Introduction: Pheochromocytomas can present as a diagnostic challenge, given their diverse clinical manifestations. Though classically taught as presenting with headaches, palpitations and paroxysmal hypertension, only 1 in 4 present with such a triad. Catecholamines affect the myocardium in various ways, ranging from beta-adrenergic receptor-mediated myofibril dysfunction to direct myocardial injury by catecholamine oxidation products. Case description: We report the case of a 41-year-old female with no significant past medical history, who presented with acute coronary syndrome. She was found to have myocardial infarction with non-obstructive coronary arteries (MINOCA), and her clinical course was complicated by erratic blood pressure management. Laboratory findings and imaging findings confirmed the diagnosis of pheochromocytoma. Post-cardiac catheterisation, she developed a thyroid storm and fatal cardiac arrest. Conclusions: The combination of hyperthyroidism with pheochromocytoma is rare but often fatal; iodinated angiography contrast likely precipitated her thyroid storm. This case underscores the importance of considering pheochromocytoma early in patients with MINOCA, particularly in those with erratic blood pressure. Pheochromocytomas have been reported to be associated with MINOCA in rare cases and have significant mortality. Current guidelines do not include pheochromocytoma as a possible differential diagnosis; recognition and early diagnosis are crucial for improved outcomes.

Cardiac implantable electronic devices (CIEDs) are essential therapeutic tools for managing various cardiac conditions but are also associated with the risk of infections, leading to significant morbidity, mortality, and healthcare costs. Risk factors include patient comorbidities, procedural aspects, and device characteristics. Prompt intervention and early recognition of CIED infections, including pocket and systemic infections, are essential for preventing complications. Advanced imaging modalities aid in accurate diagnosis, while a multidisciplinary approach involving infectious disease specialists and cardiologists guides treatment strategies. Tailored antibiotic therapy, along with device removal and lead extraction, is crucial in managing CIED infections. This article emphasizes risk factors, pathogenesis, and the development of preventive measures to address the growing challenge of CIED-related infections and improve patient outcomes.

Lymphangioleiomyomatosis (LAM) is a rare, progressive lung disease characterized by abnormal smooth muscle proliferation, leading to cystic destruction of the lung parenchyma. We present the case of a female in her early 40s who presented with intermittent chest pain for 1 month. Imaging revealed left hydropneumothorax with multiple bilateral pulmonary parenchymal cysts, and a subsequent lung biopsy confirmed the diagnosis of pulmonary LAM. The patient underwent video-assisted thoracoscopic surgery (VATS) with mechanical and chemical pleurodesis. Given her stable condition, no immediate sirolimus therapy was initiated, and close follow-up with serial imaging was planned. This case highlights the diagnostic challenges of LAM, especially with low VEGF-D levels, and underscores the role of pleurodesis as a management option in select patients. Early recognition and tailored management are essential to optimize patient outcomes.

Background: Aortic stenosis (AS) represents a prevalent valvular condition in older adults, associated with significant morbidity and mortality. The objective of the study was to examine trends in mortality related to AS in the United States (U.S.). Methods: The U.S. CDC WONDER dataset was analyzed, extracting age-adjusted mortality rates (AAMR) per 100,000 and calculating annual percentage change (APC) through Joinpoint regression. The results were stratified to identify temporal, sex-specific, racial/ethnic, and regional differences. Results: From 1999 to 2020, 267,515 deaths among older adults (>65 years old) were attributed to AS, with the AAMR declining from 28.00 to 23.69. Males had a higher AAMR (30.35) compared to females (27.42), though more deaths occurred in females (164,104 vs. 103,411). Non-Hispanic (NH) Whites exhibited the greatest AAMR (31.61), trailed by NH American Indian/Alaska Native individuals (16.62), whereas NH Asians/Pacific Islanders had the least (11.50). Significant state-wise variations were noted, with AAMRs ranging from 60.55 in Oregon to 17.23 in Mississippi, and 19 states depicting a concerning rise over the study duration. Regionally, the Northeast (32.09) had the highest AAMRs, while the South (23.06) had the lowest. Micropolitan (32.28) and noncore (28.43) areas reported higher AAMRs compared to large central metropolitan areas (24.32). Conclusions: While there is a trend towards decreased mortality due to AS in the U.S., significant disparities based on race, sex, and region persist and may be worsening. The underlying causes of these discrepancies require further investigation, and targeted strategies must be developed to address them effectively.

Actinomycosis is a rare endogenous infection characterised by indolent progression, contiguous spreading, abscess formation and draining sinuses. Here, we present a case of Schaalia odontolytica causing a mediastinal abscess that is unique in its acuity and location. Our patient presented with worsening dysphagia, and CT of her chest revealed a new mass in the posterior mediastinum displacing the oesophagus. Oesophagram revealed mild motility disorder, but no masses or ulcers within the oesophagus. Oesophagogastroduodenoscopy with endoscopic ultrasound revealed extrinsic compression of the oesophagus. Fine-needle aspiration of the mass yielded purulent fluid, which was cultured. A single colony of S. odontolytica was isolated. Initially, medical treatment was favoured, but as she developed worsening dysphagia, the abscess was drained. She continued on long-term antibiotic therapy after drainage and had complete resolution of the abscess at 1 year.

Transthyretin amyloid cardiomyopathy (ATTR-CM) arises from the accumulation of transthyretin amyloid fibrils in the myocardium, a consequence of instability and misfolding in wild-type or variant transthyretin protein. ATTR-CM should be suspected in older heart failure patients with raised myocardial wall thickness and diastolic dysfunction on echocardiography in the absence of hypertension or other known causes. This diagnosis can be further supported with late gadolinium enhancement on Cardiac MRI which indicates raised myocardial extracellular volume (ECV) hinting at the expansion of interstitial space by amyloid deposits. Diagnostic work up starts with blood and urine tests to rule out AL amyloidosis and monoclonal gammopathy of undetermined significance (MGUS) followed up by nuclear scintigraphy with Tc-99m tracer which shows increased relative tracer uptake by the myocardium on Single-photon emission computed tomography (SPECT). Genetic testing of the transthyretin (TTR) gene determines wild or variant type of ATTR amyloidosis. Tafamidis, a TTR protein stabilizer, is currently the sole approved disease-modifying therapy for ATTR cardiomyopathy. Management of ATTR-CM also involves managing heart failure, arrhythmias, and heart blocks.