Cardiology and Angiology: An International Journal

Diagnostic Yield and Symptom–Rhythm Correlation of 24-Hour Holter Monitoring: A Cross-sectional Study

Salma Nafidi — 2026-03-04

Background: Twenty-four-hour ambulatory electrocardiography (Holter) is a cornerstone of non-invasive arrhythmia investigation. However, its diagnostic yield varies widely due to the sporadic nature of symptoms, creating challenges in clinical decision-making.

Objective: This study aimed to evaluate the diagnostic yield of 24-hour Holter monitoring and analyse the electro-clinical correlation in patients presenting with palpitations, presyncope, or syncope at a tertiary care centre in Marrakech.

Methods: We conducted a cross-sectional descriptive and analytical study on 140 consecutive patients (122 outpatients and 18 inpatients) at the Mohammed VI University Hospital, Marrakech, from September 2024 to June 2025. Indications were classified into three groups: Palpitations, Dizziness/Presyncope, and Syncope. Diagnostic yield was defined as the detection of an arrhythmia explaining the symptom or a major electrical anomaly requiring intervention. Statistical analysis was performed to correlate symptom types with arrhythmia mechanisms. Statistical analysis, utilising Pearson’s Chi-square and Fisher’s exact tests, was performed to correlate symptom types with arrhythmia mechanisms.

Results: The mean age of the population was 52.6 ± 12.1 years, with a female predominance (57%). The overall diagnostic yield was 19.2% (27/140). Although 64.2% (90/140) of patients reported symptoms during the recording period, a positive electro-clinical correlation was established in only 30% (27/90) of these symptomatic patients. Palpitations were significantly associated with disorders of excitability (tachyarrhythmias) (P <.01), whereas dizziness/presyncope was strongly predictive of conduction disorders (bradyarrhythmias) (P <.01). Incidental findings, such as asymptomatic high-grade atrioventricular block, were detected in 2.9% of patients.

Conclusion: The 24-hour Holter monitor provides a diagnostic yield of approximately 20% in our practice. Its major utility lies in excluding rhythmic causes during reported symptoms, thereby offering significant reassurance value. The strong statistical association between symptom type and arrhythmia mechanism aids in clinical stratification. However, negative examinations in high-risk patients, particularly those with syncope, warrant prolonged monitoring strategies.

Study of Association between Serum Chemerin and Cardio-predictive Anthropometric Risk Factors in Type-2 Diabetes Mellitus Population

Nathaniel Odiamehi Imafidon — 2026-01-05

Background: Type 2 diabetes mellitus is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased hepatic glucose production.

Methods: One thousand (1000) participants were studied, made up of five hundred (500) diabetics and five hundred (500) non-diabetics matched for age and sex, who were within the ages of 41 to 60 years. Diabetes was confirmed using both HBA1C and fasting plasma glucose values. Apo-lipoprotein B₁₀₀ and serum chemerin in both groups were assayed, while anthropometric values were obtained using a standardized and calibrated weighing scale and a Tape rule.

Results: There was no significant difference in the mean waist circumference of the diabetic population and the control at 93.59± 8.2 and 92.94± 6.6 (P=0.662), respectively. The mean hip circumference significantly varied between the diabetic population at 80.35± 10.6 and the control at 72.46±9.7 (P < 0.001), while the waist-hip ratio (WHR) was significantly different at 0.87±0.1 for the diabetic population and 0.78± 0.1 for the control population (p= < 0.001). The diabetic participants' chemerin value had significant positive correlations with waist circumference (r=0.333, p=0.018). Using a multiple logistic regression model, Chemerin with an odds ratio of 0.442 (95% C.I.; 0.138 – 0.747), apolipoprotein B with an odds ratio of 0.522 (95% C.I.; 0.135 – 0.811) were significant predictors of abnormal blood glucose.

Conclusion: The relationship between diabetes mellitus and serum chemerin, though not fully elucidated, it shows that serum chemerin level is a cause rather than a consequence of the abnormalities in glucose metabolism, which predispose affected individuals to cardiovascular risk. Given the growing burden of diabetes and cardiovascular comorbidities in Africa, this study contributes valuable insights into the biochemical mechanisms linking adipokine dysregulation and metabolic disorders, and also confirms elevated chemerin levels in Nigerian diabetics compared to non-diabetics, strengthening existing evidence from other global populations (e.g., Iran, Iraq, and Indonesia).

Clinical Patterns of Unprovoked Venous Thromboembolism at a Tertiary Care Center in Bangladesh: A Prospective Observational Study

Dipanjan Sen — 2026-02-11

Background: Venous thromboembolism (VTE) is a multifactorial disease, and its risk depends on exposure to risk factors and predisposing conditions. One frequent and difficult clinical issue is the treatment of patients with unprovoked venous thromboembolism (UVTE). The current study was conducted to analyze the pattern of presentation of unprovoked VTE in patients presenting in a tertiary hospital of Bangladesh.

Materials and Methods: This prospective cross sectional study was conducted in the Department of Medicine of Dhaka Medical College and Hospital (DMCH) from January 2023 to December 2023 over a period of 12 months. All the patients who presented with UVTE were enrolled in the study. A p value < than 0.05 was considered statistically significant.

Results: A total number of 70 patients were enrolled the study after fulfilling the inclusion and exclusion criteria who presented to the Department of Medicine of DMCH, Dhaka, Bangladesh between January 2023 to December 2023. Mean age of the study population was 38 ± 12.5 years. Left lower limb was the most common site for DVT (n=54%). Majority of the patients presented with unilateral disease (n=90%). Out of 70 patients only 3 patients developed PE (4.2%). There was 3 mortalities during the hospital stay of the patients who suffered from PE. Besides, another 2 patients died during the follow up period due to suspected PE though the patients were on standard anticoagulant treatment. Univariate analysis showed female sex, age>40 years, Diabetes mellitus, history of rheumatological disease, history of repeated abortion, elevated D dimer and CRP were risk factors for unprovoked VTE. However multivariate analysis showed only female sex (OR: 2.08, 95%CI:1.091-2.124, p<0.05)) and history of repeated abortion (OR: 3.724, 95%CI:3.716-3.738, p<0.04) were independent predictors of UVTE.

Conclusion: The present study analyzed the pattern and risk factors of UVTE in a tertiary center of Bangladesh. Physicians should always search for identifiable cause behind UVTE and aware of the long term outcome of the patients.

Analysis of Nursing Diagnoses in Children Undergoing Cardiac Catheterization in a Pediatric Cardiology Unit

Maísa Barroso de Araújo — 2026-02-17

Background and Aims: Cardiac catheterization is a less intrusive treatment than surgery that is routinely utilized in patients with suspected heart disease for diagnostic or therapeutic purposes. It is frequently performed in hemodynamic units and operating rooms. Analyze nursing diagnoses in children who underwent cardiac catheterization in a pediatric cardiology unit in Belém, Pará.

Methodology: Quantitative, descriptive, and documentary study based on the evaluation of 25 electronic medical records of patients undergoing cardiac catheterization admitted to the pediatric clinic of the Gaspar Vianna State Hospital Foundation (FPEHCGV). Special forms were used to collect data over a period of 30 days. Medical records of children aged between 0 and 12 years were selected, excluding ineligible records and those of patients older than the age defined as “child” by the Statute of Children and Adolescents.

Results: In the analysis of pre-catheterization diagnoses, 13 main nursing diagnoses were found, subdivided into 7 groups of Basic Human Needs, namely: Safety/protection, Perception/cognition, Elimination/exchange, Comfort, Coping/tolerance, Health Promotion, and Activity/rest. Based on these same domains, 24 nursing diagnoses related to post-catheterization were identified, confirming the higher number of associated diagnoses due to the invasive nature of the procedure. Given the high risk associated with patient safety, the chances of complications and related infections are greater when related to pre-catheterization.

Conclusion: It was possible to verify and identify the most prevalent nursing diagnoses in pre- and post-pediatric cardiac catheterization, with congenital heart disease as the underlying condition, considering its high incidence in Brazil. And, based on the Systematization of Nursing, the goal is to achieve the best results and prognoses within the five stages of the nursing process. This study affirms the practice of evidence-based nursing, contributing to the improvement of the systematization of care and favoring the accuracy of clinical analyses.

Use of the Accura Balloon for Pulmonary Valvotomy across Age Groups: A Three-Patient Case Series

Kalyan Munde — 2026-01-29

Background: Severe valvular pulmonary stenosis (PS) in adults and elderly patients is uncommon and technically challenging due to large annuli, dysplastic or calcified valves, and suboptimal performance of standard balloons. The Accura balloon—originally designed for mitral valvotomy—may provide mechanical advantages in such anatomies.

Methods: This case series describes three patients with severe PS across a wide age spectrum: an adult with a large annulus (Case 1), an elderly patient with RV dysfunction and ASD (Case 2), and a 13-kg child with combined lesions (Case 3). Conventional balloons were either unsuccessful or unsuitable, and the Accura balloon was used for pulmonary valvotomy.

Results: Accura balloon valvotomy produced complete waist formation, significant gradient reduction, and stable hemodynamics in all cases.

Conclusion: The Accura balloon is feasible, safe, and effective in resistant, large-annulus, calcific, or complex PS across age groups, particularly when standard balloons fail. Its role should be considered complementary or as a bailout device rather than a replacement for standard balloons.

Furosemide-Induced Acquired Bartter-Gitelman Phenotype Causing Torsades de Pointes in Acute Coronary Syndrome with HFrEF: A Case Series

Kalyan Munde — 2026-02-04

Background: Patients with acute coronary syndrome (ACS) complicated by heart failure with reduced ejection fraction (HFrEF) are at increased risk for malignant ventricular arrhythmias due to ischemia-related electrical instability and impaired repolarization reserve (Al-Khatib et al., 2018, Wellens et al., 2014). Loop diuretics are frequently required for the management of congestion; however, furosemide-induced renal potassium and magnesium wasting may produce an acquired electrolyte phenotype resembling Bartter or Gitelman syndromes (Seyberth and Schlingmann, 2011, Colussi et al., 1992). In the proarrhythmic milieu of ACS and HFrEF, this disturbance can precipitate QT prolongation and torsades de pointes (TdP) (Al-Khatib et al., 2018, Wellens et al., 2014, Roden, 2004).

Case Summary: We report three patients with ACS and HFrEF who developed severe hypokalemia and hypomagnesemia during furosemide therapy, resulting in marked QT prolongation and TdP. All patients were successfully treated with prompt rhythm stabilization, intravenous magnesium, aggressive potassium repletion, withdrawal or modification of precipitating factors, and heart-rate augmentation when required (Al-Khatib et al., 2018, Roden, 2004, Tzivoni et al., 1988). No patient experienced arrhythmia recurrence after correction of electrolyte abnormalities.

Conclusion: In patients with ACS and HFrEF, the occurrence of TdP should prompt immediate evaluation for diuretic-induced electrolyte depletion representing a reversible acquired pseudo–Bartter/Gitelman syndrome. Early recognition and targeted correction are lifesaving and may prevent unnecessary long-term device therapy (Al-Khatib et al., 2018, Wellens et al., 2014, Roden, 2004).

When Cardiomyopathy Meets Nephrolithiasis: Tailored Anaesthesia in Dilated Cardiomyopathy for Renal Surgery

Sreelakshmi Sreelakshmi — 2026-02-04

Background: Dilated cardiomyopathy presents significant challenges due to impaired ventricular function, risk of perioperative decompensation, and sensitivity to fluids and anesthetic agents. Percutaneous nephrolithotomy (PCNL) further increases physiological stress through prone positioning, potential blood loss, and fluctuations in preload.

Case Presentation: We report the anesthetic management of a middle aged male patient with known dilated cardiomyopathy (ejection fraction 15%) scheduled for elective PCNL. Preoperative optimization included continuation of guideline – directed medical therapy and meticulous cardiovascular evaluation. Intraoperative management focused on maintaining hemodynamic stability using a balanced anesthetic technique, invasive blood pressure monitoring, ultrasound guided central venous access and goal directed fluid therapy. Induction was achieved with cardio – stable agents, and ventilation was adjusted to avoid increases in pulmonary vascular resistance. The prone position was carefully executed with continuous vigilance on cardiac performance. The surgery proceeded uneventfully with stable hemodynamics throughout. Postoperatively, the patient was monitored in a high – dependency unit and recovered without complications.

Conclusion: PCNL in patients with DCM can be safely performed with meticulous perioperative planning. Judicious choice of anesthetic agents, vigilant hemodynamic monitoring, and goal directed fluid therapy. The case highlights the importance of a individualized, physiology based anesthetic approach to minimize perioperative risk in patients with severe cardiac dysfunction.

Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention: Current Evidence, Clinical Applications and Future Research Perspectives

AbAbolore Aminat Ajakaye — 2026-02-19

Mechanical circulatory support (MCS) has emerged as a critical adjunct in high-risk percutaneous coronary intervention (PCI), offering hemodynamic stabilization in patients with complex coronary anatomy, severe left ventricular dysfunction, or cardiogenic shock. Devices such as the intra-aortic balloon pump, Impella, and veno-arterial extracorporeal membrane oxygenation have expanded the therapeutic options for interventional cardiologists, enabling safer revascularization in patients previously considered unsuitable for PCI. The intra-aortic balloon pump primarily provides afterload reduction and modest cardiac output augmentation, whereas Impella devices offer direct left ventricular unloading with greater hemodynamic support, and veno-arterial extracorporeal membrane oxygenation provides full cardiopulmonary support in refractory shock. Current evidence suggests that contemporary percutaneous MCS devices can improve procedural success and short-term hemodynamic parameters, although randomized trials have produced mixed results regarding mortality and long-term outcomes. Clinical indications vary according to hemodynamic severity, procedural complexity, and institutional expertise, with Impella and extracorporeal membrane oxygenation increasingly favored in profoundly unstable patients, while intra-aortic balloon pump remains widely used in less severe hemodynamic compromise. Clinical applications continue to evolve, with increasing emphasis on patient selection, timing of device deployment, and multidisciplinary heart team decision-making. Despite technological advances, challenges remain, including vascular complications, bleeding risk, device-related infections, and high cost, which limit widespread adoption in low- and middle-income settings. Future research is needed to refine risk stratification models, establish standardized protocols for device use, and evaluate novel MCS technologies with improved safety profiles. Additionally, large-scale randomized controlled trials and real-world registries are essential to clarify the impact of MCS on long-term clinical outcomes and cost-effectiveness. As interventional cardiology advances toward increasingly complex coronary interventions, MCS is poised to play an expanding role in improving procedural safety and patient outcomes.