Spinal anesthesia is widely used for lower abdominal and orthopedic procedures, offering advantages including active patient cooperation and reduced systemic effects. However, some patients experience significant anxiety during awake regional anesthesia, and a minority may develop acute panic attacks. We report the case of a 52-year-old woman with no prior psychiatric history who underwent elective total knee replacement under spinal anesthesia. Approximately 35 minutes after successful spinal anesthesia, she developed acute symptoms including severe anxiety, palpitations, chest tightness, dyspnea, a feeling of impending doom, and uncontrollable trembling. Vital signs revealed tachycardia (142 bpm) and hypertension (180/95 mmHg), while oxygen saturation remained within normal limits. The surgical team considered aborting the procedure and converting to general anesthesia. Immediate bedside psychological intervention was provided by the attending anesthetist (with clinical psychology training), consisting of grounding techniques, breathing retraining, cognitive reassurance, and guided imagery. Symptoms resolved within eight minutes, and surgery proceeded uneventfully. This case highlights the importance of recognizing panic attacks in the intraoperative setting and demonstrates that brief psychological intervention can avert procedure abandonment and facilitate successful completion of surgery.

Cor-triatriatum sinistrum (CTS) is a rare congenital heart disease, characterized by a membrane dividing the left atrium into two chambers. Echocardiography is the primary imaging modality. However, computed tomography and magnetic resonance imaging both play important roles in delineating the anatomy of the condition and also determining the associated anomalies. Although thought to be a disease of childhood, CTS can also present in adulthood with varied clinical manifestations like dyspnea, palpitations, and syncopal attacks. In CTS, the left atrial membrane causes pulmonary venous obstruction and eventual pulmonary arterial hypertension. It is usually associated with membrane fenestrations, which allow some antegrade flow. If not, there are relief valves, such as the ostium secundum atrial septal defect (OS-ASD) and/or the levo-atrial-cardinal vein.

Thyrotoxicosis refers to the clinical state resulting from elevated thyroid hormone levels and may occur with or without underlying hyperthyroidism. Recognizing non-thyroidal and iatrogenic causes is essential for accurate diagnosis and management. A 50-year-old woman presented to a cardiologist due to complaints of palpitations. Electrocardiogram and echocardiogram were performed showing sinus tachycardia. Beta-blocker therapy was prescribed with recommendations for thyroid function testing. The laboratory tests performed in a specialized endocrine clinic confirmed transient thyrotoxicosis without hyperthyroidism and a normal ultrasound image of the thyroid gland. Upon further assessment, an iatrogenic cause was suspected as the most plausible contributing factor-the use of a nutritional supplement for menopausal symptoms containing iodine and other active substances. We present a clinical case of transient most likely supplement-associated thyrotoxicosis without persistent hyperthyroidism with subsequent normalization of thyroid function after symptomatic therapy. Exogenous iodine intake in the form of a dietary supplement is discussed as a possible trigger. The article provides information about the diagnostic and therapeutic algorithm in patients with thyrotoxicosis in the light of real clinical practice and emphasizes the importance of detailed medication and supplement history.

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly that typically presents in any age with progressive aortic regurgitation. A 55-year-old Bangladeshi woman came with a 3 weeks history of progressive dyspnea, intermittent chest tightness, and palpitations. Trans-esophageal echocardiography confirmed a QAV with central leaflet malcoaptation and mild aortic root dilatation. Further assessment with cardiac computed tomography and magnetic resonance imaging enabled detailed anatomical characterization, severity assessment, and operative planning. Multimodality imaging is crucial for accurate diagnosis, risk stratification and surgical decision-making. This case highlights the value of comprehensive imaging and individualized surgical planning in achieving favorable outcomes in patients with QAV.

Atrial septal defects (ASDs) are among the most common forms of congenital heart disease diagnosed in adulthood. Ostium secundum defects represent the majority of cases and may remain clinically silent for decades. Delayed diagnosis can lead to progressive right-sided cardiac chamber dilation, pulmonary hypertension, arrhythmias, and heart failure. The choice between percutaneous and surgical closure depends on anatomical characteristics such as defect size and the adequacy of surrounding septal rims. We report the case of a 49-year-old woman with hypertension, type 2 diabetes mellitus, and hyperlipidemia who presented with one week of substernal chest pain, palpitations, and progressive dyspnea on exertion consistent with New York Heart Association (NYHA) functional class III limitation. Physical examination revealed a holosystolic murmur best heard along the tricuspid area with inspiratory accentuation. Transthoracic echocardiography identified a large secundum ASD measuring 35 mm × 22 mm with elevated pulmonary artery systolic pressure and right-sided chamber dilation. Transesophageal echocardiography confirmed a large defect with minimal aortic rim and limited atrioventricular valve rim, precluding percutaneous closure. Cardiac catheterization demonstrated bidirectional shunting with a Qp/Qs ratio of 2.65 and normal pulmonary vascular resistance. The patient subsequently underwent successful surgical ASD closure using a bovine pericardial patch. Her postoperative course was uncomplicated, with complete resolution of symptoms and normalization of pulmonary artery pressures on follow-up echocardiography six months later. This case highlights the potential for large ASDs to remain undiagnosed until adulthood, when progressive right-sided cardiac remodeling leads to symptomatic disease. Early detection through timely echocardiographic evaluation is critical to facilitate timely intervention and may expand eligibility for less invasive percutaneous repair. Prompt recognition and closure of hemodynamically significant ASDs can prevent irreversible cardiopulmonary complications and significantly improve long-term outcomes.

Cardiac sarcoidosis is a rare but life-threatening manifestation of systemic sarcoidosis, frequently presenting with ventricular arrhythmias, heart block, or sudden cardiac death. It remains underdiagnosed owing to its diverse clinical presentation and rarity and the limitations of conventional diagnostic modalities. We report a case of a 42-year-old man with no prior cardiac history who presented with a three-day history of recurrent palpitations and three to four syncopal episodes. Electrocardiography during syncope demonstrated self-terminating ventricular tachycardia (VT), with one episode lasting five hours, requiring pharmacological cardioversion. Coronary angiography revealed entirely normal coronary arteries. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) identified a non-ischemic, epicardial-to-mid-myocardial enhancement pattern involving the interventricular septum, inferior wall, and lateral wall, accompanied by mediastinal and hilar lymphadenopathy. Two-dimensional echocardiography revealed severe left ventricular (LV) dysfunction with an ejection fraction of 15%. Serum angiotensin-converting enzyme levels were markedly elevated at 90 U/L (reference: 12-66 U/L). The patient was commenced on systemic corticosteroids (prednisolone), antiarrhythmic therapy (amiodarone), anticoagulation, and guideline-directed heart failure therapy. This case underscores the diagnostic utility of CMR-LGE in identifying non-ischemic infiltrative cardiomyopathy and highlights the importance of considering cardiac sarcoidosis in patients presenting with unexplained VT and severely reduced LV function. Early immunosuppressive therapy and multidisciplinary management are pivotal in improving clinical outcomes.