Background. Direct coronary embolism in the setting of oral contraceptive pill (OCP) use is a rare adverse effect. It is known for OCP to increase the risk of thrombosis; however, leading to an inferior ST elevated myocardial infarction (STEMI) due to an acute occlusive embolism is a rare entity. Coronary embolism occurs in about 3 of patients with acute coronary syndrome. Case Report. We present a case of a young 41-year-old female with a past medical history significant for dysfunctional uterine bleeding on oral contraceptive pills, who presented to the hospital with chest pain. Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. The patient was taken emergently to the cardiac catheterization lab. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations. Conclusion. Coronary embolism is rare and often not considered in the differential of acute coronary syndrome. It is of utmost importance for clinicians to keep a wide differential of nonatherosclerotic causes of STEMI especially when the patient is young, without significant cardiac risk factors.

As permanent pacemaker implantation is increasingly becoming a common practice, it is important to understand potential complications associated with the procedure. We present a 78-year-old Caucasian female who developed contralateral pneumomediastinum, pneumothorax, and pneumopericardium after undergoing implantation of a dual-chamber pacemaker.

Background. Coronary anomaly is defined as the coronary feature or pattern seen in 1 of the population. The most common CAAs are anomalies of origin, specifically having a separate LCX and LAD origin with an incidence of 0.41. The second most common anomaly is the LCX arising from the RCA (0.37). Treatment options include CABG, coronary unroofing, reimplantation, or medical therapy. Case Presentation. We present the case of an 85-year-old male who presents with an acute coronary syndrome who was found to have an extremely rare combination of different coronary anomaly patterns including left main coronary artery (LMCA) atresia, small LAD arising posteriorly from the right coronary cusp, anomalous left circumflex artery arising from the RCA, and an anomalous LAD arising from the left circumflex artery which is originating from the RCA. Conclusions. To the best of our knowledge, this is the first case report to describe four coronary anomalies in a single patient. When CAAs are diagnosed, it is of utmost importance for cardiologists to do further imaging and workup that might include a stress test to be able to offer patients the best management options.

Cardiac tamponade is a life-threatening complication during left atrial appendage (LAA) closure. We report a 77-year-old woman who underwent a transseptal puncture for LAA closure with the Watchman device that was complicated by tamponade. This was successfully treated with the deployment of a Cardioform 25-mm septal occluder device. (Level of Difficulty: Intermediate.)

Objective: Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in patients with heart failure (HF), but the evidence of their efficacy in patients who have had an acute myocardial infarction (AMI) is still incompletely established. This review aimed to assess the safety and efficacy of SGLT2 inhibitors on cardiovascular and structural outcomes in patients who had a recent AMI, irrespective of HF. Methods: We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, till February 2025 to retrieve randomized controlled trials comparing SGLT2 inhibitors to placebo in patients with AMI. We performed a statistical analysis on RevMan 5.4 using the random effect model. Results: Our meta-analysis included seven RCTs involving 11 302 patients compared SGLT2 inhibitors to placebo in patients with AMI. SGLT2 inhibitors significantly decreased the rate of hospitalization for HF (RR 0.73, 95% CI: 0.61-0.88) with no significant change in mortality (RR 1.05, 95% CI: 0.78-1.40), all-cause hospitalization (RR 1.00, 95% CI: 0.84-1.17), and cardiovascular death (RR 1.03, 95% CI: 0.83-1.28). The incidence of hepatic injury, ketoacidosis, hypoglycemia, or lower limb amputation remained comparable across the two groups. SGLT2 inhibitors did not cause a significant reduction in N-terminal pro–B-type natriuretic peptide (NT-pro BNP) from baseline (MD −0.28 95%, CI: −0.61-0.05) nor improved the left ventricular ejection fraction at follow-up (MD 0.62, 95%, CI −0.73-1.97) compared to the placebo. Conclusion: In conclusion, while SGLT2 inhibitors show promise in reducing hospitalization for HF post-AMI, their impact on mortality and safety outcomes necessitates further investigation. This underscores the need for larger, more diverse RCTs to fully illustrate their role and timing of initiation in AMI management. An individualized approach based on risk assessment should guide their use in the post-AMI population.