Abdalla Hassan

PROGNOSTIC IMPACT OF SUBCLINICAL HYPOTHYROIDISM IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Subclinical hypothyroidism (SCH) is underdiagnosed in patients (pts) with heart disease, however, there has been controversy surrounding whether it is a cardiovascular risk factor or not. To determine the prognostic significance of SCH in Heart Failure (HF) with Preserved Ejection Fraction (HFpEF)

RECURRENT DYSPNEA IN A PATIENT WITH SEVERE PECTUS EXCAVATUM: THINK CONSTRICTIVE!

Dyspnea in Pectus Excavatum (PE) patients is mostly related to airflow compression with cardiac etiology being less likely. A 34 year-old male with severe persistent PE despite 2 repairs and broncho-pulmonary hypoplasia (BPH) presented with recurrent dyspnea and chest tightness limiting his

ATRIAL SEPTAL DEFECT- INDUCED PARTIALLY REVERSIBLE SEVERE PULMONARY HYPERTENSION: WHAT SHOULD WE DO?

Atrial septal defect (ASD) and severe shunt-related pulmonary hypertension (PHTN) management is controversial. The reversibility of PHTN, assessed during right heart catheterization (RHC), is the main determinant of management. However, limited data exist on how to manage ASD and PHTN with some

Prognostic significance of coronary artery disease in heart failure with preserved ejection fraction patients

Background: The cyanotic heart disease Tetralogy (TOF) is one of the common congenital heart disease in children. The catheterization of such patients still considered as important diagnostic step before surgical correction. The prevalence of abnormal coronaries in Tetralogy (TOF) has been reported up to 9% in different studies. Coronary abnormalities are usually difficult to delineate intraoperatively because of thick epicardial fat layer and adhesions particularly after BT shunt. Aim: To find out coronary abnormalities in Tetralogy of Fallot (TOF) children seen in our cardiac unit. Place and Duration of Study: The study was conducted in the Children hospital & Institute of Child Health, Lahore, Pakistan from January 2006 to December 2014. Methods: A Retrospective descriptive study was done .Records of all Patients with Tetralogy of Fallot from 9 months to 16 years whose cardiac catheterization was done before going to surgical repair in our unit were selected in this study. Two Non-selective aortic root angiogram were done i.e., standard 45 left anterior oblique (LAO) and 20 cranial and 30 right anterior oblique (RAO) views were taken to look for coronaries course. Data was analyzed in SSPS-19. Results: Total 662 patients with Tetralogy underwent cardiac catheterization were included in the study. 65.4% were male while 34.6% were female. The mean age was 69±43.14 months. 94.4% of patients with Tetralogy had a normal coronary anatomy while 5.6% of patients with Tetralogy had abnormal coronary course. Out of these patients with abnormal coronary, the most common was detected single origin of coronary artery that is 2.9% of cases. Out of which 12 patients had common origin from left sided sinus i.e., 1.8% and 7 patients had common origin from right sided sinus i.e., 1.1%. 2.6% of patients with abnormal coronary had coanal branch crossing right ventricular outflow track (RVOT) anteriorly and 0.2% of patients with abnormal coronaries had coanal branch crossing RVOT posteriorly. Conclusion: Coronary artery anomalies and its course in Tetralogy patients were detected upto 5.6% of the cases. Single origin coronary artery abnormality was found to be the most common abnormality in this study.Case presentation: A 66-year-old male presented to us with 3 days history of chest pain and difficulty breathing. He is known to be hypertensive. In the emergency room, patient has systolic blood pressure >190. Chest X-ray showed widening of mediastinum. CT angiography of chest and abdomen showed an acute dissection of the thoracic aorta extending from the mid ascending aorta to the infra-renal aorta suggestive of Stanford type A aortic dissection. Transthoracic echocardiography revealed a calcified intimal flap just beyond the distal arch. Moreover, large partially calcified intimal flap was present in the abdominal aorta with no proximal clear cut extension. Normal ejection fraction was reported with dilated aortic root, dilated aortic arch, and large pericardial effusion with no evidence of cardiac tamponade. Trans-esophageal echocardiography was done later, and it revealed a partially calcified intimal flap in the distal portion of the arch and in the descending thoracic aorta in concordance with the trans-thoracic echocardiogram findings and no abnormalities were reported in the ascending aorta. These findings were significantly consistent with Stanford type B aortic dissection. Due to the discrepancy of these tests, imaging studies were reviewed, and repeated CT chest with contrast was obtained and surprisingly confirmed that he had Stanford type B aortic dissection, with the dissection starting distal to the left subclavian artery and intact ascending aorta. Medical treatment started, and repeated CT angiography was obtained and it confirmed type B aortic dissection. One week after discharge, patient was readmitted with severe neck pain and difficulty breathing. CT chest without contrast showed grossly stable appearance of type A dissection consistent with the first CT angiography. Cardiothoracic surgery immediately reevaluated the situation and recommended surgical intervention.Results: Women constituted 55.7% of our patient population, while men represented the remaining (44.3%). Mean age was 73.5 ± 12.6 years. History of CAD was documented in 56.6% of patients. Overall, CAD was not predictive of poor outcome and cardiovascular death. Poor outcome was observed in more than half of HFpEF patients with history of CAD and in only about one third of those without CAD, 56.1% and 38.6%, respectively (P=0.1). Moreover, the number of the diseased coronary artery vessels on angiogram was not a significant predictor of poor outcome (P=0.17).H Chloro Quine (HCQ) is an antimalarial drugs that has been used for treatment of connective tissue disorders. Unlike other agents, Hydroxychloroquine has gained popularity because of its relatively safe profile and less toxic side effects. Hydroxychloroquine cardiotoxicity is a rare disease but a potentially fatal heart condition. To date, no clear guidelines or protocols exist to monitor patients for development of the cardiac side effect of HCQ. In this brief review we will focus on Hydroxychloroquine Cardiotoxicity, its clinical presentation, diagnosis,potential risk factors that are predisposing to the cardiomyopathy and variables that affect the outcome of this rare for of cardiomyopathy.Method: This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the family’s monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed.

SHORT- AND LONG-TERM PROGNOSIS OF TAKOTSUBO CARDIOMYOPATHY

Stress cardiomyopathy (SCM) is a reversible cardiomyopathy thought to have a good short-term prognosis but with a recurrence rate of 10 percent. This study sought to determine short and long term mortality and recurrence rate. 56 consecutive patients presenting to a single urban medical center who

PROGNOSIS IN STRESS CARDIOMYOPATHY IS PREDICTED BY QTC INTERVAL AT PRESENTATION

Patients with stress cardiomyopathy (SCM) who survive the initial event expect a favorable outcome with full recovery. Predictors of long-term mortality and recurrence are not known. This study was undertaken to identify clinical variables predictive of in-hospital and long-term outcomes in SCM. 56