ABSTRACT
Introduction and importance: Cardiac amyloidosis (CA) is a rare condition, characterized by fibrillary proteins infiltration in the extracellular space of the heart. Even though many types of cardiac amyloidosis exist, light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR) remain the most described forms. The diagnosis of amyloidosis represents a real challenge for clinicians, requiring both invasive and non-invasive investigations. Conduction defects and atrial arrhythmias are well known complications of cardiac amyloidosis. However, only a few studies have reported junctional rhythm a primary presentation of light chain cardiac amyloidosis (AL). An early diagnosis and proper management are crucial to improve the prognosis of this disease. Case presentation: Here, we report a rare case of a 48 year-old patient, in acutely decompensated heart failure, presenting an accelerated junctional rhythm (AJR) as initial presentation of light-chain cardiac amyloidosis. The diagnosis was made based on clinical, biological, radiological and histological findings. This case shows diagnostic difficulties and management of this rare disease.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Infective endocarditis is a severe infection of the endocardial surface of the heart. One or more heart valves can be infected. However infective endocarditis complicating mitral stenosis is rare. It can be revealed by several and various symptoms such as fever and cardiac murmurs but also by complications such as focal neurological complaints. CASE PRESENTATION: We report a case of a febrile postural instability as the primary presentation of an infective endocarditis secondary to a severe mitral stenosis in a young patient with a history of mitral stenosis for which he benefited from percutaneous mitral dilation. The diagnosis was based on the modified Duke criteria. In this case, the treatment was based mainly on antibiotic therapy. The outcome was favorable; with a clinical, biological and radiological improvement. The patient was subsequently referred to the cardiovascular department for surgical treatment of his valve disease. CLINICAL DISCUSSION: Rheumatic heart disease is the main cause of mitral stenosis and its prevalence is higher in developing nations than in the rest of the world, yet only few articles have reported infective endocarditis as a complication of mitral stenosis. CONCLUSION: Mitral stenosis is rarely complicated by infective endocarditis, but this diagnosis should not be excluded in developing countries, particularly because of its high prevalence. To that end, clinicians should recognize its symptoms and complications and act accordingly to allow early treatment.
