Acute coronary syndromes in chronic hemodialysis patients: a series of 34 cases (case series).

Cardiovascular diseases, particularly acute coronary syndrome, are the leading cause of death in chronic hemodialysis patients. Our study aims to analyze the pathophysiological, clinical, angiographic, and therapeutic characteristics of coronary heart disease in hemodialysis patients. Patients and Methods: This single-centered retrospective descriptive study included 34 hemodialysis patients hospitalized in the cardiovascular ICU. Results: The mean age of patients in our study was 64.4±11.3 years. The main cardiovascular risk factor found in our study was age, with a prevalence of 76.50%, followed by hypertension, with a prevalence of 67.60%. Diabetes was present in 55.90% of patients. The authors also found that 17.90% of patients were obese, and 29.40% had abdominal obesity. The main cause of renal disease in our study was diabetic nephropathy (52.90% of cases), followed by hypertensive nephropathy (23.50% of cases). ST segment elevation myocardial infarction was found in 14.70% of cases, and non-ST-segment elevation myocardial infarction in 85.30% of cases. Coronary angiography was performed in 76.40% of patients. Single-vessel coronary artery disease (CAD) was found in 20%, two-vessel CAD in 50%, and three-vessel CAD in 30% of the cases. Coronary artery calcifications were observed in 21.42% of cases. 38.23% had an angioplasty, and 20.58% were referred for a coronary artery bypass graft. Conclusion: Despite the high mortality rate after acute coronary syndrome, hemodialysis patients are less likely to undergo diagnostic angiography or coronary revascularization. Patients on hemodialysis tend to have multiple, diffuse, calcified CAD.

Bridge of the left anterior descending artery revealed by syncope: a case report.

The myocardial bridge is a congenital coronary anomaly defined as the presence of a region of myocardium overlying an epicardial coronary artery. This is a 51-year-old patient, diabetic for 4 years on oral hypoglycemic, has had stress angina for 4 years, neglected by the patient. The current history goes back to 2 months by the installation of an episode of syncope occurring with the effort, then of a second episode the day of its admission. Electrocardiogram on admission showed complete atrioventricular block with an heart rate of 32 beats per minute, the patient spontaneously recovered sinus rhythm with a heart rate of 88 beats per minute and a PR interval of 200 ms, coronary angiography was performed showing coronary arteries without stenosis with an intramyocardial bridge of the left anterior descending artery. During exercise and in the presence of a myocardial bridge on the left anterior descending artery, systolic compression leads to a decrease in flow to the septal branches, which is responsible for an alteration of the vascularization of the sub-nodal tissue with paroxysmal conduction disorders leading to syncope. Conduction disorders of ischemic origin are not always associated with atherosclerotic or thromboembolic lesions, but may also be secondary to myocardial bridges.

Sudden Cardiac Death Risk Stratification of the Early Repolarization Syndrome: An Updated Review of the Literature.

PURPOSE OF REVIEW: Early repolarization syndrome (ERS), once thought to be innocuous, has now been shown to be responsible for ventricular arrythmias and sudden cardiac death occurrence. This review will help the clinician to identify the patients who are most at risk for arrhythmias, so that they can adopt a preventive or secondary treatment approach, either of which is still poorly defined. RECENT FINDINGS: Patients at high risk are found to be particularly young men, with a personal or family history of syncope or sudden death, who have an inferolateral ER on the electrocardiogram, more elevated J-point, longer J-wave duration and wider J angle, a horizontal or descending ST segment, lower T/R ratio, and small and/or inverted waves. The association with a structural heart disease or another channelopathy potentiates this arrhythmic risk. Taken together, these parameters allow prediction of the malignancy of ER pattern with a certain reliability. Further research is however needed to develop concrete risk stratification algorithms and the therapeutic strategies taken in function of it.

Simultaneous total occlusion of the 3 major coronary arteries in a patient with inferior ST-segment elevation myocardial infarction complicated by cardiogenic shock and sinus bradycardia.

Simultaneous occlusion of more than one coronary artery is uncommon and associated with poor prognosis. We reported a particular case of a 62-year-old patient, who presented with an inferior ST-segment elevation myocardial infarction with right ventricular involvement complicated by cardiogenic shock, sinus bradycardia, and an extensive echocardiographic ischemia with severe left ventricular systolic dysfunction. Coronary angiography revealed occlusion of 3 major coronary arteries. Primary percutaneous coronary intervention of the right coronary artery was performed with hemodynamic recovery, chest pain, and ST-segment resolution. Treatment for heart failure with reduced ejection fraction was initiated, with a good outcome.

Hemorrhagic stroke during the acute phase of myocardial infarction: a rare and difficult situation to manage.

Given the ischemic risk due to the hypercoagulability associated with acute coronary syndromes, the administration of antiplatelet and antithrombotic agents is necessary to prevent intracoronary and postprocedural thrombosis during percutaneous coronary interventions. However, the risk of bleeding, hemorrhagic stroke included, is real, although it has a lower prevalence, and it complicates the management of the coronary event if it happens. We report the case of a 66 years old patient with no prior pathological history who was initially admitted for acute coronary syndromes, complicated by paroxysmal atrial fibrillation that was successfully thrombolysed. Subsequently, the patient benefited from a drug-eluting stent angioplasty of the proximal circumflex artery, performed within 24 hours after the symptomatology onset. Following angioplasty, the patient presented with a left parietal intraparenchymal hematoma not indicating surgery. The double antiplatelet therapy was consequently withdrawn. Two days later, the patient presented with an ST-segment elevation infarction recurrence, inciting the resumption of the dual antiplatelet aggregation therapy. On evolution, the neurological state was still stable with a stationary aspect of the hematoma on cerebral imagery but without angina recurrence or electrocardiographic modifications. Hemorrhagic complications' occurrence following thrombolysis or angioplasty for ST-segment elevation infarction challenges the short and long-term management of the disease and must push practitioners to better weigh the risks and benefits before any medication administration decision.

Acute myocardial infarction complicated by severe left ventricle systolic dysfunction in a young patient after Covid 19 vaccination: a case report.

We report the case of a 23 years old patient who developed an acute myocardial infarction one day after his second dose of COVID-19 BIBP vaccination, complicated by severe left ventricle systolic dysfunction with an ejection fraction measured at 32%, associated with left ventricular wall motion abnormalities well evolved under treatment of heart failure with reduced EF combining :angiotensin-converting enzyme inhibitor, beta blocker, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors. Coronary arteries were normal at angiography suggesting initially the diagnostic of myocarditis. Therefore, a cardiac magnetic resonance imaging was performed to confirm the latter, which showed an image consistent with a recent left ventricular subendocardial infarction, remarkably prominent in the left anterior descending artery territory and the absence of signs of myocarditis. The patient had no previous past medical history or other clinical features explaining this coronary event onset. Thus, the vaccine was potentially to be implicated in the pathophysiology of the event. Overall, complications associated with COVID-19 vaccines are extremely rare, and their benefit is well established. That's why they continue to be recommended by public health experts despite of their rare side effects.

Massive pulmonary embolism with ST-segment elevation mimicking an isolated right ventricular myocardial infarction in a patient with COVID-19 pneumonia: Case report.

Pulmonary embolism (PE) is a great simulator; It mimics step by step its main differential diagnosis which is myocardial infarction. Its clinical and electrical manifestations are unspecific. Rarely, an ST-segment elevation can occur making the diagnosis more difficult. Recognizing such an uncommon electrocardiographic (ECG) pattern is of an important relevance to lead to a prompt and suitable therapeutic management. In our paper, we discuss a 68 years-old man case who presents with dyspnea and chest pain with ST-segment elevation in V1, aVR, DIII, and right-sided leads suggestive of isolated right ventricular infarction, admitted in a stable hemodynamical status which rapidly deteriorated. Echocardiographic assessment has shown signs of acute pulmonary heart disease with the presence of the specific McConnell's sign. A computed tomography pulmonary angiogram was performed revealing massive bilateral PE that benefited from thrombolytic therapy with alteplase with a remarkable following and regression of the ST-segment elevation. To our knowledge, this is the first case report of massive PE presenting with these ECG findings in the context of COVID 19 pneumonia, of which practitioners should be aware to better orient diagnosis and therapeutic management.

Cannabis-induced myocardial infarction in a 27-year-old man: Case report.

Cannabis smoking has been reported as one of the risk factors for coronary heart disease, which can trigger in rare cases, an acute coronary syndrome (ACS). In this report, we present a case of a 27-year-old man presented with acute myocardial infarction (AMI) following cannabis consumption. The patient developed ST-segment elevation on the anterior and inferior leads. Coronary angiogram demonstrated a significant stenosis of the left anterior descending coronary artery (LAD). A Percutaneous Coronary Intervention (PCI) of the LAD, was realized with the implantation of a new generation-stent with good clinical evolution status. Healthcare professionals should consider cannabis consumption as a possible etiology of acute myocardial infarction, particularly in young patients with a susceptible social profile (drug-using patients with coronary heredity as a cardiovascular risk factor), and should educate patients regarding this emerging public health issue.

Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk. CASE PRESENTATION: We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels. CLINICAL DISCUSSION: Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome. CONCLUSION: SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.