Endomyocardial biopsy (EMB) is central to the diagnosis of giant-cell myocarditis (GCM) and planning further management. There is, however, no guideline-directed recommendation on re-biopsy or left ventricular EMB in a suspected case of acute, fulminant myocarditis following an indeterminate first biopsy. This manuscript illustrates, with a case, the changing role for EMB in the current era in the diagnosis of GCM.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-014-0028-5) contains supplementary material, which is available to authorized users.
Spontaneous coronary artery dissection (SCAD) is a rare, life-threatening condition that usually manifests as an acute myocardial infarction. Diagnosing SCAD with conventional coronary angiogram can be challenging, particularly if the true lumen is severely narrowed. Our case highlights the challenges in performing successful percutaneous coronary intervention (PCI) in patients with SCAD. Intravascular ultrasound can prove to be a pivotal tool in the diagnosis and successful management of such cases by establishing the anatomic site of dissection, and confirming stent placement in the true lumen following PCI.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-014-0029-4) contains supplementary material, which is available to authorized users.
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