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Case: A 34-year-old woman with no significant past medical history presented to the hospital with sudden onset of palpitations with associated dyspnea and chest discomfort. She denied any similar previous episodes. Initial electrocardiogram (EKG) was consistent with a short R-P interval supraventricular tachycardia (SVT). Her transthoracic echocardiogram (TTE) revealed no structural abnormalities, TSH levels were normal, and urine drug screen was negative for any recreational drugs. However, the patient had been taking phentermine for weight loss.Discussion: The exact mechanism is not clear; however, we postulate that the sympathomimetic effects of phentermine likely contribute to SVT induction through enhanced AV nodal conduction or increased atrial ectopy. Conclusions: The only medication she was taking at home was phentermine, and the palpitations did not recur after discontinuation of the drug during follow-up. It is important to collect a thorough medication history when patients present with AV nodal reentrant tachycardia (AVNRT) or other SVT. [ABSTRACT FROM AUTHOR]

Marijuana is the most commonly used psychoactive drug in the USA. A 35-year-old man with a medical history of marijuana abuse is admitted to the hospital due to crushing substernal chest pain. ECG shows evolving ST-segment elevation with a rise in cardiac enzymes, consistent with ST-elevation myocardial infarction. A urine toxicology screen is positive for cannabis and negative for cocaine and other stimulant drugs. An emergent cardiac catheterisation reveals no evidence of coronary artery disease or thrombosis. A diagnosis of coronary vasospasm is strongly considered, and the patient is started on calcium channel blocker, with a resolution of symptoms and ECG changes. Marijuana-induced coronary spasm causing myocardial infarction has rarely been reported. Marijuana is becoming a social norm in adolescents and there remains a misconception that it is harmless and even beneficial. Increasing drug abuse remains a public health concern, necessitating population education by physicians for safer healthcare practices. [ABSTRACT FROM AUTHOR]

Chemotherapeutic regimens have cardiotoxic properties and thorax irradiation is associated with accelerated coronary artery disease (CAD). There is limited data regarding the influence of cancer on outcomes after percutaneous coronary intervention (PCI), as cancer patients were not routinely included in the PCI trials. We performed a systematic review and meta-analysis to compare the early outcomes of PCI between patients with active/historical cancer and patients without a cancer history. A systematic search was made in the PubMed, Medline, and Cochrane databases using the search terms "PCI" and "Cancer". The major outcomes were in-hospital mortality, in-hospital cardiovascular mortality, 30-day mortality, and peri-procedural complications. We used random effects model to aggregate data and calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). A total of 7 studies were included, out of which 4 studies reported in-hospital mortality. Compared to patients without cancer, patients with active/historical cancer undergoing PCI had higher rates of in-hospital mortality (relative risk [RR] 1.89; 95% CI 1.33-2.70; P = 0.0004), in-hospital cardiovascular mortality (RR 2.21; 95% CI 1.19-4.08; P = 0.01), 30-day mortality (RR 2.01; 95% CI 1.24-3.27; P = 0.005), and peri-procedural blood transfusion (RR 1.73; 95% CI 1.02-2.95; P = 0.04). There were no significant differences in peri-procedural myocardial re-infarction, new-onset heart failure, shock, and stroke between the two cohorts. In conclusion, Among patients undergoing PCI, active/historical cancer was associated with worse early mortality compared to patients without a history of cancer. Management of cancer patients undergoing PCI should be individualized and involve multi-specialist team discussion to narrow the mortality gap. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 27-year-old white man, who was admitted in hospital after cocaine with a chest pain. Topics discussed include the patient undergoing a transthoracic echocardiogram (ECG), detection of the Wellens' syndrome, and association of Wellens' syndrome with cardiac diseases. It offers an answer to a question related to the findings of the ECG.