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

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

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

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

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

Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.

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

Introduction: Benign intracardiac tumours are the most common of the 5% of primary tumours and account for 90% of intracardiac tumours. Myxoma, which is the main benign tumour, rarely localizes to the mitral valve, in the order of 1-5%, associated with severe symptoms and enormous complications. The objective is to report a rare and severe case of mitral valve myxoma resulting in severe obstruction of the valve orifice. Presentation of Case: A 65-year-old Moroccan woman, without profession, the diabetic patient presented with progressive dyspnoea, in whom transthoracic echocardiography (TTE) completed by transesophageal echocardiography (TEE), a cardiac magnetic resonance imaging (MRI), a cerebro-throracoabdominopelvic Positron emission tomography-scan (PET-scan) showed a cauliflower-shaped mass embedded in the small mitral valve, evoking the diagnosis of myxoma, confirmed by the anatomopathological examination. A lumpectomy with mitral valve plasty was performed in association with coronary artery bypass surgery for a tri truncal lesion. The evolution was marked by an improvement in the clinical and echographic state. Discussion: Myxoma is the first benign tumour encountered in women between the 3rd and 6th decade, whose diagnosis is evoked by a TTE, better by a TEE or more, by a computed tomography (CT scan) or even a cardiac MRI which specifies the visualization of the soft parts with all the internal details of the myxoma, whose confirmation is carried out on the histopathological analysis of the operating room. Conclusion: The management was based on complete resection of the tumor associated with mitral valve plasty.

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

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

A Rare Case Report of “Torsades De Pointes” Induced by Fluconazole-Levetiracetam Combined Therapy

Drugs used to treat cardiovascular disease as well as those used in the treatment of multiple other conditions can occasionally produce exaggerated prolongation of the QT interval on the surface electrocardiogram and the morphologically distinctive polymorphic ventricular tachycardia that results is known as «torsade de pointe». «Torsade de pointe» (TDP) is a characteristic polymorphic ventricular arrhythmia associated with delayed ventricular repolarization as evidenced on the surface electrocardiogram by QT interval prolongation. It typically occurs in self-limiting bursts, causing dizziness and syncope, but may occasionally progress to ventricular fibrillation and sudden death. This rare case report showed the potential higher risk of the occurrences of «Tdp» when levetiracetam (KEPPRA) was used in combination therapy with fluconazole, which is already a known medication with the risk of causing polymorphic ventricular arrhythmia.

Ischemic Stroke Following Thrombolytic Therapy for Acute Inferior Myocardial Infarction: The Third Reported Case

Background: Ischemic stroke following thrombolysis for ST-segment elevation myocardial infarction(STEMI) is a rare and perplexing complication. We present an intriguing case of ischemic stroke following fibrinolytic therapy with tenecteplase for a STEMI. This is an extremely rare condition, and our case appears to be the third one reported in our departement. The three cases had one thing in common: ST-segment elevation in the inferior leads. Case Presentation: We describe the case of a 50-year-old north-african woman who suffered an acute inferior STEMI 6 hours after chest pain onset. Thrombolysis with tenecteplase was performed and few hours later an extensive right sylvian artery stroke occurred with subfalcine herniation. Decision-Making: The refractory intracranial hypertension despite medical therapy compelled a decompressive craniectomy. On the follow up, neurological deficits had increased, congestive heart failure developed, and finally the patient died on the tenth day in the intensive care unit. Conclusion: Hemorrhagic complications are not the only one, ischemic stroke can also occur after thrombolysis even if it is extremely odd. The pathophysiology is still poorly established. The prevalent implication of the inferior territory in the three cases described in the literature may open to future research prospects.

Acute Aortic Dissection Masquerading a Rare Type of Congenital Bicuspid Aortic : A Case Report

Acute aortic dissection on bicuspid aortic valve (BAV) type 0 is a rare especially in young masculine. Risk factors like smoking and intensive sport activities can hasten their apparition especially in non-diagnosed population. Trans thoracic echocardiography is very important in the diagnosis of BAV whereas Angio CT scan helps to confirm acute aortic dissection. Treatment is based on surgery for type A Stanford classification for acute aortic dissection. We report a rare case of acute aortic dissection masquerading a rare type of BAV, type 0 in a young sportive male with no history of heart disease who presented for the first-time with acute chest pain after lifting a heavy weight metal at the complex sport center. Patient was initially placed on medical treatment before surgery for heart valve and root replacement (Bentall procedure).

Prévalence des facteurs de risque cardiovasculaire et leur association avec les facteurs socio-économiques dans une population marocaine atteinte du syndrome coronarien aigu

Le but de la présente étude était d'évaluer la prévalence des facteurs de risque cardiovasculaires conventionnels et leur association avec des facteurs socio-économiques dans une population traitée pour un syndrome coronarien aigu, au département de car¬diologie du CHU Ibn Rochd de Casablanca au Maroc. Méthode : L'étude a été réalisée chez 199 patients consécutifs au cours de la phase aiguë d'un syndrome coronarien aigu. Les critères d'inclusion étaient l'ad¬mission dans les 24 heures après le début de la dou¬leur thoracique. Le facteur de risque cardiovasculaire conventionnel le plus courant chez ces patients était essentiellement le tabagisme, suivi de l'hypertension artérielle et du diabète de type II. Résultats : La prévalence de l'hypertension et du diabète était plus élevée chez les femmes atteintes du syndrome coronarien aigu que chez les hommes. Cette différence s'est également maintenue après ajustement en fonction de l'âge. Une fréquence plus élevée d'individus avec un stress au travail faible et modéré que des individus présentant des niveaux de stress au travail élevés a été observée. Cependant, les femmes qui souffraient d'un syndrome corona¬rien aigu avaient un niveau de stress au travail plus élevé que les hommes. Cette différence statistique a disparu lorsque l'âge a été utilisé comme covariant. Il n'y avait pas de différence statistique dans l'acti¬vité physique liée au travail entre les hommes et les femmes. De plus, il n'y avait aucune association entre le niveau de stress au travail, l'activité physique liée au travail et les facteurs de risque cardiovasculaires conventionnels. Conclusion : Les facteurs de risque conventionnels les plus répandus chez les patients atteints du syn¬drome coronarien aigu inclus dans l'étude étaient le tabagisme actuel, le diabète et l'hypertension. Les femmes présentaient des niveaux de stress au travail plus élevés que les hommes. Cependant, les facteurs socioéconomiques n'étaient pas associés à la préva¬lence des facteurs de risque cardiovasculaires conven¬tionnels chez les hommes et les femmes