Case #1:
52 y/o white male with no known past medical history had a syncopal episode at the local casino where he works and was brought to our Hospital. Had an initial CT followed by an MRA and MRI.
Echo: LV dilatation, EF 25% with multi wall hyokynesis.
Mildly elevated troponins and mild hyperlipidemia, lipoprotein A near 500, normal white count, hemoglobin:15,8, normal platelets, normal LFT’s, mild elevated ALT
INR: 0.94, normal renal function, glucose: 125.
Had a CCTA followed by a cardiac angio and CABG.
Courtesy: Claudio Smuclovsky, MD
Case #2:
48YM with no significant PMH presents as transfer directly to the cardiac catheterization lab for emergent ischemic evaluation for presumed high risk MI. At baseline, pt works in construction and is very active. 10 days prior began to have low grade fever, chills, cough, malaise, decreased activity, substernal continuous chest discomfort which he describes as sharp, 5-6/10 in max intensity without radiations. Spoke to a physician over the phone and about 3 days prior and was started on Ciprofloxacin via PO for presumptive pneumonia. Symptoms progressively worsened where he began to feel near syncopal and came evaluation. There a Troponin was noted to be elevated at 11 and on EKG pt had evidence of AV dissociation and runs of non-sustained ventricular tachycardia Emergently transferred to the cardiac cath lab where his coronaries were noted to be angiographically normal. LVEF on LV gram appeared around 30%.
Bedside Echocardiogram reveals acute biventricular heart failure with LVEF of 20% and global hypokinesis.
EP consult for possible need for temporary pacing wire given 3rd degree AV block with what appears to be accelerated junctional rhythm. Biopsy performed during pacer placement.
Prepared by: Jacobo Kirsch, MD | Courtesy: Travis S. Henry, MD