A 73-year-old male with end-stage heart failure underwent insertion of the HeartMate 3 (Abbott, North Chicago, IL, USA) device. Systemic anticoagulation and antiplatelets were discontinued for 52 days due to postoperative bleeding. After hemorrhage resolution, we restarted warfarin monotherapy targeting an international normalized ratio of 1.8-2.5. Eight months later, there are no reports of pump thrombosis, thromboembolism, and bleeding.

Direct oral anticoagulants (DOACs) are well known to be associated with bleeding complications. However, little is known about their association with atraumatic splenic rupture, a potentially fatal condition. We present the case of a 73-year-old female with paroxysmal atrial fibrillation managed with rivaroxaban who developed a spontaneous atraumatic splenic rupture. This highlights the importance of recognizing this complication in patients without previous risk factors, such as abdominal trauma or infiltrative splenic disease, who are under anticoagulation with DOACs. There is a strong need for further research on this complication's underlying mechanism and management.

An 84-year-old woman with depression, who witnessed the suicide of a close friend, presented with symptoms of chest pain, palpitations, and cold and clammy extremities. An electrocardiogram showed alternating tachycardia and bradycardia. Urgent transthoracic echocardiogram demonstrated left greater than right ventricular dysfunction, moderate mitral regurgitation, global hypokinesis, and an estimated ejection fraction of 20%. Cardiac catheterization demonstrated non-obstructive coronary artery disease and decreased cardiac output. Findings were consistent with Takotsubo cardiomyopathy complicated with cardiogenic shock, acute mitral regurgitation, and sinus node dysfunction. Management of this patient required the use of a mechanical device intra-aortic balloon pump, and pacemaker insertion for persistent symptomatic arrhythmia. This case highlights the challenging management of potentially fatal acute complications of Takotsubo cardiomyopathy and inadequate data on how to approach them.

Abdominal aortic aneurysms (AAA) are considered giant when they exceed >10cm, and they are rare, with only a few cases described as >14cm. AAAs can be repaired through endovascular aneurysm repair (EVAR) or open surgery. EVAR involves the placement of a graft that contacts the aortic wall and the iliac vessels to prevent the aneurysm sac to have blood flow and pressure. One of the complications of EVAR is endoleak, the most common being type II. We describe an uncommon case of a progressively giant AAA with type II endoleak with poor evolution despite multiple repair attempts.