BackgroundCardio-Renal Syndromes were first classified in 2008 and divided into five subtypes. The type 1 Cardio-Renal Syndrome (CRS) is characterized by acute decompensation of heart failure leading to acute kidney injury (AKI). Bradyarrhythmia was not mentioned in the classification as a cause for low cardiac output (CO) in type 1 CRS. Besides, CRS was not previously associated with central nervous system (CNS) injury despite the fact that cardiac, renal and neurological diseases can coexist.Case presentationWe report the case of a 93-year old diabetic man who presented for obnubilation. He had a slow atrial fibrillation, was not hypotensive and was not taking any beta-blocker. He developed, simultaneously, during his hospitalization, severe bradycardia (<35 beats per minute), oligoanuria and further neurological deterioration without profound hypotension. An ECG revealed a complete atrioventricular (AV) block and all his symptoms were completely reversed after pacemaker insertion. His creatinine decreased progressively afterwards and at discharge, he was conscious, alert and well oriented.ConclusionOur case highlights the importance of an early recognition of low cardiac output secondary to severe bradyarrhythmia and its concurrent repercussion on the kidney and the brain. This association of the CRS with CNS injury-that we called “Cardio-Renal-Cerebral Syndrome”–was successfully treated with permanent pacemaker implantation.
Background: We describe a rare case of cardiac malignancy that counts for <1% of the primary cardiac tumors with a poor prognosis. Case summary: It's a rare case of a primary cardiac lymphoma in a 59-year-old patient who presented for recurrent pleuropericarditis with low-grade fever and night sweats. Investigations revealed an infiltrating mass in the right atrioventricular groove involving the right atrium and the right ventricular free wall. Pathology confirmed the diagnosis of non-Hodgkin's lymphoma. Chemotherapy with R-CHOP regimen was a success, but the patient suffered from recurrence with a complete remission after a second chemotherapy cycle. He was a candidate for bone marrow transplant to reduce other possible relapses. Discussion: Early diagnosis is better for long-term prognosis and improves quality of life.
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