Marfan Syndrome Associated With Acute Myocardial Infarction in the First Trimester of Pregnancy.

Marfan syndrome (MFS) is a rare hereditary connective tissue disorder with autosomal dominant inheritance associated with an increased risk of cardiovascular complications due to connective tissue fragility. Acute myocardial infarction during pregnancy is also a rare event associated with poor maternal and fetal outcomes. Herein, we report a case of a 30-year-old pregnant woman with a known history of MFS. The patient had been treated surgically for an ascending aorta aneurysm and mechanical prosthetic aortic valve repair. She presented at 12 weeks of gestation with severe chest pain, which proved to be acute myocardial infarction. This is believed to be the first case of this complex medical condition presented in the first trimester of pregnancy.

Acute low back pain during intravenous administration of amiodarone: a report of two cases.

Amiodarone represents an effective antiarrhythmic drug for cardioversion of recent-onset atrial fibrillation (AF) and maintenance of sinus rhythm. We briefly describe two patients suffering from recent-onset atrial fibrillation, who experienced an acute devastating low back pain a few minutes after initiation of intravenous amiodarone loading. Notably, this side effect has not been ever reported in the medical literature. Clinicians should be aware of this reaction since prompt termination of parenteral administration leads to complete resolution.

Kearns-Sayre syndrome associated with trifascicular block and QT prolongation.

Patients suffering from Kearns-Sayre syndrome (KSS) often develop conduction defects that may lead to syncope or sudden cardiac death. The association of conduction abnormalities with prolonged QT interval in these patients is very rare. We describe a patient with KSS and diabetes mellitus who suffered a torsades de pointes-induced syncopal attack, in the presence of trifascicular block and QT prolongation (QTc: 574 ms). The patient was successfully treated with permanent pacing. This case highlights that torsades de pointes represents a potential mechanism of syncope or sudden cardiac death in patients with KSS.

Oral vitamin C administration reduces early recurrence rates after electrical cardioversion of persistent atrial fibrillation and attenuates associated inflammation.

BACKGROUND: Inflammation and oxidative stress have been recently implicated in the pathophysiology of atrial fibrillation (AF). The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF, as well as to investigate the time course of changes in these indices post-cardioversion. METHODS: We prospectively studied 44 consecutive patients after successful electrical cardioversion of persistent AF. All patients received standard treatment and were randomised in one to one fashion to either oral vitamin C administration or no additional therapy. We followed-up the patients for 7 days performing successive measurements of white blood cell (WBC) count, C-reactive protein (CRP), fibrinogen, and ferritin levels. RESULTS: One week after successful cardioversion, AF recurred in 4.5% of patients in the vitamin C group and in 36.3% of patients in the control group (p=0.024). Compared to baseline values, inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group. A significant variance was found in the serial measurements of WBC counts (F=5.86, p=0.001) and of fibrinogen levels (F=4.10, p=0.0084) in the two groups. In the vitamin C group CRP levels were lower on the seventh day (p<0.05). CRP and fibrinogen levels were higher in patients who relapsed into AF compared to patients who maintained sinus rhythm (F=2.77, p=0.044 and F=3.51, p=0.017, respectively). CONCLUSIONS: These findings suggest that vitamin C reduces the early recurrence rates after cardioversion of persistent AF and attenuates the associated low-level inflammation. These effects indicate that therapeutic approaches targeting at inflammation and oxidative stress may exert favourable effects on atrial electrical remodeling.

Acute non-ST-elevation myocardial infarction presented as occipital headache with impaired level of consciousness--a case report.

Headache represents a rare manifestation of myocardial ischemic pain. It is believed that this clinical symptom results from convergence of heart autonomic fibers with somatic inputs originating from the head. The authors describe for the first time the case of a 73-year-old woman who experienced an acute non-ST-elevation myocardial infarction that manifested solely with intense occipital headache associated with vomiting and impaired level of consciousness. This unusual case highlights that the exclusion of an intracranial event in patients presenting with a severe headache and ischemic-like electrocardiographic abnormalities should raise the possibility of an acute coronary event, especially in elderly individuals with cardiovascular risk factors. Furthermore, the occurrence of episodic short-lasting headaches during exertion should direct diagnostic work-up toward ischemic heart disease.

Leg oedema and exertional dyspnea due to aortocaval fistula complicating an abdominal aortic aneurysm.

Aortocaval fistula (ACF) represents a rare complication of abdominal aortic aneurysm (AAA) that may lead to hyperdynamic heart failure. We briefly describe a 58-year-old man with an old myocardial infarction, who developed leg oedema and worsening exertional dyspnea due to ACF complicating an AAA. This uncommon case highlights that an appropriate investigation for AAA and ACF should be performed in high-risk patients presenting with a history of worsening leg oedema and dyspnea in the absence of an obvious precipitating factor.

QRS dispersion: an electrocardiographic index of systolic left ventricular dysfunction in patients with left bundle branch block.

The presence of complete left bundle branch block (LBBB) in patients with congestive heart failure has been proposed to be a factor that negatively affects left ventricular (LV) systolic function. The aim of this study was to evaluate the relative predictive value of QRS dispersion (QRSD) and QRS duration (QRSd) in relation to systolic performance of the left ventricle. The ejection fraction of 130 consecutive patients with LBBB was evaluated by standard echocardiographic methods, whereas QRSd and QRSD were measured. It was demonstrated that QRSD in patients with complete LBBB is strongly related to LV contractility. We, therefore, suggest that this simple electrocardiographic index may serve as a useful screening test for detection of patients with LV systolic dysfunction.

Combination of traumatic pseudoaneurysm of descending thoracic aorta and bicuspid aortic valve endocarditis in a young adult.

We report on a 26-year-old man who injured in an automobile accident and developed post-traumatic bicuspid aortic valve endocarditis associated with severe regurgitation. In addition, transesophageal echocardiography (TEE) revealed a pseudoaneurysm of the descending thoracic aorta. The combination of medical and surgical therapy led to a favorable outcome.