Cardiology and Angiology: An International Journal

Double Outlet Right Ventricle Infective Endocarditis: A Rare Combination and a Therapeutic Challenge

Fri, 26 May 2023 00:00:00 +0000

Infective endocarditis involving the right side of the heart occurs rarely and often involves the tricuspid valve. The isolated pulmonary valve infective endocarditis (IPVIE) is a less common condition that occurs in specific population. The double outlet right ventricle (DORV) is an unusual congenital heart disease. The association of DORV and IPVIE darkens the prognosis. We report two cases of the association of DORV and IPVIE. The transthoracic echocardiography (TTE) is the base to the diagnosis. Right sided infective endocarditis in the lack of a guided strategy remains a therapeutic challenge.

Takayasu's Arteritis with Aortic Insufficiency as Initial Presentation: A Case Report

Tue, 30 May 2023 00:00:00 +0000

Takayasu's disease is the first cause of inflammatory aortitis in young subjects. The disease preferentially affects the women. Takayasu's disease could be a mode of non-specific reaction of the aorta to various infectious or dysimmune etiological factors. Aortic insufficiency is present in 7 to 10% of cases. It is usually moderate. Its mechanism is not unambiguous: direct damage to the aortic valves or dilation of the aortic annulus. Coronary damage responsible for angina or even myocardial infarction are also possible. We report the case of a severe aortic insufficiency secondary to takayasu disease complicated by acute coronary syndrome in a 42-year-old woman.

Adult Onset Still’s Disease Revealed by a Cardiac Tamponade: A Case Report

Imane Essaket, Assala Cherki , Mohammed El-Jamili , Mustapha El-Hattaoui — Mon, 14 Aug 2023 00:00:00 +0000

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease of unknown origin with various clinical manifestations. In this article, we describe a case of 57-year-old presenting with Still's disease complicated by cardiac tamponade.

This case highlights the importance of a prompt diagnosis of cardiac involvement in inflammatory diseases, as it can be fatal, and underlines the utility of echocardiographic evaluation not only in symptomatic patients, but also for the systematic detection of pericardial effusions. The case of hemodynamic compromise, it allows the provider to determine the timing, approach, and method of pericardial drainage due to cardiac tamponade being a very rare complication that requires an invasive approach.

Incidental Detection of a Right atrial wire Attached Mobile Thrombus of an Implantable Cardioverter Defibrillator (ICD) in a Case of MALT Lymphoma

Wed, 16 Aug 2023 00:00:00 +0000

Implantable cardioverter defibrillators (ICD) are widely used in primary prevention for cardiomyopathy patients.

A 57-year-old male with dilated cardiomyopathy post ICD implantation was found to have an incidental asymptomatic echocardiogram finding of a mobile thrombus attached to the tip of the ICD wire in the right atrium. The thrombosis is probably due to a hypercoagulability state in patient with Cardiomyopathy and MALT lymphoma. The purpose of this case report is to highlight accidental discoveries of ICD wire thrombi and the appropriate therapeutic strategy.

Left Atrial Myxoma Revealed by a Stroke in a Young Female Patient

Wed, 11 Oct 2023 00:00:00 +0000

Introduction: Cardiac myxoma is a primary benign tumor most often located in the left atrium and it is a rare source of cerebral stroke of young subjects.

Case Presentation: We report the case of a young women with cardiac myxoma revelated by hemiplegia.

The patient suddenly presented vertigo followed by a fall, a heaviness of her left body, and dysarthria.

Brain CT tomography and magnetic resonance imaging revealed cerebral ischemia in the right Sylvian territory. Transthoracic echocardiography revealed a round cardiac mass, mobile, heterogeneous, multilobed, appended to the interatrial septum and the atrial side of the large mitral valve by wide implantation, measuring 38 x 25mm in the parasternal short axis (PSAX) and apical 4 chamber views evocative of left atrium myxoma. After the surgical resection, which was postponed for a month, the removed tumor was sent for histopathological examination. The morphological examination revealed a myxoid tumor proliferation compatible with cardiac myxoma expressing calretinin by these tumor cells in the immunohistochemical study.

Conclusion: Left atrium myxoma is a benign cardiac tumor and a rare cause of ischemic stroke. Transthoracic echocardiography facilitates the diagnosis of this tumor which will then be confirmed by histological analysis.

Percutaneous Intervention for a Stuck Mechanical Prosthetic Valve at Mitral Position as a Bailout Procedure in a High Surgical Risk Candidate

Salman Shaikh, Kalyan S. Munde, Anagh T. S. — Tue, 31 Oct 2023 00:00:00 +0000

Mechanical heart valves are the preferred choice for younger individuals when the native valves cannot undergo repair, primarily due to their exceptional durability. It is crucial to meticulously manage the international normalized ratio (INR) within the range of 2.5 to 3.5 to ensure optimal valve function and minimise the risk of thromboembolic complications. Our case report serves to demonstrate the effectiveness of percutaneous balloon dilatation through transcatheter methods as an innovative and promising approach to release a stuck valve, representing a noteworthy addition to the spectrum of treatment options.

Two Swords in the Storm: Parvovirus B19 and COVID-19 Clash in a Myocardial Mayhem of Arrhythmias

Shaikh A. Khalil A. Khalikh , Kalyan S. Munde — Wed, 08 Nov 2023 00:00:00 +0000

Myocarditis can be caused by a variety of infectious and non-infectious illnesses [1]. Although viral infection remains the most commonly identified cause of myocarditis, the role of parvovirus B19 (B19V) from the Erythrovirus genus in the pathogenesis of myocarditis has been identified as a potentially important contributor to myocarditis because of the high prevalence of Parvovirus B 19 (B19V) DNA in hearts of patients with myocarditis [2]. Co-infections of cardiotropic viruses are rarely reported and the mechanisms of viral interactions remain unknown [3]. In this report, we present a case of acute myocarditis in a young male, precipitated by a co-infection of Parvovirus B19 and COVID-19, characterized by fulminant progression and the development of multiple arrhythmias.

Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Sat, 23 Sep 2023 00:00:00 +0000

Background: AF's global prevalence underscores its significance as a cardiac rhythm disorder that disrupts atrial activity, impairing normal cardiac function. Over five decades of study have illuminated the pathophysiological mechanisms underlying AF, including insights into re-entrant waves and macro-reentrant circuits. The emergence of non-uniform conduction patterns and bidirectional block regions has further enriched our understanding. Risk factors contributing to AF development encompass cardiovascular conditions, advanced age, and atrial structural changes. With its implications on stroke risk and cardiovascular health, AF has become a growing public health concern. The focus on AF epidemiology has expanded, with attention on the relationship between left atrial size and AF development. Individuals with larger left atria exhibit a heightened risk. Additionally, the elevated stroke risk associated with AF has been consistently documented.

To optimize clinical management, distinctions are drawn between chronic and paroxysmal AF, as well as the presence of structural heart disease. Mapping techniques have revealed insights into "atrial remodeling" and AF pathology. In managing AF, controlling heart rate, preventing clot formation, and restoring sinus rhythm are principal objectives. This article categorizes AF into acute, chronic, stable, or unstable forms, tailoring management approaches accordingly. While pharmacological interventions have shown efficacy, their limitations drive the exploration of nonpharmacological strategies. Approaches range from medications to cardioversion, including electrical and pharmacological methods.

Objective: This paper aimed to provide a comprehensive exploration of non-pharmacological approaches to AF management.

Methodology: This paper employed a structured methodology. This method involved a literature review, data synthesis, and critical analysis. During the literature review phase, we systematically searched electronic databases (PubMed, MEDLINE, Embase, and Google Scholar) for studies published from 1960 to 2023. Specific keywords and phrases such as "atrial fibrillation," "non-pharmacological interventions," "electrical cardioversion," "catheter ablation," "lifestyle modifications," "autonomic modulation," "left atrial appendage closure," and "exercise" were used. Our inclusion criteria encompassed studies addressing various non-pharmacological approaches for AF management, including observational studies and randomized controlled trials.

Result: The initial stage of our study involved the identification of a substantial number of relevant studies. We conducted a thorough literature search across multiple databases, using specific search terms and criteria relevant to our research topic. This comprehensive search yielded a total of 1,200 studies. After applying these stringent filtering criteria, we were left with 350 studies. To further refine our final sample and categorize the studies according to type, we conducted a detailed review of the remaining 350 studies. We categorized them into various types based on study design, methodology, and focus. We then also excluded studies with duplicate ideas and finally included 103 studies that addressed the objective of our research plan. (See reference list [1-103]).

Conclusion: This reviewed a number of non-pharmacological approaches including electrical cardioversion, catheter ablation, lifestyle modifications, autonomic modulation, left atrial appendage closure, and exercise, the paper delves into each method's advantages, potential risks, techniques, and efficacy. By offering this extensive overview, the article contributes to the expanding repository of knowledge on non-pharmacological approaches for AF management. These approaches offer potential for unique management of atrial fibrillations or in addition to pharmacologic management, may improve patient survivability or reduce complication outcomes.

In the management of Atrial fibrillation, choice between rhythm and rate control, lifestyle modifications, and patient adherence to treatment plans are critical factors influencing outcomes are factors to consider. Emerging therapies offer promise, but timely diagnosis, individualized care, and ongoing monitoring remain essential to improving AF patients' overall prognosis.

Analysis of Association of Brain Natriuretic Peptide Levels and Blood Pressure Variability

Thu, 25 May 2023 00:00:00 +0000

Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years.

Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history.

Results: The study found a significant positive association between BNP levels and blood pressure variability (β=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001).

Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.

Echocardiographic and Etiopathogenic Features of Hypertrophic Cardiomyopathy: Casablanca University Hospital Experience

Tue, 30 May 2023 00:00:00 +0000

Hypertrophic cardiomyopathy (HCM) is the most common non-ischemic cardiomyopathy with a prevalence of 1:500 in the general population, based on the recognition of the phenotype. HCM is defined by the presence of increased left ventricular (LV) wall thickness that is not solely explained by abnormal loading conditions and the phenotype also includes disorganized myocyte arrangement, fibrosis, small-vessel disease, and abnormalities of the mitral valve apparatus. In particular to this pathology, we have conducted a one-year prospective study to determine clinical, echocardiographic features and etiopathogenic aspects of hypertrophic cardiomyopathy in the Casablanca university hospital. The results concluded that 50% of the causes was due to amyloidosis 35%, sarcomeric HCM and 15% Fabry disease in which 2 cases were related with pregnancy. Transthoracic echocardiography and cardia MRI plays an important role in HCM diagnosis and prognosis.

Stenosing Intracardiac Mass of the Mitral Valve: A Case Report and Review of the Literature

Mon, 29 May 2023 00:00:00 +0000

Introduction: Benign intracardiac tumours are the most common of the 5% of primary tumours and account for 90% of intracardiac tumours. Myxoma, which is the main benign tumour, rarely localizes to the mitral valve, in the order of 1-5%, associated with severe symptoms and enormous complications.

The objective is to report a rare and severe case of mitral valve myxoma resulting in severe obstruction of the valve orifice.

Presentation of Case: A 65-year-old Moroccan woman, without profession, the diabetic patient presented with progressive dyspnoea, in whom transthoracic echocardiography (TTE) completed by transesophageal echocardiography (TEE), a cardiac magnetic resonance imaging (MRI), a cerebro-throracoabdominopelvic Positron emission tomography-scan (PET-scan) showed a cauliflower-shaped mass embedded in the small mitral valve, evoking the diagnosis of myxoma, confirmed by the anatomopathological examination. A lumpectomy with mitral valve plasty was performed in association with coronary artery bypass surgery for a tri truncal lesion. The evolution was marked by an improvement in the clinical and echographic state.

Discussion: Myxoma is the first benign tumour encountered in women between the 3rd and 6th decade, whose diagnosis is evoked by a TTE, better by a TEE or more, by a computed tomography (CT scan) or even a cardiac MRI which specifies the visualization of the soft parts with all the internal details of the myxoma, whose confirmation is carried out on the histopathological analysis of the operating room.

Conclusion: The management was based on complete resection of the tumor associated with mitral valve plasty.

Pacemaker Infective Endocarditis: Diagnostic and Therapeutic Particularities in 2 Case Reports Including One of the Left Heart

Tue, 13 Jun 2023 00:00:00 +0000

Pacemaker infective endocarditis is a more real diagnostic problem than a therapeutic one. The precise impact is not well known. Its incidence is poorly known, and it is a serious infection with an estimated mortality of around 25%. It is with this in mind that we report 2 clinical cases with a literature review.

Case 1: An 88-year-old patient with a double chamber pacemaker was admitted for febrile syndrome with a fever at 39.2°. Transthoracic and transesophageal echocardiography (TOE) found an image of vegetation on the aortic valve measuring 9mm, located on the noncoronary cusp, and overflowing on the right coronary cusp. An inflammatory syndrome was found on blood tests. Blood culture, wound swab culture, and bacteriological study of material after removal revealed Staphylococcus Aureus Meti S. The patient was initially put on Vancomycin with a loading dose of 2g / 24h then 1g / 24h, and the pacemaker was extracted.

Case 2: A 68-year-old with a double chamber pacemaker (PM) was admitted for fever at 39 ° c with suppuration of the PM pocket. Echocardiography identified an image on the tricuspid valve measuring 14x8 mm evoking vegetation given the context. Two blood cultures and swabs isolated a Staphylococcus aureus. The patient was administered Triaxon 2g / day for 4 weeks and gentamycin 180 mg for 15 days. The pacemaker was removed.

Pacemaker Infective endocarditis is rare, poorly understood, very serious, and potentially fatal, accounting for up to about 7% in some case series. In half of the cases, they affect the endocavitary leads, but also the valves, and in 45% of cases the infection of the pocket. The average age is 65 years. The clinical symptoms are disparate making the diagnosis more difficult, it must be evoked in case of unexplained fever in a patient implanted with a Pacemaker. Bactericidal dual therapy should be administered after blood cultures in case of strong suspicion of infective endocarditis (IE) and adapted after identification of the germ in question. Most authors are adamant about extracting any pacemaker whenever possible.

Coronaro Cameral Fistula: Literature Review, Diagnosis and Management, about a Case

Wed, 14 Jun 2023 00:00:00 +0000

A coronary fistula is defined as a direct connection between a coronary artery and a heart chamber, great vessel, or other vascular structure that "bypasses" the myocardial capillary bed. This is a rare pathology that is usually not discovered until later in life, and exceptionally not during childhood. We report the case of a young patient who was hospitalized for chest pain and shortness of breath and who was found to have a coronary fistula on angiography.

A 66-year-old patient. Hypertension on dual therapy for 16 years and diabetes on OAD (Oral Antidiabetic) for 4 years. He was hospitalized with typical angina pectoris and dyspnea, and the stress test was positive. Laboratory examination revealed a good general condition with NYHA stage 3 dyspneic angina pectoris extending to the upper extremities and no evidence of heart failure. Looking at the balance, we see a slight increase in troponin. ECG returns to regular sinus rhythm, with electrical LVH (left ventricular hypertrophy) and ambient negative waves, no rhythm or conduction abnormalities. Transthoracic echocardiography (TTE) reverses hypertensive heart disease with good global and partial contractility without significant valvular disease associated with systolic pulmonary arterial pressure (SPAP) at 35 mmHg. Coronary angiography is performed and shows evidence of minor involvement of the central CX artery and a coronary camera fistula from the first diagonal artery draining into the left ventricle.

Management was about optimizing medical care. The patient received an appointment and was declared discharged.

Coronary camera fistulae are rare, found in approximately 0.3% of coronary angiographic studies performed. Most are congenital and may occur primarily due to trauma, erosive infection of the vessel wall, or iatrogenicity during transluminal coronary angioplasty, myocardial biopsy, or valve replacement. In many cases, simple but complex forms can be described. The gold standard for confirming the diagnosis remains coronary angiography, which highlights both the affected arteries and drainage sites. Cardiac scanners occupy an increasingly important position, especially as they provide morphologically accurate information. Surgical or percutaneous treatment of the fistula with a coil is recommended in symptomatic adult patients, especially those with significant or complicated right-to-left shunts. The authors suggest treatment with β-blockers when multiple sinusoidal fistulas associated with ventricular wall hypertrophy are present. Close monitoring is recommended for asymptomatic small fistula.

Corneal fistula is a rare congenital or acquired condition that is mostly asymptomatic and discovered in adulthood. Coronary angiography and heart scan can be used to confirm the diagnosis. Treatment is usually surgical or endovascular. However, in some cases, drug treatment with beta-blockers may help.

AA Amyloidosis Secondary to Horton's Disease Complicated by Pulmonary Fibrosis: A Very Challenging Diagnosis and Therapy

Mon, 03 Jul 2023 00:00:00 +0000

AA amyloidosis is a classic and serious complication of many chronic inflammatory processes, whether of infectious, autoimmune, or neoplastic origin. It is frequently complicated by kidney damage, often in the form of a nephrotic syndrome. Giant cell arteritis is a common inflammatory arteritis in the elderly; however, it rarely causes AA amyloidosis. We report a rare case of Horton disease causing AA amyloidosis in an elderly patient with history of myopericarditis and repeated episodes of congestive heart failure. Patient was treated initially with dual therapy based on corticosteroids and anti TNF therapy (Tocilizumab) associated with heart failure therapy recommended by the European society of cardiology (ESC 2021 guidelines on Heart Failure). The initial outcome was favorable but later complicated by the involvement of the lungs; pulmonary fibrosis, responsible for repeated episodes of pleural effusion non controlled in spite of high dose of loop diuretics and repeated pleural punction. Patient died shortly after her second hospitalization due to respiratory insufficiency.

Severe Pulmonary Hypertension Secondary to Concomitant Mitral Stenosis with Veno-occlusive Disease in the Context of Systemic Sclerosis: Importance of Careful and Comprehensive Assessment

Tue, 18 Jul 2023 00:00:00 +0000

Pulmonary Arterial Hypertension (PAH) is a clinical syndrome consisting of physiologic/ hemodynamic criteria that are a consequence of several etiologies. Confirmation of pulmonary hypertension is based on right heart catheterization.

Pulmonary hypertension is a devastating condition that can lead to considerable morbidity and premature mortality. In the last few decades, significant advancement in the pharmacotherapy of pulmonary hypertension has resulted from better understanding of the complex pathogenesis and pathophysiology of this dreaded disease. Despite these accomplishments, pharmacotherapy of pulmonary hypertension is still far from perfect, and the mortality in this modern treatment era is still unacceptably high.

We report a complex clinical presentation characterized by severe pulmonary hypertension secondary to concomitant mitral stenosis with veno-occlusive disease in the context of systemic sclerosis.

Our case highlights the importance of a systematic and comprehensive diagnostic approach to avoid missing an underlying pathology.

Syndrome of Orthostatic Hypotension with Supine Hypertension: A Therapeutic Dilemma for Cardiologists

M. Naaim , N. Malhabi , M. Ztati , M. Eljamili , S. El Karimi , M. El Hattaoui — Tue, 08 Aug 2023 00:00:00 +0000

Orthostatic hypotension (OH) and supine hypertension (SH) are two cardiovascular symptoms of autonomic failure that frequently coexist in the same patient.

Clinicians are faced with a dilemma because aggressive orthostatic intolerance treatment can exacerbate supine hypertension, and vice versa for supine hypertension management.

The objective of our article is to provide a better framework for the clinical evaluation, the right choice of therapeutic options and the improvement of the quality of life of patients with OH-SH syndrome. For these reasons, we report three observations, whose etiologies, clinical presentation, and treatment are different, namely diabetes, multiple system atrophy type C (MSA) and Parkinson's disease.

Acquired Extrinsic Pulmonary Stenosis Secondary to a Compressing Mediastinal Tumor

M. Naaim , F. Rebbouh , M. Eljamili , S. El Karimi , M. El Hattaoui — Tue, 12 Sep 2023 00:00:00 +0000

Acquired pulmonary stenosis in adults due to extrinsic compression of the pulmonary artery is a rare manifestation of non-Hodgkin’s lymphoma (NHL). The incidence remains poorly known in the literature since only a few sporadic cases are described.

The clinical management is directed towards the treatment of the underlying disease. According to the latter, the patient may benefit from chemotherapy, radiotherapy, angioplasty, stenting, or surgery.

We describe here the case of a young patient who was diagnosed with acquired extrinsic pulmonary stenosis secondary to a type B large cell lymphoma of mediastinal location. Our clinical case affirms the interest of a transthoracic echocardiogram in the diagnosis as well as the follow-up of this unusual manifestation.

Isolated Pulmonary Valve Endocarditis on an Undiagnosed Congenital Heart Disease in a Young Adult: A Rare Clinical Entity

Tue, 12 Sep 2023 00:00:00 +0000

Background: Isolated pulmonary valve endocarditis (PVE) is a rare condition that accounts for 1.5–2% of all reported cases of endocarditis. Herein, we describe a rare case of isolated pulmonary valve endocarditis with a fortuitous discover of a congenital heart disease in a young adult subject. Unlike other cases of right sided endocarditis, we treated our patient both medically and surgically.

Case Presentation: The patient was diagnosed with an isolated pulmonary valve endocarditis after blood cultures confirming the presence of Abiotrophia defectiva, a germ difficult to cultivate whilst the echocardiographic revealed a vegetation mass measuring 8mm long alongside with the discovery of a severe pulmonary valve stenosis and a large atrial septal defect (ASD) of 39mm wide. Septic pulmonary emboli were the first clinical manifestation in our patient. Both medical and surgical treatment was indicated based on dual antibiotics, removal of the vegetation, valvulotomy and closure of the ASD.

Conclusion: Both medical and early surgery therapy should be considered in patient with right sided endocarditis associated with congenital heart disease for better clinical outcome.

Spontaneous Hematoma of the Rectus Abdominis Muscle During Treatment with Non-vitamin K Oral Anticoagulant: A Rare Clinical Occurrence and Review of the Literature

Mon, 25 Sep 2023 00:00:00 +0000

Vitamin k antagonist anticoagulants (VKAs) and non-vitamin K oral anticoagulants (NOACs) are widely used in the treatment of non-valvular atrial fibrillation and other indications, but both classes of medications carry a risk of potentially serious bleeding. Spontaneous hematoma of the rectus abdominis muscle is a rare complication of NOAC treatment. Several risk factors, such as trauma, surgery, anticoagulation, coughing, intense rectus muscle contractions, pregnancy, etc., have been reported to cause rectus sheath hematoma. We report a case of spontaneous hematoma of the rectus abdominis muscle associated with moderate hemoperitoneum in a patient treated with NOAC for non-valvular atrial fibrillation (AF). Abdominal ultrasound and computed tomography scan (CT scan) confirmed the diagnosis after clinical assessment. The treatment was generally conservative but in the case of a hemodynamically unstable patient; hemostatic procedures should be considered.

A Rare Case of Myocarditis Causing Interventricular Communication and Acute Heart Failure

Tue, 26 Sep 2023 00:00:00 +0000

Myocarditis is a rare but potentially life-threatening condition that involves inflammation of the heart muscle. It can present with a wide range of clinical manifestations, including acute heart failure, arrhythmias, and ventricular dysfunction. In rare cases, myocarditis can lead to the formation of interventricular communication, which is an abnormal communication between the left and right ventricles. We present a case report of a 31-year-old male who presented to the emergency department with acute heart failure and was subsequently diagnosed with myocarditis causing interventricular communication.

Case Report of Dressler Syndrome and Left Ventricular Aneurysm in a 47-Year-Old Male with Diabetes

Thu, 28 Sep 2023 00:00:00 +0000

We present a case report of a 47-year-old male with a known history of recent diabetes who presented with symptoms suggestive of Dressler syndrome, along with the incidental finding of a left ventricular aneurysm. Dressler syndrome is a delayed immune-mediated response following myocardial injury, commonly observed post-myocardial infarction (MI) or cardiac surgery. This case highlights the importance of recognizing the atypical presentation of Dressler syndrome and its association with complications such as ventricular aneurysm, particularly in patients with pre-existing comorbidities.

Acute Coronary Syndrome Induced by Carbon Monoxide Intoxication: A Case Report

Tue, 03 Oct 2023 00:00:00 +0000

Carbon monoxide (CO) intoxication is the most frequent etiology of toxicological morbidity and mortality in the world. If the neurological manifestations are in the foreground, then cardiovascular signs of myocardial damage by necrosis are possible, which can result in angina, an acute coronary syndrome followed by myocardial stupor, collapse or even cardiac arrest.

We report a case of CO intoxication inducing an acute coronary syndrome without ST elevation in an elderly diabetic patient with no coronary artery disease history.

Diagnosis: This patient presented a CO intoxication after an accidental exposure; the electrocardiogram showed a depressed ST segment of the inferior and apico-lateral leads; cardiac enzyme troponins gradually increased. Echocardiography showed a preserved systolic function with a disorder of the heart wall motions. Coronary angiography revealed significant lesions of the proximal left anterior descending artery (LAD) and the first marginal evoking a diagnosis of acute coronary syndrome induced by CO intoxication.

Interventions: His management consisted of the administration of hyperbaric oxygen therapy, a platelet aggregation inhibitor (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin) and myocardial support (Bisoprolol). Coronary angiography and the placement of two active stents were performed after 24hrs onset diagnosis.

Results: The patient had a good clinical outcome under hyperbaric oxygen therapy, complete revascularization of the angiographic lesions which showed improvement in cardiac function and a slight improvement of heart wall motion on echocardiography performed on the 5th day. After 6 days, the patient had recovered well and was discharged from the hospital without chest discomfort, dizziness or headache.

Lecture: This case suggests that the symptoms of carbon monoxide intoxication are complex and diverse. This can manifest as a primary hypoxic symptom or cause an exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide intoxication should actively seek a comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the patient's chances of survival.

The Effect of Exercise on Cold-Induced Neurovegetative Dysautonomia Blindness

M. Naaim, M. Ztati, M. Eljamili , S. EL Karimi, M. EL Hattaoui — Tue, 14 Nov 2023 00:00:00 +0000

The autonomic nervous system (ANS) is responsible for regulating heart rate and blood pressure and maintaining homeostasis during physiological stresses. Nervous dysautonomias are often observed in patients presenting cardiovascular symptoms. Despite that, other important but less known conditions can be encountered. We report the case of a 19-year-old young man who presented for blindness occurring in the cold and improving with exercise. Investigations revealed neurovegetative dysautonomia with significant vagal hyperactivity associated with central B-sympathetic hyperactivity. Our patient received treatment based on hygienic and dietary measures with a combination of an anti-hypotensive drug such as Etilefrine. 2 months later, a re-evaluation showed a clear improvement, confirmed during the control neurovegetative exploration but also during the ophthalmological examination.

Cardiac Papillary Fibroelastoma, an Unusual Localization in an Asymptomatic Patient with Lieberkühn Type Adenocarcinoma of the Rectum: A Case Report

Sat, 18 Nov 2023 00:00:00 +0000

Cardiac papillary fibroelastoma is histologically a benign endocardial neoplasm. Though CPF has long been reported as the second most common primary cardiac neoplasm, it has since been pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. We present a case of CPF originating from an unusual localization; the junction of the posterior mitral valve and endocardium of the left ventricle measuring 15 x 20mm, which was detected by a routine pre-evaluation transthoracic echocardiography before chemotherapy and treated by surgical mass excision in an asymptomatic female patient diagnosed with a Lieberkühn type adenocarcinoma of the rectum with a locoregional extension.

Killing Two Birds in One Stone-Percutaneous Treatment of a Large ASD and Pulmonary Stenosis in the Same Setting in an Adult Patient-a Case Report.

Kalyan S. Munde, Shrishail Kumar Jalkote , Jayakrishna Niari — Sat, 25 Nov 2023 00:00:00 +0000

Pulmonary stenosis (PS) associated with a huge ostium secundum Atrial septal defect (ASD) is relatively uncommon. In such condition, a significant left-to-right shunt across ASD is prevented by significant obstruction at pulmonary valve level and hence it protects the pulmonary bed until adulthood. Transcatheter intervention is the treatment of choice when they occur separately but when they occur together, ideal treatment option is not clear. As per literature, percutaneous transcatheter pulmonary valvuloplasty was performed first, followed by transcatheter closure of the secundum atrial septal defect. We report a case of combined ASD (Atrial septal defect) with moderate PS (Pulmonary stenosis), where we performed percutaneous BPV.

(Balloon Pulmonary Valvuloplasty) with Inoue balloon first followed by transcatheter ASD device closure in the same setting.

Myocarditis Induced by Immunotherapy: A Rare but Fatal Complication

Wed, 06 Sep 2023 00:00:00 +0000

The emergence of immunotherapy and the gradual expansion of its indications in oncology will require particular vigilance to detect and quickly take care of the potential cardiac toxicities. They have improved prognosis and survival, including patients with kidney, lung or skin cancers (melanoma) and certain lymphomas. The incidence of unwanted cardiac events under immunotherapy is rare, undoubtedly less than 1 % under Ipilimab, Pembrolizumab and Nivolumab. Cardiac toxicity can be induced by many drugs but this time we focused on myocarditis induced by immuno-modulators, which is a rare but very fatal complication and has 2 main parts: an illustration of a clinical case and a review of the literature comprising generality, pathophysiology, clinical manifestations, diagnostic strategy and therapeutic management based on the guidelines of the European Society of cardiology on cardio-oncology recently published in 2022. Corticosteroids are drugs effective in the treatment of cardiac toxicity induced by immunotherapy.

Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Thu, 25 May 2023 00:00:00 +0000

Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI.

Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records.

Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ≤30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents.

Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.

Echocardiographic Aspect of Infectious Aortic Endocarditis: Experience of the Cardiology Department, Mohammed VI University Hospital of Marrakech, Morocco

Wed, 31 May 2023 00:00:00 +0000

Introduction: Infective Endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic localization is characterized by its progression to myocardial failure and the high number of complications motivating early recourse to surgery. The diagnosis of AR is based on microbiological and imaging studies. Echocardiography is the recommended imaging modality to make the diagnosis, assess the impact and guide surgery.

Materials and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at the ERRAZI-CHU Mohammed VI Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form.

Results: During the study period, 26 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. A known history of valvular disease was found in 57% of the cases. Among the native valvular diseases, rheumatic origin was found in 85%. The most common valvular lesions were represented by vegetations (88%), which were mobile in 56%, measuring between 10 and 20 mm in half of the cases, their most predominant localization was on the ventricular side with a tilt.IE on severe IAo was found in 90% of cases. The most common associated valvulopathies were MI (53%), RAo (38%) and MR (34%), whose severity was variable. The association of aortic disease with mitral disease was the most frequent association. Echocardiographic complications were presented by fistulas, perforations and peri-aortic abscesses (2 cases each) which were correlated with severe AI. Regarding the impact of the aortic AR on the LV, we noted a marked dilatation in 42% of cases with a preserved ejection fraction in 74%. A quarter of our patients had undergone transesophageal echocardiography in addition to transthoracic echocardiography, with an average time between admission and completion of 3 days. The indication of its realization was posed in front of the doubt of the visualization of an image of vegetations or suspicion of complications not visualized with the TTE. Valvular lesions found on TEE were essentially vegetations in 45% of cases, prolapses in 22% of cases, as well as abscesses, para-prosthetic leaks and prosthesis deinsertion found in 11% of cases.

Conclusion: Aortic AR remains a frequent pathology in our context. Aortic insufficiency is the most predisposing valvulopathy and the most common sonographic appearance is vegetations. The results of our study have shown that complications of AE occur preferentially in patients with severe aortic insufficiency.

Delta of Egypt Atrial Fibrillation Registry Phase Two

Fri, 02 Jun 2023 00:00:00 +0000

Background: Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia found in clinical practice. The assessed frequency of AF in adults is between 2% and 4%, with greater incidence and frequency rates in developed nations [1,2]. AF prevalence increases with advancing age, and with some cardiac and non-cardiac disorders, also it may exist in the absence of any conditions [2]. We aimed to determine case characteristics, practice patterns, management strategies and outcomes of atrial fibrillation in the delta area of Egypt.

Methods: This registry-based cross-sectional study included 1000 atrial fibrillation patients (with any AF patterns) who were allowed to enter ER in cardiac centers and hospitals in middle Delta of Egypt from April 2020 to March 2021.

Results: 267 patients (26.7%) were unstable. Heart failure, hypertension, and coronary disease were still prevalent comorbidities in our AF dataset, where hypertension accounts for over 50% of all AF cases. Rheumatic valvular heart disorder was a major underlying disease for the development of AF, still about 25.5% by echocardiography. Lone AF still high 20.6%. CHA2DS2VASc score ≥2 is 83.5%. A high proportion of cases were treated with pharmaceuticals for rate control nearly 52.7% of the cases and nearly 30.3% of the cases were given pharmacological medications for the cardioversion to the sinus rhythm and a small proportion of the cases were given electrical cardioversion nearly 7%.

Conclusions: Coronary disease, hypertension, and heart failure were still usual comorbidities in AF. Rheumatic valvular heart disease is still about 25.5% of the total registry. Amiodarone is the most prevalent antiarrhythmic medications (AAD) used. lone AF still high 20.6%. minimal use of novel oral anticoagulant (OAC).

The Bacterial Profile of Aortic Infectious Endocards: Experience of the Cardiology Department, Mohammed VI University Hospital of Marrakech, Morocco

Tue, 06 Jun 2023 00:00:00 +0000

Introduction: Infective endocarditis is defined as infection of a native or prosthetic heart valve, endocardial surface, or cardiac device. The causes and epidemiology, as well as the microbiology of the disease have evolved over the last few decades with the doubling of the average age of patients and an increased prevalence in patients with indwelling cardiac devices.

Patients and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at ERRAZI Hospital-Mohammed VI University Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form.

Results: Over the study period, 46 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. Endocarditis on aortic prosthesis was found in 15%. The valves were rheumatic in 85%. The presumed portal of entry was cutaneous in 45%, oral and ENT in 33%, urinary in 15%, and digestive in 7%. In our series, 21 out of 26 patients presented a biological inflammatory syndrome. At least one or more blood cultures were positive in 38% of cases. Coagulase-negative Staphylococcus was the most common germ in aortic infective endocarditis, found in 40% of positive blood cultures. All the patients in our series had received a combination of broad-spectrum intravenous antibiotic therapy, initially probabilistic, taking into consideration the portal of entry. Adapted after antibiogram results. The evolution during the hospitalization, was marked by an improvement of the clinical state in only 12%, a perioperative death in 38%, and a worsening of the clinical state in 50%, with an average duration of hospitalization of 14 days. In our series, 60% of the patients with positive blood cultures died, whereas there was 75% survival in the group with negative blood cultures.

Conclusion: Infective endocarditis is a serious disease because of its high morbidity and mortality. Despite improvements in diagnostic testing, antimicrobial therapy, and surgical intervention, changes in the epidemiology of IE, including the increase in healthcare-associated infections and the virulence of staphylococcus aureus as the causative organism, increase the risk of complications and death in the acute phase of IE. Action must be taken to prevent infective endocarditis, especially in this rheumatically endemic area.

Influence of Congenital Heart Defect Types over Cardiopulmonary Bypass, Aortic Cross-Clamping, and Intensive Care Unit Length of Stay and Their Association with Genetic Factors

Fri, 09 Jun 2023 00:00:00 +0000

Aim: Surgical correction of congenital heart defects (CHD) often requires interruption of blood flow through cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC), for which duration(s) are considered to be prognostic factors, along with intensive care unit (ICU) length of stay (ICULOS). The aim of this study was to evaluate these surgical prognostic factors in pediatric patients with different types of CHD regarding their type of lesion and associated genetic factors.

Study Design: Cross-sectional cohort study with 307 pediatric patients.

Place and Duration of Study: Pediatric Intensive Care Unit (ICU) of Hospital da Criança Santo Antônio, in Porto Alegre/RS, Brazil, from 2006-2009 (3 years)

Methodology: After inclusion criteria, we studied 266 pediatric patients admitted for the first time in a reference cardiac pediatric ICU from Southern Brazil following cardiac surgery. Intraoperative prognostic factors such as duration of CPB, ACC and ICULOS, in addition to dysmorphological and cytogenetic examinations were compiled and analyzed. P-values of <0.05 were considered significant.

Results: CPB time was associated to four outflow tract defects (Tetralogy of Fallot [ToF], transposition of the great arteries [TGA], double outlet right ventricle, and truncus arteriosus [TA]), atrioventricular septal defect, and hypoplastic left heart syndrome (HLHS) (P < 0.001). ACC duration was associated with three outflow tract defects (ToF, TGA, and TA) and HLHS (P < 0.001). Moreover, CPB and ACC times showed an association with cyanotic and complex heart defects, as well as prolonged ICULOS (P < 0.001). There was no relationship between these prognostic factors and syndromic aspects or cytogenetic findings.

Conclusions: CHD type has an impact over CPB and ACC duration and ICULOS, whereas genetic factors are not associated with those prognostic factors.

Relationship between Duration of Diabetes Mellitus and Gensini Score in Patients Undergoing Diagnostic Coronary Angiography

Mon, 12 Jun 2023 00:00:00 +0000

Background: Gensini (G score) is one of the most widely used scoring systems in cardiology. It is an objective method to determine the coronary artery disease severity according to angiographic findings. The aim of this work was to assess the relation between G score and the chronicity of diabetes mellitus (DM) in cases undergoing coronary angiography.

Methods: This prospective cohort research was carried out on 300 cases with diabetes mellitus (DM) on antidiabetic treatment who were referred to diagnostic coronary angiography for suspected coronary artery disease. G score was calculated for measurement of the coronary artery disease severity. During the period from October 2020 to Aril 2022

Results: Age, smoking, chronicity of DM, cholesterol, triglycerides test, and electrocardiogram were statistically prominent positively related with G score, while female gender was statistically significant negative relation with it. Also. Mean G score was statistically prominent higher in cases with ischemic changes than in cases without ischemic changes. Therefore, the chronicity of DM was statistically significant predictor of G score.

Conclusions: significant positive relation between the G score and the chronicity of DM.

Real World Evidence of Bempedoic Acid on Efficacy and Safety in Patients with Uncontrolled LDL-c and at High Risk of CVD

Fri, 16 Jun 2023 00:00:00 +0000

Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings.

Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points.

Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24.

Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.

Blood Pressure Values in Apparently Healthy Sudanese Population

Wed, 21 Jun 2023 00:00:00 +0000

Introduction: Blood pressure is one of the most often measured clinical parameters, and assessment of blood pressure has a considerable impact on diagnostic decisions.

Objectives: To establish blood pressure normal reference values in Sudanese.

Methods: A cross-sectional study was conducted from September 2016 to November 2018. Eight hundred eighty-eight healthy adult Sudanese between the ages of 18 and 60 (203 men and 685 women) were randomly selected from the states of Khartoum, Northern, Gezira, Red Sea, and North Darfur. Clinical, anthropometric, and blood pressure measurement data were collected.

Results: The mean for all volunteers was 113.93 ± 9.917 mmHg, systolic blood pressure (SBP) and 75.29 ± 6.79 mmHg, diastolic blood pressure (DBP). SBP in men was 118.6 + 7.642 mmHg compared to 112.53 + 9.121 mmHg in women, while DBP in men was 77.51 + 5.984 mmHg compared to 74.63 + 6.844 mmHg in women. Beside the gender variations, blood pressure values also showed geographical variability. There was a positive connection between blood pressures (SBP and DBP), BMI, and age. (P < 0.05) was used for significance.

Conclusion: Blood pressure of Sudanese was found to be within the normal international range with gender and geographical variability. It showed positive correlation with age and BMI.

Impact of Training Programs on Awareness and Practice of Lifestyle Modifications among Hypertensive Patients Attending Outpatient Clinic of the University College Hospital, Ibadan, Nigeria

Tue, 27 Jun 2023 00:00:00 +0000

Aim: This study sought to investigate the impact of training programs on hypertensive patients' awareness and practice of lifestyle modifications in out-patient clinics of the University College Hospital (UCH) Ibadan, Nigeria.

Methodology: The study design was a cross-sectional survey conducted at the out-patient clinics of the University College Hospital (UCH), Ibadan, Nigeria. This setting was chosen due to the accessibility of hypertensive patients receiving regular care and follow-up. The sample size comprised 274 hypertensive patients attending the out-patient clinics for regular hypertension management. A simple random sampling method was employed to select study participants, ensuring a fair representation of the target population. A structured questionnaire was used to collect data from the participants and results were analysed using SPSS.

Results: Findings indicate that the training programs greatly increased awareness of hypertension and lifestyle factors affecting hypertension for most participants (74.42%), with all participants recommending the programs. A significant majority of participants (95.74%) reported being on hypertension medication, while nearly all (99.22%) had received some form of training or counselling on lifestyle modification for hypertension management. Notably, all participants reported having made lifestyle changes following the training programs, with the majority rating the effectiveness of the programs as highly effective (57.36%). Further analysis indicated a statistically significant relationship between the effectiveness of the training programs and the participants' age, sex, educational level, and occupation. The most frequent lifestyle modification post-training was dietary changes, with 54.65% of participants reporting that they always engage in a healthy diet for hypertension management. However, the frequency of engagement in other lifestyle modifications, such as regular physical activity and weight management, was not as high. The majority of participants reported significant improvements in hypertension symptoms following the lifestyle modifications.

Conclusion: These findings demonstrate that targeted training programs can significantly enhance hypertensive patients' awareness and practice of beneficial lifestyle modifications, thus improving health outcomes. Further, the study underscores the need for such training programs to be tailored according to the age, sex, educational level, and occupation of the patients to maximize their impact.

Predictors of Bleeding after Percutaneous Coronary Intervention

Tue, 11 Jul 2023 00:00:00 +0000

Background: Acute coronary syndrome patient outcomes have been improved using early invasive techniques. The aim of this study was to investigate the incidence, location, and severity of bleeding in PCI-treated cases to identify patient risk profiles and increased bleeding occurrences.

Methods: This prospective observational study evaluated percutaneous coronary angiography in 80 patients with hypertension and diabetes mellitus who planned to undergo primary or elective PCI. The cases were separated into 2 groups; those who reported bleeding (n=11) and those who did not (n=69). All patients underwent physical examination, laboratory evaluation, 12-lead electrocardiography, and PCI.

Results: In univariate regression analysis, age (OR: 1.09, 95% CI: 1.009 – 1.192), female gender (OR: 4.32, 95% CI: 1.157 – 16.131), history of peripheral arterial disease (OR: 7.31, 95% CI: 1.585 – 33.742), and femoral site of vascular access (OR: 9.6, 95% CI: 2.263 – 40.721) were independent predictors of major bleeding after PCI. In multivariate regression analysis, age (OR: 1.12, 95% CI:1.014 – 1.269), female gender (OR: 13.75, 95% CI: 1.983 – 161.2), history of peripheral arterial disease (OR: 43.38, 95% CI: 3.754 - 1042) and femoral site of vascular access (OR: 13.29, 95% CI: 2.233 – 128.5) were independent predictors of major bleeding after PCI.

Conclusions: Patients who reported bleeding after PCI had a significantly higher age, prevalence of female sex, serum creatinine, and transfemoral intervention before and after intervention compared to patients who did not report bleeding, while haemoglobin and transradial intervention before and after intervention were significantly lower in the bleeding cases than in the non-bleeding cases.

Myocardial Infarction, Deep Venous Thrombosis and Pulmonary Embolism in COVID-19 Hospitalizations: Stats from the Nationwide Inpatient Sample 2020

Sat, 02 Sep 2023 00:00:00 +0000

Background: The outcomes of SARS-CoV-2 (COVID) hospitalizations and their association with myocardial injury and thrombosis were studied. We aimed to provide further insights into the impact of COVID-19 on modern-day healthcare.

Methods: Retrospective analysis of the National Inpatient Sample 2020 database. We used the International Classification of Disease Code, Tenth Edition (ICD-10) to identify all hospitalizations with COVID-19. We then conducted a subgroup analysis of the population of interest: Those who also developed myocardial infarction, pulmonary embolism, and deep venous thrombosis.

Results: 335,799 hospitalizations with COVID. Of these, 1.6% (5,355) were diagnosed with non-ST-segment myocardial infarction (COVNSTEMI) were identified. The mean age of COVID-19 hospitalizations was 71.7, with 60.50% males. The population prevalence included 53.10% Whites, 17.80% Blacks, 19.20% Hispanics, and 4.10% Asians. The average Length of stay (LOS) was 10 days, and 37.60% of patients died during hospitalization. The average cost of hospitalization (TOTCHG) was $156,633. The COVSTEMI group comprised 1,364 cases, with a mean age of 67.4, in-hospital mortality of 47.4%, and the mean TOTCHG was $177,600. The DVTCOV group comprised 2,869 cases, while the PECOV group had 4,828 cases. Male predominance was observed in both groups, with mean ages of 66 years in the DVTCOV group and 64 years in the PECOV group. The DVTCOV group had a LOS of 16 days, with 24.71% mortality, while the PECOV group had a LOS of 11 days, with 19.20% mortality. The average TOTCHG in the DVTCOV group was $248,900, whereas it was $145,378 in the PECOV group.

Conclusion: Our study revealed significant mortality rates across different groups, including 38% in COVNSTEMI, 47% in COVSTEMI, 25% in DVTCOV, and 19% in PECOV. These findings highlight the severity of COVID-related complications and the substantial financial burden of hospitalization.

Tricuspid Annular Plane Systolic Excursion/Pulmonary Arterial Systolic Pressure Ratio as a Predictor of Mortality in Heart Failure Patients

Sat, 16 Sep 2023 00:00:00 +0000

Aims: We aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in Moroccan patients with heart Failure (HF).

Study Design: A retrospective study was conducted in The Cardiology Department of Ibn Rochd Hospital of Casablanca in Morocco. The study was conducted in the period between March 2012 to March 2016 with a follow-up until December 2022.

Methods: data were evaluated from the HF register patients and their relatives were contacted by phone. Patients with reduced LVEF were included, patients with pulmonary embolism, and patients with HFpEF were excluded. The endpoint of the study was mortality.

Results: 128 patients were enrolled Over an average follow-up of 58 months. 51(41.4%) patients died at the end of the follow-up, the median value of left ventricular ejection fraction was 35.2 ± 2.2%. Patients were stratified according to the TAPSE/PASP ratio (low <0.32 mm/mmHg; high: >0.32 mm/mmHg). Kaplan-Meier survival analysis showed that ten-year all-cause mortality was significantly higher in patients with TAPSE/PASP ≤0.32 mm/mmHg than in patients with TAPSE/PASP > 0.32 mm/mmHg (log-rank 7.8, p =0.008) Cox regression analysis revealed that lower LVEF (p= 0.04), and a ratio of TAPSE\PAPS <0.32 (p=0.02) were associated to an increase in all-cause mortality.

Conclusion: Correlating right ventricular function to loading conditions may be more accurate in assessing its real contractility and predicting patients’ outcomes. Our study showed that TAPSE/PASP appears as a novel prognostic predictor in patients with Heart failure.

Registry of Ischemic Heart Disease Patients in the Region of Mid Delta, Egypt Data Base and Quality Initiative Project

Tue, 26 Sep 2023 00:00:00 +0000

Background: Cardiovascular diseases are significant contributors to global increased mortality rates. coronary artery disease (CAD) is the most common cause of heart disease globally.

Aims: Detection of the characteristics [clinical, electrocardiographic, echocardiographic and coronary angiographic] of ischemic heart disease patients in Med Delta region in Egypt and also their management plan.

Methodology: The registry included 1000 patients of ischemic heart disease (IDH) at Med Delta Region. All patients underwent full medical history, full cardiac examination, detection of ECG changes, cardiac enzymes, other labs, Echocardiography and coronary angiography

Results: Out of 1000 patients studied 72.1% had chronic coronary syndromes and 27.9% had acute coronary syndrome. Seven hundreds and sixty-seven (76.7%) were known to have hypertension and 725 (72.5%) patients were smokers. left anterior descending artery (LAD) was diseased in 54.9 % of the patients. Single vessel disease was affected in 61.7%, 21.5% had double vessel disease and about 16.8 % had multi vessel disease.

Conclusion: Chronic coronary syndrome was the most common presentation in the studied patients with hypertension being the most prevalent risk factor and LAD was the mostly affected vessel.

Prevalence and Risk Factors of In-Hospital Mortality of ST Elevation Myocardial Infarction (STEMI) Patients in Bekasi Regency General Hospital in 2021

Khanza Rizqullah Syauqi , Mailani Karina Akhmad , Omar Mokhtar Siregar — Mon, 02 Oct 2023 00:00:00 +0000

Background: Acute Coronary Syndrome (ACS) is a major cardiovascular problem and has been one of the leading death in the world. ST-Elevation Myocardial Infarction (STEMI) is an indicator of total coronary artery occlusion which requires revascularization to restore the blood flow and myocardial reperfusion using fibrinolytic agents or primary Percutaneous Coronary Intervention (PCI). Early treatment showed better outcomes and reduced in-hospital mortality in ACS patients.

Aims: To determine the prevalence of Acute Coronary Syndrome (ACS) patients and the risk factors of in-hospital mortality of ST-Elevation Myocardial Infarction (STEMI) patients at Bekasi Regency General Hospital in 2021.

Place and Duration of Study: Cardiology Department and Emergency Room Unit in Bekasi Regency General Hospital, December 2021 to March 2022

Methods: This study is a descriptive cross-sectional study using secondary data (medical records) which included all the patients over 35 years old that admitted through the ER from January to December 2021 with complaints including chest pain or shortness of breath which were later hospitalized. The final sample used in this study is 117 subjects.

Results: There were 117 cases of ACS in 2021. They were 14% STEMI, 15% Non-ST Elevation Myocardial Infarction (NSTEMI), and 71% Unstable Angina Pectoris (UAP). Most patients were male (54%), and aged <65 years old (85%). The in-hospital mortality was 19% STEMI, 17% NSTEMI, and 12% UAP. Among 16 STEMI patients, 81% were male and 94% were aged <65 years old. There were 69% who came to the emergency room <12 hours and only 50% underwent fibrinolytic.

Conclusion: The risk factors of in-hospital mortality of STEMI patients were 40% late onset, 23% anterior STEMI, 20% hypertension, 60% diabetes mellitus, 50% chronic kidney disease, 33% tachycardia, and 100% Killip III.

Right Ventricular Myocardial Infarction: A Mono-Centric Retrospective Study

Wed, 11 Oct 2023 00:00:00 +0000

Coronary heart disease is one of the world's leading causes of morbidity and mortality. Much is known about left ventricular myocardial infarction. It was not until much later (1974) that right ventricular myocardial infarction was studied as a distinct entity [1]. Isolated VD MI is rare [2,3,4]. It is often associated with infero-posterior MI (in a third of patients) [2,5], with higher morbidity and in-hospital mortality due to hemodynamic and rhythmic complications [4]. The culprit lesion is often occlusion of the proximal right coronary artery [2,4,6,7]. However, the VD is relatively resistant to infarction and recovers even after prolonged occlusion [8]. In this work, we will study the epidemiological, clinical, electrical, echocardiographic and angiographic aspects of MDI with extension to the VD, as well as its complications and therapeutic modalities.

Relationship between Left Ventricular Diastolic Function and Time to Reperfusion by Primary Percutaneous Coronary Intervention in ST Segment Elevation Myocardial Infarction Patients

Mon, 16 Oct 2023 00:00:00 +0000

Background: The therapy and prognosis of acute myocardial infarction (MI) have been modified by primary percutaneous coronary intervention (PPCI). Delayed time to reperfusion in STEMI patients is risk predictor fo left ventricular diastolic dysfunction and linked to increase risk of heart failure. AMI-associated adverse remodeling, a higher possibility of heart failure, and reduced survival are all linked to echocardiographic indicators of diastolic dysfunction.

Aims: The aim of this study was to determine the relationship between left ventricular diastolic functioning and time-to-reperfusion by PPCI for individuals with STEMI.

Patients and Methods: The current study included 50 patients admitted with STEMI & underwent primary PCI in Cardiology Department in Tanta University Hospitals.

They were divided into two groups: Group 1 early reperfusion (<6h) and group 2 delayed reperfusion (>6h).

They presented by chest pain within 24 hours and conducted echocardiography within 72-hours of PPCI.

Results: The median time-to-reperfusion, which is the time from the onset of symptoms to reperfusion at the end of PPCI, was 240 minutes (interquartile range: 120-720 minutes). LV ejection fraction and E/septal e' did not vary significantly between both groups. The current research found that those with delayed time to reprfusion were troponin (+), CKMB (+), CRP (+), high LVDd, high E/e` average, high LA volume, high LA volume index and had high grade diastolic dysfunction compared to patients with early time to reperfusion. This study showed that group ІІ was significantly higher than group І regarding to time to reperfusion & diastolic dysfunction.

Conclusion: In PPCI-treated individuals who have STEMI, earlier increased LV diastolic pressure is linked to a longer time-to-reperfusion. We also found that creatine kinase, troponin and CRP were significantly higher in the late reperfusion group compared to early reperfusion group. Time to reperfusion and CRP were significantly associated with LVDD grade. CK, LVDs, LVDd, e´ Lateral, E/e´ Lateral, E/e´ average, LA volume index and Diastolic dysfunction grade were identified as independent predictors for LVDD.

Effect of Marijuana on Some Cardiac Biomarkers among Smokers in Southwest Nigeria

J. Sado , A. A. Salawu , S. K. Mosaku , T. W. Oloyede, S. A. Ojedokun — Thu, 26 Oct 2023 00:00:00 +0000

Background: Marijuana is the oldest and one of the most widely used illicit drugs, the clinical and pharmacological effects of cannabinoids have been recently studied, with much still unknown about the physiologic and pathologic effects. This study aimed to evaluate its cardiovascular effect using some cardiac makers among smokers in Nigeria.

Methods: The study was a comparative design conducted among eighty-eight test and control subjects. Venous blood was collected for AST, LDH and CK-MB. Biodata was obtained via questionnaires with anthropometric and blood pressure measures. Data were analyzed using SPSS version 21 and a significant level was taken at p<0.05.

Results: There was a decrease in systolic and diastolic blood pressure of subjects who use marijuana as observed from earlier studies. There was a significant increase in the levels of these enzymes in marijuana users as compared to non-smokers.

Conclusion: The increase in these cardiac bio-markers, though heralds the pathologic effect of the use of marijuana on the heart, will be most convincing to assay more cardiac markers such as troponin T to buttress these findings.