Case Study

Professor Stephen Westaby and colleagues describe the case of a patient who presented with cardiogenic shock that swiftly deteriorated to severe heart failure. CT revealed a large adrenal tumor that was subsequently indentified as pheochromocytoma. After the tumor was removed, the patient underwent left ventricular assist device implantation as a bridge to left ventricular recovery.

Prasad and colleagues report on the novel technique of¹¹C hydroxyephedrine PET imaging for the measurement of myocardial sympathetic neuronal activity in a patient with stress (Takotsubo) cardiomyopathy.

Lindsay et al. present an interesting case of a patient with a ruptured sinus of Valsalva aneurysm. The authors recommend the early use of imaging modalities for prompt diagnosis, as anticoagulation therapy might have detrimental effects on patient outcome. Reparative surgery is safe and successful in almost all noninfective cases.

Ramcharitar et al. describe the first case treated in the SECRITT I trial. The 63-year-old man presented with class II anginal symptoms and was diagnosed as having a culprit lesion in the left circumflex artery and a vulnerable plaque in the left anterior descending artery. The vulnerable plaque was treated with a self-expanding stent tailored to shield this type of plaque.

Dr Pasquale and colleagues demonstrate that dynamic left ventricular outflow tract obstruction was the cause of exertional chest pain and dyspnea in a patient with no evidence of hypertrophic cardiomyopathy or ischemic heart disease.

In this month's Case Study, George and colleagues present a case of antiphospholipid syndrome. The IgG anti-β₂GPI antibodies isolated from this patient enhanced experimental atherosclerosis and attenuated plaque stability in apolipoprotein-E-knockout mice.

In this month's Case Study, Versaci and colleagues present a case of congenital coronary artery fistula originating from the left anterior coronary artery and draining into right ventricle, in conjunction with an aneurysm of the left anterior descending artery. The high risk of rupture lead the authors to close the fistula surgically using normothermic cardiopulmonary bypass.

The authors highlight the benefits of using a beating-heart technique during surgical correction of myocardial bridging in this 10-year-old patient with nonobstructive hypertrophic.cardiomyopathy.

Treatment of patients with amyloidosis is centered on reducing the supply of the respective amyloid fibril precursor protein. This Case Study describes a patient with cardiac acquired monoclonal immunoglobulin-light-chain amyloidosis, who also has an incidental amyloidogenic transthyretin Val122Ile mutation, and illustrates the crucial need to characterize the presence, extent and—most importantly—fibril type of amyloid deposits in patients with amyloidosis.

Ramcharitar and colleagues present an interesting case of a patient with drug-refractory hypertrophic obstructive cardiomyopathy and NYHA class II–III heart failure who was treated with septal coil embolization. This article demonstrates, for the first time, the acute changes in hemodynamics that occur following septal coil embolization, and shows that this treatment is a viable alternative to percutaneous coronary intervention.

Several chemotherapeutic agents, including newer drugs, can have toxic cardiac effects. In this month's Case Study, To and colleagues present their patient who had capecitabine-induced cardiogenic shock. They examine the best course of action for this serious complication of chemotherapy.

Device infection is devastating in individuals with permanent pacemakers or implantable cardioverter-defibrillators. In this month's Case Study, Simon and colleagues present a patient who had a duel pacemaker lead infection and tricuspid valve endocarditis. They examine the best course of action for this serious complication.

Clozapine is an atypical antipsychotic drug which has been linked to the development of cardiovascular side-effects. Here, Azzam et al. describe a 42-year-old male with refractory schizophrenia who presented with severe dilated cardiomyopathy, which was thought to have been caused by clozapine therapy.

Congenital heart defects can remain undiagnosed until adulthood. In this Case Study, Alegriaet al. describe a 20-year-old male presenting with systemic hypertension who was found to have coarctation of the aorta, a bicuspid aortic valve, an ascending aortic aneurysm and an atrial septal defect. He was successfully treated in a single surgical procedure.

In this month's Case Study, Cha and colleagues present a 51-year-old male patient referred for consideration for heart transplantation because of recently diagnosed congestive heart failure refractory to medical therapy. He was diagnosed with cardiomyopathy resulting from pulmonary vein tachycardia, which was treated with catheter-based radiofrequency ablation of pulmonary vein tachycardia focus.

In this month's Case Study, De Visser and colleagues present a 75-year-old male patient with a recent history of transient ischemic attack who underwent routine cardiological evaluation before a cystectomy. He was found to have coronary artery disease and an aortic valve papillary fibroelastoma—a rare, benign cardiac tumor. Multislice CT was successfully used to visualize the tumor and coronary arteries, before the patient underwent surgical excision of the tumor and an end-to-side anastomosis of the left internal mammary artery and the left anterior descending coronary artery.

Premature ventricular complexes are a common form of arrhythmia and are typically considered to be benign. In this month's Case Study, however, Ezzat and colleagues present a patient with dilated cardiomyopathy which was postulated to be caused by premature ventricular complexes arising from the right ventricular outflow tract. She was successfully treated by electrophysiological mapping and cryoablation of the ectopic focus.

A definitive diagnosis of cardiac sarcoidosis relies on the results of endomyocardial biopsy. In this Case Study Greif et al. describe a patient whose biopsy was negative for sarcoidosis—leading to a diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Sarcoidosis was only revealed after the patient had progressed to end-stage heart failure and undergone cardiac transplantation several years later.

In this month's Case Study, Kataoka and colleagues report a patient who experienced three episodes of syncope over the course of 2 years. Electrocardiography and 24h Holter monitoring revealed occasional premature ventricular complexes arising from the right ventricular outflow tract which, on a subsequent occasion, triggered an arrhythmic episode that degenerated into ventricular fibrillation. She was treated with radiofrequency catheter ablation and was fitted with an implantable cardioverter-defibrillator.