Spontaneous multivessel coronary artery dissection associated with microaneurysms in a young women with thyroiditis background: Unusual case report.

Spontaneous coronary artery dissection (SCAD) is a rare condition that is frequently under-recognized. It has been connected to several triggers and predisposing factors. Interestingly, hypothyroidism has been linked to a higher likelihood of arterial dissections. We present the case of a 49-year-old woman who was admitted for acute coronary syndrome. Coronary angiography revealed signs of SCAD affecting the distal left anterior descending artery and the right ventricular branch. Additionally, microaneurysms were detected in the distal circumflex artery, the main septal artery, and a branch of the distal right coronary artery. During her hospitalization, a goiter was identified, and further evaluation confirmed autoimmune thyroiditis. The patient was managed with conservative treatment. A follow-up angiogram 6 months later showed that the previously dissected coronary segments and microaneurysms had regressed. This case highlights the possible role of hypothyroidism in increasing risk of SCAD and possibly microaneurysms which has been suggested in only isolated cases in the literature. It also demonstrates the effectiveness of a conservative treatment approach for this condition.

Unmasking the Intricate Association Between Takotsubo Syndrome, Atrial Fibrillation, and Diabetes Mellitus: A Case Report and Literature Review.

Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction without obstructive coronary artery disease, often mimicking acute coronary syndrome. Its association with diabetes mellitus and arrhythmias, such as atrial fibrillation (AF), suggests potential shared pathophysiological mechanisms. We report the case of a 76-year-old woman with diabetes who developed sudden, severe chest pain and palpitations after cataract surgery. Initial EKG showed ST-segment elevation, and laboratory tests revealed elevated high-sensitivity troponin, inflammatory markers, and diabetic ketoacidosis (DKA). Despite acute coronary syndrome symptoms, coronary angiography showed no significant obstruction. Transthoracic echocardiography revealed left ventricular apical akinesia and a moderately reduced ejection fraction. A cardiac MRI a month later demonstrated complete recovery of left ventricular function and spontaneous resolution of AF tachycardia. This case highlights a rare presentation of TTS in a diabetic patient with AF and DKA. The spontaneous resolution of AF and recovery of left ventricular function underscore the complex interplay between these conditions. Further research is needed to explore the mechanisms linking TTS with diabetes and AF to improve clinical management and outcomes.

Post-cardiac injury syndrome due to iatrogenic injury successfully managed medically: a case report.

BACKGROUND: Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions, that may eventually lead to major and fatal events such as myocardial infarction, cardiac tamponade, and ultimately death. The risk of coronary artery perforation is more significant during complex procedures as chronic total occlusions but it can occur in other circumstances such as oversized stents and/or balloons, excessive post-dilatation, and the use of hydrophilic wires. Coronary artery perforation is often not recognized during the procedure and the diagnosis is frequently not made until later when the patient develops signs related to pericardial effusion. Thus, causing a delay in management and worsening the prognosis. CASE PRESENTATION: We report a case of a distal coronary artery perforation secondary to using a hydrophilic guide in a young male patient of 52-year-old arab, initially presented with an ST-segment elevation myocardial infarction, complicated by pericardial effusion that was treated medically with a favorable outcome. CONCLUSIONS: This work highlights that coronary artery perforation is a complication that must be anticipated in high-risk situations and its diagnosis must be made early to allow adequate management.

Anomalous Left Main Coronary Artery From the Right Sinus of Valsalva.

Anomalous coronary arteries are rare, mostly benign anatomic abnormalities. Anomalous origin of the left main coronary artery from the right sinus of Valsalva (LCA-RSV) is a rare variant that may lead to myocardial ischemia or sudden cardiac death. We present the case of a 49-year-old patient with a history of type 2 diabetes and smoking who presented to the emergency department with acute chest pain and was diagnosed with inferior ST-elevation myocardial infarction (STEMI). A transthoracic echocardiogram demonstrated inferolateral wall motion abnormalities of the left ventricle. The patient underwent cardiac catheterization that showed an anomalous left main coronary artery originating from the right sinus of Valsalva, alongside atherosclerotic triple-vessel disease. He was discharged home on medical management, including dual antiplatelet therapy, beta blockers, and statins, with scheduled follow-up.

Mitral valvar anomalies causing subaortic stenosis: two rare case reports.

Subaortic stenosis (SubAS) is a common cause of left ventricular outflow tract obstruction. It may be focal or diffuse, leading to the development of a subaortic tunnel. Considered for a long time as a congenital anomaly, SubAS has been established lately as an acquired anomaly and secondary to a pre-existing anatomic alteration in the interventricular septum and mitral valve apparatus. It is a progressive disease that is often confused with obstructive hypertrophic cardiomyopathy, which can lead to several complications. Case presentation: In this paper, the authors report two cases of SubAS secondary to different mitral valvar anomalies. The analysis of echocardiographic data was a milestone in raising this diagnosis and identifying its mechanisms. Conclusion: This work highlights a rare situation, often underdiagnosed, in which the evolution can be marked by an important risk of recurrence even after surgical cure.

Mechanical prosthetic mitral valve obstruction: Pannus or thrombus? A case report.

Substitution of a defective heart valve with a prosthetic heart valve turns the native disease for prosthesis-related complications. One of the most serious and dreaded complications is prosthetic valve obstruction. It is either the result of a thrombus or pannus formation. For the evaluation of prosthetic valve obstruction, transthoracic echography and fluoroscopy provide functional information but may not provide information about the etiology of the obstruction, unlike multidetector computed tomography (MDCT) which allows a more precise etiological diagnosis to guide the therapeutic attitude. Here, we report a case of a mechanical prosthetic mitral valve obstruction in a 45-year-old patient in whom the diagnosis of pannus was retained on the basis of clinical, biological, and imaging data. The differentiation between thrombus and pannus is crucial because it conditions the therapeutic attitude. Advanced imaging specially MDCT options should be considered whenever mechanical prosthesis valve obstruction is suspected.

Severe familial coronary artery spasm in 2 siblings: About 2 cases.

Vasospastic angina is the spasm of coronary arteries causing transient myocardial ischemia. VSA is commonly managed with antispasmodic medications including calcium-channel blockers and nitrates. When vasospasm is refractory to conventional medications, unconventional treatment modalities may be used for symptomatic relief. Coronary artery spasm was observed in 2 sisters. Neither of them had significant atheromatous stenosis in the coronary arteries. The 22-year younger sister presented with rest angina in the early morning. The 32-year-old elder sister complained of rest and effort angina. Their coronary angiogram showed spontaneous spasm in the proximal segment of the left anterior descending coronary artery. The youngest one had resistant and recurrent coronary vasospasm involving different segments of the coronary tree causing myocardial infarction with total occlusion of the proximal segment in the left anterior descending coronary artery. Our patients presented with a lesser-known phenomenon called refractory VSA, where intermittent vasospasm continues despite being on a combination of 2 medications. The familial appearance of coronary artery spasm had been previously reported. Although it is not well understood, the underlying mechanism appears to involve a combination of endothelial damage and vasoactive mediators. Genetic factors such as human leucocyte antigen contribute to susceptibility to coronary spasm in some patients with VSA. Treatment for VSA is well documented; however, little data is available for refractory VSA.

Accelerated junctional rhythm (AJR) revealing light-chain cardiac amyloidosis: A case report with literature review.

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.

Acute ST-elevation myocardial infarction (STEMI) in a young woman with unknown mitral stenosis and atrial fibrillation: Case report.

Introduction and importance: Chronic rheumatic heart disease is the most common cause of mitral stenosis. It remains a major public health problem. In almost half of the cases, paroxysmal or chronic atrial fibrillation occurs during the evolution of mitral stenosis, thereby exposing to an increased risk of thrombo-embolic events.Whereas the most frequent site for embolism is the cerebral circulation, any organ may be involved, especially the coronary circulation, resulting in a myocardial infarction (MI). Case presentation: Here, we report a rare case of a 50-year-old patient, with no risk factors for cardiovascular disease, presenting an acute ST-elevation myocardial infarction (STEMI) as initial presentation of unknown mitral stenosis with atrial fibrillation and strongly suggesting an embolic origin. The diagnosis was made based on the national cerebral and cardiovascular center (NCVC) criteria for the clinical diagnosis of coronary artery embolism (CE). Coronary angiography showed a distal thrombus in the right coronary artery that has been medically treated. The outcome was favorable and the patient was referred after that for mitral valve replacement.

Systemic sclerosis and tachycardia-bradycardia syndrome: a case report.

BACKGROUND: Systemic sclerosis is a multisystemic character autoimmune disease. It is characterized by vascular dysfunction and progressive fibrosis affecting mainly the skin but also different internal organs. All heart structures are commonly affected, including the pericardium, myocardium, and conduction system. However, tachycardia-bradycardia syndrome is not common in the literature as a cardiac complication of systemic sclerosis. Case presentation We report a case of tachycardia-bradycardia syndrome in a 46-year-old Moroccan woman followed for systemic sclerosis with cutaneous, vascular, and articular manifestations. The diagnosis was based mainly on patient-reported symptoms and electrocardiogram data. A permanent pacemaker was implanted, allowing the introduction of beta-blockers with good outcomes. CONCLUSIONS: This case aims to show that even minor electrocardiogram abnormalities should be monitored in this group of patients, preferably by 24-hour ambulatory electrocardiogram because they could be a good indicator of the activity and progression of cardiac fibrosis.

Myocardial infarction in a pregnant woman revealing a transitional deficit in protein S: a rare case report.

The occurrence of myocardial ischemia and myocardial infarction in pregnancy is relatively rare, the occurrence of myocardial infarction in pregnancy is associated with cardiovascular risk factors. The deficiency of coagulation regulatory systems in the occurrence of venous thrombosis is well established; however, their role in arterial thrombosis is controversial. Here, we present an interesting case of a 34-year-old of acute myocardial syndrome without persistent ST segment elevation, which revealed transient protein S deficiency. Management of acute coronary syndrome (ACS) during pregnancy may represent a unique clinical challenge. In this manuscript, we review the clinical presentation, anatomic considerations, and management strategy in our patient presenting with ACS. Objective: this case highlights the importance of multimodality approach to help to obtain a more timely diagnosis of myocardial infarction in pregnancy and the importance collaboration between obstetricians, cardiologists, pediatricians and anesthesiologists to ensure optimal care.

[Perforated posterior mitral valve aneurysm: a rare complication of infective endocarditis: a case report]. / Perforation d'anévrysme de la valve mitrale postérieure: complication rare de l'endocardite infectieuse: à propos d'un cas.

Mitral valve aneurysm is a rare abnormality whose pathophysiology is poorly understood. It is defined as a bulge of the mitral valve leaflet toward the left atrium. Aneurysm in the posterior leaflet is exceptional. We report the case of a 26-year old man, who had been followed up for rheumatic aortic regurgitation for 4-years, hospitalized for febrile syndrome associated with episodes of left heart failure. Transthoracic echocardiographic examination (TTE) and transesophageal echocardiography (TEE) showed aortic valve vegetations with wide aneurysm of the small mitral valve associated with severe mitral valve regurgitation. The patient underwent mitral and aortic valve replacement with simple postoperative outcome. Clinical suspicion associated with suitable preoperative imaging and early surgical treatment are essential to recognize and treat this rare complication of infectious endocard.

Corrigendum: Kounis syndrome induced by oral intake of aspirin: case report and literature review.

[This corrects the article DOI: 10.11604/pamj.2018.30.301.14948.].

[Inferior myocardial infarction: first Moroccan study of 103 cases]. / Infarctus du myocarde inférieur: première série marocaine, à propos de 103 cas.

Myocardial infarction (MI) is a major cause of cardiovascular mortality. Inferior MI accounts for 30-50% of infarctions but it is associated with a favorable prognosis compared to anterior infarct. This study aimed to study the epidemiological, clinical, electrical, echocardiographic, angiographic features of inferior MI, as well as its complications and its therapeutic approaches. Over a period of 3 years, we admitted 720 patients with STEMI, of whom 103 with inferior STEMI, reflecting a rate of 14.3%. There was a clear male predominance, with an average age of 58 years (men) and 62 years (women). Smoking was the main risk factor for cardiovascular disease (57.28% of patients were smokers). Right ventricular infarction was found in 11.65% of cases. Half of these patients had hemodynamic instability. Third-degree atrioventricular block was diagnosed in 12.6% of patients. Therapeutic approach was based on thrombolysis (7 patients) and coronary angiogram (42 patients). Inferior MI was caused by right coronary lesion in 53% of cases and circumflex artery occlusion in 47% of cases. Right coronary is responsible for right ventricular infarction in 100% of cases. Coronary angioplasty was performed in 18 patients after coronary angiogram. Eleven patients underwent transluminal coronary angioplasty in the right coronary while 2 patients underwent transluminal coronary angioplasty in the circumflex artery. Early mortality at 30 days was 1.94%. In the right ventricular infarction group mortality rate was about 17%.

Kounis syndrome induced by oral intake of aspirin: case report and literature review.

The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.

Mitral aneurysm: a rare complication of subaortic diaphragm infective endocarditis / Aneurisma mitral: una complicación poco frecuente de la endocarditis infecciosa del diafragma subaórtico

Abstract Mitral valve aneurysm is a rare and uncommon complication of infective endocarditis leading to a weakened mitral tissue. The most feared mitral valve aneurysm's complications are: perforation and severe mitral regurgitation. Multiple mechanisms have been suggested to explain the development of mitral valve aneurysm in aortic infective endocarditis including: local extension of the infection, the mitral kissing vegetation and aortic regurgitation. We report the case of a 29-year-old man who had infective endocarditis of a native aortic valve and the sub-aortic diaphragm complicated by a perforated mitral valve aneurysm diagnosed only by transesophageal echocardiogram. The patient had no sign of heart failure. We hypothesized that all those mechanisms lead to the developing of the mitral valve aneurysm in this case, but also the presence of the diaphragm favored the spread of the infection.

Resumen Una de las complicaciones poco comunes e inusuales de la endocarditis infecciosa son los aneurismas de la válvula mitral. Las complicaciones más temidas de estos últimos son la perforación y la insuficiencia mitral severa. Diferentes mecanismos pueden explicar el desarrollo de dicha insuficiencia en el contexto de una endocarditis infecciosa, incluyendo una extensión local, una vegetación sobre la válvula mitral y una insuficiencia aórtica. Nuestro caso clínico es el de un joven de 29 años diagnosticado de endocarditis infecciosa sobre su válvula aortica nativa con un diafragma subaortico complicado con un aneurisma de la válvula mitral perforado. El paciente no presentaba signos de insuficiencia cardíaca. Hemos supuesto que todos los mecanismos que hemos evocado anteriormente han llevado al desarrollo de dicho aneurisma, junto con la presencia del diafragma, elemento en favor de la diseminación de la infección.

[Hydronephrosis arterial hypertension. Report of 4 cases]. / Hydronéphrose et hypertension artérielle. A propos de quatre observations.

Four cases of ureteropelvic junction syndrome associated with arterial hypertension were reported. The authors discuss the ethiopathogenic of hypertension, on the basis of these observations and a review of the literature. They conclude that union bilateral hydronephrosis can lead to hypertension and renal failure by both inappropriate production of renin and water chronic retention. The correction of ureteropelvic junction should return blood pressure to normal levels.

[Bilateral Conn's adenoma. Diagnostic discussions]. / Adénome de Conn bilatéral. Discussions diagnostiques.

Primary hyperaldosteronism represents less tha 1% of all causes of hypertension. We report one case of primary hyperaldosteronism which emphasizes the difficulty of distinguishing tumoral PHA from idiopathic PHA (bilateral adrenal hyperplasia), observed in a 57-year-old man. The diagnosis was suggested by marked hypokalemia, and was confirmed by hyperaldosteronaemia and low and poorly stimulated renin activity. Intravenous saline infusion failed to significantly suppress plasma aldosterone levels. Upright posture for 60 minutes suppressed plasma aldosterone concentration. A Computed tomography (CT) scan showed bilateral adrenal mass. Management consisted of total right adrenalectomy, and enucleation of adenoma from the opposite adenoma. The patient is normotensive 4 years after surgery.

[Testicular infarction without torsion in cryptorchism]. / Infarctus testiculaire sans torsion sur cryptorchidie.

Testicular infarction without torsion of the spermatic cord is a rare lesion, generally idiopathic and spontaneous. It may be exceptionally associated with certain risk factors (vasculitis, cholesterol emboli, malakoplakia, protein S or antithrombin III deficiency, etc.). It often simulates testicular tumour, leading to orchidectomy, which can be avoided, particularly in the case of segmental infarction, by applying conservative treatment. The authors report an original case of infarction of an inguinal ectopic testis without torsion. No cause was identified. In the light of this case and a review of the literature, the authors discuss the various aspects of this clinical entity.

Pericardial tamponade and coexisting pulmonary embolism as first manifestation of non-advanced lung adenocarcinoma.

Pericardial effusion and pulmonary embolism are relatively common complications of malignancy and are uncommon as its initial manifestation. This report describes a case of a patient, who presented with this association, due to an underlying pulmonary adenocarcinoma. When a major pericardial effusion is associated with pulmonary hypertension, some echocardiographic signs may redress the diagnosis. This case emphasizes a challenge diagnostic which may be guided by high right ventricular pressure and on the other hand the importance of keeping both these conditions in mind when dealing with context of malignancy.