Introduction: Commotio cordis (CC), or concussion of the heart, is typically characterized by a sudden impact to the chest wall precipitating ventricular fibrillation arrest. There have been very few documented cases of atrial fibrillation (AF) resulting from this mechanism. A relative consensus exists in the crucial nature of the timing of a blow at the vulnerable ventricular repolarization in the cardiac cycle, with suggestion of the impact occurring during atrial repolarization, triggering paroxysmal atrial fibrillation. Case Presentation: We present the case of a 17-year-old male patient who sustained two significant chest wall blows over the course of 8 months with initial electrocardiogram evidence of both atrial and ventricular irritability, subsequently developing AF, which did not spontaneously resolve. Conclusions: Although the focus of CC has been management of immediate and lethal ventricular arrhythmias, atrial arrhythmias such as atrioventricular block, atrial flutter, or AF can occur from abnormal depolarization or occult damage to the conduction system. Detection of these rhythms may be delayed due to lack of initial collapse. Clinicians in the emergency department need to consider the possibility of late complications even in patients who do not exhibit immediate ventricular arrhythmia.

Introduction: Left ventricular pseudoaneurysm (LVP) is a rare complication of myocardial infarction associated with very high mortality. Patients with LVP may present with heart failure, ventricular arrhythmias, or even cardiac tamponade. If left untreated, the risk of rupture may reach up to 45% within the first year. Case presentation: We present the case of a 76-year-old patient with a recent myocardial infarction, diabetes, renal failure, stroke, and tetraparesis, admitted to the Neurology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca. A cardiology consultation was requested for sudden-onset dyspnea, palpitations, and dete-rioration of the general condition. Clinical examination showed SpO2 79% and HR 100/min, without cardiac murmurs. Echocardiography revealed mildly reduced LVEF, a giant posterior LVP, dilated right heart chambers with signs of right ventricular overload, and bilateral pleural effusion. CT angiography excluded pulmonary embolism and confirmed the presence of LVP. The symptoms were interpreted as acute heart failure. Surgical closure was considered, but the Heart Team decided on conservative management due to the extremely high perioperative risk. During hospitalization, the patient developed multiple complications and eventually died following pseudoaneurysm rupture and cardiac arrest. Conclusion: Left ventricular pseudoaneurysm is a rare but life-threatening complication of myocardial infarction that requires early diagnosis and prompt management. This case highlights the challenges of treating patients with multiple comorbidities and very high surgical risk, in whom the lack of definitive treatment options may lead to a fatal outcome.

We present the case of an 88-year-old patient with multiple cardiovascular comorbidities who, on the first day after transcatheter aortic valve implantation (TAVI), developed sudden severe pain in the right lower extremity. Urgent computed tomography angiography (CTA) of the abdominal aorta and lower limbs revealed a patent right common iliac artery with thrombotic occlusion of the external iliac and femoral arteries. A transfemoral thromboembolectomy using a Fogarty catheter was performed at the iliofemoral axis, supplemented by local endarterectomy and patch angioplasty. Over the following three weeks, two additional interventions were required to evacuate an inguinal hematoma and secure hemostasis at the patch level. Three months later, the patient returned to the emergency department with severe groin pain and active bleeding from the wound. CTA revealed a large infected pseudoaneurysm of the common femoral artery, measuring approximately 4 × 2.5 cm. Reconstruction of the neo-femoral artery was carried out using an autologous bifurcated great saphenous vein graft, combined with a proximal sartorius muscle flap. At six months, CTA demonstrated patent femoral arteries without thrombus or hematoma and complete tissue healing.

Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by abnormal thickening of the ventricular myocardium. It is most commonly inherited as an autosomal dominant disorder caused by mutations in sarcomere or sarcomere-associated protein genes. We report the case of a 15-year-old female with HCM and a strong family history (mother, sister, and maternal grandfather). Despite this background, her diagnosis was made incidentally following the onset of cardiac symptoms. Genetic testing confirmed a pathogenic MYH7 mutation. Based on elevated risk scores (HCM-Risk Kids = 8.6%, Primacy Risk Score = 13.09), she was considered at high risk for sudden cardiac death and underwent implantation of an implantable cardioverter-defibrillator (ICD) for primary prophylaxis. This case highlights the importance of a comprehensive approach to pediatric and adolescent HCM, including family history, genetic testing of at-risk relatives, early diagnosis, and multidisciplinary management. It also emphasizes the urgent need for systematic family screening of first-degree relatives using echocardiography and electrocardiography. Although genetic testing confirmed the diagnosis in our patient, it could not be extended to relatives due to financial limitations. Expanding access to genetic screening at a national level should be a priority. Future research should focus on optimizing genetic testing protocols and improving quality-of-life interventions for young patients with HCM and ICDs. Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by abnormal thickening of the ventricular myocardium. It is most commonly inherited as an autosomal dominant disorder caused by mutations in sarcomere or sarcomere-associated protein genes. We report the case of a 15-year-old female with HCM and a strong family history (mother, sister, and maternal grandfather). Despite this background, her diagnosis was made incidentally following the onset of cardiac symptoms. Genetic testing confirmed a pathogenic MYH7 mutation. Based on elevated risk scores (HCM-Risk Kids = 8.6%, Primacy Risk Score = 13.09), she was considered at high risk for sudden cardiac death and underwent implantation of an implantable cardioverter-defibrillator (ICD) for primary prophylaxis. This case highlights the importance of a comprehensive approach to pediatric and adolescent HCM, including family history, genetic testing of at-risk relatives, early diagnosis, and multidisciplinary management. It also emphasizes the urgent need for systematic family screening of first-degree relatives using echocardiography and electrocardiography. Although genetic testing confirmed the diagnosis in our patient, it could not be extended to relatives due to financial limitations. Expanding access to genetic screening at a national level should be a priority. Future research should focus on optimizing genetic testing protocols and improving quality-of-life interventions for young patients with HCM and ICDs.

Introduction: Coronary artery dissection caused by trauma is a rare but serious condition that can lead to acute coronary syndrome. The dissection may result from various mechanisms, including thrombus formation and intramural hematoma, leading to intraluminal occlusion. This report presents a case of acute myocardial infarction secondary to right coronary artery dissection in a traumatic context. Case Presentation: We report the case of a 30-year-old male patient who presented to the emergency department with constrictive chest pain after sustaining direct blunt thoracic trauma caused by a pig. Clinical and imaging findings were suggestive of an acute coronary event. Coronary angiography and optical coherence tomography confirmed an acute occlusion of the right coronary artery due to dissection with intramural hematoma. A drug-eluting stent was placed to restore vessel patency. The patient had a favorable outcome, with improved ventricular function at discharge compared to admission. Conclusion: Although uncommon, coronary artery dissection should be considered in patients presenting with acute chest pain following thoracic trauma. Prompt diagnosis and timely interventional treatment are essential to improving prognosis and minimizing longterm impairment of ventricular function.

Introduction: Thyroid hormones influence multiple systems, but most often the impact on the cardiovascular system is what brings the patient to the emergency department. Basedow’s disease, an autoimmune condition, is one of the most common causes of hyperthyroidism. The purpose of this presentation is to raise attention to an extracardiac cause that can lead to cardiac failure. Case presentation: A 55-year-old woman presented to our cardiology service with rapid palpitations, shortness of breath on small efforts, and extreme fatigue. The electrocardiogram revealed sinus tachycardia with a heart rate of 144 beats per min. Paraclinical investigations and a multidisciplinary team consultation led to a diagnosis of thyrotoxicosis due to Basedow’s disease. Following the initiation of cardiological and endocrinological treatments, the patient’s condition improved. Conclusion: Although hyperthyroidism is an extracardiac cause, it brought the patient to the cardiology emergency service for heart failure symptoms. The key to achieving a correct diagnosis and determining an optimal treatment lies in the multidisciplinary approach of pathology.

Introduction: We report a rare case of an 80-year-old male patient with acute transformation of myelodysplastic syndrome (MDS) in the pericardial cavity, leading to cardiac tamponade. Case presentation: The patient had been diagnosed with MDS 7 months prior. One day before presentation, he suddenly developed dyspnea. At presentation, his blood pressure was stable, but he was in tachycardic atrial fibrillation; echocardiography revealed a pericardial effusion. Aortic dissection and acute myocardial infarction were excluded by examination upon admission. His blood pressure subsequently dropped, indicating pericardial tamponade. Pericardiocentesis was performed, and 800 ml of bloody pericardial fluid were withdrawn, stabilizing his blood pressure. The blasts ratio was higher in the pericardial fluid than in the periphera  blood; bone marrow examination revealed no evidence of acute transformation, but the presence of numerous cells with chromosomal abnormalities in the pericardial sac cavity confirmed acute MDS transformation. The patient died on day 15 due to progressive multiorgan failure. The autopsy revealed a neoplastic lesion extending circumferentially throughout the epicardium. Conclusions: When a patient with an acute onset history of hematogenous pericardial effusion is found to have a pericardial tamponade of cancerous origin, acute transformation of MDS should be considered in the differential diagnosis.