Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report

ST elevation in aVR in conjunction with diffuse ST depression in precordial leads may indicate occlusion of very proximal portion of the left anterior descending artery. We present a 54-year old man, with crushing retrosternal pain and ST-segment elevation only in aVR lead and diffuse ST-segment depression in inferior, lateral and precordial leads. The patient was scheduled for emergent coronary angiography, which showed that left anterior descending (LAD) artery was cut off at very proximal portion and urgent CABG was performed for the patient

A Mysterious Case of ST-Elevation Myocardial Infarction; an Old Man with Weight Loss and Dyspepsia

We present a 65-year-old man who developed retrosternal compressive chest pain. A 12-lead electrocardiography demonstrated ST-segment elevation in leads II, III and aVF. Emergent coronary angiography showed significant thrombus in the distal portion of the left main coronary artery. Abdomino-pelvic computed tomography scan, which was performed the next day, confirmed a pancreatic mass with peritoneal seedings, compatible with peritoneal carcinomatosis. This case underscores the importance of malignancies that may lead to a catastrophic ST-elevation myocardial infarction due to a hypercoagulable state and following thrombosis in the left main coronary artery

Angiosarcoma of the Right Atrium with Extension to SVC and IVC Presenting with Complete Heart Block and Significant Pericardial Effusion

Primary cardiac neoplasms are particularly unusual. Angiosarcoma is the most frequently seen histological subtype and is described by its infiltrating and damaging nature. Inappropriately, primary cardiac angiosarcoma is often missed as a preliminary diagnosis because of its scarcity. We present a 29-year-old previously healthy man with complete heart block and pericardial effusion who was finally diagnosed with angiosarcoma of the right atrium with extension to SVC and IVC

Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention

Acutely Onset Amiodarone-Induced Angioedema in a Patient with New Atrial Fibrillation

A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA) with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF). Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field

AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation

A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block

Evaluation of pentraxin-3 level and its related factors in patients undergoing primary percutaneous coronary intervention

BACKGROUND: Inflammation has an important role in the development and progression of atherosclerosis, and acute phase proteins such as pentraxin-3 (PTX3) can be deployed in determining the prognosis of coronary artery disease (CAD). So the purpose of this paper was to evaluate the PTX3 level and its related factors in patients undergoing primary percutaneous coronary intervention (PCI). METHODS: In this cross-sectional study, the PTX3 levels were determined for 100 patients with ST-elevation myocardial infarction referred to the Modarres Hospital, Tehran, Iran. Checklist included demographic data [age, gender, history of myocardial infarction (MI)] and characteristics of heart disease (type of MI, culprit, and pre-dilation). PTX3 was measured for all patients before PCI. RESULTS: In this study, the mean age of the participants was 58.7 (11.4). Global registry of acute coronary events (GRACE) score was higher in the group with abnormal PTX3 levels (P = 0.008). The number of the involved vessels (P = 0.005), MI type (P = 0.05), and the need for PCI all had a significant relation with abnormal PTX3 levels. The increased levels of PTX3 received higher Killip class, lower ejection fraction, and higher GRACE score. The group with abnormal PTX3 had a significant difference in platelet counts (P = 0.018) in comparison with the group with normal level of PTX3. CONCLUSION: Currently, the biomarkers are highly important in the field of cardiovascular diseases. The diagnostic and prognostic importance of PTX3 as a new marker has been underscored in recent studies. Differentiating between high-risk patients with acute cardiac infarction and low-risk ones through their clinical signs is difficult. &nbsp;&nbsp;</p