Acute coronary syndrome or perimyocarditis?--case report

Acute coronary syndrome or perimyocarditis? A case report. A case of a 25-year-old male with a severe chest pain associated with ST segment changes, elevated serum C-reactive protein, myocardial necrosis markers and normal epicardial coronary arteries is presented. The patient recently recovered from upper respiratory infection. Differential diagnosis between acute coronary syndrome and perimyocarditis is discussed.     

Microvascular dysfunction in left apical ballooning syndrome: Primary cause or secondary phenomenon?

We read with great interest the recent report from Meimoun etal.¹ indicating the time course of transthoracic coronary flowreserve in the left anterior descending artery in a patientwho suffered a transient left apical ballooning syndrome. Theauthors conclude that serial non-invasive measurements of coronaryflow reserve in     

"Once apical ballooning, always apical ballooning?"

It is important that a cardiologist knows and recognizes the entity of takotsubo cardiomyopathy or apical ballooning, but remains aware that a subsequent similar episode is not necessarily a recurrence of this syndrome. Relapse may be caused by "classical" coronary atherosclerosis, as described in this case report.     

Is concomitant coronary artery disease an exclusion criterion for transient left ventricular apical ballooning?

We describe a case of endocarditis due to Lactococcus cremoris associated with cheese consumption, that caused multiple mycotic aneurysms. Antibiotic treatment combined with surgical and radiological interventions resulted in full recovery.     

Acute coronary syndrome and stress: Is there a relationship?

IntroductionAcute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS.MethodsWe carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed.ResultsA total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5 ± 7.1. Females in the control group scored 16.6 ± 6.3 on the PSS-10 and control males scored 13.4 ± 6.5. The female population with ACS scored 22.8 ± 9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4 ± 6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission.ConclusionsACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.     

Could left ventricular apical ballooning represent spontaneous myocardial infarction abortion?

Left ventricular apical ballooning, also named tako-tsubo cardiomyopathy, is a syndrome characterized by chest pain, transient left ventricular dysfunction and specific electrocardiographic changes mimicking an acute myocardial infarction without significant stenosis on the coronary angiogram. Although the aetiology remains unknown, several reports have found that preceding psychological stress could act as a trigger. This report describes a case of tako-tsubo-like left ventricular apical ballooning in a patient with "soft" atherosclerotic plaque at the middle portion of the left anterior descending coronary artery.     

Alternative presentation of Tako-Tsubo syndrome with spontaneous echo-contrast and “onion” shaped apical ballooning

We report the case of a 79-year-old woman with transient left ventricular systolic dysfunction with apical ballooning (tako-tsubo like syndrome, TTS) showing an alternative newly reported “onion” shape. The patient was also characterized by atrial fibrillation and marked spontaneous echo-contrast: possible precipitating role for these conditions in TTS are discussed.     

Transient left apical ballooning syndrome--the need for a common terminology? A reply

The apical ballooning syndrome, called also transient left ventricular apical ballooning syndrome or Tako-tsubo cardiomyopathy is a new syndrome that mimics acute myocardial infarction. The authors comment the statement of Dr Parodi who recommended a new denomination of neuromediated myocardial stunning. According to many different denominations of the syndrome and over 25 years history of research on it, the authors recommended a name of "transient left ventricular ballooning syndrome (TLVBS)" and pursued to goal a new expert consensus.     

Acute coronary syndromes: more or less antithrombotic medication for the elderly?

The treatment of elderly patients with acute coronary syndromes (ACS) remains challenging. About two thirds of patients with ACS and four fifth of patients who died from ACS are older than 65 years. In spite of the tremendous advances in our understanding of its pathophysiolgy during the past decades and multiple treatment options we now have, ACS is still a leading cause of death., both in developed countries and in many developing countries, including China. ACS result from the disruption of the atherosclerotic plaque, leading to intracoronary thrombus formation with aggregated platelets within a fibrin mesh. In light of this, fibrinolitics, antiplatelet and anticoagulant agents, together with revascularizations and beta blockers, are currently major components of therapy for ACS .Because of the shift of risk benefit ratio among different age groups, it is extremely complex to evaluate the potential risk and benefit for each of these intervention. For example, there has been considerable controversy around whether the results of thrombolysis trials, conducted mainly in younger patients, can be applied to elderly patients. Frequently the evaluation should be performed on an individualized basis at the treating physician's discretion.     

Left main coronary artery compression syndrome and spontaneous coronary artery dissection: Coincidence or pathologic association?

Left main coronary artery compression syndrome (LMCS) in patients with severe pulmonary arterial hypertension (PAH) is an unusual, and often a missed cause of exertional angina. Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome of unknown etiology, with predilection to women in the 20s–40s. Weather the co-presence of LMCS and SCD in certain patients is a coincidence or of pathological significance is not known. The optimal management strategy of each of these conditions remains controversial. We report a case of SCD in a patient with PAH and LMCS, successfully treated with conservative medical therapy.     

Schwerer klinischer Verlauf einer Myokarditis mit „apical ballooning“

We report of a 67 year-old female who has suffered a flu-like infection three days ago and presented with symptoms of acute coronary syndrome. Coronary heart disease could be excluded. The ventriculography showed a moderate reduced left ventricular function characterized by "apical ballooning". Endomyocardial biopsies and EDTA blood gave a direct proof of human herpes virus 6 subtype A. Histological and immunohistochemical analysis revealed a myocarditis with areas of interstitial macrophages and fibrosis. This case presents for the first time the cross-link of myocarditis with HHV6A infection and the appearance of "apical ballooning".     

Susac's syndrome or catastrophic antiphospholipid syndrome?

Susac's syndrome is a microangiopathic disorder of unknown pathogenesis presenting with encephalopathy, hearing loss and branch retinal artery occlusions. The term 'catastrophic' antiphospholipid syndrome (APS) is used to define a subset of the APS characterized by thrombotic microangiopathy with clinical evidence of three or more organ involvement developed in a short period of time. We describe a patient with typical features of Susac's syndrome, that appeared in less than a week, in whom aPL were detected, thus fulfilling criteria for 'probable' catastrophic APS.     

Economy-class syndrome or Immobile Traveler's syndrome?

Economy class syndrome describes the situation of patients who suffer pulmonary embolism following prolonged immobility in a long distance flight. The objective of the present study was to analyze whether there is a risk of pulmonary thromboembolism after a long overland journey. The study consecutively enrolled 100 patients diagnosed with pulmonary thromboembolism. Nine of them had previously undertaken a long journey (>5 h), 6 of which had been over land. Consequently, we think that the preventative measures recommended for airline passengers should be extended to users of other means of transport.     

Takotsubo cardiomyopathy in a patient with Addison disease: is apical ballooning always reversible?

Takotsubo cardiomyopathy is characterized by acute ventricular dysfunction in the absence of coronary obstruction. Complete improvement of ventricular function is seen in the vast majority of the patients. We describe a 40-year-old woman with Addison disease who experienced Takotsubo cardiomyopathy but with persistent apical dysfunction during 5-month-follow up.     

Cogan syndrome or sarcoidosis?

INTRODUCTION: The Cogan's syndrome is characterized by the association of vestibulo-auditory dysfunction, non syphilitic interstitial keratitis or another significant inflammatory eye lesion. Some authors consider this disease as a vasculitis, because it is frequently associated with systemic manifestations. Based on Cogan's diagnostic criteria, Cogan's syndrome may be part of other systemic diseases, as polyarteritis nodosa or Wegener's granulomatosis. EXEGESIS: We report the case of a patient who presented with a Cogan's syndrome and developed further sarcoidosis. CONCLUSION: If Cogan's syndrome is characterized as systemic disease because of its association with aortitis or other vasculitis, on the other hand, clinical presentation may be part of many other systemic diseases.