Sudden cardiac death: the finish line as a beginning: a true endurance race in a case report.

BACKGROUND: The benefits of exercise are well documented. Intensive exercise for more than 4 h per week is associated with cardiovascular remodelling, including increases in ventricular dimensions, wall thickness, and left ventricular mass. These changes are influenced by sex, ethnicity, and type and duration of exercise. In highly trained endurance athletes, exercise is often associated with electrocardiographic changes at rest. CASE SUMMARY: A well-trained endurance athlete underwent cardiac investigation after his 33-year-old brother died while jogging. A resting 12-lead electrocardiogram showed significant first degree atrioventricular block (AVB), and longer monitoring revealed advanced AVB. This led to further testing and exercise restrictions. DISCUSSION: Although most electrocardiographic changes are related to athletic performance, the distinction between normal variants, often exaggerated by the physiology of the conditioned athlete, and myocardial or electrical disease may be challenging. Athletes should undergo comprehensive cardiovascular evaluation, with management based on these results.

Primary cardiac lymphoma in a patient with concomitant renal cancer.

Primary cardiac lymphoma is defined as non-Hodgkin lymphoma involving the heart and/or pericardium. It is a rare cancer that primarily affects the right heart and in particular the right atrium. By contrast, renal cell carcinoma is a relatively common cancer, which in rare circumstances can metastasize to the heart. It is now known that there is an association between non-Hodgkin lymphoma and renal cell carcinoma, although the underlying mechanisms are not fully understood. The authors present a case of primary cardiac non-Hodgkin lymphoma in a patient with concomitant renal cell carcinoma and explore the possible reasons for this association.

Obstructive sleep apnea syndrome: An important piece in the puzzle of cardiovascular risk factors.

The obstructive sleep apnea syndrome (OSA) is a clinical entity characterized by recurring episodes of apnea and/or hypopnea during sleep, due to a total or partial collapse, respectively, of the upper airway. This collapse originates a set of pathophysiological changes that determine the appearance of several cardiovascular complications. OSA contributes for the development of hypertension, heart failure, arrhythmias and coronary heart disease. Nowadays it is recognized to be an important public health problem, taking into account not just its repercussions but also its prevalence, since the main risk factor for the disease is obesity, a growing problem worldwide, both in developed and developing countries. The present review summarizes the current knowledge about OSA, as regards its definition, pathophysiology, clinical manifestations, diagnosis, cardiovascular effects and treatment.

A systemic disease un suspected by physical examination.

A 73-year-old man was admitted to the cardiology department with unstable angina. He had a history of macroglossia with 3 years of development, attributed to hypothyroidism. On physical examination, he presented an exuberant macroglossia. The following diagnostic procedures were performed-ECG, in sinus rhythm with low voltage criteria, and transthoracic echocardiography, which revealed a left ventricle with preserved function and marked wall thickening, with low strain values in basal segments. The coronary angiography confirmed a lesion of 90% in the right coronary artery, treated with two stents. Suspecting a systemic infiltrative disease, additional tests were performed and these revealed the presence of systemic amyloid light-chain (AL) amyloidosis with cardiac involvement, associated with multiple myeloma. The patient was sent to a consult of haematology to begin chemotherapy.

Retinal artery embolization complicating Libman-Sacks endocarditis in a systemic lupus erythematosus patient.

Libman-Sacks endocarditis (LSE) is the most characteristic cardiac manifestation of systemic lupus erythematosus (SLE). It is usually clinically silent but heart failure due to valvular dysfunction, secondary infective endocarditis and embolic phenomena can complicate valvular abnormalities. We present a patient with SLE and blindness due to right central retinal artery occlusion. Echocardiographic examination revealed a verrucous vegetation on the posterior mitral valve leaflet consistent with LSE. Anticoagulation therapy was started. Echocardiographic regression of the vegetation was observed and there has been no recurrence of thromboembolic events to date.