From the existing body of literature regarding this patient population, it is unclear why there is a higher incidence of adverse myocardial events. It may be that coronary ischemia has been missed in patients with preeclampsia. Troponin I is now readily available for detection of myocardial damage and should be used in this patient population only when clinically indicated, such as when chest discomfort or new electrocardiogram changes are observed. Patients with preeclampsia may be at higher risk for coronary events, and troponin I levels could be a valuable tool with which to monitor women who develop related symptoms.

We describe a patient with limited systemic sclerosis who presented with a large pericardial effusion with tamponade on echocardiogram, requiring pericardiocentesis to drain 1.2 l of fluid. She had a rapid re-accumulation of pericardial fluid and subsequently required a pericardial window. Although small pericardial effusions are common in patients with systemic sclerosis it is rare to have hemodynamic compromise. Previously reported large pericardial effusions have been seen in patients with pulmonary hypertension and renal failure however these were absent in our patient.

A 66-year-old female was brought to the emergency department for acute-onset left-sided chest pain. Prior to arrival, she was at an outpatient appointment with a vascular surgeon for elective sclerotherapy treatment of her lower extremity varicose veins. After receiving an IV injection of polidocanol, she developed severe chest pain with left arm and jaw numbness for the first time in her life. Upon arrival to the ED, the patient reported that her symptoms had resolved. Electrocardiogram (ECG) on presentation was significant for T-wave inversions in leads V1-V3. An initial set of cardiac enzymes showed a troponin I level of 0.62 ng/mL, which subsequently increased to 2.26 ng/mL. Her echocardiogram was significant for mild left ventricular systolic dysfunction with apical hypokinesis (ejection fraction 50%). A repeat ECG showed new T-wave inversions compared to that from the time of admission. The patient eventually agreed to cardiac catheterization, which revealed patent vessels without coronary artery disease, supporting our diagnosis of Takotsubo syndrome and what is the first reported case of likely polidocanol-induced Takotsubo syndrome in the United States.

Myocardial infarction (MI) is associated with complications in spite of appropriate management. The incidence of mechanical complications declined over time secondary to reperfusion therapies, improved control of blood pressure, the use of beta blockers and angiotensin-converting enzyme inhibitors, and aspirin. A high degree of suspicion is required, especially in elderly patients with complications post-PCI (percutaneous coronary intervention). Herein, we present a case of elderly male diagnosed with an inferior wall MI who had a PCI. He was found to have a post-infarction ventricular septal rupture (VSR) and basal inferior wall aneurysm that progressed over three weeks to a myocardial free wall rupture with hemopericardium. This case emphasizes the need for close monitoring of complications.

No abstract