Takotsubo or stress cardiomyopathy is a non ischemic disease affecting the myocardium, which presents with typical features of myocardial ischemia. Although the presentation with acute central chest pain and shortness of breath mimics acute myocardial ischemia, there is an absence of actual disruption of cardiac blood supply via the coronaries due to acute plaque rupture or vascular spasm. The underlying pathophysiology of this clinical entity remains largely unclear, but a definite association with physical or emotional stress has been well established, hence the term “stress cardiomyopathy.” The list of potential triggers continues to grow as the disorder is increasingly detected by clinicians and cardiologists, with better clinical insight and improved availability of cardiac investigations. We report a patient with Takotsubo cardiomyopathy associated with severe hyponatremia.

We report the case of a 20-year-old female splenectomised thalassaemia major patient with severe iron overload, who presented with life threatening sepsis associated with a liver abscess. Her clinical course was complicated with an intra cardiac thrombus. 2D echocardiogram and Contrast Enhanced Computed Tomography (CECT) chest revealed a large oscillating mass in right atrium extending from the left hepatic vein through the inferior vena cava. After a prolonged Intensive Care Unit (ICU) stay supported with antibiotics and anticoagulation she had a good clinical recovery with evidence of resolution of the intra cardiac thrombus.

Clozapine is known to cause innocuous as well as severe and or fatal cardiovascular side effects. These side effects are commonly reported at the initiation of clozapine therapy. We report a patient who was stable on clozapine for several years but in whom we had to withhold clozapine for medical reasons and subse-quently developed significant hypotension and heart rate changes when rechallenged with a small dose of clozapine.

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Background . Long term quality of recovery following percutaneous coronary intervention in Sri Lanka are unknown. We evaluated quality of recovery at one year, compliance with secondary prevention medications and access to and uptake of cardiac rehabilitation services. Methods . The GRACE Risk Model was used to compare predicted and actual mortality at hospital discharge and at one-year. Quality of recovery was assessed by the Seattle Angina Questionnaire. Compliance with secondary prevention therapy was assessed using international guidelines. Access to cardiac rehabilitation was assessed via telephone- administered interview. Results . Between April 2017 and March 2018, 699 consecutive patients underwent percutaneous coronary intervention. Mortality at one year was 13.6% (93); predicted mortality was (4.5–11%). Functional activity was significantly worse at one year 64.4 (75.6–55.6) compared to pre-admission (100, 100 − 84.4) (P-value < 0.01). Frequency of angina was greater at one year (80, IQR = 100 − 60), compared with 1-month post-discharge (100[IQR = 100 − 80], P-value < 0.01). Stability of angina remained unchanged (median[IQR] = 72[100 − 50]). Patients’ perceptions of treatment satisfaction were high (P-value < 0.01), disease perceptions worsened (P-value < 0.01). Self-perceived compliance with secondary prevention therapy ranged from 75%-82%. Of the 362 patients followed up 146 (44.5%) reported being offered the opportunity to attend cardiac rehabilitation; 128 (87.7%) attended. Conclusions . Outcomes at one year were poorer than expected. Patient-reported levels of satisfaction were high, despite worsening burden of symptoms. Research is needed to better understand patients' expectations of quality of acute myocardial infarction care.