Pectus is the most common congenital chest wall deformity, with pectus excavatum being the most prevalent type characterized by a sunken sternum. It has been proven that in severe cases this anomaly can result in cardiopulmonary compromise affecting patients' daily activity and ability to exercise. Despite the latest research, the deformity may still be viewed by some as a cosmetic issue that does not necessitate treatment. Since primary care physicians are often the first to evaluate these patients, a thorough understanding and comprehensive treatment approach for pectus is needed. Patients with pectus excavatum can present with a wide range of symptoms, although some may be entirely asymptomatic. Depending on the cardiopulmonary impact of the deformity, the severity of symptoms can range from mild exertional dyspnea to syncopal episodes, which may progress with aging. There have been several publications that have documented the improvement in quality of life and cardiopulmonary function that can occur in patients who have undergone repair of their pectus excavatum deformity. This article reviews updated information and recommendations and can serve as a guide to primary care physicians in the diagnosis, evaluation, and referral of pectus excavatum patients.

We reported an aging male patient who experienced deterioration of cardiac function accompanied by the onset of ventricular tachycardia 10 months after right ventricular pacing (RVP). We reviewed the literature on the mechanism of pacing-induced cardiomyopathy (PICM) and the physiological pacing techniques commonly employed in current clinical practice. The patient is a 68-year-old male who experienced a decline in cardiac function accompanied by the onset of ventricular tachycardia 10 months after dual-chamber pacemaker implantation for "atrioventricular block." After excluding other potential causes of cardiac dysfunction, pacing-induced cardiomyopathy (PICM) was diagnosed. Given the history of ventricular tachycardia episodes, the non-physiological right ventricular pacing was upgraded to physiological biventricular synchronous pacing with defibrillator therapy (CRT-D). During the one-month follow-up after CRT-D implantation, the patient's symptoms of chest tightness and dyspnea were significantly alleviated. Repeated echocardiography revealed a marked improvement in left ventricular ejection fraction (LVEF), and the left ventricular end-diastolic diameter (LVEDD) returned to the size observed before the initial pacemaker implantation. PICM was successfully corrected, and ventricular remodeling was reversed. Right ventricular pacing is associated with PICM in certain patients. Despite the availability of various surgical modalities for physiological pacing, pacing experts should select an individualized physiological pacing protocol that is specifically tailored to the specific condition of each patient.

A 38-year-old woman with a history of migraine headaches presented with episodic headaches, palpitations, chest pain, and worsening dyspnea. On arrival, she was hypertensive and tachycardic. Electrocardiography demonstrated inferolateral ST-segment depressions, QT interval prolongation, and elevated troponin levels, raising concern for acute myocardial infarction. Emergent coronary angiography revealed normal coronary arteries, while left ventriculography demonstrated basal hypokinesis with apical hyperkinesis, consistent with reverse takotsubo cardiomyopathy. Abdominal computed tomography identified a 3 cm right adrenal nodule, and 24-hour urine metanephrine levels were elevated to >8× the upper limit of normal, suggestive of pheochromocytoma. The patient was managed conservatively with alpha-adrenergic blockade. Follow-up abdominal magnetic resonance imaging demonstrated a decrease in nodule size to 2.3 cm with evidence of intralesional hemorrhage, and catecholamine levels subsequently normalized, leading to deferral of adrenalectomy. At 6-month follow-up, transthoracic echocardiography showed normalization of left ventricular function, and repeat abdominal computed tomography revealed marked reduction in the adrenal mass. At 1 year, she remains asymptomatic with normal biochemical testing.

We report a 62-year-old woman with a long history of palpitations who presented with fatigue and acute dyspnea. ECG demonstrated a regular narrow-QRS tachycardia with long RP' intervals and 1:1 atrioventricular conduction. Episodes were recurrent despite amiodarone and beta-blockers, and transthoracic echocardiography revealed severe biventricular dysfunction which improved after rhythm control. We discuss the ECG features, mechanisms, and diagnostic clues of long RP' supraventricular tachycardia in adults.

The atrioventricular (AV) node is a subendocardial structure located in the inferior-posterior right atrium. In an average adult, an AV node measures approximately 1 x 3 x 5 millimeters and sits within an anatomic region bordered posteriorly by the coronary sinus ostium, superiorly by the tendon of Todaro, and anteriorly by the septal tricuspid valve annulus. This anatomic region is also commonly referred to as the triangle of Koch. The blood supply to the AV node is from the AV nodal branch of the right coronary artery (90%) or the left circumflex artery (10%) depending on the right or left dominant blood supply to the heart. The first septal perforator of the left anterior descending artery also supplies blood to the AV node. Atrioventricular nodal reentrant tachycardia (AVNRT) is a type of paroxysmal supraventricular tachycardia that results due to the presence of a reentry circuit within or adjacent to the AV node. The diagnosis of AVNRT requires visualization on an electrocardiogram (ECG). In most cases, an ECG will show heart rate between 140 and 280 beats per minute (bpm), and in the absence of aberrant conduction, a QRS complex of fewer than 120 milliseconds. ECG criteria based on the reentrant circuits are as follows: Slow-Fast AVNRT: Pseudo-S wave in leads II, III, and AVF. Pseudo-R' in lead V1. Fast-Slow AVNRT: P waves between the QRS and T waves (QRS-P-T complexes). Slow-Slow AVNRT: Late P waves after a QRS - often appears as atrial tachycardia.

Mediastinal bronchogenic cysts are sporadic congenital tumors, accounting for approximately 10%-15% of all mediastinal masses. In most cases, they remain asymptomatic. We present a case of a young man with new-onset atrial fibrillation caused by extra cardiac compression of the left atrium by mediastinal bronchogenic cyst. We report the first documented case in our country of a patient with a mediastinal bronchogenic cyst presenting with cardiac symptoms.