Cardiac metastasis from a renal cell carcinoma

Here we report a case of asymptomatic right ventricular tumor, for which surgical removal was done.  Pathology reveals that the mass is a metastasis of a renal carcinoma.Key words: Renal cell carcinoma, cardiac metastasis, myocardium, cardiac tumor

Przetoka wieńcowa uchodząca do lewej komory z objawami dławicy piersiowej

Coronary arterial fi stula is a rare defect characterized by a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. Complications include ‘steal’ from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fi brillation, rupture, endocarditis/endarteritis and arrhythmias. Here we report the case of a 73-year-old female that was admitted for unstable angina. Coronary angiography revealed the presence of multiple large coronary-cameral fi stula. CT scan confi rmed the presence of ecstasis of the left main artery, associated with coronary-cameral fi stulae between left ventricle and ramus intermedius artery and the circumfl ex artery.Przetoka wieńcowa to rzadka wada naczyniowa polegającą na obecności połączenia między jedną lub większą liczbą tętnic wieńcowych a jamą serca lub dużym naczyniem krwionośnym. Powikłania obejmują podkradanie krwi z przyległego obszaru mięśnia sercowego, zakrzepicę i zatorowość, niewydolność serca, migotanie przedsionków, pęknięcie, zapalenie wsierdzia/zapalenie ściany tętnic i zaburzenia rytmu. W niniejszej pracy przedstawiono przypadek 73-letniej chorej przyjętej do szpitala z powodu niestabilnej dławicy piersiowej. Koronarografi a ujawniła poszerzenie pnia lewej tętnicy wieńcowej oraz obecność dużej mnogiej przetoki wieńcowo-komorowej między lewą komorą a gałęzią pośrednią i gałęzią okalającą

Ischemic cardiomyopathy revealed by central retinal artery occlusion (CRAO)

Here we report a case of central retinal artery occlusionrevealing an ischemic cardiomyopathy. A 54-year old smoker man presented at the hospital because of sudden visual loss in his left eye. There was cherry-red spot in the macula in his left eye. We performed a fluorescein angiogram and cervical color Doppler. Later   investigations revealed an ischemic cardiomyopathy undiagnosed until then.Key words: Central retinal artery occlusion, ischemic cardiomyopathy, cardiac thrombu

Hypertension control in the Tunisian elderly

Background: Hypertension is a major public health problem. Despite therapeutic progress, blood pressure control remains insufficient particularly in the elderly. Purpose: The aim of our study was to identify the factors associated with poor blood pressure control in the elderly in Tunisia. Material and methods: We conducted a descriptive study including 101 Tunisian treated hypertensive patients, aged 65 years and over, followed on an outpatient basis between November and December 2019. Results: Median age was 73 and sex ratio was 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia (48.5%) and smoking (40.6%). About 33% of the hypertensive patients realized regular physical activity and 31% had a high-sodium diet. Our patients were completely dependent in 4% of cases and among those aged 80 and over, 68.2% were frail. The prevalence of poor blood pressure control was 59%. Adherence to treatment was satisfactory in 75.2% of cases. In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment [odds ratio (OR) = 0.19; p = 0.013], frailty (OR = 7.194; p = 0.004), the number of antihypertensive tablets (OR = 0.382; p = 0.008), non-use of thiazide diuretics (OR = 25.903; p = 0.001) and the patient's lack of knowledge of antihypertensive treatment (OR = 0.56; p = 0.008). Conclusion: Detection of the risk of non-compliance, the use of combined treatments screening for frailty and informing the patient about his/her treatment are necessary to improve blood pressure control in our Tunisian context

The effects of fasting on heart rate variability in hypertensive patients

Heart rate variability (HRV) is an independent indicator of increased mortality in patients with myocardial infarction and congestive heart failure. The effects of fasting on the HRV are not known in hypertensive patients. Therefore, studying the effects of Ramadan fasting on hypertensive patients’ HRV seems reasonable to address. We conducted a prospective study including 20 hypertensive patients with sinus rhythm. HRV was determined twice by ambulatory 24-hour Holter recordings at fasting during and after Ramadan. Subjects mean age was 55 ± 11.8 years. Sex-ratio was 1.5. When two groups compared, statistically significant differences were found in terms of SDNN (113 ± 71 vs 140 ± 38, p = 0.001), SDANN (109.7 ± 45 vs 134.8 ± 48.3, p = 0.008), T power (2368.7 ± 121.3 vs 3660.5 ± 170.9, p = 0.03) and LF (552.2 ± 31.3 vs 903.7 ± 48.9, p < 0.0001) values. HRV parameters were found to be decreased in Ramadan. Thus, Ramadan fasting enhances the activity of the sympathetic system in hypertensive patients

Cerebral embolism complicating left atrial myxoma: a case report

Cardiac myxoma are the most common benign primary cardiac tumors that can lead to many complications as described in literature. Here we report the case of a boy aged 11 that was referred for etiological diagnosis of ischemic stroke. Transthoracic echocardiography reveals a myxoma in the left atrium. Patient was referred to surgery. The diagnosis was confirmed and the mass was completely resected.Pan African Medical Journal 2016; 2

Effect of intermittent fasting and chronotherapy on blood pressure control in hypertensive patients during Ramadan

Introduction: During Ramadan, repeated cycles of fasting, associated with alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. Studies on the effects of fasting on blood pressure of hypertensive patients are rare, and have provided inconclusive results. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily. Methods: The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital of Tunis. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24 hour, awake and asleep systolic and diastolic blood pressure and 24 hour, awake and asleep heart rate. Results: We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics, 46% dyslipidemics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2). Average 24hour blood pressure in the whole group was 129±18/74±10 mmHg before Ramadan and 129±19/74±10 mmHg during Ramadan (p &gt; 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p &lt; 0.05). Conclusions: In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed

Ulcer like projection: a case report and follow up

Here we report the case of a 57-year-old female with an aortic intramural hematoma that was treated with medical approach. Follow confirmed the favorable clinical evolution.The Pan African Medical Journal 2016;2

Both mediastinal and pericardial hydatidosis revealed by ST elevation acute coronary syndrome

Hydatidosis remains an endemic disease in some regions of the world, such as Tunisia. The liver and the lungs are the most common sites in adults. Mediastinal and pericardial hydatid cysts are very rare even in endemic areas and true incidence has not been described in the literature. We report the case of a 74-year-old woman with clinical, biological and electrocardiographic features of acute myocardial infraction. Two-dimensional echocardiography and detailed imaging revealed a mediastinal and pericardial hydatid cyst. The particularity of the clinical presentation, the complementary investigations as well as the management and follow-up of the patient are discussed. This case is of great interest since the rarity of concomitant hydatid cyst in two uncommon localizations: mediastinum and pericardium, and the unusual incidental discovery during a myocardial infarction

A rare cardiac manifestation in autosomal-dominant polycystic kidney disease

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disorder associated with various extrarenal complications. There is little information regarding the occurrence and distribution of cardiovascular abnormalities during the course of ADPKD. The major cardiovascular complications of ADPKD include valvulopathies and vascular ectasia. Aneurysm of the atrial septum (ASA) is a very rare manifestation in ADPKD. A 37-year-old woman who was diagnosed with ADPKD was admitted to our hospital for advanced renal failure. Pelvic computed tomography revealed multiple variable-sized cysts in both kidneys. Trans-thoracic echocardiography showed ASA while the patient was completely asymptomatic