Spontaneous coronary artery dissection (SCAD) is an important and rare cause of myocardial infarction (MI), particularly among young women without traditional atherosclerotic risk factors. Late pregnancy and postpartum period are associated with more risk for developing SCAD. No enough data exist regarding the ideal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies.
We present three cases of SCAD, two of them were postpartum women while one involved an obese young woman with no identifiable risk factors. We describe the pathophysiology, types of SCAD, risk factors, clinical presentation, and management approach. This case series highlights the need to raise awareness of SCAD and to facilitate accurate diagnosis promptly.
Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell Non-Hodgkin lymphoma (NHL) associated with immunocompromised states such as HIV. We present a case of PBL in an HIV patient presenting as spontaneous tumor lysis syndrome and discuss the clinical challenges hence encountered.
Dobutamine stress echocardiography (DSE) is a commonly utilized method for coronary artery disease (CAD) diagnosis, and it provides important long-term prognostic information. We report a case of a 53-year-old female with multiple cardiovascular risk factors who underwent DSE for evaluation of underlying CAD. The examination was complicated by wide complex tachycardia and promoted administration of esmolol, which shortly led to ST-segment elevation myocardial infarction (STEMI). Coronary angiography showed complete absence of CAD. Coronary vasospasm was a possible suggested mechanism due to the pharmacologic interaction between beta-blockers and dobutamine on alpha- and beta-adrenergic receptors.
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