Massive haemorrhagic pericardial effusion as the cardiac manifestation of Salmonella enteritidis infection in a severely immunocompromised patient

A 41-years-old gentleman was admitted for reduced effort tolerance with non-specific symptoms of weight loss and generalised body weakness. Chest X-ray (CXR) showed cardiomegaly. Echocardiography showed a large pericardial effusion with septation. Emergency pericardiocentesis was performed and pericardial fluid culture grew Salmonella enteritidis (S. enteritidis). He tested positive for the retroviral disease, with a CD4 count of 10 cells/µL. Intravenous (IV) ceftriaxone was administered. A pericardial drain was inserted due to the rapid re-accumulation of pericardial fluid after the initial pericardiocentesis. He also had drainage of his left pleural effusion. He had a guidewire exchange of pericardial drain around 2 weeks after admission, with flushing performed whenever the flow was poor. A repeat echocardiogram showed early signs of constrictive pericarditis with residual pericardial effusion in which intrapericardial fibrinolysis was considered. He was started on antiretroviral therapy (ART) and his condition remained stable. The pericardial drain was kept throughout his admission. Unfortunately, he developed severe sepsis and succumbed to it about a month post-admission

A stormy chase of coronary artery spasm : Thyroid storm in acute myocardial infarction

SUMMARY Cardiovascular disease represents the largest cause of death globally, with multifactorial causes. This is a case study of a thyroid storm with hyperactive coronary arteries resulting in acute myocardial infarction (AMI). A 56-year-old gentleman presented with left-sided chest pain radiating to the neck. Initial ECG showed ST elevation over anterior leads, which dynamically changed to Lambda-wave (“shark fin” pattern) over inferior leads 60 minutes later, along with raised cardiac enzymes. Urgent invasive coronary angiogram was performed, in which we repeatedly did ballooning of the left anterior descending coronary artery due to recurrent spasms in the artery, with the patient’s haemodynamics being labile with systolic blood pressure of as low as 60 mmHg. He was intubated for acute pulmonary oedema and admitted to cardiac intensive care unit postprocedure and had persistent tachycardia with multiple episodes of tachyarrhythmia. Laboratory test revealed hyperthyroidism, and he was treated for thyroid storm with Burch-Wartofsky Point Scale of 50 points. However, his clinical condition deteriorated rapidly with the development of acute kidney injury and severe metabolic acidosis. He eventually succumbed after 4 days of intensive care despite maximum multidisciplinary resuscitation effort. This study calls for routine screening of thyroid function test in patients with persistent tachycardia during AMI

Ventricular tachycardia storm as predominant cardiac manifestation of lupus myocarditis

SUMMARY Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that can affect any part of the heart, causing arrhythmias on top of other cardiac manifestations. Malignant ventricular tachyarrhythmias are rare manifestations of SLE. Our case is the first one reported in the literature of an SLE patient with multi-organ involvement who subsequently presented with ventricular tachycardia (VT) storm as a cardiac manifestation. This case also demonstrates the use of Stellate ganglion block to treat intractable VT storm when chemical and electrical cardioversions failed, while waiting for immunosuppressive drugs to take effect. Timely treatment resulted in a good outcome for our patient