Mhd Baraa Habib

Alkhanafsa M, et al. J Cardiovasc Interv. 2027 ;6:e12. https://doi.org/10.54912/jci.2026.0033

Myocarditis can closely mimic acute myocardial infarction (AMI), particularly in young patients without atherosclerotic risk factors. We report a 27-year-old man with recurrent severe chest pai7n, transient ST-segment elevations, and markedly elevated high-sensitivity troponin-T, in whom coronary angiography was repeatedly normal. Serial cardiac magnetic resonance and 18F-fluorodeoxyglucose positron-emission tomography revealed a migratory pattern of myocardial inflammation, with new lesions emerging as earlier ones resolved, fulfilling criteria for recurrent myocarditis. Recurrent oral ulcers, folliculitis, arthralgias, and pathergy-like skin reactions raised suspicion for Behçet’s disease. Treatment with vasodilators, colchicine, corticosteroids, and azathioprine produced sustained clinical and biochemical remission. This case highlights the importance of considering myocarditis in young patients with recurrent angina-like symptoms and normal coronaries, the value of serial multimodal imaging in detecting migratory inflammation, and the recognition of Behçet’s disease as a rare underlying cause of recurrent myocarditis.

While atherothrombosis accounts for the majority of acute coronary syndrome (ACS) cases, non-atherosclerotic mechanisms like coronary embolism are important considerations in end-stage renal disease (ESRD). A 52-year-old woman with ESRD and tertiary hyperparathyroidism presented with myocardial infarction. Echocardiography identified mobile mitral valve masses. Angiography showed a left anterior descending artery occlusion, but intravascular ultrasound revealed minimal plaque burden. Histopathological analysis of aspirated material confirmed calcified necrotic debris rather than thrombus. Despite concurrent COVID-19 infection, the rigid mechanical behavior of the masses during attempted percutaneous aspiration distinguished the pathology from infective endocarditis. This case highlights calcific coronary embolism as a rare ACS cause in ESRD patients. Multimodal imaging and histopathology are crucial for accurate diagnosis.

BackgroundAcute myocardial infarction complicated by cardiogenic shock (AMICS) carries a high mortality rate despite advances in reperfusion and supportive strategies. While intra-aortic balloon pump (IABP) support remains a widely used modality, the effect of fluid balance on outcomes in these patients remains uncertain.Methods This retrospective cohort study at a tertiary cardiac center in Qatar included patients with AMICS treated with IABP between 2012 and 2021. Participants were stratified by 72-hour cumulative fluid balance into positive (PCFB) and negative (NCFB) groups. The primary endpoint was a composite of all-cause 30-day mortality and multi-organ. Multivariable Cox and logistic regression models adjusted for clinical confounders.Results: Of 330 screened patients, 122 met eligibility criteria (62 PCFB; 60 NCFB; mean age 54 ± 10 years; 94% male). The composite outcome occurred in 71% of PCFB versus 37% of NCFB patients (adjusted hazard ratio [aHR] 2.59, 95% confidence interval [CI] 1.53-4.39; p<0.001). Each 1-litre increment in cumulative fluid balance was independently associated with the composite outcome (day 1 adjusted odds ratio [aOR] 1.40, 95% CI 1.03–1.81, p=0.032; day 2 aOR 2.06, 95% CI 1.53-2.77, p<0.001; day 3 aOR 2.50, 95% CI 1.64-3.79, p<0.001). All-cause mortality, mechanical ventilation, renal replacement therapy and VA-ECMO escalation were each more frequent in the PCFB group.Conclusion: Positive cumulative fluid balance within 72 hours of IABP initiation is independently associated with higher mortality and multi-organ failure. Early attention to fluid management may improve outcomes in AMICS.

Background: Oxymetazoline nasal spray is a widely used over-the-counter sympathomimetic decongestant. While generally safe at therapeutic doses, overdose can result in systemic vasoconstriction and potentially life-threatening cardiovascular complications. Case summary: We report the case of a previously healthy 27-year-old man who presented after an out-of-hospital cardiac arrest following excessive use of oxymetazoline nasal spray. He was found in ventricular fibrillation and required cardiopulmonary resuscitation and defibrillation. Post-resuscitation electrocardiogram showed transient ST-segment elevations, and cardiac biomarkers were markedly elevated. However, emergent coronary angiography revealed normal coronary arteries. Comprehensive cardiac evaluation, including cardiac magnetic resonance imaging and electrophysiologic studies, excluded myocardial infarction, myocarditis, myocardial fibrosis, and Brugada syndrome. The patient experienced prolonged neurological recovery but improved with rehabilitation. Discussion: Oxymetazoline overdose should be considered a potential cause of acute coronary syndrome, malignant arrhythmias, and cardiac arrest, even in young individuals without pre-existing cardiovascular disease. Clinician awareness and patient education on the safe use of sympathomimetic agents are essential for prevention.