Acute right heart failure in a patient with right heart thrombus and pulmonary thromboembolism

Right Heart Thrombus (RiHT) management is really controversial, and appropriate guidelines are not present for the management. In patients referring with RiHT and Pulmonary Embolism (PE), there are three ways of managing these patients. Out of the three one is thrombectomy which is with high risk taking in mind the comorbidities these patients have. The other is using thrombolytic which, in many cases is contraindicated or with high risk. The other less effective way is full anticoagulation. It is really controversial to choose between these ways of management and no clear approach is present. The case presented is a 44-year-old morbid obese male with history of dyspnea on exertion (functional Class II) and foot oedema or the last three months, who was transferred to the emergency department with respiratory distress and hypoxia. Echocardiography was done for the patient which showed moderate Right Ventricular (RV) dysfunction with severe RV enlargement and a severe Tricuspid Regurgitation (TR) with TR gradient of 70mmHg. He also had a semi-mobile large pedunculated mass in favour of a clot in his RV cavity. With the impression of PE heparin was administered to the patient and he was admitted in the coronary care unit. Pulmonary Computed Tomography (CT) angiography showed sub-segmental Pulmonary Thromboendarterectomy (PTE) in the left lung. He had negative cardiac markers and stable vital signs and so full anticoagulation was chosen for his treatment. His clinical course was uneventful and after 10 days of treatment the RV size and function improved significantly. On follow-up after a month he was doing well. Although recent Guidelines of European Society of Cardiology in management of acute PE stated that RiHT, particularly mobile, are associated with a significantly increased early mortality risk in patients with acute PE. Immediate therapy is mandatory, but optimal treatment is controversial in the absence of controlled trials. Thrombolysis and embolectomy are probably both effective while anticoagulation alone seems to be less effective. � 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Acute type A aortic dissection missed as acute coronary syndrome

Although the aortic dissection is not common, its outcome is frequently fatal, and many patients with aortic dissection die before referral to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar to myocardial ischemia. A 66-year-old male referred to our hospital with suspicion of aortic dissection after echocardiography while evaluating for his high blood pressure. He had symptoms of acute coronary syndrome two years before and had done coronary angiography. On presentation to our hospital he had a high blood pressure. On reviewing his past medical history and examining, in the film of coronary angiography, the dissection flap in ascending aorta was identified. Although type A aortic dissection is a catastrophic condition with high mortality and requires prompt surgical treatment but in some cases it may be misdiagnosed as acute coronary syndrome. Sometimes against its high mortality when left untreated, patients survive and are diagnosed later in life incidentally. So it is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with chest pain and the predisposing factors. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Acute myocardial infarction following blunt chest trauma and coronary artery dissection

Blunt chest traumatic coronary artery dissection is an uncommon cause of atherosclerotic and non-atherosclerotic Acute Myocardial Infarction (AMI). Injuries of the coronary artery after blunt chest trauma are caused by different mechanisms such as vascular spasm, dissection and intimal tear or rupture of an existing thrombus formation. Chest pain might be masked by other injuries in patients with multiple traumas in car accident. Present case report is on a 37-year-old male without any specific past medical history who reported to the emergency department of a hospital with chest discomfort and was discharged with the impression of chest wall pain. After three days he experienced severe chest pain and he was admitted with the impression of acute coronary syndrome and underwent coronary angiography which showed Left Anterior Descending (LAD) artery dissection. The possibility of injury of the coronary artery should be kept in mind after blunt trauma to the chest. This condition is sometimes underdiagnosed. Its diagnosis may be difficult because chest pain can be interpreted as being secondary to chest wall contusion or it may be overshadowed by other injuries. Coronary dissection diagnosis after chest trauma requires clinical suspicion and systematic evaluation. Electrocardiography (ECG) should be done for every patient with thoracic trauma as the clinical findings may be misleading. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved

Epidemiological aspects and clinical outcome of patients with rhinocerebral zygomycosis: A survey in a referral hospital in Iran

Introduction: No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran. Methods: This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments. Results: Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6 were female. Among those, 67.2 were diabetic, 26.6 were hypertensive and 29.7 had history of cancer. Different sinuses were infected in 73.4 of the patients. Out of all the patients 26.6 underwent surgical procedures and 17.2 were controlled medically. Extensive debridement was carried out in 40.6. Neutropenia ( 14 days) was found in 60.9. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay. Conclusion: There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment. © Vida Bozorgiet al

Cardiovascular patients in COVID-19 era, a case series, an experience from a tertiary cardiovascular center in Tehran, Iran

Different cardiovascular presentations of coronavirus disease 2019 can be seen because of the systemic involvement. Considering its new presentations, there is need for further studies regarding the mechanistic pathways involved. © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Lt

Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved

Relationship between the pulmonary artery pressure and the occurrence of atrial fibrillation after coronary artery bypass graft surgery

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We selected 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P � 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P �0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. © 2017, Iranian Heart Association. All rights reserved