Background
Systemic sclerosis is a multisystemic character autoimmune disease. It is characterized by vascular dysfunction and progressive fibrosis affecting mainly the skin but also different internal organs. All heart structures are commonly affected, including the pericardium, myocardium, and conduction system. However, tachycardia–bradycardia syndrome is not common in the literature as a cardiac complication of systemic sclerosis.
Case presentation
We report a case of tachycardia–bradycardia syndrome in a 46-year-old Moroccan woman followed for systemic sclerosis with cutaneous, vascular, and articular manifestations. The diagnosis was based mainly on patient-reported symptoms and electrocardiogram data. A permanent pacemaker was implanted, allowing the introduction of beta-blockers with good outcomes.
Conclusions
This case aims to show that even minor electrocardiogram abnormalities should be monitored in this group of patients, preferably by 24-hour ambulatory electrocardiogram because they could be a good indicator of the activity and progression of cardiac fibrosis.
Introduction and aims: Post-myocardial infarction ventricular septal defect is a rare dreadful complication of myocardial infarction. It usually occurs between the 3rd and 7th day of the infarction. Several risk factors for its occurrence have been identified. The aim of our work is to discuss these different risk factors through clinical cases with a literature review. Material and methods: This is a retrospective study conducted from 2015 to 2021 including 18 consecutive patients with post-myocardial ventricular septal defect presented in either cardiac intensive care unit or cardiac surgery department of Mohammed V Military Teaching Hospital Rabat. All patients had at least a clinical examination, an electrocardiogram, and an echocardiogram showing ventricular septal defect. Surgery was performed at cardiac surgery department. Results: Mean age was 65.2± 26.4 years. There were more men than women in our study (17 males/1 female). Diabetes (55.6%) and smoking (55.6%) were the two predominant cardiovascular risk factors. The average body mass index was 23.7 ± 2.98 kg/m². Anteroseptal was the most observed infarct location (38.9%.) 16 patients presented after 12 hours of pain onset. 2 of them underwent percutaneous intervention and 1 underwent coronary artery bypass graft intervention whereas 15 didn't undergo any revascularisation strategy. The culprit artery was left anterior descending artery in 13 patients. The death rate was 55.6%, 50% before surgery and 50% after surgery. Conclusion: Delayed or absence of coronary reperfusion remains the main risk factor for post-myocardial infarction ventricular septal defect occurrence which explains its frequency decline since reperfusion strategies development.
Background: The combination of coronary and carotid artery disease is not rare since both entities share the same risk factors. However, when surgery is indicated for both pathologies, the question that remains is whether to opt for a simultaneous or staged surgery. Case Report: We report the case of a 73-year-old male, with a history of uncontrolled hypertension, dyslipidemia, diabetes and heavy smoking, admitted with an acute chest pain. Physical examination revealed bilateral carotid bruits especially at the right side. Electrocardiogram showed an ST depression in the anterior, lateral, inferior and posterior leads. Troponin was high. Trans-Thoracic Echocardiography showed an ischemic cardiopathy with preserved ejection fraction. Coronary angiography showed a triple-vessel disease requiring surgery. CT angiography of the neck showed a right carotid artery stenosis of 90 % also requiring surgery. He underwent a simultanous intervention with good outcomes. Conclusion: There are many debates about the choice of a simultaneous or staged surgery T the indications are still unclear. Multicentric studies must be carried out.
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