Stress cardiomyopathy, takotsubo cardiomyopathy, is a syndrome characterized by transient regional left ventricular dysfunction in the absence of significant coronary artery disease. Possible pathogenic mechanisms include catecholamine excess, microvascular dysfunction, and multivessel coronary artery spasm. The diagnosis should be suspected in adults who present with a suspected acute coronary syndrome when the clinical manifestations are out of proportion to the degree of elevation in cardiac biomarkers. A physical or emotional trigger is often but not always present. Wall motion abnormalities in patients with stress cardiomyopathy are typically the apical type, and atypical variants including mid-ventricular, basal, focal, and global types. The differential diagnosis of stress cardiomyopathy includes acute coronary syndromes, coronary artery spasm, myocarditis, and pheochromocytoma. A high index of suspicion is key in the diagnosis and management.

Presence of right ventricular infarction imposes a higher risk of adverse events in inferior wall myocardial infarction. Presence of right ventricular myocardial infarction imposes an increased risk of shock, arrhythmia and death in inferior wall myocardial infarction. In this study, we attempted to correlate various indices of right ventricular function assessed by echocardiography with presence of a proximal right coronary artery stenosis  in patients with acute inferior  wall myocardial infarction. A case-control study performed on thirty patients with inferior myocardial infarction and twenty control are enrolled in the study.

Pulmonary Alveolar Proteinosis PAP is a rare pulmonary disease characterized by alveolar accumulation of surfactant.  The Primary PAP accounts for approximately 90% of all cases and appears to be mediated through a circulating neutralizing antibody (anti granulocyte macrophage colony stimulating factor and immunoglobulin neutralizing immunoglobulin G antibody).

The reported incidence is 1:300,000 persons in the United States.  Pulmonary Alveolar Proteinosis occurs in 3 clinically distinct forms: congenital, secondary and acquired. Acquired Pulmonary Alveolar Proteinosis may be due to inhalational exposure, hematologic cancers, immune deficiency or medications.

Cardiac Resynchronization Therapy (CRT) is the established management for HF patients with LV systolic dysfunction and signs of electrical dyssynchrony. Some patients after CRT implantation become ‘super-responders’. Our proposed definition of super-responders is patients with an increase LVEF of ≥15% and an improvement of (NYHA) functional class (at least 1 class). The aim of our study was to identify predictors of being a super-responder to CRT in our population.

Thirty five consecutive patients underwent CRT for a period of one year were studied prospectively. Before and 3months after implantation clinical, electrocardiographic and echocardiographic evaluations were performed. At the 3 months follow-up, patients were classified as ‘super-responders’.

Of the 35patients, there were17.1%super-responders. At baseline, there were some significant differences between super-responders and the other patients that they had significantly smaller LV end-diastolic diameter (65.4±6.4vs.73.4±9.3mm,P=0.001), smaller degree of MR(mean 1.9±0.9vs.2.6+0.8,P=<0.001), smaller left atrium (42.8±4.6vs.50.0±6.5 mm, P < 0.001), a shorter duration of HF symptoms (months; 15.1±17.8vs.33.9±35.7,P=0.01) and they all had non-ischemic cardiomyopathy. After 3 months, we observed a significant improvement of NYHA functional class, LVEF, LV diameters, MR grade in both groups. Regarding the magnitude of response LV diameters, LVEF showed a significantly greater improvement in super-responders. In the multivariate logistic regression analysis, MR grade, LVEDD and the duration of symptoms for <12 months were independent predictors of super-response to CRT.

Location anomaly of coronary arteries, so called myocardial bridge (MB) first was described by Reyman in 1737.  According to the literature, anomaly frequency on autopsy varies from 7% to 85%, while on angiography just 0.5%-12%. We have diagnosed and treated 355 symptomatic patients with MB. ECG data, angiograms and intraoperative findings were compared. We have identified an informative ECG signs that allow us to suspect the presence of MB. 330 (92.9%) patients had sinus rhythm, 15 (4.2%) had atrial fibrillation, atrial fluttering appeared in 6 (1.6%) and 4 (1.1%) patients had rhythm migration. The heart rate range was 43 to 169 beats per minute with average of 68. For 281 of patients (79.1%) we noticed left ventricular (LV) hypertrophy, 329 patients (92.6%) had different signs of chronic coronary insufficiency. In 27 cases (7.6%) left bundle branch block (LBBB) was founded. In 71 patients (20%) we found focal changes in the anterior wall of LV. 18 patient (5.07%) had acute ischemia, 3 (0.84%) patients had acute Q-MI, 61 patients (17.1%) had ruptures. Ruptures localization were as following: 29 (47.5%) on anterior-septal wall of LV, 21 (34.4%) on the posterior wall of LV and 11 (18.03%) on apical-lateral area of LV. The transient change in the depth of inverted T wave in left precordial leads was noticed due to the dynamic nature of compression of the coronary artery.

Heart Failure (HF) is a chronic disease that is known to be an expensive diagnosis due to the associated healthcare cost related to management.  As the incidence of HF continues to increase in our society it is imperative that current interventions are improved to help improve the management. The purpose of this retrospective chart review will be to test the feasibility of an outpatient intravenous diuretic clinic at a community hospital. The study will evaluate patients admitted for HF that would have been idealistic for an outpatient intravenous diuretic clinic based on a specified inclusion criterion. The studied included 100 charts that were reviewed of which the results indicate that 41% of the patients would qualify for an outpatient diuretic clinic. Inclusion criterion includes length of stay of equal to less than three days, no significant acute kidney injury, and disposition to home. When compared to the average cost of HF management the chart review indicates that avoided hospitalizations could result in a saving of over $485,440.  The results of this chart review indicate that an outpatient diuretic clinic is a safe, efficient, and cost-effective intervention.