Subjects -> MEDICAL SCIENCES (Total: 8669 journals)
    - ANAESTHESIOLOGY (120 journals)
    - CARDIOVASCULAR DISEASES (338 journals)
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    - RESPIRATORY DISEASES (104 journals)
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    - SURGERY (406 journals)

CARDIOVASCULAR DISEASES (338 journals)                  1 2 | Last

Showing 1 - 200 of 338 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 8)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 60)
American Journal of Cardiology     Hybrid Journal   (Followers: 68)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 18)
American Journal of Hypertension     Hybrid Journal   (Followers: 29)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Circulation     Open Access   (Followers: 2)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 6)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 4)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 2)
Arrhythmia & Electrophysiology Review     Open Access   (Followers: 1)
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 33)
Artery Research     Hybrid Journal   (Followers: 5)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 4)
ASEAN Heart Journal     Open Access   (Followers: 3)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 9)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 18)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiac Failure Review     Open Access   (Followers: 2)
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 11)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 9)
Cardiology in the Young     Hybrid Journal   (Followers: 35)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 11)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 9)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 16)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 103)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 268)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 19)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 16)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 35)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 10)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 5)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 3)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 5)
Current Cardiology Reports     Hybrid Journal   (Followers: 6)
Current Cardiology Reviews     Hybrid Journal   (Followers: 3)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 13)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 1)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Cardiology Review     Open Access   (Followers: 1)
European Heart Journal     Hybrid Journal   (Followers: 67)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 7)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 13)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 9)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 5)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 2)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension     Open Access   (Followers: 2)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 4)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 17)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 3)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 32)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Open Access  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 19)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 30)

        1 2 | Last

Similar Journals
Journal Cover
European Heart Journal : Case Reports
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2514-2119
Published by Oxford University Press Homepage  [412 journals]
  • Eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome)
           masquerading as acute ST-elevation myocardial infarction with complete
           resolution after immunosuppressive therapy: a case report

    • Authors: Chai J; McGrath S, Lopez B, et al.
      Pages: 1 - 6
      Abstract: BackgroundEosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg–Strauss syndrome) is a rare autoimmune condition characterized by inflammation of small- and medium-sized blood vessels, which usually presents with systemic vasculitis preceded by airway allergic hypersensitivity.Case summaryHere, we report a highly unusual case of acute ST-elevation myocardial infarction in a young and fit man with no cardiovascular risk factors. His emergency coronary angiography revealed disproportionately severe widespread coronary artery disease. We describe the diagnostic challenges with emphasis on meticulous history-taking (deep hyponasal voice, anosmia, and childhood asthma), supported by timely blood markers (peripheral eosinophilia and raised CRP), and multi-modal imaging (severe paranasal sinusitis on cranial magnetic resonance imaging and multiple lung infiltrates with small patches of ground-glass appearance on thoracic computed tomography), to reach a diagnosis of EGPA coronary vasculitis with particular reference to the American College of Rheumatology EGPA classification. Importantly, with prompt immunosuppression, his coronary lesions resolved completely without the need of any surgical or percutaneous revascularisation. He remained well and asymptomatic on maintenance immunosuppressants at 1 year follow-up.DiscussionThis case highlighted the rare but recognized involvement of the coronary arteries in systemic EGPA vasculitis, which can sometimes mimic atherosclerotic coronary disease and acute coronary syndrome.
      PubDate: Fri, 21 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty075
      Issue No: Vol. 2, No. 3 (2018)
  • Primary percutaneous intervention in anomalous right coronary artery
           originating from anomalously arising single coronary trunk

    • Authors: Gupta M; Girish M, Bansal A, et al.
      Pages: 1 - 2
      PubDate: Fri, 14 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty080
      Issue No: Vol. 2, No. 3 (2018)
  • Implantation of a subcutaneous implantable cardioverter defibrillator with
           right parasternal electrode position in a patient with D-transposition of
           the great arteries and concomitant AAI pacemaker: a case report

    • Authors: Lüker J; Sultan A, Sreeram N, et al.
      Pages: 1 - 5
      Abstract: BackgroundImplantable cardioverter defibrillator (ICD) therapy is indicated in patients with structural heart disease who have had an aborted cardiac arrest (ACA). After atrial repair of d-transposition of the great arteries (d-TGA, Mustard repair) patients seem to be at a higher risk of failing intraoperative subcutaneous ICD (S-ICD) shock testing.Case summaryWe report the case of a 45-year-old patient with congenital heart disease (CHD) who suffered a cardiac arrest from ventricular fibrillation and was subsequently implanted with a S-ICD. We describe the challenges of ICD therapy in patients after Mustard procedure for d-TGA, with the additional challenge of concomitant AAI pacemaker therapy. In this patient, we opted for the implantation of an S-ICD, and detail the necessary considerations and operative technique employed in this patient. A right parasternal electrode position was chosen and intraoperative shock testing was successful.DiscussionPatients after atrial switch surgery for d-TGA and ACA require careful consideration of the appropriate type of ICD therapy. Subcutaneous ICD implantation with right parasternal electrode position may be a viable option in these patients.
      PubDate: Wed, 12 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty099
      Issue No: Vol. 2, No. 3 (2018)
  • Solitary neuroendocrine carcinoma of the heart: a case report

    • Authors: Wißt T; Jehn C, Vierbuchen M, et al.
      Pages: 1 - 5
      Abstract: BackgroundCardiac tumours are of rare incidence and usually occur in the form of secondary tumours. Most metastatic tumours are melanomas, sarcomas, lung, and haematological malignancies. Neuroendocrine carcinomas (NECs) of the heart are extremely unusual. This case report demonstrates a solitary high-grade NEC of the heart with an individual therapy strategy and follow-up.Case summaryA 50-year-old gentleman presented with a 2 days history of recurrent episodes of chest pain. Echocardiography, computed tomography, and magnetic resonance imaging revealed tumorous lesions of the ventricles and aortic valve with large circular pericardial effusion. Histopathology results of the biopsy revealed a poorly differentiated small cell tumour of the neuroendocrine type. Despite further investigations with multiple imaging modalities and laboratory, no primary was found. Chemotherapy was initiated but size progression of the tumour was detected. As no other tumorous lesions were detected and resection was not possible because of the tumour complexity, decision on heart transplantation was made. However, due to the necessary immunosuppression after the heart transplantation, multiple metastasis where discovered in the course of treatment.DiscussionThe presence of a NEC in the heart without evidence of any other metastasis or evidence of primary tumour in other organs is clinically unique. For this individual case, heart transplantation was the therapy of choice due to tumour progression under chemotherapy and lacking possibility of resection, as no other suspect lesion was found other than the ones found in the heart. However, the risk of exacerbation of undiscovered micrometastases under necessary immunosuppression following the heart transplantation should be considered.
      PubDate: Wed, 12 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty096
      Issue No: Vol. 2, No. 3 (2018)
  • A case with purulent pericarditis diagnosed by the unintended

    • Authors: Nagumo S; Ebato M, Maeda A, et al.
      Pages: 1 - 2
      PubDate: Thu, 06 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty093
      Issue No: Vol. 2, No. 3 (2018)
  • Spontaneous mitral annular rupture

    • Authors: Ewen S; Schäfers H, Fries P, et al.
      Pages: 1 - 2
      PubDate: Tue, 04 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty097
      Issue No: Vol. 2, No. 3 (2018)
  • A case report of locally invasive Aspergillus fumigatus infection in a
           patient on canakinumab

    • Authors: Chandrakumaran A; Malik M, Stevens M, et al.
      Pages: 1 - 4
      Abstract: BackgroundCanakinumab is a human monoclonal interleukin-1 antibody that has been studied in the Canakinumab Anti-Inflammatory Thrombosis Outcome Study (CANTOS) trial and shown to prevent recurrent cardiovascular events, while increasing the incidence of neutropenia and risk of severe infections.Case summaryThis is a case report of a locally invasive aspergillus infection in a patient with uncontrolled diabetes mellitus who was receiving canakinumab for 3.5 years as part of the CANTOS trial. He presented with headaches and left eye pain and was found to have a large left ethmoid sinus mass extending into the orbit on computed tomography scan of the head. Cultures from an endoscopic biopsy of left ethmoid sinus grew Aspergillus fumigatus. Canakinumab was discontinued, and he was discharged on voriconazole with improvement in his headaches and left eye pain.DiscussionThe anti-inflammatory properties of canakinumab could have blunted the patient's immune response allowing the mycetoma to invade adjacent tissue. If canakinumab was approved for the secondary prevention of cardiovascular events then it is important to be cognizant of its potential to delay the presentation of any infection.
      PubDate: Tue, 04 Sep 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty098
      Issue No: Vol. 2, No. 3 (2018)
  • Case report of a metastatic squamous cell carcinoma to the pericardium
           masquerading as ST elevation myocardial infarction on ECG

    • Authors: Brailovsky Y; Darki A, Mathew V.
      Pages: 1 - 2
      Abstract: A 55-year-old male patient presented with acute onset of substernal chest pain and dyspnoea. He had a previous medical history of oesophageal squamous cell carcinoma diagnosed 1 month prior to presentation, for which he underwent chemotherapy, radiation, and oesophageal stent placement. Vital signs on presentation were notable for heart rate of 79 b.p.m., respiratory rate of 18, blood pressure 114/87 mmHg, and oxygen saturation of 100% on room air. Initial electrocardiogram (ECG) demonstrated ST segment elevations in leads II, III, aVF, V4–V6, concerning for acute ST elevation myocardial infarction in the inferolateral territory (Figure 1). He was taken emergently to the cardiac catheterization laboratory for coronary angiography, which revealed no occlusive coronary artery disease.
      PubDate: Wed, 29 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty095
      Issue No: Vol. 2, No. 3 (2018)
  • Multiple embolic strokes as a result of Libman–Sacks endocarditis
           associated with lupus and secondary antiphospholipid antibody syndrome: a
           case report

    • Authors: Arnautovic J; Yamasaki H, Rosman H.
      Pages: 1 - 6
      Abstract: BackgroundLibman–Sacks endocarditis (LSE) is an infrequently recognized pathogenesis of embolic cerebrovascular disease. Patients often have asymptomatic valvular dysfunction which if not recognized promptly, can lead to serious complications such as heart failure, arrhythmias, cerebroembolic phenomena with increased neurocognitive disability, and even death. It can be associated with systemic lupus erythematosus and/or antiphospholipid antibody syndrome (APLS).Case summaryPreviously very healthy and active, 49-year-old Caucasian female with past medical history of mild lupus, for which she stopped treatment 10 year ago, saw a primary care physician complaining of intermittent double vision of 2 months duration. Urgent brain magnetic resonance imaging revealed multiple embolic infarcts of the brain stem. Further comprehensive work-up led to diagnosis of mitral LSE and APLS. After 2 months of systemic anticoagulation with warfarin and immunosuppressive therapy with hydroxychloroquine sulfate, repeat imaging demonstrated resolution of the mitral valve vegetation with no clinical recurrence of thromboembolic events at 6 months.DiscussionMild, often silent, autoimmune disease as described in our case can lead to significant cerebrovascular disease. Patients who present with cryptogenic strokes with high suspicion of underlying autoimmune disease should be worked up thoroughly for possible valvular heart disease associated with lupus, APLS, or both. Acquisition of transoesophageal images proved superior to transthoracic approach and it should be implemented in these subsets of patients. With this case report, we highlight the importance of early recognition of cardiac manifestations, amelioration of risk factors, as well as close follow-up of lupus or APLS patients, as crucial steps in reducing their morbidity and mortality along with preventing recurrence or progression of cerebrovascular disease.
      PubDate: Fri, 17 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty094
      Issue No: Vol. 2, No. 3 (2018)
  • Venous varices of the heart: a case report of spontaneous coronary sinus
           thrombosis with persistent left superior vena cava

    • Authors: Moey M; Ebin E, Marcu C.
      Pages: 1 - 3
      PubDate: Thu, 16 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty092
      Issue No: Vol. 2, No. 3 (2018)
  • Cardiogenic shock as the first manifestation of large vessel vasculitis in
           a young patient: case report

    • Authors: Isaza N; Posada A, Diaz M, et al.
      Pages: 1 - 5
      Abstract: BackgroundCardiogenic shock secondary to coronary involvement in large vessel vasculitis (LVV) is an unsuspected finding, even more, when no other vascular territories are compromised and when it constitutes the initial clinical manifestation. This case report illustrates a case in which a complete diagnostic study uncovered this aetiology.Case summaryA 33-year-old woman with cough and chest pain who was diagnosed with acute bronchitis returned with worsening dyspnoea, chest pain, and developed cardiogenic shock. The initial differential diagnoses included myocarditis and takotsubo cardiomyopathy (TCM) owing to a positive troponin I, and echocardiogram with left ventricular dilation, dyskinesia in mid-ventricular and apical segments, systolic dysfunction, and functional mitral regurgitation. A cardiac magnetic resonance showed contractility abnormalities resembling the pattern of TCM but lacked the characteristic myocardial oedema. Subsequently, a coronary angiography expected to result without obstructions showed a critical narrowing of the left main coronary artery. Surgical management consisted of a pericardium patch grafted in the stenotic ostium to restore adequate perfusion. The surgical specimens were sent to the pathology laboratory that reported findings compatible with LVV. Four days after the surgical intervention the patient was discharged alive with a complete recovery of left ventricular systolic function.DiscussionChest pain symptoms in a young woman, could be caused by multiple entities, and an ischaemic aetiology from a non-atherosclerotic origin should be kept in mind. A complete study with coronary angiography is crucial to rule out an ischaemic cause even in low-risk groups for atherosclerotic coronary heart disease.
      PubDate: Fri, 03 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty091
      Issue No: Vol. 2, No. 3 (2018)
  • Rupture of a giant aneurysm of the sinus of Valsalva leading to acute
           heart failure: a case report demonstrating the excellence of

    • Authors: Wierda E; Koolbergen D, de Mol B, et al.
      Pages: 1 - 2
      PubDate: Thu, 02 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty090
      Issue No: Vol. 2, No. 3 (2018)
  • Case report: pericardial adhesions from a previous coronary artery bypass
           surgery contain a left ventricular free wall rupture after an acute
           myocardial infarction to form a pseudoaneurysm

    • Authors: Singh A; Sivakumar K.
      Pages: 1 - 5
      Abstract: BackgroundFatal mechanical complications of acute myocardial infarctions include free wall rupture and ventricular septal rupture. If pericardial adhesions wall off a free wall rupture, it may lead to formation of pseudoaneurysms that are characterized by a narrow mouth. Even though pseudoaneurysms are common after myocardial infarctions, they may also occur following surgery, trauma, and infections rarely.Case summaryWe present a case of a 62-year-old man who developed a left ventricular pseudoaneurysm 2 weeks after thrombolysis for an acute inferolateral myocardial infarction. Multiple non-invasive imaging modalities demonstrated the anatomy, regional and global ventricular function, distortion of mitral annulus by the eccentric large aneurysm. Pericardial scars after a previous coronary bypass surgery contained this left ventricular free wall rupture and helped in providing a safe window period for corrective surgery.DiscussionWhile left ventricular pseudoaneurysms that develop following myocardial infarctions warrant emergency surgery due to the high impending chances of rupture and tamponade, previous surgical pericardial adhesions guarded against an imminent collapse. Multimodality imaging of the aneurysm helped in planning the surgical strategy.
      PubDate: Tue, 31 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty081
      Issue No: Vol. 2, No. 3 (2018)
  • Dehiscence and embolization of CorMatrix tricuspid valve replacement in
           the setting of infective endocarditis: a case report

    • Authors: Tomdio A; Moey M, Siddiqui I, et al.
      Pages: 1 - 5
      Abstract: BackgroundDue to increased morbidity and mortality, prosthetic valve infective endocarditis (IE) with dehiscence requires urgent intervention. Early identification and therapy may prevent embolization.Case summaryA 27-year-old Caucasian woman with a history of hepatitis C, intravenous drug abuse, and tricuspid valve (TV) replacement was admitted for recurrent IE. She was found to have bacteraemia and fungaemia, and empiric antibiotics were initiated. Transthoracic echocardiogram (TTE) revealed a mobile ‘mass’ on the TV and dehiscence. The patient developed cardiogenic shock and repeat TTE showed a ruptured TV and absence of the ‘mass’, suspicious of embolization. She underwent emergent surgery with TV replacement using a Biocor valve and retrieval of the old CorMatrix valve found in the right mid pulmonary artery (PA). The patient was successfully weaned off inotropic agents and completed a prolonged course of antibiotics and anti-fungals.DiscussionThe multi-disciplinary decision on timing of surgical intervention was challenging, especially due to ongoing mycobacterial infection that increased operative risk. With clinical deterioration, urgent surgery was performed revealing an embolized prosthetic valve in the PA. New surgical options for TV replacement in IE with extracellular-based material have shown promising outcomes with little reported data of long term complications. This case demonstrates a rare occurrence of embolized CorMatrix TV and highlights the challenge in timing of appropriate surgical intervention in a septic patient with thrombocytopenia.
      PubDate: Tue, 31 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty086
      Issue No: Vol. 2, No. 3 (2018)
  • Immunoglobulin G4-related disease of the thickened aortic valve extending
           to the left ventricular outflow tract causing severe aortic regurgitation
           and complete atrioventricular block: a case report

    • Authors: Kosugi S; Okada M, Iwata K, et al.
      Pages: 1 - 5
      Abstract: BackgroundImmunoglobulin G4-related disease (IgG4-RD) is a systemic disease characterized by the tumefactive lesions and infiltration of IgG4-positive plasma cells. IgG4-RD has been described in various organs, but rarely the aortic valve. There are only a few reports of aortic stenosis, and none on significant aortic regurgitation. In addition, previous case reports relating to aortic valve lesions led to surgery as a first-line treatment. The effect of steroid treatment has not yet been determined.Case SummaryA 62-year-old man, receiving steroid therapy, who presented with general malaise, shortness of breath, and bradycardia. He had suspected IgG4-RD because of pancreatitis, lacrimal gland enlargement, and retroperitoneal fibrosis. An examination revealed a thickened aortic valve extending to the left ventricular outflow tract with severe aortic regurgitation and complete atrioventricular block. He received intensive steroid therapy for a suspected IgG4-related aortic valve lesion. The complete atrioventricular block improved, but worsening aortic regurgitation caused congestive heart failure. He required replacement of the aortic valve. A histopathological examination of the excised aortic valve leaflets revealed IgG4-positive lymphoplasmacytic infiltration with fibrotic tissue. The prosthetic valve was functioning well without leakage around the valve at the 1-year follow-up.DiscussionThis case highlights the rare possibility that IgG4-RD of the aortic valve also causes significant aortic regurgitation. Conservative treatment with steroids may induce regression of the lesion and contribute to the stability of the prosthetic valve after surgery, but it may also exacerbate heart failure due to the progression of aortic regurgitation in patients with aortic valve lesions.
      PubDate: Tue, 31 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty087
      Issue No: Vol. 2, No. 3 (2018)
  • Calcified mitral stenosis imitates a MitraClip® and forms a double

    • Authors: Lange M; Bültel H, Wichter T.
      Pages: 1 - 2
      Abstract: Learning pointsClinically significant mitral stenosis in industrialized countries is more often degenerative calcific than rheumatic, and therefore, not suitable for percutaneous mitral commisurotomy.Cardiac surgery is performed less in older patients with calcific mitral stenosis (MS), respectively mitral annular calcification because of a higher perioperative risk.Degenerative calcified MS and mitral annulus calcification can form bizarre formations.
      PubDate: Fri, 27 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty084
      Issue No: Vol. 2, No. 3 (2018)
  • Severe ischaemic cardiogenic shock with cardiac arrest and prolonged
           asystole: a case report

    • Authors: Strangl F; Schwarzl M, Schrage B, et al.
      Pages: 1 - 5
      Abstract: BackgroundExtracorporeal life support (ECLS) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a valuable treatment option during severe cardiogenic shock and during cardiac arrest unresponsive to conventional management. It is applied to bridge the first critical days until the patient recovers or a destination therapy is established.1 Prolonged episodes without cardiac electrical activity during VA-ECMO are a major problem, as they may cause pulmonary oedema and severe left ventricular (LV) thrombosis.2 Here, we report a case of a 50-year-old man who presented with a 30-h episode of complete absence of electromechanical activity during ECLS and finally recovered with favourable neurological outcome.Case summaryA 50-year-old man with out-of-hospital cardiac arrest was transferred to a peripheral hospital after initial successful cardiopulmonary resuscitation (CPR). In the emergency room, he presented with ST-segment elevation myocardial infarction and cardiogenic shock with third-degree atrioventricular block. After immediate insertion of a temporary pacemaker, he received percutaneous coronary intervention of the left anterior descending artery and the circumflex artery. Due to worsening cardiogenic shock, ECLS with VA-ECMO and an Impella® pump was established. Cumulative time of CPR (out of hospital and in hospital) was 41 min. After transfer to our institution’s intensive care unit, both the heart’s mechanical and electrical activity ceased for more than 24 h and recovered slowly thereafter. After showing promising neurological outcome, epicardial pacemaker leads, an implantable cardioverter-defibrillator, and finally, a LV assist device were implanted. He was dismissed into rehabilitation with only minor neurological residua 6 weeks later.DiscussionImpella® implantation on top of VA-ECMO may be considered beneficial in the therapy of prolonged cardiac arrest.3 While VA-ECMO ensures oxygenation and organ perfusion, Impella® vents the left ventricle and enhances coronary perfusion. In the presented case, a favourable outcome was reached despite an ‘untreated’ prolonged absence of cardiac electromechanical activity. Under specific circumstances during ECLS with extracorporeal membrane oxygenation and Impella®, waiving of temporary pacing may be considered in absent cardiac electromechanical activity to avoid further complications.
      PubDate: Fri, 27 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty088
      Issue No: Vol. 2, No. 3 (2018)
  • Recurrent valve obstruction in a patient with a pure carbon bileaflet
           metallic mitral valve: a case report

    • Authors: Bhandari S; Nicolson W.
      Pages: 1 - 7
      Abstract: BackgroundDespite overcoming the morbidity from severe native valve disease, prosthetic metallic valve replacement is not without its inherent morbidity, in particular from prosthetic valve thrombosis (PVT). The contemporary pure carbon bileaflet metallic valve confers reduced thrombogenicity.Case SummaryWe describe the case of a 45-year-old woman with a pure carbon bileaflet metallic mitral valve replacement (27/29 mm On-X) 6 months previously for severe rheumatic mitral stenosis, who presented with a rapid onset of dyspnoea, paroxysmal nocturnal dyspnoea, and haemoptysis. This was preceded by an interruption in therapeutic anticoagulation. On admission the patient was in cardiogenic shock. Transthoracic and transoesophageal (TOE) echocardiograms revealed increased transmitral gradients with disc hypomobility, suggestive of PVT, unexpected given the favourable safety profile of the On-X valve. Fluoroscopy confirmed the findings. The patient was thrombolysed successfully with alteplase, with restoration of normal transmitral gradients. A target international normalized ratio of 3.5–4.5 was chosen, in addition to aspirin 75 mg, to minimize thrombotic sequalae. Repeat TOE 6 weeks later revealed disc hypomobilty with a large adherent clot. Due to the high risks from thrombolysis, emergency redo-mitral bioprosthetic valve surgery was performed, to negate the need for long-term anticoagulation.DiscussionSubtherapeutic anticoagulation and the rapid development of dyspnoea, should prompt the clinician to suspect PVT. Thorough clinical examination and immediate bedside echocardiography are critical for assessing prosthetic valve patients in cardiogenic shock. The treatment of PVT is complex, with considerable risks to the patient, irrespective of the strategy (thrombolysis/emergency valve replacement), necessitating the expertise of cardiologists and cardiac surgeons.
      PubDate: Fri, 27 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty089
      Issue No: Vol. 2, No. 3 (2018)
  • Case report: Posterior myocardial infarction in presence of right bundle
           branch block: an old concept with new findings

    • Authors: Cornejo-Guerra J; Manzur-Sandoval D, Guadalajara-Boo J, et al.
      Pages: 1 - 5
      Abstract: BackgroundThe diagnosis of acute ischaemic coronary syndromes in presence of an intra-ventricular conduction disturbance represents a clinical challenge. In the cardiac segmentation model the posterior wall is replaced by the basal inferior segment. However, in the clinical scenario of acute coronary syndrome the concept of posterior myocardial infarction (PMI) endures. The association of a PMI and right bundle branch block (RBBB) is a rare condition characterised by broad R waves and ventricular repolarization disorders in right precordial leads in both entities, which could lead to misinterpretation and delay in reperfusion therapy.Case SummaryWe describe a case report of a 74-year-old man with acute chest pain and an electrocardiogram with broad R waves, a 4 mm ST-segment downsloping (excessively discordant) in right precordial leads, RBBB, and ST-segment elevation in posterior leads. There was resolution of ST-segment downsloping in right precordial leads after percutaneous coronary intervention and stenting of the circumflex artery, with disturbance of the repolarization process only attributable to RBBB.DiscussionPatients with acute chest pain with RBBB and a ST segment with an excessive downsloping (out of proportion of what is expected in isolated RBBB) suggest PMI with occlusion of the circumflex coronary artery.
      PubDate: Mon, 23 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty085
      Issue No: Vol. 2, No. 3 (2018)
  • ESC CardioMedThe new ESC Textbook of Cardiovascular Medicine, ESC
           CardioMed, is a continuously updating electronic database (Figure 1)

    • Pages: 1 - 3
      PubDate: Sat, 21 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty079
      Issue No: Vol. 2, No. 3 (2018)
  • Asymptomatic ventricular tachycardia: diagnostic pitfalls of
           Andersen–Tawil syndrome—a case report

    • Authors: Nguyen D; Ferns S.
      Pages: 1 - 4
      Abstract: BackgroundAndersen–Tawil syndrome (ATS) is a rare arrhythmia disorder caused by a mutation in the KCNJ2 gene. Typical presentation includes a triad of cardiac arrhythmia, dysmorphia, and periodic paralysis. However, KCNJ2 mutations can mimic other disorders such as catecholaminergic polymorphic ventricular tachycardia (CPVT) making treatment challenging.Case summaryA 9-year-old asymptomatic female patient presented with an irregular heart rate noted at a well-child visit. Physical examination revealed short stature and facial dysmorphism. An initial rhythm strip showed intermittent runs of non-sustained bidirectional ventricular tachycardia with a prolonged QT interval of 485 ms at rest. Exercise testing showed no significant increase in ectopy from baseline at higher heart rates. Cardiac imaging was normal, and the burden of ventricular ectopy was significantly reduced on a beta-blocker and Class IC antiarrhythmic combination. Genetic testing marked a D71N mutation in the KCNJ2 gene.DiscussionClinical distinction between ATS and CPVT is a challenge. Genetic testing in the above patient attributed a likely pathogenic variant for both ATS and CPVT to a single D71N mutation in the KCNJ2 gene. Further evaluation revealed no clinical CPVT, emphasizing the need for cautious interpretation of genetic results in inherited arrhythmia disorders.
      PubDate: Tue, 17 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty083
      Issue No: Vol. 2, No. 3 (2018)
  • A rare case of accessory mitral valve tissue causing left ventricular
           outflow tract obstruction associated with parachute mitral valve,
           ventricular septal defect, bicuspid aortic valve, unruptured aneurysm of
           aortic sinus: a case report

    • Authors: Li Y; Hu Y, Wang J, et al.
      Pages: 1 - 5
      Abstract: BackgroundAccessory mitral valve tissue rarely causes left ventricular outflow tract obstruction in adults. It is often associated with other cardiac and vascular congenital malformations. Here, we report the rarest presentation of accessory mitral valve tissue (AMVT) causing left ventricular outflow tract obstruction.Case summaryA 22-year-old female patient presented with a history of shortness of breath and chest pain for more than 5 years. A diagnosis of AMVT with parachute mitral valve, ventricular septal defect (VSD), bicuspid aortic valve, unruptured aneurysm of aortic sinus, and left ventricular outflow tract obstruction was made. Successful closure of VSD with mitral valve replacement, excision of AMVT, and repair of the aortic sinus were performed. The post-operative course was uneventful, and an echocardiogram showed complete resection of the accessory mitral valve, no residual shunt and no left ventricular outflow gradient. Additionally, the peak gradient of rapid filling phase and atrial systolic phase across the prosthetic mitral valve were 16 mmHg and 4 mmHg, respectively. The peak velocity across left ventricular outflow tract was 1.4 m/s.DiscussionAccessory mitral valve tissue is associated with other cardiac abnormalities and is usually diagnosed in the first or second decade of life. It is responsible for left ventricular outflow tract obstruction. The obstruction can occur in the early period of life due to continued deposition of fibrous tissues within left ventricular outflow tract. Accessory mitral valve tissue should be considered a rare but important cause of left ventricular outflow tract obstruction.
      PubDate: Mon, 16 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty082
      Issue No: Vol. 2, No. 3 (2018)
  • Impairment of the antegrade fast pathway in patients with atrioventricular
           nodal reentrant tachycardia can be functional and treated by slow pathway
           ablation: a case report study

    • Authors: Cheniti G; Glover B, Frontera A, et al.
      Pages: 1 - 6
      Abstract: BackgroundSlow pathway (SP) ablation is considered to be the standard treatment for symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). This may be challenging in patients with documented PR interval prolongation due to the potential increased risk of atrioventricular (AV) block in some patients.Case SummaryWe report two cases of symptomatic recurrent AVNRT refractory to medical treatment with significant baseline PR interval prolongation (304 ms and 336 ms). In both of these cases, the baseline electrophysiological study demonstrated dual AV nodal physiology with a functional antegrade fast pathway and evidence for transient normalization of the PR interval. Slow/fast AVNRT was confirmed in both cases. Slow pathway ablation was successfully performed resulting in normalization of the PR interval to 144 ms and 168 ms with no evidence of AV block. After a mean follow-up of 30 months, the patients remained asymptomatic with normal PR interval, no recurrence of AVNRT, and no documentation of high degree AV block.DiscussionOur cases illustrate a common dilemma when dealing with patients with AVNRT and prolonged baseline interval. We show that SP ablation is feasible and safe as long as a preserved antegrade FP is present.
      PubDate: Fri, 13 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty078
      Issue No: Vol. 2, No. 3 (2018)
  • Post-ischaemic exuberant left ventricular mass: thrombus vs.
           tumour—case report

    • Authors: Viscuse P; Bartlett D, Foley T, et al.
      Pages: 1 - 7
      Abstract: BackgroundWe present a case that illustrates the diagnostic challenge of differentiating thrombus from tumour when confronted with a large left ventricular (LV) cardiac mass.Case SummaryA 43-year-old Caucasian woman polysubstance-abuser presented to a regional hospital with an ST-elevation myocardial infarction and underwent aspiration-thrombectomy and successful circumflex artery bare metal stenting. She was noted to have an exuberant LV mass on transthoracic echocardiogram the following day and transferred to our care. Transthoracic echocardiogram, transoesophageal echocardiogram, and cardiac magnetic resonance imaging were performed in an attempt to characterize the mass with conflicting findings for either thrombus or tumour. The mass was surgically excised and final pathology indicated a fibrin-rich thrombus.DiscussionThe association of the mass with an infarcted area of the left ventricle supported the diagnosis of thrombus. However, due to the size and some imaging features a myxoma could not be completely ruled out. Atypical presentations of thrombus can be difficult to differentiate from cardiac tumours.
      PubDate: Wed, 11 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty077
      Issue No: Vol. 2, No. 3 (2018)
  • Subcutaneous implantable cardioverter-defibrillator implantation for
           ventricular fibrillation caused by coronary artery spasm: a case report

    • Authors: Ito N; Kurabayashi M, Okishige K, et al.
      Pages: 1 - 5
      Abstract: BackgroundCoronary artery spasm usually has a good prognosis, except when it induces lethal ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) implantation in addition to optimal medical therapy including prescription of coronary vasodilators and smoking cessation is a therapeutic option for coronary artery spasm patients who present with lethal ventricular arrhythmia. Subcutaneous ICDs are now available as an alternative to conventional transvenous ICDs.Case SummaryWe report the first case of a 50-year-old Japanese male without any structural heart disease who presented with ventricular fibrillation caused by coronary artery spasm, and underwent subcutaneous ICD implantation for secondary prevention of sudden cardiac death (SCD). We attributed his aborted SCD to coronary artery spasm based on findings of cardiac catheterization including acetylcholine provocation test and cardiac electrophysiological study. During the 1 year of follow-up, the patient discharged on calcium channel blockers and nicorandil has been free of angina, ventricular arrhythmias, and appropriate ICD therapy.DiscussionCoronary artery spasm patients with aborted SCD may be good candidates for implantation of subcutaneous ICDs, because most of them have no need for concomitant bradycardia therapy, cardiac resynchronization therapy, or anti-tachycardia pacing therapy.
      PubDate: Tue, 03 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty074
      Issue No: Vol. 2, No. 3 (2018)
  • Coronary artery dissection in a 33-year-old man with fatigue and episodic
           retrosternal burning: a case report

    • Authors: Mehrani M; Nematollahi A, Hatami M, et al.
      Pages: 1 - 4
      Abstract: BackgroundNon-atherosclerotic spontaneous coronary artery dissection (SCAD) is a rare disease that predominantly affects women. It presents with acute chest pain, ventricular arrhythmias, and even sudden cardiac death.Case SummaryA 33-year-old man presented to emergency department with fatigue and cold sweat. He had no complaint of chest pain at the time of admission. He experienced a retrosternal chest pain 2 days ago after lifting a 30 pounds weight in the gym. Para-clinic results such as coronary computed tomography angiography and electrocardiogram were normal. However, coronary angiography showed multiple coronary dissections. We followed the patient for 4 months. He was asymptomatic except for one episode of chest pain during Tehran earthquake, while he was carrying his child to escape the room. Follow-up myocardial perfusion scan was negative for ischaemia.DiscussionStressors such as intense exercise, emotional stress, and Valsalva manoeuvre may cause SCAD in otherwise healthy patient. As in our case, lifting heavy weights was the most likely reason for SCAD. Stable patients without ongoing chest pain will be followed conservatively.
      PubDate: Mon, 02 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty068
      Issue No: Vol. 2, No. 3 (2018)
  • Cardiogenic shock following balloon post-dilatation in transcatheter
           aortic valve implantation: first case report of all three stuck leaflets

    • Authors: Okuyama K; Izumo M, Akashi Y.
      Pages: 1 - 5
      Abstract: BackgroundA stuck leaflet and frozen cusp are reported complications following transcatheter aortic valve implantation (TAVI). These complications are rare but can drastically change haemodynamics and be potentially life-threatening; thus, their awareness during TAVI is indispensable. Leaflet malfunction generally presents in one of the three leaflets of a prosthetic valve; however, we encountered a case where all three leaflets were simultaneously stuck.Case SummaryA 94-year-old woman was referred to our cardiology department with severe aortic stenosis. She underwent transfemoral TAVI. After a 20 mm balloon was inflated, a 23 mm Sapien 3 valve was deployed. Since the delivery balloon slipped into the ventricle, the valve top was not fully expanded. Post-dilatation using a 23 mm balloon was performed, which led to cardiogenic shock. Immediate cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation were provided. Since aortography and haemodynamics indicated severe aortic regurgitation and transoesophageal echocardiography depicted no leaflets inside the Sapien 3, we confirmed that all leaflets were stuck. The valve-in-valve procedure using the second 23 mm valve was successfully performed, and her haemodynamics dramatically improved. The patient was discharged 20 days later.DiscussionOnly a handful of cases have been reported on a stuck leaflet following post-dilatation. Root rupture is a major concern of the abrupt change after post-dilatation, but a stuck leaflet should also be considered even when the new-generation balloon-expandable valve, Sapien 3, is used. Here we report the first case in which all three leaflets were stuck.
      PubDate: Mon, 02 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty073
      Issue No: Vol. 2, No. 3 (2018)
  • Vasopressin antagonist-like effect of acetazolamide in a heart failure
           patient: a case report

    • Authors: Kataoka H.
      Pages: 1 - 5
      Abstract: BackgroundHyponatraemia is easily corrected by treatment with an oral vasopressin antagonist, but these medications are costly and their use at outpatient clinics is restricted by government-managed insurance in Japan. Acetazolamide could be an alternative diuretic to a vasopressin antagonist.Case SummaryAn 83-year-old dyspnoeic male patient was emergently admitted to the hospital due to decompensated heart failure (HF), hypotension, and hyperkalaemia-associated sinus arrest with a junctional escape rhythm. Urgent treatment with a noradrenaline drip infusion and a beta stimulant adhesive skin patch promptly restored sinus rhythm with conducted normal QRS complex, which resolved the hypotension. Blood tests on admission revealed moderately elevated b-type natriuretic peptide (BNP, 576 pg/mL), hyponatraemia (128 mEq/L), hypochloraemia (95 mEq/L), hyperkalaemia (5.7 mEq/L), and preserved renal function (creatinine, 1.0 mg/dL) under no cardiovascular medications. Immediately after admission, low-dose oral acetazolamide (500 mg/day) and polystyrene sulfonate-Ca jelly (Argamate, 25 g/day for 3 days) were prescribed to correct the decompensated HF status and electrolyte disturbance. Three days later, both the serum sodium and chloride concentrations had recovered to normal levels (136 mEq/L and 104 mEq/L, respectively), and the serum potassium concentration had decreased to 4.5 mEq/L. Two weeks later, the patient’s HF status became stable and the serum BNP concentration returned to normal (55 pg/mL).DiscussionThe present case indicates that the classic diuretic of acetazolamide would have a vasopressin blockade-like effect and could be an alternative diuretic to vasopressin antagonists for some proportion of HF patients with hyponatraemia.
      PubDate: Mon, 02 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjcr/yty076
      Issue No: Vol. 2, No. 3 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

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