We present the case of a 76-year-old Caucasian woman who survived two major earthquakes, presenting on each occasion with stress cardiomyopathy. She first presented following the first Christchurch earthquake of September 4, 2010. Coronary angiography demonstrated diffuse atheroma. Echocardiography showed a classic takotsubo pattern. Follow-up echocardiogram on September 28 was normal. However, during the second earthquake of February 22, 2011, she again developed chest pain with a TnI rise. Echocardiogram showed a midwall variant takotsubo with apical sparing. At follow-up echocardiography on July 27, her left ventricle was again normal.

Obstruction to a prosthetic cardiac valve is a well-recognized complication of cardiac valve replacement. We report a 48-year-old female with dysfunction of mechanical mitral prosthetic valve due to suture entrapment.

Intracardiac metastases of thyroid carcinoma are a rare event. Their incidence is low in large autopsy series, and antemortem diagnosis is even less common. We present the case of a woman with advanced poorly differentiated thyroid carcinoma, who had extensive intracardiac metastases. This case highlights the usefulness of echocardiography and magnetic resonance imaging in the diagnosis and differential diagnosis of cardiac metastases.

This case report illustrates an accessory mitral valve (AMV) leaflet which is a rare congenital anomaly thought to result from abnormal development of the endocardial cushion. In this case of a 20-year-old woman who presented with dyspnea, transthoracic echocardiography demonstrated a membrane-like structure in the left ventricular outflow tract (LVOT) and severe aortic incompetence (AI). The “subaortic membrane” had a connection to the anterolateral papillary muscle via a strand of chordal tissue and was causing obstruction in the LVOT. After reviewing the literature it was concluded that this structure was an AMV leaflet causing LVOT obstruction associated with AI.

A 41-year-old woman with a history of neurocardiogenic syncope treated with beta-blockers was admitted with chest pain. Dobutamine echocardiogram images demonstrated decreased global left ventricular (LV) systolic wall motion and thickening. Coronary angiograms were normal. Beta-blockers were stopped and dobutamine stress echocardiogram (DSE) was repeated. Dobutamine images demonstrated increased global LV systolic wall motion and thickening. Beta-blockers were restarted and again dobutamine produced global LV dysfunction. This case suggests that DSE wall motion response may be falsely abnormal in a patient on beta-blockers. Physicians should be aware of this possibility when interpreting dobutamine echocardiography in patients taking beta-blockers.

First reported by Coto in 1980, aorta-right atrial tunnel (ARAT) is a rare congenital vascular connection between the aortic root and RA. The case report presents an adult male patient with ARAT. We have discussed the diagnostic experience of the rare congenital cardiac anomaly in echocardiography.

We present a case of a rare complication of atrial septal defect (ASD) device closure causing cor triatriatum dextro iatrogenica. A 29-year-old female presented with sudden onset dysarthria and ataxia and was found to have basilar and thalamic infarcts. Further evaluation using transthoracic echocardiography revealed an ASD which was repaired using the Gore HELEX septal occluder. Transesophageal echocardiography done after 2 months of ASD closure revealed an interesting finding termed cor triatriatum dextro iatrogenica.

Mitral annular abscess is an uncommon entity that rarely develops during the course of infective endocarditis. In this report, we present a case of a young girl who presented with acute decompensated heart failure due to acute mitral regurgitation caused by an abscess of the medial mitral annulus that perforated leading to left ventriculo-atrial fistula. This report includes echocardiographic images of this rare complication of infective endocarditis.

We report an echocardiographic presentation of intramyocardial hemorrhage (IMH) immediately after percutaneous coronary intervention in a patient with anterolateral ST-elevation myocardial infarction and an acutely occluded left anterior descending artery. IMH was confi rmed on cardiac magnetic resonance (CMR). Echocardiography and CMR three weeks later showed progressive left ventricular (LV) remodeling with interval thinning of LV apex. Intramyocardial hemorrhage can be seen on contrast echocardiography and is associated with LV remodeling.

We present a 75-year-old man who had a coronary artery bypass operation 1 year ago after an anterior wall myocardial infarction. The lateral chest x-ray showed a second contour with a smooth border within the cardiac silhouette. On transthoracic echocardiography, a large echolucent area mimicking isolated pericardial effusion was seen next to the lateral free wall of the left ventricle, and color flow imaging revealed a narrow passage between the left ventricle and the echolucent sac. Multisliced computed tomography scan confirmed a large pseudoaneurysm of the left ventricle.

The patient was an 80-year-old white woman who had noted increasing dyspnea for the past 6 months. Heart auscultation revealed grade 3/6 pansystolic murmur at mitral area. Preoperative transesophageal echocardiogram showed severe mitral regurgitation with an echolucent and looped structure in the anterior leaflet of mitral valve. Intraoperatively, the anterior mitral leaflet was found to have a diverticulum measuring 8 mm in size. Mitral valve replacement was performed. Noninfectious diverticulum of mitral valve has been rarely reported previously. The case illustrates the unique fi ndings on echocardiography that would help to differentiate diverticula from other valvular pathologies.