Introduction: SARS-CoV-2 infection is frequently associated with coagulation disorders and an increased risk of thromboembolic complications that may involve multiple vascular territories, with potentially fatal consequences. Case Series: We present six patients with confirmed COVID-19 who developed confirmed or suspected venous, arterial, or cardiac thromboembolic complications. Patients ranged in age from 54 to 79 years (mean, 64.4 years). All exhibited progressive increases in ferritin levels during hospitalization, while elevated inflammatory markers and dynamic D-dimer changes were observed in association with thromboembolic events. Despite prophylactic or therapeutic anticoagulation, severe complications still occurred. Three patients died from suspected intra-atrial mass, acute femoral and popliteal artery occlusion, and fulminant massive pulmonary thromboembolism, respectively. Conclusions: This case series highlights the systemic and heterogeneous nature of COVID-19-associated thromboembolism, which may occur despite anticoagulant prophylaxis, affect multiple vascular territories, and develop even in the absence of traditional thrombotic risk factors.

Introduction: Systemic amyloidosis (SA) comprises a heterogeneous group of disorders characterized by extracellular deposition of misfolded protein fibrils, leading to progressive organ dysfunction. Amyloid A (AA) amyloidosis is a systemic disorder that may involve multiple organs, including the gastrointestinal tract, heart, and serosal surfaces. Case presentation: We report a middle-aged man with long-standing ankylosing spondylitis who presented with progressive dyspnea and marked functional decline. Laboratory evaluation demonstrated severe hypoalbuminemia, chronic kidney disease with severe albuminuria, and markedly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) despite only mild high- sensitivity troponin elevation. Electrocardiography showed low QRS voltage with a pseudoinfarction pattern. Transthoracic echocardiography revealed concentric left ventricular hypetrophy, mildly reduced ejection fraction, an infiltrative myocardial appearance, and severely impaired global longitudinal strain disproportionate to the degree of systolic dysfunction. Gastrointestinal biopsies demonstrated Congo red-positive amyloid deposits with positive amyloid A immunostaining, confirming systemic AA amyloidosis. Conclusions: This case illustrates systemic AA amyloidosis as a rare but devastating complication of long-standing, poorly controlled ankylosing spondylitis. The combination of dyspnea with large serosal effusions, markedly elevated NT-proBNP disproportionate to troponin elevation, low-voltage electrocardiography, and left ventricular hypertrophy with severely impaired global longitudinal strain should raise suspicion for cardiac amyloidosis in patients with chronic inflammatory diseases and prompt timely diagnostic evaluation.

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.