbations. The increasing burden of HF prompted investigation of underlying pathophysiological mechanisms and the design of pharmacotherapeutics that would target these pathways.A MEDLINE search for relevant original investigations and review articles of newer hormonal drugs for HF since the year 2005 till October 2017 provided us with necessary literature. Major trials and relevant clinical investigations were discussed.A multitude of hormonal pathways central to HF were identified, including the natriuretic peptide system and neurohormones such as relaxin, arginine vasopressin, and endothelin. However, drugs targeting these novel pathways (aliskiren, tolvaptan, ularitide, serelaxin, bosentan, macitentan) failed to show mortality benefit. This emphasizes a tremendous unmet need in the pharmacotherapy for HF, especially for the subtypes of acute HF and HF with preserved ejection fraction. Sacubitril/valsartan demonstrated substantial mortality benefit in chronic systolic HF population and is endorsed by international HF guidelines. If proven to be efficacious in larger outcome trials, finerenone can be a valuable addition baseline HF therapy. More basic, translational, and phenotype specific clinical research is warranted to improve HF pharmacotherapy.

Background: Correlation of ST-segment elevation on the 12-lead electrocardiogram (ECG) with the expected affected coronary territory is established in patients with ST-elevation myocardial infarction (STEMI). In patients with non-ST-elevation myocardial infarction (NSTEMI), correlation of ischemic ECG abnormalities with the affected coronary territory has not been well-established. We sought to investigate the correlation of electrocardiographic abnormalities with the location of 1-vessel obstructive coronary artery disease (CAD) in patients with both STEMI and NSTEMI. Methods: In this retrospective study, the charts of all patients referred for coronary angiography in 2012 were reviewed. Patients with a single obstructive coronary artery plus angina-equivalent symptoms and an elevated cardiac troponin I was included. Available ECGs were interpreted by an experienced cardiologist (WSA) blinded to the result of angiography. Patients with complete bundle branch block or ventricular pacing were excluded. Ischemic ECG changes were correlated to a coronary territory based on predefined criteria. Results: Of 131 included patients (mean age 64±13 years; 74% male), 29 had STEMI and 102 had NSTEMI. Eleven of 11 patients (100%) with anterior STEMI had left anterior descending artery (LAD) obstructive CAD. Of 18 patients with inferior STEMI, 14 (78%) had right coronary artery (RCA) obstructive CAD, 3 (17%) had left circumflex artery (LCX) artery obstructive CAD, and 1 (5%) had LAD obstructive CAD. Of 102 NSTEMI patients, 53 (52%) had definite ECG ischemic abnormalities. Of 31 patients with anterior definite ECG ischemic abnormalities, 30 (97%) had LAD obstructive CAD, and 1 (3%) had RCA obstructive CAD. Of 22 patients with inferior definite ECG ischemic abnormalities, 14 (64%) had RCA obstructive CAD, 5 (23%) had LCX obstructive CAD, and 3 (14%) had LAD obstructive CAD. Conclusions: Patients with anterior STEMI had LAD obstructive CAD. Patients with inferior STEMI were highly likely to have RCA or LCX obstructive CAD. Only half of NSTEMI patients had definite ischemic ECG abnormalities. When present, anterior ischemic ECG changes in patients with single vessel CAD with NSTEMI were predictive of LAD obstructive CAD.

Wolff-Parkinson-White [WPW] syndrome has classically been described in younger patients and is rarely seen in the elderly as they are treated early or the accessory pathway may lose its conductive properties with age. An 83 year old female with recently diagnosed WPW on EKG presented with chest

Takotsubo cardiomyopathy is a transient cardiac syndrome that typically causes mid-ventricular circumferential and apical hypokinesis mimicking an acute coronary syndrome (ACS). Etiology is felt to be diffuse microvascular spasm and ischemia with resulting stunning of the myocardium as a result of

Severe aortic stenosis (AS) can adversely affect right ventricular function (RVF). RVF is an important determinant of transcatheter aortic valve replacement (TAVR) outcomes. Immediate changes in echocardiographic parameters of RVF have not been previously reported. We report changes in

We present a patient with acute Pulmonary Embolism (PE), who underwent emergent combined Coronary Artery Bypass Grafting (CABG) & pulmonary thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension (CTEPH). 57 year old male with history of myocardial infarction, stroke, diabetes

Hemodynamic instability immediately post heart transplant (OHT) could be due to primary graft dysfunction (PGD). Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as temporary mechanical circulatory support in PGD until graft function normalizes. We aim to study the donor and

Hemodynamic instability in orthotropic heart transplant (OHT) recipients in the peri-transplant period is deleterious and not infrequent. Mechanical circulatory support (MCS) devices have been used to provide temporary hemodynamic support. We aim to study the trends in utilization of MCS use in OHT