Severe aortic stenosis typically presents with reduced exercise tolerance, exertional chest pains, or syncope. We report on a case of a young female on therapeutic anticoagulation and a history of nephrotic syndrome, who presented with subacute limb ischaemia resulting from axillary artery thrombus. Urgent echocardiogram demonstrated a bicuspid aortic valve with critical stenosis, and she underwent surgical aortic valve replacement. Her presenting symptoms resolved after three months of warfarin therapy. This case highlights the importance of systemic evaluation of unexplained arterial thrombosis.

Pregnancy poses significant risks for women with congenital heart disease (CHD) due to major cardiovascular changes that can lead to complications which increases the morbidity and mortality rate in these patients. CHD is the leading cause of pregnancy-related deaths in the United States. In this review, we present the steps required to reduce these risks. We cover the changes to the maternal cardiovascular system that occur in pregnancy, and how they can significantly impact the cardiac patient where the disease may lead to poor adaptation in pregnancy. We discuss the epidemiology of this growing challenge and analyse the available the risk stratification models necessary to recognise and mitigate the chance of maternal cardiovascular complications arising in pregnancy. We follow on to discuss the necessity of pre-pregnancy counselling, which is often missed, but allows the potential mother to have a full conversation regarding the implication of pregnancy on her and her baby. We highlight the need to cover topics such as contraception, medication, subfertility, and maternal and fetal risk. Finally, we discuss the need of a pregnancy heart team; what specialist should be involved in the care of these high-risk women and where antenatal and delivery care should take place.

To describe trends in chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD)-related mortality in the United States from 1999 to 2020 using data from CDC WONDER. This study analyzed mortality data from CDC WONDER, identifying decedents aged 25 years and above using ICD-10 codes. A total of 1,459,562 deaths occurred between 1999 and 2020. Annual crude and age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by age, sex, race, and region. Annual percentage changes (APC) were determined using Joinpoint regression. The overall AAMR declined from 24.78 in 1999 to 18.5 in 2020, with a gradual decrease from 1999 to 2018 (APC = -2.06 [95% CI: -2.27, -1.90]) and a subsequent rise through 2020 (APC = 4.53 [95% CI: 0.56,6.41]). Males had higher AAMRs (28.2) than females (13.95). Non-Hispanic Whites had the highest AAMRs (21.93). Mortality among adults aged 45-64 was stable until 2008, then increased through 2020. For adults ≥ 65 years, AAMRs declined until 2018 but rose sharply thereafter. Non-metropolitan areas (AAMR: 26.29) had higher mortality than metropolitan areas (AAMR: 18.42). States in the 90th percentile, such as Tennessee and Kentucky, had AAMRs approximately three times higher than those in the 10th percentile, including Arizona and Hawaii. Substantial demographic and regional disparities persist in COPD and IHD-related mortality, necessitating targeted interventions in high-risk populations.

Cardiomyopathies are diseases of the heart muscle, characterised by structural and functional abnormalities of the myocardium that are not caused by ischemia, valvular problems or congenital heart disease. They are responsible for one-third of pregnancy-related cardiovascular deaths. A woman may enter pregnancy with a pre-existing diagnosis, or the cardiomyopathy may emerge or develop de novo during pregnancy. The most common cardiomyopathies encountered in pregnancy are dilated cardiomyopathy, hypertrophic cardiomyopathy and peripartum cardiomyopathy. All cardiomyopathies can be complicated by clinical heart failure, arrhythmia and thromboembolic events. Pregnancy may be poorly tolerated in women with dilated cardiomyopathy. New York Heart Association Class (NYHA) III/IV symptoms, and severe left ventricular dysfunction are the main determinants of adverse maternal outcomes. Peripartum cardiomyopathy is a diagnosis of exclusion with symptom onset towards the end of pregnancy, or within a few months following delivery. The management of heart failure and arrhythmias is based upon established guidelines, tailored for the unique considerations of pregnancy. Contemporary data suggests that recovery in cardiac function by 12 months is approximately 60-70% for the peripartum group. Maternal cardiovascular risk can be determined using specific risk-predictive scores. All patients with cardiomyopathy who wish to consider pregnancy should be offered individualized pre-conception and contraceptive counselling by a multidisciplinary team. This article reviews the management of women with cardiomyopathy during pregnancy and breastfeeding, focusing on the essential role of the multidisciplinary team at every stage of pregnancy and postpartum period to improve the maternal, fetal, and neonatal outcomes.

Pregnancy is an exciting time, with great anticipation of the future for the woman and her baby. However, for women with mechanical heart valves (MHVs) pregnancy is a challenging undertaking fraught with risk to them and their baby. This article considers the issues for the woman, highlighting pre-surgical opportunities, pre-pregnancy counselling, the issues to consider with fertility treatment, the options during pregnancy for anti-coagulation management and the recognition and management of complications. This update stresses the complex challenges in the management of women with MHV during pregnancy and the need for specialist multi-disciplinary team involvement.

Timely fibrinolysis remains the cornerstone of reperfusion for ST-elevation myocardial infarction (STEMI) in settings without reliable access to primary percutaneous coronary intervention (PCI). International guidelines recommend a door-to-needle time (DTNT) of 30 min or less. We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals. We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp-Hartung adjustment. Heterogeneity was assessed by Cochran's Q and I 2, and sensitivity analyses evaluated robustness. Across 12 eligible studies encompassing a total of 2193 STEMI patients, about 1261 individuals (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1011 patients), the overall pooled mean DTNT was 74.8 min (95% confidence interval: 44.4-105.2; I 2 = 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolyzed patients achieved a DTNT of ≤30 min. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 min. African STEMI patients experience door-to-needle delays more than twice the guideline target, with fewer than 4 in 10 receiving timely fibrinolysis. In such settings lacking widespread PCI, implementation of standardized reperfusion protocols, optimized in-hospital workflows, and targeted quality-improvement initiatives is urgently needed to accelerate fibrinolysis, maximize myocardial salvage, and reduce adverse cardiovascular outcomes.

Statins are the most widely prescribed drugs for dyslipidemia and CAD. But evidence on their cognitive effects is conflicting. A unique genetic makeup and variable lipid patterns make South Asians more susceptible to statin adverse effects. But literature on statin safety in this group is scarce. We aimed to assess the cognitive status of adult Indian statin users over two years and explore factors associated with it. A prospective cohort was established for cognitive profiling of adult statin users, visiting the out-patient cardiology department of a tertiary care center in North India. The Montreal Cognitive Assessment Scale measured cognitive function. Analysis was conducted using mixed-effects linear regression modelling to account for repeated measurements. 273 participants were enrolled. The mean cognitive score was 15. Age and education were significant predictors of cognition (P-value .005 and <.001 respectively). Participants over 60 scored had significantly lower scores and those who had completed secondary school and above scored significantly higher scores. No significant associations were observed between cognitive score and other covariates- sex, follow-up period, statin type and duration of use. The statins-cognition relationship is controversial. This study demonstrated statistically significant relationships of cognition with age and education and showed no change in cognition over 2 years. The findings provide hypotheses for more in-depth assessments. Statins remain the most effective lipid-lowering treatment. However, further research is warranted for a more holistic understanding of the issue & optimizing their risk-benefit ratio.

Pro-adrenomedullin (proADM) involved in cardiovascular hemostasis, has shown promise as a prognostic biomarker in heart failure (HF). However, it's precise role in predicting HF outcomes has yet to be defined. We conducted a systematic review and meta-analysis to determine whether proADM can effectively predict outcomes in patients with HF. We systemtically searched Pubmed, Cochrane, Web of Science, and Scopus for studies on proADM levels in adults (≥18 years) diagnosed with HF. Cohort studies, case-control studies, and randomized controlled trials were considered. The primary outcomes were mortality and hospitalization, with the risk of bias assessed using the QUIPs tool. A random effects meta-analysis was conducted to report pooled hazard ratio (HR) and 95% confidence intervals. Our search identified 956 studies, of which 25 met the inclusion criteria after full-text screening, encompassing a total of 13,915 patients. ProADM emerged as a robust predictor of mortality (HR = 2.46, 95% CI [2.02-3.01]) and combined mortality/hospitalization (HR = 2.96, 95% CI [2.17-4.04]). Notably, each 1-log-unit (nmol/L) increase in proADM was associated with a 196% higher risk of mortality or hospitalization and a 146% higher risk of mortality. ProADM shows significant potential as a prognostic biomarker for HF, with elevated levels linked to a higher risk of mortality and hospitalization. Future research should focus on integrating proADM into risk assessment tools for predicting worsening HF events, as this could influence management guidelines and reshape our approach to treating HF patients.

Thyroid hormone plays a key role in cardiovascular diseases (CVDs), and stress may impact this relationship by affecting cortisol and triiodothyronine (T3) levels. This study explored the association between stress, indicated by cortisol levels, and thyroid function in cardiovascular patients, particularly those with hypertension. A cohort of 87 cardiovascular patients (37 females, 50 males) and 60 healthy controls (28 females, 32 males) was analyzed. Patients included those with coronary artery disease, acute myocardial infarction, and a high proportion with anterior wall myocardial infarction (AWMI, 52%). Anthropometric data and blood samples were collected, and cortisol and T3 levels were measured using the radioimmunoassay method. Blood pressure measurements were also recorded to assess associations with cortisol, thyroid function, and hypertension. Cardiovascular patients had significantly higher cortisol levels (1065.99 ± 700.54 ng/mL vs 768.35 ± 563.10 ng/mL, p < .001) and lower T3 levels (1.25 ± 0.48 ng/mL vs 1.33 ± 0.46 ng/mL) compared to controls. The prevalence of AWMI was 52%. Blood pressure was significantly higher in cardiovascular patients of both sexes (p < .0007). Additionally, 39% of cardiovascular patients had elevated cortisol, and 38% had reduced T3. No sex-based differences in cortisol levels were observed. This study found significant associations between elevated cortisol and reduced T3 levels in cardiovascular patients, particularly those with hypertension. Although stress-induced thyroid dysfunction remains a hypothesis, these findings suggest a potential link between cortisol, T3, and CVD. Further longitudinal research is needed to explore causal mechanisms.

Aortic dissection in pregnancy has a high mortality rate for mother and fetus. Women at risk are largely those with hereditary thoracic aortic disease, that is typically undiagnosed. Existing literature has focussed on characterising the phenotype of these women, but many questions remain about the causes of dissection in pregnancy and how to best manage women antenatally and postnatally. The widespread uptake of genetic testing has allowed us to refine the genotype and we need to use this to better individualise risk. We do not know how often to screen women during pregnancy and postpartum, nor do we know whether beta-blockers affect event rates. We have very little data on the outcomes of women who have undergone aortic surgery who embark on a pregnancy, including those who have residual dissection. Passive vaginal delivery is advised for delivery, but we do not know if this is safer than elective caesarean section and there is a paucity of evidence on the effectiveness of neuraxial anaesthesia in these women. Dissection postpartum can occur days or weeks after delivery. There is little evidence on the postnatal care or blood pressure control of women who have dissected postpartum and no guidelines on best postpartum care. Lastly, we know little of the birth experience of these women and whether birth plans were successful. This paper aims to discuss some of these unanswered questions in the hope that with further research and discussion of best practice we can collectively reduce this devastating event in young women.