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Objective: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital condition which can manifest as various cardiac symptoms. Case presentation: A 64-year-old male patient presented with functional class deterioration and typical angina to hospital. He was stratified by an ischemia-induced study and underwent coronary angiography that found to have ALCAPA. Conclusions: This is a rare case of ALCAPA due to the patient´s age. Survival to adulthood is possible due to collateral circulation, though the cost is the presence of heart failure, and wherein due to the high surgical risk, in this case optimal medical therapy was decided.

Objective: Coronary anomalies do not generate symptoms, it is incidental findings when performing a coronary angiography in a patient with ischemic heart disease or valvular heart disease. The anomalous origin of the circumflex (LCX) of the right coronary artery (RCA) is one of the common anomalies. We describe a case of CX orifice arising from right coronary sinus in a ``shotgun`` manner with orifice of RCA and successful percutaneous coronary intervention (PCI) of lef anterior descending artery (LAD). Case Report: In this case, the anomalous incidental finding was the arising of the CX artery in “shotgun” shape with the RCA (separate ostium) in a clinic scenario of anterior ST-segment elevation myocardial infarction wherein the patient received fibrinolytic therapy with alteplase, presenting reperfusion criteria (>50% ST-segment resolution at 60 minutes and relief angina) and then underwent to successful PCI. Conclusion: The ectopic origin of the CX is a well-recognized variant, which is considered the most common coronary anomaly. Although this anomaly is classified as benign and asymptomatic, a few cases of sudden death, myocardial infarction, and angina pectoris in the absence of atherosclerotic lesion have been reported. We described coronary anomaly without atherosclerotic lesion identified in a patient with ST elevation anterior myocardial infarction who underwent successful PCI of culprit LAD. Such coronary anomalies should be considered as well in patients with STEMI undergoing PCI.

The case of a patient with repetitive syncope episodes with a history of using loperamide at high doses for recreational purposes in search of an effect similar to heroin, is reported. In the diagnostic approach with Holter monitoring, ventricular tachycardia and ventricular fibrillation were evidenced. We also present the treatment of our case and review the literature.

Abstract Background Malignant primary cardiac tumors are infrequent and can lead to an unfavorable prognosis if not identified and treated promptly. Early detection and prompt treatment of malignant primary cardiac tumors are crucial for a better prognosis. This article presents a case of primary cardiac leiomyosarcoma and reviews the literature on this topic. Case presentation Female patient that developed recurrent pericardial effusion and hemodynamic instability caused by a cardiac tumor, later identified as leiomyosarcoma. Multidisciplinary treatment was administered to the patient. Conclusions The initial approach to this type of pathology should include multimodality imaging to establish a prompt diagnosis leading to complete standard treatment, to minimize risks to the patient's heart function which may include resection with complete margins of the neoplasm, otherwise the prognosis may be poor.