Primary tumours of the heart are often encountered in clinical practice. Different autopsy series estimate the incidence to be anywhere from 0.001% to 0.19%. Cardiac lipoma is a rare type of tumour of the heart and pericardium. It comprises approximately 10–19% of all cardiac tumours. We present a case of a large cardiac lipoma in a fifty-year-old female. She presented with sharp chest pains, palpitations, and dizziness. Acute coronary syndrome was ruled out. A transthoracic echocardiogram showed an abnormal, large, fixed right atrial mass. The mass was noted to be occupying most of the right atrium. It was excised due to its large size and persistent symptoms. On pathophysiology, the mass was definitively diagnosed to be an 80 mm × 70 mm cardiac lipoma. Postoperatively, the patient did well with resolution of her symptoms. This case provides evidence that even large, invasive, symptomatic cardiac lipomas can be successfully resected with good outcomes.

A 58-year-old male presented with severe substernal chest pain along with bilateral lower extremity pain. He was tachycardic, tachypneic, and hypoxic with tender right calf. Electrocardiogram showed ST elevation in anterior-lateral leads. Emergency coronary angiography revealed widely patent proximal left anterior descending (LAD) artery and total distal occlusion with an abrupt cut-off. The remaining coronary arteries did not have significant disease. An Export aspiration catheter was used and thrombus was aspirated from the LAD with return of TIMI flow grade 3 and normalization of the ST elevations. Doppler ultrasound revealed deep vein thrombosis; transthoracic echocardiogram using agitated saline echocontrast showed a patent foramen ovale. Nearly 5% of patients with ST elevation myocardial infarction do not have demonstrable atherosclerosis by coronary angiography; paradoxical coronary embolism is among the leading causes in such cases. Paradoxical embolism to the coronary tree is under diagnosed and its antemortem diagnosis is difficult. Information regarding appropriate management of myocardial infarction due to coronary embolism is scant. Aspiration of intracoronary thrombus provides good clinical results, avoiding clot fragmentation and balloon injury associated with angioplasty. We present a rare case of antemortem diagnosis of paradoxical embolism to the coronary artery successfully treated with aspiration alone.

Quadricuspid aortic valve (QAV) is a congenital heart anomaly in which the aortic valve has four cusps of various size possibilities, as opposed to the three symmetrical cusps generally observed. This cardiac valvular abnormality is rarely identified, with an estimated incidence rate of 0.013% to 0.043%, although recent technological advancements in diagnostics have contributed to an increase in detection. Historically, it had been typically encountered during open heart surgery or postmortem; however, it is presently diagnosed primarily via ultrasound echocardiography, and could go undetected unless specifically considered. It was first reported by Babington in 1847, and since then approximately 300 cases have been published. This condition is sporadically associated with additional congenital cardiovascular defects, with coronary artery irregularities being the most common. In more than half of published QAV incidences it has led to the progressive development of aortic regurgitation (AR) usually sans aortic stenosis, particularly amongst elderly patients, often requiring surgical intervention after 50 years of age. A fifth of total instances, but two-thirds of instances with AR, warrant surgery seldom amidst complications, with reconstructive tricuspidization preferred over valve replacement.

BackgroundTypical or classical takotsubo cardiomyopathy (TCM) is associated with the characteristic abnormality of a ballooned left ventricular apex with basal segmental hyperkinesis. TCM may not present with the “classical” wall motion abnormalities but can have a variety of segmental wall motion abnormalities. The aim of our work was to assess for any unique identifying factors that can help distinguish typical and atypical variants of TCM.MethodsWe studied 11 consecutive patients between 2010 and 2012 admitted with chest pain, electrocardiographic and cardiac biomarker changes consistent with acute coronary syndrome (ACS) who underwent left heart angiography and were clinically diagnosed to have TCM.ResultsOur study found no specific features distinguishing typical and atypical variants of TCM. In our study, all patients were female and all had excellent outcome. One patient was in fourth decade of life, three patients in fifth and sixth decade of life, while remaining were older. One patient had diabetes mellitus, five had hypertension, four had concurrent coronary artery disease, but no patient had any family history of TCM. Nine of 11 patients had immediate clear-cut stressors. Three patients had normal ECG, two with ST segment elevation, with nine patients having only modest troponin elevations. One patient had an anomalous RCA take-off from the right coronary cusp, otherwise remaining patients had normal anatomy. One patient had only apical involvement, remaining had multiple wall motion abnormalities, and all patients had involvement of the anterior wall. Four patients had apical sparing. No inverted TCM pattern with basal akinesis with normal wall motion in the midventricular and apical regions was found among our patients.ConclusionsWe report that the classification of TCM as typical versus atypical is probably not clinically meaningful. The regional wall motion abnormalities are related to catecholamine excess and to the susceptibility of that particular region to excess catecholamine. We do not know why such differences in regional susceptibility exist, and agree with the other authors that sub-classification would only add to confusion, and a delay in understanding of the disease process.

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An otherwise healthy 26-year-old female presented with sudden cardiac arrest. She was resuscitated with unsynchronized cardioversion for ventricular fibrillation. A left heart cardiac catheterization showed anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). Cardiac computed tomographic angiography confirmed this abnormality. She underwent direct translocation of the left main coronary artery to the aorta, and after a stormy postoperative course was discharged home. ALCAPA is a rare congenital abnormality of the coronary system that is associated with early infant mortality and adult sudden death. The use of advanced cardiac imaging has resulted in an increase in the number of diagnosed ALCAPA cases, especially in the adult population, sometimes even in the asymptomatic. The extent of collateral circulation that develops between the right coronary artery and the left coronary artery determines the outcome; the more collateral circulation there is, the less the hypoxic damage to the ventricle. This not only informs us that people survive ALCAPA into adulthood but also highlights the importance for adult cardiologists to be aware of this interesting disease. Corrective surgery remains the treatment of choice. We present a rare case of ALCAPA, with first presentation in adulthood in the form of a malignant ventricular arrhythmia.