Cardiology and Angiology: An International Journal

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https://imsear.searo.who.int/handle/123456789/151218

ISSN: 2347-520X

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.sciencedomain.org/journal-home.php?id=26

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NSTEMI and Coronary Amyloid Infiltration: Challenges and Therapeutic Strategies in CHU Ibn Rochd, Casablanca
(Ms. M. B. Mondal, 2025-06) Al-Timimi, A; Afendi, L; Essadqi, F; Bouazizi, AE; Bouziane, M; Haboub, M; Arous, S; Benouna, G; Drighil, A; Habbal, R.
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.
No Cut, Just Close: Transcatheter Device Closure of Mitral Paravalvular Leak
(Ms. M. B. Mondal, 2025-06) Munde, K; Kothari, G; Jain, P; Mutha, S; Munde, A; Shah, R; Nihari, J; Shaikh, S; Shaikh, K; Gaba, V; Rane, V; Gupta, AK.
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.
A Rare Case of Mistaken Identity: Mitral Valve Prolapse Disguised as Endocarditis in Systemic Sclerosis
(Ms. M. B. Mondal, 2025-06) Ejjebli, S; Altimimi, A; Jabouri, J; Haboub, M; Arous, S; Bennouna, MG; Drighil, A; Habbal, R.
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�% 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.
Carcinoid Syndrome-induced Multi-valvular Heart Disease: A Rare Cause of Heart Failure in a 45-Year-Old Woman
(Ms. M. B. Mondal, 2025-06) Alaa, AT; Saleh, O; Samia, E; MERYEM, A; Meryem, H; Rachida, H.
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.
Epidemiology and Left Ventricular Impact of Secondary Hypertension: A Case Series
(Ms. M. B. Mondal, 2025-06) ROUAM, H; ISLAH, Y; ELMASRIOUI, J; ELJAMILI, M; KARIMI, SE; HATTAOUI, ME.
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抯 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
(Ms. M. B. Mondal, 2025-06) QADI, CE; HAMDOULI, N; ZARIDI, I; YAHYA, AA; ZTATI, M; JAMILI, M; HATTAOUI, M.
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 C?HEST 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 C?HEST 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
(Ms. M. B. Mondal, 2025-06) Couissi, A; Boutaleb, AM; Berrami, H; Mehdi, RE; Aboulouidad, C; Habbal, R.
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抯 cardiologist's daily routine.
Exploring Lipid Levels as Indicators of Cardiovascular Risks in a University抯 Executive staff: A Case Study at Rivers State University, Nigeria
(Ms. M. B. Mondal, 2025-06) Onwuli, DO; Chidinma, IJ.
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抯 instructions, while Low density lipoprotein cholesterol (LDL cholesterol) was calculated using the Friedewald抯 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�04mmol/L 0.78�55mmol/L, 1.65�44mmol/L and 2.47�15mmol/L respectively for male and 4.56�79mmol/l, 0.72�79mmol/l, 1.65�55mmol/l and 2.50�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.
Characteristic and Pattern of Aortic Stenosis: An Observational Study in a Designated Population of Patients
(Ms. M. B. Mondal, 2025-06) Zarrouk, S; Bennajma, K; Zahid, H; Masrioui, J; Karimi, S; JAMILI, M; BOUMZEBRA, D; Hattaoui, M.
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 cm�, 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.
An Acute Coronary Syndromes (ACS) Revealing a Severe Mitral Stenosis: A Case Report
(Ms. M. B. Mondal, 2025-06) REBBOUH, F; DALI, I; MALHABI, N; SAADAOUI, H; KARIMI, SE; HATTAOUI, ME.
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.
Sex Differences in Systolic Heart Failure in Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention
(Ms. M. B. Mondal, 2025-03) Zahid, B; Azm, THA-E; Zaghloul, HG; Elnagar, A.
Aims: Sex differences refer to the biological and physiological variations in the cardiovascular system that arise from distinct gene expressions associated with sex chromosomes. Notable and well-documented sex differences in ST-elevation myocardial infarction (STEMI) indicate that women tend to be elderly and present with a more significant number of comorbidities in comparison to men. The aim is to investigate sex-specific differences in systolic heart failure (SHF) among patients with acute STEMI who are undergoing primary percutaneous coronary intervention (PCI). This study also included a follow-up period of three months to assess the occurrence of major adverse cardiovascular events (MACE) and to conduct a conventional echocardiographic evaluation. Study Design: This investigation is a prospective cohort study. Place and Duration of Study: Department of Cardiology, Faculty of Medicine, Benha University, AlQalyubia, Egypt, between October 2023 and October 2024. Methods: We included 116 adult patients with SHF following STEMI undergoing primary PCI. The subjects were divided into two equal groups: male (58 cases) and female (58 cases). Results: Females exhibited significantly higher NT-proBNP levels and lower left ventricular ejection fraction (LVEF) than males (P<0.001, P=0.02, respectively). Readmission with acute heart failure (AHF) at three months was significantly increased in females compared to males (P => 0.001). Cardiovascular death and AHF at three months were significantly higher in females compared to males (P = 0.031). Females showed significantly higher MACE compared to males (P= 0.016). Conclusions: Female patients with SHF following STEMI who undergo primary PCI have a higher risk of cardiovascular mortality within the first three months compared to males. The observed difference in mortality suggests that female patients may require different clinical approaches and closer follow-up to improve outcomes.
Cardio-protective Activities of Annona muricata Leaf Extract in Isoproterenol Myocardial Infarction-Induced Wistar Rats
(Ms. M. B. Mondal, 2025-03) FC, C; MO, E; AA, O; OA, A; MA, A; UA, E; VC, E.
Cardiovascular disease (CVD) is a severe heart condition characterized by impaired blood flow to the heart muscle, leading to tissue damage and dysfunction. Among different medicinal plants, Annona muricata is now becoming more attractive because of its therapeutic potentials, especially in the prevention and treatment of cardiovascular related disorders, particularly myocardial infarction. Hence, this study was carried out to evaluate the cardio-protective activity of Annona muricata in isoproterenol-induced myocardial infarction using animal model. Thirty (30) male wistar rats were randomly grouped into five classes (A, B, C, D and E) of six rats each. Groups A, B and C were orally pre-treated daily for fourteen (14) days with 100mg/kg, 200mg/kg and 400mg/kg of Annona muricata extract respectively. Group D was orally administered 10 mg of lisinopril (standard drug), this served as the positive control group while group E was orally administered 0.2 ml distilled water, and this served as the negative control group. All the rats were intraperitoneally induced with 150 mg of isoproterenol after fourteen days (two weeks) of pretreatment. Cardiac biomarkers (lactate dehydrogenase (LDH) and creatinine kinase (CK-MB)), were measured to assess cardiac injury, using standard method while lipid bioassay such as high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides (TG) were assayed using standard assay kits. Results showed that rats pre-treated with Annona muricata extract showed significant effect on cardiac biomarkers compared to the control group. Results further showed a significant increase (P<0.05) in low density lipoproteins (LDL) and triglyceride levels in a dose-dependent manner (100<200<400 mg/kg body weight) among the extract treated groups when compared to the untreated control group. This study has shown that extract of Annona muricata could help to mitigate cardiovascular diseases and could be used to produce plant based products to combat myocardial infarction, and consequently improving general wellbeing.
Routine Health Checks and Implications among Staff of a Tertiary Health Facility in Nigeria
(Ms. M. B. Mondal, 2025-03) O, O; EK, E.
Background: Non-communicable disease is a globally recognized cause of significant morbidity and mortality with a rapidly increasing prevalence. Its rising burden among health workers, reduces their productivity and strains service delivery in the sector. Awareness and knowledge of important metabolic indices and regular monitoring is key to healthier living, early detection, prevention of complications and mortality from Non- communicable diseases. Objectives: This study aimed to assess the prevalence of non-communicable disease among staff at University of Port Harcourt Teaching Hospital (UPTH), to assess their knowledge and monitoring habit of important health Numbers. Methodology: A descriptive cross-sectional study was conducted among staff. Interviewer administered semi structured questionnaire was used to collect data on medical and family history, health screening habit, and awareness of complications of Non -communicable diseases. Data was analyzed using SPSS version 23. Results: A total of 102 staff participated. Most 73(71.6%) were females, 46(45.1%) were doctors and 85(82.5%) had attained tertiary level of education. 27(26.5%) had a known medical history, 58(56.9%) had family history of various medical conditions and 34(33.3%) were on medication. 44(43.6%) of participants were overweight and 19(18.8%) had class 1 obesity. Only 31(30.7%) had normal blood pressure, 34(34.0%) were pre-diabetic and 8(8.0%) were diabetic. Abdominal obesity was found in 44.8% of participants. Participants understood the implications of obesity, (41.2%) diabetes (36%) and hypertension (50%) Participants checked their numbers quite frequently, with weight and blood pressure having the highest frequencies within the previous one month while blood glucose was checked by more people within the previous 6 months. However, a significant knowledge gap about the implications of abdominal obesity was identified. Conclusion: The findings revealed a high prevalence of Non -communicable diseases among hospital staff. Though health numbers were checked regularly, varying levels of awareness about complications of non-communicable diseases were found with a significant gap in knowledge about abdominal obesity.
Clinical, Electrocardiographic and Imaging Features of Acute Aortic Syndromes: A Retrospective Study
(Ms. M. B. Mondal, 2025-03) F., KADDARI; MASRIOUI, JEL; MARDOULI, MEL; D., BOUMZEBRA; KARIMI, SEL; HATTAOUI, MEL.
Introduction: Acute aortic syndromes (AAS) relate to a range of different entities, including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcers (PAU) and traumatic or iatrogenic aortic dissection. They require rapid diagnosis and a high level of clinical suspicion to identify thier symptoms. The aim of this study was to define the range of clinical presentations, electrocardiographic and imaging findings, in patients presenting with AAS. Materials and Methods: This study was a retrospective study of the clinical, electrocardiographic and imaging data in patients hospitalized for acute aortic syndromes from December 2021 to December 2024. Patients with traumatic or iatrogenic aortic dissection were excluded. Results: A total of 10 patients were included, with a mean age of 45 years, and 70% of patients were male. The most frequent symptoms were chest pain alone (50%) or chest pain associated with back pain (40%). Classical “tearing” pain, often associated with aortic dissection, was less frequently reported. Differential blood pressure was observed in 30% of cases. The electrocardiogram showed ST-segment depression in the apical, lateral and inferior leads, as well as ST-segment elevation in the AVR lead and T-wave changes, which were the most frequently observed abnormalities. The most frequent diagnosis was type A aortic dissection (TAAD) (70%), followed by type B aortic dissection (TBAD) (20%) and intramural hematoma (IMH) (10%). The initial diagnosis was made primarily by computed tomography angiography (CTA) in 70% of cases, and by transthoracic echocardiography (TTE) in 30%. Magnetic Resonance Imaging (MRI) was not performed in any of these patients. A diagnostic discordance was found between CTA and TTE in two patients, particularly in one patient with IMH and aortitis. In addition to one case of false-positive TAAD. Conclusions: In conclusion, this study is a reminder that patients with acute aortic syndromes have diverse clinical presentations and may not present with the symptoms typically reported. Relying on classical signs can lead to misdiagnosis. A well-structured approach combining imaging techniques improves diagnostic accuracy, reduces errors and improves patient outcomes.
Knowledge and Attitude towards Cardiopulmonary Resuscitation among Community Members in Selected Communities of Obio/Akpor Lga, Rivers State, Nigeria
(Ms. M. B. Mondal, 2025-03) Awajionye, EE; Oluwatosin, OA.
The survival chances of an out of hospital cardiac arrest are significantly increased by provision of bystander cardiopulmonary resuscitation (CPR). Early bystander cardiopulmonary resuscitation has been documented as one of the most important predictors of out-of-hospital cardiac arrests survival. The study was designed to assess the knowledge and attitude towards cardiopulmonary resuscitation among community members in three selected communities in Obio-Akpor, Rivers State. Cross sectional descriptive design utilizing mixed method was adopted. A total of 427 participants were selected by purposive sampling. Structured questionnaire was utilized to assess community members “knowledge on cardiopulmonary Resuscitation. Mean score was determined and mean scores and above was categorized as good knowledge while below mean scores was categorized as poor knowledge. To access the attitude towards cardiopulmonary resuscitation, mean score was determined and mean scores and above was categorized as positive attitude while below mean scores was categorized as negative attitude. The data was analyzed using descriptive analysis and inferential statistics of chi- square to test the set hypothesis at p ?0.05. Most occurring age group of the respondents were between 31-40 years and 50.5% are single. The findings on knowledge of CPR from this study revealed that 59.8% had poor knowledge while 40.2% had good knowledge of CPR. Overall, 58.5% had negative attitude towards administering CPR while 41.5% of the community members had positive attitude towards administering CPR to out of hospital cardiac arrest victims. There is a significant association between sex, marital status, level of education, occupation and knowledge on CPR as well as marital status and attitude towards CPR. Also, there is statistically significant association between knowledge on CPR and attitude towards CPR.
Rare ECG Dynamics in Acute Coronary Syndrome: Co-Occurrence of De Winter and Wellens' Signs in Proximal LAD Occlusion
(Ms. M. B. Mondal, 2025-03) Kumar, P; Prasad, P; NK, RD.
The present study explores about rare ECG Dynamics in Acute Coronary syndrome. De Winter sign and Wellens sign are two electrocardiogram patterns which have been described in acute coronary syndrome due to acute occlusion of left anterior descending coronary artery. A 69-year-old male with cardiovascular risk factors including hypertension, diabetes mellitus and a sedentary lifestyle presented with typical rest angina lasting more than 20 minutes. Initial ECG taken at nearby hospital showed de Winter’s pattern. Wellens’ syndrome has been described as occurring in 14% to 18% of patients with unstable angina 3,4, while the de Winter pattern is known to be in 2% of patients admitted with anterior wall infarction5. The coexistence of the De Winter and Wellens patterns in the same patient is an extremely rare finding.
Spectrum, Treatments and Outcomes of Shock in Acutely-ill Children Seen at the Emergency Room of a Tertiary Hospital in Southern Nigeria
(Ms. M. B. Mondal, 2025-03) Abiodun, MT; Sadoh, WE.
Introduction: Shock is a state of inadequate tissue perfusion. The emergency care of shock in children is dynamic but fluid therapy remains its cornerstone, with variable effectiveness. We evaluated the spectrum, therapies and outcomes of shock in our Children Emergency Room. Methods: This was an analytic, cross-sectional study. Data were collected using a structured questionnaire comprising demography, clinical features, shock diagnoses, emergency care and outcomes. Co-existing morbidities in the participants were mainly infection-related. Both descriptive and inferential analyses were done; prognostic factors in children with shock were identified, using odds ratio (OR) and 95% confidence intervals (CI). Results: Five hundred and fifty-four acutely-ill children participated in the study. Their mean duration of illness was 13.5 days (± 4.7). The incidence of shock was 83 (15.0%). For the types of shock recorded (n = 42), hypovolemic shock was the commonest, 24 (57.1%). Septic shock occurred in 14 (33.3%) children, while cardiogenic shock was seen in 4 (9.6%) children. Among the affected children, 17 (40.5%) were fluid responsive, 5 (11.9%) were fluid refractory, and 20 (47.6%) were fluid refractory and dopamine dependent. The case fatality rate of shock was 57.8%. Children who presented with shock were more likely to die compared to others (OR = 11.811, 95% CI = 6.976–19.998, p < 0.001). Dopamine infusion was significantly associated with lower mortality risk, with an odds ratio of 0.039 (95% CI 0.008-0.196, p < 0.001). Conclusion: Circulatory failure especially hypovolemic shock is common in acutely-ill children with dire consequences. Fluid therapy and catecholamine infusion can improve survival in the emergency setting.
A Rare Case of Aggressive Infected Atrial Myxoma
(Ms. M. B. Mondal, 2025-03) Qadi, CAIT EL; Zaridi, I; A., Dicko; Massrioui, JEL; Yahya, AAIT; Houatti, REL; Karimi, SEL; Hattaoui, MEL.
Cardiac myxomas are known to be the most common primary benign intracardiac tumors in adults, but infected myxomas represent a rare and challenging complication. We report here the case of a 50-year-old patient with no prior medical history, admitted for febrile ischemic stroke, which revealed an infected left atrial myxoma, treated by surgery and antibiotics. This case underscores the diagnostic and therapeutic challenges of infected cardiac myxomas, which can lead to severe complications such as systemic embolism. Given the rarity and nonspecific clinical presentation of this condition, timely diagnosis and management are crucial. While rapid surgical resection is often advocated due to the high embolic risk, careful assessment of the benefit-risk balance remains essential, particularly in patients with neurological compromise, as our patient. Further studies are warranted to establish a consensus on the optimal management of infected cardiac myxomas.
Beyond the Kidneys: Cardiac Involvement in Anca Vasculitis
(Ms. M. B. Mondal, 2025-03) Zerhoudi, R; Bourzeg, K; Eljazouli, H; Elmasrioui, J; Yahya, AA; Ztati, M; Eljamili, M; Elkarimi, S; Hattaoui, ME.
Introduction: ANCA-associated vasculitis (AAV) is an autoimmune disease primarily affecting the kidneys and lungs; however, cardiac involvement, though rare, can present a significant diagnostic challenge. This complication is often underestimated and may manifest as myocarditis or heart failure, necessitating a thorough cardiological assessment. Diagnosis relies on echocardiography and advanced imaging techniques, while therapeutic management involves a combination of corticosteroids and immunosuppressants. Aim: This case report highlights the importance of rigorous cardiac monitoring in this systemic disease. Case Report: We report the case of a 40-year-old patient with seronegative ANCA-associated vasculitis complicated by severe renal insufficiency, previously treated with corticosteroids and immunosuppressants. The patient presented with worsening chronic dyspnea, episodes of hemoptysis, and a deterioration of general health status. Investigations revealed severe anemia, acute renal failure, and signs of alveolar hemorrhage on thoracic imaging. Cardiac assessment demonstrated a dilated hypokinetic cardiomyopathy with severe left ventricular dysfunction (LVEF of 36%), without evidence of right heart failure. The patient was managed with emergency hemodialysis, blood transfusion, corticosteroid therapy, and methotrexate, in addition to heart failure treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEIs). A significant improvement in cardiac function was observed at the three-month follow-up, with an LVEF of 45-50%. Discussion and Conclusion: Cardiac involvement in ANCA-associated vasculitis is a rare but serious complication that requires early detection and a multidisciplinary approach. This case emphasizes the importance of systematic cardiac monitoring to improve patient prognosis. Echocardiographic evaluation and treatment with corticosteroids and immunosuppressants resulted in significant clinical improvement, highlighting the need for an appropriate diagnostic and therapeutic strategy.
Association of Poor Sleep Quality with Ischemic Heart Disease
(Ms. M. B. Mondal, 2025-03) Samajpaty, S; Zhuravlov, AK; Dmitrii, E; Sergeivich, IY.
Sleep is a topic of current discourse in medical science. The twenty-first century lifestyle has contributed to changes in the pattern of human behavior manifold. Sleep cycle disruption, reduced sleep hours and decreased sleep quality is one of the most affected aspects and reality of the modern world. Multiple studies have already established that insomnia is a significant cause of mortality increment but discrepancies persist. Insomnia may not be a direct cause of mortality but a secondary etiological factor, giving rise to morbid disorders including cardiovascular changes. This is a nested case-control study that establishes a relationship between the quality of sleep quantified in PSQI scale and the risk of development of ischemic heart diseases. The study recruited patients in experimental and control groups and found the relationship to be statistically significant with p<0.001, OR = 5.76 at Ci 95% with 4.392 Z-score. The correlation between low sleep quality on PSQI and development of ischemic heart disease was found to have AR 60.97%.

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