Coronary computed tomography angiography (CCTA) has evolved significantly over the past decade, expanding from stable coronary artery disease (CAD) assessment to diverse cardiovascular applications. However, its role in non-ST-elevation acute coronary syndromes (NSTE- ACSs) remains incompletely defined despite excellent diagnostic accuracy. This review synthesizes current evidence on the performance of CCTA in NSTE-ACS, examining diagnostic capabilities, advanced plaque characterization, clinical outcomes, and knowledge gaps requiring future investigation. CCTA demonstrates high negative predictive value (>90%) for ruling out obstructive CAD in NSTE-ACS, particularly in low-to-intermediate risk patients. Despite this diagnostic performance, contemporary evidence reveals a persistent disconnect between anatomical accuracy and clinical benefit, with CCTA-guided strategies failing to demonstrate improvements in major adverse cardiovascular events or reductions in healthcare costs when compared to standard invasive approaches. Advanced plaque characterization techniques offer potential refinement in risk stratification. Pericoronary adipose tissue analysis via fat attenuation index correlates with vulnerable plaque features and inflammatory markers in NSTE-ACS populations. Critical evidence gaps persist regarding optimal patient selection algorithms, timing strategies across risk stratification, and cost-effectiveness analyses. Future research must prioritize outcome-driven investigations demonstrating that CCTA-guided management improves clinical endpoints, prospective validation of advanced imaging biomarkers, and integration into personalized algorithms to bridge the gap between diagnostic capability and meaningful clinical impact.

Patent foramen ovale (PFO) is a common congenital cardiac anomaly, present in approximately 25% of the general population, representing a persistent interatrial communication. This review summarizes current evidence on the clinical manifestations, diagnostic approaches, and management strategies for PFO in accordance with the most recent international guidelines. In patients with high-risk anatomical features or cryptogenic stroke, PFO closure may be indicated. The decision to close a PFO is based on careful risk stratification and comprehensive imaging, typically including contrast-enhanced transesophageal echocardiography. Several randomized controlled trials have demonstrated the efficacy of percutaneous closure devices, and PFO closure is currently considered an effective strategy for secondary prevention of cryptogenic stroke in carefully selected patients aged 18 to 60 years.

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Accurate assessment of coronary lesion severity is essential for guiding revascularization. Fractional flow reserve (FFR) is the gold standard for functional evaluation of coronary stenoses, but data on intracoronary hemodynamic assessment in patients with acute myocardial infarction are limited. Optical coherence tomography (OCT) provides highresolution intravascular imaging and may offer additional insights into lesion severity. Aim: To investigate the correlation between OCT-derived measurements and FFR values in patients with acute myocardial infarction. Methods: The study included 114 patients with acute myocardial infarction (STEMI or NSTEMI) undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion. Intermediate stenoses in non-culprit vessels (151 lesions) were evaluated during staged procedures with OCT and FFR. Minimal luminal area (MLA) and percent luminal area stenosis (PAS) were analyzed in relation to FFR values. Results: OCT-derived parameters showed good correlation with FFR values. In multivariable logistic regression, MLA and PAS were independent predictors of FFR <0.80. The optimal cut-off values were 2.08 mm2 for MLA and 76.85% for PAS. Conclusions: OCT-derived parameters may help identify functionally significant non-culprit lesions in patients with acute myocardial infarction and can complement physiological assessment in clinical practice.

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.