Primary cardiac tumors are extremely rare. In one study, incidence was reported being less than 0.1%. The purpose of this case report is to review different presentations of cardiac myxoma. A 34-year-old female with past medical history of drug abuse was brought into the emergency department (ED) after a motor vehicle collision. She was found to have multiple fractures with a hypodense mass in the left atrium. Further evaluation showed a left atrial myxoma. The patient underwent myxoma resection. The clinical appearance of myxoma varies from non-specific to life-threatening complications, such as stroke, acute heart failure, or even sudden death.A surgical resection is the treatment of choice for cardiac myxomas.

Hyperthyroidism is a common metabolic disorder with many cardiovascular manifestations. In rare cases, untreated hyperthyroidism can lead to thyrotoxic cardiomyopathy with severe left ventricular (LV) dysfunction. This case report aims to discuss the pathogenesis of heart failure in hyperthyroidism and the available treatment options.A 51-year-old male with a past history of untreated hyperthyroidism presented to our hospital for the evaluation of shortness of breath and dysphagia. Workup revealed atrial flutter and severe biventricular dilated cardiomyopathy. Stabilization thyroidectomy was performed due to dysphagia, and treatment with oral antithyroid medications was initiated. The patient was discharged on synthroid and beta-blockers.Untreated hyperthyroidism can lead to biventricular failure even in the young. Untreated hyperthyroidism leads to significant mortality and morbidity. Untreated hyperthyroidism is associated with atrial fibrillation, heart failure, pulmonary hypertension (PH), and angina-like symptoms. Further studies should be done to evaluate the pathogenesis of Graves/Goiter hyperthyroidism and the least-invasive, safe, and definitive treatment options should be discovered. Current treatment options are limited and include medication that needs to be taken lifelong; they are associated with toxicity. Radioactive iodine ablation comes with the drawback of long-term replacement therapy. The last option is surgery, which is invasive and has its own complications.

Orthodromic atrioventricular reentrant tachycardia (AVRT) is the second-most-common form of supraventricular tachycardia (SVT) and is inducible in approximately 55% of individuals with Wolff Parkinson White (WPW) syndrome. Antidromic AVRT, where the accessory atrioventricular connection is used as the antegrade limb and the atrioventricular node serves as the retrograde limb of the circuit, has been clinically documented in less than 5% of patients with WPW syndrome and may be induced in less than 10% of these WPW cases in the electrophysiology laboratory. Left lateral pathways are considered more frequent and septal locations are less common when associated with antidromic AVRT.We report a case of 21-year-old male with a history of WPW syndrome who had undergone a prior electrophysiology study in 2010 at an outlying facility, documenting an anteroseptal accessory pathway near the His bundle along with an unsuccessful attempt at radiofrequency ablation at that time. No supraventricular tachycardia was induced at that previous study. The surface electrocardiogram (ECG), at this time, was consistent with the anteroseptal WPW pattern. The patient now presented with a complaint of intermittent palpitations with no definitive trigger. He also described a recent syncopal episode while walking inside his home. His physical exam and all lab work were within normal limits for his age. He underwent a repeat electrophysiology (EP) study where the baseline PR interval was 62 milliseconds and the QRS duration was 172 milliseconds in a pre-excited pattern. There was found to be an antegrade-only conducting accessory pathway at the anteroseptal region near the His bundle. Antegrade AVRT was induced with a single ventricular extra stimulus while on 2 mcg/min isoproterenol. Cryoablation was performed in a position slightly posterior to the His bundle, which successfully resolved the accessory pathway conduction. First-degree atrioventricular (AV) block was noted in the sinus rhythm with a PR interval of 226 milliseconds post-cryoablation. There was no recurrence of accessory pathway conduction on follow-up ECG 24 hours post-cryoablation.Antidromic AVRT is a very rare finding in WPW syndrome during an EP study. Catheter ablation is the treatment of choice for patients who have symptomatic WPW syndrome. Catheter ablation can be especially challenging when the accessory pathway is in close proximity to the normal conduction pathways. The prognostic significance of inducible antidromic AVRT is controversial in asymptomatic patients and limited data indicate it may be a poor prognostic sign in children. In adults, the prognostic significance is not well-established. Cryoablation is an option for the ablation of accessory pathways that are close to the normal conduction pathways. “Cryomapping” is designed to have precise ablation and to reassure the absence of complications.

Background and Aim: Brain-derived neurotrophic factor (BDNF) has shown to promote myelination besides its effect on survival, differentiation, and plasticity of neurons. It has an important role in maintaining cardiovascular health in addition to its central nervous system function. The present study aimed to determine the serum level association with DNA Methylation status of brain derived neurotrophic factor with severity of coronary artery disease. Methods: This cross-sectional study was carried out on 164 major coronary artery patients in the department of Biochemistry & Pharmacology of Bahawal Victoria Hospital Bahawalpur from April 2022 to December 2022. Individual with possible cardiac symptoms such as chest pain and dyspnea were enrolled. Patients were distributed as CAD group (n=82) and non-CAD group (n=82). CAD severity was measured by Gensini scoring system. The coronary artery lumen stenosis was defined as follows: 1, 2, 4, 8, 16, and 32 was for 1-25%, 26-50%, 51-75%, 76-90%, 91-99%, and total occlusion respectively. Prior to angiography, patients’ anthropometric parameters such as BMI, systolic, and diastolic pressure were recorded. Demographic details such as age, gender, and smoking status were also noted. SPSS version 27 was used for data analysis. Results: Of the total 164 patients, there were 82 study group comprised of 58 (70.7%) male and 24 (29.3%) females whereas control group was comprised of 40 (48.8%) male and 42 (51.2%) females. Study group had at least one major coronary artery with > 50% stenosis classified as CAD group and non-CAD group patients had completely normal coronary angiographies. The CAD group patients had higher mean age and smokers than non-CAD group. The incidence of hypermethylated BDNF gene in CAD and non-CAD group was 86.6% and 70.7% respectively. There were insignificance difference of serum BDNF concentration mean values in CAD group (1.82 [1.61-2.12] ng/ml) versus non-CAD group (1.69 [1.39-2.03]). The BDNF methylation was found 81.2% in male and 83.4% in female patients. Regarding serum BDNF mean value, no significance difference was observed in men (1.82 [1.52–2.12]) and women (1.70 [1.44–2.02]). Conclusion: The present study concluded that the increased risk of CAD associated with BDNF hypermethylation may be useful for identifying subjects at risk. A significant correlation was also found between BDNF hypermethylation and CAD severity. There was no significant association between severity of CAD and BDNF serum level. Keywords: Brain-derived neurotrophic factor, serum level, Coronary artery disease, Severity, DNA methylation

The anomalous origin of coronaries is rare. The purpose of this case report is to show a rare anomalous origin of coronaries.A 64-year-old female presented with chest pain that was typical in nature. The patient had left heart catheterization that showed an anomalous origin of coronaries, where all the coronaries were arising from the right coronary cusp. The patient had a significant disease in the distal left anterior descending artery, but it was a small vessel. Medical management was chosen.This is a rare presentation of the coronary anatomy.