Highlights: It discusses pediatric HCM which is usually caused by autosomal dominant traits caused by mutation in cardiac sarcomere protein genes. It explains how to recognize the cardiac risk Abstract: Hypertrophic Obstructive Cardiomyopathy (HOCM) is a disease characterized by increased left ventricular (LV) wall thickness and accompanied by obstructive physiology measured by increased LV outflow tract gradient. It is mainly inherited in autosomal dominant traits caused by a mutation in cardiac sarcomere protein genes. In pediatrics, HOCM is rare and comprises a different diagnosis and management approach compared to adults. The risk of sudden cardiac death (SCD) is also higher in the pediatric population. Case Summary. This report is about a case of HOCM found incidentally in a 6-year-old boy and a discussion based on the latest literature review. The patient first came for evaluation for cardiac murmur and abnormality in ECG and chest x-ray. Diagnosis of HOCM was made through echocardiography assessment. Discussion. ICD implantation for primary prevention of SCD was considered based on individualized 5-year SCD risk assessment which is around 7%. Optimal pharmacological therapy with beta-blocker, careful planning of ICD implantation with balanced benefit and risk, and septal reduction surgery when indicated should extend the life expectancy and quality of life of pediatric HOCM. It is both essential and interesting to recognize pediatric HOCM diagnostic findings and to pursue further research about therapies of this rare disease.
Myocardial bridging is an anatomical variant characterized by a coronary artery that tunneled through the myocardium. Often asymptomatic, myocardial bridging could also go to a further extent, presenting as myocardial ischemia in the form of stable angina pectoris, acute coronary syndrome, arrhythmias, or even sudden cardiac death. Although these are uncommon manifestations, it is still a challenge for physicians when encountering such cases. Additional imaging techniques are often required to diagnose myocardial bridging. This report is about a unique case of a 72-year-old man presenting with acute coronary syndrome (ACS) in the form of unstable angina pectoris (UAP), which was later found to be caused by myocardial bridging on coronary angiography. Following administration of beta-blocker, antiplatelet, and statin, the angina symptoms, as well as ischemic sign on electrocardiography (ECG), were completely resolved.
Diagnosing Acute Myocardial Infarction (AMI) in the setting of the Left Bundle Branch Block (LBBB) proposes a great challenge to the clinician. Despite current therapy recommendations, early reperfusion may not be appropriate for all patients with new or presumed new LBBB because only a minority is caused by acute myocardial infarction with true occluded artery. This is a case of a 47-year-old man presented at a rural hospital emergency with highly suspected acute myocardial infarction, a history of old infarct, and LBBB on ECG. Relying on careful clinical examination and close evaluation of hemodynamic with serial ECG, the patient was decided to be managed conservatively. Thorough clinical judgment is required in diagnosing and managing patients with acute MI and LBBB. Avoiding unnecessary burdens and risks resulting from early reperfusion therapy may have a significant impact especially in the centre with limited modality settings.
Coronary artery spasm, marked by coronary vasoconstriction, is one of the etiologies of myocardial ischemia, often presenting as vasospastic angina. Vasospastic angina is diagnosed when angina which predominantly occurs at rest, is accompanied by ST-segment changes in ECG, or in the setting of borderline ECG changes, a positive provocation test through coronary angiography is required. Although coronary artery spasms could manifest in wide clinical settings, the occurrence of ventricular arrhythmias and acute myocardial infarction solely caused by spasms without evidence of prior coronary artery disease is rare. This case report is about a 46-year-old man who presented with ventricular tachycardia and acute myocardial infarction that later was found to be secondary to coronary vasospasm observed directly through coronary angiography. We aim to emphasize the importance of coronary artery spasms as the etiology of malignant ventricular arrhythmias and acute myocardial infarction manifestation. Optimization in treatment and prevention shall reduce future life-threatening complications of coronary artery spasms.
Tamponade jantung merupakan kondisi emergensi yang disebabkan oleh peningkatan tekanan intraperikardium karena akumulasi cairan pericardium, sehingga terjadi kompresi ruang-ruang jantung, mengakibatkan curah jantung menurun. Terapi definitif tamponade jantung adalah perikardiosentesis, dapat dilakukan dengan bantuan ekokardiografi. Keberhasilan perikardiosentesis ekokardiografi mencapai >95%, namun juga memiliki risiko tinggi hingga beberapa komplikasi. Kasus seorang perempuan 17 tahun dengan SLE dan tamponade jantung datang dengan instabilitas hemodinamik. Perikardiosentesis ekokardiografi berhasil dilakukan. Laporan ini disertai langkah-langkah prosedur perikardiosentesis ekokardiografi dan pembahasan komorbiditas hipertensi pulmonal dan komplikasinya. Cardiac tamponade is an emergency condition caused by intrapericardial pressure increase due to pericardial fluid accumulationresulting in compressed cardiac chambers and reduced cardiac output. Definitive therapy is pericardiocentesis, which could be done with the guidance of echocardiography. Echocardiography-guided pericardiocentesis procedure has a>95% success rate, but it carries some potential high risks and several complications. The case is a 17-year-old SLE female patient presenting with cardiac tamponade and hemodynamic instability. Echocardiography-guided pericardiocentesis was successfully done. This case report is supplemented by a step-by-step procedure and discussion on possible pulmonary hypertension comorbidities and their complications.
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