Coronary artery spasm can result in acute coronary syndrome. This vasospastic syndrome can cause profound morbidity and mortality as a significant proportion of patients continue to have angina despite optimal medical therapy. We illustrate the dilemma in managing a young woman who presented with non ST-segment myocardial infarction as a result of it. She did not have the conventional risks for coronary artery disease except the family history of myocardial infarction. Vasospasm was demonstrated at the mid right coronary artery which resolved with intracoronary nitroglycerine during angiogram. Most women with no significant heart disease following demonstration of normal or “near normal” coronary arteries after angiography are offered no treatment beyond reassurance each year. New data suggest that this approach may no longer be appropriate and the prognosis in such patient is not as benign as previously thought. We discuss the management dilemma of such patient with associated mild atherosclerotic plaque.
Advances in neonatal care now enable more infants to be kept alive despite clear clinical evidence of inevitable or imminent death on a life-support system. It is therefore no longer acceptable to the society that a patient is left to die in the hospital, without any form of treatment or intervention. We report a case of severe birth asphyxia, hypoxic-ischemic encephalopathy, neonatal seizures and left cephalohematoma. In spite of initial successful resuscitation, the infant could not survive until all possible methods of treatment were exhausted. This case illustrates one of many examples of the process involved in dealing with ending of life decision in a condition considered as futile.
A 43-year-old man presented with acute extensive anterior ST-segment elevation myocardial infarction. During coronary angiogram, a segment of myocardial bridging was noted in the mid-segment of left anterior descending artery. The association of myocardial bridging and an anterior ST segment elevation is rarely reported in the medical literature. Myocardial bridging is caused by systolic compression of a coronary artery by overlying myocardium tissue. It is a rare coronary artery anomaly, which usually has a benign prognosis despite some case reports of myocardial ischemia leading to myocardial infarction, lethal arrhythmias and sudden cardiac death. We report one such case of myocardial bridging that was complicated with acute extensive anterior myocardial infarction.
The normal aortic valve has three leaflets, which are almost equal in size. A bicuspid aortic valve developed as a result of abnormal aortic cusp formation during early embryogenesis. Complications such as valvular stenosis or incompetence are well known. Delayed in identifying the congenital abnormality or the complications may cause morbidity and mortality. We report two cases of congestive cardiac failure as the results of undiagnosed bicuspid aortic valve with severe aortic incompetence. Both young men in their productive age without cardiac risk factors, were unfortunate to present too late. Although one of them was lucky to survive the ordeal, most late presentation ends up gravely. Aortic valve replacement can be offered if early detection is made. Those with severe disease at diagnosis may require a heart transplant.