Epidemiology of Cardiac Myxoma in the Kingdom of Bahrain.

BACKGROUND: Cardiac myxomas (CM) are the most prevalent type of primary cardiac tumour. The majority of primary cardiac tumours, including CM, are found to be benign. In the context of this study, the objective was to investigate and analyse the experience of CM over a period of 10 years, specifically in Bahrain. By examining this particular subset of cardiac tumours, valuable insights can be gained regarding their prevalence, clinical presentation, diagnostic methods, treatment approaches, and outcomes in the Bahraini population. METHODS: We retrospectively evaluated the medical records of 20 patients who presented with CM at the Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre in the Kingdom of Bahrain from January 2010 to January 2021. All patients had transthoracic echocardiography to establish a preoperative diagnosis. All of the patients underwent an operation using the median sternotomy, and a histopathology examination confirmed the final diagnosis. RESULTS: The mean age at the time of presentation was 57 (± 18.1) years, ranging from 17 to 80 years, and 55% (12 patients) were female. Dyspnea (n=8, 40%) and peripheral embolism (n=4, 20%), which include cerebrovascular accidents and acute monocular vision loss, were the most frequently observed symptoms. The largest diameter of the myxoma was 5.1 cm (±1.7). The left atrium was the predominant location for myxoma formation (n=16, 80%), with the majority of the myxomas attached to the atrial septum. CONCLUSION: CM poses a significant risk of cardiac and systemic complications. Early detection and timely gross-complete resection result in excellent early and long-term outcomes.

Clinical Characteristics and Outcomes of ST-Elevation Myocardial Infarction in Young Patients: A Single-Center Experience.

Objective This study aimed to examine the clinical characteristics, risk factors, and outcomes of patients aged ≤45 years with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods From January 2018 to March 2020, this retrospective observational study took place at a tertiary cardiac center in Bahrain. We included patients aged ≤45 years who were admitted with STEMI and had primary percutaneous coronary intervention (pPCI). Results In this study, 510 patients with STEMI receiving pPCI were included, of whom 95 (18%) were younger than 45 years. The young age group had more smokers (57.9% vs. 40.5%, p = 0.003), newly diagnosed dyslipidemia (41.1% vs. 25.5%, p = 0.004), and a positive family history of early coronary artery disease (CAD) (14.7% vs. 4.3%, p = <0.001). Traditional cardiovascular risk factors, such as diabetes mellitus, systemic hypertension, and dyslipidemia, were significantly less common in young patients. Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly less common in young patients at the one-year follow-up (2.1 vs. 8.4%, p = 0.05). Conclusion Young patients with STEMI are more often smokers with undiagnosed dyslipidemia and have a family history of CAD. MACCE at one year is significantly lower as compared to older patients, but it is not negligible. Public health efforts are needed to reduce the prevalence of modifiable risk factors among the susceptible population.

Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention.

BACKGROUND: The aim of the current study is to determine the safety of early discharge (ED) within 48 hours (h) for ST-elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PPCI) and to define the criteria of low-risk patients that can be considered for ED. METHODS: This is a single-center retrospective study that took place at Mohammed bin Khalifa Cardiac Centre in the Kingdom of Bahrain. 301 patients who underwent PPCI between January 2018 and March 2019 were included. Endpoints at 30 days follow-up comprised cardiac re-admission, cardiovascular death, non-fatal myocardial infarction, stroke, and major adverse cardiovascular and cerebrovascular events. RESULTS: Of the 301 patients included in our study, 74 (24.5%) were discharged within 48 h (group 1) compared with 227 (75.5%) hospitalized for more than 48 h after PPCI (group 2) (<0.0001). In terms of baseline characteristics, group 2 had higher proportions of chronic kidney disease (P = 0.051), mean HbA1c (P = 0.016) and mean CPK (P < 0.0001) compared to their group 1 counterparts. The prevalence of anterior STEMI was twice as high among group 2 (P < 0.0001), with a significantly higher prevalence of left main stenting (P = 0.025). Additionally, larger proportion of group 2 required inotropic therapy (P = 0.031), oral anticoagulation (P = 0.005) and had a significantly lower ejection fraction (LVEF) (P < 0.0001) with more procedural complications (P = 0.005). LVEF exerts a large effect on ED, as reflected by a high deviance R2 = 20.4%, and was able to correctly classify the subjects into their pertaining discharge group with an accuracy of 80.4%, a specificity of 82.7%, and a sensitivity of 71.2%. According to the fitted LVEF values using the logistic equation, each 1% increase in LVEF is associated with a 3.5% increase in the chance of ED. The two groups recorded fairly similar clinical outcomes at 30-day. CONCLUSION: Preserved LV systolic function is a good predictor of early and safe discharge after successful PPCI. The presented data support the practice of ED, with length of stay even shorter than current guidelines recommendation in selected low-risk patients.

First Report of Acute Myocarditis Post-Pfizer-BioNTech COVID-19 Vaccination in the Kingdom of Bahrain.

We present a case of a 24-year-old male patient who presented to our institution five days after receiving his first dose of Pfizer-BioNTech vaccine to rule out acute coronary syndrome due to chest pain along with troponin increase and ECG changes. Acute coronavirus disease 2019 (COVID-19) infection was excluded based on a negative real-time reverse transcription-polymerase chain reaction (RT-PCR) test of specimens acquired using nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and all other viral serologies were found to be negative. Coronary angiogram showed normal coronaries, and the presence of late gadolinium enhancement, which is indicative of myocarditis, was identified using cardiac magnetic resonance imaging (MRI). Our case report raises concern that the COVID-19 vaccine may cause myocarditis as a rare side effect.

Unusual Cardiac Presentation of COVID-19 with Significant Sinus Pauses.

There is growing evidence of cardiac complications due to corona virus disease 2019 (COVID 19). Our case is a case of a young patient with COVID-19 and symptomatic sinus pauses.