Cardiovascular Diseases

All Items

• New-onset cardiac amyloidosis while in remission from systemic AL amyloidosis Abiodun Idowu, Lillian Tung, Catherine Chu, Jamario Skeete, Agne Paner, Tochukwu Okwuosa Views: 456 HTML: 65 PDF: 294

  In light chain amyloidosis, a reduction in dFLC to below 40 mg/l is a prerequisite for organ recovery as nearly half of the patients who achieve very good partial haematological responses have improvement in the function of the involved organ. We describe a patient who developed new-onset cardiac amyloidosis despite a post-treatment reduction in dFLC to <10 mg/l.

• Cardiogenic shock associated with acute norovirus gastroenteritis: what is needed to prove causality? Abbie Evans, Juthipong Benjanuwattra , Barbara Mora, Mahmoud Abdelnabi Views: 1234 HTML: 227 PDF: 479

  Acute myocarditis is a well-recognized condition attributable to a variety of viral illnesses. Common viral aetiologies include enteroviruses including coxsackie, adenovirus, influenza, echovirus, parvovirus B19 and herpesvirus. A high index of suspicion, early diagnosis, and prompt management with supportive anti-failure measures, and in selected cases immunosuppressive therapies including high-dose steroids, might be considered for better outcomes. The authors report a case of sudden onset of acute heart failure complicated by cardiogenic shock caused by viral myocarditis in a patient who initially presented with norovirus gastroenteritis. She had no previous cardiac history or significant cardiovascular risk factors. Prompt medical management for cardiogenic shock for norovirus-induced myocarditis was started, her symptoms gradually improved, and she was discharged safely on regular follow-up.

• A pregnant woman with an extra cardiac cavity: an acquired iatrogenic complication— A case report and literature review Leila Bigdelu, Ossama Maadarani Views: 361 HTML: 60 PDF: 294

  According to the modified World Health Organization (WHO) classification, mechanical valves pose a high maternal risk and complications for pregnant women with heart disease. Left atrial appendage aneurysm (LAAA) is a rare condition that can manifest clinically in several ways or remain silent for a long time and can be either congenital or acquired. We present the case of a pregnant woman who had a LAAA discovered several years after her last mitral valve replacement.

• Anterior thalamic ischaemic stroke secondary to cardiopulmonary arrest João Luís Cavaco, Francisco Capinha, Maria José Pires, Ana Furão Rodrigues, Ana Oliveira Pedro, António Pais de Lacerda Views: 334 HTML: 76 PDF: 279

  Introduction: Ischaemic anterior thalamic lesions are rare and can present with disturbances of behaviour and memory. We describe a patient with post-cardiac arrest thalamic stroke.

  Case description: A 63-year-old man presented with cardiac arrest, was resuscitated after receiving life support, and showed no lesions on computed tomography. Three days later, he presented with short-term memory disturbance and disorientation, with a de novo anterior thalamic lesion.

  Conclusion: The anterior thalamic nucleus, supplied by the posterior communicating artery, is part of the Papez circuit and has a role in modulating behaviour and memory. An anterior thalamic syndrome presents with no sensory-motor deficits.

• Aortic dissection in a patient with novel frameshift COL5A1 variant of classical Ehlers-Danlos syndrome Lídia Caley, Ana Campar, Teresa Mendonça, Fátima Farinha Views: 361 HTML: 107 PDF: 308

  Classical Ehlers-Danlos syndrome (cEDS) is one of the 13 subtypes of Ehlers-Danlos syndrome, which has the major clinical criteria of hyperextensibility skin, atrophic scars, and generalised joint hypermobility. The occurrence of aortic dissection has been described in some subtypes of Ehlers-Danlos, but it has a rare association with the cEDS subtype. This case report discusses a 39-year-old female with a past medical history of transposition of great arteries with a Senning repair at the age of 18 months and controlled hypertension with medication, who presents a spontaneous distal aortic dissection. The diagnosis of cEDS was made using the major criteria, and a novel frameshift mutation in COL5A1 was discovered. The reported case emphasises that in patients with cEDS, vascular fragility may be a complication.

• Dalbavancin for Successful Treatment of Infective Endocarditis Caused by Enterococcus faecalis Francisco Javier Teigell Muñoz, María Mateos-González, Elsa Bernal-Hertfelder, Ana Sánchez de Torre, María García-Ferrón, Carmen de Cáceres Velasco, Coralia Bueno Muiño Views: 577 HTML: 79 PDF: 396

  Infective endocarditis is a relatively uncommon infection that requires a high index of suspicion, which can sometimes delay its diagnosis. It requires several weeks of intravenous antibiotics, which traditionally requires long hospital stays. Dalbavancin is a novel antibiotic with high activity against several Gram-positive pathogens. Its weekly administration allows the outpatient management of complicated infections requiring parenteral treatment, but only a few cases of Enterococcus faecalis endocarditis treated with dalbavancin have been reported in the literature. We here report a case of successful treatment with dalbavancin of an infectious endocarditis caused by E. faecalis.

• Inferior Vena Cava Atresia: A Rare Vascular Malformation Telma Alves, Diogo Leal, Ricardo Rodrigues, Carolina Terra, Sandra Santos, Joana Cascais Costa, Fàtima Silva Views: 580 HTML: 64 PDF: 327

  Inferior vena cava (IVC) atresia is a rare congenital vascular malformation. We describe the case of a 20-year-old woman with IVC atresia who presented with a 3-month history of fatigue, oedema of the lower limbs and episodes of lipothymia. Transthoracic echocardiography and cardiac catheterization were performed, revealing interruption of the IVC with circulation through the azygos and hemiazygos system. An abdominal and pelvic computerized tomography (CT) scan confirmed the findings, demonstrating the absence of the IVC below the renal veins. Blood tests did not reveal any relevant results. These findings are consistent with the diagnosis of IVC atresia, a rare condition with no standard treatment. As a surgical approach was not possible, pharmacological measures were implemented for primary prevention of possible thrombotic events.

• Pain Management Options in a Patient with Livedoid Vasculopathy and Peripheral Neuropathy Nageshwari Palanisamy, Justine Chinnappan, Ghassan Bachuwa Views: 502 HTML: 215 PDF: 451

  Livedoid vasculopathy (LV) is a rare clinical condition presenting as painful lesions mostly on the lower extremities. We present a case of LV with peripheral neuropathy in a young man initially misdiagnosed and treated for cellulitis. He was started on aspirin, pentoxifylline and apixaban immediately after the diagnosis of LV. However, pain management was a real challenge for the clinicians. Hence, he was later treated with epoprostenol and amlodipine for vasodilation, steroids for any possible inflammation, and antibiotics to treat superimposed infection. Irrespective of all the above, his pain was uncontrollable, and he finally received ketamine infusions along with narcotics, achieving better pain control. Various studies support the use of intravenous immunoglobulin and anti-TNF agents for pain relief in idiopathic and secondary LV. Intermittent low-dose dabigatran has also been found to be effective in the maintenance of remission in LV. However, no large studies have yet been conducted to confirm the efficacy of these medications.

• Thrombolysis Through Punctured Coronary Balloon and 014 Wire Mediated Guitaring After IVC Filter Insertion in Iliofemoral Deep Vein Thrombosis Mark Christopher Arokiaraj Views: 339 HTML: 49 PDF: 335

  This is a report of a patient who presented with iliofemoral deep vein thrombosis, and was treated with pharmaco-invasive and pharmaco- mechanic methods using coronary balloon and mechanical disruption of clots with coronary 014 wire.
  A 65-year-old male presented with acute deep vein thrombosis extending from the left common iliac to the popliteal vein. The patient had signi cant swelling and pain. An inferior vena cava (IVC) lter was inserted, and catheter-directed thrombolysis was planned. A technical difficulty was encountered entering the proximal common iliac vein. Hence, a 014 balance middle weight (BMW) wire with coronary balloon support was introduced through a Cordis® 6 F. diagnostic catheter, and the 014 wire was advanced with guitaring technique up to the femoral vein. Thereafter, the coronary balloon was ruptured at high pressure, and thrombolysis using streptokinase was performed along the balloon tract up to the ostium of the common iliac vein. The patient symptomatically improved signi cantly and is currently on anticoagulants. Follow-up after one year showed minimal residual oedema, and less pain in the ankle region.
  Pharmaco-mechanical treatment is possible using coronary balloon dilatations and thrombolysis through a ruptured coronary balloon. Mechanical disruption of clots to some extent is feasible using 014 wire by a guitaring technique.

• Abiotrophia defectiva Endocarditis: A Rare Cause with Aggressive Systemic Embolisation and Need of Valve Replacement Ana Cochicho Ramalho, Sofia Marques Santos, João Abecasis, Rui Rodrigues , Francisco Araujo , Helena Cantante Views: 354 PDF: 385 HTML: 62

  Infective endocarditis (IE) is a well-described infectious disease, one with increased morbidity and mortality being the third or fourth most common life-threatening infection syndrome.
  Abiotrophia defectiva is a non-motile, catalase negative, Gram-positive coccus in a chain, which can be isolated from the oral cavity, intestinal, and genitourinary tracts. IE due to this agent is rare and associated with heart valve destruction, congestive heart failure, and high embolisation rates, these being the major mortality causes.
  We present a case of IE due to this agent, complicated with a stroke, and splenic and renal infarction, with the need for aortic valve replacement. 
  This article highlights the gaps of knowledge left by the rarity of this disease, which range from its diagnosis to its treatment, and what we need to mitigate such gaps, supported with a case description of a successful treatment of this infection.