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The following electronic only articles are published in conjunction with this issue of Heart.
Takayasu’s arteritis: management of left main stem stenosis
I S Malik, O Harare, A AL-Nahhas, K Beatt, J Mason
Takayasu arteritis is a chronic vasculitis involving the aorta and its main branches, the pulmonary arteries, and the coronary tree, and needs to be considered in a young patient with angina, in particular when pulses are absent. This case illustrates the limitations of exercise testing in diagnosing the extent of coronary artery disease and the risks associated with coronary angiography in patients with inflammatory disease in the left main stem coronary artery. It also highlights the novel use of non-invasive scanning with positron emission tomography using 18-fluorodeoxyglucose in assessing remission from this disease. Revascularisation was performed with percutaneous transluminal coronary angioplasty and stenting as an emergency procedure, but treatment of the restenosis with directional atherectomy was based on a review of the available literature. The lymphocytic alveolitis seen in this patient has not been previously described in Takayasu’s disease.
Artefact mimicking tachycardia during magnetic resonance imaging in a patient with an implantable loop recorder
J R Gimbel, B L Wilkoff
An implantable loop recorder (ILR) was implanted in a 45 year old man with recurrent syncope. A subsequent episode of injurious syncope led to performance of a cranial and shoulder magnetic resonance imaging (MRI). An artefact mimicking both wide and narrow complex tachycardias was recorded by the ILR during the shoulder MRI but not the cranial MRI. Caution should be used when interpreting the ECGs of ILRs in patients who have undergone MRI.
Unexplained recurrent pericardial effusion: a lethal warning?
C H Lee, G S W Chan, W M Chan
A case of a 37 year old man with cardiac angiosarcoma causing recurrent pericardial effusion, who eventually died of cardiac rupture, is presented. The diagnosis was not established until the postmortem examination despite echocardiography, pericardiocentesis, and pericardial biopsy investigations. There is neither a specific manifestation that enables early recognition nor well proven effective treatment against this disease. Accordingly, the prognosis of cardiac angiosarcoma remains grave. A high index of suspicion is recommended in patients who present with unexplained pericardial effusion.