Respiratory distress in a patient with Klinefelter syndrome: a suspicion of COVID-19 hiding severe pulmonary embolism.

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.

[Sudden cardiac death of rhythmic origin in athletes: literature review]. / La mort subite d'origine rythmique chez le sportif: revue de la littérature.

The sudden death in athletes is, in the vast majority of cases, related to ventricular fibrillation, often in a subject with unknown cardiovascular abnormality; this dramatic event has a significant impact on society and the medical profession. We conducted through a literature review an analysis of data on sudden cardiac death of rhythmic origin in athletes; sudden death may be cardiovascular in 95.3% of cases and related to ventricular arrhythmia in 88% cases. The main causes are: hypertrophic cardiomyopathy, congenital anomalies of coronary arteries, and arhythmogenic right ventricular dysplasia for athletes under 35 years, and atherosclerosis beyond 35 years. Prevention is based on three main areas: the medical assessment and screening for cardiovascular disease; the chain of survival; the education of the athlete and the public. All these measures should improve significantly the survival prognosis of patients suffering from these accidents.

[A rare cause of myocardial infarction: carbon monoxide intoxication]. / Une cause rare d'infarctus du myocarde: l'intoxication au monoxyde carbone.

We describe a 34-year-old man who suffered an acute myocardial infarction after carbon monoxide domestic exposure. The coronary angiogram was normal. The necrosis is explained in part by a severe coronary spasm. The purpose of this work was to assess the pathophysiology and the treatment of this rare cause of myocardial infarction.

[Congenital coronary aneurysm. Three case reports]. / Anevrysmes coronaires congenitaux. A propos de trois observations.

Congenital coronary aneurysms are an unusual anatomical entity. Their prognosis appears to be particularly dependent on the presence or absence of aneurysm thrombosis. We report three cases of congenital coronary aneurysms, diagnosed in one case after myocardial infarction. Two patients were treated successfully by an exclusion of the aneurysm and coronary bypass and the third patient was treated medically. The aim of this study is to discuss the clinical features, prognosis and management of this disease.

[Left main coronary stenosis: clinical and paraclinical aspects]. / Stenose du tronc commun gauche: aspects cliniques et paracliniques.

The authors report a retrospective study about 20 cases of left main coronary disease admitted during 7 years. The mean age is 60 years with a large predilection for men (65% cases). The left main coronary stenosis generally presented as instable angina in 45% cases, myocardial infarct in 40% cases and left ventricular dysfunction in 10% cases. The left main coronary disease was associated with three vessel disease in 45% cases, two vessel disease in 20% cases and one vessel disease in 15% cases. The left main stenosis is frequently distal (60% cases), severe left myocardial dysfunction (EF < 40%) is found in 25% cases. 13 patients had coronary artery by pass graft with favourables outcome in all patients. The mortality was evaluated at 20% cases, only in medical group.