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Remdesivir has been extensively employed during the coronavirus disease 2019 (COVID-19) pandemic as it has proven to be efficacious against the causative SARS-CoV-2. However, there is not much evidence on the cardiovascular adverse effect profile of remdesivir. In addition, limited data support the occurrence of sinus bradycardia associated with remdesivir. Herein we chronicle a clinical encounter of a patient suffering from COVID-19 whose clinical course was complicated by marked sinus bradycardia that began acutely after remdesivir initiation and resolved on cessation of the medication. The patient denied symptoms and completed a 5-day course with a resolution of bradycardia on completion of medication. We suggest that the physicians be cognizant of this rare side effect of remdesivir and suggest a continuation of this medication unless symptomatic bradycardia precludes management.

Cutibacterium acnes is a skin commensal which is most often regarded as a contaminant when detected on blood cultures. In rare instances, it may be the causative pathogen in severe systemic illnesses. Subacute endocarditis, especially of prosthetic valves and devices, is an important grave pathology caused by Cutibacterium acnes. Herein we report two cases of prosthetic valve endocarditis with varied presentations as valve dehiscence with a \"rocking\" prosthetic valve apparatus in one encounter and as a septic embolic stroke in the second encounter. Although a rare cause of endocarditis, it becomes an especially important entity in patients with prosthetic devices and should be high in the list of differentials.

Bicuspid aortic valve is the most common congenital heart disease. Bicuspid aortic valves are prone to accelerated degenerative changes and aortopathies. These changes often manifest in adulthood as severe aortic stenosis or mixed aortic valve disease. Cystic fibrosis patients are at high risk of adverse surgical outcomes. As survival in cystic fibrosis continues to increase, managing comorbidities including severe aortic stenosis requires consideration. The relatively non-invasive transcatheter aortic valve replacement has been posed as an intervention for high-risk patients with severe symptomatic aortic stenosis. However, traditional randomized trials have excluded patients with bicuspid aortic valves. Herein we present an extremely rare association of severe bicuspid aortic valve stenosis in an adult cystic fibrosis patient. Furthermore, we discuss the clinical course and a multi-disciplinary approach for the management of this rare scenario.

Lung transplantation is increasingly being performed for end-stage lung disease in patients with bronchiectasis and pulmonary hypertension. Outcomes of bilateral lung transplantation (BLT) are better in patients with pulmonary hypertension, whereas single lung transplant remains a controversy in bronchiectasis with fear of infections from the residual diseased lung. However, in patients with adhesions and extreme structural changes due to severe disease, BLT may be considered technically challenging. We describe a case of successful management of a patient with bronchiectasis-induced lung disease causing extreme mediastinal shift with a BLT. The patient was successfully bridged to transplant with central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for acute decompensated pulmonary hypertension while awaiting transplantation.

Euglycemic diabetic ketoacidosis (DKA) is a rarely reported side effect of sodium-glucose cotransporter-2 inhibitor (SGLT2i) empagliflozin. A 51-year-old female with Gitelman syndrome and type 2 diabetes mellitus (DM) presented with abdominal pain after a recent hospitalization for acute pancreatitis. Her diabetes medications included metformin, pioglitazone, and empagliflozin. Diabetic ketoacidosis was suspected; however, glucose levels were below the cutoff for DKA; therefore, she was diagnosed with euglycemic DKA. Her pancreatitis workup was insignificant. Severe symptomatic hypokalemia despite aggressive repletion limited the management of DKA with insulin infusion therapy. As her ketonemia resolved, she was initiated on subcutaneous insulin with a small but acceptable decrease in potassium. The therapeutic dilemma of managing euglycemic DKA due to SGLT2i in a patient with Gitelman syndrome has not been previously described.

Vaccine-mediated immune thrombocytopenia, although previously reported, is considered exceedingly rare. The probability of the incidence of profound thrombocytopenia following the COVID-19 mRNA-based vaccine has been less elucidated. We present the case of an 81-year-old female patient who became profoundly thrombocytopenic with bleeding manifestations six days after the Moderna mRNA-1273 vaccine administration. Fortunately, she exhibited platelet count recovery after treatment with intravenous immunoglobulins and steroid therapy. Furthermore, we show that the inherent risk of COVID-19 infection leading to thrombocytopenia significantly outweighs the vaccine's risk.

Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic and asymptomatic patients. The most frequent mediastinal masses in adults are thymoma, lymphoma, thyroid masses, and germ cell tumors. Potential complications of these masses due to localized invasion include hemoptysis, post-obstructive pneumonia, and superior vena cava syndrome. Pericardial tamponade is usually secondary to pericarditis, trauma, infections, radiation, uremia, vascular diseases, and uremia. However, this report presents a case of a young patient who was found to have a large pericardial effusion and early signs of pericardial tamponade, which have not previously been reported as complications of extragonadal germ cell tumors, to the best of our knowledge.

Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is the underlying cause of a global crisis that the entire world is facing. It is a highly contagious viral infection, which is why social distancing seems to be effective. Its ability to survive on various surfaces and aerosolize necessitates very meticulous precautions, including airborne isolation for severely ill patients requiring mechanical ventilation. However, these patients may need routine diagnostic investigations including chest computed tomography and chest tomography angiogram scans (CT and CTA) to rule out other potential differential diagnoses and guide management. In this case, we focus on the utility of multiorgan ultrasonography (MOU) at the bedside to diagnose and manage pulmonary embolism (PE) in COVID-19 patients.

Stanford type A acute aortic dissection (AAD) is a life-threatening illness that presents with chest pain and hemodynamic instability. Prompt and accurate evaluation and management are critical for survival as it is a cardiac surgical emergency. We aim to highlight the physicians about this potentially fatal condition, by reporting two cases of Stanford type A AAD, with atypical presentations that were initially misdiagnosed.

Duplex ultrasonography of renal arterial circulation revealed a normal kidney size, peak velocities of 440 cm/s (figure 1C) in the TRA and 122 cm/s in the EIA (figure 1D) with a renal/iliac ratio of 3.1, normal parenchymal blood flow with an unchanged resistive index. Drug-eluting stents have shown reductions in restenosis and target vessel revascularisation compared with bare-metal stents. Endovascular therapy with percutaneous transluminal angioplasty and drug-eluting stent placement results in improved blood pressure control and renal function.