Cardiology and Angiology: An International Journal

An Acute Coronary Syndromes (ACS) Revealing a Severe Mitral Stenosis: A Case Report

F. REBBOUH — 2025-04-09

Background: Coronary artery embolization is an exceedingly rare cause of myocardial infarction, but a few cases in association with prosthetic mechanical valves have been reported. We report a case of embolic myocardial infarction in a patient with critical mitral stenosis and AF.

Objective: Presenting a Rare co-existance of disease or pathology.

Case Report: A 62-year-old man was admitted to the catheterization lab for early coronary intervention due to an ST-elevation myocardial infarction. His electrocardiogram showed ST elevation in leads II, III, and aVF, along with a Q wave of necrosis and atrial fibrillation. Coronary angiography revealed a complete blockage of the posterior descending artery with a thrombus. Following treatment with thrombo- aspiration and tirofiban, the thrombus was moved distally. Echocardiography identified severe mitral stenosis. The combination of angiographic findings, atrial fibrillation, and mitral stenosis confirmed coronary embolism as the underlying cause of the myocardial infarction. Anticoagulation therapy was started, and the patient was referred for mitral valve replacement.

Conclusion: Coronary artery thromboembolism is a rare cause of acute coronary syndrome. Treatment typically involves intensive anticoagulation, antiplatelet therapy, and different interventional strategies. In this context, secondary prevention is crucial and includes educating patients on proper anticoagulation management with an oral vitamin K antagonist, as well as providing medical guidance on the potential risks of thromboembolism.

A Rare Case of Mistaken Identity: Mitral Valve Prolapse Disguised as Endocarditis in Systemic Sclerosis

Samia Ejjebli — 2025-05-10

Systemic sclerosis (SSc) is a systemic disease involving collagen overproduction, microvascular damage, and immune activation.Organ involvement appears early, including Raynaud's phenomenon, lung fibrosis, renal crisis, and cardiac complications. Cardiac issues occur in 20–80% of patients, depending on the study. Mitral valve prolapse is seen in up to 60% of cases but is often asymptomatic and hemodynamically insignificant. Due to its rarity, valvular involvement is not a typical feature of SSc, making this case particularly noteworthy.

We report the case of a 61-year-old diabetic patient hospitalized for MRSA septicemia, complicated by meningitis and a corneal abscess.

She was transferred to cardiology after transthoracic echocardiography suggested mitral valve vegetation. On admission, she was asymptomatic with right upper limb paresis and mucocutaneous signs suggestive of scleroderma. Echocardiography revealed a calcified mitral valve with suspected vegetation and transesophageal echocardiography showed P3 prolapse without mobile vegetations
Immunological tests confirmed systemic sclerosis,The patient was transferred to internal medicine for specialized management of systemic sclerosis.

Cardiac involvement in systemic sclerosis (SSc) is often silent and may be detected early through imaging modalities like echocardiography, ECG, CT, and MRI.

Mitral valve prolapse occurs in about 20% of SSc-related valvular diseases, with unclear pathophysiology likely linked to inflammation and microvascular damage.

Valvular involvement in SSc may resemble that in non-SSc patients, making diagnosis challenging.
Echocardiography remains key for assessing valve structure, while cardiac CT and MRI offer complementary insights.

In our case, mitral prolapse was confirmed only via transesophageal echocardiography, while initial suspicion of endocarditis was misleading due to infectious context and TTE findings.

No Cut, Just Close: Transcatheter Device Closure of Mitral Paravalvular Leak

Kalyan Munde — 2025-05-22

Paravalvular leaks (PVLs) are increasingly recognized after valve replacement procedures, resulting from factors such as incomplete sealing, suture dehiscence, or annular calcification. Mitral PVLs are particularly common and can lead to symptoms ranging from mild dyspnea to severe heart failure. While surgical repair remains the traditional approach, transcatheter PVL closure has emerged as a less invasive alternative, offering comparable outcomes with reduced procedural risks. This technique is guided by advanced imaging modalities, with three-dimensional trans esophageal echocardiography (TEE) serving as the gold standard for assessing leak location, size, and severity. Recently, devices have been developed specifically for PVL closure, demonstrating high technical success rates and favorable post-procedural outcomes. The procedure can be performed via antegrade or retrograde approaches, depending on the leak's anatomy, and is associated with a low incidence of complications such as device embolization or stroke. Overall, percutaneous PVL closure represents a promising strategy, particularly for patients with suitable anatomy and contraindications to surgery, leading to significant improvements in symptoms and quality of life.

NSTEMI and Coronary Amyloid Infiltration: Challenges and Therapeutic Strategies in CHU Ibn Rochd, Casablanca

A. Al-Timimi — 2025-05-28

Acute coronary syndromes (ACS) are major cardiovascular emergencies requiring prompt and appropriate management to reduce complications and improve prognosis. We report an unusual case of high-risk non-ST-segment elevation myocardial infarction (NSTEMI) in a 63-year-old patient with hypertrophic cardiomyopathy (HCM) and coronary amyloid infiltration. Cardiac investigations revealed severe triple-vessel coronary artery disease with myocardial necrosis sequelae, leading to the recommendation for coronary artery bypass grafting (CABG). This rare association complicates management due to structural alterations from amyloid infiltration, increasing ischemic and arrhythmic risks. This case highlights the importance of a multidisciplinary approach and rigorous follow-up to adapt therapeutic strategies to complex clinical presentations.

Carcinoid Syndrome-induced Multi-valvular Heart Disease: A Rare Cause of Heart Failure in a 45-Year-Old Woman

AL TIMIMI Alaa — 2025-04-24

Background: Carcinoid syndrome, a rare neuroendocrine disorder, can lead to progressive valvular fibrosis due to the excessive secretion of serotonin and other vasoactive substances. This typically affects the right-sided cardiac valves and rarely the left side. The resulting carcinoid heart disease represents an uncommon but serious cause of heart failure.

Presentation of Case: We report the case of a 45-year-old woman admitted for progressive heart failure symptoms, including dyspnea, peripheral edema, and fatigue. She also experienced flushing and diarrhea suggestive of carcinoid syndrome. Transthoracic echocardiography revealed severe tricuspid, mitral, and aortic valve involvement, with biatrial dilation and features of severe stenosis and regurgitation. Work-up revealed elevated urinary 5-HIAA and chromogranin A levels, and imaging identified a hyper vascular ileocecal mass consistent with a neuroendocrine tumor. The diagnosis of carcinoid syndrome with multivalvular carcinoid heart disease was established.

Discussion: This case illustrates the diagnostic challenge of distinguishing carcinoid heart disease from other etiologies such as rheumatic heart disease. The rare left-sided valvular involvement, likely due to high circulating serotonin levels, underscores the severity of tumor burden. Early identification through echocardiography and biochemical markers is crucial. Management requires both symptomatic treatment of heart failure and control of the underlying tumor through somatostatin analogs and surgical or oncologic intervention.

Conclusion: Carcinoid-induced multivalvular heart disease is a rare but critical diagnosis in patients with neuroendocrine tumors. Optimal care requires a multidisciplinary approach combining cardiology, oncology, and cardiac surgery to improve outcomes and manage complex systemic involvement.

Exploring Lipid Levels as Indicators of Cardiovascular Risks in a University’s Executive staff: A Case Study at Rivers State University, Nigeria

Onwuli, Donatus Onukwufor — 2025-04-04

Introduction: Executive staff are the senior administrative and academic officers responsible for overall management of the university. These group of officers are at risk of developing abnormal lipid profile, which is a major risk factor in developing cardiovascular disease (CVD), due to occupationally related stress and sedentary lifestyles. This study was designed to explore the status of lipid parameters of executive staff in Rivers State University.

Materials and Methods: A total of two hundred executive staff, ranging from administrative to senior academics enrolled for this study and blood samples were obtained from all participants who indicated interest to participate in the study and also qualified in the inclusion criteria. Serum triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL Cholesterol) was analyzed spectrophotometrically with kits obtained from Spectrum Diagnostics employing manufacturer’s instructions, while Low density lipoprotein cholesterol (LDL cholesterol) was calculated using the Friedewald’s equation. BMI w determined by calculation from height and weight of participants, while the blood pressures were determined using automatic blood pressure kit. The results were analyzed with SPSS version 24. Mean values were considered statistically significant when p<0.05.

Results: The mean value of total cholesterol, triglyceride, high density lipoprotein cholesterol and low-density lipoprotein Cholesterol levels were 4.37±1.04mmol/L 0.78±0.55mmol/L, 1.65±0.44mmol/L and 2.47±1.15mmol/L respectively for male and 4.56±0.79mmol/l, 0.72±0.79mmol/l, 1.65±0.55mmol/l and 2.50±0.90mmol/l respectively for women. There were no significant differences when males were compared with females. However, when the participants were grouped into age bracket, the middle aged and the older participants had significant elevation in total cholesterol (p=0.04), triglyceride (p=0.003) and LDL (p=0.04). Furthermore, when the BMI of the participants were grouped into normal weight, overweight and obese, the triglyceride was significantly elevated in the overweight and the obese participants (P=0.03). The total cholesterol (P=0.007) and the triglyceride (P=0.001) were significantly elevated in participants with high blood pressure.

Conclusion: The results of this study suggest the incidence of dyslipidemia in the executive staff of Rivers State University. Based on these findings, we advocate for life style modifications such as regular exercise, healthy dieting and regular medical checks among the study population in order to prevent and manage unhealthy lipid profile levels.

Epidemiology and Left Ventricular Impact of Secondary Hypertension: A Case Series

H. ROUAM — 2025-05-03

Secondary hypertension is defined as arterial hypertension due to an identifiable cause, and therefore can be cured when the underlying cause is treated. It is a rare entity, often underdiagnosed, with an overall prevalence estimated at 10% of hypertensive patients in literature. However, it is important to look for it given its reversible nature after treatment of the cause. This is a case series aiming to uncover this often heterogeneous entity by highlighting its epidemiological particularities and its impact on the left ventricle in our patient population and comparing its results with data in literature. The left ventricle is a primary target for hypertension end-organ damage. In addition to being a marker of hypertension, left ventricular hypertrophy (LVH) is a major independent risk factor for not only cardiovascular disease morbidity and mortality but also for all-cause mortality and neurological pathologies. Electrocardiogram and 2D transthoracic echocardiography are the primary diagnostic tools for the diagnosis and quantification of LVH. To identify the cause of hypertension in our patients, radiological examinations were used such as renal artery ultrasound, abdominal CT scan, and arteriography. Polysomnography was also used when obstructive sleep apnea was suspected. Routine blood tests were performed such as potassium level, as well as aldosterone level and plasma renin activity in case of suspected primary aldosteronism. In our case series, primary aldosteronism was the most frequent etiology of secondary hypertension representing 22.7% of the cases as well as renal artery stenosis. Primary aldosteronism, also known as Conn’s syndrome, is described in literature as the most common form of secondary hypertension.

Prediction of New Onset Atrial Fibrillation in Acute Coronary Syndrome : Using C2HEST Score

C.AIT EL QADI — 2025-05-19

Atrial fibrillation (AF) is a common complication of acute coronary syndrome (ACS) and is associated with poorer clinical outcomes. This study aims to assess the clinical profile of ACS patients with AF and to evaluate the predictive value of the C₂HEST score. A total of 61 patients with ACS and AF were analyzed for demographics, comorbidities, and risk scores. Most patients had ST-segment elevation myocardial infarction (STEMI) (55.7%), with hypertension and diabetes as prevalent comorbidities. High C₂HEST scores were linked to an increased risk of complications.

Adapting the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) for Moroccan Arabic Speakers: A Study on Translation, Cultural Relevance and Validation in Heart Failure Patients

Abdessamad Couissi — 2025-05-24

Objectives: Heart failure is the final stage in the progression of all cardiac diseases, significantly modulating the quality of life and survival of patients. As a result, several means of assessing and predicting mortality have been developed, including the Kansas City cardiomyopathy Questionnaire (KCCQ).

Aim: This study aimed to evaluate an Arab cultural adaptation of the KCCQ score, taking into account the increasing trend of heart failure in Morocco and the Arab world, With the KCCQ-12 score, a patient's heart failure profile is broken down into five domains: physical function (3 questions), symptom frequency (4 items), quality of life (2 items), and social limitations (3 things). These five subcategories are ranked from worst to best based on an average score that ranges from 0 to 100. The KCCQ-12 questionnaire was translated by a competent translator and a bilingual healthcare expert fluent in Arabic and English medical terminology.

Methods: We conducted a prospective study involving patients consecutively presenting with chronic heart failure aimed to evaluate the cultural adaptation and validation of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12 in Moroccan Arabic population, addressing the rising prevalence of heart failure in Morocco and the broader Arab region. The KCCQ-12 assesses patients' health status across four domains: physical limitation (3 items), symptom frequency (4 items), quality of life (2 items), and social limitation (3 items), generating a summary score from 0 to 100, with higher scores indicating better health status. This KCCQ-12 has undergone validation and exhibits excellent agreement with the major score, which consists of 23 items. For this adaptation, the questionnaire was translated into Moroccan Arabic by a professional translator and a bilingual healthcare expert proficient in both Arabic and English medical terminology, ensuring linguistic accuracy and cultural relevance.

Results: 149 patients were included, and all of them were questioned with the translated KCCQ questionnaire. We conducted several statistical tests and correlations with a significant correlation between the KCCQ and our results. Each subgroup's set of questions underwent a reliability test. For each subgroup, the Cronbach's alpha coefficient was calculated, except the symptoms domain score all of which were greater than 0,70, which displays a strong internal reliability. We used the Spearman Correlation Coefficient to assess the convergence and divergence of construct validity between the KCCQ-12 and NYHA functional classification, with a great validity correlation.

Conclusion: Our study demonstrated the feasibility and cultural appropriateness in Morocco of our translated version of KCCQ-12, Taking into account the cultural similarities between Morocco and the Arab world this questionnaire may be used with small modifications in the Arab countries. The QOL scores are generally Better than the NYHA classification. It may be beneficial to use this important tool in Moroccan and Arab’s cardiologist's daily routine.

Characteristic and Pattern of Aortic Stenosis: An Observational Study in a Designated Population of Patients

S. Zarrouk — 2025-06-02

Aim: The study aims to investigate the correlation between hemodynamic assessment in isolated Aortic stenosis (AS) and multivalvular disease.

Background: No one can deny the unpredictable progressive character of aortic stenosis. Aortic stenosis (AS) is a frequent valvular heart disease in the elderly, marked by narrowing of the aortic valve, leading to left ventricular hypertrophy and diastolic dysfunction. Calcification of the valve leaflets is the main pathological mechanism, often accompanied by lipid infiltration and fibrosis. AS has been asymptomatic for years, with symptoms like dyspnea, angina, and syncope signalling disease progression.

Methodology: This study retrospectively analyzed 100 adult patients with severe AS from July 2021 to October 2024. Echocardiography assessed AS severity via jet velocity, mean gradient, and aortic valve area (AVA). Data were analyzed using SPSS; t-tests and Chi-square tests compared clinical variables. The mean patient age was 57.26 years; 56.9% were male. Most had preserved left ventricular function and concentric hypertrophy. Severe AS was defined by AVA <1 cm², mean gradient >40 mmHg, and velocity >4 m/s.

Result: The findings showed that Males had a higher prevalence of pure AS; hemodynamic parameters were similar across sexes. Calcific AS is now recognized as an active inflammatory condition, not just degenerative. Echocardiography remains central in diagnosis and severity grading but CT and MRI can provide advanced structural insights but are not routinely used. Despite being asymptomatic initially.

Conclusion: AS progression varies, and untreated symptomatic patients face high mortality within 3 years so early detection and accurate grading are crucial for timely intervention.AS has poor outcomes post-symptom onset without intervention. So, valve replacement is indicated upon symptom development; management of asymptomatic patients remains complex.