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 Acute Coronary Syndrome with ST Segment Elevation: New Electrocardiographic Pattern A 58-year-old man with a history of hypertension and diabetes, presented to the emergency department (ED) after 2 hours of oppressive, severe chest pain radiating to the left arm and associated with dyspnea. Upon arrival he was stable, an ECG was performed that demonstrated an isolated elevation of the J point in DIII, with depression of the J point in DI, DII, AVL, V4 to V6, with isoelectric ST segment in AVF. Troponine was not expected because an ST equivalent pattern was suspected. Should the patient be treated for an acute coronary syndrome with elevation of the ST or non-ST elevation based on the ECG findings? Acute Coronary Syndrome with elevation of the inferior ST segment. The ECG in Figure 1 shows an isolated elevation of the J point in DIII without concomitant elevation of the contiguous derivatives in the inferior face (subtle under-elevation of the J point in DII and isoelectric ST segm...

 Large Coronary Intramural Hematoma Presenting as Acute Coronay Syndrome Isolated spontaneous coronary intramural hematoma is characterized by a hemorrhage limited to the media–adventitial layers, causing subsequent hematoma formation without visible intimal flaps. Spontaneous isolated intramural hematoma may occur in the absence of associated intimal dissection. It is an infrequent and serious coronary vessel wall pathology with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both diagnostic and treatment strategy. We report a case of intramural coronary hematoma in a patient presenting with non ST-segment elevation myocardial infarction. Spontaneous coronary intramural hematoma in major epicardial coronary vessels is a rare cause of chest pain. The hematoma formation i...

 Unusual presentation of a patent ductus arteriosus: A case report A 48 years old patient, with no medical history was referred to the cardiovascular surgeon of our department for a right medio-ventricular resection diagnosed after 2 episodes of syncope. The transthoracic echocardiography revealed a severe RV hypertrophy with aspect of sub-pulmonary stenosis. An invasive hemodynamic assessment was performed and concluded to a severe Pulmonary arterial hypertension. During the invasive right cardiac exploration, the catheter run easily into an unknown large patent ductus arteriosus (PDA). PDA in adults is an extremely rare clinical phenomenon since it is usually discovered and treated during childhood. However, physicians need to be aware of potential situations, signs and symptoms that might suggest a previously undiagnosed PDA. Although few epidemiological data are available on the relationship between adult congenital heart disease and pulmonary arterial hypertension (PAH), a Eur...