Ivabradine is used to control heart rate in patients of heart failure with reduced ejection fraction. Although considered safe, it is reported to prolong QTc interval when given with other QTc prolonging drugs or in setting of hypokalemia or hypomagnesemia. Ivabradine causing isolated QTc interval prolongation without any provoking condition is rare. Our patient developed Torsades de Pointes after initiating Ivabradine and her QTc interval reduced after stopping Ivabradine. This may be due to a potential independent dose dependent effect of Ivabradine on QTc interval by its effects on its effects on human Ether-à-go-go-Related Gene (hERG) potassium channels.
Background: Mucormycosis is an invasive fungal infection most commonly seen in immune compromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immune competent individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient with disseminated Mucormycosis who presented as rhino orbital Mucor mycosis with pericardial involvement. Case summary: A 17-year-old female presented with intermittent high-grade fever of 1 month duration. She was diagnosed as Rhino orbital Mucormycosis as evidenced by MRI brain and orbits and biopsy of maxillary sinus. Patient underwent left endoscopic debridement of sinuses and left endoscopic Denker's procedure with left orbital decompression and was treated with Amphotericin B subsequently. During the course of hospitalisation, patient developed large pericardial effusion with cardiac tamponade secondary to invasive mucor infection as evidenced by pericardial fluid culture. Conclusion: Disseminated Mucor mycosis is a rare condition that involves two or more non-contiguous organ systems. Disseminated Mucor mycosis is the least common and the worst prognosis type, and it mostly starts with lesions in the lungs and then disseminates to other sites. Cardiac dissemination of rhino orbital Mucor mycosis, like in our case, is unusual and often diagnosed post-mortem; an antemortem diagnosis is very rare. Cardiac involvement is a rare, yet fatal, complication that can occur in disseminated disease and a strong index of suspicion is necessary for prompt treatment, especially in high-risk patients.
A Patent Foramen Ovale (PFO) with paradoxical right to left shunt is a well-known culprit for conditions like cryptogenic stroke, migraine and de-compression sickness. Till date, there is scanty data on the relationship between right to left PFO shunt and vertigo. Our case highlights the importance of high level of suspicion for coexistence of paradoxically shunting PFO in patients with unexplained dizziness and paroxysmal vertigo.
The Society of Cardiovascular Angiography and Intervention (SCAI) classified cardiogenic shock (CS) into five stages ranging from A-E. There remains significant ambiguity regarding the assessment and management of SCAI Stage B. Given its nebulous nature that can rapidly escalate, prompt interventions are needed. Here, we describe the trajectory of cases that presented with SCAI Stage B CS.
A 32-year-old man presented with recurrent ventricular tachycardia and peripheral eosinophilia. Echocardiogram showed features suggestive of infiltrative cardiomyopathy. A hybrid PET/MR demonstrated the characteristic features of myocarditis, the absence of extra-cardiac FDG uptake, and an endomyocardial biopsy showed the features of eosinophilic myocarditis.
Implantable loop recorders (ILR) are relatively novel tools for the diagnosis and clinical management of patients with cryptogenic strokes, syncope and cardiac arrhythmias. The ILR implantation is considered a minimally invasive and low-risk procedure, however rare complications can occur, including device migration. We present the case of a 60-year-old woman who underwent implantation of the new generation ILR BioMonitor III (Biotronik) as part of recurrent syncope workup. The procedure was unremarkable, without acute complications, except for a sharp and persistent chest pain during and after. While at implantation we could activate the device from standard position, we were not able to connect to the device at control after 1 week despite normal functioning of remote monitoring. Chest X-ray and chest computed tomography at one week confirmed device migration into the left postero-inferior part of the pleural cavity. The device was retrieved during thoracoscopy without further complications.
Hyperthyroidism can lead to thyrotoxic periodic paralysis (TPP), an infrequent yet fatal complication. It leads to a drop in the levels of serum potassium which in turn causes episodes of muscle weakness. This condition is exceptionally associated with respiratory insufficiency and arrhythmias, making it fatal. We present a rare case of a young male presenting with quadriparesis and ventricular tachycardia. A thorough laboratory work confirmed diagnosis of thyrotoxicosis and hypokalemia. This case further strengthens that recognition of TPP well before time is critical for early initiation of treatment.
Pericardial effusions are associated with various etiology, with treatment varying from careful monitoring to pericardiocentesis, particularly in those symptomatic or reaching cardiac tamponade. Pericardial effusion in pregnancy poses a different challenge as treatment decisions can influence both mother and fetus. We reported a case of large hydropericardium with impending cardiac tamponade successfully treated with an emergency cesarian section without urgent pericardiocentesis.
A fistula between the left ventricular outflow tract and left atrium is a very rare phenomenon. In this case report, we will introduce a Marfan patient who underwent an aortic root repair, leading to a complication of a left ventricular outflow tract to left atrium fistula.
A patient presented with acute respiratory failure and shock due to severe prosthetic mitral valve stenosis. A valve-in-valve transcatheter mitral valve replacement procedure was performed via the transeptal approach due to his high-risk presentation with good results.
Background:Coronavirus disease 2019 COVID-19 still remains a major cause of morbidity and mortality worldwide, mainly due to Acute Respiratory Distress Syndrome (ARDS). Nevertheless, other extra-pulmonary pathological aspects of COVID-19, notably cardiovascular, were disclosed as the global understanding of the pathogen agent advanced. Objectives:To detect and evaluate acute myocarditis in patients with active and symptomatic COVID-19 infection. Materials and methods:In this prospective analysis, patients presented with active COVID-19 illness and meeting the inclusion criteria were identified at the University Hospital Complex of Rabat between January and September 2021. Results:Fifteen patients (8 males and 7 females) aged from 17 to 52 were included during the analysis period, the average delay between the confirmation of COVID-19 and the onset of myocarditis symptomatology was 17 days. The symptomatology was dominated by chest pain, unexplained cardiogenic shock and palpitations. The ECG showed essentially diffuse repolarization disorders. The inflammatory markers were significantly disturbed with an elevation of ultra-sensitive cardiac troponin I in all patients. Cardiac MRI showed impaired global longitudinal strain (GLS) myocardial edema, early and late subepicardial Gadolinium enhancement, compared to the control group (p < 0,01). Conclusion:Cardiac involvement was detected in a proportion of patients with active COVID-19. Age, gender, clinical and electrical presentations didn't seem to influence the diagnosis. Cardiac MRI played an essential role for detecting and evaluating active myocarditis. Patients who presented myocardial injury had to have a longer follow-up as current understanding of long-term prognosis is still lacking.
Multiple left ventricular aneurysms (LVAs) are distinctly rare and have varied etiology. Manifestations of these entities are similar to the commonest LVA of ischemic origin. Our case is a young male with multiple LVAs with histological evidence of chronic granulomatous disease, and cardiac imaging suggestive of sarcoidosis, responded well to immunosuppressive therapy.
66yrs old, Male, presented to our hospital with history of low-grade fever of one month duration. Only significant past history was right coronary artery (RCA)stenting done a year ago. Physical examination no localizing signs of fever. Blood culture identified pseudomonas aeruginosa. Electrocardiogram (ECG) showed old inferior wall myocardial infarction changes. Echocardiography (ECHO) detected myocardial abscess along the right atrioventricular groove and vegetation on tricuspid valve. Coronary angiogram showed totally occluded and infected RCA stent with formation of coronary cameral fistula, draining into right atrium. A positron emission tomography (PET) scan and a computed tomography (CT) scan showed increased tracer uptake in RCA stent, peri-stent abscess. Infected stent, artery, and vegetation removed surgically, then graft given to distal RCA. The multi-diagnostic modality helped in identifying this condition early. Timely surgical intervention helped the patient to recover in otherwise life-threatening complication.
Pregnancy poses a significant maternal and foetal risk in women with pulmonary arterial hypertension (PAH). With extremely limited treatment options available, we used Selexipag in addition to tadalafil in managing a pregnancy complicated by PAH. Selexipag may be a promising add-on therapy in this unique subset.
Post-cardiac injury syndrome is an immune-mediated inflammatory process involving the pericardium and, to a lesser extent, the pleura, epicardium, and myocardium. It usually happens following cardiac surgery, myocardial infarction, or cardiac trauma, but can also develop after interventional procedures like transvenous pacemaker implantation. We present the case of an 83-year-old patient who underwent pacemaker upgradation(from VDD to DDR) with fixation of a new atrial screwing lead following the end of the life of the pulse generator. He presented to the emergency department within one week of the procedure with fever, chest pain, worsening respiratory difficulty, new onset pericardial and bilateral pleural effusion, and raised blood inflammatory markers. The patient responded well to anti-inflammatory medication and therapeutic pleural tapping and was subsequently discharged.
Mitral regurgitation (MR) is the leading cause of heart valve disease worldwide. In aging population, the incidence of mitral regurgitation (MR) has gradually surpassed that of aortic valve stenosis. We present a report of 5 cases,with history of rheumatic heart disease and old malfunction bioprosthetic valve, presenting with dyspnea, poor ejection fraction.Investigations revealed severe mitral stenosis and regurgitation. TMVR (trans catheter mitral valve replacement) was done with successful outcome.
