Lipomatous hypertrophy of the interatrial septum is being increasingly recognised and should be considered as part of the differential diagnosis for any cardiac tumour. We present the case of a 65-year-old male patient who presented at the emergency department complaining of palpitations. Transthoracic and transoesophageal echocardiography detected a lipomatous membrane separating the dilated left atrium from the right atrium. Diagnosis was confirmed by MRI. In such cases, the opinion of a specialist echocardiologist would help to avoid a misdiagnosis and unnecessary intervention.

We describe the case of a patient presented with isolated right heart failure with atrial fibrillation and severe tricuspid regurgitation due to hyperthyroidism. Treatment of the thyroid disease resulted in the disappearance of signs of right heart failure and resolution of the valve incompetence and normalization of the heart rhythm. Although thyrotoxicosis may be associated with congestive heart failure, isolated right heart failure with marked tricuspid regurgitation is rarely seen.

DESCRIPTIONThe congenitally corrected transposition of the great arteries (TGA) is a rare condition accounting for less than 1% of all congenital heart diseases, usually combined with other congenital heart anomalies such as a ventricular septal defect or pulmonary outflow tract obstruction. Very often they present with abnormalities of the left-sided systemic tricuspid valve. In rare cases (<5%), some patients have no associated cardiac abnormalities and they can go unnoticed until adulthood.1 A 53-year-old man presented to the emergency department complaining of chest pain suggestive of angina. Medical history was positive for hypercholesterolaemia, smoking and arterial hypertension. The patient also revealed a positive family history of coronary heart disease. The admission ECG showed repolarisation abnormalities of the anterolateral wall (inverted T waves at leads I, aVL, V1-V5) consistent with ischaemia and suggestive of a possible non-ST elevation myocardial infarction (figure 1). The blood pressure on admission was 150/85 mm Hg and the patient was haemodynamically stable. The primary differential diagnosis at the time of admission was coronary ischaemia. A bedside transthoracic echocardiogram was performed and the aorta and the pulmonary artery were shown to be transposed. The left and right ventricles were also transposed. Systolic function of both ventricles was normal and the ejection fraction of the right (functionally left) ventricle was estimated to be approximately 60%. There were no identifiable regional wall motion abnormalities of either the left or right ventricle. It needs to be emphasised that a number of limitations hamper the evaluation of the right ventricle by transthoracic echocardiography. However, imaging was performed by an experienced consultant, and the quantitative methods for the evaluation of the right ventricle including tricuspid annular plane systolic excursion and systolic tissue Doppler imaging velocity of the tricuspid annulus were also commensurate with normal function.Following the early stabilisation phase, cardiac troponin I, creatine kinase and creatine kinase MB mass tests were found marginally positive (troponin levels at 0.28 mg/dl with a laboratory cut-off value of 0.10 mg/dl and minor increases of creatine kinase and creatine kinase-MB). The patient was prescribed standard acute coronary syndrome medical treatment as this was the most likely explanation for his clinical condition, including acetylsalicylic acid, clopidogrel, metoprolol, atorvastatin and enalapril. Low molecular weight heparin was also administered. He was promptly referred to the catheterisation laboratory for a coronary angiography and aortography that showed anomalous origin of the coronary arteries with the left coronary artery originating from the right sinus of Valsalva and the right coronary artery originating from the left sinus of Valsalva, a finding typical of congenitally corrected TGA where each coronary artery follows the course of its respective ventricle.Both coronaries were free of ...

BackgroundApical ballooning syndrome mimics acute coronary syndromes and it is characterized by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis.Case presentationThis is a case of a 40-year-old Caucasian male without any health related problems that was submitted to an urgent coronary angiography because of acute chest pain and marked precordial T-wave inversions suggestive of acute myocardial ischemia. Coronary angiography showed no significant stenosis of the coronary arteries. Left ventriculography showed systolic apical ballooning with mild basal hypercontraction.ConclusionPhysicians should be aware of the presentation of apical ballooning syndrome, and the chest pain after following acute stress should not be readily attributed to anxiety.

We report the case of a 43-year-old female patient who was admitted to the Cardiology Department from the Rheumatology Clinic where she was being treated for multi-organ serositis, fatigue and mild dyspnoea on exertion. The patient had a known medical history of systemic lupus erythematosus (SLE). Following extensive evaluation with blood tests for immunological and viral culprits, cardiac ultrasound, chest and abdominal computed tomography (CT) and heart magnetic resonance imaging (MRI), the diagnosis of effusive constrictive pericarditis secondary to her SLE was made. Treatment with β-blockers, diuretics and corticosteroids was given with excellent results, and one year post discharge the patient remains asymptomatic. Systemic lupus erythematosus patients often manifest cardiac complications such as pericarditis. The practising physician should always bear in mind this possibility when treating such patients.