Left Atrial Myxoma Causing Coronary Steal: An Atypical Cause of Angina

Cardiac myxomas are rare primary cardiac tumors that usually present with dyspnea or manifestations of systemic embolization. Coronary steal is a rare phenomenon of unbalanced blood flow that is seen primarily in patients who have undergone coronary artery bypass grafting and have subclavian artery stenosis.We report the case of a 72-year-old woman who presented with fatigue, weakness, and exertional chest heaviness and had abnormal results on a cardiac stress test. The results of coronary angiography showed no obstructive coronary artery disease but revealed a large intracardiac left atrial mass that was supplied by 2 anomalous coronary arteries. The patient underwent successful ligation of the anomalous coronary arteries and resection of the mass, which was histologically an atrial myxoma. The patient''s symptoms resolved, and results of a repeat cardiac stress test were normal.To our knowledge, this is the first report of a highly vascularized atrial myxoma that caused coronary steal with objective evidence of ischemia, and with subsequent resolution after resection of the mass and ligation of the anomalous coronary arteries.     

An Unusual CO-conspirator in a Case of Acute Coronary Syndrome

Carbon monoxide (CO) poisoning is a common cause of morbidity and mortality that exerts its physiological effects by competition with molecular oxygen. Therefore, tissues that extract a high fraction of oxygen from circulating blood are at high risk for injury due to CO toxicity. While neurological complications of CO poisoning have been well described, cardiac damage secondary to CO poisoning also occurs, but has been less frequently reported. We present the case of a young man with CO poisoning who had elevated cardiac biomarkers, a regional wall motion abnormality, and was found to have obstructive coronary disease. Evidence of myocardial necrosis in the setting of CO toxicity should prompt consideration of an evaluation for coronary artery disease, particularly among those with risk factors.     

Dynamic Coronary Thrombosis: A Possible Cause of Prinzmetal's Variant Angina

Two patients presented with features typical of Prinzmetal's variant angina: recurrent episodes of chest discomfort at rest associated with transient ST segment elevation. Episodes of recurrent ischemia persisted despite treatment with intravenous nitroglycerin. Coronary arteriography disclosed a high grade stenotic lesion and intracoronary thrombus in both patients. Coronary spasm was not demonstrated. These observations suggest that "dynamic thrombosis" may have a more important role than heretofore recognized in some patients with Prinzmetal's variant angina.     

An Unusual Cause for Recurrent Syncope in a Female Adult with LEOPARD Syndrome

The LEOPARD syndrome is a rare autosomal dominant, multisystem disease involving the skin, skeletal and cardiovascular systems. Echocardiography including stress testing was used in a patient with LEOPARD syndrome and recurrent syncope to reveal the hemodynamic relevance of a giant aneurysm of the interventricular membraneous septum ballooning into the right ventricular outflow tract. This case impressively underlines the vital necessity of dynamic testing particularly in patients with symptoms during exercise even if these symptoms might be addressed to other findings.     

An Unusual Cause of Dyspnea

Background. Right-sided arcus aorta (RSAA) is a rare condition and usually asymptomatic. However, it may be symptomatic if it causes tracheal or esophageal compression. Methods. The authors evaluated clinical and radiological features of seven patients with RSAA who had the diagnosis between May 2006 and May 2009. Results. The authors found that the incidence of RSAA was 0.16% in patients who had applied to their clinic. The age of patients ranged from 17 to 55 years. The male to female ratio was 6/1. Four patients were symptomatic due to RSAA. Most common symptoms were dyspnea during exercise, which is similar to exercise-induced asthma and dysphagia. Two patients were misdiagnosed as asthma. The flow-volume curves on spirometry of the patients showed intrathoracic upper airway obstruction. Thorax magnetic resonance imaging (MRI) revealed marked narrowing of the tracheal air column due to external compression of RSAA in three patients. Conclusions. RSAA should be included in the differential diagnosis of asthma. Spirometry may help to suspect RSAA. Thorax computed tomography (CT) and/or MRI are the best imaging methods for the diagnosis of RSAA.     

An Unusual Cause of Diarrhea

Digestive Diseases and Sciences -