And importance: Ebstein's anomaly (EA) is a rare congenital heart disease characterized by apical displacement of the tricuspid valve associated with atrialization of the right ventricle. Most of the cases are diagnosed in childhood but asymptomatic cases may remain undiagnosed and survive until old age. We present a rare case of Ebstein's Anomaly with pericardial effusion which was diagnosed for the first time in her mid-fifties when she developed atrial fibrillation and right heart failure with severe tricuspid regurgitation, which was managed medically. The patient with Ebstein's anomaly can be found even at an older age with variable presentation and the association with pericardial effusion although very rare can present in such patients. Ebstein's anomaly despite being a rare congenital condition can present clinically even beyond the age of fifty without any previous diagnosis and surgical intervention for the condition. It usually presents with features of heart failure and arrhythmia but can also have a rare association like pericardial effusion.

Introduction and importance: Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder that causes fibrosis due to an accelerated inflammatory response. One of the most frequent co-morbidities with SSc is interstitial lung disease (ILD), which is also one of the biggest killers among SSc patients. Case presentation: The authors present a rare case of diffuse SSc with ILD and myocardial infarction having a history of Raynaud phenomenon, skin thickening, and shortness of breath. Antinuclear antibody and antitopoisomerase antibody tests were positive. The patient was managed medically and the condition of patient is improving. Clinical discussion: SSC can affect the skin as well as other organs, with the lungs being the most frequently involved and seriously impacted. SSc patients can have multiple organ involvement like the skin, lungs, heart, kidneys, and gastrointestinal tract. Because ILD is the leading cause of death among people with SSC, early diagnosis and high suspicion of lung involvement can reduce mortality. Conclusion: The mortality rate for SSC associated with ILD is extremely high. Even though ILD is common in SSc, it might be difficult to identify and detect early for which a high-resolution CT scan can be used. In SSc patients, heart involvement can coexist with ILD.

Introduction: and importance: Acute massive pulmonary thromboembolism is a potentially life-threatening condition requiring urgent management to decrease mortality. Although the standard dose of systemic throm-bolysis with alteplase is 100 mg, half the dose of alteplase can be used to break up clots successfully, especially if bleeding is a concern.Case presentation: We report a case of massive pulmonary thromboembolism presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, anticoagulants, and low-dose thrombolytics.Clinical discussion: Management of massive pulmonary thromboembolism includes medical thrombolysis along with maintenance of hemodynamic stability. Our patient was successfully managed with low-dose thrombolytics and was continued with standard oral anticoagulants for 6 months.Conclusion: In patients of acute massive pulmonary thromboembolism, a low dose of the thrombolytic agent can achieve complete resolution of the thrombus with less bleeding risk.

Coronavirus disease 2019 (COVID-19) causes a hyperinflammatory state, endothelial injury, microvascular thrombosis and myocardial dysfunction, which may lead to worsening circulatory failure in septic shock. Using a large National Inpatient Sample (NIS) database from 2020 to 2022, we aimed to compare in-hospital mortality, need for mechanical ventilation, acute kidney injury (AKI), need for renal replacement therapy (RRT), cardiac arrest, acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO), tracheostomy, acute liver failure, disseminated intravascular coagulation (DIC), hospital length of stay (LOS), and total hospital charges in septic shock hospitalizations with and without COVID-19. A total of 2,175,619 adult septic shock hospitalizations were identified, of which 378,635 (17.4%) had COVID-19 infection. Hospitalizations with COVID-19 had significantly higher mortality (60.3% vs. 32.2%; aOR 3.43, 95% CI 3.35–3.50), increased need for non-invasive ventilation, invasive ventilation, and higher incidence of AKI, RRT, cardiac arrest, ARDS, ECMO use, and tracheostomy. Additionally, hospital LOS and total hospital charges were also significantly higher in hospitalizations with COVID-19. There was no significant difference in acute liver failure or DIC. In conclusion, COVID-19 infection was independently associated with worse outcomes and increased hospital resource utilization in adult septic shock hospitalizations.