European Heart Journal: Case Reports最新文献

{"title":"Case report of transcatheter flow restriction in isolated non-redundant major aorto-pulmonary collateral arteries.","authors":"Nandini Mehra, Hani Najm, Justin Tretter, Nicholas Szugye, Joanna Ghobrial","doi":"10.1093/ehjcr/ytaf426","DOIUrl":"10.1093/ehjcr/ytaf426","url":null,"abstract":"<p><strong>Background: </strong>Major aorto-pulmonary collateral arteries are congenital remnants of the segmental arteries that supply the lungs. They are commonly associated with congenital heart disease, particularly in cases where the main pulmonary artery branches are not well developed, these segmental collaterals do not regress and continue to supply oxygenated blood to the pulmonary vasculature. Over time, these collaterals can become problematic, particularly if they enlarge, leading to clinically significant symptoms such as haemoptysis, segmental pulmonary hypertension, and left heart volume overload.</p><p><strong>Case summary: </strong>Herein, we describe a rare case of isolated major aorto-pulmonary collaterals without associated congenital heart disease that presented with haemoptysis and managed percutaneously with a modified flow-reducer device.</p><p><strong>Discussion: </strong>This is a novel therapy for this very unique clinical scenario. Both multidisciplinary discussion and patient centred shared decision-making were utilized while discussing this case.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf426"},"PeriodicalIF":0.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112221","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":"Sympathectomy in refractory ventricular arrhythmias in patients with left ventricular assist device: a grand round case report.","authors":"Melanie Fernández-Caso, Alejandro Carta-Bergaz, Javier Castrodeza, Iago Sousa-Casasnovas, Carlos Ortiz-Bautista, Álvaro Pedraz-Prieto, José María Barrio-Gutiérrez, Javier Bermejo","doi":"10.1093/ehjcr/ytaf378","DOIUrl":"10.1093/ehjcr/ytaf378","url":null,"abstract":"<p><strong>Background: </strong>Ventricular tachycardias (VTs) are a life-threatening complication of patients with end-stage left ventricular dysfunction, and are a frequent cause for considering advanced therapies. Their management in patients supported by a left ventricular assist device (LVAD) presents unique challenges, requiring a multidisciplinary approach to tailored strategies.</p><p><strong>Case summary: </strong>We present the case of a 70-year-old male with a history of VTs who underwent HeartMate 3 (Abbott, USA) implantation for advanced heart failure secondary to ischaemic cardiomyopathy and refractory VTs. Following LVAD implantation, he developed an electrical storm refractory to a combination of antiarrhythmic drugs and both radiofrequency and pulse-field catheter ablations. Due to persistent VT, neuromodulation of the sympathetic nervous system was considered as a last-resort strategy. Percutaneous radiofrequency ablation of the stellate ganglion was unsuccessful; however, left surgical sympathectomy effectively controlled the arrhythmias. The patient has remained free of arrhythmic events at 1-year follow-up.</p><p><strong>Discussion: </strong>Management of VTs in LVAD carriers is typically stepwise, beginning with correction of reversible triggers and the use of antiarrhythmic drugs. However, monotherapy is often insufficient, and achieving arrhythmic control often depends on a multimodal approach. In cases refractory to conventional measures, escalation to catheter ablation, neuromodulation techniques, and stereotactic arrhythmia radioablation may prove effective.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf378"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947673","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":"Conservative non-surgical management of penetrating cardiac injury with three retained metal nails: a case report.","authors":"Ramtin Khanipour, Saro Mazmanian, Andrew Jung, Ali Dahhan","doi":"10.1093/ehjcr/ytaf380","DOIUrl":"10.1093/ehjcr/ytaf380","url":null,"abstract":"<p><strong>Background: </strong>Traumatic penetrating cardiac injuries are usually immediately fatal. The management approach (surgical vs. conservative) in surviving patients can be challenging. A conservative approach is appropriate in selective cases; however, long-term complications should be considered.</p><p><strong>Case summary: </strong>A frail 83-year-old male who had undergone coronary artery bypass grafting surgery 20 years ago presented with encephalopathy. He had persistent bacteraemia. Chest computed tomography revealed three metal nails penetrating the anterior thoracic wall through the myocardium. Later, we learned that he had attempted suicide 2 years ago by shooting himself in the chest using a nail gun. Conservative non-surgical approach was pursued at that time given his multiple comorbidities. We adopted a conservative approach again. He survived for additional 6 months on chronic suppressive antimicrobial therapy but ultimately passed away from pneumonia.</p><p><strong>Discussion: </strong>The favourable outcome in this patient underscores the role of a conservative approach in selective cases. Retained foreign bodies pose a risk of infective endocarditis; therefore, empirical chronic antimicrobial therapy and tetanus vaccination should be considered.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf380"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947623","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":"The use of multimodality imaging in heart transplant recipients: a case series.","authors":"Kamil Stankowski, Rita Bello, Pedro Lopes, Christopher Strong, Alessandro Villaschi, Stefano Figliozzi, Gianluca Pontone, Antonio Ferreira","doi":"10.1093/ehjcr/ytaf341","DOIUrl":"10.1093/ehjcr/ytaf341","url":null,"abstract":"<p><strong>Background: </strong>Acute cardiac allograft rejection and cardiac allograft vasculopathy are among the most common and dreaded complications occurring after successful heart transplantation and mandate lifelong monitoring. Non-invasive cardiac imaging with cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) has the potential to reduce the number of invasive exams needed with patient and economic benefits. We present our experience with these imaging techniques in the care of heart transplant recipients.</p><p><strong>Case summary: </strong>The first case is a 48-year-old man diagnosed with severe cardiac allograft vasculopathy and subacute asymptomatic anterior myocardial infarction with no residual viability at CMR, where CCT demonstrated complete recanalization of an occluded left anterior descending artery after intensified immunosuppressive therapy. The second case is a 57-year-old man presenting with cardiac arrest due to coronary artery spasm that caused transitory regional wall motion abnormalities subsequently documented with CMR and successfully treated with medical and interventional therapy, owing to the presence of a functionally-significant coronary stenosis possibly triggering vasospasm. The third case is a 69-year-old man hospitalized for acute allograft rejection and severe biventricular dysfunction where CMR was key in managing immunosuppression intensification, alongside endomyocardial biopsy, with complete normalization of biventricular function.</p><p><strong>Discussion: </strong>The role of CCT is growing, representing a valid alternative to invasive coronary angiography for screening of cardiac allograft vasculopathy. Cardiovascular magnetic resonance, on the other hand, with the capability to non-invasively characterize myocardial tissue, represents a promising tool in the management of acute cardiac allograft rejection. Further evidence is awaited to validate these techniques in contemporary clinical practice.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf341"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946483","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 reconsidered diagnosis in an unresolving myocarditis-a case report.","authors":"Bradley Woolfenden, Christian Cawley, Deirdre Ward","doi":"10.1093/ehjcr/ytaf379","DOIUrl":"10.1093/ehjcr/ytaf379","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis typically presents with chest pain, a raised troponin and is associated with late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). However, non-resolution of symptoms despite treatment should raise cause for concern that an alternative diagnosis may be present.</p><p><strong>Case summary: </strong>A 17-year-old gentleman with a background history of developmental delay, gastrointestinal motility issues, retractile testes, and patellar dislocation presented to our emergency department with chest pain. Investigations revealed static mildly elevated troponin T. An electrocardiogram and transthoracic echocardiogram were both unremarkable. CMR revealed sub-endocardial and mid-wall LGE. He was treated as myocarditis with steroids and colchicine, however symptoms persisted and repeat CMR reported progressive LGE. The diagnosis of myocarditis was reconsidered given an atypical presentation and taking into account his past medical history, and so a whole gene exome was performed. This revealed a dual diagnosis of Klinefelter's Syndrome and a mutation in the dystrophin gene located on the X chromosome.</p><p><strong>Discussion: </strong>In this case, an interplay between Klinefelter's Syndrome and Muscular Dystrophy is demonstrated, potentially protecting our patient against a more aggressive Duchenne phenotype of muscular dystrophy. Upon non-resolution of symptoms, re-evaluating his presentation, investigations and taking into account his background multi-system medical history lead us to performing the genetic testing which revealed the correct diagnosis.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf379"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947620","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":"Permanent pacemaker implantation complicated by anchoring sleeve embolization through cephalic vein: case report and discussion of management strategies.","authors":"Saleh Altaf, Thivanka Witharana, Alexander Tindale, David Gareth Jones","doi":"10.1093/ehjcr/ytaf416","DOIUrl":"10.1093/ehjcr/ytaf416","url":null,"abstract":"<p><strong>Background: </strong>Anchoring sleeve embolization is a rare complication of first-time permanent pacemaker (PPM) implantation, and there is little guidance on how to manage such an eventuality.</p><p><strong>Case summary: </strong>An 82-year-old lady underwent PPM implantation for symptomatic 9-second sinus pause. During procedure, the anchoring sleeve from the atrial lead embolized through cephalic vein to the left superior lingular artery. The patient remained haemodynamically stable and multimodality imaging demonstrated only a small affected area of lung with patent pulmonary blood flow distal to the sleeve. Therefore, the patient was managed with anticoagulation alone and has remained well at 26-month follow-up.</p><p><strong>Discussion: </strong>Most case reports dealing with embolization of pacing apparatus to the pulmonary vasculature document endovascular retrieval. We lay down a framework of considerations for assessing management strategies to help guide practitioners to the most efficacious treatment plan. This includes factors affecting the risks of leaving the foreign body in place and outlines the rationale for no active treatment, through anticoagulation, and towards endovascular and surgical retrieval.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf416"},"PeriodicalIF":0.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112164","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":"ECG challenge: a double speed heart.","authors":"Hong Yee Lim, Yew Chung Chan, Lee Yee Lim","doi":"10.1093/ehjcr/ytaf433","DOIUrl":"10.1093/ehjcr/ytaf433","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf433"},"PeriodicalIF":0.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112166","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":"Concomitant acute pulmonary embolism in recent dengue virus infection in an endemic country: case series.","authors":"Astrid Putri, Rizky Hendiperdana, Siti Untari, Sumardjo, Listyowati, Syuharul Qomar, Ihsan Nurcahyo, Nugroho Sigit","doi":"10.1093/ehjcr/ytaf428","DOIUrl":"10.1093/ehjcr/ytaf428","url":null,"abstract":"<p><strong>Background: </strong>There is a substantial gap in the understanding of dengue fever pathogenesis and pathophysiology concerning haemostatic equilibrium alteration. While haemorrhagic manifestation is common in dengue infection, the alteration towards venous thromboembolism (VTE) event is also known despite being infrequently reported. The VTE spectrum is composed of deep vein thrombosis (DVT) and pulmonary embolism (PE).</p><p><strong>Case summary: </strong>We reported six cases in similar presentation of acute shortness of breath in the recent phase of dengue virus infection. All patients had increased serum D-dimer level with clinical criteria of pulmonary thromboembolism. Four of six patients had pulmonary thrombosis confirmation from pulmonary angiography computed tomography imaging. The patients were diagnosed with acute pulmonary thrombosis in the setting of recent dengue infection. Parenteral and oral anticoagulants were administered in all patients with favourable outcome in five patients but one patient died during admission.</p><p><strong>Discussion: </strong>Haemorrhagic manifestation concern made the PE complication in dengue infection patients often overlooked. Significant clinical challenges arise upon the decision to treat PE pharmacologically in the clinical setting of haemorrhagic diathesis; anticoagulants in dengue are somewhat questionable and meet clinical dilemmas. Although PE is uncommonly described as a dengue complication, this may be an underlying mechanism in which well-known complication in dengue commonly described such as circulatory collapse. This has become a challenge for clinicians to broaden the differential diagnosis to include PE in the setting of complicated dengue infection. Clinician vigilance to increase awareness of thrombotic complication in dengue is of utmost importance especially in the endemic area hospital settings.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf428"},"PeriodicalIF":0.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136932","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":"Staggered use of sodium nitroprusside and levosimendan in a patient with refractory cardiogenic shock: a case report.","authors":"Andre Rodrigues Duraes, Yasmin de Souza Lima Bitar, Geonys Marlan Gonçalves Oliveira, Lilian Rosamar Vieira Franklin, Jesus Batista Vieira Lima Junior","doi":"10.1093/ehjcr/ytaf430","DOIUrl":"10.1093/ehjcr/ytaf430","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a complex syndrome characterized by inadequate tissue perfusion due to reduced cardiac output resulting from a wide array of underlying causes. It is generally an acute and devastating condition with short-term mortality ranging from 30% to 40% and 1-year mortality around 50%.</p><p><strong>Case summary: </strong>A 31-year-old previously healthy male presented with progressive dyspnoea, fatigue, and signs of low perfusion, ultimately developing CS requiring ICU admission. Transthoracic echocardiography revealed severe left ventricular dysfunction (left ventricular ejection fraction 18%) with diffuse hypokinesia and moderate functional mitral regurgitation (Type IIIb). Despite high-dose inotropic support (dobutamine, milrinone) and vasopressors, the patient remained in refractory shock. A therapeutic trial with sodium nitroprusside led to transient haemodynamic improvement, followed by a secondary deterioration. Due to unavailability of immediate mechanical circulatory support (MCS), levosimendan was initiated at 0.1 μg/kg/min (without loading dose), resulting in rapid and sustained clinical improvement and weaning from vasoactive agents.</p><p><strong>Discussion: </strong>Given the heterogeneous nature of CS and the various physiological derangements, several vasoactive medications may be attempted to try to stabilize or reverse the haemodynamic picture with or without the installation of MCS. These devices have evolved as novel treatment strategies to restore systemic perfusion to allow cardiac recovery in the short-term. But, this case demonstrates the potential of combining vasodilator and inotropic therapies-specifically dobutamine and milrinone with sodium nitroprusside and levosimendan-as a bridge strategy in severe CS when MCS is not feasible.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf430"},"PeriodicalIF":0.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112267","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":"Monitoring of cardiorespiratory vagal desynchrony using novel biomarkers derived from smartwatch electrocardiograms in a patient recovering from long COVID: case report.","authors":"Gustaf Kranck, Marcus Ståhlberg, Ulf Andersson, Johan Lundin, Artur Fedorowski","doi":"10.1093/ehjcr/ytaf425","DOIUrl":"10.1093/ehjcr/ytaf425","url":null,"abstract":"<p><strong>Background: </strong>Long COVID and cardiovascular autonomic dysfunction, including postural orthostatic tachycardia syndrome (POTS), present significant healthcare challenges. Long-term monitoring is challenging due to the evolving nature of symptoms and the limited availability of objective diagnostic tools. With over 200 million electrocardiogram (ECG)-enabled smartwatches sold worldwide, these devices offer a promising solution for at-home diagnostics and disease tracking.</p><p><strong>Methods and results: </strong>This study examines a 35-year-old male with long COVID, POTS, and chronic fatigue syndrome (CFS), who recorded 328 ECGs over using a Samsung smartwatch. The protocol required ECG recordings to be taken first in a sitting posture, followed by a standing position, with slow, controlled breathing. For testing, the patient used a Samsung smartwatch to perform a 30-s hand-to-hand single-lead ECG while engaging in 0.1 Hz diaphragmatic controlled breathing, consisting of 5 s of inhalation followed by 5 s of exhalation (<i>Appendix 1</i>). S-/R-peak amplitude ratios, heart rhythm changes, and other biomarkers were analysed to assess autonomic function. Fatigue levels were self-reported via the BREATHE FLOW app using a three-grade scale, and health status was tracked monthly with the EQ-5D-5L model. Initially, the patient experienced severe fatigue and heart rhythm changes consistent with POTS. Electrocardiogram analysis revealed an increased S-wave amplitude and higher S/R ratio in standing posture, along with worsening respiratory sinus arrhythmia (RSA), indicating cardiorespiratory desynchrony. Over time, as symptoms improved, heart rate responses between sitting and standing normalized, and S/R ratio and RSA index followed self-reported fatigue levels, including fluctuations due to post-exercise fatigue.</p><p><strong>Conclusion: </strong>Smartwatch-derived S-/R-wave amplitude ratio may serve as an accessible biomarker for tracking disease progression in long COVID. Given the widespread availability of smartwatches, standardized at-home protocols could improve diagnostics and monitoring for autonomic dysfunction.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf425"},"PeriodicalIF":0.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231855","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}