Objectives: The objectives of this study were to evaluate the prevalence of the right ventricular infarction and its diagnostic, therapeutic and prognostic characteristics. Patients and methods:A single center retrospective study was carried out between January 2011 and December 2014. Patients who were diagnosed with right ventricular infarction at electrocardiogram and echocardiography were recruited.Outcomes: Among the 159 patients hospitalized for myocardial infarction, 10 had myocardial infarction extended to the right ventricle (6.3%). It occurred on an inferior infarction in 7 cases out of 35 and anterior infarction in 3 cases out of 124. The mean age was 53 years and sex ratio M/F of 2.33. All patients had at least 3 cardiovascular risk factors. Right-sided heart failure was found in 4 patients. Right ventricular infaction was associated with inferior STEMI in 7 patients, and anterior STEMI in 3 patients. Echocardiography showed right ventricular dilatation and impaired right ventricular systolic function in respectively 6 cases. Thrombolysis was performed in 7 patients and rescue angioplasty in 1 case. A regressive cardiogenic collapse was noted in 6 cases and one death in 1 case. Conclusion:Right ventricular infarction is relatively rare and usually related to an extension of an inferior myocardial infarction. Hemodynamic instability is of worse prognosis.
Vasospastic angina is considered rare but its prevalence is probably underestimated, especially in the case of atheromatous coronary lesions. Its diagnosis remains important because of its poor prognosis and its therapeutic features. We report a clinical case illustrating the issue of vasospastic angina's diagnosis. Diagnostic ways such as coronary spasm challenge tests must be adapted to the evolution of the techniques and the use of coronary angiography nowadays, in particular the preferential use of the radial pathway especially in women with a smaller radial caliber compared to men. Clinical CaseWe report through this clinical observation the issue of the diagnosis of vasospastic angina or Prinzmetal's angina (VSA).Mrs. GV, 41 years old, had as a cardiovascular risk factor an active smoking at the rate of 15 packs-year and a family history of coronary heart disease. She was admitted to the emergency department for a stable angina evolving for three weeks with episodes at rest.Biology noted an elevation of ultra-sensitive troponins to 220 ng/l. The electrocardiogram was normal, echocardiography noted moderate hypokinesis of left ventricle contractility in apical anterior, apex and anterior territories.The coronary angiography performed by right radial artery access with a 5 french catheter concluded to intermediate coronary lesions at 50% in the distal part of the left main coronary artery (LMCA), encompassing the origin of the left circumflex artery (LCA) and left anterior descending artery or LAD (Classification Medina 1-0-0), and a lesion of 50% in the distal portion of the middle right coronary artery or RCA (Figures 1 and 2).The measurement of the coronary reserve by Fractional Flow Reserve [FFR] towards the three axes was respectively 0.82 to the LAD, 0.83 to the circumflex artery and 0.92 to the right coronary artery.Drug therapy including beta-blockers, aspirin, clopidogrel, statins and a nitroglycerin transdermal patch was initiated. The patient was advised on the need for good control of cardiovascular risk factors, specially smoking cessation.Three days later, she presented a new recurrence of identical chest pain that occurred at rest for 10 minutes, leading her back to the emergency room.At rest, the electrocardiogram showed electrical modifications like repolarization disorders of biphasic T-type in V1 and V2 precordial leads; getting normal on the following electrocardiograms. Troponins were increased to 327 ng/l.The control coronary angiography performed again by the right radial artery access without injection of vasodilator, did not find an evaluative lesion. The methylergometrine testing was positive with the reappearance of chest pain, T-wave negativity in V1 lead (Figure 3) and spastic occlusion of the proximal LAD (Figure 4), regressive after intra-coronary injection of 3 milligrams of isosorbide dinitrate (Figures 5 and 6).
The aortic ring abscess is a rare and serious complication of infectious endocarditis. Echocardiography remains the diagnostic key, the treatment is expensive and the prognosis is generally dark .we report the case of a 29 years old patient with multiple value diseases who presented an aortic ring abscess.Observation: This is Miss M. D, 29, known with a rheumatic multiple valve disease: a combined mitral and tricuspid disease and an aortic regurgitation for over 15 years, with a history of multiple hospitalizations.At admission, she was in bad condition, suffered significant weight loss, was pale, a congestive heart failure, mitral regurgitation and stenosis signs, aortic regurgitation and pulmonary hypertension on a background of fever in the long course. The biology test noted anon specific inflammatory syndrome and negative blood cultures. Echocardiography showed, in addition to the multiple valve disease, a fluid collection at the valsalva sinus, suspicious of an abscess and multiple vegetation at the aortic valves.The patient received probabilistic anti biotherapy and congestive heart failure treatment. Surgery was indicated.Under probabilistic anti biotherapy, evolution was favorable at first then the clinical condition has deteriorated resulting in the death of the patient. The check up echo cardiographic noted a significant increase in the volume of the abscess. Conclusion:The aortic ring abscess is a serious complication of infectious endocarditis on native and prosthetic valve.Diagnosis is based mainly on Transthoracic and transosoephagial echocardiography. Surgery is indicated.
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