Recurrent spontaneous coronary artery dissections

A 41-year-old Caucasian female with a history of hypertension presented with exertional chest pain. Her vital signs were stable on admission and physical examination was unremarkable. An Electrocardiogram (EKG) revealed inferior ST segment elevations consistent with acute myocardial infarction and cardiac enzymes were elevated. She was started on heparin, and underwent immediate cardiac catheterization

Varicella pneumonia

44 year old Hispanic male with no significant past medical history, recently discharged from prison, presented to the hospital with rash all over the body with itching. The rash started on the face, at the back of the ear and then spread to the trunk and legs. He denied fever, chills, cough, shortness of breath or sick contacts. Physical examination revealed a young, comfortable looking male with stable vital signs except for a temperature of 102 F

A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: the Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study

Background: The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study evaluated the concordance of intracardiac echocardiography (ICE) with transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF). Methods and Results: Patients with AF undergoing right heart catheterization underwent left atrium (LA) and interatrial septal (IAS) imaging by TEE and ICE. A blinded comparison of the 2 modalities was performed at a core laboratory. Ninety-five patients aged 58 +/- 12 years completed the study. The LA was profiled in all patients with both techniques, and concordance for image quality was 96%. LA appendage (LAA) imaging was achieved in 85% with ICE and 96% with TEE. There was no difference in the presence of spontaneous echo contrast between ICE and TEE during LA imaging, but there was a trend toward a greater incidence in the LAA with TEE (P=0.109). Intracardiac thrombus was uncommonly seen (TEE, 6.9%; ICE, 5.2%). The concordance for the presence or absence of thrombus was 97% in the LA and 92% in the LAA, but the latter was detected more frequently with TEE. IAS imaging was achieved in 91% with ICE and in 97% with TEE (P=0.177). Concordance for patent foramen ovale and atrial septal aneurysms was 100% and 96%, respectively. A negative ICE examination was associated with absence of dense echo contrast or thrombus on TEE in 86%. Conclusions: This study provides validation for the use of ICE for LA and IAS imaging. ICE imaging was less sensitive compared to TEE for LAA thrombus identification