Background: Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis which if not managed appropriately is fatal. PDS as an entity has dispersed literature; this review is to understand its epidemiology, presentation, and management. Methodology: Medline: Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified since 1983 to 2019. A total of 6508 articles were reviewed out of which 210 were short listed, after removal of duplicates 49 manuscripts were included in this review. For Statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. T test was done for continuous variable and chi square test was done for categorical data was used for analysis. Results: A total of 42 full length case reports, 2 poster abstracts, 3 case series of 2 patients , 1 case series of 4 patient s and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, Pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause pericardial effusion was found to be malignancy in 35.6% (n=21). 23 cases reported pre-procedural ejection fraction which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. Use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. Conclusion: Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.

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Identification of hypoperfused areas in myocardial perfusion single-photon emission tomography studies can be aided by bull's-eye representation of raw counts, lesion extent and lesion severity, the latter two being produced by comparison of the raw bull's-eye data with a normal data base. An artificial intelligence technique which is presently becoming widely popular and which is particularly suitable for pattern recognition is that of artificial neural network. We have studied the ability of feed forward neural networks to extract patterns from bull's-eye data by assessing their capability to predict lesion presence without direct comparison with a normal data base. Studies were undertaken on both simulation data and on real stress-rest data obtained from 410 male patients undergoing routine thallium-201 myocardial perfusion scintigraphy. The ability of trained neural networks to predict lesion presence was quantified by calculating the areas under receiver operating characteristic curves. Figures as high as 0.96 for non-preclassified patient data were obtained, corresponding to an accuracy of 92%. The results demonstrate that neural networks can accurately classify patterns from bull's-eye myocardial perfusion images and detect the presence of hypoperfused areas without the need for comparison with a normal data base. Preliminary work suggests that this technique could be used to study perfusion patterns in the myocardium and their correlation with clinical parameters.

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Background: A grave complication of thyrotoxicosis, or thyroid storm, is the development of heart failure and cardiomyopathy. Recognizing this condition is imperative in preventing further left ventricular dysfunction and cardiogenic shock. This manuscript aims to review the literature on cardiogenic shock associated with thyrotoxicosis and present management recommendations on this rare condition. Method: A literature search was performed in December of 2018, using the PubMed medical search engine. A systematic search was carried out using the keywords Thyroid Storm AND Cardiogenic Shock and Thyrotoxicosis AND Shock. Management: A) Decrease of thyroid hormone levels using therapeutic plasma exchange B) LV Unloading and ventilation by Impella and Extracorporeal Mechanical Ventilation (ECMO). Conclusion: Patients presenting with thyroid storm-induced shock may not be suitable candidates for traditional management with β-adrenergic blockers (β-blockers). Use of β-blockers could exasperate their condition. Through extensive literature review on this rare condition, the most effective management was found to be therapeutic plasma exchange in order to decrease thyroid hormone levels, which have direct toxic effect on the heart. Furthermore, the use of ECMO and Impella are advised to reduce pressure on the heart and ensure the patient’s organs are well oxygenated and perfused while the left ventricle is recovering.

Twenty-four subjects with suspected ischaemic heart disease underwent a treadmill exercise stress test (TEST). Nine individuals developed ischaemia as defined by standard criteria. Total plasma antioxidant status (TPAS), and serum concentrations of vitamin E were measured pre-TEST, and 0, 1, 2, 4, 8 and 24 h following the treadmill test. Mean serum vitamin E concentrations fell by 33% in the group as a whole (from 9.53 +/- 0.92 mg/L pre-TEST to 6.39 +/- 1.06 mg/L immediately post stress test, P < 0.02) and rose to baseline over the subsequent 24 h. The levels of serum vitamin E fell by 34% in the group of patients who had a positive TEST, and 32% in those who did not develop ischaemia during the TEST. Serum cholesterol concentrations also fell significantly during the TEST. In the total group serum cholesterol fell by 6.5% (P = 0.0052), and in the subgroup who were positive for ischaemia the fall in serum cholesterol was 10.3% (P = 0.004). The reduction in serum cholesterol was 4.1% in the subgroup who did not develop ischaemia (P > 0.05). Mean total plasma antioxidant status showed no significant temporal change for the group as a whole, although there was a nonsignificant decrease immediately post-TEST in the ischaemic group and a slight rise at 8 h in the group negative for ischaemia.

Elastofibroma dorsi (ED) is a benign connective tissue tumor that most commonly occurs on the inferior pole of the scapula. It can be found incidentally on radiologic imaging or due to clinical symptoms. Patients may become apprehensive due to it mimicking new malignancy or recurrence of prior malignancy. Treatment is only recommended in symptomatic cases and biopsy is usually unnecessary. We present a case of a 70-year-old female status-post lung cancer resection who was found to have a lump at the inferior pole of her right scapula. She was seen by multiple different specialties and subsequently, a biopsy confirmed her mass to be consistent with ED. Since ED is a benign soft tissue tumor, educating physicians is of utmost importance to avoid pursuing unnecessary diagnosis and to thereby decrease the cost of care to the patient. Therapeutic excision should only be performed in symptomatic patients and observing these lesions in asymptomatic patients would be sufficient.