Cardiac Manifestations Research Articles

Venous and arterial thrombosis in patients with VEXAS syndrome

AbstractVEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, caused by somatic mutations in UBA1, is an autoinflammatory disorder with diverse systemic manifestations. Thrombosis is a prominent clinical feature of VEXAS syndrome. The risk factors and frequency of thrombosis in VEXAS syndrome are not well described, due to the disease’s recent discovery and the paucity of large databases. We evaluated 119 patients with VEXAS syndrome for venous and arterial thrombosis and correlated their presence with clinical outcomes and survival. Thrombosis occurred in 49% of patients, mostly venous thromboembolism (VTE; 41%). Almost two-thirds of VTEs were unprovoked, 41% were recurrent, and 20% occurred despite anticoagulation. The cumulative incidence of VTE was 17% at 1 year from symptom onset and 40% by 5 years. Cardiac and pulmonary inflammatory manifestations were associated with time to VTE. M41L was positively associated specifically with pulmonary embolism by univariate (odds ratio [OR]: 4.58, confidence interval [CI] 1.28-16.21, P = .02) and multivariate (OR: 16.94, CI 1.99-144.3, P = .01) logistic regression. The cumulative incidence of arterial thrombosis was 6% at 1 year and 11% at 5 years. The overall survival of the entire patient cohort at median follow-up time of 4.8 years was 88%, and there was no difference in survival between patients with or without thrombosis (P = .8). Patients with VEXAS syndrome are at high risk of VTE; thromboprophylaxis should administered be in high-risk settings unless strongly contraindicated.

Cardiac manifestations of human ACTA2 variants recapitulated in a zebrafish model

The ACTA2 gene encodes actin α2, a major smooth muscle protein in vascular smooth muscle cells. Missense variants in the ACTA2 gene can cause inherited thoracic aortic diseases with characteristic symptoms, such as dysfunction of smooth muscle cells in the lungs, brain vessels, intestines, pupils, bladder, or heart. We identified a heterozygous missense variant of Gly148Arg (G148R) in a patient with a thoracic aortic aneurysm, dissection, and left ventricular non-compaction. We used zebrafish as an in vivo model to investigate whether or not the variants might cause functional or histopathological abnormalities in the heart. Following the fertilization of one-cell stage embryos, we injected in vitro synthesized ACTA2 mRNA of wild-type, novel variant G148R, or the previously known pathogenic variant Arg179His (R179H). The embryos were maintained and raised for 72 h post-fertilization for a heart analysis. Shortening fractions of heart were significantly reduced in both pathogenic variants. A histopathological evaluation showed that the myocardial wall of ACTA2 pathogenic variants was thinner than that of the wild type, and the total cell number within the myocardium was markedly decreased in all zebrafish with pathogenic variants mRNAs. Proliferating cell numbers were also significantly decreased in the endothelial and myocardial regions of zebrafish with ACTA2 variants compared to the wild type. These results demonstrate the effects of ACTA2 G148R and R179H on the development of left ventricle non-compaction and cardiac morphological abnormalities. Our study highlights the previously unknown significance of the ACTA2 gene in several aspects of cardiovascular development.

DECODING CARDIOVASCULAR COMPLEXITIES IN VIRAL INFECTIONS: COMPREHENSIVE INSIGHTS

The intricate interplay between viral infections and cardiovascular complications has become a focal point of research attention. This period of extensive investigation has uncovered substantial connections between various viruses and cardiovascular diseases, including cytomegalovirus (CMV), coxsackievirus, influenza, human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as coxsackievirus A and B, enteroviruses, adenovirus, and parvovirus B19. These viruses exert diverse influences on cardiovascular health through multiple pathways, contributing to endothelial dysfunction, causing direct damage to cardiac tissue, and triggering inflammatory responses. The intricate interplay between viral infections and cardiovascular health emphasizes the importance of considering viral pathogens in the context of cardiovascular disease development, clinical management practices, and future research initiatives. This systematic review thoroughly examines the cardiovascular impacts resulting from various viral infections, shedding light on their underlying mechanisms and associated clinical implications. These valuable insights can inform clinical management strategies, preventive measures, and further investigations into the complex connection between viral infections and cardiovascular diseases, highlighting the necessity for ongoing research and vigilance in understanding and managing these pathogen-induced cardiac manifestations.

A case of Brugada phenocopy unmasked following giant Asian honey bee stings

This case report details a rare occurrence of Brugada phenocopy (type 1 Brugada electrocardiographic pattern) precipitated following giant Asian honey bee (Apis dorsata) stings in a previously healthy Sri Lankan male. The patient had an uneventful course. While similar ECG patterns can arise from non-genetic factors, Giant Asian honey bee sting as a causal factor is exceedingly unusual and unreported previously. This case adds to the spectrum of cardiac manifestations of Hymenopteran venom highlighting the requirement for close cardiac monitoring and clinical vigilance in these patients.

Cardiac Manifestation in a Child With Atypical Hemolytic Uremic Syndrome.

Cardiac Manifestation in a Child With Atypical Hemolytic Uremic Syndrome.

Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening.

Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. Mean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.

Anderson-Fabry Disease: Red Flags for Early Diagnosis of Cardiac Involvement.

Anderson-Fabry disease (AFD) is a lysosome storage disorder resulting from an X-linked inheritance of a mutation in the galactosidase A (GLA) gene encoding for the enzyme alpha-galactosidase A (α-GAL A). This mutation results in a deficiency or absence of α-GAL A activity, with a progressive intracellular deposition of glycosphingolipids leading to organ dysfunction and failure. Cardiac damage starts early in life, often occurring sub-clinically before overt cardiac symptoms. Left ventricular hypertrophy represents a common cardiac manifestation, albeit conduction system impairment, arrhythmias, and valvular abnormalities may also characterize AFD. Even in consideration of pleiotropic manifestation, diagnosis is often challenging. Thus, knowledge of cardiac and extracardiac diagnostic "red flags" is needed to guide a timely diagnosis. Indeed, considering its systemic involvement, a multidisciplinary approach may be helpful in discerning AFD-related cardiac disease. Beyond clinical pearls, a practical approach to assist clinicians in diagnosing AFD includes optimal management of biochemical tests, genetic tests, and cardiac biopsy. We extensively reviewed the current literature on AFD cardiomyopathy, focusing on cardiac "red flags" that may represent key diagnostic tools to establish a timely diagnosis. Furthermore, clinical findings to identify patients at higher risk of sudden death are also highlighted.

ImmunoglobulinA vasculitis

The immune-mediated small vessel vasculitis is known as Schoenlein-Henoch purpura predominantly from pediatrics and in these cases occurs more frequently after infections of the upper airways. In adults, immunoglobulinA (IgA) vasculitis often proceeds more severely und recurrently with the classical tetrad of skin manifestations in the sense of leukocytoclastic vasculitis, joint affection, gastrointestinal involvement and IgA nephritis, in contrast to the mostly mild and self-limiting course in children. The background of this systemic vasculitis with formation of IgA immune complexes is considered to be an altered glycosylation of IgA, as this causes the exposure of binding sites for autoantibodies so that an immune complex reaction can be elicited. This ultimately leads to perivascular deposition of IgA and afurther activation of neutrophils. Groundbreaking in the diagnostics is the histological detection of leukocytoclastic vasculitis and in cases of renal manifestations akidney biopsy with characteristic deposits of immune complexes, which cannot be clearly differentiated from IgA nephropathy. The treatment is aimed at the respective manifestation and is mostly based on consensus recommendations due to the lack of randomized studies. In addition to immunosuppressive medication, in the presence of achronic kidney disease general nephroprotection is becoming increasingly more important also by inhibition of sodium-glucose transporter2 (SGLT2). The type and extent of kidney involvement and also rare cardiac manifestations are the main determinants of the prognosis. Continuous medical accompaniment of those affected is necessary due to the possible progression of the disease and the risk of recurrence.

The impact of the COVID-19 pandemic on cardiovascular disease in the cardiovascular center of Kermanshah, in the west of Iran

BackgroundCardiovascular diseases (CVD) are known as the most common cause of mortality worldwide. Hence, exploring the impact of COVID-19 pandemic on CVD and its risk factors. This study aimed to explore clinical and echocardiographic characteristics and cardiac manifestations in COVID-19 patients. MethodsThis cross-sectional study was conducted on 386 patients with COVID-19 admitted to Imam Ali Hospital, the largest specialized cardiology hospital in western Iran. The checklist included information about age, gender, hypertension, BMI, diabetes, chronic renal disease, cigarette smoking, echocardiography and ECG findings, in-hospital MACE, venous and arterial thrombotic events. To analyze the data, SPSS23, paired-samples t-test, chi-square test and logistic regression analysis were used. ResultsOur findings showed 57 % of patients were male and 43 % were female. The paients' average age was 64.61 ± 14.21 years. Moreover, 25.9 % of patients had diabetes, 27.7 % had blood pressure, 11.7 % were cigarette smokers and 11.1 % had hyperlipidemia. The main electrocardiographic abnormalities were ST-T changes in 1.31 % of the patients, sinus tachycardia in 16.3 % and atrial fibrillation in 11.1 % of patients. Mild to moderate pericardial effusion was observed in 8.1 % and pleural effusion in 9.1 % of the sample. Common cardiac complications were ACS in 52.9 %, DHF in 24.4 %, and CHB in 4.4 % of patients. 19.4 % of patients died during hospitalization. Mild to moderate pericardial effusion (OR = 1.96, 95 % CI 1.18–2.14, P = 0.012) was an independent predictor of mortality in COVID-19 patients. ConclusionResults of the study showed it is essential to pay closer attention to elderly, diabetic and hypertensive patients, who are more prone to COVID-19 infection. Moreover, common cardiac complications were ACS and DHF, respectively.

Digestive Bleeding Revealing Aortic Valve Stenosis: Heyde’s Syndrome

Heyde’s syndrome is an under reported systemic disease of gastrointestinal and cardiac manifestation in older adults. It is characterized by a triad of aortic stenosis, angiodysplasia with bleeding and acquired von Willebrand syndrome. Heyde’s syndrome is a treatable condition in most cases, especially in the current era of evolution in interventional cardiology and gastroenterology. Newer endoscopic technologies may prove beneficial. Aortic valve replacement is claimed to minimize or even stop the bleeding in such patients. The aim of our review article is to summarize the basic pathophysiology, diagnostics and management of Heyde’s syndrome.

Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 109/mm3. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (p < 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock. Conclusion: MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity.What is Known:• MIS-C is an infrequent but serious disease entity.• Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems.What is New:• NT-pro-BNP levels may provide a better prediction and monitoring of the disease course.• Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.

“Not much room for mushrooms” in the heart: knowns and unknowns of fungal infective endocarditis

Fungal infective endocarditis is a rare but highly lethal condition. Its diagnosis is often delayed due to nonspecific symptoms, inconclusive medical imaging, and negative blood cultures. Recent reviews of cases and series over the last 5 years indicate that the condition remains rare and lethal. If fungi are identified as the causative agents in more than 5% of patient cases with infective endocarditis, it is likely that risk factors such as immune suppression or cardiac implants are probably involved. A series derived from recent case reports indicates that Candida and Aspergillus are still the main causative infectious agents, with. C parapsilosis on the rise. From these cases, diagnostic clues (frequent embolisms, ophthalmic involvement, large, mobile and friable vegetation, non-valvular cardiac manifestations) are pointing towards fungal IE. These reports, however, are not standardized and a publication bias towards rare microorganisms or towards a favorable outcome might exist. Complications might be underreported, and important data such as diagnostic delay are absent or difficult to retrieve. Pharmacologic treatment is not fully standardized. Knowledge of resistant strains in this respect is important. Statistical analysis for the effect of complications and treatment modalities on outcome shows that any result should be treated cautiously. The current series is by no means a valid substitute for a well-designed series of fungal endocarditis. However, the better outcome with Candida and patients treated with surgery confirm earlier results. An international multicentric standardized registry of cases with fungal endocarditis in order to improve the outcome of this disease is highly needed. The effect of diagnostic delay on outcome remains elusive and should be resolved.

Hepatocellular Carcinoma with Right Atrial Metastasis

Cardiac tumours may be primary or secondary-metastatic (malignant). Secondary cardiac tumours are much more common than primary cardiac tumours. Their frequency on large anatomical studies varies between 3.4% and 13.9%. Though cardiac metastases may originate from any malignant tumor, melanomas have the greatest propensity for cardiac involvement, and also carcinomas of the thorax, including breast, lung, and esophageal [12,13]. The routes of metastasis include direct invasion, hematogenous, lymphatic, or transvenous, especially through the inferior vena cava [9,10]. Cardiac involvement should be suspected or sought in any patient with a known malignancy who develops new cardiovascular signs or symptoms. Imaging methods - echocardiography, computed tomography (CT) and MRI, are essential in establishing the diagnosis and the invasion of the tumour in the cardiac cavity. The severe evolution of secondary cardiac tumors depends on the extension of the primary tumour, but also on the severity of the clinical cardiac manifestations. Generally, the treatment is surgical. A correct diagnosis is important in the clinical setting since cardiac metastases are able to induce sudden cardiac death1. Primary hepatocellular carcinoma (HCC) is the sixth cause of cancer in the world and the second cause of cancer mortality worldwide, with more than 830,000 deaths recorded annually2. We present a case of HCC growth into the vena cava inferior (VCI) and invasion into the right atrium (RA).

Characteristics and biomarkers associated with mortality in COVID-19 patients presenting to the emergency department.

This study aimed to investigate the diverse clinical manifestations and simple early biomarkers predicting mortality of COVID-19 patients admitted to the emergency department (ED). A total of 710 patients with COVID-19 were enrolled from 6,896 patients presenting to the ED between January 2022 and March 2022. During the study period, a total of 478 patients tested positive for COVID-19, among whom 222 (46.4%) presented with extrapulmonary manifestations of COVID-19; 49 (10.3%) patients displayed gastrointestinal manifestations, followed by neurological (n=41; 8.6%) and cardiac manifestations (n=31; 6.5%). In total, 54 (11.3%) patients died. A Cox proportional hazards model revealed that old age, acute kidney injury at presentation, increased total leukocyte counts, low platelet counts, decreased albumin levels, and increased LDH levels were the independent predictors of mortality. The albumin levels exhibited the highest area under the curve in receiver operating characteristic analysis, with a value of 0.860 (95% confidence interval, 0.796-0.875). The study showed the diverse clinical presentations and simple-to-measure prognostic markers in COVID-19 patients presenting to the ED. Serum albumin levels can serve as a novel and simple early biomarker to identify COVID-19 patients at high risk of death.

Co-existence of hematological disease in cardiac patients presented with chest pain

Abstract Introduction The important association between hematological disorders and cardiovascular system originates within multiple points of interface, ranging from heart and its structural constituents, coronary arteries and veins, cerebrovascular, pulmonary and peripheral vasculature. Any anomaly of either of the blood components can severely affect the blood flow and blood viscosity which finally leads to thrombosis. Objective This study will help clinicians to evaluate those patients having hematological abnormality and are having potential prothrombotic state due to abnormal hemostasis. Rationale Introducing cardiac health screening in patients with any hematological disease can improve the quality of life of these patients. Material and methods This cross sectional analytical study was conducted in hematology Department of Peshawar institute of Cardiology after approval from hospital ethical and research committee. Study duration was 6 months. All patients were subjected to detailed history, clinical examination. Demographic (Age, Gender) and relevant clinical information. Investigation like CBC, coagulation profile, hemolytic profile, Chest X-ray, ECG, Echo, Angiography findings were used to monitor patient’s clinical status. Results Out of 43 patients, 08 cases (18.60%) presented were of benign hematological disorder and the rest 35 cases (81.40%) presented with malignant hematological disorders. A significant P- value of (0.000) was observed in patients with malignant hematological disorder in association with benign hematological disorders. Conclusion From our study findings, several local and international platforms data, it can be concluded that those hematological abnormalities which have direct or indirect association with thromboembolic events can present with cardiac manifestation in the form of chest pain or acute myocardial injury at any stage of disease process. Therefore, clinicians must evaluate patients having hematological abnormality and are having potential prothrombotic state due to abnormal hemostasis for cardiac manifestation of the disease as well.

Assessment of QRS duration and presence of fragmented QRS in patients with celiac disease.

Background: Celiac Disease (CD) is characterized by small intestine involvement. However, cardiac manifestations may also be seen in the clinical course. The significance of the QRS prolongation and the presence of QRS fragmentation (fQRS) has been previously studied in many chronic inflammatory disorders as an independent predictor of cardiac manifestations. The study aimed to evaluate the QRS duration and presence of fQRS in patients with CD. Methods: 164 patients with CD and 162 healthy controls were included in the present study. QRS duration and presence of fQRS were calculated from the 12-lead electrocardiogram and compared between groups. The association between these parameters and disease duration was also evaluated. Results: QRS duration was found to be higher in the CD group compared to the control group (83 (76.8-93) vs. 91 (84-94), p<0.001). The presence of fQRS was demonstrated to be higher in the CD group (n=68 (41.5%) vs n=42 (25.9%), p=0.003). Notably, QRS duration was positively correlated with disease duration (Spearman's Rho= 0.47, p<0.001). In addition, disease duration was significantly higher in the fQRS (+) group (60 (23,5-144) vs. 28,5 (15-71,5), p=0.002). Conclusion: This study revealed that QRS prolongation and the presence of fQRS were higher in patients with CD. The presence of these findings may be an indicator of early subclinical cardiac involvement, especially in those with long disease duration. Thus, patients with these ECG findings can be considered for further cardiac evaluation.

Calcium Channel Blocker Overdose.

Emergency medicine residents and medical students on emergency medicine rotation. Calcium channel blocker (CCB) overdoses can be severe with potentially serious adverse outcomes. CCBs work by blocking the calcium channels on smooth and cardiac muscle tissue. At low dose ranges, dihydropyridine CCBs (such as nifedipine, amlodipine, and nicardipine) block the L-type calcium receptors in the peripheral vasculature, whereas non-dihydropyridine CCBs (such as: verapamil and diltiazem) affect the L-type calcium receptors in the myocardium.1 Because of this distinction, dihydropyridine CCB toxicity manifests as arterial vasodilation and non-dihydropyridine CCB toxicity is associated with cardiac manifestations such as bradycardia and negative inotropy.2 It is important to note that in high concentrations (such as in overdoses), CCBs lose specificity for their specific receptors and can show all the manifestations of toxicity such as bradycardia, peripheral vasodilation, and hypotension. Patients can develop both vasoplegic shock from peripheral vasodilation and cardiogenic shock. This is a high acuity low occurrence case with infrequently used but specific treatments, and thus this case provides educational value. At the end of this oral board session, examinees will: (1) demonstrate ability to evaluate a patient with undifferentiated shock with bradycardia and discuss the differential diagnosis, (2) recognize the signs and symptoms of calcium channel blocker overdose, (3) demonstrate ability to manage treatment of a patient with calcium channel overdose. This oral board case followed the standard American Board of Emergency Medicine-style case in a tertiary care hospital with access to all specialists and resources needed. This case was tested using 12 resident volunteers ranging from PGY 1-2 in an ACGME (Accreditation Council for Graduate Medical Education) accredited emergency medicine residency program. Immediate feedback was solicited both from the learners and from the evaluators following the debriefing session. Residents were asked to evaluate the educational value of the case using a 1-5 Likert scale (5 being excellent). Evaluators were asked to score the residents using the ACGME core competencies with a scale of 1-8, 1-4 being unacceptable and 5-8 being acceptable. Seven PGY1 residents and five PGY2 residents, thus twelve residents in total, completed the case. The average score was 5.10/8. Three residents missed zero critical actions. The most common critical action missed was consulting cardiology or cardiothoracic surgery for circulatory support options. Many residents failed to recognize that the patient did not have a perfusing blood pressure at the beginning of the case and did not start CPR. Although most residents recognized the patient's hemodynamic collapse was from a calcium channel blocker overdose, most did not know the treatment for this beyond atropine and intravenous fluids.The learners rated the educational value of the case as 4.9/5. Seven residents reported that the case definitely increased their medical knowledge; five residents reported that it somewhat increased their medical knowledge. All residents rated the case as helpful in preparing to manage this medical condition. The educational content from this case was effective. This is a high acuity low occurrence case that has unique treatments that are not commonly used. This makes this case excellent for practice and discussion. We learned during implementation that this case has a high degree of difficulty compared to other cases, and junior learners will need more prompting. It is also important for the proctor to keep the case moving because there is a lot to cover in the allotted amount of time. Calcium channel blocker overdose, toxicology.

Clinical Manifestations and Treatment Outcomes of Brucella Endocarditis: A Retrospective Cohort Study at a Tertiary Cardiac Centre in Bengaluru, Karnataka, India

Introduction: Brucella is a rare cause of Infective Endocarditis (IE), requiring prompt early recognition and treatment to prevent life-threatening complications. Diagnosis is often missed or delayed, leading to an increase in cardiac morbidity and mortality. Aim: To analyse the clinical profile, laboratory parameters, cardiac manifestations, management patterns, and outcomes of Brucella endocarditis. Materials and Methods: A retrospective cohort study was conducted at the Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangaluru, Karnataka, India on patients with blood culture-confirmed Brucella endocarditis, diagnosed using modified Duke’s criteria between January 2010 and December 2021. The present study evaluated the clinical presentation, treatment modalities, and outcomes. Descriptive statistical analyses were performed. Results: A total of 34 cases were identified during the study period. The mean age of the patients was 35.6±14 years (age range: 15-66 years), with 82.4% males and 17.6% females. Underlying valvular heart disease was present in 82.4% of the patients, while 17.6% had no pre-existing valvular heart disease. Both aortic and mitral valves were involved with equal frequency. All patients presented with fever. Most patients had a normal leukocyte count (61.8%). Thrombocytopenia (32.3%) and pancytopenia (17.6%) were also observed. Large vegetations (&gt;1 cm) were seen in 38.2% of patients, and complications related to IE were observed in 35.2%. The majority of patients (82.4%) were managed medically alone in the acute phase. The antibiotic regimen of doxycycline with rifampicin combined with intravenous gentamicin was used in the majority of the patients. The observed mortality rate was 17.6%. Conclusion: Brucella endocarditis can present with thrombocytopenia/pancytopenia along with normal or reduced leukocyte count. The addition of intravenous gentamicin to oral therapy may reduce relapse rates.

Evaluation of QRS duration and presence of fragmented QRS in patients with inflammatory bowel disease.

Background: Inflammatory Bowel Disease (IBD) is mostly characterized by gastrointestinal tract involvement, however can also be accompanied with cardiac manifestations. QRS prolongation and the presence of QRS fragmentation (fQRS) have been previously evaluated in many chronic inflammatory diseases, as an independent predictor of cardiac events. In this study, we aimed to evaluate the QRS duration and fQRS in patients with IBD. Methods: The presented study was designed as a single-center retrospective cohort study. The study population consisted of 217 patients with IBD and 195 healthy controls. QRS duration and presence of fQRS were evaluated using a 12-lead electrocardiogram. These parameters were compared between groups. Results: QRS duration was demonstrated to be higher in the IBD group compared to the control group (92 (86-98) vs. 82 (75-90), p<0.001). The presence of fQRS was significantly higher in the IBD group (n=101 (47%) vs n=59 (30%), p=0.006). In addition, a positive correlation was demonstrated between QRS duration and disease duration (Spearman's Rho= 0.4, p<0.001). Notably, disease and QRS duration were significantly higher in the fQRS (+) group (102 (56.5-154) vs. 55 (24.3-118.3), <0.001; 94 (86-100) vs. 92 (84-96), 0.016; respectively). Conclusion: Our results demonstrated that QRS prolongation and the presence of fQRS (+) were more common in IBD patients, and associated with longer disease duration. These findings may indicate subclinical cardiac involvement in IBD. Therefore, IBD patients, especially those with long-standing disease, should be followed more closely in terms of cardiac manifestations.

A rare case of cardiac and ophthalmic manifestations of meningococcal septicemia.

A rare case of cardiac and ophthalmic manifestations of meningococcal septicemia.