Tako-Tsubo Syndrome Triggered by a Fibroscopy: Case Report.

Tako-Tsubo cardiomyopathy, also called stress cardiopathy, is a rare syndrome characterized by transient regional systolic dysfunction. It can mimic myocardial infarction but the absence of coronary obstruction allows to redress the diagnosis. Its pathogenesis is not well understood. However, the role of physical or emotional stress has often been associated with this pathology. Here we report, a rare case of a 63-year-old female, with no cardiac risk factors, who presented Tako-Tsubo syndrome after a fibroscopy. This case aims to show that Tako-Tsubo syndrome should be suspected in patients, especially women, with no cardiac risk factors, who present acute chest pain in the context of physical or emotional stress, after excluding differential diagnoses.

Rare case of cardiac angiosarcoma and alveolar hemorrhage in an adolescent patient initially suspected COVID19 infection: A case report and literature review.

Primary cardiac tumors are a rarity, and sarcomas emerge as the prevailing form of primary malignant cardiac tumors across age groups, encompassing both children and adults. Within this category, angiosarcoma stands out, constituting around 31% of all primary malignant cardiac tumors. Primary cardiac angiosarcoma displays a notably aggressive nature, characterized by early systemic metastasis, and is accompanied by a generally unfavorable prognosis. We describe a case concerning a previously healthy teenage girl who displayed persistent constitutional symptoms and hemoptysis for 15 days. Subsequent investigation uncovered alveolar hemorrhage, ultimately linked to a cardiac angiosarcoma. The difficulty in this instance arose from the vague nature of the initial symptoms, posing a challenge to promptly and accurately diagnose the condition. This case highlights the aggressive nature of primary cardiac angiosarcoma. The vague initial symptoms underscore the need for early detection and optimized treatment to improve the generally unfavorable prognosis associated with this condition. Increased awareness and a multidisciplinary approach are crucial in addressing the diagnostic and therapeutic challenges posed by primary cardiac angiosarcoma.

Spontaneous coronary artery dissection (SCAD): a case report.

Spontaneous coronary artery dissection (SCAD) is often revealed by an acute coronary syndrome classified then as a MINOCA. The typical patient is a female patient with no or few cardiovascular risk factor. Our work aims to illustrate the effectiveness of medical treatment in patients with SCAD. Case Report: We report a case of a 56-year-old female patient who was admitted after 3 days of infarct-like thoracic pain related to an anterior extended ST-elevation myocardial infarction. The coronarography showed a SCAD of the left anterior descending coronary artery. The patient was discharged under medical treatment. Six weeks later, coronarography showed a perfused coronary artery. Discussion: Most cases of SCAD present as acute coronary syndrome. Coronary angiography remains the 'first-line' examination. The use of endocoronary imaging such as IVUS and optical coherence tomography is necessary in case of diagnostic doubt (especially in SCAD type 2 and 3). The optimal management of SCAD remains unclear. A conservative approach should be the preferred strategy. Conclusion: SCAD should be considered in any young woman presenting with suspicious chest pain with positive troponin. The diagnosis is initially angiographic and may require endocoronary imaging for greater accuracy. Conservative treatment remains the best option.

Pulmonary tumor embolism secondary to urothelial carcinoma of urinary bladder: case report and literature review.

BACKGROUND: Tumor embolism is the least well-described cause of pulmonary embolism, taking into account the non-specificity of radiographic and nuclear imaging results, the necessity of anatomopathological evidence and the frequency of deep venous thrombosis in the course of solid tumors, suggesting thus thromboembolism. CASE PRESENTATION: We report a rare case of urothelial carcinoma of the urinary bladder associated with persistent pulmonary embolism despite being on different anticoagulation regimens, the patient was ultimately found to have tumor thrombus in the pulmonary trunk secondary to tumoral extension. We provide a literature review as well about the diagnosis, evaluation and prognosis and of this rare clinical entity. CONCLUSIONS: Our case highlights the importance of keeping this unusual etiology in mind, particularly when faced with pulmonary embolism occurring in the context of a solid tumor and the ineffectiveness of various anticoagulation protocols. Furthermore, it emphasizes the pivotal role of cytology in confirming diagnosis and guiding therapy.

Complex Coronary Artery Fistula in a Young Adult: Not Seeing the Wood for the Trees.

Coronary artery fistulas (CAFs) represent rare congenital anomalies that exhibit a wide range of clinical implications and a heightened risk of complications. It is imperative to accurately identify and delineate these fistulas to avoid missed diagnoses and to recommend suitable therapeutic measures. We present the case of a 46-year-old obese woman who was hospitalized for chest pain associated with palpitations. Clinical examination and ECG results were within normal limits. A 24-hour ECG holter revealed paroxysmal atrial fibrillation. Transthoracic echocardiography revealed a systolodiastolic aliasing originating from the aorta and coursing along the right atrium. Transesophageal echocardiography and coronary angiography confirmed this finding. The diagnosis of a voluminous and tortuous coronary-cameral fistula was established through coronary CT angiography with 3D reconstruction images. A positive stress test indicated the need for surgical closure, given the size and aneurysmal nature of the fistula. However, the patient unfortunately passed away two days after the surgery. This case highlights the critical need for precise identification and management of CAFs. The patient's unfortunate post-surgical outcome underscores the complexity and risks associated with these anomalies, emphasizing the ongoing need for improved treatment strategies and research in this area.

A case report of a primary pericardial leiomyosarcoma: An extremely rare cardiac neoplasm.

Introduction and importance: Primary malignant pericardial tumors are an entity that is infrequently encountered and may be a cause of pericardial effusion. Primary pericardial leiomyosarcoma are even rarer, and highly aggressive tumors, with no more than 200 cases reported in the literature. In this case report, we are presenting a rare case of a primary pericardial leiomyosarcoma that was diagnosed at our institution. We discuss the available diagnostic modalities and also shed light on alternative therapies when patients are not ideal surgical candidates. Case presentation: A 27-year-old male patient was admitted with a gradually worsening dyspnea associated with a deterioration of general condition. Echocardiography examination showed a circumferentiel pericardial effusion with significant fibrin deposits and pericardial thickening. An open surgical biopsy of the pericardium was indicated which was in favor of the diagnosis of pericardial leiomyosarcoma. Unfortunately, the patient died during the procedure. Clinical discussion: Despite its rarity, primary pericardial leiomyosarcoma should be considered as a differential diagnosis in the assessment of a pericardial effusion of an unknown etiology. Cardiac magnetic resonance imaging is considered to be the reference standard technique for evaluation of a suspected pericardial tumor. Surgical biopsies provide the best odds for detection of the cell of origin, but it's fought with periprocedural risks depending on the site of the tumor. Conclusion: Primary pericardial leiomyosarcomas appear to have a poor prognosis. Surgical approach is the primary modality of treatment. Chemotherapy and radiotherapy should be offered to patients who are not ideal surgical candidates.

Essential thrombocythemia and aortic dissection,causal or incidental association?

Only few cases of vascular dissection and essential thrombocythemia association have been reported. To the best of our knowledge, we reported the second case of aortic dissection and essential thrombocythemia association in a 60-year-old man with positive JAK2V617F mutation who had no history of hypertension or connective tissue disorders. Through this case, we discussed the eventual existence of a causal relationship between the two conditions. We also suggested the use of hydroxyurea as a prevention treatment of thrombosis in myeloproliferative neoplasms.

Cerebellar stroke complicating coronary catheterization: a case report.

Cerebrovascular events are rare but devastating events that can complicate any coronary intervention. In the vast majority of cases, they involve major cerebral arteries. We report the case of a 56-year-old woman admitted for unstable angina associated with severe left systolic dysfunction. She developed moderate cerebellar stroke while undergoing percutaneous coronary intervention, with a national institutes of health stroke scale score of 5. Immediate systemic thrombolysis was performed, but her neurological status deteriorated. A large hemorrhagic transformation was then diagnosed, and she died despite surgical intervention. Periprocedural strokes are marred with high morbidity and mortality, therefore preventionis key, as many risk factors can be controlled or mitigated. Our patient presented many of these factors; they can be procedure-related (transfemoral approach, anticoagulation) or patient-related (age, diabetes mellitus, uncontrolled hypertension, diffuse atherosclerosis).

[How to differentiate COVID-19 pneumonia from heart failure? A case report]. / Comment différencier une pneumonie COVID-19 et un œdème aigu du poumon? À propos d'un cas.

We report the case of a 64-year-old patient with a history of coronary artery disease and severe left ventricular dysfunction ischemic requiring medical therapy only admitted for dyspnea. The association of heart failure with COVID-19 pneumonia is discussed. The distinction between these two pathologies is based on a set of clinical, biological and radiological arguments.

Myocardial Infarction Caused by an Enclosed Thrombus in a Patent Foramen Ovale.

Paradoxical embolism in coronary artery is a rarely diagnosed clinical entity. In the majority of reported cases; the diagnostic of this pathology is « presumptive ¼ based on certain criteria. It can be considered "proven" when the embolus is found lodged in the abnormal communication between the venous and arterial circulation; which is very rare. We herein report a case of myocardial infarction caused by a proven paradoxical coronary embolism through a patent foramen ovale. The authors highlight through this paper the contribution of echocardiography and particularly trans-esophageal echocardiography, especially if performed soon after presentation, for early diagnosis.

Acute coronary syndrome with non ST segment elevation myocardial infarction revealing anomalous connection of the left anterior descending artery.

The occurrence of an acute coronary syndrome (ACS) with an anomalous connection of coronary artery (ANOCOR) identified as a culprit artery is very rare. This association may lead in some anatomical forms to a delay in coronary reperfusion. We report the clinical case of a patient admitted for high-risk Non ST elevation myocardial infarction (NSTEMI) in whom coronary angiography accidentally discovers an anomalous connection of the left coronary network from the right anterior. In light of this case and a review of literature, we discuss the peculiarities of these anomalous connections.

Unexpected normal left ventricular systolic function after total chronic occlusion of left main coronary artery and stenosis of right coronary artery: a case report and review of the literature.

INTRODUCTION: Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function. CASE PRESENTATION: We describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery. CONCLUSIONS: Total occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.

Reoperation for isolated rheumatic tricuspid regurgitation.

BACKGROUND: The reoperation for isolated tricuspid regurgitation in rheumatic population is rare and still unclear and controversial because of the rarity of publications. The aim of this study was to analyze short and long-term results and outcome of tricuspid valve surgery after left-sided valve surgery in rheumatic patients. METHODS: Twenty six consecutive rheumatic patients who underwent isolated tricuspid valve surgery after left-sided valve surgery between January 2000 and January2017 were retrospectively registered in the study. The mean age was 48.2 ± 8.6 years with 8.3% as sex-ratio (M/F). EuroSCORE was 6.1 ± 5 (range 2.5 to 24.1). The mechanism of tricuspid regurgitation was functional and organic in respectively 14 (53.8%) and 12 cases (46.2%). Ten patients (38.5%) had previous tricuspid valve repair. Surgery consisted of 15 ring annuloplasty and 11 tricuspid valve replacement (5 bioprostheses and 6 mechanical prostheses). Follow-up was 96.1% complete, with a mean follow-up of 55.6 ± 38.8 months (range 1 to 165). RESULTS: The operative mortality rate was 15.4% (n = 4) and the cumulative survival at 1, 5 and 10 years was respectively 80% ± 8%, 75.6% ± 8.7% and 67.2% ± 11.1% with no significant difference at 8 years between tricuspid valve replacement (80% ± 12.6%) and repair (57.6% ± 16.1%) (p = 0.5). Multivariable Cox regression analysis revealed that ascites (HR, 5.8; p = 0.01), and right ventricular dysfunction (HR, 0.94; p = 0.001) were predictors of major adverse cardiac events. There were no recurrence of tricuspid regurgitation and no structural or non-structural deterioration of valvular prostheses. CONCLUSION: The reoperation of rheumatic tricuspid regurgitation should be considered before the installation of complications such as right ventricular dysfunction and major signs of right heart failure. Despite the superiority of repair techniques, tricuspid valve replacement should not be banished.

[Myocardial infarction in patients with diabetes: comparative series of 85 patients with 16 patients without diabetes]. / Infarctus du myocarde chez le diabétique: présentation d'une série de 85 patients diabétiques comparée à 106 patients non diabétiques.

OBJECTIVES: The aim of this study was to determine the clinical characteristics, treatment and development of myocardial infarction in patients with diabetes. METHODS: From September 1999 through December 2003, 191 patients with myocardial infarction were hospitalized in the cardiology department of the Mohamed V military teaching hospital in Rabat, Morocco. They included 85 patients with diabetes (D) and 106 without it (ND). RESULTS: Comparison of these two groups showed a higher percentage of women among the patients with diabetes. Hypertension was more frequent in patients with diabetes, while smoking was frequent in both groups. The clinical picture was similar in both groups, as was the frequency of left ventricular dysfunction, determined by transthoracic echocardiography. Coronary angiography showed damage in three arteries was more common in the D group, while single-artery damage was more frequent in the ND group. Treatment was similar in both groups. In all, 49 patients underwent myocardial revascularization, and its method (angioplasty or aortic surgery) did not differ by group. Neither hospital mortality nor other complications differed between the two groups, with a follow-up of 3.98 +/- 1.99 years for ND patients and 2.68 +/- 1.32 years for D patients. CONCLUSION: Correct management of myocardial infarction and its cardiovascular risk factors, development of means of revascularization, and close collaboration between cardiologists and endocrinologists should improve prognosis for patients with diabetes who have myocardial infarctions.