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Speckle tracking imaging is a relatively new technique for obtaining myocardial strain based on the tracking of speckles in gray-scale echocardiographic images. Speckles are acoustic markers that can be tracked from frame to frame over the cardiac cycle, providing non-Doppler information about global and segmental myocardial deformation. In this article, the general principles of good practice of echocardiography will be revisited in order to obtain a better evaluation of myocardial deformition and to optimize these clinical contributions in current practice. [ABSTRACT FROM AUTHOR]

Some beneficial effects of statins have been demonstrated in vitro and in vivo , both experimentally and clinically, independently on their hypolipidemic effects. These "pleiotropic" effects are multiple: improved endothelial function, improved atherosclerotic plaque stability, reduced oxidative stress and inflammation, inhibition of the thrombogenic response and modulation of the immune system. Logically, numerous clinical trials have evaluated the benefits of a loading dose of statin, administered before and usually a few days after coronary reperfusion surgery. Unfortunately, all these trials evidenced a "neutral effect", i.e. no detectable beneficial effect. In June 2023, Liakopoulos et al. -published a perfectly designed and conducted clinical trial in the European Heart Journal , confirming the absence of significant effect of an oral statin load during and following surgical coronary revascularization. Lina Badimon et al. , undisputed experts in the field, point out in an editorial in the same issue that the plasma statin doses required to obtain pleiotropic effects are much higher than those needed to induce a reduction in plasma LDL levels. The metabolic effects of higher doses are different, leading to inactivation of G proteins, which in turn are responsible for the pleiotropic effects of statins. Experimental studies in large animals confirm that intravenous administration of a statin significantly reduces the size and severity of a myocardial infarction following coronary ligation. The authors therefore recommend validating, in humans, the feasibility and safety of a loading dose of statin administered intravenously during coronary reperfusion procedure. [ABSTRACT FROM AUTHOR]

Cannabis is one of the most widely used drugs in the world today. Cardiovascular manifestations associated with its consumption, in particular acute coronary syndroms, have long been propagated in the literature. This contrasts with the lack of awareness of its harmful effects. The legalization of this drug in several countries of the world with the increase in its use for non-recreational purposes should be associated with a wide prevention and sensibilization of health care workers, patients and consumers in order to prevent cardiovascular disorders. We then report the case of a 36-year-old young man whose risk factor is regular cannabis consumption and chronic smoking who presents for an acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction. Late complications of myocardial infarction (MI) are important causes of re-hospitalization and mortality in patients with type 2 diabetes mellitus (DM). The objective of the study was to predict the development of late complications after MI in type 2 DM patients, to improve the quality of diagnostic tests for this group of patients. Material and methods. A total of 109 patients with type 2 DM after MI was divided into two groups: the study group (n = 74) and the validation group (n = 35). The levels of adropin and C1q/tumour necrosis factor-related protein 3 (CTRP 3) were measured by enzyme-linked immunosorbent assay. The model for predicting late complications of MI was calculated using binary logistic regression. Results. The median age of patients was 61.0 (54.5 – 67.0) years and 68.8% were male. Mathematical model components on the 14th day of follow-up were qualitative adropin, qualitative CTRP3, total cholesterol (TC), triglycerides (TG), ejection fraction (EF), low-density lipoprotein (LDL), left atrium (LA). The model attained the highest under the receiver operating characteristic curve for predicting late MI complications in the study and control groups (0.949 and 0.966, respectively), with the highest diagnostic accuracy in both groups (94.6% and 97.1%, respectively). Conclusions. This study has shown that the integral assessment of adropin, CTRP 3, TC, TG, EF, LDL, LA, measured on the 14th day after MI in type 2 DM patients who underwent percutaneous coronary intervention (PCI), could predict late complications of MI after PCI.

Cardiovascular diseases are among the most common causes of disability and death in the world, and the number of patients with this category of diseases is increasing every year. This study aimed to investigate the role of vitamin D and the problems caused by its deficiency on the cardiovascular system. Level of D-(25[OH]D) in blood was studied by enzyme immunoassay in 95 elderly patients with myocardial infarction (MI) (the main group) and 92 elderly patients with no history of MI. The level of lipid metabolism as an indicator was determined using a KoneLab 300 auto-analyzer. Based on the results of this study, it was found that the elderly group without MI had the highest amount of D-(25[OH]D)(24.5±1.2), compared to the elderly group with MI (14.8±1.3). The rates of expressed deficiency, deficiency, and insufficiency in the group of elderly with MI were 53.6±5.1, 23.2±4.4, and 12.6±3.4%, respectively. This experiment has shown that D-(25[OH]D) is involved in lipid metabolism and reduces the accumulation of cholesterol by macrophages. The content of vitamin D in blood plasma was a prognostic predictor of MI, which improved MI in the elderly. Regardless of pathological changes, the deficit level of D-(25[OH]D) should be considered a laboratory predictor of MI in the elderly.

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From hypoglycemia to myocardial infarction: another particularity of diabetes Diabetic myocardial infarction can be completely silent. Hypoglycemia is rarely a circumstance of discovery unlike hyperglycemia and ketoacidosis which can mask myocardial infarction. We report the case of a 43-year-old patient with type 1 diabetes who had lipothymia at home that has shown hypoglycemia corrected after sugar intake, in whom a complicated acute myocardial infarction of the atrioventricular block was diagnosed. He benefited from the placement of a temporary pacemaker in emergency and revascularization of the right coronary seat of a thrombotic occlusion. [ABSTRACT FROM AUTHOR]

Aim: The forecast of Myocardial Infarction for humans employing a Machine learning model by corresponding a Logistic Regression Algorithm with a CatBoost Classifier. The accuracy is enhanced by utilizing the novel LR Classifier. Materials and Methods: The study utilized a total of 20 sample iterations, with 10 samples per group. Group 1 was analyzed using a logistic regression algorithm, while Group 2 was analyzed using a decision tree classifier. The statistical power was set at 80%, and the confidence level was set at 95%. Results: The accuracy of the outcome with logistic regression is 94.61% and CatBoost Classifier is 79.516%, both the groups are statistically significant as p = 0.015 (

Introduction: Cardiac rehabilitation (CR) is an effective intervention to support patients in achieving their health objectives and in decreasing their risk of suffering from another myocardial infarction (MI). However, in several remote areas, no cardiac rehabilitation program (CRP) exists to support patients having experienced an MI. Before the creation of an intervention CRP adapted to patients living in these areas, it is essential to describe patients and healthcare professionals' needs regarding cardiac rehabilitation care. Objective: This study describes the needs of remote patients and healthcare professionals for the essential components in a CR program following myocardial infarction and percutaneous transluminal coronary angioplasty. Methods: A qualitative formative research study was conducted involving 10 men, 6 women, and 4 family physicians. Data were collected through in-depth individual interviews and one focus group. Results: Results show that patients who have suffered an MI have multiple unmet needs. This gap may be due to the variability in follow-ups by healthcare professionals. In the absence of a cardiac rehabilitation program, these patients must adapt quickly to their new health condition. Discussion and conclusion: It is critical that the needs of patients living in remote areas are better addressed in cardiac rehabilitation. To do this, it is essential to create a CRP that is tailored to the needs of both patients and professionals, thus providing patient-centered care.

We report a case of fatal myocardial infarction (MI) after electrocution in a 26-year-old male patient without cardiovascular risk factors. The patient was admitted to the Emergency Department of the University Clinics of Lubumbashi for management of accidental electrocution on a high-voltage power line. The admission ECG showed lesions consistent with myocardial infarction. Despite treatment, the patient died 30 minutes after admission., Competing Interests: Disclosures The authors have nothing to disclose., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Patients with type 2 diabetes (T2D) are frequently exposed to comorbidities, mainly cardiovascular complications. Thus, a polypharmacy is often mandatory, targeting not only T2D but also comorbidities such as coronary artery disease and heart failure. Interestingly, some drugs improve glucose control, cardiovascular prognosis and heart failure outcome. This versatility may cause trouble regarding prescriptions by practitioners, especially because of the restricted conditions for the reimbursement in Belgium. This clinical vignette aims at discussing the path of pharmacotherapy for a patient with T2D who suffers from a myocardial infarction and subsequently develops a heart failure. It will mainly focus on the place of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporters 2 (gliflozins) as well as the potential of their combination in this context, considering the current restrictions for the reimbursement.

Introduction: Post-infarction ventricular septal defect (PIVSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Over the last decade, percutaneous closure is increasingly undertaken, with results similar to cardiac surgery. We present a case of ST-elevated anterior AMI, complicated by apical PIVSD successfully treated with transcatheter closure., Case Report: An 83-year-old man was hospitalized for chest pain occurred 18 hours before, during the night time. He was an active smoker. Clinical examination revealed normal heart sounds and pulmonary bibasilar crackles. ST-segment elevation with deep T waves inversion in anterior leads were detected on the electrocardiogram. A mildly-reduced ejection fraction (40%) was found by transthoracic echocardiogram. The patient underwent emergency coronary angiography, which revealed a subocclusive stenosis of the mid left anterior descending artery with a TIMI 2 flow, treated by balloon angioplasty and drug-eluting stent. Four days after revascularization, the patient developed an acute deterioration with signs of decompensated heart failure and a new holosystolic murmur with large irradiation. Inotropic agents' administration was required to maintain a precarious hemodynamic condition. A bedside Echo revealed an apical VSD, measuring 15 × 10 mm, with left-to-right shunting, and pulmonary hypertension. The patient was scheduled for transcatheter PIVSD closure. The procedure was performed under fluoroscopic guide. Two vascular access sites were placed, femoral arterial and right internal jugular vein. Through the right internal jugular vein, a 24-mm Amplatzer atrial septal occluder on a 9 French Amplatzer TREVISIO™ intravascular delivery system was advanced via right ventricle into the PIVSD. Contrast fluoroscopy was used to assess apposition and the degree of shunt reduction before release. Echocardiographic evaluation performed 48 hours later confirmed a correct apposition of the device with insignificant residual shunt. At 6 months follow-up, he was asymptomatic, with unchanged prosthetic findings., Conclusion: Percutaneous closure has been emerged as a valid cost-effective alternative to surgery and should be advised. However, debate remains on the optimal preprocedural optimization, timing of repair and modality of treatment., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé: Le cannabis est la drogue illicite la plus consommée dans le monde, en Europe et en France. Son principal composé psychoactif est le delta-9 tétrahydrocannabinol (Δ-9-THC), classé comme stupéfiant. Si les effets psychiatriques et neuropsychiques du cannabis sont depuis longtemps largement décrits, les effets somatiques du cannabis fumé, notamment cardiovasculaires, ne sont rapportés que depuis peu avec des publications sur des infarctus du myocarde (IDM) du sujet jeune qui se sont multipliées depuis les années 2000. Les mécanismes impliqués dans la survenue des IDM restent hypothétiques, associant dysfonctionnement du système nerveux autonome, altération de la fonction plaquettaire, induction d'un vasospasme et effets toxiques directs des constituants de la fumée et des produits adultérins. La relation causale entre la consommation de cannabis et la survenue d'IDM reste sujette à débat. Cependant, parce qu'il s'agit de complications graves, touchant très majoritairement des hommes jeunes, pouvant entraîner le décès, et que l'existence d'une relation temporelle entre leur survenue et la prise de cannabis suggère fortement un lien de causalité, il serait prudent, malgré les limites des études mentionnées, d'informer les professionnels et les usagers sur l'existence possible de ce type de complication, notamment lors d'un usage chronique et en quantité importante, ce d'autant que l'on fait face à l'augmentation du nombre de consommateurs et aussi de la teneur en THC des produits consommés. Today, cannabis is the most frequently used psychoactive substance after alcohol and tobacco, particularly among young people, the main psychoactive constituent being 9-tetrahydrocannabinol (Δ-9-THC), responsible for the euphoric effects of cannabis. In parallel with increasing cannabis consumption and rising THC concentrations, a growing number of published case reports have described cannabis-induced adverse cardiovascular events such as myocardial infarction (MI). The literature suggests that cannabis use plays a role in inducing MI, particularly in young, otherwise healthy adults who present shortly after use. Increased autonomic stimulation, altered platelet aggregation, vasospasm, and toxic smoke constituents have all been proposed as explanations of this effect. However, it is likely that the true pathogenesis is multifactorial. As most studies are observational in nature, causality link, although not proven, is suggested by the existence of a temporal relation between occurrence of these complications and cannabis use. It would be desirable in cases of myocardial infarction of the young person, to systematically seek cannabis use. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms are uncommon, are usually associated with atherosclerosis, and rarely involve all three major coronary arteries. Data on the optimal choice of AMI´s revascularization in the context of polyarteritis nodosa (PAN) is limited to case reports and is still an open question. The present report describes a rare case of a young male patient followed for PAN presenting with acute myocardial infarction (AMI). Coronary angiography revealed multiple severe aneurysmal and stenotic changes. Based on clinical feature and angiographic findings, it was strongly suspected that the AMI was a complication of his vasculitis. This case indicates that coronary artery involvement should be carefully monitored during the chronic phase of PAN. The pathophysiology of AMI in PAN patients should be kept in mind and the interventional approach must be performed according to the angiographic findings to avoid complications.

We report the observation of an acute coronary syndrome in an 84-year-old woman evolving to an anterior myocardial infarction with persistent elevation of the ST segment (STEMI), without significant stenosis of the left descending coronary artery after manual aspiration of a distal thrombus. The diagnostic workflow secondary to this clinical condition of MINOCA (Myocardial Infarction with Non Obstructive Coronary Arteries), integrated, according to the very latest definition of myocardial infarction, in the infarcts subgroup type 2 (not linked to an athero-thrombotic event) led to the very high probability of the diagnosis of coronary embolism related to a chronic and untreated atrial fibrillation. The purpose of this article is to provide a formal and updated definition for the broadly labelled term MINOCA (incorporating the definition of AMI from the newly released "Fourth Universal Definition of Myocardial Infarction") and to provide a clinically useful framework and algorithms pertaining to the diagnostic evaluation and management of these patients. [ABSTRACT FROM AUTHOR]

Left ventricular aneurysms (LVA) are mainly a late consequence of transmural myocardial infarction. Approximately 80% of LVA are located in the anterior and/or apical walls, most commonly associated with left anterior descending artery occlusion but any region may be engaged.Basal inferior wall aneurysms are rare and constitute nearly 3% of all LVA. A calcified LVA is seldom observed in modern clinical practice. And a calcified basal inferior LVA is an even rarer coincidence. We report a case of an 82-year-old women with life threatening arrhythmia revealing a giant calcified aneurysm of the basal inferior wall, medically treated with good outcomes. The exact incidence of left ventricular aneurysms (LVA) following myocardial infarctions is hard to precise but it is clearly decreasing. Eighty percent (80%) of LVA are located in the anterior or apical walls, but any region may be engaged. Basal inferior wall aneurysms constitute 3% of all LVA. Echocardiography is the first diagnostic tool and there is still no clear guidelines on how to treat LVAs. Surgery is preferred but medical treatment may help improve the quality of life.

Introduction: Despite the demonstrated efficacy of cardiovascular (CV) preventive measures, data from international literature indicate that control of CV risk factors (RF) remains insufficient in very high-risk patients., Aim: This study aimed to assess prevalence of achievement of recommended therapeutic targets for the major and modifiable CVRF 12 months after myocardial infarction (MI)., Methods: From 1st January to 30th April 2023, we collected consecutive patients with type 1 MI who had completed 12 months follow-up. Primary endpoint was prevalence of achievement of all recommended therapeutic targets of low-density lipoprotein cholesterol (LDL-C), diabetes mellitus (DM), arterial hypertension (HTN), and smoking. Targets and treatment goals were defined according to the 2021 European Society of Cardiology guidelines on CV disease prevention., Results: 107 patients, mean age 58.8 ± 8.8 years, 74.8% male, were included. 42 (39.3%) patients had HTN, 50 (46.7%) were diabetics, 77 (72.0%) were smokers and eight (7.5%) had hypercholesterolemia. At 12 months, primary endpoint was achieved in 20 (18.7%) patients. 55 (71.4%) of 77 smoker patients were weaned. Blood pressure was at target in 26 (61.9%) among hypertensive patients. In DM patients, HbA1c target was achieved in 23 (46.0%) of them. 32 patients (29.9%) achieved the goal of LDL-C < 0.55 g/L., Conclusions: Secondary prevention of CV disease was suboptimal. Less than a fifth of patients achieved treatment target for most major and modifiable risk factors. Improvement in follow-up care and treatment after MI is needed.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8th December 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.

We report the case of a 59 year-old male with medical history of hypertension and diabetes mellitus, who was referred to the emergency department for chest pain that occured 24 hours before, associated with shortness of breath. On admission, blood pressure was 110/60 mmHg, heart rate was 110 beats/minute, saturation was 96% while breathing ambient air, and cardiac auscultation revealed a left sternal systolic murmur. Electrocardiogram (ECG) showed a 6 mm Convex ST-segment elevation with pathological Q-waves in anterior leads. Transthoracic echocardiography (TTE) showed a 15mm apical Ventricular Septal Defect(VSD) (A,B) with left-to-right shunt, associated with regional wall motion abnormalities :large apical akinesia and severe antero-lateral hypokinesia with a calculated left ventricular ejection fraction of 35%, in addition to an estimated pulmonary artery systolic pressure (PASP)of 60 mmHg. The patient immediately underwent coronary angiography that revealed a total occlusion of the left anterior descending (LAD) artery, where a drug-eluting stent was successfuly placed. After the patient´s stabilization, the case was discussed by the heart team after which, the patient underwent a surgical VSD repair on day 10 of onset, with good operative result. The post operative follow-up was uneventful and no residual vegetation in the control TTE. The patient was discharged from the hospital in stable condition.

Résumé: Les bêtabloquants font partie de l'ordonnance classique du patient coronarien, comme les antiagrégants plaquettaires ou les statines. Pourtant, s'il existe des preuves nombreuses et formelles du bénéfice pronostique en prévention secondaire des antiagrégants et des statines, ce n'est pas le cas pour les bêtabloquants. L'objectif ici est de resituer l'action des bêtabloquants dans la physiopathologie de l'athérome coronaire et de ses complications, et de refaire un point sur les données factuelles de la littérature et des dernières recommandations de la Société Européenne de Cardiologie, afin de remettre à jour et adapter la place des bêtabloquants dans la prise en charge quotidienne de nos patients coronariens. Betablockers are part of the classic prescription of the coronary patient, like antiplatelet agents or statins. However, if there is numerous and formal evidence of the prognostic benefit in secondary prevention of antiaggregants and statins, this is not the case for beta-blockers. The objective here is to re-situate the action of beta-blockers in the pathophysiology of coronary atheroma and its complications, and to review the factual data in the literature and the latest recommendations of the European Cardiology Society, in order to update and adapt the place of beta-blockers in the daily care of our coronary patients. [ABSTRACT FROM AUTHOR]

À travers le monde, observée surtout en période estivale, l'envenimation scorpionique (ES) constitue un vrai fléau de santé publique. Elle est très répandue dans les régions rurales des pays à climat chaud. En raison de sa fréquence, l'ES est la première (50 à 60 %) de l'ensemble des intoxications déclarées au Centre antipoison au Maroc [1]. Bien que le scorpion jaune soit considéré comme le plus dangereux, parce qu'il exerce une toxicité cardiaque, nous rapportons un cas de toxicité cardiopulmonaire chez un adulte suite à une envenimation par le scorpion noir. Dans moins de 3 % de l'ensemble des piqûres de scorpion, il existe une défaillance d'organes, principalement des perturbations cardiorespiratoires mettant en jeu le pronostic vital. Ces manifestations correspondent à une insuffisance cardiaque aiguë se déclinant sous la forme d'un état de choc et/ou d'un œdème pulmonaire aigu (OAP) [2]. Nous rapportons ici une présentation inhabituelle d'un cas d'envenimation scorpionique sévère compliquée par un OAP et un choc cardiogénique chez un adulte, dont l'évolution a été favorable. [ABSTRACT FROM AUTHOR]

Ляшук Петр, Ляшук Руслана Музы с врачебным саквояжем: штрихи врачебной деятельности и литературного творчества, обстоятельства и причины смерти Резюме. В статье на основании данных литературы приведены факты общности деятельности врача и литературного творчества. Благодаря последнему эскулапы сыскали большую популярность. Раскрыты обстоятельства и причины смерти рыцарей скальпеля и пера: Степана Руданского и Антона Чехова (туберкулез легких), Михаила Булгакова (хроническое заболевание почек, почечная недостаточность), Викентия Вересаева (инсульт), Ярослава Окуневского (самоубийство), Софии Окуневской (аппендикулярный перитонит), Модеста Левицкого (кишечная непроходимость), Яноша Корчака (расстреляный) и Василия Кархута (инфаркт миокарда, сердечная недостаточность). Ключевые слова: врач, писатель, туберкулез, заболевание почек, инсульт, перитонит, кишечная непроходимость, расстрел, инфаркт миокарда. Liashuk Petro, Liashuk Ruslana Muses carrying a medical bag: Milestones of medical practice and literary work, circumstances and causes of death. Abstract. Tradition of combining medicine and literature has its origins in antiquity. Apollo, the god of poetry and medicine, is a symbol of such wonderful ‘’wedlock’’. Fruitfulness of alike union is undeniable. Most ancient doctors had humanitarian education except the medical one and vice versa – outstanding writers often graduated from medical schools. The fact that doctors sometimes change scalpel for pen was noticed long ago. They both are somehow connected the need for figuring out human’s psychology, thoughts, motives of their deeds. “There is no profession nowadays, which would demand such a shrewd and profound contact, such a spiritual and psychic intimacy between an expert and a human being, as a profession of doctor”. Medicine and literature, these equivalent fields of science and arts, which acknowledge human’s life, get into sacramental mysteries of our body and soul and heal not only by means of medical instruments and healthful power of pills but with the bottomless power of word as well, intertwined enormously in a given profession. “This is probably the reason of some affinity between the worldview, outlook, sensory perception necessary for both – literary work and medical practice”. This article provides some common features of medical and artistic practice on the basis of literary data. Aesculapius became popular due to art throughout our history. This work reveals the circumstances and cases of death of some knights of scalpel and pen, such as: Stepan Rudansky and Anton Chekhov (pulmonary tuberculosis), Mikhail Bulgakov (chronic kidney disease, renal failure), Vincent Veresaeva (stroke), Yaroslav Okunevskaya (suicide), Sophia Okunevskaya (appendix, peritonitis) Modest Levitsky (ileus) Janos Korczak (shoot) and Basil Karhuta (myocardial infarction, heart failure). The issue of medical historiography is an immense sphere of culture of the humanity, which gives us an opportunity to analyse an interesting and complicated essence of an artist and a doctor in one person and, in particular, to find out the cases and causes of their death. One of the complications of diphtheria, which suffered Bulgakov, is kidney damage. Moving it to St. Petersburg (adverse climatic conditions) led to the progression of renal disease. Chekhov in his youth suffered peritonitis (presumably tuberculous). Later, after hypothermia, the poet appeared cough, sputum streaked with blood. We know that cold promotes activation of tuberculosis. V.Karhut returned from exile with symptoms of asthma. It is likely that asthma was mixed genesis (bronchial, cardiac), which led to the development of myocardial infarction Key words: doctor, writer, tuberculosis, kidney disease, stroke, shot, peritonitis, intestinal obstruction, myocardial infarction.

The occurrence of myocardial ischemia and myocardial infarction in pregnancy is relatively rare, the occurrence of myocardial infarction in pregnancy is associated with cardiovascular risk factors. The deficiency of coagulation regulatory systems in the occurrence of venous thrombosis is well established; however, their role in arterial thrombosis is controversial. Here, we present an interesting case of a 34-year-old of acute myocardial syndrome without persistent ST segment elevation, which revealed transient protein S deficiency. Management of acute coronary syndrome (ACS) during pregnancy may represent a unique clinical challenge. In this manuscript, we review the clinical presentation, anatomic considerations, and management strategy in our patient presenting with ACS. Objective: this case highlights the importance of multimodality approach to help to obtain a more timely diagnosis of myocardial infarction in pregnancy and the importance collaboration between obstetricians, cardiologists, pediatricians and anesthesiologists to ensure optimal care.

This corrigendum corrects article "Kounis syndrome induced by oral intake of aspirin: case report and literature review" and its publication references ie The Pan African Medical Journal. 2018;30:301. doi:10.11604/pamj.2018.30.301.14948.

The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.

The French PCI Registry collects up to 150 clinical, procedural, and one-year follow-up data on all coronary angiographies and angioplasties performed in the 61 participating centers in September 2023. Thanks to the support of the GACI, the DGOS, the ARS, and numerous hospitals, the registry is continuing to expand its coverage across the entire territory, with 90 centers expected to participate in 2024, accounting for nearly half of the French centers. The high quality of this data has already led to the publication of 18 studies in international journals, and around twenty others are currently being written. The online publication of comprehensive and comparative annual reports, along with the implementation of quality indicators to assess practices, would enhance the performance of all participating centers and ultimately benefit our coronary patients., Competing Interests: Déclaration de liens d'intérêts None, (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis. . The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: The polypill strategy could become widely accepted in cardiovascular prevention due to reduced costs and its simplicity, which promote compliance. Aspirin is often included as a component of the polypill for primary prevention, but three powerful recent trials failed to show any favorable net benefit even in high-risk subgroups. Our objective is to estimate the net benefit associated with aspirin in primary cardiovascular prevention., Methods: We simulated the impact of different polypill compositions combining pravastatin, ramipril, hydrochlorothiazide, with or without aspirin, on a realistic French virtual population between 35 and 65 years old. We assessed how this impact on myocardial infarction and stroke varied according to gender, diabetes, and arterial hypertension. We identified the subgroup of individuals whose specific benefit from aspirin was greater than twice the risk of serious bleeding it induced., Results: The absolute benefit associated with aspirin was reduced by co-prescriptions. No subgroup of women benefited from aspirin, and the subgroup of women with a clear net benefit represented 128 women out of 529,421. Men at high risk of cardiovascular death, or with diabetes and hypertension, had a benefit from aspirin exceeding the risk of bleeding induced, but this risk represented more than half of the benefit. No subgroup analyzed did show a benefit greater than twice the risk of bleeding. The proportion of men whose expected benefit from aspirin was greater than twice the risk of bleeding represented 3% of all men. An optimal polypill strategy in primary prevention between the ages of 35 and 65, combining three drugs but not aspirin, can hope to save two out of three strokes and more than one out of two myocardial infarctions. It would prevent a major cardiovascular accident every 16 to 193 individuals treated according to the subgroups considered., Conclusion: Until proven otherwise, aspirin has only a limited place in individuals between 35 and 65 years without a cardiovascular history. We showed how simulating therapeutic strategies on a realistic virtual population could be used for best applying available evidence., (Copyright © 2023 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Myocardial infarction (MI) is a multifactorial coronary artery disease influenced by environmental and genetic factors. Being one of the leading causes of morbidity and mortality in developed countries, it is becoming a national health concern in developing countries such as Morocco. In the present work, we aim to study the association between 4 Alu polymorphisms (ACE, FXIII-B, TPA-25 and APOA1) genes and the risk of MI in the Moroccan population. 210 patients with a history of myocardial infarction and 203 healthy individuals were included in this study. The Alu polymorphisms were determined by the PCR technique followed by direct electrophoresis. Only the I / I_APOA1 genotype showed a significant association with the risk of MI (p˂0.001; OR = 2.171), while genotypes carrying the D allele (D / D or I / D) showed a protective effect (p

The article focuses on chronic stable angina and electroacupuncture and a controlled randomized trials to four arms. Topics discussed include evaluation on safety and efficacy electroacupuncture in angina Chronic Stable (ACS), anti-angina treatments to reduce the frequency angina attacks, and the criteria of the American College of Cardiology and the American Heart Association like an angina attack occurring at least twice a week.

Myocardial infarction (MI) is a major cause of cardiovascular mortality. Inferior MI accounts for 30-50% of infarctions but it is associated with a favorable prognosis compared to anterior infarct. This study aimed to study the epidemiological, clinical, electrical, echocardiographic, angiographic features of inferior MI, as well as its complications and its therapeutic approaches. Over a period of 3 years, we admitted 720 patients with STEMI, of whom 103 with inferior STEMI, reflecting a rate of 14.3%. There was a clear male predominance, with an average age of 58 years (men) and 62 years (women). Smoking was the main risk factor for cardiovascular disease (57.28% of patients were smokers). Right ventricular infarction was found in 11.65% of cases. Half of these patients had hemodynamic instability. Third-degree atrioventricular block was diagnosed in 12.6% of patients. Therapeutic approach was based on thrombolysis (7 patients) and coronary angiogram (42 patients). Inferior MI was caused by right coronary lesion in 53% of cases and circumflex artery occlusion in 47% of cases. Right coronary is responsible for right ventricular infarction in 100% of cases. Coronary angioplasty was performed in 18 patients after coronary angiogram. Eleven patients underwent transluminal coronary angioplasty in the right coronary while 2 patients underwent transluminal coronary angioplasty in the circumflex artery. Early mortality at 30 days was 1.94%. In the right ventricular infarction group mortality rate was about 17%. [ABSTRACT FROM AUTHOR]

Résumé: L'anémie est une condition fréquemment retrouvée chez les patients admis pour un infarctus du myocarde (IDM), en particulier chez les personnes âgées. S'il apparaît bien établi que le taux d'hémoglobine est un prédicteur indépendant d'événements cardiovasculaires chez ces patients, l'intérêt de la transfusion de culots globulaires dans ce contexte n'est pas encore tranché. Certains mécanismes pourraient expliquer que la transfusion soit délétère, en particulier par une augmentation de la thrombogénicité, de la réponse inflammatoire, de l'activation plaquettaire et de la dysfonction endothéliale. Seuls deux essais de petite taille ont évalué une stratégie de transfusion « restrictive » ou « libérale » chez des patients admis pour IDM et leurs résultats se sont révélés contradictoires. De même, les données observationnelles sont également discordantes, probablement en rapport avec de nombreux facteurs confondants. Deux larges essais randomisés sont en cours : l'essai REALITY (étude française pilotée par le groupe académique FACT) et l'essai MINT (étude nord-américaine). Les résultats de ces essais permettront d'établir l'intérêt de la transfusion chez les patients anémiques admis pour un IDM et ainsi d'adapter notre pratique clinique dans ce groupe de patients à haut risque. Anaemia is a frequent condition in patients presenting with acute myocardial infarction (MI), in particular among elderly patients. If the haemoglobin level appears as an independent predictor of adverse cardiac events, the impact of transfusion in this context remains however unclear. Several reasons could explain that transfusion could be pejorative in patients with MI: increase in thrombogenicity, inflammatory response, platelet activation and endothelial dysfunction. Only two small randomized trials have compared a "restrictive" vs a "liberal" transfusion strategy, yielding contradictory results. Observational data are also discordant, probably due to multiple confounding factors. Two randomized controlled trial are currently assessing this critical issue: the REALITY trial (a French trial conducted by the FACT academic group) and the MINT trial (a North American trial). Results of these two trials will allow to establish the interest of transfusion in anaemic patients presenting with MI and therefore to improve management of this high risk subset of patients. [ABSTRACT FROM AUTHOR]

The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.

Introdution: This study aimed to investigate the factors associated with the occurrence of acute heart failure (AHF) in patients hospitalized due to myocardial infarction (MI) at the National University Hospital of Cotonou. Methods: We conducted a descriptive retrospective study on the frequency of AHF, on the factors associated with its occurrence and on in-hospital mortality in patients hospitalized from January 2011 to December 2013. Results: Our study included 70 patients (67.14% were men) with an average age of 58,39 years. AHF was diagnosed in 47.14% of cases. The identified factors associated with its occurrence were advanced age, extensive electrocardiographic change and co-morbidities such as infections, anemia and renal failure. During hospitalization, 7.46% of patients died, reflecting a rate of 12.5% in patients with AHF and of 2.86% in patients without AHF. Similar results hve been reported by many earlier publications. Conclusion: AHF is poor prognostic factor in MI. Early myocardial revascularization associated with adequate treatment of co-morbidities and rhythmic complications may improve patients' prognosis. [ABSTRACT FROM AUTHOR]

Introduction: This prospective study was conducted at the Laboratoy of Biochemistry of the HMIMV, Rabat, over a period of 1 year. It aimed to analyse the kinetics of troponin lc (cTnl) after on-pump cardiac surgery in order to establish threshold values for the diagnosis of perioperative myocardial infarction. Methods: The study included 58 patients who had undergone on-pump valvular surgery or on-pump coronary artery bypass surgery. These patients were separated into 3 groups according to their clinical and electrical evolution as well as their laboratory tests (cTnI) during the immediate post-operative period. We batched and followed the kinetics of cTnl using immuno-enzymatic technique, CTNI Flex® reagent, before and after on-pump cardiac surgery, at H0, H3, H6, H12, H21, H24 and H72 using automatic SIEMENS Dimension Xpand Plus. Results: The results were higher than in cardiology, even among the group of patients without postoperative cardiac complications, with an average cTnl rate of approximately 2.5 times higher than the threshold value in cardiology. The kinetics of release differed significantly among the 3 groups (p‹ 0.05). Conclusion: The threshold value that we propose to confirm the diagnosis of perioperative myocardial infarction is 13ng/ml obtained between H12 and H24. We recommend to collect 1-2 samples at H12 and then between H20 and H24. [ABSTRACT FROM AUTHOR]

Résumé La pathologie cardiovasculaire de la femme est complexe, surtout dans la population la plus jeune. Les syndromes coronariens aigus ont une présentation clinique parfois trompeuse dans un contexte peu évocateur de pathologie cardiaque, car peu de facteurs de risques cardiovasculaires. Cette complexité entraîne un retard au diagnostic, qui assombrit le pronostic des infarctus du myocarde, et expose ces patientes à des complications liées à l’absence de reperfusion coronaire. Nous rapportons le cas d’une patiente qui a présenté un infarctus apical passé inaperçu, compliqué d’un volumineux thrombus intraventriculaire avec migration d’un embole dans la circulation cérébrale, responsable d’un accident ischémique. L’association des deux pathologies compliquant la prise en charge thérapeutique. Comme cela est déjà largement publié, le pronostic de l’infarctus du myocarde chez la femme est moins bon que chez l’homme, pour diverses raisons. Il est probable que dans la population la plus jeune, un autre mécanisme physiopathologique soit souvent en cause : l’hématome et la dissection coronaire spontanée. Le diagnostic est souvent complexe, y compris à l’angiographie coronaire. Comme nous le rapportons dans cette observation, une analyse trop rapide conclut fréquemment à un examen normal. Il est aussi fort probable que la physiopathologie différente, ne faisant pas intervenir la rupture de plaque mais un hématome ou dissection de paroi coronaire, influence défavorablement de pronostic du fait d’une mauvaise adaptation des traitements. En conclusion, en cas d’accident ischémique cérébral, un bilan cardiologique précis doit être réalisé, y compris chez les femmes jeunes sans facteur de risque cardiovasculaire car des pathologies comme l’hématome ou dissection coronaire peuvent survenir et par le biais de l’infarctus du myocarde contribuer la formation de thrombus muraux. L’IRM cardiaque semble être un élément de choix dans le diagnostic d’infarctus compliqué de thrombus intracavitaire. Cardiovascular disease in women is a particularly complex pathology especially in the youngest population. The clinical presentation of acute coronary syndromes is sometimes misleading and does not necessarily point to the potential presence of cardiac disease given the frequent absence of cardiovascular risks. Such complexity results in delayed diagnosis, which worsens the outcome of myocardial infarction and generates complications related to the absence of coronary revascularization. We report the case of a patient who suffered an (undiagnosed) apical myocardial infarction that went undetected and was complicated by a voluminous intraventricular thrombus with embolus migration in the cerebral circulation resulting in an ischemic accident. The combination of these two pathologies make their therapeutic management particularly difficult. As widely reported in the literature, the outcome of myocardial infarction in women is poorer than in their male counterparts for a number of reasons. We can assume that in the youngest patients, another physiopathological mechanism is often involved, namely, the occurrence of hematoma and spontaneous coronary dissection. Diagnosis is often difficult even with coronary angiography diagnosis. As shown in the case reported here, initial examination results, if not thoroughly analyzed, may be erroneously interpreted as normal. It is also likely that the presence of hematoma or coronary wall dissection without any plaque rupture may negatively influence the outcome owing to the implementation of inappropriate treatments. In conclusion, in patients presenting with an ischemic cerebral accident, meticulous cardiac examination must be performed even in young women with no cardiovascular risk factors given that the occurrence of hematoma or coronary dissection may contribute to the formation of mural thrombi in the setting of myocardial infarction. Cardiac MRI seems to be particularly effective in the diagnosis of myocardial infarction complicated by the presence of intracavitary thrombi. [ABSTRACT FROM AUTHOR]

Résumé La responsabilité de l’effort dans la survenue des accidents cardiaques est connue depuis l’antiquité, on en parlait déjà au Marathon d’Athènes en 492 avant JC. L’infarctus du myocarde à l’effort représente environ 4 % des infarctus du myocarde. Il est plus fréquent chez l’homme et les jeunes patients. Il survient généralement lors des efforts intenses et surtout chez les patients non entraînés porteurs de multiples facteurs de risque. Il serait plus grave avec plus fréquemment d’onde Q de nécrose sur les électrocardiogrammes des victimes, une élévation plus importante de la troponine et un score GRACE plus avancé. La rupture de la plaque d’athérome en est la cause essentielle, elle est à l’origine de la formation du thrombus qui occlut l’artère coronaire responsable de l’infarctus du myocarde. Les contraintes hémodynamiques à l’effort imposées aux artères coronaires souvent athéromateuses favorisent la rupture et la survenue d’infarctus du myocarde lors des efforts intenses. À ces contraintes hémodynamiques lors de l’effort s’ajoutent des modifications biochimiques et rhéologiques qui favorisent la formation du thrombus intracoronaire. La survenue d’accidents coronariens aigus lors de l’effort intense, chez des patients souvent non entraînés ne doit pas nous faire oublier l’effet bénéfique de l’exercice physique sur la qualité de vie et sur la baisse de la morbi-mortalité. Heavy exertion as a trigger of cardiac events has been known since antiquity as it was already described in 492 BC in the famous Athens Marathon. Myocardial infarction occurring after physical exertion accounts for about 4% of myocardial infarctions. It is more common in men and younger patients. It usually occurs during intense efforts and especially in inactive people with multiple risk factors. It would be more severe with more frequent Q waves of necrosis on the victims’ electrocardiograms, with greater troponin release and a more raised GRACE score. Atherosclerotic plaque rupture is at the center of its pathophysiology, this event is responsible of a thrombus formation occluding the coronary artery. The hemodynamic stress imposed on the often-atheromatous coronary arteries during exercise, favor the plaque rupture and the occurrence of myocardial infarctions. To these hemodynamic constraints, are added biochemical and rheological modifications, which favor the formation of an intra-coronary thrombus. The occurrence of acute coronary events during heavy exertion in patients who are often untrained must not make us forget about the benefit of regular exercise on both the life quality and morbimortality levels. [ABSTRACT FROM AUTHOR]

Résumé Cette revue sur les thrombophilies et les thromboses coronaires prend en compte les thrombophilies « classiques » que l’on a l’habitude de rechercher en pathologie veineuse et dont on évalue les conditions dans lesquelles leur recherche pourrait être utile dans certaines formes de thromboses artérielles en particulier coronaires. En plus des thrombophilies classiques, on évoque les thrombophilies exceptionnelles qui souvent sont à la fois facteurs des thromboses veineuses mais aussi artérielles. S’y rajoutent des thrombophilies qui sont plus spécifiques au système artériel comme l’homocystéine potentiellement à la fois facteur de thrombose mais aussi de lésion pariétale artérielle ou la sérotonine facteur de spasme artériel et en particulier coronaire. Enfin sous ce terme de thrombophilie, on peut rajouter les états thrombophilies en particulier les cancers et les états inflammatoires. This review of thrombophilia and coronary thrombosis takes into account the “classical” thrombophilia commonly found in venous pathology and the conditions under which their research may be useful in certain forms of arterial thrombosis especially coronary thrombosis. In addition to the classical thrombophilia, exceptional thrombophilia are evoked, which are both factors of venous thrombosis but also arterial thrombosis. There are also thrombophilia that are more specific to the arterial system such as – homocystein which is potentially both a thrombosis factor but also an agent of arterial parietal lesion or – serotonin which is a factor of arterial spasm and especially coronary spasm. Finally, under the term thrombophilia, it is possible to include thrombophilic conditions, in particular cancers and inflammatory conditions. [ABSTRACT FROM AUTHOR]

Résumé Le syndrome de Kounis est un syndrome coronarien aigu d’origine allergique. Il survient sur artères saines ou pathologiques. Ses complications, bien que souvent bénignes, peuvent amener à un arrêt cardiocirculatoire et au décès. Ses facteurs déclenchants sont multiples et incluent des produits de contraste utilisés en imagerie diagnostique. Nous rapportons l’observation d’un patient de 81 ans en cours de bilan d’un carcinome hépatocellulaire, présentant un syndrome de Kounis de type 2 avec infarctus du myocarde inférieur, compliqué d’arrêt cardiocirculatoire par bloc auriculo-ventriculaire complet suite à une injection d’acide gadotérique. Kounis syndrome is an allergic acute coronary syndrome. It occurs on healthy or pathological arteries. Its complications, although often benign, can lead to cardiac arrest and death. Its triggering factors are multiple and include contrast products used in diagnostic imaging. We report the case of an 81 years old patient affected by hepatocellular carcinoma, who presented a type 2 Kounis syndrome with inferior myocardial infarction, complicated by cardiac arrest related to complete heart block following a gadoteric acid injection. [ABSTRACT FROM AUTHOR]

This review of thrombophilia and arterial thrombosis takes into account the "classical" thrombophilia commonly found in venous pathology and the conditions under which their research may be useful in certain forms of arterial thrombosis especially coronary thrombosis. In addition to the classical thrombophilia, exceptional thrombophilia are evoked, which are both factors of venous thrombosis but also arterial thrombosis. There are also thrombophilia that are more specific to the arterial system such as (1) homocystein, which is potentially both a thrombosis factor but also an agent of arterial parietal lesion, or (2) serotonin, which is a factor of arterial spasm and especially coronary spasm. Finally, under the term thrombophilia, it is possible to include thrombophilic conditions, in particular cancers and inflammatory conditions. [ABSTRACT FROM AUTHOR]

Cardiac lesions secondary to blunt chest trauma vary from insignificant arrhythmias to fatal cardiac rupture. Of these, a distinction remains difficult; face to ST-segment elevation on ECG with positive cardiac biomarkers, is it a myocardial contusion or a genuine myocardial infarction (MI) secondary to coronary lesions? We report the case of a patient admitted for multiple trauma. Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. We would like to discuss, through this case, the similarities and the differences between myocardial infarction due to coronary lesions and myocardial contusion in a traumatic context, but also emphasize the difficulty of striking the right balance between thrombotic and bleeding risks in this situation, and insist on the importance of a multidisciplinary and collegial reflexion so we can offer these patients the best care there is.