Cardiac thrombi in different clinical scenarios

Intracardiac thrombi are commonly found in patients with ischemic stroke. The echocardiographic identification of thrombi is important in decision-making since it represents an indication to long-term anticoagulation, in order to reduce the risk of new stroke. Intracardiac thrombi can develop during the time course of several cardiac pathologies that favor blood stasis and/or predispose to the aggregation of thrombotic material. Examples of cardiac pathologies that favor the formation of thrombus are illustrated and discussed.

Contrast-induced nephropathy

Contrast-induced nephropathy [CIN] is a serious complication of angiographic procedures resulting from the administration of contrast media [CM]. It is the third most common cause of hospital acquired acute renal injury and represents about 12% of the cases. CIN is defined as an elevation of serum creatinine [Scr] of more than 25% or >/= 0.5 mg/dl [44 micromol/l] from baseline within 48 h. More sensitive markers of renal injury are desired, therefore, several biomarkers of tubular injury are under evaluation. Multiple risk factors may contribute to the development of CIN; these factors are divided into patient- and procedure-related factors. Treatment of CIN is mainly supportive, consisting mainly of careful fluid and electrolyte management, although dialysis may be required in some cases. The available treatment option makes prevention the corner stone of management. This article will review the recent evidence concerning CIN incidence, diagnosis, and prevention strategies as well as its treatment and prognostic implications.

Giant left atrium: a review

Giant left atrium is a rare condition, with a reported incidence of 0.3%, and following mainly rheumatic mitral valve disease. Although rheumatic heart disease represents the main cause of giant left atrium, other etiologies have been reported. Giant left atrium has significant hemodynamic effects and requires specific management. In this review, we present two cases, discuss the different definitions, etiologies, clinical presentation and management modalities

Hypertrophic cardiomyopathy: prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar

Hypertrophic cardiomyopathy [HCM] is a genetic disease associated with risk of morbidity and sudden cardiac death. The prevalence, hypertrophy patterns, mode of presentations, and different ECG findings vary in different regions of the world. To date, no data is present regarding these variables in Qatar. A retrospective, cross sectional, descriptive analysis of all patients referred for echocardiography study at Hamad General Hospital, Qatar. The study period was from January 2008 till December 2010. Aims: To study 1] the prevalence of HCM, 2] the different patterns of hypertrophy, and 3] the clinical and ECG presentations in this population. Out of the 29,286 cases evaluated, 38 patients were found to have HCM [0.13%]. Their clinical, ECG, and echocardiography findings were analyzed. Mean age was 47 y, 35 males [92%] and 3 females [8%]. Four patterns of hypertrophy were described; 17 [44.7%] had septal hypertrophy alone, 6 [15.8%] had septal and other segments hypertrophy but sparing the apex, 10 [26.3%] had apical segments along with any other segment hypertrophy, and 5 [13.2%] had apical hypertrophy alone. No obstruction was found in 19 [50%], left ventricular outflow [LVO] tract obstruction was found in 13 [34%], and mid cavity obstruction [MCO] in 6 [16%]. Twenty one [55.3%] patients were referred because of chest pain, 15 [39.5%] with palpitations, 15 [39.5%] with shortness of breath, and 5 [13.2%] with syncope. Nine patients [23.7%] were asymptomatic and were referred because of cardiac murmur during routine examination. ECG evidence of LV hypertrophy was found in 29 [76.3%]. The prevalence of HCM in our population group is 0.13% with a male predominance [12:1]. There was a diversity of clinical presentation, ECG abnormalities and patterns of LV hypertrophy among HCM patients