हृदय रोग एवं निदान

Background: Human Immunodeficiency Virus (HIV) infection is one of the leading causes of acquired heart diseases and specifically of symptomatic heart failure and pulmonary arterial hypertension. In the clinical course of HIV infection, CD4 + count decreases with disease progression and it has been considered to be correlated with LV dysfunction in the disease process. Method: This was a cross-sectional case-control study. One hundred newly diagnosed HAART naïve HIV/ AIDS individuals seen in the retroviral clinic were evaluated clinically. One hundred age and sex matched HIV negative controls were recruited. Those with other cardiovascular risk factors were excluded. Blood samples were screened and confirmed for HIV1 and 2 infections using double ELISA. CD4 + count was estimated using the flow cytometry method. Left ventricular diastolic function and geometry were assessed using transthoracic echocardiography. Results: The mean age of cases with HIV/AIDS was 35.7 ± 10.13 years. Females were more than males in a ratio of 2.3:1. Diastolic dysfunction assessed by E/A ratio, deceleration time and isovolumic relaxation time (IVRT) occurred more in the cases compared to the controls (40% versus 6%) and this was statistically significant (x2=38.15, p=0.001). Abnormal geometry assessed using LVMI and RWT was commoner in the cases than in the control group and this was statistically significant (x2=25.49, p=0.01). There was an insignificant negative correlation between CD4 + count and IVRT (R=- 0.0086, P=0.393). Subjects with CD4 + count <200 cells/μL were more likely to have diastolic dysfunction (OR=1.680, P=0.2112). Lastly, there was an insignificant negative correlation between CD4 + count and LVMI (R=- 0.303, P=0.816). Subjects with CD4 + count<200 cells/μL were more likely to have abnormal geometry (OR=1.182, P=0.6312). Conclusion: Left ventricular diastolic dysfunction and abnormal geometry were shown in this study to be more common in people with HIV/AIDS than in the control group and there was association between degree of immunosuppression and diastolic dysfunction as well as abnormal geometry, although these were statistically not significant.

Interrupted aortic arch (IAA) is a congenital anomaly that affects approximately 3 per million live-births. Adult presentation of complete aortic interruption is extremely rare. Surgical repair of IAA is the mainstay of treatment, however beneficial effects of intervention in the adult population are still debated. Late complications of surgical or percutaneous procedures have to be considered when managing asymptomatic adults.

Introduction: Rheumatic heart diseases are redoubtable complication of acute articular rheumatic. Without treatment, pulmonary hypertension and right heart failure may occur. This pulmonary hypertension was admitted as predictor of worse outcome after surgery. The aim of our study is to value the results after mitral surgery in patients with moderate and severe pulmonary hypertension. Methods: This is an observational descriptive retrospective study between January 2006 and December 2012; a total of 201 patients were operated for mitral or mitro-tricuspid disease with pulmonary arterial hypertension in “Djeghri Mokhtar” hospital. These patients are divided into two groups according to preoperative pulmonary hypertension (PAH) degree: (Group A: 102 patients in moderate PAH, 40 ≤ sPAP<60 mmHg; Group B: 99 patients in severe PAH, Spap ≥ 60 mmHg). In our study, sPAP was measured with doppler echocardiography. Preoperative, operative and postoperative data collection included age, sex, functional class, type of surgery and cardiopulmonary bypass. Pulmonary arterial systolic pressure, left atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction were recorded and compared. Results: The follow up is in mean of 61.73 months (from 30 to 108 months). The functional class was improved in majority of patients. There is a significant decrease in mean sPAP during follow up:(48.72 ± 5.85 versus 29.12 ± 8.29 mmHg in group A;77.90 ± 15.62 versus 28.87 ± 10.61 mmHg in group B). Global hospital mortality is 0.49% (0% in group A, 0.98% in group B). Late mortality is 2.48%( 3.92% in group A; 1.01% in group B). Survival at 05 years is 96.5%. Conclusion: Pulmonary arterial systolic pressure decreased near normal value in most patients after surgery. Severe pulmonary hypertension must not be an absolute contraindication for mitral surgery, the outcome has been improved by developing cardiopulmonary bypass, myocardial protection and anesthetic technique.

Left ventricular free wall rupture (LVFWR) is a rare, yet lethal, complication of acute myocardial infarction (AMI), occurring in approximately 2% of cases. In the era of percutaneous coronary intervention, however, it is less frequently encountered.

We were confronted with a case of AMI complicated with LVFWR after receiving thrombolytic therapy. The diagnosis was established using transthoracic echocardiography (TTE). Unfortunately, the patient passed away before surgical intervention. This case demonstrates the importance of prompt diagnosis and management of such a lethal complication.

Considering to pathogenetic mechanisms of MI a few classical biomarkers have been used for diagnosis of MI or acute coronary syndrome. Lately novel markers have been identified to provide diagnostic and prognostic information and outcome of MI or acute coronary syndrome. A few novel biomarkers are overviewed in this article. A few novel biomarkers mentioned in this article showed significant relation to left ventricle remodelling and poor prognosis after myocardial infarction.

Background: Kearns Sayre Syndrome (KSS) is a rare mitochondrial disorder with systemic involvement characterised by skeletal, smooth and cardiac muscle dysfunction; pigmentary retinal changes; neurological and endocrine dysfunction. KSS arise from a large-scale deletion of mitochondrial DNA which typically occurs as a sporadic event. Recurrent cardiac syncope is one way of the initial presentation of this syndrome due to involvement of cardiac conduction system. Case presentation: A 51-year-old male, previously well apart from having stable angina for which he was on aspirin and statin, presented to medical casualty with recurrent syncopal episodes with loss of consciousness lasting 3 minutes to 5 minutes and spontaneous recovery after each event. On ocular examination he was found to be have poor vision (best corrected visual acuity in both eyes was 6/60), bilateral posterior subcapsular cataract and both eyes fundus revealed features of retinitis pigmentosa with cystoid macular oedema. A 12 lead electrocardiography (ECG) on admission showed evidence of atrial flutter with variable heart block leading to significant pauses and the patient underwent permanent pacemaker insertion as he was severely symptomatic. Patient was referred to visual rehabilitation. Conclusion: Mitochondrial myopathy is an important differential diagnosis which needs to be considered in a patient presenting with recurrent cardiac syncope in the context of multisystem involvement.