European Heart Journal: Case Reports最新文献

{"title":"Flecainide toxicity with pill-in-pocket approach from accidental overdose: a case report.","authors":"Mohamad Anas Oudih, Avraham Ginsburg, Mumin Hakim, Fengwei Zou, Nils Guttenplan","doi":"10.1093/ehjcr/ytae522","DOIUrl":"10.1093/ehjcr/ytae522","url":null,"abstract":"<p><strong>Background: </strong>The Pill-in-the-Pocket (PiP) approach may be used in highly selected patients to achieve acute pharmacological cardioversion into sinus rhythm. Flecainide toxicity is rarely reported, especially with patients who take flecainide as PiP, and only limited evidence exists in its management. We present a case of accidental flecainide overdose for a patient who is on PiP and the acute management strategy.</p><p><strong>Case summary: </strong>A 78-year-old female with persistent atrial fibrillation (AF), previously underwent pulmonary vein isolation and maintained on verapamil 240 mg twice daily, presented to the electrophysiology clinic following a recent hospital admission for recurrent AF. Due to infrequent recurrent episodes of symptomatic AF, the patient preferred to avoid both repeat ablation and additional daily medications. After an initial trial on telemetric monitoring, a PiP approach with flecainide 300 mg was adopted. Unfortunately, palpitations and dyspnoea in the context of chronic obstructive pulmonary disease exacerbation led the patient to self-medicate with multiple doses of albuterol and flecainide. Twelve-lead electrocardiogram showed slow AF with a wide QRS complex. The patient received 1 g of calcium gluconate with a 180 mEq bolus of sodium bicarbonate 8.4% and was started on continuous sodium bicarbonate infusion at 150 mL/h. Over a 12 h period, the QRS complex narrowed down, and the rhythm returned to normal sinus rhythm with a QRS interval of 136 ms.</p><p><strong>Discussion: </strong>The PiP strategy with flecainide is safe and effective. Reinforcement of medication dosing and frequency with patient read back is key to avoid accidental toxicity, which could be life-threatening. Treatment with sodium bicarbonate is quick and highly effective.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 10","pages":"ytae522"},"PeriodicalIF":0.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystemic presentation of disseminated renal cell carcinoma.","authors":"Karim Jamhour-Chelh","doi":"10.1093/ehjcr/ytae561","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae561","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae561"},"PeriodicalIF":0.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First case report of a percutaneous coronary intervention with intracoronary lithotripsy in a heavily calcified and tortuous right coronary artery using the R-One⁺ robotic system.","authors":"Milad Golabkesh, Diana Mundfortz, Michael Haude","doi":"10.1093/ehjcr/ytae563","DOIUrl":"10.1093/ehjcr/ytae563","url":null,"abstract":"<p><strong>Background: </strong>Advancement in interventional techniques has significantly improved the ability of percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Despite these advancements, coronary artery calcification poses a substantial challenge during PCI, contributing to increased risks of procedural complications, prolonged procedure duration, and an increase in radiation exposure dose for both patients and physicians. Recently, robotic PCI has emerged, allowing physicians to remotely control and deliver wires and catheters, leading to a notable reduction of the operator radiation exposure and a decrease in the risk of operator physical injuries such as back pain.</p><p><strong>Case summary: </strong>We report the first robotic PCI with the R-One⁺™ robotic system using intracoronary lithotripsy for lesion preparation of two heavily calcified lesions in a tortuous right coronary artery of a 60-year-old male patient followed by double drug-eluting stent implantation.</p><p><strong>Discussion: </strong>Robotic PCI with the R-One⁺™ system can not only manage wires, balloons, or stent systems but can also precisely position more bulky catheters such as intracoronary lithotripsy catheters to the target site even in the presence of a tortuous access.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae563"},"PeriodicalIF":0.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac involvement in a female patient with Beçhet's disease: newer diagnostic and therapeutic approaches-a case report.","authors":"Maria Kouremeti, Athanasios Kordalis, Yannis Dimitroglou, Konstantinos Tsioufis, Constantina Aggeli","doi":"10.1093/ehjcr/ytae544","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae544","url":null,"abstract":"<p><strong>Background: </strong>Behçet's disease (BD) is a multisystemic chronic inflammatory disorder. Cardiac manifestations in BD are extremely rare. There have been no reports of cardiac involvement of BD and especially endomyocardial fibrosis in the left ventricle (LV).</p><p><strong>Case summary: </strong>A 50-year-old woman presented at the emergency department experiencing palpitations and fatigue, accompanied by elevated levels of B-type natriuretic peptide. Her medical history included mucocutaneous involvement of BD. Vital signs were within normal ranges, and electrocardiography showed a normal sinus rhythm. Physical examination did not reveal any pathological findings. The 24 h ambulatory electrocardiogram monitoring indicated sinus rhythm with premature ventricular contractions. Transthoracic echocardiography demonstrated a reduced LV ejection fraction. Further investigation with cardiac magnetic resonance imaging reported diffused areas of subendocardial enhancement, indicative of fibrosis likely due to vasculitis probably associated with BD. The patient was administered tartrate metoprolol, eplerenone, and dapagliflozin in addition to the ongoing medical treatment for BD, which included methylprednisolone, colchicine, and apremilast. This treatment approach resulted in an improvement in the patient's clinical condition.</p><p><strong>Discussion: </strong>This case highlights that diffuse subendocardial fibrosis of the LV may be associated with the underlying BD.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae544"},"PeriodicalIF":0.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pacemaker lead extraction saved a severe lead-induced tricuspid regurgitation: a case report.","authors":"YuLiang Chai, Qiang Liu, Zhiwen Chen, Wenjing Zhang, Yuanqing Liu","doi":"10.1093/ehjcr/ytae560","DOIUrl":"10.1093/ehjcr/ytae560","url":null,"abstract":"<p><strong>Background: </strong>Pacemaker lead-induced tricuspid regurgitation is a common complication after cardiac implantable electronic device (CIED) implantation. Cardiac implantable electronic device lead removal is a challenge procedure.</p><p><strong>Case summary: </strong>A 72-year-old lady was admitted due to worsening heart failure. She had a history of permanent atrial fibrillation and had a permanent single-chamber pacemaker implanted 8 years ago due to complete heart block. Transthoracic echocardiography identified severe lead-related tricuspid regurgitation. The patient underwent successful lead extraction and received a new implantation of left bunch bundle area pacing. Transthoracic echocardiographic examination 2 days after the procedure showed a significant decrease of the tricuspid regurgitation. The patient also reported an improvement in heart failure symptoms.</p><p><strong>Discussion: </strong>Pacemaker lead-related tricuspid regurgitation introduces negative haemodynamic overload, carrying high risk for the development of heart failure and worse outcome. The present case shows a rapid relief of symptom and improvement of echocardiography findings, indicating the significance of mechanistic approach in the treatment of lead-related tricuspid mechanical interference.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae560"},"PeriodicalIF":0.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac arrest in pregnancy with successful stabilization and delivery on veno-arterial extracorporeal membrane oxygenation: a case report.","authors":"Alice Burton, Seshika Ratwatte, David Zalcberg, Matthew Morgan, Rajit Narayan, Rachael Cordina","doi":"10.1093/ehjcr/ytae551","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae551","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest in pregnancy is rare. Clinicians need to adapt management to the altered anatomy and physiology of pregnancy, and the well-being of two patients (mother and foetus) may come into consideration. The medical literature has limited reports on outcomes following extracorporeal membrane oxygenation (ECMO) in pregnancy.</p><p><strong>Case summary: </strong>We report the evaluation, management, and outcome of a woman with cardiac arrest and severe left ventricle (LV) dysfunction in mid-trimester of pregnancy. The previously well woman had tolerated two prior term pregnancies without complication. At 25 weeks of gestation, she presented to the hospital with breathlessness and vomiting after a pre-syncopal episode at home. She then had in-hospital cardiac arrest, managed initially with cardiopulmonary resuscitation. The LV was dilated, thin walled, and severely impaired (LV ejection fraction 14%), and there was a secundum atrial septal defect (ASD). She was supported with veno-arterial ECMO. Planned birth occurred 5 days post-arrest for maternal indication. Coronary angiography demonstrated 99% proximal left anterior descending artery stenosis and aneurysm, raising the possibility of previous subclinical Kawasaki disease. She underwent surgical revascularization and ASD closure. Both mother and infant made a good recovery.</p><p><strong>Discussion: </strong>We report a case of cardiac arrest in pregnancy as first presentation of severe LV dysfunction. The case highlights the role of ECMO for cardiac arrest in pregnancy and outlines specific interventions and management concepts in this setting.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae551"},"PeriodicalIF":0.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19-associated acute transcatheter aortic valve thrombosis.","authors":"Amine Boussofara, Julien Le Moal, Alexandre Canville, Quentin Landolff","doi":"10.1093/ehjcr/ytae554","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae554","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 10","pages":"ytae554"},"PeriodicalIF":0.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Word of caution: clinically apparent coronary spasm following pulsed field cavotricuspid isthmus ablation despite nitroglycerin prophylaxis - a case report.","authors":"Melanie A Gunawardene, Jens Hartmann, Eike Tigges, Johanna Jezuit, Stephan Willems","doi":"10.1093/ehjcr/ytae553","DOIUrl":"10.1093/ehjcr/ytae553","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is a novel ablation technology. A rare side-effect is the occurrence of mostly subclinical coronary spasms when PF energy is applied in proximity to coronary arteries. However, it has been described that prior application of nitroglycerin attenuates these effects.</p><p><strong>Case summary: </strong>A 75-year-old female underwent catheter ablation with a penta-spline PFA catheter. After pulmonary vein isolation, the PFA catheter was positioned on the cavotricuspid isthmus (CTI). Before ablation, 2 mg of nitroglycerin was administered intravenously. After 10 PFA applications, the CTI was successfully blocked. After a timely delay of 95 s, a clinically apparent vasospasm with ST elevations in leads II, III, and aVF on the electrocardiogram was noticed. Shortly thereafter, the clinical course was aggravated by haemodynamically relevant non-sustained ventricular tachycardias (nsVTs) followed by asystole, requiring pacing and additional 4 mg of nitroglycerin. Twelve minutes later, a stable sinus rhythm with normalized ST segments was restored. The spasm resolved without any sequelae. Post-procedural coronary angiogram showed right dominant coronary circulation.</p><p><strong>Discussion: </strong>This is the first report of a timely delayed, clinically apparent coronary spasm with a presentation of haemodynamically relevant nsVT and asystole despite the prophylactic application of high-dose intravenous nitroglycerin prior to PFA along the CTI. Subclinical vasospasm during PFA at the CTI has been described before. Severe spasms could be prevented by nitroglycerin. A word of caution needs to be raised as prophylactic nitroglycerin did not prevent the haemodynamically relevant coronary spasm in the here reported patient. Until now, it remains unclear how much later such effects may occur; therefore, patients should be monitored closely.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae553"},"PeriodicalIF":0.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interatrial septal haematoma detected by intracardiac echocardiography during catheter ablation.","authors":"Tsukasa Oshima, Kenichiro Yamagata, Katsuhito Fujiu","doi":"10.1093/ehjcr/ytae552","DOIUrl":"10.1093/ehjcr/ytae552","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae552"},"PeriodicalIF":0.8,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of an unprovoked neonatal pulmonary embolism: management strategies and cardiopulmonary complications.","authors":"Aashana Dhruva Cowan, Ezinwanne Rosemary Emelue, George Spyropoulos, Mehul Thakkar, Jorge Di Paola, Andrew Glatz, Edon J Rabinowitz","doi":"10.1093/ehjcr/ytae527","DOIUrl":"10.1093/ehjcr/ytae527","url":null,"abstract":"<p><strong>Background: </strong>Neonatal pulmonary embolism is a rare occurrence, especially when idiopathic, instead occurring in patients with identifiable risk factors including severe dehydration, presence or history of a central venous line, or identifiable genetic causes. Given the rarity of paediatric and neonatal pulmonary emboli, few guidelines exist to support the clinician in both the initial resuscitation and ongoing management of the critically ill patient with pulmonary emboli.</p><p><strong>Case summary: </strong>We present a 5-day-old female with unprovoked massive pulmonary embolism and associated haemodynamic compromise. She presented with central cyanosis and weak respiratory effort with hypoxaemia, persistent tachycardia, and hypotension despite initial fluid resuscitation, intubation, and administration of 100% FiO₂ with inhaled nitric oxide. She was ultimately diagnosed with a massive pulmonary embolism involving the right pulmonary artery by both echocardiography and computed chest tomography, initiated on inotropic support and systemic anticoagulation, after which she underwent mechanical thrombectomy. She was successfully extubated soon thereafter, with subsequent resolution of her emboli. No provoking factors were able to be identified for this patient.</p><p><strong>Discussion: </strong>This case highlights the cumulative burden of pulmonary obstruction and inter-ventricular interactions that lead to haemodynamic compromise in the event of massive pulmonary embolism, with resultant considerations of key management strategies. These include the risks of fluid resuscitation and introduction of positive pressure ventilation, as well as the need for early consideration of inotropic support and an institutional pathway for anticoagulation, ultimately proposing a multidisciplinary algorithm for the clinician to deploy when faced with impending cardiovascular collapse from massive pulmonary embolism.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"8 11","pages":"ytae527"},"PeriodicalIF":0.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}