Adult patients with congenital heart disease have now surpassed the pediatric population due to advances in surgery and improved survival. One such complex congenital heart disease seen in adult patients is the Fontan circulation. These patients have complex physiology and are at risk for several complications, including thrombosis of the Fontan pathway, pulmonary vascular disease, heart failure, atrial arrhythmias, atrioventricular valve regurgitation, and protein-losing enteropathy. This review discusses the commonly encountered phenotypes of Fontan circulatory failure and their contemporary management.

This chapter presents multiple-choice question-and-answers on the topic of heart disease and pregnancy in cardiology. It is written for the primary purpose of helping candidates prepare for the American Board of Internal Medicine subspecialty certification. It will be very useful for those preparing for initial and recertification exams in Cardiology. Each of the questions is followed by few answers to choose from and the discussions address not only the rationale behind picking the right choice, but also fills in information around the topic so that important key concepts are clearly laid out. The questions address all areas of cardiology, some of which include: physical examination, ECG section with high resolution images, and non-invasive and invasive imaging. The chapter also facilitates comprehensive and critical review of cardiovascular medicine to enhance one's diagnostic and therapeutic skills.

This chapter presents multiple-choice question-and-answers on the topic of cardiac catheterization in cardiology. It is written for the primary purpose of helping candidates prepare for the American Board of Internal Medicine subspecialty certification. It will be very useful for those preparing for initial and recertification exams in Cardiology. Each of the questions is followed by four answers to choose from and the discussions address not only the rationale behind picking the right choice, but also fills in information around the topic so that important key concepts are clearly laid out. The questions address all areas of cardiology, some of which include: physical examination, ECG section with high resolution images, and non-invasive and invasive imaging. The chapter also facilitates comprehensive and critical review of cardiovascular medicine to enhance one's diagnostic and therapeutic skills.

Background Perivascular epithelioid cell tumours (PEComas) are rare soft tissue neoplasms that commonly occur in the uterus, skin, and liver and less commonly in the retroperitoneum, colon, and mediastinum.Case summary A 36-year-old male patient with a history of mediastinal PEComa status post resection, essential hypertension, and atrial fibrillation status post appendage ligation currently not on anticoagulation presented with a 1-week history of fevers, chills, productive cough, chest pain, dyspnoea on exertion, loss of appetite, and general weakness. Vital signs, physical exam, laboratory data, electrocardiogram, and chest radiograph were grossly unremarkable. A multimodality imaging approach utilizing transthoracic echocardiogram, transoesophageal echocardiogram (TEE), cardiac magnetic resonance imaging (cMRI), and computed tomography angiography of the chest, abdomen, and pelvis revealed a local 40 mm x 53 mm globular bilobed vascularized scar-free posterior mediastinal mass arising from the roof of the left and right atria and extending superiorly to the main pulmonary artery and inferiorly to the inferior vena cava. Based on the mass' size and proximity to vital structures and tumour recurrence, the case was presented during tumour board rounds, and the outcome was to surgically resect the mass and then have the patient follow up with medical oncology and radiation oncology for possible chemotherapy and radiation, respectively.Discussion Perivascular epithelioid cell tumours are rare, and mediastinal PEComas are even rarer, warranting a multimodality imaging approach involving TEE and cMRI and a multidisciplinary approach involving anaesthesiologists, cardiologists, cardiothoracic surgeons, medical oncologists, pathologists, radiologists, and radiation oncologists.

Ischemic heart disease, a major risk factor for myocardial infarction (MI), occurs when the blood vessels supplying oxygen-rich blood to the heart become partially or fully occluded by lipid-rich plaques, resulting in myocardial cell death, remodeling, and scarring. In addition, MI occurs as result of lipid-rich plaque rupture, resulting in thrombosis and vessel occlusion. Cardiac fibroblasts (CFs) and CF-derived growth factors are crucial post-MI in myocardial remodeling. Information regarding the regenerative phenotypes of CFs is scarce; however, regenerative CFs are translationally relevant in myocardial regeneration following MI. The emerging technologies in regenerative cardiology offer cutting-edge translational opportunities, including synthetic cells. In this review, we critically reviewed the current knowledge and the ongoing research efforts on application of synthetic cells for improving cardiac regeneration post-MI. Impact statement Synthetic cells offer tremendous regenerative potential in otherwise deleterious cardiac remodeling postmyocardial infarction. Understanding the role of fibroblasts in cardiac healing and the therapeutic applications of synthetic cells would open a multitude of novel cardiac regenerative approaches. The novel concept of synthetic fibroblasts that emulate native cardiac fibroblasts can provide an effective solution in cardiac healing.

This chapter provides cardiologists and cardiology/echocardiography trainees with case-based questions and figures regarding aortic diseases. It includes clear explanations and discussions for every question. Reviewing these questions and answers helps trainees to successfully prepare for the ABIM Cardiology Board Review examination. The conditions affecting the aorta include hypertension, atherosclerosis, genetic conditions, trauma, inflammatory and mural thrombi. Myocardial infarction in ascending aortic dissection is due to involvement of coronary arteries, with the right coronary more commonly involved than the left coronary with incidence rate 1-2%. Thrombolytics are absolutely contraindicated, as mortality increases to over 70%, mostly due to bleeding into the pericardial sac causing pericardial tamponade. Pleural effusion in ascending aortic dissection is caused by blood from rupture and fluid from inflammation around the aorta. More commonly in the left hemithorax. Rupture and dissection are the most dreaded complication.