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1.  Eosinophilic myocarditis: two case reports and review of the literature 
BMC Research Notes  2013;6:538.
Background
Eosinophilic myocarditis is a rare and often under-diagnosed subtype of myocarditis with only around 30 cases published in the medical literature. In this article we present two patients with eosinophilic myocarditis with the aim to demonstrate the often elusive nature of the disease and present the current scientific literature on this topic.
Case presentation
A 76 years old Caucasian gentleman and a 36 years old Aboriginal gentleman both presenting with heart failure symptoms were eventually diagnosed with eosinophilic myocarditis after extensive evaluation. Their presentation, assessment, and medical management is explored in this article.
Conclusions
Eosinophilic myocarditis remains a rare and likely under-diagnosed subtype of myocarditis. The key features of this disease include myocardial injury in the setting of non-contributory coronary artery disease. Endomyocardial biopsy remains the definitive gold standard for diagnosis of noninfectious eosinophilic myocarditis. Non-invasive cardiac imaging in the setting of peripheral eosinophilia can be strongly suggestive of eosinophilic myocarditis with potential for earlier diagnosis. Failure to diagnose eosinophilic myocarditis and the delay of therapy may lead to irreversible myocardial injury. Therapies for this disease have yet to be validated in large prospective studies.
doi:10.1186/1756-0500-6-538
PMCID: PMC3878496  PMID: 24344829
Eosinophilia; Myocarditis; Endomyocardial; Biopsy
2.  Spontaneous dissection of the coronary and vertebral arteries post-partum: case report and review of the literature 
Background
Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period.
Case presentation
This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery.
Conclusion
We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.
doi:10.1186/1471-2393-12-122
PMCID: PMC3495043  PMID: 23121892
Spontaneous dissection; Vasculature; Pregnancy; Imaging
3.  Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report 
BMC Research Notes  2012;5:583.
Background
Ventricular septal rupture (VSR), a mechanical complication following an acute myocardial infarction (MI), is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE) with color flow Doppler and cardiac MRI (CMR) are reliable tests for the non-invasive diagnosis of VSR.
Case presentation
A 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography.
Conclusion
We review the presentation, diagnosis and management of VSR post MI.
doi:10.1186/1756-0500-5-583
PMCID: PMC3505164  PMID: 23098382
Echocardiography; Cardiac Mri; Ventricular septal rupture
4.  A complex dissected chronic occlusion: targeted balloon dilatation of false lumen to access true lumen, combined localized subintimal tracking and re-entry, parallel wire, contralateral injection and a useful antegrade lumen re-entry technique 
Heart International  2012;7(1):e7.
Chronic total occlusion (CTO) angioplasty is one of the most challenging procedures remaining for the interventional operator. Recanalizing CTOs can improve exercise capacity, symptoms, left ventricular function and possibly reduce mortality. Multiple strategies such as escalating wire, parallel wire, see-saw, contralateral injection, subintimal tracking and re-entry (STAR), retrograde wire techniques (controlled antegrade retrograde subintimal tracking, CART), reverse CART, confluent balloon, rendezvous in coronary, and other techniques have all been described. Selection of the most appropriate approach is based on assessment of vessel course, length of occluded segment, presence of bridging collaterals, presence of bifurcating side branches at the occlusion site, and other variables. Today, with significant operator expertise and the use of available techniques, the literature reports a 50–95% success rate for recanalizing CTOs.
doi:10.4081/hi.2012.e7
PMCID: PMC3366303  PMID: 22690300
percutaneous coronary intervention; chronic total occlusion.
5.  An unusual presentation of left ventricular free wall rupture 
The Canadian Journal of Cardiology  2010;26(8):e328-e329.
Left ventricular free wall rupture (LVFWR) is one of the most lethal complications following myocardial infarction. It accounts for approximately 12% to 21% of all in-hospital deaths following myocardial infarction. The majority of patients die shortly after LVFWR from instantaneous pericardial tamponade and hemodynamic collapse. However, up to one-third of cases are subacute in nature, allowing limited time for emergent surgical repair to prevent sudden death. A high index of suspicion and timely use of diagnostic tests are important in recognizing cases. The present report describes the case of a 69-year-old man who initially presented with acute pericardial tamponade and was subsequently diagnosed with LVFWR in the operating room as the cause of his hemopericardium. The pathology, diagnosis and management of LVFWR are reviewed.
PMCID: PMC2954544  PMID: 20931104
Echocardiography; Hemopericardium; Mechanical complications; Myocardial infarction
6.  A case of circumferential multi-vessel coronary intramural hematoma in a post-menopausal woman 
Heart International  2011;6(2):e10.
Spontaneous coronary dissections are a well described entity which are often difficult to treat. Intramural hematoma is one type of coronary dissection. Previous case reports have described the treatment for angiographically visible dissection. We describe the first report of diffuse intramural hematoma visualized only on intravascular ultrasound with no angiographically obvious evidence of dissection treated with multivessel drug eluting stenting. This case highlights the importance of a high level of suspicion and atypical presentations of coronary dissection, and the use of multimodality imaging with intravascular ultrasound and computerized tomography for both diagnosis and therapy.
doi:10.4081/hi.2011.e10
PMCID: PMC3205786  PMID: 22049309
PCI; IVUS; CT; intramural hematoma.
10.  Clinical utility of tissue Doppler imaging in patients with acute myocardial infarction complicated by cardiogenic shock 
Background
Echocardiography is widely used in the management of patients with cardiogenic shock (CS). Left ventricular ejection fraction (EF) has been shown to be an independent predictor of survival in CS. Tissue Doppler Imaging (TDI) is a sensitive echocardiographic technique that allows for the early quantitative assessment of regional left ventricular dysfunction. TDI derived indices, including systolic velocity (S'), early (E') and late (A') diastolic velocities of the lateral mitral annulus, are reduced in heart failure patients (EF < 30%) and portend a poor prognosis. In CS patients, the application of TDI prior to revascularization remains unknown.
Objective
To characterize TDI derived indices in CS patients as compared to patients with chronic CHF.
Methods
Between 2006 and 2007, 100 patients were retrospectively evaluated who underwent echocardiography for assessment of LV systolic function. This population included: Group I) 50 patients (30 males, 57 ± 13 years) with chronic CHF as controls; and Group II) 50 patients (29 males, 58 ± 10 years) with CS. Spectral Doppler indices including peak early (E) and late (A) transmitral velocities, E/A ratio, and E-wave deceleration time were determined. Tissue Doppler indices including S', E' and A' velocities of the lateral annulus were measured.
Results
Of the entire cohort, the mean LVEF was 25 ± 5%. Cardiogenic shock patients demonstrated significantly lower lateral S', E' and a higher E/E' ratio (p < 0.01), as compared to CHF patients. The in-hospital mortality in the CHF cohort was 5% as compared to the CS group with an in hospital mortality of 40%. In the subset of CS patients (n = 30) who survived, the mean S' at presentation was higher as compared to those patients who died in hospital (3.5 ± 0.5 vs. 1.8 ± 0.5 cm/s).
Conclusion
Despite similar reduction in LV systolic function, CS patients have reduced myocardial velocities and higher filling pressures using TDI, as compared to CHF patients. Whether TDI could be a reliable tool to determine CS patients with the best chance of recovery following revascularization is yet to be determined.
doi:10.1186/1476-7120-6-11
PMCID: PMC2311277  PMID: 18355412

Results 1-10 (10)