Analysis of the arterial pressure waveform remains useful in modern practice to assess alterations that may indicate significant abnormalities of cardiovascular parameters. The recognition of abnormalities of the incisura and dicrotic wave should alert the clinician to seek specific etiologic factors. Understanding the physiological origins of the incisura and dicrotic notch enhance its clinical utility in accurately diagnosing abnormal hemodynamic states. This review summarizes the hemodynamic events causing and affecting the inscription of the incisura in the arterial waveform.

Raoultella species are a group of gram-negative, non-motile bacilli commonly isolated from the environment. The group was considered a member of the genus Klebsiella until the late 1990s. Raoultella planticola is a rare cause of human infections. We report the first case of liver abscess caused by this organism. The patient was successfully treated with appropriate antimicrobials combined with operative drainage.

Glucocorticoid remediable aldosteronism (GRA) is rare familial form of primary aldosteronism characterized by a normalization of hypertension with the administration of glucocorticoids. We present a case of GRA and thoracoabdominal aneurysm complicated by multiple aortic dissections requiring complex surgical and endovascular repairs. Registry studies have shown a high rate of intracranial aneurysms in GRA patients with high case fatality rates. The association of thoracoabdominal aneurysms with GRA has not been described, thus far, in literature. Studies have shown that high tissue aldosterone levels concomitant with salt intake have a significant role in the pathogenesis of aneurysms and this may explain the formation of aneurysms in the intracranial vasculature and aorta. The association of GRA with thoracic aortic aneurysms needs to be further studied to develop screening recommendations for early identification and optimal treatment. Also, the early use of mineralocorticoid antagonists may have a significant preventive and attenuating effect in aneurysm formation, an association which needs to be confirmed in future studies.

Coronary artery ectasia (CAE) is an uncommon anomaly, usually found in 1.2-2% of patients undergoing coronary angiography, defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. Atherosclerosis is considered as the cause of half of the CAE cases. We herein present a 65-year-old Asian male with past medical history of Kawasaki disease (KD) who developed recurrent episodes of inferior wall ST-elevation myocardial infarction (STEMI) despite treatment with dual antiplatelet therapy (DAPT). Repeat coronary angiogram showed severely ectatic and tortuous coronary arteries more predominant on the right coronary artery (RCA) with diffuse thrombus in its mid segment. Given his unfavorable vascular anatomy, the condition was managed medically with the addition of warfarin to his DAPT with target international normalized ratio (INR) 2 - 3. This case highlights the association of CAE with a prior history of KD and its therapeutic challenge.

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