Pseudo-Wellens syndrome: A rare entity associated with cocaine use

Wellens syndrome usually indicates critical left anterior descending artery (LAD) occlusion. Pseudo-Wellens syndrome consists of criteria of Wellens syndrome in the absence of critical LAD occlusion. We report a case of Pseudo-Wellens syndrome related to cocaine use. A 52-year-old male with a medical history of hypertension and diabetes, presented with acute retrosternal chest pain of 3 days duration. Physical examination was unremarkable. EKG on presentation showed deep T-wave inversions in leads V2 to V5. Highly sensitive troponin was elevated. The patient admitted to using cocaine daily for the past two months. Due to concerns for Wellens syndrome, the patient had an immediate coronary angiography which revealed mild disease of the LAD (\u3c 30%) only. Inpatient echocardiogram revealed preserved left ventricular ejection fraction and no segmental wall motion abnormalities. Subsequent EKG at the cardiology clinic showed improvement in T-wave inversion. The patient was advised to abstain from using cocaine. As Pseudo-Wellens syndrome is a diagnosis of exclusion, patients with a history of recent cocaine use presenting with acute chest pain history, evidence of myocardial injury, and EKG findings suggestive of Wellens syndrome should undergo an emergent coronary angiogram to exclude critical LAD occlusion

Non-Obstructive Accessory Mitral Valve Tissue in an Asymptomatic Adult: A Case Report and Review of Literature

Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly that is often an asymptomatic incidental finding. However, it has also been reported to be an important cause of left ventricular outflow tract obstruction (LVOTO) in subset of patients. When symptomatic, patients can often present with symptoms, including dyspnea, chest pain and palpitations/arrhythmias. Surgical resection is indicated in symptomatic cases with significant LVOTO. We here report a 50-year-old male who presented with chest pain and was incidentally found to have AMVT on an echocardiogram. No evidence of LVOTO was seen at rest, Valsalva, or stress. We also provide a review of literature in regards to most relevant clinical implication of AMVT

A Case of Double Orifice Mitral Valve in a Patient with Bicuspid Aortic Valve: Coincidental or a Missed Finding?

A 63-year-old male with past medical history of bicuspid aortic valve and ascending aortic aneurysm was referred to cardiology for aortic valve replacement (AVR) and aneurysm repair. Transthoracic echocardiogram (TTE) showed bicuspid aortic valve with severe aortic valve stenosis. Patient underwent transesophageal echocardiogram which showed an incidental finding of double orifice mitral valve (DOMV) with fusion of A/P cusps along anterolateral commissure not noted on previous TTE. Patient underwent AVR with bioprosthetic aortic valve along with resection and replacement of the ascending aortic aneurysm. No intervention was performed for the asymptomatic DOMV. DOMV is a rare congenital cardiac abnormality, easily missed on routine TTE. It warrants need for careful evaluation of mitral valve apparatus in patients with other congenital cardiac abnormalities known to be associated with DOMV