Cardiology and Angiology: An International Journal

Comparative National Prescriptive and Dosimetric Characteristics of Beta-Blocker Therapy in Asian Heart Failure Patients

Jonathan Kenigson — 2025-09-24

Beta-blocker therapy remains a cornerstone of heart failure (HF) management, but its role in Asian populations is shaped by unique pharmacogenomic and economic factors. Registry data show prescription rates ranging from 61% in Indonesia to 91% in Japan, with consistently favorable outcomes despite markedly lower achieved doses compared to Western cohorts. Japanese patients, for example, attain equivalent survival and functional benefits at one-third of U.S. target doses, underscoring the need for region-specific dosing strategies. Across HF phenotypes, beta-blockers reduce mortality and hospitalization with no significant differences in adverse event rates among agents, and lower discontinuation rates in Asian cohorts suggest superior tolerability. Combination therapy with SGLT2 inhibitors, such as dapagliflozin, yields additive benefits, as efficacy persists regardless of background beta-blocker use. These findings support individualized therapy in Asia, highlighting the importance of integrating pharmacogenomics, health system capacity, and comorbidities into clinical decision-making.

Cardiotoxicity of Targeted Therapies in Non-Hematologic Cancers: Mechanisms, Risks and Monitoring

Rachida Habbal — 2025-10-11

Cardiotoxicity has emerged as an increasingly recognized concern in modern oncology, particularly with the growing use of targeted therapies such as small-molecule inhibitors and monoclonal antibodies. These agents have revolutionized cancer care by offering remarkable precision in selectively attacking molecular pathways essential for tumor growth and survival. However, despite their therapeutic benefits, targeted therapies may inadvertently affect the cardiovascular system, leading to adverse outcomes that can compromise both quality of life and long-term prognosis in cancer survivors. As cancer survival improves, the burden of treatment-related cardiovascular complications has become more evident, highlighting the need for early recognition, prevention, and management strategies.

The mechanisms underlying cardiotoxicity from targeted therapies are highly complex and multifactorial. Unlike traditional chemotherapeutic agents, which often exert direct toxic effects on cardiomyocytes, targeted therapies may interfere with signaling pathways critical to both malignant and normal cardiovascular cellular functions. This disruption can manifest through a wide spectrum of adverse cardiovascular events, ranging from left ventricular dysfunction and arrhythmias to hypertension, thromboembolic events, and accelerated atherosclerosis. Importantly, these toxicities are often unpredictable and may vary according to the drug class, dosage, treatment duration, and patient profile.

Risk factors for cardiotoxicity extend beyond the pharmacological properties of targeted therapies. Patient-specific characteristics—such as preexisting cardiovascular disease, age, sex, genetic predisposition, and concurrent exposure to other cardiotoxic agents—significantly modulate individual susceptibility. Moreover, the coexistence of traditional cardiovascular risk factors, including hypertension, diabetes, and dyslipidemia, may further exacerbate the incidence and severity of treatment-related complications. Identifying and stratifying patients according to these risk factors is therefore a crucial step in optimizing care.

Given the rising incidence and clinical impact of treatment-related cardiotoxicity, effective management necessitates a multidisciplinary and integrated approach. Collaboration between oncologists, cardiologists, and emerging cardio-oncology units is essential to ensure timely detection and intervention. Regular cardiac monitoring, individualized risk assessment, and the prompt recognition of early warning signs form the cornerstone of preventive care. Furthermore, evidence-based strategies for mitigating cardiovascular risk ranging from lifestyle modification and optimization of comorbidities to pharmacological cardioprotection are increasingly being incorporated into clinical practice.

In this review, we provide a focused overview of cardiotoxicity associated with targeted therapies, with particular emphasis on its underlying mechanisms, risk factors, and approaches to clinical management. By bridging oncology and cardiology perspectives, this work underscores the importance of proactive cardio-oncology collaboration to improve patient outcomes in the era of precision cancer medicine.

Relationship between Apolipoproteins and Hypertension: Insights into the Pathophysiology of Hypertensive Disease

Awosiku Femi Francis — 2025-10-27

Background: One of the most common cardiovascular conditions in the world, hypertension greatly increases morbidity and mortality. Its underlying biochemical and molecular factors are still not fully known despite a great deal of research. The pathophysiology of hypertension is becoming understood to be largely dependent on apolipoproteins, which are important regulators of lipid transport and arterial integrity.

Aim: To examine the connection between hypertension and apolipoproteins (ApoA-I and ApoB), clarifying their function in the etiology of hypertensive cardiovascular disease.

Methods: Participants with hypertension and normotension who were purposefully selected from a tertiary healthcare center participated in a cross-sectional study. The immunoturbidimetric test was used to quantify the serum levels of ApoA-I and ApoB, and normal clinical procedures were used to measure blood pressure and lipid parameters. An indicator of atherogenic risk was the ApoB/ApoA-I ratio. SPSS version 26 was used to analyze the data, and Pearson correlation and linear regression were used to find correlations between blood pressure, cholesterol indices, and apolipoprotein levels. The threshold for statistical significance was p < 0.05.

Results: ApoA-I levels were significantly lower (p < 0.05) and mean ApoB concentrations and ApoB/ApoA-I ratios were significantly greater (p < 0.001) in hypertensive participants than in normotensive controls. While ApoA-I exhibited inverse correlations (r = −0.52, p < 0.01) with systolic and diastolic blood pressures, ApoB exhibited positive correlations (r = 0.68 and 0.61, respectively). The ApoB/ApoA-I ratio was found to be an independent predictor of the severity of hypertension by regression analysis, which accounted for 46% of the observed variation in blood pressure.

Conclusion: The vascular dysfunction that underlies hypertension is largely caused by changes in the balance of apolipoproteins, specifically increased ApoB and decreased ApoA-I. In hypertensive populations, the ApoB/ApoA-I ratio is a better biomarker for evaluating cardiovascular risk.

Knowledge on the Types of Cardiovascular Diseases among Academic Staff in Abia State University, Uturu, Abia State, Nigeria

UKA-KALU, EZINNE CHIOMA — 2025-10-29

Cardiovascular diseases (CVDs) are the leading cause of death globally, with increasing prevalence in low- and middle-income countries, including Nigeria. Academic staff are often exposed to sedentary lifestyles and occupational stress, which may elevate their risk of developing CVDs. Understanding their knowledge and preventive practices is crucial for targeted interventions. This study assessed the knowledge of the types, risk factors, and preventive practices of cardiovascular diseases among academic staff of Abia State University, Uturu, Abia State, Nigeria. A descriptive cross-sectional study was conducted among 253 academic staff selected using a two-stage sampling technique. Simple random sampling was used to select seven faculties, while availability sampling was employed to recruit respondents. A structured, self-administered questionnaire was used to collect data. Descriptive statistics were used to analyse the results and were presented in tables. The majority of the respondents (58.1%) were male and within the 31–40 age group (36.8%). A high proportion (99.2%) had heard of CVDs, and 86.6% correctly identified a heart attack as a type of CVD. Knowledge of risk factors was high for smoking (99.6%), excessive alcohol intake (98.4%), and unhealthy diets (92.9%), while knowledge was lower for diabetes (6.7%) and obesity (4.0%). Preventive practices such as regular medical checkups were reported by 43.9%, while 54.5% monitored their blood pressure or cholesterol regularly. The internet and social media (53.0%) were the major sources of information, while only 22.1% had attended a health education programme on CVDs at their workplace. However, 78.7% expressed interest in attending future workshops or seminars on CVD prevention. While awareness of CVDs and their risk factors among academic staff was generally high, there were notable gaps in specific knowledge areas and preventive practices. Institutional health education interventions and workplace wellness programs are recommended to bridge these gaps and promote cardiovascular health.

Cardiac Papillary Fibroelastoma Mimicking Infective Endocarditis in an Octogenarian: A Case Report

SIYAM Hamady — 2025-09-12

Introduction: Papillary fibroelastoma is a rare benign cardiac tumor, usually discovered incidentally or during evaluation for embolic events. Its echocardiographic appearance often mimics infective endocarditis, making diagnosis challenging.

Case Presentation: We report the case of an 83-year-old man with a history of hypertension and hypercholesterolemia, presenting with progressive dyspnea, orthopnea, and angina. Initial evaluation revealed elevated biomarkers and pulmonary edema. Transthoracic and transesophageal echocardiography showed a mobile mass attached to the posterior mitral leaflet, raising suspicion of infective endocarditis. However, blood cultures remained negative, and PET scan was inconclusive. The patient underwent surgical excision, and histopathological examination confirmed a papillary fibroelastoma. Postoperative evolution was favorable.

Conclusion: Papillary fibroelastoma should be considered in the differential diagnosis of valvular masses. Multimodal imaging is crucial, but histology remains the gold standard. Early surgical excision is recommended in symptomatic patients, even in advanced age, to prevent embolic complications.

Cryptogenic Stroke with Isolated Cranial Nerve Deficits Attributable to a Small PFO: Successful Management with Cocoon Occluder

Kalyan Munde — 2025-09-17

Patent foramen ovale (PFO) is present in approximately 20–25% of the general population but is implicated in only a small subset of ischemic strokes, particularly in young adults with cryptogenic events. Stroke in individuals under 45 years accounts for only 10–15% of all ischemic strokes, and PFO-related presentations with isolated cranial nerve involvement are exceptionally rare.

We report a 40-year-old male who presented with acute slurring of speech and deviation of the mouth to the left. Neurological examination revealed dysarthria and tongue deviation without motor weakness. A thorough work-up for young-onset stroke was performed: bilateral carotid and vertebral Doppler were normal, chest radiograph was normal, antinuclear antibody (ANA) and antiphospholipid antibody (APLA) profiles were negative, homocysteine was borderline elevated, and fundus examination showed no papilledema. CT venous angiography of the lower limbs ruled out deep venous thrombosis. Magnetic resonance imaging demonstrated acute non-hemorrhagic infarcts in the right inferior frontal gyrus and right post-central gyrus. Transthoracic echocardiography with bubble contrast revealed right-to-left shunting during Valsalva, and transesophageal echocardiography (TEE) confirmed a 4-mm PFO.

Given the patient’s young age and isolated cranial nerve presentation, TEE-guided PFO closure was performed with a Cocoon 30/30 occluder device under fluoroscopic guidance, with no residual shunt post-procedure. The patient remained hemodynamically stable, developed no arrhythmia, and demonstrated marked improvement in speech function during follow-up.

This case underscores the clinical relevance of small but hemodynamically significant PFOs in young patients with cryptogenic stroke and highlights the importance of systematic etiological evaluation and timely intervention.

Bleeding Beyond the Heart: Alveolar Hemorrhage Post Thrombolysis

Vaishali Gaba — 2025-09-19

Alveolar hemorrhage (AH) is a rare yet severe clinical condition marked by significant bleeding into the alveolar spaces, often leading to high mortality. AH can occur following systemic thrombolysis for acute myocardial infarction (AMI), a complication that is infrequent but potentially life-threatening and may result in acute respiratory failure. This entity is rarely reported in the literature. This case report presents an instance of AH following intravenous thrombolysis for AMI in a 58-year-old male patient.

Postoperative Takotsubo Syndrome Presenting with Malignant Ventricular Arrhythmia: A Case Report

F. ARABI — 2025-09-26

Background: Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy characterized by transient left ventricular systolic dysfunction, typically triggered by emotional or physical stress. While usually reversible, TTS can be complicated by severe events, with ventricular arrhythmias representing a particularly serious risk linked to increased morbidity and mortality.

Case Summary: We report a 63-year-old postmenopausal woman with hypertension and type 2 diabetes mellitus who underwent elective cholecystectomy under general anesthesia without intraoperative complications. Two days postoperatively, she developed persistent chest discomfort followed by sudden-onset palpitations. Electrocardiography revealed sustained monomorphic ventricular tachycardia at 180 bpm causing hemodynamic instability, which required urgent pharmacological and electrical intervention. Cardiac biomarkers showed a peak troponin of 1.2 ng/mL, and QTc was prolonged at 510 ms. Transthoracic echocardiography demonstrated a left ventricular ejection fraction (LVEF) nadir of 35%, and cardiac MRI confirmed apical ballooning and myocardial edema, consistent with TTS. The patient was stabilized with anti-arrhythmic therapy and beta-blockers, and discharged after seven days. At follow-up, LVEF normalized to 52%, troponin returned to baseline, and no arrhythmic events occurred.

Discussion: This case underscores the risk of malignant ventricular arrhythmias in TTS, particularly in the perioperative context where surgical stress can act as a trigger. The arrhythmogenic mechanism likely involved sympathetic overdrive, postoperative inflammatory responses, and repolarization abnormalities. Prompt recognition and timely management of arrhythmias are crucial to prevent life-threatening outcomes.

Conclusion: Although TTS is generally self-limiting, it can be complicated by potentially fatal ventricular arrhythmias. Clinicians should maintain a high index of suspicion in postmenopausal women presenting with acute chest pain or arrhythmia following recent surgery, as early diagnosis and intervention are essential to improving prognosis.

Persistent Complete Heart Block Unmasked by Severe Diabetic Ketoacidosis in a Young Woman: A Case Report

F. ARABI — 2025-10-04

Background: Cardiac conduction disturbances are rare complications of diabetic ketoacidosis (DKA). They are usually transient and reversible with correction of metabolic abnormalities.

Case Presentation: We report the case of a 27-year-old woman with type 1 diabetes who presented with DKA and was found to have a complete atrioventricular block (AVB) on admission. Despite standard management with intravenous insulin, isotonic saline, and potassium replacement, the patient developed severe hypokalemia complicated by ventricular fibrillation and cardiac arrest. Resuscitation was successful, and metabolic abnormalities were corrected; however, the complete AVB persisted.

Outcome: A dual-chamber permanent pacemaker was implanted, with subsequent full recovery and discharge in stable condition.

Conclusion: This case highlights that AVB in the context of DKA may not always be reversible. Persistent conduction disturbances, particularly when complicated by malignant arrhythmias, require timely pacemaker implantation and individualized management.

T-Stenting Technique for Iatrogenic Left Main–LCX Dissection: A Case Report

Kalyan Munde — 2025-10-04

Iatrogenic left main (LM) dissection is a rare but life-threatening complication of PCI that can result in abrupt occlusion of both LAD and LCX, especially when the LCX is dominant, leading to hemodynamic collapse and conduction disturbances such as complete heart block (CHB). We present the case of a 58-year-old male with evolving anterior wall MI who developed LM–LCX dissection during PCI, causing TIMI 0 flow in both LAD and a dominant LCX. Because the LAD supplied the largest myocardial territory, LM–LAD stenting was performed first to restore perfusion to the majority of myocardium, followed by bailout T-and-Protrusion (TAP) stenting of the dominant LCX with final kissing balloon inflation (FKBI) and proximal optimization technique (POT), achieving TIMI 3 flow in both branches. The patient recovered fully and was discharged on guideline-directed therapy. T-stenting was one of the earliest bifurcation techniques, and its refinement, TAP, allows optimal side branch ostial coverage with minimal metal overlap (7). Contemporary studies confirm that TAP, when performed with second-generation DES, FKBI, and POT, offers excellent outcomes comparable to more complex techniques such as DK-crush. This case highlights TAP as a rapid, effective, and lifesaving bailout strategy in LM bifurcation PCI, particularly when both branches are occluded but priority must be given to revascularizing the main branch supplying the largest myocardium.

Successful Percutaneous Device Closure of a Large Secundum Atrial Septal Defect in an Elderly Female with COPD and Atrial Fibrillation: A Case Report

Kalyan Munde — 2025-10-09

We describe a 72-year-old female with chronic obstructive pulmonary disease (COPD), atrial fibrillation, and a large ostium secundum atrial septal defect (ASD), who presented with progressive dyspnea, hypoxemia, and acute COPD exacerbation. Despite advanced age, lung disease, arrhythmia, and a high surgical risk score, the defect was successfully closed percutaneously using a 46 mm Lifetech CERA device. ASD and COPD both have synergistic effect on Right heart volume overload leading to Right heart failure. This case demonstrates that transcatheter ASD closure can be safely and effectively performed in carefully selected elderly patients with significant left-to-right shunting and without Eisenmenger physiology, even in the presence of multiple comorbidities (1–3). Transcatheter ASD closure has less adverse events and faster recovery rates with reduction in duration of Hospital stay as compared to surgical closure.