Rev Cardiovasc Med
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Review Case Reports
Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.
A 79-year-old woman with a history of bioprosthetic aortic and mitral valve replacement with coronary artery bypass graft surgery presented with pulmonary edema 4 years after surgery. Transthoracic echocardiography and transesophageal echocardiography revealed an obstruction of the left ventricular outflow tract caused by the bioprosthetic mitral valve. We present this case, accompanied by a review of the literature.
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Statins are frequently used as chronic therapy for reducing cardiovascular mortality and morbidity, but there has been less emphasis on the role of statins in the perioperative period. This review evaluates data regarding statin use in vascular and noncardiac surgery, the use of statins in combination with β-blockers in the perioperative period, perioperative statin use in patients already treated with statins, and the safety of statin therapy in the perioperative period. Current recommendations state that patients who are prescribed statins as chronic therapy should continue treatment in the perioperative period, but data suggest that there may be benefit from the use of perioperative statins in a wider population.
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Review Case Reports
A review of electrocardiography in pulmonary embolism: recognizing pulmonary embolus masquerading as ST-elevation myocardial infarction.
A 64-year-old woman with hypertension and diabetes presented with acute shortness of breath and left-sides chest discomfort. Electrocardiopgram (ECG) demonstrated Q waves, coved ST-segment elevations, and T-wave inversions in leads V₁-V₄, suggesting acute anterior ST-elevation myocardial infarction (STEMI). catheterization revealed nonocclusive coronary artery disease with elevated pulmonary and right heart pressures, confirmed by echocardiography. Ventilation perfusion scan was deemed high probability for pulmonary embolism (PE). ⋯ This case exemplifies similarities in clinical presentation of PE and acute STEMI. The presence of Q waves in anterior leads wih coved ST-elevation after PE has not been described previously. We review the differential diagnosis of ST elevation and the assorted spectrum of ECG changes seen in PE.
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Takotsubo cardiomyopathy is a syndrome characterized by transient apical ballooning or reversible midventricular systolic dysfunction. Most cases occur in postmenopausal women and are typically triggered by an acute medical illness or emotional or physical stress. Its presentation is highly suggestive of myocardial ischemia, but there is little or no evidence of epicardial coronary artery disease. To our knowledge there are only three reported cases in the literature of Takotsubo cardiomyopathy induced by opioid agonist withdrawal in adults; ours is the first reported case of iatrogenic methadone withdrawal leading to Takotsubo cardiomyopathy.
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Acute myocardial infarction (MI) in the setting of sexual intercourse following the concomitant use of cocaine, alcohol, and sildenafil has not been previously reported. We present a case of a middle-aged patient with no previous history of angina pectoris or coronary artery disease who presents with severe ischemic chest pain and an MI induced by cocaine, alcohol, sildenafil, and sexual intercourse.