Cardiology and Angiology: An International Journal http://journalca.com/index.php/CA <p style="text-align: justify;"><strong>Cardiology and Angiology: An International Journal (ISSN:&nbsp;2347-520X)</strong>&nbsp;aims to publish high quality papers (<a href="/index.php/CA/general-guideline-for-authors">Click here for Types of paper</a>) in all areas of ‘Cardiology and Angiology research’. The journal also encourages the submission of useful reports of negative results. This is a quality controlled,&nbsp;OPEN&nbsp;peer reviewed, open access INTERNATIONAL journal.</p> SCIENCEDOMAIN international en-US Cardiology and Angiology: An International Journal 2347-520X Intraoperative Hypertensive Crisis in a Patient with Normotensive Primary Aldosteronism. Lessons from a Clinical Case http://journalca.com/index.php/CA/article/view/30107 <p>Primary hyperaldosteronism is the most frequent cause of secondary hypertension. However, it can also be found in apparently normotensive patients, often associated with recurrent hypokalemia and isolated hypertensive episodes.</p> <p>We hereby present the case of a normotensive 50-year-old female patient with a surgical left kidney mass; however, after anaesthetic induction, surgery was aborted due to a severe hypertensive crisis. She was referred to our Hypertension Outpatient Clinic to rule out pheochromocytoma/ paraganglioma. The anamnesis revealed unexplained episodes of hypokalemia. Ambulatory blood pressure monitoring showed normal mean values of blood pressure and heart rate, with an isolated hypertensive peak. Plasma glucose, ions, creatinine, lipids, metanephrines and chromogranin A were normal, but plasma aldosterone was clearly elevated with suppressed plasma renin activity and high aldosterone/renin activity ratio. Primary aldosteronism was confirmed by the captopril test. Abdominal CT was compatible with left adrenal hyperplasia. Treatment with low-dose spironolactone was well tolerated and resulted in normal blood pressure, normokalemia and unsuppressed plasma renin activity. The patient underwent successful laparoscopic removal of a renal oncocytoma.&nbsp;</p> <p>We conclude that normotensive primary aldosteronism is not harmless; it can be associated with severe hypokalemia, anxiety, depression, hypertensive crisis and cardiovascular damage. Patients can also develop resistant hypertension. Adequate treatment can decisively improve the survival and quality of life of the patients with primary aldosteronism, but a correct diagnosis is needed first. Therefore, it must be considered as a diagnostic possibility in normotensive patients with unexplained hypokalemia or isolated hypertensive episodes.</p> Agnieszka Kuzior Manuel Esteban Nivelo-Rivadeneira Paula Fernandez-Trujillo-Comenge Esperanza Perdomo-Herrera Alba Lucia Tocino-Hernandez Marta Martin-Perez Paula Gonzalez-Diaz Maria Victoria Sainz de Aja-Curbelo Ana Delia Santana-Suarez Francisco Javier Martinez-Martin ##submission.copyrightStatement## 2019-07-06 2019-07-06 1 7 10.9734/ca/2019/v8i430107 A Rare Case of Left Ventricular Outflow Tract Obstruction 18 Years after a Mechanical Mitral Valve Replacement http://journalca.com/index.php/CA/article/view/30110 <p><strong>Background</strong><strong>:</strong> Left ventricular outflow tract (LVOT) obstruction is a serious complication that can occur after various mitral-valves, surgical or percutaneous, interventions.</p> <p>It was rarely described in mechanical mitral valve replacements.</p> <p><strong>Aim</strong><strong>:</strong> to describe a rare case of late LVOT obstruction after a mitral valve replacement by a low-profile mechanical prosthesis.</p> <p><strong>Case Presentation:</strong> A 48-year woman, with a history of rheumatic mitral valve disease and mechanical mitral replacement by a hemi-disc valve 18 years ago, presented for a recent dyspnea. Echocardiography showed a narrowing of the LVOT, with anterior position of the mitral prosthesis, aorto-mitral annular angulation, septal thickening and remnant native sub-valvular tissue attached to the septum in the LVOT region. This resulted in LVOT obstruction with a peak gradient of 75 mmHg. The heart team opted for a redo surgery, but the surgical decision was refused by the patient.</p> <p><strong>Discussion</strong><strong>:</strong> This is a rare case of late LVOT obstruction after mitral valve replacement by mechanical low-profile prosthesis. Preserved native mitral valve tissue, which is the main described cause of LVOT obstruction after mechanical mitral valve replacements was not the unique cause of obstruction in this patient who had also a septal thickening and anterior prosthetic position. Aorto-mitral annular angulation that was identified as a risk factor of LVOT obstruction after trans-catheter mitral valve replacements, should be, probably, also took into account and assessed pre-operatively in patients undergoing surgical mitral replacements.</p> <p><strong>Conclusion</strong><strong>:</strong> LVOT obstruction can occur after mechanical mitral replacements event with low profile prosthesis. In patients with identified risk factors of LVOT obstruction, preservation mitral anterior leaflet should be avoided, and preservation of other native mitral tissue should be discussed.</p> Fathia Mghaieth Zghal Selim Boudiche Abdeljelil Farhati Ali Bonkano Manel Ben Halima Bassem Rekik Sana Ouali Mohamed Sami Mourali ##submission.copyrightStatement## 2019-10-18 2019-10-18 1 7 10.9734/ca/2019/v8i430110 Unmasking Brugada Syndrome with Oral Flecainide Provocation. A Case Series of Three Patients http://journalca.com/index.php/CA/article/view/30108 <p>The present case series discuss three patients who had brugada type 2/ type 3 like ECG pattern that was converted to type 1 pattern with oral flecanide challenge test. Brugada syndrome is associated with a high incidence of sudden cardiac death,&nbsp;&nbsp; typical ECG pattern being ST-segment elevation in the right precordial leads with T wave inversion. Pharmacological provocation should only be performed when the baseline ECG is not diagnostic of Brugada Syndrome. PR prolongation in the baseline ECG is also a contraindication because of the risk of inducing AV block. Drug challenge is performed under strict monitoring of BP and 12-lead ECG and facilities for cardio version and resuscitation are available. Atypical RBBB pattern/type 2/3 Brugada pattern on ECG in patients of syncope or family history of sudden cardiac arrest is commonly encountered by a cardiologist. This can be performed to provoke type 1 brugada pattern on ECG. Diagnosed cases of Brugada may be treated with ICD with proper indication if needed and thus prevent sudden cardiac death.</p> R. Singla A. Udyavar A. Gupta A. Bade K. Munde N. O. Bansal ##submission.copyrightStatement## 2019-07-16 2019-07-16 1 6 10.9734/ca/2019/v8i430108 Percutaneous Balloon Mitral Valvotomy and Percutaneous Coronary Intervention of Left Anterior Descending Artery in Combined Procedure http://journalca.com/index.php/CA/article/view/30111 <p>In countries like India rheumatic heart disease (RHD) is still a common problem, and with improvements in diagnosis and treatment, the lifespan of these patients is increased. With increase in the lifespan, these patients may develop coronary artery disease (CAD) and present as acute coronary syndrome (ACS). In some cases especially RHD with severe mitral stenosis (MS), thrombus that develop in left atrium may embolize in one of the coronary arteries, leading to acute coronary syndrome. We report a case of 51 year old female who was a known case of rheumatic heart disease and now presented with acute coronary syndrome. Patient was hemodynamically unstable and underwent percutaneous balloon mitral valvotomy (PBMV) and percutaneous coronary intervention (PCI) simultaneously. We here discuss the possible complications that need to be addressed in such scenario and how can we approach such cases. This is first of such intervention at our institute and also there are very few such records available online. Patient tolerated the procedure well with significant clinical improvement.</p> Akshat Jain Gurkirat Singh Aditya Gupta Vishal Patil Narendra Omprakash Bansal ##submission.copyrightStatement## 2019-11-02 2019-11-02 1 7 10.9734/ca/2019/v8i430111 Risk Factors of Cardiovascular Disease among Ghanaian Police Officers http://journalca.com/index.php/CA/article/view/30109 <p><strong>Background:</strong> Cardiovascular diseases continue to be a global public health burden among occupational groups like Police officers. Police officers play important roles to ensure law and order in countries. However, the nature of police work exposes them to violence and stress. Again, irregular food habits, irregular exercise, inadequate sleep, smoking and drinking are lifestyles which makes police officers prone to high incidence of cardiovascular disease (CVD).</p> <p><strong>Aim:</strong> This study looked at the prevalence of CVD risk factors among police officers in Kumasi, Ghana.</p> <p><strong>Study Design:</strong> Cross- sectional.</p> <p>Place and Duration of study: Ashanti Regional Police Headquarters, Kumasi, Ghana, between September, 2017 to July, 2018.</p> <p><strong>Methodology:</strong> Weight, height, Body Mass Index (BMI), waist circumference, lipid profile, systolic and diastolic blood pressure of 120 officers were measured. Additionally, lifestyle and dietary factors such as exercise and intake of fruits of Police officers were assessed. Data were analyzed by SPSS version 22.0.</p> <p><strong>Results:</strong> Slightly more than half (63, 52.5%) of the officers were females and the remaining (57,47.5%) were males. The mean of the various CVD risk factors among the total study participants are as follows; BMI 28.184±4.461 kg/m<sup>2</sup>, waist circumference 92.702±10.941 cm, systolic blood pressure (SBP) 128.121±17.047 mmHg, diastolic blood pressure (DBP) 85.569±10.854 mmHg, fasting blood sugar 5.387±1.756 mmol/l, high density lipoprotein (HDL) 1.546±0.211 mmol/l, low density lipoprotein 2.321±0.706 mmol/l (LDL) and total cholesterol (TC) 4.362±0.906 mmol/L.&nbsp; Prevalence of obesity among male and female officers were 43.9% and 36.5% respectively. With regards to hypertension, policemen and women recorded 31.6% and 20.6% respectively and dyslipidemia among males and females were 43.9% and 85.7% respectively.</p> <p>Conclusion: The officers were generally overweight, with over a quarter having hypertension and about two-thirds having dyslipidemia, making their risk for CVDs high. Further studies to elucidate the causes are required, routine medical screening and nutritional support are recommended.</p> Miriam Essien Herman Erick Lutterodt Reginald Adjetey Annan ##submission.copyrightStatement## 2019-09-09 2019-09-09 1 9 10.9734/ca/2019/v8i430109