Background: Pembrolizumab is a humanized IgG4 antibody from the immune-checkpoint inhibitors (ICI) family that has been proven to improve clinical outcomes in many solid organ malignancies. Despite its great therapeutic results, this novel drug has undesirable side effects, including uncommon cardiac and neuromuscular adverse effects. Case presentation: The patient, a known case of hypertension, COPD, HFpEF and NSCLC presented with mild chest pain and shortness of breath on exertion for 5 days. His CT scan revealed no pulmonary emboli. His echocardiogram indicated an EF of 10-15%, worldwide hypokinesis, reduced RV function, and a moderately enlarged left atrium. He underwent coronary angiography, which revealed no obstructive lesions. He was managed with IV Lasix, IV methylprednisolone in hospital and prednisone, furosemide, metoprolol succinate, and lisinopril on discharge. He was prescribed spironolactone at his two-week follow-up. Conclusion: Pembrolizumab-induced cardiomyopathy is uncommon and should be treated with care because there is no cure.

Title Page Title: Letter to the Editor: ”Urinary TIMP-2 and IGFBP-7 protein levels as early predictors of acute kidney injury after cardiac surgery”.Article type: Letter to the editor.

Background: Coronary artery aneurysms are reported in 1.5 to 4.9 percent of the population receiving coronary angiography. Whether there is coronary stenosis or atrial fibrillation, it might result in an acute coronary syndrome. Case presentation: The patient was in his usual health when he began to experience pain while watching television an hour before his visit to the emergency department . The patient, a smoker with a history of hypertension, presented at our hospital with significant retrosternal chest pain. A CT angiography of the coronary arteries revealed a large RCA aneurysm thrombus-laden aneurysm. He was given 324 mg aspirin, 400 mcg Nitro-glycerin, 80 mg Atorvastatin, and a Heparin infusion immediately. An emergency RCA bypass grafting procedure was performed after a cardiothoracic surgical team assessed the patient. Conclusion: Coronary artery aneurysm is an infrequent disorder that can appear in a variety of ways. Before any further therapy, it should be thoroughly evaluated.

TITLE: Letter to the Editor: Anatomical reasons for failure of dual‐filter cerebral embolic protection application in TAVR: A CT‐based analysisARTICLE TYPE: letter to the editorCORRESPONDENCE: 1. Muhammad Ali MuzammilContact; +92 3313657590 Email; muzammil200077@gmail.comInstitute: Dow University of Health Sciences, karachiAddress: A-49 Street No.8 Block:2 Chapal Sun city near kiran Hospital Scheme#33 Gulzar-e-hijriCo-Authors ; 2. Rahat Ahmed MemonEmail: rahatahmed227@yahoo.com Contact: +12677091949Institute: Abington Memorial Hospital