We report a case of acute ST-segment elevation myocardial infarction with an unusual evolution of ST-segment elevation. Several possible explanations of this progression are discussed with supportive evidence for each explaination. The clinical, electrocardiographic, and angiographic features of this case are also illustrated.

No abstract

Prinzmetal angina, also known as vasospastic or variant angina, is defined as an intermittent focal coronary artery spasm often associated with an atherosclerotic lesion near the site of spasm. It is caused by a focal or diffuse spasm of the smooth layer of the arterial wall of an epicardial coronary artery. Acute infarctions or malignant arrhythmias may develop during spasm-induced ischemia. Evaluation includes observation of echocardiogram (EKG) for transient ST elevations during discomfort; diagnosis is confirmed with coronary angiography using provocative testing. We describe two cases of patients who presented for non-cardiac complaints, but had episodes of vasospastic angina during their hospitalization. Both underwent cardiac catheterization with differing results, demonstrating the importance of catheterization in patients who experience vasospastic angina.

A 70-year-old white male, with past medical history of coronary artery disease, peripheral arterial disease status-post bilateral femoral artery stents, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, arthritis, tobacco use, and alcohol use, presented with shortness of breath and an abnormal finding on a recent transesophageal echo. This had revealed a large, fixed mass in the right atrium. Our differential diagnosis had included thrombus, endocarditis, myxoma, papillary fibroelastoma, sarcoma, and metastatic tumor. The cardiothoracic surgeon excised this mass, which upon culturing, revealed what we found to be the only reported case of an atrial myxoma infected with Escherichia coli. In addition to surgical excision, the patient was treated with six weeks of intravenous cefepime.

The AngioVac (Angiodynamics) system is indicated for the removal of right-sided venous soft thrombi and emboli. This is the first report that demonstrates the AngioVac system can be extended to the extraction of right-sided cardiac tumors, in the current case, a pulmonary valve papillary fibroelastoma infected with Streptococcus salivarius and Rothia species. ( Level of Difficulty: Advanced. )