Simultaneous acute myocardial infarction, bilateral pulmonary embolism, and acute ischaemic cerebral stroke, a delayed complication in a patient with COVID-19 infection: case report.

BACKGROUND: The simultaneous occurrence of acute myocardial infarction, pulmonary embolism, and acute cerebral stroke is a rare concomitant finding that requires thorough aetiological investigation. Multiple reports note delayed COVID-19 arterial and venous thromboembolic complications. However, to the best of our knowledge, this is the first report of such a simultaneous finding after COVID-19. CASE SUMMARY: A 60-year-old male patient, with a history of Type II diabetes and no risk factors for thromboembolism, experienced simultaneous acute myocardial infarction, bilateral pulmonary embolism, and acute ischaemic stroke. The occurrence of these multi-systemic thromboembolic events made us rule out differential diagnoses of thrombophilia, systemic lupus erythematosus, antiphospholipid syndrome, vasculitis, cancer, disseminated intravascular coagulation, and paradoxical embolism through a patent foramen ovale. On laboratory analysis, the patient was positive for IgG SARS-COV2 antibodies, but negative for IgM antibodies and had two negative nasal polymerase chain reaction swab tests. After thorough aetiological investigation, the most probable diagnosis was thought to be delayed complications of COVID-19 infection. DISCUSSION: Multiple mechanisms, such as endothelial dysfunction, complement activation, and virus-induced antiphospholipid syndrome, may explain the hypercoagulable state related to COVID-19. To the best of our knowledge, this is the first case of concomitant multi-systemic thrombosis development, recognized as a delayed complication of COVID-19 infection. This highlights a need among cardiologists for an increased awareness of such late-onset complications. It also emphasizes the importance of identifying the optimal duration and dose of prophylactic anticoagulation as well as the characteristics of the population that would benefit from it after COVID-19.

Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care.

BACKGROUND: Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. METHODS: This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. RESULTS: A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40-60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. CONCLUSIONS: More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

A large aneurysm of a left sinus of Valsalva invading the interventricular septum--a rare cause of syncope.

Sinus of Valsalva aneurysms are uncommon, especially those in the left sinus of Valsalva. A case of a 45-year-old woman with syncope is presented. She was in complete heart block. Auscultation revealed moderate aortic regurgitation. Transthoracic echocardiography revealed a subaortic membrane attached to the interventricular septum with expansion in diastole and collapse in systole. A diastolic flow was seen at the edge of this membrane. Transesophageal echocardiography revealed a cystic mass that was thought to be a large aneurysm with a parietal thrombus of the left coronary sinus extending into the interventricular septum. Magnetic resonance imaging confirmed the diagnosis. The aneurysm extension to the interventricular septum resulted in complete heart block, presumably through compression of normal atrioventricular nodal function. Case reports of the latter association are extremely rare. The present is a rare report describing the magnetic resonance imaging appearance of a left sinus of Valsalva aneurysm.