Dilated cardiomyopathy complicated by an intracavitary thrombus and acute heart failure: A rare presentation of systemic lupus erythematosus.

Introduction: Cardiac manifestations during systemic lupus erythematosus (SLE) are diverse and often have major prognostic consequences. Lupus cardiomyopathy is an uncommon event in the course of SLE and initial clinical manifestation as decompensated dilated cardiomyopathy is very rare. Case report: we report the case of a 52-years-old female who presented with acute onset decompensated dilated cardiomyopathy as the initial feature of SLE. The diagnosis was based on clinical, electrocardiographic, angiographic and biochemical characteristics. Conclusion: Although rare, SLE cardiomyopathy deserves the attention due to its infrequent clinical presentation. It is a complex disease that requires prompt investigation and treatment, otherwise the damage is unrecoverable.

An aortic root abscess complicating a non-previous underlying heart disease infective endocarditis in an immunocompetent young patient: A case report.

Introduction: and importance: Aortic infective endocarditis is a well described fatal disease that develops along the edges of the heart valves, although it can affect native and prosthetic valves, infection seldom affects a previously normal ones. Aortic root abscess as a complication of normal native aortic valve endocarditis is less recognized and described, it is a potentially fatal condition, which the diagnosis is based on clinical, biology, echocardiography and especially the intraoperative findings. Both native and prosthetic valve infection can be complicated by an aortic abscess, associated with a significant mortality rate, which often requires surgical intervention. Case report: We report here a case of young man, with no major pathological history, non-systemic or valvular predisposing diseases, was admitted for the assessment of a prolonged fever with no obvious cause, and in whom an aortic abscess was suspected on an echocardiography and confirmed by transesophageal echocardiography and histopathology, complicating a negative blood culture infective endocarditis. Conclusion: Up to date, the incidence of infective endocarditis continues to rise, with a significant rate of mortality and complications, however the physiopathology mechanism remain insufficiently studied.

Incidental diagnosis of a large cardiac thrombus swinging through an interatrial communication in a COVID-19 patient: Case report and literature review.

INTRODUCTION: The hypercoagulability state induced by COVID-19 has been well established and various forms of subsequent thromboembolic events have been reported throughout literature including multiple cases of intracardiac thrombi, four of which in our center alone, this case being the fifth. CASE REPORT: We report the case of a 38-year-old male with no prior cardiovascular history who -subsequently to a COVID-19 infection-developped a right atrial thrombosis associated to a pulmonary embolism, and in whom cardiography revealed an interatrial communication. Management relied upon curative doses of low molecular weight heparin (LMWH) with favourable outcome. DISCUSSION: In our discussion, we lay out the various physiopathological mechanisms incriminated throughout literature in the genesis of a hypercoagulability state distinctive of COVID-19, before highlighting the incidence of an interatrial communication (whether a Potent Foramen Ovale or Atrial Septal Defect) discovered in patients with COVID-19, and the potential paradoxical embolization risks they imply as well as reported cases. A mention of hemostatic parameters monitored was also warranted. Finally we discuss the guidelines in terms of prophylactic and therapeutic anticoagulation in hospitalized patients before discussing cardiac thrombosis's therapeutic options. CONCLUSION: Our case highlights various key points which could change the prognosis of COVID-19 patients, whether related to the underdiagnosis of interatrial abnormalities or with regards to the diagnosis to thromboembolic events, but also the indisputable place of anticoagulation in COVID-19 management.

Spontaneous subdural hematoma in a patient receiving dual antiplatelet therapy following percutaneous coronary intervention: A case report.

INTRODUCTION: and importance: Dual antiplatelet therapy with clopidogrel and aspirin is routinely prescribed after coronary artery stenting, plays a critical role in secondary prevention among patients with acute coronary syndrome and has decreased the rates of re-infarction and stent thrombosis after percutaneous coronary intervention, but they are prone to internal bleeding. Intracranial hemorrhage is the most serious bleeding complication in a patient put on antiplatelet therapy following PCI. Acute spontaneous subdural hematoma (ASSDH) without trauma is a rare event, which needs to be promptly recognized and managed. CASE PRESENTATION: In this mini-review, we report a case of a 71-year-old man who represented spontaneous acute subdural hematoma receiving dual antiplatelet (aspirin and clopidogrel) following percutaneous coronary intervention for acute coronary syndrome. Rapid discontinuation of all of the antiplatelet drugs and hematoma evacuation were performed with good postoperative evolution. CLINICAL DISCUSSION: Management of hemorrhagic patients under antithrombotic therapy is very difficult. Resuming the treatment could lead to recurrence bleeding, on the other hand, suspension or stopping of treatment could expand the thrombotic risk. ASSDH after PCI is true diagnostic then therapeutic emergency, especially in patients with rapid neurological degradation. Treatment may be managed by nonoperative conservative approach in selected cases. CONCLUSION: Spontaneous subdural hematoma is a rare, serious entity, although it can engage the functional and vital prognosis of the patient, hence the interest of diagnosis and prompt treatment to improve the prognosis.

Spontaneous massive pectoral hematoma induced by vitamin K antagonist therapy: a case report.

Vitamin K antagonists (VKA) based oral anticoagulation, is widely used for the prevention and treatment of thromboembolic disease. The major complication of this therapy is bleeding, and sometimes it can occur in unsuspected areas. Spontaneous pectoral hematoma is one of the rare complications due to over anticoagulation by VKA therapy, with only a few cases reported in the literature. Concomitant use of this therapy with commonly used antibiotic, especially in the elderly with multiple comorbidities, can increase the risk of bleeding. Herein, we report a case of a 72-year-old woman under VKA for the treatment of atrial fibrillation, who presented with a spontaneous massive pectoral hematoma, while using antibiotic to treat a respiratory tract infection, who was successfully managed.

Serious Right Coronary Artery Thrombosis Revealing Behçet's Disease in a Female Patient: A Case Report.

Although atherosclerosis remains the major cause of acute coronary syndrome, there are many other etiologies that should be taken into account, especially in young patients with no atherosclerotic risk factors. Coronary involvement is extremely rare in patients with Behçet's disease, notably in young patients. In addition, acute inferior myocardial infarction revealing Behçet's disease has rarely been reported. Through this article, we report a case of Behçet's disease with arterial involvement diagnosed after myocardial infarction resulting from thrombosis of the right coronary artery in a 50-year-old woman with no specific medical history.

An uncommon acute type A aortic dissection mimicking an inferior STEMI.

Aortic dissection in the most common fatal disease affecting the aorta. Ascending aortic dissection can lead to coronary malperfusion causing myocardial infarction with ST elevation. The distinction between aortic dissection and a primary myocardial infarction can be difficult because both conditions can have similar presentations. Making the right diagnosis is essential because the therapies used to treat myocardial infarction can be fatal for patients with aortic dissection. Emergency transthoracic echography presents a rapid imaging procedure that provides strong hints of the coexistence of these two diseases, leading to further imaging examination and prevent inappropriate administration of treatments that could cause catastrophic outcome. We report a case of a 62-year-old man admitted to our hospital with chest pain, who was diagnosed as inferior wall myocardial infarction based on electrocardiographic findings. The diagnosis was reassessed due to a significant aortic regurgitation and an intimal tear in the ascending aorta on transthoracic echocardiography. Computed tomography angiogram of the chest and transesophageal echography fully confirmed the presence of ascending aortic dissection. Emergency surgery was successfully performed and the patient recovered well.

Symmetrical and Peripheral Gangrene Complicating a Third-Degree Atrioventricular Block: A New Presentation of a Known Disease.

Symmetrical peripheral gangrene (SPG) is a rare, serious entity characterized by ischemic changes of the distal extremities with no vessel occlusion, leading to fatal complications. It is related to numerous causes, and the treatment is not yet consensual. We present the first case of SPG related to low cardiac output secondary to a third-degree atrioventricular block. Physicians should be aware of this entity, as early recognition and adequate management can help in reducing morbidity and mortality and prevent fatal complications.