Rheumatic Complete Atrioventricular Block: A Case Report

Acute rheumatic fever is a well-known disease that is still widely observed in developing countries, including our country Morocco. It is known that the majority of patients diagnosed with acute rheumatic fever display abnormalities of the conduction system; However, there are only a few case reports that describe severe impairment in the electrical conduction system. We describe a 21-year-old man who was diagnosed with acute rheumatic fever with complete atrioventricular block. In our patient, the diagnosis of acute rheumatic fever was established. 24-hour electrocardiography showed a paroxistic complete atrioventricular block. Penicillin prophylaxis was made, and salicylate treatment in an anti-inflammatory dose was initiated. The electrocardiographic abnormalities of the patient disappeared. Although rare, this diagnosis should be considered in patients with complete heart block, particularly when it is associated with other features of acute rheumatic fever. Conduction disorders associated with acute rheumatic fever often resolve following appropriate treatment without the need for permanent pacemaker placement

Identification of deep trap levels from thermally stimulated current spectra of semi-insulating CdZnTe detector material

Deep trap levels in the semi-insulating (SI) CdZnTe detector material were characterized by simultaneous multiple peak analysis based on thermally stimulated current (TSC) measurements. In our TSCs that have been published previously electron hole pairs were created through the use of proton beam irradiation. Charge carriers were captured in deep traps and afterward released by thermal emission, which was recorded in the 90–300 K range. We showed that the obtained TSC spectra could be well fitted with a unique set of 14 different deep traps, which were all simultaneously and completely characterized. The obtained trap data are in good accordance with earlier deep trap characterizations of the other authors obtained on similar SI CdZnTe materials using different methods

Scimitar Syndrome Issued from a Consanguineous Marriage: A Rare Congenital Cardiomyopathy

We present here a rare case of Scimitar syndrome on a full-term newborn female issued from consanguineous marriage and diagnosed at the age of two months who was suffering from polypnea since the age of two weeks. She was admitted at the age of two months for polypnea, non-dysmorphic facies, healthy systemic arterial tension, regular pulse, but the family history raises that before her birth, two newborns respectively boy and girl died both at an early age with dilated cardiomyopathy. After hospitalization, we realized chest radiography, which has shown opaque right lung and suspicion of scimitar syndrome. After that, an echocardiogram was performed, showing severe hypoplasia of the right pulmonary artery with pulmonary hypertension. The Thoracic computed tomography confirmed the diagnosis by revealing hypoplasia of the right pulmonary artery with pulmonary arterial hypertension, right pulmonary hypoplasia (bilobar), and abnormal partial right pulmonary venous return toward the vena cava under the diaphragm

Properties of Cd1-xZnx Te crystals grown by High Pressure Bridgman (HPB)

In this paper we present results of a modelling of the current-voltage characteristics of metal/ultra-thin oxide/semiconductor structures with negatively biased metal gate (V<0), when the oxide thickness varies from 45Å to 80Å. We analyze the theoretical influence of the temperature and Schottky effect on the Fowler-Nordheim (FN) conduction. The results obtained show that these influences depend on the electric field in the oxide and on the potential barrier at the metal/oxide interface. At the ambient temperature, the influence on this potential barrier is lower than 1.5%. However, it can reach 45% on the pre-exponential coefficient of the FN current. It is therefore necessary to consider in the FN classical conduction expression a correction term that takes account the temperature and Schottky effects. These results are validated experimentally by modelling the current-voltage characteristics of the realized structures at high field.In this paper we present results of a modelling of the current-voltage characteristics of metal/ultra-thin oxide/semiconductor structures with negatively biased metal gate (V<0), when the oxide thickness varies from 45Å to 80Å. We analyze the theoretical influence of the temperature and Schottky effect on the Fowler-Nordheim (FN) conduction. The results obtained show that these influences depend on the electric field in the oxide and on the potential barrier at the metal/oxide interface. At the ambient temperature, the influence on this potential barrier is lower than 1.5%. However, it can reach 45% on the pre-exponential coefficient of the FN current. It is therefore necessary to consider in the FN classical conduction expression a correction term that takes account the temperature and Schottky effects. These results are validated experimentally by modelling the current-voltage characteristics of the realized structures at high field

Patient with Purulent Pericardial Effusion Revealing Squamous Cell Lung Carcinoma

Bacterial pericarditis is a rapidly progressive infection sown with heavy mortality. It usually occurs as a secondary infection to either a contiguous or hematogenous spread from a distant focus of infection. The primary involvement of the pericardium without evidence of underlying infection disease elsewhere, is sporadic. We present a unique case of a 69 -year-old patient who was diagnosed as having purulent acute bacterial pericarditis caused by Streptococcus pneumonia, revealing an underlying squamous cell lung carcinoma in the cardiology department of IBN ROCHD University hospital of Casablanca

Impact of hemodialysis on P-wave amplitude, duration, and dispersion

Atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing hemodialysis (HD). P wave duration (PWdu) and P wave dispersion (PWdi) have been shown to be predictors of emerging AF in different clinical conditions. We sought to study the impact of HD on PWdu, PWdi, and P wave amplitude in a cohort of patients undergoing HD. Seventeen patients (8 men, 31±10 years) were studied. Echocardiography parameters, the sum of the amplitude of P waves in all 12 ECG leads (SP), mean PWdu, and PWdi, along with a host of other parameters (body weight, heart rate, electrolytes and hemoglobin/hematochrit) were measured 1/2h, before and after, HD. SP increased (11.8±3.9 vs 15.3±4.0 mm, p = 0.004), mean PWdu remained stable (82.7±11.1 vs 81.6±10.5 ms, p = 0.606), PWdi decreased (51.7±19.1 vs 41.7±19.1 ms, p = 0.03), and left atrial dimension decreased (37.96±3.90 vs 30.62±3.38 mm, p = 0.0001), after HD. The change in PWdi correlated with fluid removed by HD (r = -0.55, p = 0.022). Re-measurements of P-wave parameters in a random group of 11 of the 17 patients revealed augmented SP (p = 0.01), and stable mean PWdu (p = 0.36), and PWdi (p = 0.31), after HD. Fluid removed by HD leads to an increase in SP, a stable mean PWdu, and decrease (or stability on re-measurement in a subgroup of patients) in PWdi. Stability of PWdu may be due to the effects of augmentation of the P-wave amplitude and the reduction of the left atrial volume, cancelling each other. Variability of PWdi may stem from the occasional impossibility to measure PWdu (or measure it correctly) in minute P-waves in certain ECG leads, which in turn profoundly affects the PWdi

Diagnostic Value of Transthoracic Echocardiography in Patients with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and sudden death in adults. Transthoracic echocardiography (TTE) plays an important role in early detection and diagnosis of ALCAPA as a noninvasive modality. However, its diagnostic value is not well studied. The purpose of this study is to determine the performance of TTE in the diagnostic assessment of ALCAPA as compared with coronary CT and invasive coronary angiography. A total of 22 patients (13 women and 9 men, mean age, 12.9±19.5 years) with ALCAPA who underwent echocardiographic examination for clinical diagnosis were retrospectively reviewed and analyzed. Transthoracic echocardiographic features of ALCAPA were analyzed and its diagnostic value was compared with invasive coronary angiography and coronary CT angiography (CTA) with surgical findings serving as the gold standard. Surgery was performed in all of the patients to establish the dual coronary artery system. Five underwent the Takeuchi procedure and 17 had re-implantation of the anomalous left coronary artery. Of 20 patients, echocardiographic diagnoses were in good agreement with findings at surgery, resulting in the diagnostic accuracy of 90.9%. Two cases were misdiagnosed-one as the right coronary artery to pulmonary artery fistula and the other as rheumatic heart disease. The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 20 patients; enlargement of the right coronary artery in 17 patients; abundant intercoronary septal collaterals in 17 patients; and moderate and significant mitral regurgitation in 14 patients. The diagnostic accuracy of invasive coronary angiography (in 17 patients) and coronary CTA (in 9 patients) was 100%. This study shows that TTE is an accurate, noninvasive imaging modality for displaying the origin of coronary arteries and demonstrating the coronary courses as well as other associated abnormalities in patients with ALCAPA

Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering

A typical acquisition protocol for multi-row detector computed tomography (MDCT) angiography is to obtain all phases of the cardiac cycle, allowing calculation of ejection fraction (EF) simultaneously with plaque burden. New MDCT protocols scanner, designed to reduce radiation, use prospectively acquired ECG gated image acquisition to obtain images at certain specific phases of the cardiac cycle with least coronary artery motion. These protocols do not we allow acquisition of functional data which involves measurement of ejection fraction requiring end-systolic and end-diastolic phases. We aimed to quantitatively identify the cardiac cycle phase that produced the optimal images as well as aimed to evaluate, if obtaining only 35% (end-systole) and 75% (as a surrogate for end-diastole) would be similar to obtaining the full cardiac cycle and calculating end diastolic volumes (EDV) and EF from the 35th and 95th percentile images. 1,085 patients with no history of coronary artery disease were included; 10 images separated by 10% of R–R interval were retrospectively constructed. Images with motion in the mid portion of RCA were graded from 1 to 3; with ‘1’ being no motion, ‘2’ if 0 to <1 mm motion, and ‘3’ if there is >1 mm motion and/or non-interpretable study. In a subgroup of 216 patients with EF > 50%, we measured left ventricular (LV) volumes in the 10 phases, and used those obtained during 25, 35, 75 and 95% phase to calculate the EF for each patient. The average heart rate (HR) for our patient group was 56.5 ± 8.4 (range 33–140). The distribution of image quality at all heart rates was 958 (88.3%) in Grade 1, 113 (10.42%) in Grade 2 and 14 (1.29%) in Grade 3 images. The area under the curve for optimum image quality (Grade 1 or 2) in patients with HR > 60 bpm for phase 75% was 0.77 ± 0.04 [95% CI: 0.61–0.87], while for similar heart rates the area under the curve for phases 75 + 65 + 55 + 45% combined was 0.92 ± 0.02. LV volume at 75% phase was strongly correlated with EDV (LV volume at 95% phase) (r = 0.970, P < 0.001). There was also a strong correlation between LVEF (75_35) and LVEF (95_35) (r = 0.93, P < 0.001). Subsequently, we developed a formula to correct for the decrement in LVEF using 35–75% phase: LVEF (95_35) = 0.783 × LVEF (75_35) + 20.68; adjusted R2 = 0.874, P < 0.001. Using 64 MDCT scanners, in order to acquire >90% interpretable studies, if HR < 60 bpm 75% phase of RR interval provides optimal images; while for HR > 60 analysis of images in 4 phases (75, 35, 45 and 55%) is needed. Our data demonstrates that LVEF can be predicted with reasonable accuracy by using data acquired in phases 35 and 75% of the R–R interval. Future prospective acquisition that obtains two phases (35 and 75%) will allow for motion free images of the coronary arteries and EF estimates in over 90% of patients