Jennie Han

Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac condition, often caused by mutations in genes encoding desmosomal proteins. The pathologic hallmark of the disease is a fibrofatty replacement of the myocardium, which constitutes the substrate for potentially fatal ventricular arrhythmias. ACM is one of the most common etiology of sudden cardiac death in athletes and young individuals. Although it is well established that regular exercise confers multiple health benefits and better survival in the general population, intense exercise may accelerate the phenotypic expression and the propensity to ventricular arrhythmias in patients with ACM. This review discusses current evidence regarding the safety and the effects of exercise in ACM. We scrutinize research findings based on animal and human models that raise concerns on the possible detrimental role of intense exercise in this condition. Finally, we examine the current knowledge on exercise prescription focusing on the optimal amount of exercise that should be recommended to patients with ACM.

Chronic wounds occur as a result of a disordered healing process. They can be associated with complications such as chronic pain and infection, but also rarely lead to malignant transformation. There have been few cases of squamous cell carcinomas arising in a surgical wound. We present the case of a 67-year-old patient who developed an advanced invasive squamous cell carcinoma seven years post laparostomy for abdominal compartment syndrome. Surgical resection was not possible due to the advanced stage of the malignancy. This case highlights the importance of good wound care, suspecting malignant development in a non-healing chronic surgical wound site, and the importance of using histological analysis to inform surgery when involving a chronic wound.

The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions.

An 82-year-old man presented to the emergency department with delirium, vomiting and an initial hyponatraemia of 112 mmol/L the day after successful transurethral vaporisation of the prostate. He had a tonic-clonic seizure in the acute surgical unit and was managed subsequently in the intensive care unit with a controlled rate of hypertonic saline. Initial work-up for the cause of hyponatraemia revealed a low urine osmolality, suggestive of relative excess water intake. Detailed examination of the operation notes revealed no discrepancy between intraoperative irrigating fluid input and output. Careful collateral history revealed that the patient had drunk 8 L of water in the 24 hours following the operation, after taking advice to ‘drink plenty of water’ literally. This case highlights the importance of conveying specific advice to patient, the lower incidence of transurethral resection syndrome in resections using saline as an irrigation fluid and outlines the pathway for investigation and management for hyponatraemia.

Background: Apical hypertrophic cardiomyopathy (AHCM) is a relatively rare variant of hypertrophic cardiomyopathy. The condition is associated with numerous clinical and electrocardiogram (ECG) features, some of which are well documented in the literature. Case Presentation: We present a case of a 77-year-old female who presented with a syncopal episode. Her ECG showed lateral ST segment elevation and her cardiac biomarkers were not in keeping with a myocardial infarction. She was diagnosed with AHCM based on characteristic findings on echocardiography. The association between AHCM and lateral ST segment elevation is one that has only been described in a handful of cases in literature. Conclusion: The authors hope that in presenting this case we can add to the body of literature and remind readers to be aware of the possibility that lateral ST segment elevation may be an indicator of AHCM, especially when this electrocardiographic feature occurs in the absence of the other well-known causes of ST segment elevation.

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

Key Clinical Message. Tension pneumothorax is an uncommon presentation in patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) or COVID-19 pneumonia. We present a case of tension pneumothorax in a patient with COVID-19 pneumonia and myocarditis. This was an unlikely diagnosis in a patient with no known underlying lung condition and no other precipitating factors such as barotrauma. In an acute deterioration of patients with SARS-CoV-2, it is important to always consider alternative diagnoses and repeat imaging.