Ivabradine is used to control heart rate in patients of heart failure with reduced ejection fraction. Although considered safe, it is reported to prolong QTc interval when given with other QTc prolonging drugs or in setting of hypokalemia or hypomagnesemia. Ivabradine causing isolated QTc interval prolongation without any provoking condition is rare. Our patient developed Torsades de Pointes after initiating Ivabradine and her QTc interval reduced after stopping Ivabradine. This may be due to a potential independent dose dependent effect of Ivabradine on QTc interval by its effects on its effects on human Ether-à-go-go-Related Gene (hERG) potassium channels.
Background: Mucormycosis is an invasive fungal infection most commonly seen in immune compromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immune competent individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient with disseminated Mucormycosis who presented as rhino orbital Mucor mycosis with pericardial involvement. Case summary: A 17-year-old female presented with intermittent high-grade fever of 1 month duration. She was diagnosed as Rhino orbital Mucormycosis as evidenced by MRI brain and orbits and biopsy of maxillary sinus. Patient underwent left endoscopic debridement of sinuses and left endoscopic Denker's procedure with left orbital decompression and was treated with Amphotericin B subsequently. During the course of hospitalisation, patient developed large pericardial effusion with cardiac tamponade secondary to invasive mucor infection as evidenced by pericardial fluid culture. Conclusion: Disseminated Mucor mycosis is a rare condition that involves two or more non-contiguous organ systems. Disseminated Mucor mycosis is the least common and the worst prognosis type, and it mostly starts with lesions in the lungs and then disseminates to other sites. Cardiac dissemination of rhino orbital Mucor mycosis, like in our case, is unusual and often diagnosed post-mortem; an antemortem diagnosis is very rare. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease and a strong index of suspicion is necessary for prompt treatment, especially in high-risk patients.
A Patent Foramen Ovale (PFO) with paradoxical right to left shunt is a well-known culprit for conditions like cryptogenic stroke, migraine and de-compression sickness. Till date, there is scanty data on the relationship between right to left PFO shunt and vertigo. Our case highlights the importance of high level of suspicion for coexistence of paradoxically shunting PFO in patients with unexplained dizziness and paroxysmal vertigo.
The Society of Cardiovascular Angiography and Intervention (SCAI) classified cardiogenic shock (CS) into five stages ranging from A-E. There remains significant ambiguity regarding the assessment and management of SCAI Stage B. Given its nebulous nature that can rapidly escalate, prompt interventions are needed. Here, we describe the trajectory of cases that presented with SCAI Stage B CS.
A 32-year-old man presented with recurrent ventricular tachycardia and peripheral eosinophilia. Echocardiogram showed features suggestive of infiltrative cardiomyopathy. A hybrid PET/MR demonstrated the characteristic features of myocarditis, the absence of extra-cardiac FDG uptake, and an endomyocardial biopsy showed the features of eosinophilic myocarditis.
