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Key Clinical Message: Tuberculous myocarditis is a rare presentation of tuberculosis, posing diagnostic challenges in endemic countries. Clinicians should consider this entity in patients with unexplained heart failure, conduction abnormalities, or sudden cardiac events in tuberculosis-endemic regions. Abstract: Tuberculous myocarditis is an uncommon manifestation of tuberculosis, often presenting as a diagnostic challenge, particularly in tuberculosis-endemic regions. We report a case of a 58-year-old male with a history of chronic cough and fever, who presented with progressive dyspnea, generalized body swelling, and New York Heart Association (NYHA) Class IV heart failure. Clinical examination revealed signs of cardiac decompensation and congestive heart failure. Emergency echocardiography demonstrated biventricular dysfunction, and imaging showed clots in both atria and the left ventricle. The patient responded well to initial treatment with anticoagulants, antibiotics, diuretics, and inotropic support. Subsequent investigations, including computed tomography pulmonary angiogram (CTPA) and high-resolution computed tomography (HRCT), confirmed active pulmonary tuberculosis. Anti-tuberculous treatment (ATT) was initiated, and the patient showed remarkable improvement. The diagnosis of tuberculous myocarditis was based on clinical, radiological, and laboratory evidence, as cardiac biopsy was not performed due to resource limitations. Tuberculous myocarditis is an underreported condition, and clinicians should be vigilant about its occurrence, especially in tuberculosis-endemic regions. Early recognition and prompt initiation of ATT can lead to favorable outcomes. This case highlights the importance of considering tuberculous myocarditis in patients with unexplained heart failure or cardiac abnormalities in areas with a high burden of tuberculosis.
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Background Depression is a well-known risk factor that aggravates the chances of having various complications of acute coronary syndrome (ACS) such as cardiovascular collapse, heart failure, arrhythmia, recurrent myocardial infarction, and stroke among patients of ACS. ACS is a broad term which includes unstable angina as well as myocardial infarction (MI). The purpose of this study is to analyze the prevalence of depression among the patients of MI admitted to the tertiary care hospitals of Karachi, Pakistan. Methods and materials A hospital-based, cross-sectional study was conducted in which 375 admitted and diagnosed patients of MI with a mean age of 58 years were interviewed at the cardiology department of the Civil Hospital and National Institute of Cardio-Vascular Diseases (NICVD) Hospital, Karachi, from June to November 2017 using a self-made validated questionnaire, including patient health questionnaire-9 (PHQ-9). Results Overall, about 12.8% of the cases were screened positive for severe depression, 17.1% for moderately severe depression, 17.6% for moderate depression, and 32% for mild depression (total of 79.5%). Of 146 female subjects, 119 (81.5%) were found to be suffering from some degree of depression while 179 (78.2%) of the 229 males screened positive for some degree of depression. Furthermore, 79 (82.3%) of the 96 smokers were suffering from a range of depression while 219 (78.5%) of the 279 non-smokers suffered the same. In addition, the results of the PHQ-9 were cross-tabbed with age (p=0.34), gender (p=0.66), marital status (p=0.07), living status, smoking (p= 0.72), hypertension (p=0.55), and diabetes (p=0.19). Conclusion This study concludes that many of the patients of MI who were admitted to the tertiary care hospitals in Karachi, Pakistan, are suffering from major depressive behavioral changes following the cardiovascular event, which is known to aggravate the chances of having complications associated with it.
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Infective endocarditis (IE) is uncommon but a very serious infection during pregnancy. In most cases, the disease tends to run a subacute course and involves the mitral valve. We present the case of a 25-year old pregnant female who developed shortness of breath and fever 2 weeks prior to parturition. The symptoms did not subside after her delivery, which was carried out via c-section. Based on vegetations attached to aortic valve cusps and positive blood culture for staphylococcus Aureus, the diagnosis of infective endocarditis was made.
