Complete heart block revealing adrenal tuberculosis.

Complete heart block is a commonly encountered entity in clinical cardiology practice, which may be secondary to a variety of diseases including metabolic disorders. Here, we report the case of a 60-year-old female patient who presented with persistent symptomatic complete heart block despite the correction of electrolyte disorder and required admission for permanent pacemaker implantation. The etiologic investigation revealed underlying adrenal insufficiency due to tuberculosis. The clinical and biological presentation of adrenal insufficiency is variable with a difficult etiologic assessment. Although cardiac manifestations are rare, significant electrocardiographic abnormalities can be observed in untreated adrenal insufficiency, such as conduction abnormalities. Hence, in our case, we highlight one of the rare etiologies of conductive disorders and the complexity of the extrapulmonary manifestations of tuberculosis that clinicians should be aware of it.

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.

Uncommon ascaris induced eosinophilic myocarditis simulating acute coronary syndrome without ST segment elevation: A case report.

Introduction: and importance: Ascaris lumbricoides is a nematode parasite that causes ascariasis. Cardiac involvement in ascariasis is uncommon and rarely reported in the literature. Case presentation: We present the case of 45 years-old man, with previous medical history of ascaris infection one week before his admission to the emergency department for acute chest pain. The electrocardiogram revealed ST-segment and T wave abnormalities in septo-apico-lateral and inferior leads, along with high levels of troponin T and eosinophil blood cells count, while transthoracic echocardiography showed lateral and inferior walls motion abnormalities. The diagnosis of myocardial infarction was made and an urgent coronary angiography was carried out revealing normal coronary arteries which redressed the diagnosis and supported ascaris induced eosinophilic myocarditis (EM). The patient was put under anthelmintic drugs with favorable clinical, biological and imaging evolution. Clinical discussion: Eosinophilic myocarditis may present with variable and misleading scenarios ranging from asymptomatic patients to cardiogenic choc and sudden death and in some cases with clinical presentation of acute coronary syndrome. Conclusion: The aim of this work was to increase recognition of EM in the light of this clinical case report of ascaris lumbricoides associated myocarditis simulating an acute coronary syndrome without ST segment elevation.

Vascular Complications of Infective Endocarditis: Diagnosis and Management.

INTRODUCTION: The complications of infective endocarditis (IE) are frequent and severe. Our aim was to study the clinical and paraclinical profiles and prognosis of vascular complications, observed in a cardiology unit in Oujda, Morocco. Among 57 patients hospitalized for IE between 2015 and 2020 at the cardiology unit, 19 patients, or 33.3% of patients, had one or more vascular complications. We present here a retrospective analysis. AIM: Prevention, early diagnosis, and treatment of vascular complications are primordial to improving prognosis, following the guidelines of the European Society of Cardiology. PATIENTS AND METHODS: We retrospectively studied 57 patients hospitalized for IE. The diagnostic criteria for IE were modified from the Duke University criteria and we present all vascular complications among this cohort. RESULTS: Nineteen patients presented with one or more vascular complications, 10 men and nine women, with a mean age of 49 years. IE had grafted on a mechanical prosthetic valve in four cases. Overall, we found 25 vascular lesions: six neurological complications, five cases of peripheral vascular involvement, nine splenic infarcts, and five recurrent septic pulmonary embolisms (SPEs). The vascular complications accrued after three to 14 days of antibiotherapy or on extension reports; blood cultures were positive in 17 (89.4%) cases; streptococcus was isolated in nine cases; Staphylococcus aureus in seven cases; and acinetobacter in one case. CONCLUSION: Vascular complications of IE are severe, the most common in our study being splenic infarct. Prevention and early diagnosis are essential to instituting optimal management. All the patients were followed up with a mean follow-up of three years. Late mortality involved one patient in connection with a hemorrhagic stroke secondary to an accident with vitamin K antagonists after its release in one month. No cases of recurrence of endocarditis were noted in this group. Data were collected from archived medical records and analyzed by Statistical Package for the Social Sciences.

Severe Myocardial Infarction Caused by Excessive Cannabis Consumption.

The cardiovascular effects of cannabis are not well known. Cannabis use has been shown to cause arrhythmia, including ventricular tachycardia, sudden death, and increase in the risk of myocardial infarction (MI). We report a 62-year-old woman with chronic cannabis abuse inducing MI complicated by cardiogenic shock, chronic dilated cardiomyopathy, and atrial fibrillation.

Incidental Asymptomatic Giant Hydatid Cyst of the Interventricular Septum Bulging Into the Right Ventricle.

Hydatid disease is caused by the larvae of Echinococcus granulosus. Domestic animals like cats and dogs are the primary carriers of echinococcal organisms. This parasitosis is still endemic in some particular regions of the world. The cardiac hydatid cyst is an exceptional infection. We report a case of an asymptomatic giant cardiac hydatid cyst in the interventricular septum (IVS) protruding in the right ventricular diagnosed incidentally by scan tomography during acute pancreatitis emergency. Transthoracic echocardiography revealed a cystic mass in the IVS bulging into the right ventricle. The diagnosis was confirmed by a cardiac CT scan.

An Acute Limb Ischemia Concomitant With a Myocardial Infarction.

Acute limb ischemia (ALI) is an abrupt interruption of limb blood flow due to acute occlusion of the peripheral artery. Its concomitant occurrence with myocardial infarction (MI) constitutes a rare but serious clinical situation that worsens the functional prognosis of the affected limb or leads to the death of the patient. We report a case of an 87-year-old male patient who was diagnosed with acute left lower limb ischemia concomitant with MI. The diagnosis was based on clinical, electrical data and arterial angiography scan of limb findings. Thanks to urgent myocardial revascularization associated with that of the lower limb, curative heparin therapy, and armed clinical surveillance, the evolution was favorable.

The Surgical Management of a Giant Innominate Artery Aneurysm in a Patient With Coronary Disease: A Case Report.

The innominate artery aneurysm (IAA) accounts for a small percentage of all peripheral aneurysms. However, its clinical outcomes are potentially devastating, especially when it is associated with coronary disease, due to the high risk of spontaneous rupture and thromboembolic complications. Surgical repair is always recommended in such cases. The treatment of such a condition presents a surgical challenge with high morbidity and mortality rates. In this report, we discuss the case of a 56-year-old male who presented with a right cervical mass secondary to a large IAA with underlying coronary artery disease. The patient underwent a simultaneous operation for IAA and coronary bypass grafting.

Acute Coronary Artery Thrombosis in a Patient With Non-Small Cell Lung Cancer.

Patients with cancer are at major risk for both venous and arterial thrombotic complications. Venous involvement of cancer-associated thrombosis encompasses deep vein thrombosis and pulmonary embolism. Arterial manifestations include mainly stroke and myocardial infarction. We present the case of a 59-year-old woman admitted to the hospital for chest pain of five hours duration. She had been diagnosed with advanced lung cancer one month before. Electrocardiogram showed ST-segment elevation in all leads except aVR, suggesting a myocardial infarction. Coronary angiography revealed thrombi in both the right coronary artery and the left anterior descending coronary artery in the absence of any atherosclerotic lesions. Tirofiban infusion was administered; furthermore, a computed tomographic pulmonary angiography showed a distal pulmonary embolism. The patient progressed well and was discharged on anticoagulation with vitamin K antagonist. These findings highly imply that the malignancy altered the patient's blood coagulability and induced the formation of the thrombi ensuing acute myocardial infarction and pulmonary embolism. We will emphasize the relationship between cancer and thrombosis with a special focus on the conservative management strategy with anticoagulant and antiplatelet therapy in acute coronary syndrome without evidence of atherosclerotic lesions.

Serious Right Coronary Artery Thrombosis Revealing Behçet's Disease in a Female Patient: A Case Report.

Although atherosclerosis remains the major cause of acute coronary syndrome, there are many other etiologies that should be taken into account, especially in young patients with no atherosclerotic risk factors. Coronary involvement is extremely rare in patients with Behçet's disease, notably in young patients. In addition, acute inferior myocardial infarction revealing Behçet's disease has rarely been reported. Through this article, we report a case of Behçet's disease with arterial involvement diagnosed after myocardial infarction resulting from thrombosis of the right coronary artery in a 50-year-old woman with no specific medical history.

Right-Sided Cardiac Hydatid Cyst Complicated With Pulmonary Embolization: A Pediatric Case Report.

Echinococcosis is an endemic zoonotic parasitic infection found in Morocco, due to Echinococcus granulosus. Cardiac localization is a rare form, presenting in various ways. The right heart is an uncommon site of cardiac involvement. We report a case of a right-sided cardiac hydatid cyst complicated with multiple pulmonary embolism, revealed by dyspnea at rest, in a 15-year-old male. The patient successfully underwent surgical removal which confirmed the diagnosis. This case report demonstrates one of the various clinical presentations of this condition, and the importance of early treatment in order to prevent its potentially fatal complications, particularly in the young.

Acinetobacter Baumannii Native Valve Infective Endocarditis: A Case Report.

Infective endocarditis caused by Acinetobacter (A.) baumannii is a rare but severe complication that affects seriously ill, hospitalized patients undergoing invasive procedures. It is associated with an increased mortality rate than that of endocarditis due to the HACEK group (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) gram-negative bacteria. We report a case of a 54-year-old woman who was diagnosed with infective endocarditis caused by A. baumannii three days following her admission to the intensive unit care (ICU). The diagnosis was made on the basis of repeated blood cultures and transthoracic echocardiography, which revealed mobile vegetation attached to the mitral valve. In spite of aggressive therapeutic regimens, outcomes were poor and the patient died. This report underlines the severe nature of A. baumannii infections, which are still associated with a prolonged hospital stay, and increased morbidity, mortality, and medical costs.

Association of Acute Pancreatitis and Myocardial Infarction: Is the Heart Victim or Culprit? - A Case Report and Review of the Literature.

Acute pancreatitis can be associated with electrical changes mimicking acute coronary syndrome with normal coronary arteries. The association of acute pancreatitis with ST-segment elevation and elevated cardiac enzymes has been reported in few observations. The pathophysiological mechanisms of this association remain poorly understood. We report the case of a 63-year-old woman presenting with chest pain, changes in the electrocardiogram and elevated cardiac enzymes with normal coronary arteries associated with acute pancreatitis. Stress cardiomyopathy or Takotsubo syndrome associated with acute pancreatitis was the most likely diagnosis in our case. Stress cardiomyopathy should be considered a possibility in case of patients with acute pancreatitis who present with clinical signs suggestive of acute coronary syndrome.

Symmetrical and Peripheral Gangrene Complicating a Third-Degree Atrioventricular Block: A New Presentation of a Known Disease.

Symmetrical peripheral gangrene (SPG) is a rare, serious entity characterized by ischemic changes of the distal extremities with no vessel occlusion, leading to fatal complications. It is related to numerous causes, and the treatment is not yet consensual. We present the first case of SPG related to low cardiac output secondary to a third-degree atrioventricular block. Physicians should be aware of this entity, as early recognition and adequate management can help in reducing morbidity and mortality and prevent fatal complications.

Fatal Multi-Vessel Coronary Vasospasm: A Case Report.

We report a case of a 59-year-old female who experienced a history of an acute ST myocardial infarction. Percutaneous intervention and isosorbide dinitrate perfusion were successful in reversing the severe vasospasm on the left anterior descending, the first diagonal, and posterior interventricular arteries. The patient received calcium channel blockers and nitrates with a good in-hospital clinical evolution. One month later, the patient presented to the ED with chest pain leading to cardiac arrest despite cardiopulmonary resuscitation. This case highlights the fatal outcome of coronary artery vasospasm.

Isolated Cardiac Hydatid Cyst Causing Complete Heart Block.

Cardiac hydatidosis is an unusual disease and the interventricular septum is infrequently involved. It can cause various complications because of rupture and embolization. Interventricular septal cysts, may in rare conditions, induce symptoms corresponding to compression of the conduction pathway such as atrioventricular block. In this report, we present an uncommon case of cardiac echinococcus located in the basal part of the interventricular septum presenting as complete heart block managed by medical treatment and implantation of a permanent pacemaker.

When a Peripartum Cardiomyopathy Patient Hides Various and Serious Risk Factors for Recurrent and Fatal Thromboembolic Events Even Under Well-Conducted Oral Anticoagulation.

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that occurs during the final month of pregnancy through about five months after delivery, without any other known cause, and it increases the risk of thromboembolic events by many folds. A 38-year-old female with a history of peripartum dilated cardiomyopathy was admitted to our hospital, one month after a cesarean section, for severe breathlessness. Examination revealed signs of global heart failure and right deep vein thrombosis. Pulmonary CT angiography revealed pulmonary embolism of the right pulmonary artery. The patient was treated by oral anticoagulation with acenocoumarol with all international normalized ratio (INR) values within the target range (2-3). One month later, she was admitted to the emergency department with acute dyspnea and superior vena cava syndrome. Thoracic CT angiogram showed bilateral pulmonary emboli associated with an extensive deep vein thrombosis of both internal jugular veins, sigmoid sinuses, subclavian veins, innominate venous trunks, and the origin of the superior vena cava without any lesion suspected of malignancy. The thrombophilia screen performed six weeks after the suspension of vitamin K antagonists (VKAs) revealed severe deficiencies of protein C and protein S. In this report, we present the first case of recurrence of fatal thromboembolic events under well-conducted oral anticoagulation in a patient with PPCM associated with severe protein C and protein S deficiencies.

[Pulmonary embolism mimicking acute coronary syndrome]. / Une embolie pulmonaire simulant un syndrome coronarien aigu.

Pulmonary embolism is an acute and severe medical condition. Its clinical characteristics are not pathognomonic and can mimick other medico-surgical emergencies. We report the case of a patient admitted with a clinical manifestation of acute coronary syndrome with electrical changes and elevation in cardiac enzymes without abnormal substrate on the coronarography, enabling diagnosis of pulmonary embolism.

[Infectious mitroaortic endocarditis complicated by valve perforation, mycotic aneurysm and splenorenal infarction]. / Endocardite infectieuse mitro-aortique compliquée de perforation valvulaire, d'anévrisme mycotique et d'infarctus spleno-rénal.

Infectious endocarditis is regarded as a potentially serious pathology despite the advances in diagnostic and treatment options. Valves on the left side of the heart are most affected and embolic events, mycotic aneurysms, abscesses as well as valve perforations are life-threatening consequences of this disease. We here report a case of endocarditis with aortic and mitral valve involvement complicated by splenic and renal infarction, cerebral mycotic aneurysm and mitral valve perforation. The interest in the subject of this case study is the positive medico-surgical treatment outcome obtained despite a multitude of complications.