Background: A cardiac myxoma in a young person may pose a diagnostic challenge as symptoms may be variable and the differential diagnosis is wide. The differential diagnosis can include rheumatic mitral valve disease, pulmonary hypertension, endocarditis, myocarditis and vasculitis. Case presentation: This case report involves a 49 years old female with a 2.8 cm × 3.4 cm myxoma in the left atrium causing mitral valve obstruction. She presented with fatigue, fever of unknown origin, transient ischemic attack and shortness of breath. Prompt surgery is often recommended due to the risk of embolic complications or complete obstruction. Due to her symptoms, patient underwent successful cardiothoracic surgery to excise the myxoma within 2 weeks of confirmation by cardiac echocardiography. Conclusion: This case also emphasizes the diagnostic challenge as symptoms may be variable, ranging from fatigue, fever and shortness of breath to transient ischemic attack and at worst, sudden cardiac death. In conclusion, if a cardiac mass is suspected, echocardiography should be performed early. Surgical resection is curative and recurrence rate is very rare in sporadic isolated myxomas, however, recurrence can be higher in genetic diseases associated with increased frequency of myxomas such as Carney complex. This subpopulation of patients may present further research opportunity to learn more about the perioperative management of patients with myxomas such as determining the optimal time to surgical intervention and decision to anticoagulate.

Complex regional pain syndrome (CRPS) usually occurs after an inciting injury. Poor understanding of pathophysiology, management, and disease awareness has led to misdiagnosis of this condition. We report a rare case of a 69-year-old male who developed CRPS following a Florida Coral snake bite on his right foot. Initially, it was misdiagnosed as recurrent cellulitis; however, he developed chronic right lower extremity (RLE) pain with worsening flares associated with right leg swelling and erythema. Examination was remarkable for nonpitting edema, erythema, and severe tenderness to light touch of the RLE, all symptoms that highly supported the diagnosis of CRPS. Treatment was initiated and consisted of physical therapy in addition to gabapentin which resulted in marked improvement. CRPS remains a challenging diagnosis due to lack of gold standard test and can be easily misdiagnosed. Clinical evaluation applying Budapest criteria can aid with diagnosis and should be routinely used for all patients with suspected CRPS.

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Statins are a class of medications indicated for atherosclerotic cardiovascular diseases and dyslipidemia. Ever since their introduction, various side effects have been reported with their use. Statin-induced myopathy is a well-established side effect of the medication, ranging in severity from mild myotoxicity to fatal rhabdomyolysis, with or without an increase in creatine kinase levels. Statin-induced diplopia, ptosis, or ophthalmoplegia are very rare, but they have been reported as adverse events in a handful of cases. These adverse events typically result from the progressive weakening of the external ocular musculature or the levator palpebrae superioris muscle. In this report, we present a rare case of statin-induced diplopia in a patient who had been on atorvastatin therapy for years. We believe this report will increase awareness among physicians about such an adverse event related to statins.

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) syndrome is a very rare congenital heart disease with an incidence of one in 300,000 and a high rate of mortality early in life if left untreated. Adult-type ALCAPA presents when significant collaterals develop from the right coronary artery (RCA) to the left coronary artery (LCA). Even with the collaterals, chronic sub-endocardial ischemia occurs in most cases, and patients die from sudden cardiac death.Here we present a case of a 38-year-old female who lived an active and healthy life and presented with chest pain and palpitations. Initial electrocardiography (EKG) showed atrial fibrillation with rapid ventricular response. Although initial cardiac enzymes were negative and there were no ischemic EKG changes, troponins became elevated over the course of the hospital stay and the patient underwent a left heart catheterization. Results revealed a dilated RCA extending to the left ventricle and an anomalous left main originating from the pulmonary artery with complete occlusion. The patient received medical management for acute coronary syndrome, including heparin infusion for 48 hours, aspirin, metoprolol, and atorvastatin. She was referred to a tertiary care facility for surgical correction of anomaly of the coronary arteries. The next day, the patient arrived in the emergency department with an acute onset of speech difficulty and leftsided weakness. A brain CT without contrast showed hematoma in the right frontal lobe. The patient underwent surgical evacuation of the hematoma with marked improvement of her weakness. The patient recovered after a successful surgical repair involving translocation of the left main coronary artery to the aorta.It has been reported that ALCAPA should be considered in a young adult with dilated cardiomyopathy and mitral regurgitation (MR). Other common presentations include acute myocardial infarction, angina, and dyspnea on exertion. Sudden cardiac death is not uncommon; however, it tends to decrease with age of diagnosis. Interestingly, our patient was known to have MR with regular follow-up at the cardiology clinic for years. Echocardiogram never showed any abnormalities other than MR. She never received further workup to address the reason of MR, although she has no underlying chronic conditions that can explain it. In relatively young patients with a healthy lifestyle presenting with chest pain, a broader look at etiologies should be considered. We would like to emphasize the importance of looking up for possible coronary artery disease, especially in young individuals.

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A 66-year-old woman with no relevant medical history presented at the emergency department with new-onset atrial fibrillation. We initiated intravenous amiodarone therapy. At 20 hours, the patient experienced severe neurologic symptoms, hyponatremia, and syndrome of inappropriate antidiuretic hormone. We discontinued amiodarone, infused saline solution, and restricted the patient's fluid intake. She recovered in 3 days. This case illustrates that amiodarone-induced syndrome of inappropriate antidiuretic hormone with hyponatremia can occur far earlier than expected during acute amiodarone therapy.