A 70-year-old male presented with dyspnea New York Heart Association (NYHA) class II since 1994. Dyspnea was not progressive. There was no history of cough, fever, chest pain, or palpitation. He was investigated and was told to have some abnormality in his heart and was advised surgery. Since patient was not very symptomatic, he did not undergo surgery. He did not have any record of his ailment. This time he was referred to us for fitness for noncardiac surgery. His electrocardiogram (ECG) showed normal sinus rhythm and right atrial (RA) enlargement. His echocardiography showed large cystic mass in his RA, occupying almost three-fourth of RA (Fig. 1). His noncontrast contrast-enhanced computed tomography (NC CECT) of thorax was done. It showed well defined cystic lesion with internal heterogeneous contents and calcification along its wall in RA, measuring 8.1 × 8.3 × 8.4 cm, suggestive of hydatid cyst of RA (Fig. 2).

Tachycardia-induced cardiomyopathy secondary to persistent tachycardia in children is a distinct form of cardiomyopathy caused by sustained or frequent tachyarrhythmias. It is characterized by cardiac enlargement, impaired cardiac function, and heart failure and is clinically reversible with early and standardized treatment. Herein, we report a challenging pediatric case presenting with recurrent intermittent dyspnea and palpitations for 1 year. The final diagnoses were as follows: (a) paroxysmal atrial tachycardia and (b) tachycardia-induced cardiomyopathy. Under the guidance of a three-dimensional electroanatomical mapping system, an intracardiac electrophysiological study accurately localized the focal atrial tachycardia to the posterior margin of the right upper pulmonary vein, followed by successful radiofrequency ablation. The patient's clinical symptoms improved significantly postoperatively, and the patient was discharged uneventfully. During the 8-month follow-up period, no recurrence of atrial tachycardia was documented. Follow-up echocardiography confirmed normalization of cardiac dimensions and function.

Raynaud's phenomenon is characterized by episodic vasospasm of the extremities, often triggered by cold or stress. It is a hallmark of systemic sclerosis (SSc) and is frequently associated with pulmonary arterial hypertension (PAH). PAH may cause right atrial dilatation, predisposing to atrial fibrillation (AF). While Raynaud's and PAH are well-documented, their coexistence with AF is rarely reported. A 71-year-old male presented with rapid AF and pulmonary oedema. On admission, vital signs were stable, but he developed symmetrical discoloration of the fingers, palms, and feet after cold exposure in the ICU, accompanied by numbness and pain. Laboratory tests revealed prolonged PT, high ESR (65/121 mm/hr), and positive ANA (44.8 IU/mL). ECG showed rapid AF with left ventricular hypertrophy. Chest X-ray demonstrated pulmonary artery dilatation and cardiomegaly. Echocardiography revealed moderate tricuspid regurgitation and severe PAH. This case illustrates a rare combination of Raynaud's phenomenon, PAH, and AF, likely secondary to autoimmune vascular dysfunction. PAH-induced atrial dilatation may trigger AF, while endothelial dysfunction may worsen Raynaud's symptoms. A positive ANA suggests underlying SSc or SLE. Early recognition and multidisciplinary management targeting pulmonary pressure, arrhythmia control, and vasospasm are crucial to prevent complications. Long-term outcome was not assessed due to loss to follow-up.

Background and Clinical Significance: The crista terminalis (CT) is a physiological fibromuscular ridge in the right atrium. While benign, rare cases of CT hypertrophy present a diagnostic challenge, as it can mimic a pathological right atrial mass on cardiac imaging. The CT also presents arrhythmogenic potential and is known to be associated with right atrial tachyarrhythmias. Case Presentation: We present the case of a 58-year-old female that presented with rapid, irregular palpitations, accompanied by hypertension. Holter electrocardiography (ECG) confirmed self-limiting episodes of atrial tachycardia (max heart rate 170 bpm). Initial transthoracic echocardiography (TTE) identified an echogenic, non-mobile mass on the posterolateral right atrial wall. Transesophageal echocardiography (TEE) confirmed a 12 × 9 mm homogenous structure with a broad base of implantation and no intrinsic mobility, initially raising the suspicion of an atrial lipoma. Subsequent cardiac computed tomography angiography (CCTA) provided high-resolution tissue characterization, identifying the mass as a hypertrophied CT due to its precise anatomical orientation and its lack of contrast enhancement, also ruling out neoplastic and thrombotic aetiologies. Conclusions: CT hypertrophy is a key differential diagnosis for right atrial masses, particularly in females in their sixth decade. A multimodal imaging approach, transitioning from TTE to TEE and finally CCTA or Cardiac Magnetic Resonance Imaging (CMR), is advantageous in preventing unnecessary invasive interventions or anticoagulation.

A 61-year-old woman presented to our hospital with palpitations and dyspnea persisting for several months. Electrocardiography revealed atrial tachycardia, and X-ray revealed bilateral hilar enlargement. Computed tomography (CT) was performed for suspected sarcoidosis of the respiratory system, which revealed hilar lymph node enlargement in the bilateral lungs. 18F-Fluorodeoxyglucose (18F-FDG)-positron emission tomography-CT revealed abnormal 18F-FDG uptake in the hilar lymph nodes, liver, and left atrium (LA), but not in the left ventricle. Contrast-enhanced cardiac magnetic resonance imaging revealed late gadolinium enhancement (LGE) in the LA. Mediastinal lymph node, transbronchial lung, and right ventricular biopsies were performed, but no specific pathological findings were observed. Echocardiography-guided liver biopsy was also performed, which revealed non-caseating epithelioid granulomas. We definitively diagnosed systemic sarcoidosis, including cardiac lesions. Following the initiation of immunosuppressive therapy, abnormal 18F-FDG uptake in the liver, lymph nodes, and LA resolved, and atrial tachycardia improved, likely owing to the suppression of atrial inflammation. However, LGE in the LA persisted after immunosuppressive therapy, suggesting that structural damage had persisted. In this case, multimodality imaging helped us understand the disease state and post-treatment course.

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to incomplete valve closure, TR leads to right heart dilation, systemic congestion, and eventually right-sided heart failure. Importantly, TR may contribute to the onset of atrial fibrillation (AF), the most common sustained arrhythmia, affecting approximately 59 million individuals worldwide. Despite its growing clinical importance, the pathophysiology of TR remains incompletely understood, and current animal models of TR, based on direct valve manipulation, limit translational applicability. We present a novel, minimally invasive porcine model of TR established via femoral/jugular vein catheterization with deployment of an inferior vena cava (IVC) filter. The filter partially impedes tricuspid valve closure, inducing TR without valvular injury. Validation was achieved through multimodal imaging, including fluoroscopy, echocardiography, and electrocardiography, confirming hallmark features of TR, including right atrial and ventricular enlargement and arrhythmic activity. This model provides a reproducible, minimally invasive platform for studying selected features of TR progression. Its minimally invasive nature and preservation of native valvular structure make it a useful preclinical platform for mechanistic and translational research.

ECG is the most used tools in cardiology. Some life-threatening arrhythmias and cardiac abnormalities can be diagnosed with ECG. The aim is to assess the role of ECG for the detection of cardiac disease in children, from September 2014 to January 2020, ECG was performed in 52 primary school in Como. 5793 children (49.4% female) aged 8.1 (± 1.3) years had an ECG; 79 (1.3%) were abnormal due to the following findings: 34 (43%) right bundle branch block (RBBB), 9 (11%) abnormal ventricular repolarization, 7 (9%) long QT, 7 atrio-ventricular block (AVB), 7 (9%) accessory pathway, 5 (5%) premature ventricular beat, 5 (5%) anterior hemiblock, 4 (5%) left ventricular hypertrophy, 1 (2%) ST alteration. Long QT syndrome was excluded in all children with long QT. Among those with RBBB, 2 had severe inter-atrial septal defect (one underwent to closure), while one had moderate mitral valve regurgitation and bicuspid aortic, and 2 had moderate mitral regurgitation. One child with AVB had pacemaker implantation. One child with accessory pathway had Wolf-Parkinson syndrome and undergone to catheter ablation. Among apparently healthy children, ECG may be useful to detect cardiac disease with potential consequence in the adulthood.