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Background: Aortic aneurysms, particularly those affecting the ascending aorta, pose significant health risks due to their potential to cause life-threatening complications such as rupture and dissection. While the etiology of ascending aortic aneurysms has traditionally been associated with non-inflammatory processes, emerging evidence suggests a potential role of inflammation in their development. Methods: This study investigates the relationship between inflammatory markers and ascending aortic aneurysms, focusing on high-sensitivity C-reactive protein (hs-CRP) and the monocyte-to-HDL ratio (MHR). A total of 135 patients with ascending aortic aneurysms and 40 control subjects underwent comprehensive evaluations, including echocardiography, computed tomography imaging, and serum biomarker measurements. Results: The results indicate significantly elevated levels of hs-CRP and MHR in patients with ascending aortic aneurysms compared to the control group, suggesting a potential inflammatory component in the pathogenesis of these aneurysms. However, the precise mechanisms underlying this association remain to be elucidated. Conclusion: Despite limitations such as the cross-sectional study design and relatively small sample size, this study provides valuable insights into the potential involvement of inflammation in ascending aortic aneurysms. Further research, including longitudinal studies and histopathological analysis of aortic tissue, is warranted to confirm these findings and explore the utility of inflammatory markers as diagnostic and prognostic indicators in this patient population.
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Introduction: The door-to-balloon time, the time between a patient's arrival at the hospital and percutaneous coronary intervention, is crucial for managing myocardial infarction. Aiming for less than 90 minutes is recommended, as shortened times are associated with improved outcomes. However, limited healthcare resources, infrastructure, transportation and poverty impact management, leading to poorer outcomes and delayed door to balloon time. Addressing these challenges and their causes is essential for optimal care. Methodology: A retrospective analysis of 103 patients' medical history records from May 2022 to June 2023 at the Mogadishu Somali Turkish Training and Research Hospital in Somalia was conducted. The data was mainly collected from the hospital's electronic medical records system, analyzing patient demographics, clinical characteristics, and angiographical records. The study analyzed variables responsible for door-to-balloon (D2B) time delay, patient angiography results, cause of delay, procedure length, etc. Results: A study of 103 patients who had angiography performed between May 2022 and July 2023 was done. The predominant gender in the study was 73% male, with a mean age of 58 years. The most common risk factors were hypertension (33%), smoking (38%), and diabetes (39%). Of all the vessels, the Left Anterior Descending (LAD) was the most commonly obstructed (63%). Time delays from door-to-balloon were frequent, median door-to-balloon time was 169 minutes, frequently brought on by social problems and financial limitations. The majority (77.4%) of the patients had only percutaneous angiography (PCI), while 22.6% were recommended for bypass following PCI of the infarct-related artery (IRA). Complications in the delayed treatment group were the main cause of the death rate of 24.2%. Conclusion: Door-to-balloon time is crucial for acute myocardial infarction treatment which is challenging in impoverished countries like Somalia. Investments in healthcare infrastructure, public health education, and emergency services can improve patient outcomes.
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Introduction: Myocardial infarction and cardiovascular disease are significant global health issues, particularly in Somalia. The Somali population faces challenges due to armed conflict, limited education, and underdeveloped healthcare infrastructure. Cardiovascular risk factors like diabetes, hypertension, and obesity are prevalent, and Somali people face increased susceptibility. Methods: This study examined Somalia residents' perceptions, attitudes, and behaviors towards myocardial infarction using a cross-sectional paper-based questionnaire. The sample consisted of 313 urban residents in Mogadishu, aged 20 and above. The questionnaire was written in Somali and was designed for the demographic. Knowledge, attitude, and practice scores were categorized into two groups, with associations between knowledge, attitude, and practice with sociodemographic and health characteristics assessed using Logistic Regression. Results: This study analyzed data from A random sample of participants who arrived at the hospital for various reasons regarding their perceptions, attitudes, and responses towards myocardial infarction. The mean age was 42 ±19 years, with 54% being male and 46% female. Hypertension was the most common comorbidity, followed by dyslipidemia and diabetes. Over half of the respondents had no formal education, and only 3.8% had a smoking history. About 5.7% had a previous history of myocardial infarction. The mean knowledge score was 11.07 ± 0.697, with 53.35% of respondents not knowing enough about myocardial infarction. The majority of the patients showed a favorable attitude, but only a slight majority could recognize symptoms of myocardial infarction. The majority of the patients had inadequate practice and behavior, with 53.6% not practicing regularly or engaging in sports. Conclusion: The research highlights gaps in Mogadishu's Somali community's knowledge and practices regarding myocardial infarction. It emphasizes the need for health education, primary care, and community involvement to improve cardiovascular health awareness and reduce MI incidence.
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Diabetes Mellitus , Hipertensão , Infarto do Miocárdio , Humanos , Feminino , Masculino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Somália/epidemiologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologiaRESUMO
INTRODUCTION: Pseudoaneurysm of the brachiocephalic artery is a rare condition that can occur as a result of various causes, including trauma, iatrogenic injury, and infection. The clinical presentation of brachiocephalic artery pseudoaneurysms can vary depending on the size and location of the pseudoaneurysm. The treatment options for innominate artery pseudoaneurysms include both surgical and endovascular approaches. Our goal of the study is to increase awareness and early detection of blunt injuries in the chest, clavicle, or sternoclavicular joint that may cause a vascular injury. CASE PRESENTATION: We present here A 24-year-old male came to present with an acute onset of dyspnea, stridor (an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway), a worsening cough, and chest pain that had been worsening over several months. His medical history was significant for blunt chest trauma secondary to a bicycle fall 3 months earlier. DISCUSSION: A traumatic giant pseudoaneurysm of the innominate artery is a rare but potentially life-threatening condition. Treatment options for brachiocephalic artery pseudoaneurysm include both endovascular and surgical approaches. This case report contributes to the current literature when any patient has a blunt injury in the chest, clavicle, or sternoclavicular joint and is highly suspect of a vascular injury. To increase awareness, we first need to exclude if there is any vascular injury, which helps to detect it early and intervene. CONCLUSION: Brachiocephalic artery traumatic large pseudoaneurysm is an uncommon but potentially fatal disorder that can arise from a number of different sources. Achieving favorable results requires prompt diagnosis and proper care, which may include open surgical repair and endovascular procedures. To better comprehend the condition and optimize its management approaches, more investigation and case studies are required.
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Atrioventricular valve parachute deformity is rare and is generally seen in the mitral position, called the parachute mitral valve. It is rare to see it in the tricuspid valve and up to now, there have been approximately 14 cases of parachute abnormalities in tricuspid valves in a literature review. We present here a 21-year-old male who presented to the emergency department with progressive shortness of breath over several months. Despite the absence of chest pain, palpitations, or weight changes, examination revealed a soft, holosystolic murmur at the left lower sternal border. Further investigation through electrocardiogram and echocardiogram identified a rare structural abnormality known as parachute tricuspid valve, resulting in significant tricuspid regurgitation with mild right chamber enlargement. The patient was recommended to go abroad for further management since a cardiothoracic surgeon is not available in our country.
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Spontaneous coronary artery dissection is described as the intramural bleeding that separates the layers of an epicardial coronary artery wall, either with or without an intimal tear. Atherosclerosis, iatrogenic damage, or trauma are not linked to this syndrome. Here we present a 28-year-old male with 1 month history stroke but no any chronic disease as well family history of heart disease who presented with 2 days' duration of typical cardiac chest pain. Based on an emergency electrocardiogram that showed biphasic T-wave inversion with ST-elevation myocardial infarction, the patient was taken to the a catheterization laboratory(cath-lab), with the result of spontaneous coronary artery dissection of the left anterior dissenting artery with thrombolysis in myocardial infarction flow grade 0 and normal of other vessels. Then we successfully did angioplasty, and the patient was discharged with aspirin 100 mg 1 × 1, clopidogrel 75 mg 1 × 1, and rivaroxaban 20 mg 1 × 1.
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INTRODUCTION: Penetrating cardiac injuries are a significant challenge for surgeons and can have varying outcomes depending on factors such as initial care, characteristics of the wounds, and surgical management. These injuries can result from both stab wounds and gunshot wounds, with different mortality rates associated with each. Life-threatening illnesses include penetrating injuries to the heart. CASE PRESENTATION: We present here A 4-year-old child who was injured by a pencil while running and falling on the ground presented to our emergency room with a piercing injury in the right third ICS. She was awake but had trouble breathing when they got there. DISCUSSION: Penetrating cardiac injuries can also occur as a result of intentional penetration or accidental direct penetration of foreign bodies into the heart. The main pathophysiological determinant for most survivors is acute pericardial tamponade, which can lead to shock and hemodynamic instability. This case report contributes to the current literature when any patient has a penetrating injury in the cardiac box and is highly suspect of a cardiac injury, regardless of the material of the injury. To increase health education among people, never try to remove any material stuck in the body until the patient has a suitable place and equipment. CONCLUSION: Penetrating cardiac injuries are severe and life-threatening conditions that require prompt diagnosis and management, which in most cases need surgical treatment is required. To improve outcomes for patients with penetrating heart injuries, further research and improvements in diagnostic and treatment methods are required.
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A spontaneous coronary artery dissection (SCAD) is a tear that forms in a blood vessel in the heart without any obvious underlying etiology. It could be a single vessel or multiple vessels. We present a 48-year-old male known to be a heavy smoker without any chronic diseases or family history of heart disease who presents to the cardiology outpatient clinic with shortness of breath and chest pain on exertion. Electrocardiography demonstrated ST depression with T wave inversion of anterior leads, while echocardiography of the patient showed left ventricular systolic dysfunction with severe mitral regurgitation and mildly dilated left chambers. Based on his risks for coronary artery disease, his electrocardiography, and echocardiography, the patient was referred for elective coronary angiography to exclude the possibility of coronary artery disease. The angiography was done with the result of multivessel spontaneous coronary artery dissections involving the left anterior descending artery (LAD) and circumflex artery (CX) with a normal dominant right coronary artery (RCA). Due to the multi-vessel involvement of the dissection and the high risk of extension of the dissection, we preferred conservative management, including smoking cessation and heart failure management. The patient is doing well with regular heart failure treatment in cardiology follow-up.
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Background and Aims: The etiological investigation of the potential cardiac source of acute ischemic stroke is important for the secondary prevention of recurrent and future embolization. Transthoracic echocardiography is one of the most useful investigations for the assessment of the potential cardiac etiology of ischemic stroke. Our aim is to evaluate echocardiographic findings in patients with acute ischemic stroke admitted to a tertiary care hospital in Mogadishu, Somalia. Methods: This was a retrospective observational study conducted in the neurology department of a tertiary care hospital in Mogadishu, Somalia. We enrolled 315 patients with acute ischemic stroke admitted to the hospital who had undergone transthoracic echocardiography between March 2019 and March 2022. We analyzed transthoracic echocardiography findings, ischemic stroke subtypes, and their associated comorbidities. We also compared the demographic data, comorbidity, and survival status of patients with abnormal echo findings to those with normal echo findings. Findings: The mean age of patients was 62±12 years. Co-morbidities were present in about 251 (80%) of the subjects, hypertension was the most common comorbidity 99 (31.4%), followed by diabetes 72 (23%), and hyperlipidemia 37 (11.7%). Overall cardiac pathology in this study was 170 (54%). Forty-seven (15%) of the patients had low ejection fraction on transthoracic echocardiography. Male patients had slightly less left ventricular systolic dysfunction than female patients. 100 (32%) had left ventricular diastolic dysfunction (LVDD), while 113 (36%) had left ventricular hypertrophy (LVH). Patients with hypertension and diabetes had more echo abnormalities compared to others (P-values of 0.047 and 0.024, respectively). More abnormal echo findings were seen in patients who died during hospitalization than in those who survived (P = 0.008). Severe left ventricular systolic dysfunction was associated with higher mortality (P < 0.001). Conclusion: Most patients with stroke in this study had abnormal echocardiograms; however, only a few had cardioembolic strokes. Abnormalities in echocardiography were more common in patients who died during hospitalization than in those who survived.
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New oral anticoagulants (NOACs) have become more popular in the last few decades. Although apixaban has been proven to be safer than warfarin and causes less hemorrhage in comparison to other NOACs, it still poses a risk of spontaneous bleeding. We present here an 81-year-old male known case of heart failure with reduced ejection fraction (HFrEF) associated with an apical thrombus of 0.93×1.29 cm who presents with cognitive decline, slurred speech, and right side weakness following apixaban use for his apical thrombus. On further evaluation of non-contrast brain computerized tomography (CT), there was a large extra-axial subacute subdural hematoma with thick septations in the left parietal region, measuring 2.6 cm in thickness, causing an a mass effect, and an a midline shift of 1 mm. Following neurosurgery, cardiology, and anesthesiology discussions, the surgery was deferred due to his age and coexisting conditions with regular follow-ups. The patient has now gained full consciousness and is currently undergoing physiotherapy. This case highlights an elderly patient with apixaban-induced subdural hemorrhage, which is a rare entity in the medical literature. Although apixaban is safer than other NOACs, it may cause subdural hemorrhage.
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Intensive care for a hypertensive mother with preeclampsia or eclampsia is crucial for both maternal and neonatal outcomes. This study highlights the level of morbidity and mortality among women with preeclampsia and eclampsia admitted to the intensive care unit. Methods. This retrospective study was conducted in Mogadishu, Somalia, at the Mogadishu Somali Türkiye Training and Research Hospital from February 2019 to July 2022. The study focused on the different complications, managements, and final outcomes of preeclampsia and eclampsia mothers admitted to the intensive care unit. The data was retrieved from the electronic records of patients admitted to the intensive care unit. Results. During our study period, a total of 237 patients were identified as having preeclampsia/eclampsia, of whom 71 required intensive care admission. The mean age of the studied patients was 25 ± 6 years. The most common reason for being taken to the intensive care unit (ICU) was having a seizure (n = 33, 46.5%), followed by having very high blood pressure (n = 20, 28.2%), and being confused (n = 18, 25.3%). Peripartum infection was the most common maternal complication during ICU admission (66.7%), followed by cardiac-related arrhythmia (66.7%), postpartum bleeding (48%), acute kidney injury (18.4%), HELLP syndrome (16.4%), severe anemia (9.6%), and stroke (8.7%). Among patients, 65 (91.5%) needed mechanical ventilation. About 11.1% of these patients died during hospitalization. There were associations between mortality and some complications, particularly acute kidney injury (p value less than 0.02) and peripartum infection (p value less than 0.003). Conclusion. Hypertensive disease of pregnancy (preeclampsia/eclampsia) requiring intensive care unit admission has a very high morbidity and mortality rate.
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Massive pulmonary embolism (PE) combined with right atrial (RA) thrombus is associated with significant mortality. Hemodynamic collapses, which can manifest as hypotension, severe dyspnea; cyanosis, syncope, shock, and right ventricular heart failure are the hallmark of massive PE. Moreover, hemodynamic collapse can be the earliest clinical presentation and the most common cause of death in the first days. Although fibrinolytic therapy has contraindications; exclusion is necessary to minimize bleeding risk, but it can be lifesaving and prevent complications such as shock, right ventricular heart failure, and multi-system organ failure. Here, we report a 70-year-old woman who has an atypical presentation of sudden onset of a persistent hiccup for 8 hours diagnosed with massive pulmonary embolism with multiple free floating thromboses in the right atrial and right ventricle which has been successfully treated with systemic fibrinolytic. Furthermore, the patient was given a Tenecteplase as a last resort to save her life due to the unavailability of the catheter or surgical embolectomy besides an absolute contraindication for thrombolytic.
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Constrictive pericarditis is an uncommon complication of acute pericarditis, mainly caused by non-idiopathic sources. Pneumopericardium is the presence of air in the pericardial sac resulting from various procedures and circumstances, including trauma, iatrogenic, non-iatrogenic and natural causes. Here, we report a 16-year-old girl who came to the cardiology outpatient complaining of weakness, abdominal distention and shortness of breath while lying down and exertion. An echocardiography evaluation revealed a thickened precordium and massive pericardial effusion. Pericardiocentesis was performed for diagnosis and treatment purposes. Despite the patient's remaining symptomatic and having no improvement following the procedure, we decided to perform chest computed tomography, which revealed a thickened pericardium with pneumopericardium. Partial pericardiectomy was performed successfully, and the sample was sent to the pathology department, which confirmed tuberculous constrictive pericarditis. The patient's symptoms improved, and she was discharged on postoperative Day 5 standing on her foot.
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Introduction: and importance: Isolated left ventricular noncompaction cardiomyopathy (LVNC), uncommon type of primary hereditary cardiomyopathy. It is a spongy morphological appearance of the myocardium that occurs largely in the LV. Case presentation: We discuss here a case of 19 years old female with no known past medical history who present with Shortness of breath (SOB) and left sided weakness following delivery.Bedside Echocardiography demonstrated Left ventricular trabiculation with reduced ejection fraction. While brain Computed tomography showed acute ischemic stroke primly due to non-compaction cardiomyopathy as the embolic. Patient was discharged after successfully managed. Clinical discussion: Left ventricular non-compaction cardiomyopathy (LVNC) is characterized by progressive ventricular trabeculation and deep intratrabecular recesses caused by the functional arrest of myocardial maturation, which is a rare case of congenital cardiomyopathy. Our patient had isolated non-compaction cardiomyopathy of the type that was complicated by an acute ischemic stroke and was treated accordingly. Conclusion: It is usually associated with congenital heart disease, but isolated left ventricular non-compaction cardiomyopathy is very uncommon.