When Fever and Heart Block Point Beyond the Valve
A 65-year-old man with a bioprosthetic aortic valve presented with fever and complete AV block. Echocardiography revealed vegetations and a periannular abscess, connecting the electrical finding to infection around the prosthetic ring.
When a coronary anomaly looks impressive — but physiology remains quiet
A suspected left circumflex–coronary sinus fistula looked striking on angiography, but the reported work-up found no significant shunt or relevant exercise limitation. Anatomy, physiology and individual risk must inform the decision.
Before the Contrast: The Warning Was Already on the Pressure Curve
Pressure damping during left coronary engagement prompted caution before an ostial lesion with thrombus was identified in a patient with systemic sclerosis.
When the X-ray Tells the Story: CRT-D and CCM in Advanced Heart Failure
An 85-year-old patient with ischemic cardiomyopathy and recurrent decompensation illustrates the different roles of CRT-D, CCM and foundational heart-failure medication.
When the Coronary Map Does Not Follow the Textbook
Separate LAD and circumflex origins and a shepherd’s-crook RCA changed the catheter strategy. Recognizing the anatomy was more important than forcing engagement.
The “Toothpaste Tumor”: When a Cardiac Mass Is Not a Tumor
A mitral annular mass on echocardiography raised concern for a tumor. CT supported caseous calcification, allowing conservative management and follow-up.
When “severe aortic stenosis” turns out not to be aortic stenosis at all
A woman referred for presumed severe aortic stenosis had a well-opening aortic valve. SAM and dynamic LVOT obstruction changed the diagnosis.
Spontaneous Coronary Artery Dissection: Anatomy, Physiology, and Restraint
A young woman with chest pain and dynamic troponin elevation. Angiography suggested SCAD, shifting the decision from intervention to restraint.