European Journal of Cardiovascular Medicine

Coronary artery aneurysm (CAA) is described as a localized dilatation of a coronary artery segment by more than 1.5-fold compared with the adjacent normal segments. The incidence of CAA varies from 0.3 to 5.3% with atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention (PCI) being the common etiologic factors. Owing to its varying presentation and absence of robust treatment guidelines, management of CAA is a challenge. Management of every patient must be tailored according to the presentation and expertise of the cardiac team available. Here, we present case reports of two patients with CAA who presented with acute coronary syndrome. As a result of unstable presentation, both patients underwent immediate intervention (CABG and PCI respectively) with successful revascularization having no complication and mortality.

Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. In addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.

'Brugada phenotype' on electrocardiogram (ECG) secondary to hyperkalemia is a known entity. However, 'Brugada phenotype' has rarely been documented secondary to tramadol usage and rhabdomyolysis. We present the case of a 25-years-old male doctor who was brought to the emergency room in a state of unconsciousness. His blood investigations showed acute kidney injury with elevated creatinine and urea. The former roommate found five used tramadol ampules, a bottle of normal saline, and intravenous (IV) sets in his room which gives the possibility of self• medication. The 'Brugada phenotype' appeared on ECG following 'Tramadol overdosage' and 'Exertional Rhabdomyolysis'. This ECG phenotype might very well be confused with ST-segment elevation myocardial infarction on ECG. After a dose of naloxone 1 mg IV, his ECG showed resolution of ST elevation in V1-V2 and he was managed medically along with daily haemodialysis. Brugada phenotype on ECG is a precursor for life-threatening arrhythmias.