Coronary microvascular dysfunction (CMD) is increasingly being recognized as a significant contributor of ischemic heart disease, particularly affecting women with angina and non-obstructive coronary arteries. This contemporary review synthesizes recent landmark evidence (2022–2024) revealing a striking paradox in CMD management. While diagnostic capabilities have advanced dramatically—with CMD now identified in 41% of patients with non-obstructive coronary disease—this diagnostic success has not translated into therapeutic benefits. Recent meta-analyses demonstrate that CMD doubles cardiovascular risk (HR 2.08–2.45), yet the first randomized trial of invasive endotyping (CorCTA) found that improved diagnosis failed to improve symptoms despite a 4-fold enhancement in diagnostic accuracy. This diagnosis–treatment gap represents one of the most pressing challenges in contemporary cardiovascular medicine, reflecting fundamental failures that demand urgent reconceptualization. We examine current evidence on its prevalence, diagnostic approaches, and prognostic implications, highlighting the urgent need for CMD-specific therapies to bridge the gap between diagnostic capability and clinical outcomes. Until CMD-specific therapies emerge from dedicated research programs, clinicians must optimize available treatments while advocating for the resources and research focus this condition deserves.

The rapid expansion of structural heart interventions over the past decade has created unprecedented challenges in procedural planning and complication prediction. While traditional imaging provides essential anatomical information, translating two-dimensional images into a comprehensive three-dimensional understanding of complex cardiac structures remains challenging. This review encompasses finite element analysis (FEA), computational fluid dynamics (CFD), and fluid–structure interaction (FSI) technologies across major structural heart procedures, including transcatheter aortic valve implantation (TAVI), transcatheter mitral valve interventions, and left atrial appendage occlusion (LAAO). We evaluated the technical foundations, clinical validation studies, and practical applications of various simulation platforms. Advanced computer simulation has demonstrated feasibility and clinical utility across multiple structural heart procedures. Computer simulation for structural heart interventions has evolved from a proof of concept to clinical implementation, with growing evidence of procedural planning benefits in TAVI and LAAO. While feasibility has been established across multiple intervention types, this field requires larger validation studies to demonstrate accuracy and clinical outcome improvements. Future directions include integration of machine learning, real-time simulation capabilities, and expanding applications to complex anatomies and redo procedures. This technology represents an emerging paradigm that may facilitate precision medicine in structural heart interventions, with potential for significant improvements in procedural success and patient safety.

Large cell neuroendocrine carcinoma (LCNEC) constitutes a rare subset of highly undifferentiated malignancies known for their aggressive nature. Although these tumors commonly originate in the lungs and gastrointestinal tract, their potential occurrence is not restricted to specific anatomical sites, giving rise to a variety of symptoms. Notably, cases of neuroendocrine tumors (NETs) with an unidentified primary source exhibit a graver prognosis and shorter survival periods compared to those with clearly identified origins. NETs frequently demonstrate a propensity to metastasize, spreading to diverse anatomical regions such as the liver, lungs, lymph nodes, and bones, illustrating their aggressive nature and the complexity of their management. In this context, we present the case of a 59-year-old male who sought medical attention in the emergency department due to right upper quadrant (RUQ) abdominal pain. Initial diagnostic assessments revealed significantly elevated liver function tests and severe hypercalcemia. A right upper quadrant ultrasound (RUQ US) was subsequently performed, which revealed heterogeneous hepatic echotexture with innumerable echogenic masses, suggesting a metastatic process. A computed tomography (CT) scan was then ordered to evaluate further the RUQ US findings, which showed numerous hypovascular liver masses, raising concerns of malignancy. A liver biopsy confirmed a diagnosis of LCNEC with an unidentified primary source.

Cardiac amyloidosis remains critically underdiagnosed, with a median diagnostic time of 2 years, as official echocardiographic reports generally fail to identify high-risk patients. We aimed to identify workflow barriers in patients undergoing echocardiographic assessment, including inconsistent strain imaging application and absence of standardized screening criteria for cardiac amyloidosis at the point of image acquisition. A systematic screening protocol was implemented for early identification of patients at risk for cardiac amyloidosis. We targeted patients ≥65 years (≥60 years for African Americans) with an interventricular septal wall thickness of ≥1.2 cm. Five innovations were implemented: daily technologist-driven screening, educational interventions, holographic visual aids, standardized strain imaging, and structured communication pathways. Among 82 patients screened over 7 months, 48.8% were classified as high risk, with most confirmed cases emerging from this tier. A total of 8 patients demonstrated positive or equivocal pyrophosphate scans, 2 had positive cardiac magnetic resonance imaging, and 2 had a positive biopsy, leading to 6 patients (7.3%) with confirmed cardiac amyloidosis after comprehensive work-up. Notably, 69.5% were identified during noncardiac admissions, where screening would typically be overlooked based on historical data. The protocol increased referrals and achieved meaningful diagnostic yield compared with near-zero detection at baseline. Systematic screening with technologist empowerment and visual reminders dramatically improves cardiac amyloidosis detection, with most cases identified during incidental imaging that would otherwise be missed.

Fusobacterium nucleatum (F. nucleatum) is a commensal Gram‐negative anaerobic bacterium that lives in the oral cavity and gastrointestinal tract of humans. While it is a regular resident of the human oral cavity, F. nucleatum has been implicated in various infections and inflammatory conditions. This case report highlights an unusual association between F. nucleatum and isolated superior mesenteric vein (SMV) thrombosis.