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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The Incidence of Contrast-induced Acute Kidney Injury in Patients on Dapagliflozin Undergoing Percutaneous Coronary Interventions
(Ms. M. B. Mondal, 2024-11) Ebaid, HH; Hafeez, ABEDAE; Rabat, KEEDE; Elakabawi, K
Background: Sodium glucose cotransporter 2 receptor inhibitor (SGLT2i) dapagliflozin protects the renal function of individuals with coronary artery disease (CAD) and reduces incidence of contrast-induced acute kidney injury (CI-AKI) among individuals having percutaneous coronary interventions (PCI). The purpose of this work was to assess the CI-AKI incidence across individuals on dapagliflozin underwent PCI. Methods: This single-center, prospective observational work had been conducted on 200 diabetic individuals ranging in age between 25 and 80 years old, both genders, with CAD were going to have elective coronary angiogram and PCI. We identified CI-AKI by the ESUR and KDIGO definition. Patients were divided into two equal groups: Group I: Type 2 diabetes mellitus (T2DM) were on dapagliflozin (SGLT2i) and group II: T2DM were on non SGLT2i glucose-lowering drugs. Results: CI AKI according to European society of urogenital radiology (ESUR) and kidney disease improving global outcome score were significantly higher among group II contrasted to group I (P<0.05). no significant correlations existed between contrast volume and creatinine post-PCI, estimated glomerular filtration rate (eGFR) post-PCI, high-density lipoprotein, total cholesterol, and hemoglobin A1c in both groups. Dapagliflozin use was significantly correlated with 76.2% risk reduction of AKI. Dapagliflozin usage had been correlated with a 72.6% risk reduction of AKI but with borderline significance (P = 0.064). eGFR post-PCI was significantly greater among group I cootrasted to group II (P <0.05). Conclusions: Regarding the predictors of AKI according to ESUR criteria, multivariate logistic regression analysis and demonstrated that using dapagliflozin was substantially correlated with 76.2% risk reduction of AKI controlling for age, sex, hypertension, smoking, and dyslipidemia.
Type A Aortic Dissection: A Call for Vigilance in Chest Pain Diagnosis
(Ms. M. B. Mondal, 2024-02) Zahri, S; Khaldi, M; El Jaouhari, Z; Zeroual, MA; Bouziane, M; Haboub, M; Arous, S; Bennouna, G; Drighil, A; Azzouzi, L; Habbal, R
Introduction: Acute aortic dissection (AD) is a rare and life-threatening condition associated with high mortality rates in the absence of prompt intervention. This article provides an in-depth examination of the clinical presentation, diagnostic approach, and management of Stanford type A AD in a 62-year-old hypertensive female patient with atypical symptoms. Case Report: The patient presented with retrosternal chest pain and rapidly worsening dyspnea, demonstrating a 3/6 diastolic murmur over the aortic area. Diagnostic findings included negative T-waves on ECG, significant mediastinal widening on chest X-ray, and transthoracic echocardiography revealing an intimal flap, ascending aorta dilation, and acute aortic insufficiency. Computed tomography confirmed a Stanford type A aortic dissection. Discussion: Acute AD poses a diagnostic challenge, as atypical presentations can lead to misdiagnoses. The case emphasizes the importance of considering AD in the differential diagnosis of chest pain and conducting thorough investigations, especially when faced with unusual symptoms. Management strategies, encompassing both pharmacological and surgical interventions, are crucial for addressing AD promptly. Conclusion: This case underscores the significance of recognizing both typical and atypical presentations of AD to ensure timely intervention and avoid potentially catastrophic outcomes. A comprehensive understanding of diagnostic approaches and management protocols is essential in the emergency setting. Overall, this article contributes to the growing body of knowledge surrounding acute aortic dissection and emphasizes the critical need for awareness and rapid intervention in clinical practice.
An Extremely Rare Case of Cardiac Hydatid Cyst Co-infected with Brevundimonas Nasdae: Diagnostic Challenges and Management
(Ms. M. B. Mondal, 2024-11) KADDARI, F; ELMASRIOUI, J; ARAFAOU, D; THIOMBIANO, A; MHIRIG, I; BOUCHTELLA, Y; MARDOULI, ME; SORAA, N; HOUATI, RE; ELKARIMI, S; ELHATTAOUI, M
Cardiac hydatid cyst (HC) is a rare localisation of hydatidosis. The main preoperative diagnostic tools are serology, Transthoracic Echocardiography (TTE), Cardiac Tomography (CT) and Nuclear Magnetic Resonance Imaging (MRI). MRI is the key examination for diagnosing cardiac masses. It enables anatomical relationships to be studied and a reliable etiological orientation to be made. We report a challenging case of pericardial hydatid cyst associated to a rare infection to Brevundimonas nasdae clinically revealed by chronic dyspnea and atypical acute chest pain evolving in a febrile context. In our case, the HC presented as a cardiac mass, with an atypical appearance on echocardiography suggestive of a rhabdomyosarcoma. The MRI rectified the diagnosis, which was subsequently confirmed on operative finding, and on anatomo-pathological examination. The Patient was successfully managed after multidisciplinary treatment including combined surgical, antibiotics and antiparasitic treatments.
A Case Study of Chronic Coronary Syndrome Revealing a Proximal Left Anterior Descending Artery Aneurysm
(Ms. M. B. Mondal, 2024-11) Amal, E-N; Abdellah, B; Saleh, O; Alaa, A; BOUZIANE, M; HABOUB, M; Habbal, R
Context: Coronary artery aneurysms (CAA) are rare entities associated with significant clinical consequences, including thrombotic occlusions. Chronic coronary syndrome (CCS) may reveal CAA, complicating patient management, particularly when associated with coronary thrombosis. This case discusses a 55-year-old male presenting with angina and dyspnea, later found to have a proximal left anterior descending artery (LAD) aneurysm with thrombotic occlusion. Case Presentation: A 55-year-old male with a history of hypertension, diabetes, and hyperlipidemia presented with exertional chest pain and dyspnea over three months. Coronary angiography revealed a large proximal LAD aneurysm with thrombotic occlusion of the mid-LAD (type B1). Initial management included thromboaspiration and stent placement, followed by dual antiplatelet therapy (DAPT). Despite recanalization, the patient developed a no-reflow phenomenon, managed with vasodilators and anticoagulation. Conclusion: CAA can complicate the course of coronary syndromes, especially when associated with thrombosis. Percutaneous intervention can be successful, but complications like reocclusion and no-reflow may require intensive management strategies.
Exploring Cardiac Variability in Hypereosinophilia: Clinical Insights and Echocardiographic Findings
(Ms. M. B. Mondal, 2024-11) ZERHOUDI, R; ROUAM, H; BENNEJMA, K; ELMASRIOUI, J; ELKARIMI, S; ELHATTAOUI, M
Introduction: The cardiac manifestations of hypereosinophilia include mainly endomyocardial fibrosis, which is the most frequently observed form. However, eosinophilic cardiopathy can manifest itself in different ways, affecting the various layers of the heart and presenting a variety of clinical and echocardiographic presentations. Aim: The aim of our study is to describe the various aspects of cardiac involvement observed in hypereosinophilia, based on our case series and data from the literature. Methods: This is a retrospective, descriptive study of five observations illustrating the diversity of eosinophilic cardiopathy, from the cardiology department of the Mohammed VI University Hospital in Marrakech, over a period of 12 months. Results: Over the period of the study, five patients presented with cardiac damage in the context of hypereosinophilia. The mean age was 53.8 years, with a predominance of women (sex ratio 0.66). In the majority of cases, the discovery of cardiac involvement was incidental to a cardiovascular check-up requested during the course of their medical condition. All cases had high levels of hypereosinophilia, with an average of 5681. These observations illustrate the wide variety of aetiologies of hypereosinophilia, all of which were represented: 3 cases of Churg-Strauss syndrome, 1 case of idiopathic hypereosinophilia syndrome, and 1 case of DRESS syndrome. The cardiac disorders observed were hypokinetic cardiomyopathy at the dilated stage in 60% of cases, acute eosinophilic myocarditis in 20%, and acute pericarditis in the remaining cases. The outcome was marked by an improvement in the FE in 60% of cases, stabilisation in 20%, and a fatal outcome in the remainder. Treatment is based on symptomatic therapy of the CHF and treatment of the underlying aetiology. Discussion and Conclusion: Eosinophils are cytotoxic through the release of granular proteins that initially attack the endocardium, leading to thrombosis and embolic events. Subsequently, this aggression contributes to fibrosis and valvular complications. Cardiac damage can also manifest itself as potentially serious acute myocarditis or pericarditis, which can progress to cardiac tamponade. These cardiac disorders and the diversity of possible aetiologies serve as a reminder that vital prognosis may be at stake in the acute phase, and to emphasise that functional prognosis depends on early echocardiographic screening and rapid initiation of treatment to limit the risk of thrombo-embolic and fibrosing complications.
Left Ventricular Ultrasound Diastolic Parameters in Postmenopausal Breast Cancer Patients Treated with Adjuvant Anthracycline and Trastuzumab
(Ms. M. B. Mondal, 2024-11) Chitadze, T; Sharashidze, N; Lomia, N; tsiklauri, M
Background: Breast cancer remains the leading cause of cancer-related deaths among women of all ages. As age increases, so does the risk of both cancer and cardiovascular diseases, heightening the likelihood of short-term and long-term cardiovascular side effects. Therefore, strategies for early diagnosis and prevention of cardiotoxicity are crucial. he optimal use of conventional echocardiographic parameters is important, especially given the limited access to advanced echocardiography in developing countries. Aims: To evaluate changes in left ventricular (LV) ultrasound parameters, including diastolic parameters, in postmenopausal women with breast cancer (BC), as a high-risk group receiving anthracycline-trastuzumab-containing regimens. Study Design: A prospective 24-month single-center study. Place and Duration of Study: From December 2019 to March 2024 at the ultrasound laboratory of Tbilisi State University Medical Center, Tbilisi, Georgia Methodology: Seventy-four postmenopausal patients with primary BC receiving anthracycline or anthracycline-trastuzumab were assessed for LV systolic and diastolic parameters before the anticancer therapy and at six subsequent visits. Cardio-protection was administered to high-risk patients preventively and to others when cardiotoxicity developed. Multiple regression was used to estimate relationships between various independent and dependent variables. Cardiotoxicity was assessed using survival analysis tools (Kaplan-Meier curves and Cox proportional model). Results: The two-year CTRCD survival rate was 63.5%. During the 2-year follow-up, the mean E/e' increased across the entire cohort, but remained within the normal range. E/e' >15 was noted only in CTRCD patients at 6th month mark (4.1%, n=3, P=.056) within the high-risk group, peaking at 9th month (10.8%, n=8, P< .00). Multiple regression indicated a significant association of IVRT baseline value with late cardiotoxicity (adj. beta-coefficient= 0.32; t = 2.73, P=.008) and DT baseline value with early cardiotoxicity (adj. beta-coefficient = -0.25; t = -3.31, P=0.002). GLS demonstrated predictive value from the first month in 13.5% of the cohort and in 34.5% of patients with CTRCD (P< .00). Conclusion: Our 2-year longitudinal prospective study of anthracycline–trastuzumab-containing regimens in postmenopausal women with early BC revealed that: 1) Predictive association of E/e' with cardiotoxicity was not detected. 2) A reliable association with late cardiotoxicity (T7) from the diastolic parameters was revealed only by IVRT baseline value 3) A reliable association with early cardiotoxicity (T4) from diastolic parameters was revealed only by DT baseline. 4)GLS is superior to E/e' in its prognostic value and diagnostic ability of cardiotoxicity .
The Global Burden and Risk Factors of Cardiovascular Diseases in Adolescent and Young Adults: A Systematic Review
(Ms. M. B. Mondal, 2024-11) Ojukwu, VE; Ndoh, CU; Okolo, D; Jegede, AO; Okobi, OE; Aniekwe, CE; Aboyeji, A; Odozi, MI; Olaniyi, M
Background and Objectives: Globally, cardiovascular diseases (CVDs), mainly stroke and ischemic heart disease (IHD) remain the leading and major causes of mortality in addition to being the key contributors to disabilities. The objective of this systematic review entails the evaluation of the global burden and the risk factors associated with CVDs in adolescents and young adults. To attain this objective, the study will examine the various underlying causes of CVD mortality and the associated risk factors. Methodology: The study entailed an in-depth search of various online databases for original studies focusing on the global burden of CVDs and risk factors in adolescents and young adults. The search was conducted on databases that included Embase, PubMed, Google Scholar, SCOPUS, and Web of Science. The identified studies were subjected to evaluation and screening, and the selection of the apt studies was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 15 studies were selected and included in this systematic review Results: CVD prevalence and incidence rates in adolescents and young adults are highest in low and low-middle socio-demographic index (SDI) nations, despite the CVD burden progressively increasing in high and high-middle SDI countries. Male adolescents and young adults have the highest prevalence, incidence, and disability-adjusted life year (DALY), and mortality rates for endocarditis, even as females aged 30 to 39 years have the highest atrial fibrillation and atrial flutter-related DALY and mortality rates. Conclusion: The global CVD burden in adolescents and young adults remains a major global health challenge. Therefore, it is important that factors that include disparities observed in the SDI levels amongst the nations, age and gender attributes of the populaces, the primary CVD types, and the various attributable risk factors are taken into consideration during the formulation and execution of prevention strategies and interventions.
Value of CHA2DS2-VASC Score as Predictor of Contrast-Induced Nephropathy in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
(Ms. M. B. Mondal, 2024-01) Khalil, DS; Khalil, SS; Elbarbary, MA; Ashmawy, MM
Background: PCI necessitates the usage of iodinated contrast agent which in some cases is accompanied by CIN and the potential for worse outcomes. The current study aimed to use the CHA2DS2-VASc score with its simple and available components as a predictor of risk of developing CIN in NSTEMI cases who will undergo PCI. Methods: This single center observational study was conducted on 200 cases diagnosed with NSTEMI who were subjected to primary PCI. The basic level of serum Cr was detected at time of admission followed by monitoring for 48?h, and seven days following the approach to detect the occurrence of CIN. Electrocardiogram (ECG) and transthoracic echocardiography are assessed to all patients. Results: At cut off ?2 (area under curve (AUC)=0.649), CHA2DS2-VASc could be used as a predictor for post-PCI CIN with sensitivity and specificity, PPV, NPV and accuracy of 77.6%, 52.3%, 34.5%, 87.8% and 58.5% respectively. There was a statistically significant correlation between occurrence of CIN and all the studied factors (female sex, HTN, DM, anemia, CHF, hemoglobin (HBG), pre-existing renal disease, previous stroke, pre-creatinine, 48hrs and 7 days post-creatinine, pre glomerular filtration rate (GFR) and cha2ds-vasc score and dehydration) with exception of age and vascular disease (p>0.05) being non-significant. Contrast volume, CHA2DS VASC score, metformin use, eGFR after 48h and ACEI /ARB II antagonists ’inhibitor use were significant independent predictors for CIN. Conclusions: In NSTEMI cases who are subjected to PCI, CHADS2 VASC score ? 2 is accompanied by a high risk for CIN and in hospital morbidity and mortality. CHA2DS2-VASC score is considered a useful novel, easy, and reliable method to anticipate CIN in NSTEMI cases undergoing urgent P.
Hypercholesterolemia Familial: Early Cardiovascular Complications, Treatment Challenges, and the Fatal Consequences of Delayed Diagnosis: an in-Depth Case Study
(Ms. M. B. Mondal, 2024-02) Boutgourine, M; Rouam, H; Jamili, ME; Hattaoui, ME
Familial Hypercholesterolemia (FH) is among the most common genetic disorders, present from birth. The transmission is mainly autosomal dominant. It is characterized by a exclusive increase in low-density lipoproteins (LDL). It is associated with a high risk of premature cardiovascular complications. The diagnosis of FH is generally based on the clinical presentation or genetic tests. The commonly used criteria are those of the Dutch Lipid Clinic Network. FH is a hereditary condition still largely underdiagnosed and undertreated. The prognosis of the disease is related to atheromatous cardiovascular complications, which, in the absence of treatment, lead to the patient's death in the first three decades, often due to myocardial infarction or sudden death. The management of familial hypercholesterolemia systematically involves two categories of measures: so-called hygienic-dietary measures associated with the treatment of other risk factors when they exist, and drug treatments. Familial hypercholesterolemia is still poorly detected. It is necessary to develop systematic approaches to identify patients with FH, conduct cascade screening of their relatives, and increase awareness and control of FH.
Outcomes of Urgent Coronary Artery Bypass Graft Surgery Following Non-ST Elevation Myocardial Infarction
(Ms. M. B. Mondal, 2024-11) Sherif, AF; Ghalwash, MM
Background: Non-ST elevation myocardial infarction (NSTEMI) significantly reduces patient survival, a condition that is essential for the optimization of results and the restoration of effective vascular flow multivessel coronary artery disease, Emergency coronary artery bypass grafting (CABG) is frequently contemplated. In the aftermath of NSTEMI, the objective of this investigation is to assess the results of urgent CABG, to prioritize risk stratification through the use of the Global Registry of Acute Coronary Events (GRACE) score Methods: An analysis of 60 consecutive patients who underwent emergent CABG following NSTEMI was conducted retrospectively. Data on patients were obtained from a prospectively compiled database, and the GRACE score was implemented to evaluate the probability of mortality. Patients were divided into three risk categories: low (<10%), intermediate (10-19%), and high (?20%), based on their predicted mortality percentages. Results: Patients in the high-risk group (Group 3) exhibited significantly lower Euro Scores and ejection fractions (EF) than those in the low and intermediate groups, as demonstrated by the study. Additionally, the cross-clamp time was notably longer in Group 3, highlighting the urgency of intervention in this population The postoperative complications' overall incidence did not differ significantly between the groups. Even though Group 3 exhibited an increased in-hospital mortality rate. Conclusions: The findings underscore the importance of timely intervention and tailored management strategies for NSTEMI patients, more specifically, the individuals who have been classified as high-risk by the GRACE score. This study contributes to the growing body of literature supporting urgent CABG as a lifesaving procedure and emphasizes the need for further research to optimize outcomes in this vulnerable patient population. The results advocate for a multidisciplinary approach to enhance perioperative care and improve survival rates among NSTEMI patients undergoing CABG.
The Impact of Different Revascularization Strategies Implemented in Acute Myocardial Infarction on the Recovery of Left Ventricular Functional and Deformational Parameters
(Ms. M. B. Mondal, 2024-11) Ebaid, HH; Eldarky, E-SAA-K; Atia, AI; El-Sayed, SM
Background: Despite well-established therapeutic techniques, such as direct revascularization through percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) remains a leading cause of mortality and morbidity. Objectives: To determine if two-dimensional speckle tracking echocardiography (STE) deformation parameters and the early recovery of left ventricular (LV) functions are affected by the timing of PCI in AMI. Methods: A total of 200 cases with newly-onset acute myocardial infarction (AMI) who had a baseline left ventricular ejection fraction (LVEF) higher than 35% and received effective therapy with percutaneous coronary intervention (PCI) were included in this investigation. Cases were categorized as either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Cases were grouped into four groups according to the time between presentation and PCI. Using standard echocardiography and two-dimensional (2D) STE, individuals were re-evaluated initially and three months later to find out if remodeling had taken place or if the LV function had returned. Results: Of the 200 AMI patients, including 140 males (70%), improvement in global longitudinal strain (GLS) and harmed longitudinal strain (HLS) were better in STEMI and NSTEMI patients received urgent revascularization with PCI (groups I and III) versus patients with pharmacoinvasive strategy or routine invasive strategy (Groups II and IV) (P < 0.05) while there was an insignificant difference between group I and III (P = 0.79). Of the 200 patients, 47 patients (23.5%) presented signs of LV remodeling at 3 months follow up. Age, smoking history, hypertension, dyslipidemia, Killip class, peak creatine phosphokinase - MB level, baseline left ventricular end diastolic volume (LVEDV), HLS, and harmed longitudinal strain rate (HLSR) were all factors that were found to be significantly associated with left ventricular remodeling (P<0.05) in the univariate logistic regression analysis. The following factors were identified as independent predictors of left ventricular remodeling in multivariate logistic regression analysis: damaged left ventricular ejection fraction (EF) and end-systolic volume, peak troponin I, Killip class, culprit left anterior descending (LAD), 2 and 3-vessel coronary artery disease (CAD), and wall motion score index (WMSI). Conclusion: Earlier PCI in AMI helps earlier improvement in myocardial strain parameters. HLS and HLSR are excellent predictors for LV remodeling and may do better than global parameters.
Clinical Presentation and Prognosis of Infective Endocarditis Prosthesis: A Retrospective Study in a Tertiary Cardiology Center
(Ms. M. B. Mondal, 2024-10) YAHYA, AA; KABBOUR, MB; ZTATI, M; JAMILI, ME; KARIMI, SE; HATTAOUI, ME
Introduction: Prosthetic valve endocarditis (PVE) is a serious infection involving the prosthetic heart valve and the endocardium. It carries high morbidity and mortality, especially in patients with mechanical valves. Aim of the Study: To investigate the clinical, biological, bacteriological, and echocardiographic characteristics of patients with prosthetic valve endocarditis and identify the predictive factors of in-hospital mortality. Patients and Methods: This retrospective, descriptive study was conducted over a period of 5 years, from June 2020 to July 2024, and included 82 cases of PVE diagnosed at a tertiary cardiology center. Results: A total of 82 patients were included, with an average age of 39.12 ± 5.6 years. All patients had mechanical valves, with the infection localized to the mitral valve in 53 cases and the aortic valve in 29 cases. Positive blood cultures were obtained in 36 patients, and Staphylococcus aureus was the most common pathogen, isolated in 26 cases (31.7%), followed by coagulase-negative Staphylococcus in 18 cases (21.95%). Transthoracic and transesophageal echocardiography revealed vegetations in 75 patients (91%), with prosthesis disinsertion in 27 cases and periprosthetic abscesses in 15 cases. The most common complications included heart failure in 17 patients, embolic events in 46 patients, and renal failure in 15 patients. Antibiotic therapy was administered to all patients, with a total average duration of 39.26 days. Surgery was indicated in 62 patients, with an average surgery delay of 42 ± 2 days. The main surgical indications were uncontrolled heart failure (32 cases), embolic complications (17 cases), and failure to control infection with antibiotics (13 cases). The overall mortality rate was 26%. Predictive factors of mortality included heart failure, delayed surgery, and early-onset PVE. Conclusion: Prosthetic valve endocarditis remains a challenging and life-threatening condition. Prompt diagnosis, appropriate antibiotic therapy, and timely surgical intervention are essential for improving patient outcomes. Mortality is influenced by multiple factors, including the timing of the infection and the presence of comorbid conditions.
From Tamponade to Triumph: LA Rupture Resulting in Cardiac Tamponade during BMV Successfully Managed with Device Closure, Followed by Successful BMV
(Ms. M. B. Mondal, 2024-10) Munde, K; Kolapkar, H; Munde, A; Jain, P; Paliwal, M; T S, A
The main objective of Balloon Mitral Valvuloplasty (BMV) is to relieve the symptoms of Mitral stenosis (MS) by percutaneous approach and avoiding valve replacement surgery. However, complications like rupture of the Aortic root or heart chamber can lead to hemopericardium and eventually increase morbidity and mortality associated with emergency surgery. In this case report, we discussed a case in which the rupture of the left atrium was managed by device closure, BMV was done successfully by percutaneous route, and valve replacement surgery was avoided.
Successful Coronary Interventions with the Ingenious Vector Balloon in Chronic Total Occlusion (CTO): A Preliminary Study
(Ms. M. B. Mondal, 2024-10) Shah, BS; Kumar, D; Mahajan, AU
Aims: To assess the safety and plausibility of successful coronary interventions in Chronic Total Occlusion (CTO) with the innovative Vector balloon through balloon-assisted crossing technique. Study Design: Observational, prospective study. Place and Duration of Study: Department of Cardiology, King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai. The study was carried out between the months of March and June, 2024. Methodology: A total of 20 patients were included in the study. All patients with chronic coronary syndrome were being planned for Percutaneous Coronary Intervention (PCI) for CTO. During PCI, the standard protocol of intervening CTO lesions was followed. When the operator was not able to cross the lesion with standard CTO guidewires, Vector balloon-assisted crossing was planned. This technique was used in a total of seven (35%) patents. Success was defined as the possibility of advancing the guidewire further to the target lesion and being able to deploy a drug eluting stent. Safety was assessed as reporting complications like kinking or rupture of the balloon shaft, loss of balloon inside the guide or the coronary artery and the balloon burst rate after inflation exceeding the Rated Burst Pressure (RBP) according to the manufacturer’s reference table. Results: The mean age of the patients was 58.1 ± 3.6 years. The balloon-assisted crossing was successful in all seven patients. The most commonly used diameter of the balloon was 1.25 mm (42.85%). Conclusion: The novel Vector balloon catheter showed excellent result when deployed to treat the CTO after the usual strategy of guidewire escalation had failed. The proximal shaft with polytetrafluoroethylene (PTFE) coating brings the flexibility to navigate complex and tortuous vascular pathways with ease due to its laser welded core-wire. A study with a larger sample size and a comparator arm would rather clarify if such a balloon-assisted crossing technique in CTO would decrease the need of costly devices like double lumen microcatheters.
Bilateral Adrenal Hemorrhage in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome (APS): A Rare Case Report
(Ms. M. B. Mondal, 2024-10) Abdellah, B; Hamady, S; Ismail, AF; Badr, A; Drighil, A; bouziane, M; Habbal, R
Context: Adrenal hemorrhage is a recognized yet rare complication associated with antiphospholipid syndrome (APS), an autoimmune disorder characterized by the presence of antiphospholipid antibodies that increase the risk of thrombosis. The incidence of adrenal hemorrhage in patients with APS has a diagnostic yield of approximately one-third, indicating that it may often go unrecognized in clinical practice. Traditionally, the management of APS has relied on anti-vitamin K therapy, such as warfarin. However, the advent of direct oral anticoagulants (DOACs) has prompted discussions about their use as an alternative. Recent clinical guidelines, however, strongly advise against the use of DOACs in patients with APS due to concerns over their safety and efficacy in preventing thromboembolic events. Case Presentation: This case study describes a 53-year-old woman with a history of venous thromboembolism who was treated with apixaban, a direct oral anticoagulant. She presented with acute abdominal pain and symptoms suggestive of adrenal insufficiency. Initial evaluations revealed significant changes in her clinical condition, leading to further diagnostic imaging. A CT scan demonstrated bilateral adrenal hemorrhage, which was a surprising finding given her anticoagulation therapy. Subsequent laboratory tests indicated a positive triple antibody profile, confirming a diagnosis of primary antiphospholipid syndrome. This case is particularly noteworthy as there have been limited documented instances of adrenal hemorrhage in patients receiving chronic anticoagulation with apixaban. The presentation of bilateral adrenal hemorrhage in the context of APS adds a crucial dimension to the understanding of the disease and its management. Conclusion: This case highlights the potential for serious complications, such as adrenal hemorrhage, in patients with antiphospholipid syndrome, particularly those treated with direct oral anticoagulants. It underscores the necessity for clinicians to remain vigilant for such rare yet significant events in the management of APS. Additionally, this case raises important questions regarding the appropriateness of DOACs in this patient population, especially given the latest recommendations against their use. Increased awareness and further investigation into the implications of anticoagulation strategies in APS patients are warranted to improve patient outcomes and safety.
Transient Brugada Like after Scorpion Sting: An Unexpected Connection
(Ms. M. B. Mondal, 2024-11) ZERHOUDI, R; BOURZEG, K; MOUHSSINE, A; ELMASRIOUI, J; JAMILI, ME; OUBAHA, S; ELHATTAOUI, M
Introduction: Brugada syndrome was described in 1992 as a new clinical and electrocardiographic syndrome involving susceptibility to ventricular arrhythmias and sudden cardiac death in patients without obvious structural heart disease. Brugada phenocopy (BrP) is an evolving term for Brugada-like ECG patterns due to reversible causes. In this article, we will illustrate the case of a patient presenting with a transient Brugada pattern following a scorpion sting. Case Report: A 65-year-old woman with age and menopause as cardiovascular risk factors, but no notable medical history, presented to the emergency department with atypical chest pain five hours after a scorpion sting. She had no associated symptoms such as dyspnoea, syncope, or palpitations, nor a personal or family history of sudden death. On admission, she was conscious, hemodynamically stable, normotensive, and tachycardic, with no signs of heart failure. Her ECG showed a 2 mm elevation at the J point and an inverted T wave in V1 and V2, indicating a Brugada pattern. She was admitted to the ICU for close monitoring. An echocardiogram revealed normal left and right ventricular function. Lab tests showed negative troponins, a normal blood ionogram, and normal renal and hepatic function. The Brugada pattern resolved within a few hours, and the patient remained stable. Discussion and Conclusion: Our case highlights the importance of conducting a thorough medical history to rule out the presence of arrhythmia, syncope, or a family history of sudden cardiac death in similar situations. If the history raises concerns, cardiological follow-up is essential to investigate the possibility of Brugada syndrome. Performing a follow-up ECG at discharge is beneficial to confirm the reversibility of the findings. This distinction is crucial as it helps differentiate between Brugada syndrome and the Brugada pattern, the latter being a condition that may occur in patients with scorpion stings or other triggers.
Study on Unguided Temporary Pacing Via the Jugular Vein at the Mohamed VI University Hospital of Marrakech: Safety, Effectiveness and Practicability
(Ms. M. B. Mondal, 2024-09) YAHYA, AA; KABBOUR, MB; ARABI, F; JAMILI, ME; KARIMI, SE; HATTAOUI, ME
This study evaluates the safety, effectiveness, and feasibility of unguided temporary pacemaker insertion in 348 patients at the Mohamed VI University Hospital of Marrakech. The procedure was performed by cardiology residents and showed a high success rate of 99.71%, with successful access to the right internal jugular vein in 89.66% of cases. The majority of patients (66.38%) achieved venous access on the first attempt, with an average procedure time of 11.5 ± 2.1 minutes. Minor complications were observed in 10.63% of patients, including local hematomas (3.45%), accidental arterial punctures (2.30%), pneumothorax (1.15%), and other issues such as local infections and non-sustained ventricular tachycardia. No deaths attributable to the procedure were reported. The clinical significance of this study lies in its demonstration that unguided temporary pacemaker insertion is a safe and effective alternative in resource-limited settings, reducing treatment delays and potentially lowering mortality among patients requiring temporary cardiac pacing. Based on these results, it is recommended to encourage clinicians in primary and secondary healthcare settings to adopt this approach to improve access to urgent cardiac care in under-resourced regions.
Atypical Presentation of Pre-excited Atrial Fibrillation in an Elderly Patient: A Case Report
(Ms. M. B. Mondal, 2024-10) Karmouchi, H; Abdalani, B; Bennouna, MEG
Pre-excited atrial fibrillation (AF) is a significant clinical condition associated with Wolff-Parkinson-White (WPW) syndrome, characterized by an accessory pathway that enables rapid conduction of atrial fibrillatory waves to the ventricles, leading to dangerously elevated ventricular rates. While WPW syndrome is typically diagnosed in younger individuals, its occurrence in elderly patients is rare and often underreported. This case report discusses a 79-year-old male with well-controlled hypertension who was admitted for poorly tolerated irregular tachycardia with broad QRS complexes, indicative of pre-excited atrial fibrillation (AF). Urgent synchronized electrical cardioversion successfully restored sinus rhythm. Although catheter ablation was proposed as a definitive treatment, the patient chose to postpone the procedure, with close monitoring implemented afterward. This case underscores the challenges of diagnosing WPW syndrome in elderly patients, the potential dangers of pre-excited AF, and the importance of individualized management strategies tailored to patient preferences and comorbidities.
Ischemic Stroke Unveiling Takayasu Arteritis Complicated by Coronary Arteritis: A Case Study
(Ms. M. B. Mondal, 2024-10) Abdellah, B; Ismail, EF; Obeida, S; Maha, B; Meriem, H; Rachida, H
Context: We present the case of a 38-year-old woman admitted for ischemic stroke. Etiological evaluation revealed halo signs on transesophageal echocardiography (TEE), suggestive of Takayasu arteritis. Case Presentation: During hospitalization, the patient developed chest pain, elevated troponin levels (300 ng/L), left ventricular hypokinesia on echocardiography, and T-wave inversions on electrocardiogram (ECG), indicating coronary arteritis. High-dose corticosteroid therapy led to rapid improvement in inflammatory markers. The diagnosis of Takayasu arteritis was confirmed based on the American College of Rheumatology (ACR) criteria. This case highlights the variable clinical presentation of Takayasu arteritis, including coronary involvement, and underscores the effectiveness of corticosteroid therapy in controlling inflammation. Conclusion: Takayasu arteritis, though rare, can manifest with ischemic stroke and coronary arteritis. Prompt recognition and corticosteroid treatment are essential in managing this potentially life-threatening condition.
Acute Limb Ischemia as a Complication of Early Infectious Endocarditis Following Surgical Closure of an Atrial Septal Defect: Case Analysis and Literature Review
(Ms. M. B. Mondal, 2024-10) Boucetta, A; Hamady, S; Saleh, O; Arous, S; Drighil, A; Habbal, R
Background: This study reports the case of a 47-year-old woman who presented with acute pain and coldness in the left lower limb, occurring 5 months after a surgical closure of an atrial septal defect (ASD). Initial examination suggested acute limb ischemia. Methods: Doppler ultrasound and computed tomography (CT) angiography of the lower extremity arteries confirmed the presence of an occlusion in the left popliteal artery. Echocardiography revealed vegetation on the surgical patch used for the ASD closure. Blood cultures were positive for Staphylococcus aureus. Treatment: The patient was treated with antibiotics for 6 weeks and underwent replacement of the surgical patch. Conclusion: This case underscores the importance of screening for endocarditis in patients with systemic embolism and a history of ASD patch closure, even though endocarditis is a rare complication. In cases of systemic emboli and large vegetations, a therapeutic approach often requires surgical removal and replacement of the closure patch.

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