Search Results (1,358)

Acute extracardiac conditions can occasionally produce electrocardiographic abnormalities that closely mimic acute coronary occlusion, posing a diagnostic challenge and increasing the risk of unnecessary activation of invasive cardiac pathways. Severe gastrointestinal distension, although uncommon, is a recognized cause of transient ST-segment elevation due to mechanical displacement of the heart, autonomic imbalance, and abrupt changes in ventricular loading conditions. These alterations may be particularly misleading in patients with chronic regional wall motion abnormalities, in whom new ECG changes risk being misinterpreted as recurrent ischemia. We report the case of a 68-year-old man with a history of inferior myocardial infarction who presented with marked abdominal distension secondary to a closed-loop small bowel obstruction. Despite the absence of chest pain, his ECG showed significant anterolateral ST-segment elevation. High-sensitivity troponin I remained negative, and transthoracic echocardiography demonstrated preserved anterior and apical motion, chronic inferior akinesia, and unchanged global longitudinal strain. Following nasogastric decompression, the ST-segment normalized completely within fifteen minutes. Subsequent imaging confirmed a closed-loop volvulus requiring urgent surgical intervention, with full bowel viability preserved. This case underscores the importance of integrating clinical context, biomarkers, and rapid echocardiographic assessment when evaluating ST-segment elevation, helping avoid unnecessary coronary angiography in the presence of extracardiac causes. Full article

Long QT associated with pheochromocytoma is rare but clinically significant. A 43-year-old woman presented with palpitations, chest pain, and recurrent syncope. ECG showed ST-segment elevation, while coronary angiography revealed normal arteries but Takotsubo-like left ventricular dysfunction. Hypertension and tachycardia raised suspicion for pheochromocytoma, later confirmed by imaging and biochemical tests. The patient exhibited QT prolongation (QTc 570 ms) in parallel with Takotsubo episodes. Following adrenalectomy, both QT duration and ventricular function normalized. The European Society of Cardiology now classifies pheochromocytoma-induced cardiomyopathy within the Takotsubo spectrum. Early recognition is crucial due to the risk of sudden cardiac death. Full article

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for managing inflammation, but they are associated with gastrointestinal and renal toxicity upon long-term use. Selective cyclooxygenase-2 (COX-2) inhibitors, or coxibs, were developed to avoid these adverse effects while maintaining anti-inflammatory efficacy. However, accumulating evidence indicates that coxibs may increase the risk of cardiovascular complications. This review explores the pathophysiological mechanisms underlying adverse cardiovascular effects in patients treated with COX-2 inhibitors. These mechanisms include an imbalance between prothrombotic and antithrombotic factors, an altered endocannabinoid metabolism, and downregulation of PPARδ, contributing to thrombosis. Additionally, COX-2 inhibition disrupts renal prostaglandin synthesis, particularly PGE2 and prostacyclins, reduces EP4 receptor expression in macrophages, promotes chemotaxis, and elevates arterial pressure via increased iNOS, ADMA, and L-NMMA activity. At the molecular level, genetic polymorphisms, matrix metalloproteinases, signaling cross-talk, and direct cardiomyocyte injury are implicated. Collectively, these alterations promote a prothrombotic state, fluid retention, enhanced vasoconstriction, impaired vasodilation, myocardial injury, cell death, and cardiac fibrosis. Despite these risks, coxibs are often prescribed without adequate cardiovascular assessment, particularly in patients with pre-existing cardiovascular risk factors. Greater awareness of these mechanisms is essential to optimize the benefit–risk ratio in clinical decision-making involving selective COX-2 inhibitors. Full article

Transcatheter aortic valve implantation is rapidly emerging as the leading treatment for severe aortic valve stenosis, especially in elderly and high-risk or inoperable patients. Prosthetic embolism is a rare but serious complication of transcatheter aortic valve replacement. Patients who develop prosthetic embolism are at increased risk of mortality and morbidity. These include stroke and aortic dissection associated with manipulation of the prosthesis in the ascending aorta. Treatment of valve embolisms into the aorta may differ depending on the type of valve; however, it traditionally relies on repositioning the valve to an appropriate position. To date, there are no established pharmaceutical guidelines for the management of patients with valve prosthesis embolization. We present a case report of the implantation of a second aortic valve prosthesis after periprocedural embolization of the first transcatheter valve, resulting in residual floating in the ascending aorta and following treatment with oral anticoagulation as well as single antiplatelet therapy due to the increased risk of thrombogenesis. This case report provides an example of the management of a transcatheter valve embolization with residual floating and highlights the need for further studies to address this issue. Full article

Arterial hypertension (HTN) is a global public health problem with three distinct subtypes: isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systodiastolic hypertension (SDH), each with unique clinical implications. This systematic review and meta-analysis aimed to determine the global prevalence of ISH, IDH, and SDH and their variability. Following PRISMA guidelines, a search was conducted in SCOPUS, Web of Science, PubMed, and EMBASE. A random-effects model with the Freeman-Tukey transformation was used for the meta-analysis, and a meta-regression was performed to assess temporal trends. Twenty-seven studies from five continents were included, revealing pooled global prevalence rates of 10.72% for ISH, 5.07% for IDH, and 11.71% for SDH. Extreme heterogeneity was observed (I² = 100%), reflecting substantial methodological diversity. The meta-regression suggested an increasing trend for ISH over time, while non-significant decreasing trends were observed for IDH and SDH. In conclusion, all three HTN subtypes show clinically relevant prevalences, with ISH and SDH being nearly twice as common as IDH. The high heterogeneity underscores the urgent need for research standardization, and these findings highlight the importance of differentiating subtypes for more effective population-level screening and public health planning. Full article

Over the past few years, large observational trials have confirmed the consistent association between vulnerable plaques identified by intracoronary imaging and major cardiovascular events in patients with coronary artery disease. Lipid-lowering therapies have reduced the occurrence of cardiovascular events in these patients; however, the exact pathophysiological mechanisms behind their clinical benefits have remained underexplored. Intracoronary imaging modalities, including intravascular ultrasonography, near-infrared spectroscopy, and optical coherence tomography have provided fundamental insight into the biological plausibility of these clinical results. Imaging trials employing serial intravascular ultrasonography have suggested that lipid-lowering therapies can either slow disease progression or promote plaque regression, depending on the degree of lipid lowering achieved. More recently, new randomized trials have added significant insights on the additional beneficial effects of achieving very low low-density lipoprotein cholesterol levels on high-risk plaque features, including fibrous cap thickness, lipid accumulation, and inflammatory cell accumulations. This literature review aimed to summarize current evidence on the clinical usefulness of plaque characterization using contemporary intracoronary imaging and the effects of high-intensity lipid-lowering therapies on vulnerable plaque features. Full article

The incidence of severe bleeding in patients treated with dual antiplatelet therapy, including the new P2Y12 inhibitors or new direct oral anticoagulants, who are undergoing urgent cardiac surgery is very high. Novel strategies, including the removal of antithrombotics via intraoperative hemoadsorption, have shown promising results, which are summarized in this holistic review. Overall, current evidence supports antithrombotic removal via hemoadsorption as a potential new therapy in the management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiopulmonary bypass-assisted cardiac surgery. Full article

The interpretation of the surface electrocardiogram and intracardiac recordings is key for the appropriate diagnosis and interventional treatment of cardiac arrhythmias. This report describes a patient with both a focal atrial tachycardia (AT) and an atypical atrioventricular-nodal reentrant tachycardia that were repeatedly induced and terminated by atrial ectopic beats. Radiofrequency ablation of the slow pathway, as well as targeted ablation of the specific AT focus effectively eliminated both tachycardias. Full article

Cardiac arrhythmias are a major cause of morbidity and mortality. Cardiac rhythm management devices (CRMDs) are used to diagnose and treat heart rhythm abnormalities. Many prospective randomized trials over the past decade have established the efficacy of CRMD therapy in reducing all-cause mortality and improving the quality of life. The manufacturer of every device provides its longevity in its technical characteristics, which are, as studies show, shorter in practice. Patients are concerned about the replacement procedure due to the risk of the procedure and other socioeconomic reasons. The longer the longevity of the devices, the better for the patients, the payers, the doctors and the health care systems. Given the recently redefined term of health technology assessment on a European level, a new regulatory framework has been proposed. Its intention is that, across different healthcare systems, the upfront costs and the reimbursement costs of these devices should be proportional to their longevity. Full article

We present a challenging case of a patient with an isolated right ventricular myocardial infarction (iRVMI) caused by the spontaneous occlusion of a right ventricular branch mimicking an anterior myocardial infarction on the electrocardiogram. A high index of suspicion is required to diagnose an iRVMI because the electrocardiogram may be misleading. Full article