ABSTRACT
Background - Acute coronary syndrome with high level of troponin is a common pattern for emergency consultation. In 10% of cases, coronary angiography concluded that there were no significant coronary lesions. The contribution of cardiac magnetic resonance imaging (MRI) in the etiological investigation is increasing in these conditions. Aim - We analyzed the diagnostic value of cardiac MRI in case of acute coronary syndromes with elevated troponin and normal coronary angiography. Methods - It's a retrospective analytical study including 31 patients presenting with acute coronary syndrome with positive troponins and normal coronary angiography. All these patients underwent cardiac MRI. Results - The average age was 44.94 years. Cardiovascular risk factors were present in 38.70%. The average level of troponin was 4.85 ng/ml. Modification in the ST segment was noted in 87.1% of which 51.6% had ST elevated segment. Cardiac MRI was performed in the average of 8 days. MRI has contributed to the diagnosis in 77.4%: a myocardial infarction (MI) with no significant coronary lesions in 38.7% of cases, myocarditis in 29% of cases, Tako-Tsubo syndrome in 6.5% of cases and apical HCM in 3.2% of cases. MRI was normal in 22.6% of cases. Conclusions - The contribution of cardiac MRI is growing in the diagnostic management of patients with chest pain, elevated level of troponin and normal coronary angiography. The differential diagnoses have discriminating characteristics in MRI, allowing their identification with excellent diagnostic accuracy. The two main etiologies are myocardial necrosis and myocarditis.
Subject(s)
Acute Coronary Syndrome/diagnostic imaging , Coronary Angiography , Magnetic Resonance Imaging , Acute Coronary Syndrome/blood , Acute Coronary Syndrome/etiology , Adult , Diagnosis, Differential , Humans , Middle Aged , Myocardial Infarction/diagnostic imaging , Retrospective Studies , Takotsubo Cardiomyopathy/diagnostic imaging , Troponin/bloodABSTRACT
BACKGROUND: Infective endocarditis (IE) is a serious pathology which is in a continuum evolution in the setting of diagnosis and therapeutic fields AIM: To describe clinical, echocardiographic, microbiological, therapeutic and outcome characteristics of infective endocarditis in a Tunisian population. METHODS: The records of 135 patients admitted to adult cardiology department of la Rabta hospital between January 1981 and December 2011 were collected. The diagnosis of certain IE was retained according to modified Duke Criteria. RESULTS: The mean age of patients was 38.5 ± 16 years, with a male predominance (sex ratio: 1.4). IE affected native valves in 77% of cases, prosthetic valve in 15.5% of cases, congenital heart disease in 2% and pacemaker in 1.48% of patients. The portal of entry was identified in 43.7% of the patients, the oral origin was predominant. Blood cultures were positive in only 34% of patients. Causative microorganism was staphylococcus in 43.6%, streptococcus in 43.6% and negative bacill gram in 17.4% of patients. Echocardiography showed vegetation in 98% of patients, cardiac abscess in 23.7% of patients and valve mutilation in 17.7% of cases. Prosthesis dehiscence was present in 4.5% of cases. Complications were primarily hemodynamic (57%) followed by embolic events (34%). Surgery occurred in 57.7% of patients, it was early in 69% of cases. The indication was mainly hemodynamic and mixed in 70%of patients. Hospital mortality was 28% with predictor's factors: left heart (p=0.02), prosthesis (p <0.05), staphylococcus (p<0.005), heart failure (p<0.05) and neurological complications (p=0.04). CONCLUSION: According to our study, infective endocarditis has always touched a young population in Tunisia, rheumatic valve disease is still the predominant underlying heart disease and both streptococcus and staphylococcus are most frequently isolated. Mortality remains high despite considerable progress in terms of diagnosis and therapy.
