Subclavian steal syndrome in acute myocardial infarction masquerading as acute embolism to left upper extremity-a case report

Subclavian steal syndrome is an uncommon entity diagnosed with angiography after neurologic symptoms occur during activity with the upper extremity. Cardiac symptoms or silent ischemia have been described in patients who have undergone cardiac bypass using the ipsilateral internal mammary artery. Our patient presented with acute chest pain radiating to the left upper extremity and a diminished pulse. Angiography to rule out an acute embolus instead revealed subclavian artery occlusion. As atherosclerosis is the most common cause, the ipsilateral subclavian artery should be carefully evaluated, particularly in cardiac patients undergoing coronary angiography. Recognition of coexisting subclavian artery occlusion could prevent cardiac complications that may occur with use of the ipsilateral internal mammary artery during coronary artery bypass surgery.     

Pneumopericardium masquerading as an acute myocardial infarction

We report a case of a 64-year-old woman with increasing shortness of breath due to massive pericardial effusion. Cardiac magnetic resonance imaging (CMRI) identified typical findings for pericarditis. Pericardectomy was needed due to suspicion of pericardial abscess formation. Histological examination of the resected tissue revealed an undifferentiated primary pericardial synovial sarcoma. The present case illustrates that pericardial tumours could be an important differential diagnosis to pericarditis, even if typical findings of pericarditis were present in CMRI.     

Fulminant dengue myocarditis masquerading as acute myocardial infarction

Dengue fever is manifested by a sudden onset of fever (http://en.wikipedia.org/wiki/Fever), with severe headache, myalgias (http://en.wikipedia.org/wiki/Myalgia), arthralgias (http://en.wikipedia.org/wiki/Arthralgia) and characteristic bright red petechia (http://en.wikipedia.org/wiki/Petechia). The exact incidence and pathophysiological mechanism of dengue myocarditis remain obscure, but most of these cases are self-limiting. Fatal dengue myocarditis is a very rare complication of dengue fever. The non-specific symptoms and signs of dengue myocarditis make early diagnosis difficult. A 25-year-old Indian male, suffered from fulminant dengue myocarditis, presented to a our hospital with symptoms and electrocardiographic features mimicking acute myocardial infarction. Unfortunately, the patient succumbed before the dengue serology results were available.     

Cardiac chagas disease masquerading as an acute myocardial infarction

Although myocardial infarction is most often the manifestation of epicardial coronary artery disease, Chagas heart disease due to chronic Trypanasome Cruzi infection may present with a syndrome of chest pain and elevations in markers of cardiac myonecrosis. In the setting of an increasingly diverse global population and immigration of peoples from endemic areas of Trypanasome Cruzi, it is important to be aware of the myriad cardiac manifestations of Chagas disease.     

False aneurysm of the ascending aorta with perforation into the right ventricle presenting as acute inferior myocardial infarction

The authors describe the case of a 76-year-old woman who presented with acute inferior myocardial infarction 8 years after prosthetic aortic valve replacement. Echocardiography and cardiac catheterization revealed a false aneurysm of the ascending aorta with fistulous communication to the right ventricle. The right coronary artery originated from the false aneurysm with no antegrade perfusion.     

Fever with dissecting aneurysm of the aorta

Following acute aortic dissection, in two of the four cases we describe the patients experienced a prolonged febrile syndrome which spontaneously resolved five and 11 weeks later. Because of fever and a murmur of aortic regurgitation, the two other patients with aortic dissection were initially treated for acute bacterial endocarditis. These four cases serve to re-emphasize fever as an important clinical manifestation of dissecting aneurysm of the aorta.     

Subclavian steal syndrome presenting as recurrent pulmonary oedema associated with acute left ventricular diastolic dysfunction

Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.     

Progressive coronary artery aneurysm presenting as acute myocardial infarction

Coronary artery aneurysms (CAA) are commonly of atherosclerotic origin and asymptomatic. The natural history is uncertain given its uncommon occurrence and lack of longitudinal data. We report a case of CAA, presenting with myocardial infarction. Follow-up coronary angiography revealed enlargement of the CAA, suggesting a progressive nature.     

Atrioventricular block complicating dissecting aneurysm of the aorta

A 67-year-old patient who presented with acute dissecting aneurysm of the aorta was complicated by progressive transient atrioventricular heart block. Post-mortem examination findings confirmed the diagnosis of dissection of the ascending aorta and revealed an interatrial haemorrhage in the area of the septal atrioventricular junction.