International Journal of Cardiovascular Practice
Volume:5 Issue: 1, Jun 2020

Bacterial pericarditis is a rapidly progressive infection sown with heavy mortality. It usually occurs as a secondary infection to either a contiguous or hematogenous spread from a distant focus of infection. The primary involvement of the pericardium without evidence of underlying infection disease elsewhere, is sporadic. We present a unique case of a 69 -year-old patient who was diagnosed as having purulent acute bacterial pericarditis caused by Streptococcus pneumonia, revealing an underlying squamous cell lung carcinoma in the cardiology department of IBN ROCHD University hospital of Casablanca.

We present here a rare case of Scimitar syndrome on a full-term newborn female issued from consanguineous marriage and diagnosed at the age of two months who was suffering from polypnea since the age of two weeks. She was admitted at the age of two months for polypnea, non-dysmorphic facies, healthy systemic arterial tension, regular pulse, but the family history raises that before her birth, two newborns respectively boy and girl died both at an early age with dilated cardiomyopathy. After hospitalization, we realized chest radiography, which has shown opaque right lung and suspicion of scimitar syndrome. After that, an echocardiogram was performed, showing severe hypoplasia of the right pulmonary artery with pulmonary hypertension. The Thoracic computed tomography confirmed the diagnosis by revealing hypoplasia of the right pulmonary artery with pulmonary arterial hypertension, right pulmonary hypoplasia (bilobar), and abnormal partial right pulmonary venous return toward the vena cava under the diaphragm.

One of the rare abnormalities of coronary artery anatomy is the common origin of all three coronary arteries from the right sinus of Valsalva, which, may associated with myocardial ischemia. Percutaneous coronary intervention of such patients with anomalous coronary arteries is particularly challenging. In such patients femoral route is usually chosen for coronary angioplasty, various studies have proved that the radial access provides better engagement and robust support to the guide catheter. We report a rare case diagnosed with ST-segment elevated myocardial infarction. The patient underwent successful trans-radial primary angioplasty with a buddy wire, parked in the non-culprit artery

Acute rheumatic fever is a well-known disease that is still widely observed in developing countries, including our country Morocco. It is known that the majority of patients diagnosed with acute rheumatic fever display abnormalities of the conduction system; However, there are only a few case reports that describe severe impairment in the electrical conduction system. We describe a 21-year-old man who was diagnosed with acute rheumatic fever with complete atrioventricular block. In our patient, the diagnosis of acute rheumatic fever was established. 24-hour electrocardiography showed a paroxistic complete atrioventricular block. Penicillin prophylaxis was made, and salicylate treatment in an anti-inflammatory dose was initiated. The electrocardiographic abnormalities of the patient disappeared. Although rare, this diagnosis should be considered in patients with complete heart block, particularly when it is associated with other features of acute rheumatic fever. Conduction disorders associated with acute rheumatic fever often resolve following appropriate treatment without the need for permanent pacemaker placement.

Fabry disease is an X-linked disorder due to deficiency of the lysosomal hydrolaseagalactosidase A and the resultant accumulation of glycosphingolipids throughout the body, such as in the heart. Cardiac manifestations in Fabry disease are due to glycosphingolipid deposition in the myocardium, valves, and conduction system. Fabry cardiomyopathy, characterized by progressive severe concentric left ventricular hypertrophy. We, as a result of this, have reported a case of Fabry disease with left ventricular hypertrophy. He was admitted with dyspnea and also dizziness, general weakness, and acroparesthesias. Physical examination showed Angiokeratoma on the skin. The electrocardiography revealed ST-segment depression in leads V3–V6, and changes related to left ventricular hypertrophy. Echocardiography showed concentric left ventricular hypertrophy.

Coronary bifurcation lesions are frequently observed and remain a challenging patient population for successful treatment. Currently, the provisional approach of treatment is considered the first-line method of treatment. Many dedicated bifurcation stents and newer treatment approaches such as drug-coated balloons and bioresorbable scaffolds are also particularly attractive concepts. The aim of this article is to review the current treatment approaches for coronary bifurcation lesions, mainly the dedicated bifurcation stent systems while briefly covering the related topics of provisional and two-stent procedures of treatment and the current status of drug-coated balloons and bioresorbable scaffolds. This article highlights the critical trials involving these strategies. We searched PubMed, Google Scholar, Medline and ClinicalTrials.gov to identify all the relevant trials assessing the safety and efficacy of dedicated bifurcation stent systems, drug-coated balloons vs. other traditionally used coronary stents. A debate still prevails to treat coronary bifurcation lesions optimally. Provisional stenting strategy remains the gold standard for treating a majority of coronary bifurcation lesions, but the two-stent approach can be indicated for some lesions. More long-term follow-up trials are required to concretely define the role of newer treatment approaches such as dedicated bifurcation stents, drug-coated balloons, and bioresorbable scaffolds.

vitamin D affects the function of most of the cells in the body, including myocytes and endothelial cells, and also affects platelet function. This study aims to evaluate the relation between vitamin D deficiency and in-hospital and 6-month outcomes of patients with the acute coronary syndrome.

This was a prospective cohort study of patients admitted to Mousavi hospital with the diagnosis of acute coronary syndrome. A venous bloodsample obtained from patients at the time of admission and 25-hydroxyvitamin D, lipid profile, and hs-troponin-I levels were measured. After coronary angiography, the severity of the coronary artery stenosis was calculated by the syntax score. Patients also evaluated in-hospital outcomes and even followed up for 6-month results.

Totally, 204 patients were included in the study. The mean ± SD of age was 60 ± 11.6-year-old. The overall vitamin D deficiency was 80.9%. There was no association betweenvitamin D deficiency and in-hospital and 6-month mortality in patients with acute coronary syndrome (P = 0.824). There was a direct and statistically significant association between vitamin D levels and HDL cholesterol (P = 0.011). Twenty-eight percent ofpatients with negative hs-troponin-I and 14% with positive hs-troponin-I had normal vitamin D levels, which was statistically significant (P = 0.045).

This study does not demonstrate an association between vitamin D levels and in-hospital and 6-month outcomes in patients with the acute coronary syndrome.

Atrial fibrillation (AF) is the most prevalent dysrhythmia in the intensive care unit (ICU). This study aimed to assess the prevalence, clinical outcomes, and risk factors of new-onset AF in patients admitted to ICU, concerning mortality and length of stay.

This cohort study consisted of patients above 18 years old admitted to the ICU of Firoozabadi hospital in 2019_2020. New-onset AF diagnosis was confirmed by ECG electrographic changes watched by cardiologists in 24 hours for each patient. Patients were divided into two groups: without new-onset AF [171 patients, 54.4% men, age: 65.09 (18–97) years] and with new-onset AF [23 patients, 52.2% men, age: 79 (55–95) years]. Clinical and laboratory features, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to- lymphocyte ratio (PLR), were compared between the groups.

Among 194 patients, 118 (61%) were survivors, and 76 (39%) were non-survivors. Twenty-three patients (11.9%) developed new-onset AF. The AF group was significantly older than those in the no AF group (AF vs. no AF: 79 ± 11.5 years vs. 65 ± 20 years, P = 0.02). ICU survivors had a significantly shorter ICU stay than non-survivors (6 ± 0.5 days versus 13.6 ± 1.9 days, P < 0.001). Also, patients with new-onset AF had longer ICU stay (AF vs. no AF: 15.5 ± 10.9 days vs. 7.8 ± 10.6 days, P = 0.02). Patients who developed new-onset AF in the ICU had not greater in-hospital mortality (AF vs. no AF: 16.4% vs. 9.6%, P > 0.05). The NLR of AF and no AF subjects were 16.7 ± 12.6 and 11.6. ± 14.9, respectively (P = 0.008). There was no significant difference between the PLR of the AF group (284.6 ± 211.8) and no AF group (264.8 ± 204.8) (P = 0.7).

Atrial fibrillation may not be independently associated with hospital mortality. NLR is a predictor of new-onset AF in critically ill patients.

Prosthetic heart valve thrombosis (PHVT) is a potentially fatal complication of heart valve replacement with mechanical prostheses mainly due to thrombosis.

The study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy. Settings & design: This was prospective, observational study conducted from June, 2016 to April, 2017. Total 133 patients with prosthetic heart valve thrombosis were included.

Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by fluoroscopy and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients. Statistical analysis: Parametric values between two groups were performed using the independent sample t-test or chi-square test, as appropriate. Univariate and multivariate logistic regression was used to find out factors associated with outcome.

All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.

From our single centre experience, fibrinolytic therapy is fairly effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy.

Door to balloon time is a marker of primary Percutaneous Coronary Intervention (PCI) timeliness. Door to balloon time duration, associated factors and it's relation to outcomes are not similar in various centers. Herein we aimed to define these issues in our region.

In this study, 188 patients with ST-Elevation Myocardial infarction (STEMI) diagnosis eligible for primary PCI were included. Demographic, clinical, and time intervals from arrival in the hospital to patients' catheterization data were recorded. Patients were followed for six-month in terms of mortality and admission.

After excluding patients with missed data, 174 patients were entered into the study. The mean age of patients was 60.8 ± 11.81 years, and 78% of patients were male. Median DBT was 70 minutes (IQR 25-75: 55-97 minute). One hundred and twenty-three patients (71%) had a timely door to balloon time. Patients with delayed door to balloon time had lower age, lower prevalence of typical chest pain, and higher prevalence of PCI on Left Circumflex Artery (LCX) than the timely group, but these differences were not significant. (P-values were 0.068, 0.074 and 0.070 respectively). Delayed DBT was evident in three segments of the door to ECG, ECG to code, and code to cath times (P-values were < 0.0001, 0.009, and < 0.0001, respectively), but the cath to balloon time was not significantly different between the two groups (P-value: 0.159). Although in-hospital mortality was higher in the delayed group than the timely group, the difference was not meaningful. (11.7% vs 4.9%, P-value: 0.103). Six-month mortality and admission rate were not different between the two groups.

Door to balloon time was acceptable in this study and was comparable to developed countries. Albeit there is room for improvement due to modifiable delayed parts.

Acute aortic dissection is a rare but lethal disaster during pregnancy and early postpartum. It has a very high mortality. Emergent or urgent surgical correction is the preferred treatment for most patients. We report a case of postpartum type A aortic dissection who underwent a successful emergent Bental procedure.

Catheter-related infection is one of the severe complications in hemodialysis patients with high morbidity and mortality. Transesophageal echocardiography is a suitable diagnostic method that helps diagnose catheter infections with relatively high accuracy. A 70-year-old woman on chronic dialysis through a catheter was admitted with a suspected catheter infection. In transesophageal echocardiography and fluoroscopy, an elongate guidewire was observed from the right atrium to the femoral veins left there since previous catheter insertion one year ago. The Guidewire was removed surgically, and the tricuspid valve was replaced with a mechanical valve because of infective endocarditis.

Cor triatriatum sinister is a congenital cardiac anomaly involving a fibromuscular membrane that divides even the left atrium or the right into two chambers. This abnormality has been reported in only 0.1% to 0.4% of patients with congenital heart disease. Most patients are diagnosed with the condition in infancy or childhood; adult cases are rare. We describe three rare complications of cor triatriatum. The first case is about pulmonary embolism complicating a cor triatrium dextran in a 44-year-old man, which has never been reported, at least to the best of our knowledge. He underwent curative resection of the membrane and was asymptomatic after that. The second case is about sudden death on a cor triatrium sinistrum 9-month-old infant. The last one is an about 45-year-old male patient admitted with atrial fibrillation revealing cor triatrium.

Double aortic arch is a congenital vascular abnormality in which the connected segments and their branches course between and compress the trachea and esophagus, often resulting in invariable airway compression and gastrointestinal presentations. A 2-month girl with a history of double aortic arch diagnosis in fetal echocardiography was admitted to our hospital with recurrent pneumonia. The double aortic arch was confirmed by computed tomography angiogram. After surgery, the patient was followed for one year of age and had no problem. Our study showed early diagnosis and treatment of a double aortic arch might prevent chronic, irreversible complications.