Intracardiac thrombus in Behçet's disease: Two case reports

Intracardiac thrombus in Behçet's disease is an extremely rare manifestation. We report two such cases. A 20-year-old man presented with dyspnoea, cough and haemoptysis. Right heart thrombus associated with pulmonary artery aneurysm and thromboembolism was identified by helical CT and transoesophageal echocardiography. The second case was a 29-year-old male admitted for fever and chest pain. A diagnosis of right atrial thrombosis associated with pulmonary embolism and hyperhomocysteinemia was made. Due to the absence of haemodynamic compromise, medical management consisting of immunosupressive and anticoagulation therapy was adopted which resulted in complete dissolution of the thrombus with dramatic clinical improvement in both cases of clinical status. Conclusion: intracardiac thrombus is a rare complication of Behçet's disease. As shown in our patients, medical treatment should be considered as the first line

Apolipoprotein gene polymorphisms and plasma levels in healthy Tunisians and patients with coronary artery disease

<p>Abstract</p> <p>Aim</p> <p>To analyze apolipoprotein gene polymorphisms in the Tunisian population and to check the relation of these polymorphisms and homocysteine, lipid and apolipoprotein levels to the coronary artery disease (CAD).</p> <p>Methods</p> <p>In healthy blood donors and in patients with CAD complicated by myocardial infarction (MI) four apolipoprotein gene polymorphisms [APO (a) PNR, APO E, APO CI and APO CII] were determined and plasma levels of total homocysteine, total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HLD-C) and apolipoproteins (apo A-I, Apo B, Apo E) were measured.</p> <p>Results</p> <p>Analysis of the four apolipoprotein gene polymorphisms shows a relative genetic homogeneity between Tunisian population and those on the other side of Mediterranean basin. Compared to controls, CAD patients have significantly higher main concentrations of TC, TG, LDL-C, apo B and homocysteine, and significantly lower ones of HDL-C, apo A-I and apo E. The four apolipoprotein gene polymorphisms have not showed any significant differences between patients and controls. However, the APO E4 allele appears to be associated to the severity of CAD and to high levels of atherogenic parameters and low level of apo E, which has very likely an anti-atherogenic role.</p> <p>Conclusion</p> <p>Although APO (a) PNR, APO CI and APO CII genes are analyzed in only few populations, they show a frequency distribution, which is not at variance with that of APO E gene and other widely studied genetic markers. In the Tunisian population the APO E 4 appears to be only indirectly involved in the severity of CAD. In the routine practice, in addition of classic parameters, it will be useful to measure the concentration of apo E and that of Homocysteine and if possible to determine the APO E gene polymorphism.</p

042: Real life dual antiplatelet therapy after NSTE-ACS in a Tunisian population: is there a need for 12 months of treatment?

AimEven if the recommended duration for dual antiplatelet therapy (DAT) after non ST elevation acute coronary syndromes (NSTE-ACS) is 12 months, evidence concerning the benefit of clopidogrel adjunction especially beyond 3 months remains poor. The aim of the study was to assess the effective clopidogrel intake and the incidence of a composite endpoint including all causes death and non fatal myocardial infarction in a Tunisian population after NSTE-ACS.MethodsWe included patients admitted for NSTE-ACS in our department between January 2010 and August 2011 for whom long term evaluation was possible. In-hospital deaths were excluded (including post operative deaths). By telephone follow up, we evaluated the effective DAT duration and the occurrence of all causes death and non-fatal myocardial infarction.ResultsOne hundred thirty patients were included. Mean (SD) follow up was 261 (99) days. DAT was effectively observed during 94(103 days (extremes ranging from 0 to 360 days). Angioplasty was performed in 51.5%, coronary artery bypass graft in 8.4% and medical therapy was considered in 40.1%. In 35 (26.9%) patients, aspirin was the only antiplatelet therapy taken after discharge although DAT was prescribed; 46.9% of the patients took the DAT for more than 3 months, and 23.1% for more than 6 months. The composite endpoint occurred in 6 (4.6%) patients: 2 deaths (both of cardiac causes) and 4 myocardial infarctions. Three of them were under DAT, and the 3 others remained event free during 7, 240 and 270 days after clopidogrel withdrawal. These findings suggest that DAT does not protect against death or myocardial infarction. The rebound phenomenon after clopidogrel withdrawal isn’t patent in our population.ConclusionIn the Tunisian context, DAT observance is poor after NSTE-ACS. Death and non fatal myocardial infarction don’t seem to be reduced by DAT and the rebound phenomenon after clopidogrel withdrawal isn’t patent. This may be in part attributed to the small sample of population and the predominantly low risk (as assessed by TIMI risk score), but larger studies are needed to strengthen the evidence for DAT after NSTE-ACS

Stenosis and Aneurysm of Coronary Arteries in A Patient with Behcet’s Disease

Coronary artery disease is extremely rare in patients with Behçet’s disease. We report the case of a patient with a history of Behçet’s disease who was admitted in our hospital with instable angina pectoris. The patient’s electrocardiogram was normal. Coronary angiography revealed aneurysm of the distal right coronary artery with a tight stenosis of the proximal part of the posterolateral branch. These two conditions were initially treated with immunosuppressive treatment. Three years later coronary angiography showed a total occlusion of the right coronary artery treated with medical therapy. More than fourteen cases of coronary involvement were reported in the literature but the etiopathogeny and the treatment are yet unknow

222: Relation between pulse pressure and vascular event among the elderly in Monastir: a population-based study

BackgroundThe sixth Joint National Committee (JNC-VI) classification system of blood pressure emphasizes both systolic blood pressure (SBP) and diastolic blood pressure (DBP) for cardiovascular disease risk assessment. Pulse pressure (PP)=[SBP - DBP], may also be a valuable risk assessment tool.ObjectivesIn this study, we examined the association of cardiovascular events with arterial pulse pressure in elderly as well as their correlations within diabetes.Patients and methodsA Population based survey supported by WHO and FNUAP, was undertaken in 2008-2009 to investigate health behaviours and health status of elderly living in their home in Monastir. This study was carried out in a representative sample of elderly aged more than 65 years. Standardized techniques were used for blood pressure (BP). Hypertension was defined as BP more than 140/90mmHg. Diabetes was defined as known diabetics. Regression analyses were used to examine the relationships among pulse pressure age, diabetes and cardiovascular events (myocardial infarction, arteritis and stroke) This project was approved by the research Ethics Committee, CHU F Bourguiba, university of MonastirResultsThe study included 598 participants (396 women and 202 men) who were aged ≥65 years.The prevalence of hypertension and diabetes was respectively 52% (n=311) and 27,4% (n= 164). Pulse pressure was more than 65mmHg for 132 subjects (22%), only 43 subjects without a history of hypertension.The mean of PP is significantly high in hypertensive elderly (52.3 vs 58.4mmHg), with cardiovascular events (55 vs 58mmHg), diabetic subjects (53 vs 58mmHg), with comorbidity (54 vs 58mmHg) and polymedication (52 vs 57mmHg). Using pulse pressure (high PP ≥65mmHg) as dependent variable, the multiple regression analysis reveals the independent influence of diabetes and cardiovascular events on PP.ConclusionThis study has confirmed that subjects with the widest PP have the greatest risk of cardiovascular events. Elderly diabetic patients have a higher PP than non diabetic elderly. These hemodynamic changes may contribute to the increase risk of cardiovascular disease associated with diabetes

0106: Hyponatremia and outcomes in patients admitted for acute heart failure

PurposeThe aims of this study is to characterize hyponatremic hospitalized patients with HF and to clarify the relations between hyponatremia and outcomes during hospitalization and at 6 months.MethodsThis is a retrospective study of 234 patients admitted in the cardiology department of Fattouma Bourguiba Monastir hospital between January 2010 and March 2011.Hyponatremia was defined as a blood value of sodium < 135mmol/l.ResultsThe mean serum sodium concentration is 138±5mmol / l. Hyponatremia (Na + <135mmol / l) was noted in 63 (26.9%) patients.Hospital mortality was 7.3% (N = 17). Cardiovascular origin was observed in 58.8% of cases. This mortality was significantly higher in patients with hyponatremia, 15.87%, compared to 4.09%, in those with normonatremia (p=0.004). After their outputs, 39 patients (19.69%) required at least one rehospitalization during the first 6 months of follow-up. The 6-month mortality was 11, 5%. The rate of readmission and mortality at 6 months was higher in patients who had hyponatremia; respectively 32.07% vs 13.41%, p =0.002 and 21.42% vs 7.78%, p =0.005.ConclusionIn our study, the presence of hyponatremia in patients hospitalized for acute heart failure is predictive of hospital mortality, readmission and mortality at 6 months