Rapidly Evolving Coronary Aneurysm in a Patient with Rheumatoid Arthritis

Coronary artery aneurysm (CAA) formation in the setting of an acute inflammatory state due to connective tissue disease is rare. We report a case of rapid progression from an ectatic to an aneursymatic left circumflex coronary artery leading to an acute coronary event in a patient with rheumatoid arthritis (RA). We report the accelerated growth of the aneurysm as it was temporally related to the lapse in treatment and the management strategies involved with this entity

A Case of Critical Aortic Stenosis Masquerading as Acute Coronary Syndrome

Serum cardiac troponins I and T are reliable and highly specific markers of myocardial injury. Studies have shown that at least 20% of patients with severe aortic stenosis have detectable serum troponins. This case report describes a patient who presented as suspected acute coronary syndrome with markedly elevated troponin levels, who was later found to have normal coronaries and critical aortic stenosis. This case highlights the need for comprehensive and accurate physical examination in patients who present with angina. Critical aortic stenosis may cause such severe subendocardial ischemia as to cause marked elevation in cardiac markers and mimic an acute coronary syndrome. Careful physical examination will lead to an earlier use of non invasive techniques, such as echocardiography to confirm the correct diagnosis and the avoidance of inappropriate treatments such as intravenous nitroglycerin and glycoprotein IIb/IIIa inhibitors

Carotid Artery Stenting: 2016 and Beyond

Surgical options developed to treat carotid artery stenosis have evolved in the last six decades, and studies have shown the superiority of carotid endarterectomy (CEA) compared to medical therapy. Similarly, as endovascular therapy has evolved over the last two decades, studies reflecting safety, feasibility, and equivalence of carotid artery stenting (CAS) to CEA have been replicated in several studies for intermediate to high surgical risk patients. However, since its inception, the field of CAS has been mired in several controversies and has been subject to intense scrutiny from multiple stakeholders within the field of medicine. This review discusses specific issues concerning CAS that are relevant in the current era