35/F diagnosed case of Rheumatic Heart Disease since 1996. P | Figure 1

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35/F diagnosed case of Rheumatic Heart Disease since 1996. Previously well until 2 months post partum (2000) when patient noted onset of heart failure symptoms. Patient would then be admitted for on/off bipedal edema and dyspnea at rest. She was advised to undergo mitral valve repair or replacement but was then lost to follow up. She came back to the Emergency Department with palpatory BP and progressive dyspnea. Chest X-ray shows multiple chamber enlargement.

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This patient has straightening of left heart border. Double outlet right heart. Prominent vascular markings. He had been suffering from SOBE, Orthopnea, feeling of death. I did an Echo and found things are more interesting than Mitral Stenosis.

Shone complex (SC) is a rare congenital heart disease characterized by four obstructive anomalies, including parachute mitral valve (PMV), left atrial supra-valvular ring, subaortic stenosis, and coarctation of the aorta. Typically, SC manifests early in life. However, we encountered a 52-year-old female with a history of hypertension diagnosed at 26 years and left-sided weakness post-stroke. She presented with worsening dyspnea and palpitations, prompting a thorough investigation. Echocardiography revealed a heavily calcified bicuspid aortic valve with severe aortic stenosis and parachute mitral valve with severe mitral stenosis and preserved ejection fraction, raising suspicions regarding the presence of SC. Cardiac catheterization, aortic-angiography, and non-contrast chest computed tomography (CT) revealed abrupt occlusion of the postductal aorta, giving a picture of aortic coarctation with well-established collateral vessels including prominent right and left internal mammary arteries. So, she was diagnosed with an incomplete SC at the age of 52. This case emphasizes the rarity of late presentations of SC and highlights the importance of early diagnosis and intervention to improve outcomes. An incomplete SC should be considered in adult patients presenting with left-sided obstructive lesions.

This 88-year-old woman presented with worsening heart failure and hemoptysis. She had undergone bioprosthetic mitral valve replacement 12 years ago for severe mitral stenosis with an early postoperative baseline echocardiogram that showed normal LV and RV size and function, normal prosthetic valve function, and a pulmonary systolic pressure of 40 mm Hg. On exam now she has a blood pressure of 100/70 mm Hg, heart rate of 74 bpm with an irregular pulse, a jugular venous pressure of 20 cm H2O, distant heart sounds, and bilateral pulmonary rales. The most likely cause of her current symptoms is:

A young female patient presents with atrial fibrillation and dyspnoea and a chest X-Ray showing mitralization of the heart.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?