http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Cardiovascular medicine" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/jun19_1/bcr2013010090?rss=1 We present two case reports of patients treated with dabigatran for stroke prevention. Both have non-valvular atrial fibrillation and both were scheduled for direct current electrical cardioversion (DCCV). Both had their activated partial thromboplastin time (aPTT) measured prior to their DCCV to assess the anticoagulant activity of dabigatran. The decision to measure the aPTT resulted in differing levels to otherwise straightforward cases. Rahmat, N. Khan, A. 2013-06-19 doi:10.1136/bcr-2013-010090 Dabigatran, electrical cardioversion and measuring the aPTT. A safety measure or an unnecessary assessment? BMJ Publishing Group Ltd JUN19_1 2013 201301009 2013-06-19 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun18_1/bcr2013009523?rss=1 Aortitis is uncommon but well described in patients with polymyalgia rheumatica (PMR). While glucocorticoid remains the mainstay therapy for large-vessel vasculitis, there have been cases where tocilizumab therapy led to clinical and serological improvement in patients with relapsing or refractory disease. We report a case of life-threatening PMR with aortitis in the absence of manifestations related to giant cell arteritis, which, having failed to respond to corticosteroid therapy, was successfully treated with tocilizumab and emergency reconstruction of the ascending aorta. This case adds to the literature supporting the potential value of interleukin-6 inhibition in rare rheumatological conditions such as inflammatory aortitis. Ashraf, F. A. M. Anjum, S. Hussaini, A. Fraser, A. 2013-06-18 doi:10.1136/bcr-2013-009523 Refractory PMR with aortitis: life-saving treatment with anti-IL6 monoclonal antibody (tocilizumab) and surgical reconstruction of the ascending aorta BMJ Publishing Group Ltd JUN18_1 2013 201300952 2013-06-18 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun18_1/bcr2013009814?rss=1 We report a case of atrioventricular (AV) accessory pathway with anterograde decremental conduction property. The {delta} wave polarity suggested the presence of a right posteroseptal accessory AV pathway. During atrial pacing, Wenckebach-type AV block over the accessory pathway was observed with prolongation of the local AV conduction time without the change in QRS morphology. No retrograde ventriculoatrial conduction was observed. During mapping of the right midseptal area, mechanical conduction block at the level of the proximal input to the accessory pathway was induced repeatedly by catheter manipulation. Radiofrequency energy delivery eliminated the accessory pathway. In this case only the bump phenomenon was the best marker of successful ablation. Fujita, S. Fujii, E. Sugiura, S. Ito, M. 2013-06-18 doi:10.1136/bcr-2013-009814 Atrioventricular accessory pathway with anterograde decremental conduction property BMJ Publishing Group Ltd JUN18_1 2013 201300981 2013-06-18 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun16_1/bcr2013009741?rss=1 A case of a 30-year-old woman with an end-stage renal disease and recently diagnosed with infective endocarditis, who presented with acute abdominal pain. An initial assessment of acute appendicitis was made. A CT scan of the abdomen showed a partially occluded superior mesenteric artery with radiographic evidence of ischaemia in an ileal loop. Intraoperatively, a 5-6 cm segment of the distal ileum was found to be non-viable. The segment was resected with the creation of a double-barrel ileostomy. This case report draws attention to the question of a need for anticoagulation for a septic embolus in the superior mesenteric artery. We could not find evidence on the use of postoperative anticoagulation in this scenario. In this case, the patient was started on oral anticoagulation. Waqas, M. Waheed, S. Haider, Z. Shariff, A. H. 2013-06-16 doi:10.1136/bcr-2013-009741 Acute mesenteric ischaemia with infective endocarditis: is there a role for anticoagulation? BMJ Publishing Group Ltd JUN16_1 2013 201300974 2013-06-16 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun13_1/bcr2013010303?rss=1 Description The posterior descending artery (PDA) arises from the right coronary artery (RCA) in approximately 85% of people in right dominant circulation. Whereas only in 10-15% of cases, it arises from the circumflex artery (LCX) or from both RCA and LCX.1 Rarely the posterior descending artery can arise from the left anterior descending (LAD) coronary artery.2 3 A 65-year-old man presented with new onset effort angina of Canadian Cardiovascular Society class II severity. He was hypertensive and a smoker. Exercise treadmill test was positive in 9.1 metabolic equivalents of task (METS). Blood investigations revealed only the presence of hyperlipidaemia (low density lipoprotein 141 mg/dL). ECG was normal and echocardiography was found to have normal left ventricular ejection fraction with concentric left ventricular hypertrophy with no regional wall motion a ... Patra, S. BC, S. Agrawal, N. CN, M. 2013-06-13 doi:10.1136/bcr-2013-010303 Super dominant left anterior descending artery with origin of both posterior descending artery and posterior left ventricular artery from septal branch BMJ Publishing Group Ltd JUN13_1 2013 201301030 2013-06-13 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun12_1/bcr2012008300?rss=1 This case of chest pain complicating therapy received for ulcerative colitis in a young patient highlights the importance of a thorough history and clinical examination. The complication can be rapidly fatal if not recognised and treated quickly. Mukherjee, N. Pandya, N. Bhaduri, B. Bala, K. 2013-06-12 doi:10.1136/bcr-2012-008300 Chest pain in a 12-year-old girl with ulcerative colitis after therapy with mesalazine BMJ Publishing Group Ltd JUN12_1 2013 201200830 2013-06-12 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun12_1/bcr2013010092?rss=1 We present a case of a young woman who was initially diagnosed with acute stroke with no obvious risk factors. Preliminary investigation with transthoracic echocardiography and subsequent advanced imaging with transoesophageal echocardiography suggested the diagnosis of a benign cardiac tumour on the anterior leaflet of mitral valve. The patient underwent urgent surgical resection. Histology confirmed the diagnosis of cardiac papillary fibroelastoma. She made complete clinical recovery with no recurrence of symptoms. Abbasi, A. S. Da Costa, M. Hennessy, T. Kiernan, T. J. 2013-06-12 doi:10.1136/bcr-2013-010092 Cardiac papillary fibroelastoma presenting as acute stroke BMJ Publishing Group Ltd JUN12_1 2013 201301009 2013-06-12 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun11_1/bcr2013009610?rss=1 Among all myxomas, left ventricular outflow tract (LVOT) myxomas are very rare. This article reports an LVOT myxoma in a 67-year-old woman presenting with palpitations and weight loss. Surgical excision of the LVOT myxoma was performed. Cetin, M. Cakici, M. Ercisli, M. Polat, M. 2013-06-11 doi:10.1136/bcr-2013-009610 Unusually located left ventricular outflow myxoma: a brief review of the literature BMJ Publishing Group Ltd JUN11_1 2013 201300961 2013-06-11 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun10_1/bcr2012008371?rss=1 Right atrial intracardiac tumours are uncommonly seen during echocardiography. Our patient presented with primary mediastinal large B-cell lymphoma with intracardiac involvement. The tumour was seen by echocardiography and the extent of the tumour was defined by CT scan of the chest. Following chemotherapy directed to her specific tumour cell type, there was complete resolution of the intracardiac mass. Sidhu, M. S. Dellsperger, K. C. 2013-06-10 doi:10.1136/bcr-2012-008371 Resolution of an intracardiac mass with chemotherapy BMJ Publishing Group Ltd JUN10_1 2013 201200837 2013-06-10 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jun10_1/bcr2013010083?rss=1 Aspirin is one of the most commonly used medications. We report a patient who presented with severe weakness, altered mental status and complete heart block requiring temporary pacing. Despite the patient's family denying that the patient used aspirin, an arterial blood gas that revealed a respiratory alkalosis and metabolic acidosis suggested the diagnosis of salicylate toxicity. The salicylate level was extremely elevated and the patient was successfully treated with haemodialysis. Our case illustrates that salicylate toxicity should be considered in a patient with a combined metabolic acidosis and respiratory alkalosis. A prompt salicylate level should be obtained. This is also the first case of salicylate toxicity causing complete heart block in an adult. The heart block resolved with treatment of the salicylate toxicity. Aggarwal, N. Kupfer, Y. Chawla, K. Tessler, S. 2013-06-10 doi:10.1136/bcr-2013-010083 Altered mental status and complete heart block: an unusual presentation of aspirin toxicity BMJ Publishing Group Ltd JUN10_1 2013 201301008 2013-06-10 CASE-REPORT