Abstract Background Coronary artery anomalies are rare congenital defects that often remain undetected due to their asymptomatic nature. However, in certain cases, they represent an important cause of sudden cardiac death (SCD), particularly among younger individuals with low to intermediate risk factors for coronary artery disease. Case summary We report the case of a 35-year-old woman who presented to the cardiology outpatient clinic with intermittent typical anginal chest pain. Despite having a low-to-moderate risk profile for ischaemic heart disease, limited to well-controlled hypertension and hypercholesterolaemia, further evaluation with computed tomographic coronary angiography (CTCA) revealed an anomalous right coronary artery (RCA) originating from the left coronary sinus with a malignant course. An exercise stress echocardiogram demonstrated ischaemic electrocardiographic (ECG) changes in the absence of physical symptoms. Her cardiovascular risk factors were managed with medications; however, due to evidence of inducible ischaemia, she was referred to a tertiary Adult Congenital Heart Disease centre for ongoing surveillance and consideration of appropriately timed surgical intervention. Conclusion Although rare, anomalous coronary artery disease may represent a significant cause of angina in younger patients. A thorough clinical history remains essential in identifying this condition and facilitating potentially life-saving management.
Abstract Background Anti-Kv1.4 antibody-associated myocarditis is an extremely rare condition and its optimal long-term management remains unclear. Case Summary A 66-year-old woman presented with myasthenia gravis-like symptoms, marked creatine kinase elevation, leukopenia, and hypogammaglobulinaemia. She developed acute myocarditis with ventricular arrhythmias and a reduced left ventricular ejection fraction. Intravenous immunoglobulin and corticosteroid therapy resulted in rapid clinical and cardiac improvement. During cautious tapering of oral prednisolone, she was readmitted with febrile neutropenia and subsequently developed progressive ventricular dysfunction and cardiogenic shock. Cardiac magnetic resonance imaging demonstrated extensive myocardial fibrosis, and autopsy revealed diffuse lymphocytic infiltration. Postmortem testing confirmed positivity for anti-Kv1.4 antibodies. Discussion This case highlights the potentially fatal course of suspected anti-Kv1.4 antibody-associated inflammatory myocardial disease despite an initial favourable response to immunosuppressive therapy. It illustrates the diagnostic and therapeutic challenges of distinguishing immune-mediated progression from other causes of myocardial injury and implies the need for individualised long-term management strategies.
Abstract Background Cardiac myxomas are the most common primary cardiac tumors. While they can present with embolic events, catastrophic embolization causing acute limb ischemia is rare. Case Presentation A 63-year-old gentleman with no significant medical history presented with acute bilateral lower limb weakness, abdominal pain and atrial fibrillation (AF). Examination revealed signs of acute limb ischemia. Point-of-care ultrasound (POCUS) suggested an aortic thrombus, which was confirmed on urgent computed tomography (CT) angiography. CT revealed not only extensive thrombus in the aorto-iliac, renal, and mesenteric arteries, but also a 2.2 cm left atrial mass. The patient underwent emergency bilateral femoral embolectomy. Histology of the retrieved emboli confirmed a cardiac myxoma. Subsequent cardiac magnetic resonance imaging (MRI) characterized a 2.4cm left atrial mass, with features classical for myxoma. The patient underwent successful surgical excision of the tumor, an EnCompass MAZE procedure, and left atrial appendage closure. His postoperative course was complicated by fast atrial flutter but he made a full neurological recovery. At three-month follow-up, his left ventricular ejection fraction (LVEF) improved from 28% to 50% after satisfactory rate control with no residual mass or neurological deficits. Conclusions This case illustrates a rare presentation of left atrial myxoma with catastrophic systemic embolization. The concurrent AF should not prematurely terminate the diagnostic workup. Clinicians must routinely screen for occult cardiac embolic source via rapid imaging (e.g. POCUS and echocardiography) and secure definitive diagnosis through other advanced imaging and histopathology of the surgical specimen. Ultimately, a thorough diagnostic approach is essential to pave the way for prompt, multidisciplinary intervention that maximizes neurological and myocardial recovery. Given the risk of tumor recurrence, lifelong follow-up is mandatory.
Abstract Background Cardiac involvement in Plasmodium falciparum malaria is uncommon, and the combination of severe left ventricular (LV) systolic dysfunction and LV apical thrombus formation is rarely reported. We describe a young man with confirmed falciparum malaria who developed severe LV systolic dysfunction and two LV apical thrombi in a resource-limited setting. Case summary A previously healthy 23-year-old man from a malaria-endemic rural coastal region presented with febrile illness and subsequently developed progressive dyspnoea and acute decompensated heart failure. Peripheral blood smears repeatedly demonstrated P. falciparum ring forms. Echocardiography showed severe global LV systolic dysfunction, with an estimated LVEF of 16.9–19%, LV dilatation, and two mobile LV apical thrombi. Intravenous artesunate followed by oral artemether–lumefantrine was administered, together with diuretic therapy, guideline-directed heart failure treatment, and therapeutic anticoagulation. At 1-month follow-up, LVEF had increased to approximately 30%, and the previously visualised thrombi were no longer detected, although complete resolution could not be confirmed because contrast-enhanced echocardiography and cardiac magnetic resonance imaging were unavailable. During later follow-up, a small popliteal arterial thrombus was identified, and rivaroxaban was increased to 20 mg once daily. Discussion Severe LV systolic dysfunction and intracardiac thrombus formation may occur during falciparum malaria. In resource-limited settings, delayed antimalarial treatment and limited access to advanced cardiac imaging may complicate diagnosis, management, and assessment of causality.
