Brucella involving the heart: a hidden disease.

Brucellosis is a multisystemic disease with serious cardiac involvement mainly endocarditis. It is a lethal but rare complication involving congenital, prosthetic and even native valves. Positive hemoculture confirm the diagnosis. Brucella endocarditis is known for large vegetations and surgery is the treatment of choice. Abscess formation can be seen in untreated patients. An 80-year-old male patient presented with fever, cough and progressive shortness of breath for 14 days. His known history revealed a poorly treated brucellosis 18 months ago due to noncompliance. Four months later, he presented for recurrent fever. Physical examination showed a systolic aortic murmur radiating to the carotid. Blood cultures were negative; however, blocking antibodies were 1/2560. Echocardiography showed calcified aortic stenosis. Transesophageal echocardiogram (TEE) showed an abscess formation at the level of the non-coronary cusp. A quadritherapy was initiated involving Ceftriaxone, gentamicin, doxycycline, and trimethoprim-sulfamethoxazole (shortage in molecule replaced by ciprofloxacin). Patient underwent surgery. An aortic valve bioprostheses was successfully implanted one week after initiating antibiotics. Intraoperative cultures were negative. A post-operative transthoracic echocardiography revealed a moderate periprosthetic aortic leak with a mean gradient of 18mmHg. He was discharged 18 days following surgery on doxycycline, rifampicin, and ciprofloxacin for 3 more months, with adequate follow up. The challenge remains in the timing of diagnosis which affects the prognosis of the disease. Early diagnosis and effective medical and surgical management are essential.

Lymphoma Involving the Heart: A Case Report.

Background: We describe a rare case of cardiac malignancy that counts for <1% of the primary cardiac tumors with a poor prognosis. Case summary: It's a rare case of a primary cardiac lymphoma in a 59-year-old patient who presented for recurrent pleuropericarditis with low-grade fever and night sweats. Investigations revealed an infiltrating mass in the right atrioventricular groove involving the right atrium and the right ventricular free wall. Pathology confirmed the diagnosis of non-Hodgkin's lymphoma. Chemotherapy with R-CHOP regimen was a success, but the patient suffered from recurrence with a complete remission after a second chemotherapy cycle. He was a candidate for bone marrow transplant to reduce other possible relapses. Discussion: Early diagnosis is better for long-term prognosis and improves quality of life.

Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome.

Native aortic valve thrombosis in primary antiphospholipid syndrome (APLS) is a rare entity. We describe a 38-year-old man who presented with neurological symptoms and a cardiac murmur. Transthoracic echocardiography detected a large bicuspid aortic valve thrombus. Laboratory evaluation showed the presence of antiphospholipid antibodies. Anticoagulation was started, and serial echocardiographic studies showed complete resolution of the aortic valve vegetation after 4 months. The patient improved clinically and had no residual symptoms. This report and review of the literature suggests that vegetations in APLS can be treated successfully with conservative treatment, regardless of their size.

Arrhythmogenic ventricular cardiomyopathy and sudden cardiac death: Left or right?

Arrhythmogenic right ventricular cardiomyopathy is a leading cause of sudden cardiac death among athletes in Italy and the Mediterranean region. Although it often involves the right ventricle causing scarring, dilation, systolic impairment with aneurysm formation, it can also involve the left ventricle or present as isolated left ventricular cardiomyopathy. Cardiac magnetic resonance imaging is considered the gold standard in confirming the diagnosis. We summarize four cases of arrhythmogenic ventricular cardiomyopathy with different presentations observed over the past 2 years.

Factors influencing dyslipidemia in statin-treated patients in Lebanon and Jordan: results of the Dyslipidemia International Study.

BACKGROUND: Cardiovascular disease is the leading cause of death and disability worldwide. Therefore, as part of the Dyslipidemia International Study (DYSIS), we have analyzed the prevalence of lipid abnormalities and risk factors for dyslipidemia in statin-treated patients in Lebanon and Jordan. METHODS: This cross-sectional, multicenter study enrolled 617 patients at 13 hospitals in Lebanon and Jordan. Patients were at least 45 years old and had been treated with statins for at least 3 months. Multivariate logistic regression analysis was used to determine patient characteristics contributing to dyslipidemia during statin therapy. RESULTS: Our findings indicated that 55.9% of statin-treated patients (mean age 60.3 years, 47% female) in Lebanon and Jordan did not achieve goal levels for low-density lipoprotein cholesterol which were dependent on Systematic Coronary Risk Evaluation (SCORE) risk, and 70% of patients (76% men and 63.3% of women) were at very high cardiovascular risk. Low-density lipoprotein cholesterol goals were not achieved in 67.2% of those with very high cardiovascular risk. The most commonly prescribed statin was atorvastatin (44.6%), followed by simvastatin (27.7%), rosuvastatin (21.2%), fluvastatin (3.3%), pravastatin (3%), and lovastatin (0.2%). Approximately half of the population was treated with a statin dose potency of 4, equaling 40 mg of simvastatin. In Lebanon and Jordan, the strongest independent associations with low-density lipoprotein cholesterol not at goal were current smoking (odds ratio [OR] 1.96; 95% confidence [CI] 1.25-3.08), diabetes mellitus (OR 2.53; 95% CI 1.70-3.77), and ischemic heart disease (OR 2.26; 95% CI 1.45-3.53), while alcohol consumption was associated with reduced risk (OR 0.12; 95% CI 0.03-0.57). CONCLUSION: We observed that many patients in Lebanon and Jordan experienced persistent dyslipidemia during statin treatment, supporting the notion that novel lipid-lowering strategies need to be developed. Also, social programs aimed at combating the extremely high rates of tobacco use and obesity in Lebanon and Jordan are critical for combating cardiovascular disease in these countries.

[Epidemiology of cardiac tumors in adults in Lebanon]. / Epidémiologie des tumeurs cardiaques des adultes au Liban.

Primary cardiac tumors are rare but potentially fatal. No studies have discussed this issue yet on the national level. We describe the epidemiology of cardiac tumors in adults in Lebanon. The data were taken from the hospitals, the patients and/or their doctors by means of a questionnaire. Fifty-seven cases of cardiac tumors were found, mainly myxomas in the left atrium. Dyspnea was the most frequent symptom. Transthoracic echocardiography was the main diagnostic tool. Transesophageal echocardiography was inconstantly made, scanner and MRI rarely while contrast echocardiography has never been used. Almost half of the patients had a follow-up and none had a familial screening. The collected data urged us to propose a unique and homogenous strategy for diagnosis, treatment and follow-up of cardiac tumors in Lebanon.