Left ventricular non-compaction presenting as cardio-embolic stroke

A 39-year-old male with no known comorbidities presented with sudden onset right-sided weakness.On examination,blood pressure was 128/79 mmHg,National Institutes of Health Stroke Scale score was 4 and there were no signs of heart failure.Emergent computerized tomography demonstrated an ischemic infarct of the left middle cerebral artery distribution and brain magnetic resonance imaging later confirmed it(Figure 1).

A rare sighting: left atrial appendage thrombus seen on transthoracic echocardiogram

The left atrial appendage(LAA)is the most common site of left atrial thrombus with more than 90%of thrombi formed within this structure.[1]Transesophageal echocardiography(TEE)is the gold standard imaging technique for identifying LAA thrombus,with sensitivity and specificity both of 95%–100%.[1,2]An imaging modality that is used on most cardiac patients is the transthoracic echocardiogram(TTE).While quick and noninvasive,it is not known for its ability to detect left atrial appendage thrombi.Detecting a thrombus on TTE is a great advantage as it allows for rapid initiation of anticoagulation and avoidance of cardioversion early in atrial fibrillation patients.This case demonstrates the rare occurrence of a patient who was found to be in atrial fibrillation in the setting of thyrotoxicosis who was subsequently discovered to have a left atrial appendage thrombus on TTE.

Coxsackievirus B infection presenting as a hemorrhagic pericardial effusion causing tamponade

The coxsackievirus is well known for its vastly differing clinical presentations.Patients with coxsackievirus usually present with a viral prodrome which can then progress to the cardiac symptoms of chest pain and/or palpitations.Most patients improve quickly with simply supportive care and nonsteroidal anti-inflammatory medications.

An elderly parachute mitral valve:still landing well

An 80-year-old male with type Ⅱ diabetes mellitus,hypertension and hyperlipidemia presented with chest pain.Vital signs were significant for severely elevated blood pressure of 190/100 mmHg,but otherwise normal.Physical examination was unrevealing.Chest X-ray and electrocardiogram were unremarkable.In Figure 1A,the transthoracic echocardiogram demonstrated an ejection fraction of 55%–60%with a parachute mitral valve(PMV),which had no stenosis or regurgitation.The patient’s chest pain resolved with normalization of his blood pressure and he was discharged with medical management.

Typical atrial flutter from blunt cardiac injury:an atypical cause

Atrial flutter(AFL)is a detrimental cardiac arrhythmia caused by multiple pathologic conditions.Certain unsuspecting cases,however,may be an inciting factor.Among them is blunt cardiac injury(BCI),characterized by nonpenetrating mediastinal trauma,leading to arrhythmias due to myocardial tissue injury.AFL is a rare sequela of BCI that has seldom been reported.We present a case of a healthy 50-year-old lady who was incidentally diagnosed with AFL in the setting of BCI.

Invasive versus non-invasive hemodynamic monitoring of heart failure patients and their outcomes

Acute decompensated heart failure(HF)is the most common cause of hospital ad-mission in patients older than 65 years.Mean length of hospital stay is about 5-6 days and with a frequent number of hospital readmission rates of 25%to 50%at 30 days and 6-12 months,respect-ively.[1]Treatment options are vast and depend on certain patient characteristics,including hemody-namics,which drive the acute management.A pop-ular modality to assess hemodynamics in acute HF is the right heart catheterization(RHC).While in-vasive,the use of RHC gives providers the oppor-tunity to evaluate values that directly contribute to the management of the patient.These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy.