Search

Aim: The risk of ischemic stroke is increased 5-fold in patients with atrial fibrillation (the most common reason for cardiac arrhythmia). The aim is to investigate whether insufficiency in anterior pituitary hormones develops in patients diagnosed with atrial fibrillation and no history of cerebrovascular accident. Method: A group of 65 patients with chronic /paroxysmal atrial fibrillation without a history of cerebrovascular accident and a group of 65 healthy controls without arrhythmia were included in this study. Atrial fibrillation was diagnosed by electrocardiography or 24-hour rhythm holter. Demographic data, biochemical tests, echocardiography findings were compared between the groups. P

Abstract Recent studies elucidate that coronavirus disease 2019 (COVID‐19) patients may face a higher risk of cardiovascular complications. This study aimed to evaluate association of COVID‐19 with the risk of pulmonary embolism (PE) or deep vein thrombosis (DVT). This nationwide population‐based retrospective cohort study included Korean adult citizens between January 2021 and March 2022 from the Korea Disease Control and Prevention Agency COVID‐19 National Health Insurance Service cohort. The Fine and Gray's regression with all‐cause death as a competing event was adopted to evaluate PE and DVT risks after COVID‐19. This study included a total of 1,601,835 COVID‐19 patients and 14,011,285 matched individuals without COVID‐19. The risk of PE (adjusted hazard ratio [aHR], 6.25; 95% confidence interval [CI], 3.67–10.66; p

Atrial septal defects (ASD) are congenital cardiac anomalies, characterized by abnormal communication between the atria. These are commonly diagnosed in childhood and occasionally remain asymptomatic and undetected until the later stages of life. In ASD, there is communication between atria. Until the 4th decade of life, the majority of ASD are asymptomatic. Some exhibit the signs of exhaustion, syncope, exercise intolerance, and dyspnea with effort. Eisenmenger syndrome, paradoxical embolism, and atrial arrhythmias are among the problems that some people may later on develop. We describe a particular case of a 70-year-old male who arrived with a transient ischemic attack where he had left-sided upper limb weakness due to a paradoxical embolism due to ASD.

Key Clinical Message Although retroperitoneal bleeding and massive hematuria are potential complications of angiomyolipoma (AML), the pulmonary embolism as a presenting symptom is extremely rare. It is important to be aware that benign AMLs can present with pulmonary fat embolism.

Introduction: Venous Thromboembolism (VTE) and Pulmonary Embolism (PE) are more common following orthopaedic surgeries around the hip than other surgeries. However, there is still a dilemma among orthopaedic surgeons regarding whether routine thromboprophylaxis is justified in patients. Aim: To describe current practices among orthopaedic surgeons regarding routine thromboprophylaxis among patients with proximal femur fractures. Materials and Methods: A cross-sectional exploratory study was conducted at Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India between March 2022 and May 2022 among orthopaedic surgeons. A Google survey form, containing 10 prevalidated multiple-choice questions, was shared on social media and medical groups. Descriptive analysis was undertaken, and statistical analysis was done with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Results: Among the 141 respondents, 72% were from private sector institutions/hospitals. Over 90.78% of the respondents indicated that there was a role for anticoagulation therapy in proximal femur fractures, and 92% used low molecular weight heparin. The responses varied slightly depending on whether anticoagulant treatment was used preoperatively (51%) or postoperatively (48%), and if there was a waiting time of less than 24 hours to 3-5 days before surgery. Most orthopaedic surgeons opted for anticoagulation therapy in the presence of a previous history of Deep Vein Thrombosis (DVT)/PE (79%), age greater than 70 years (61%), and use of hormone replacement therapy (64%), or if the surgery lasted more than two hours (61%). Conclusion: The present study concludes that 9.2% of orthopaedic surgeons do not use anticoagulation therapy and nearly half (48%) do not administer anticoagulation therapy preoperatively. As the proportion of elderly patients increases, consensus building will enable the formulation of practice guidelines based on evidence generated through such surveys.

Primary cardiac tumors are rare and most frequently benign. The most common primary cardiac tumors are myxomas. Early clinical symptoms can resemble different cardiovascular and systemic diseases. The heterogeneity in their presentation is due to the different localization of myxomas and different structural characteristics. In most cases an echocardiographic examination is sufficient to establish the diagnosis. Early diagnosis and referral for surgery can prevent debilitating complications. The definitive treatment is surgical extirpation of the tumor. We present two clinical cases of cardiac myxomas, the first of which was localized in the left atrium and had villous characteristics, presenting mainly with embolic events. In the second case, the tumor formation was in the right atrium, solid in nature, causing angina and dyspnea.

Background: Literature on the preferred anticoagulant for treating left ventricular thrombus (LVT) is lacking. Thus, our objective was to compare the efficacy of DOACs versus warfarin in treating LVT. Methods: Databases were searched for RCTs and adjusted observational studies that compared DOAC versus warfarin through March 2024. The primary efficacy outcomes of interest were LVT resolution, systemic embolism, composite of stroke, and TIA. The primary safety outcomes encompassed all-cause mortality and bleeding events. Results: Our meta-analysis including 31 studies demonstrated that DOAC use was associated with higher odds of thrombus resolution (OR: 1.08, 95% CI: 0.86–1.31, p: 0.46). A statistically significant reduction in the risk of stroke/TIA was observed in the DOAC group versus the warfarin group (OR: 0.65, 95% CI: 0.48–0.89, p: 0.007). Furthermore, statistically significant reduced risks of all-cause mortality (OR: 0.68, 95% CI: 0.47–0.98, p: 0.04) and bleeding events (OR: 0.70, 95% CI: 0.55–0.89, p: 0.004) were observed with DOAC use as compared to warfarin use. Conclusion: Compared to VKAs, DOACs are noninferior as the anticoagulant of choice for LVT treatment. However, further studies are warranted to confirm these findings.

Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8–34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.

Mesenteric ischemia is a rare etiology of abdominal pain caused by impaired blood flow to the mesenteric circulation. This condition has acute and chronic variations and is associated with high mortality and morbidity. Early diagnosis is needed to determine management and prevention efforts towards a worse prognosis. The main principles of management of mesenteric ischemia are the restoration of bowel perfusion and resection of the necrotic bowel. This review will discuss the basic materials, diagnosis, and patient management strategies based on the conditions and causes of mesenteric ischemia.

Chronic rheumatic heart disease (RHD) is the most troublesome complication of rheumatic fever. Extensive valvular scarring and ventricular remodeling due to pressure and volume overload occur in chronic RHD. Deformed valves are at potential risk for developing infective endocarditis (IE) with further systemic embolism. We hereby describe a case of a patient diagnosed with chronic rheumatic heart disease and severe ventricular dysfunction, planned for aortic valve replacement. The patient developed septic shock during a hospital stay. The autopsy revealed infective endocarditis in the aortic valve with septic thromboembolism in the peripheral branches of the coronary artery and early multifocal myocardial infarction changes.

Abstract Background Bullet embolus is a rare condition following gunshot injuries and represents a clinical challenge regarding both diagnosis and management. Case presentation We report the case of a 35-year-old Iranian (Middle-Eastern) male patient with a shotgun injury to both buttocks, which traveled to the heart and the popliteal area through the femoral vein and superficial femoral artery, respectively. Surgical intervention was applied for the popliteal pellet, and the patient was discharged without further complications. Conclusion Although bullet emboli can be a clinical challenge, with the advent of modern procedures, removal has become safer. X-ray, computed tomography, and transthoracic and/or transesophageal echocardiography may be used as adjuncts to help establish the diagnosis.

Resumen: La presencia de un trombo en el cayado aórtico sin anomalías es inusual, sin embargo, supone un reto para el clínico. Por un lado, su diagnóstico suele ser incidental o secundario a una embolia sistémica y, por otro, no existe consenso para su tratamiento debido a la falta de estudios aleatorizados.Presentamos el caso de un varón de 54 años que ingresó en la unidad de reanimación tras ictus isquémico de la arteria cerebral media izquierda no revascularizable. Una angiografía por tomografía computarizada con contraste evidenció un trombo pediculado de 7 cm en la aorta torácica con origen en la aorta ascendente medio-distal, aparentemente sin otras anomalías. Se realizó extracción completa del trombo y de la membrana en la base de implantación ante la sospecha de un posible síndrome aórtico agudo. El examen histológico confirmó la presencia de fibrina, sin embargo, los estudios de laboratorio no establecieron una causa principal que justificara la formación del trombo. Abstract: Flotant thrombus in the aortic arch without abnormalities is unusual. Arterial embolic disease continues to challenge clinicians. The diagnosis is usually incidental or secondary to a systemic embolism, although there are no randomized controlled trials for consensus as to its treatment.A 54-year-old man was admitted to the critical care resuscitation unit after a nonrevascularizable left middle cerebral ischaemic stroke. CTA with contrast showed a 7-cm pedunculated thrombus in the thoracic aorta originating from the mid ascending aorta and arch, without other abnormalities. Complete removal of the thrombus and complete resection of the basement membrane were performed due to the suspicion of a possible acute aortic syndrome. Histological examination confirmed the presence of fibrin, however, laboratory studies did not establish a main cause that justified the formation of the thrombus.

Abstract Background Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia. Case report A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection. Conclusion Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.

Iatrogenic air embolism is a rare and potentially fatal complication of gastrointestinal endoscopy. We present a 66-year-old male patient who developed cerebral arterial gas embolism shortly after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for acute biliary pancreatitis, which is the first case reported in Hong Kong according to latest literature search. Some risk factors of iatrogenic air embolism in this patient include cholangitis with intraductal stones, sphincterotomy and bleeding at papillotomy site which required haemostasis with balloon tamponade. Early diagnosis and timely treatment with hyperbaric oxygen therapy resulted in full neurological recovery of our patient.

Decompression sickness (DCS) causes venous and arterial embolization, resulting from decreased nitrogen solubility in the blood and tissues due to the rapid drop in external pressure, when rising to the surface after deep underwater dives. Neurological involvement is frequently seen in the medulla spinalis, but there may also be cranial involvement. A 36-year-old male patient, working as a professional diver, was brought to the emergency department with confusion, cerebellar syndrome findings, and paraplegia, soon after consecutive deep dives. Radiological examinations showed involvement of the bilateral cerebral and cerebellar hemispheres, along with the cervical and thoracic spinal cord. This patient with medulla spinalis and cranial involvement of DCS, observed simultaneously, was presented with follow-up clinical and radiological findings.

Objective: To determine the effect of high altitude on frequency and risk factors of venous thrombosis in individuals ascending to high altitude Study Design: Cross-sectional analytical study. Place and Duration of Study: Armed Forces Bone Marrow Transplant Centre, Combined Military Hospital Skardu, from Apr 2015 to Aug 2018. Methodology: High Altitude was taken as height equal to or more than 8000 feet. Polycythemia as hemoglobin >16.5 g/dl OR hematocrit >49%. Medical records of all patients evacuated from high altitude through Combined Military Hospital Skardu were analyzed retrospectively. A proforma was designed to include necessary variables. Results: We evaluated medical records of 539 individuals and found frequency of 86 (15.9%) for venous thromboembolism (VTE) at high altitude. Cerebral venous sinus thrombosis (CVST) was most common thrombotic complication seen in 39 patients (46%). Majority of thrombotic episodes occurred at >18000 feet (likelihood ratio (LR) 5.99, p-value 0.009). Majority of thrombotic episodes 34 (39%) occurred within first 45 days of ascent to high altitude. Thrombosis was linked to smoking 47 (55%) (likelihood ratio 21.3 and p-value

Abstract We treated an 80‐year‐old Japanese woman who had Takotsubo syndrome (TTS) concomitant with a left atrial (LA) tumor. Left ventriculography revealed a variant of TTS. In cardiac surgery, the LA mass was successfully resected without embolism, with the pathological diagnosis of myxoma.

To compare the clinical effectiveness of the two most commonly used LMWHs, dalteparin (DALT) and enoxaparin (ENOX), in thromboprophylaxis of elective total hip replacement (THR) or total knee replacement (TKR).

OBJECTIVE: A considerable fraction of ischemic stroke cases remain cryptogenic and there is increasing data suggesting the role of missed paroxysmal atrial fibrillations (pAF) in at least a number of these cases. Since electrophysiological identification of pAFs can be challenging, there has been an accumulation of proposed predictors and biomarkers for pAFs. The predictive values of these is varying and sometimes conflicting among studies. Therefore, we aimed to verify a fraction of previously reported parameters for pAF detection by investigating an independent clinical sample. METHODS: Using a publicly available data downloaded from the MIMIC-3 intensive care unit database, we tested the predictive role of particular risk factors and biomarkers for pAF detection after ischemic stroke in 124 patients with ischemic stroke admitted within 24 hours of stroke onset. RESULTS: Our evaluation revealed a strong association of older age in women, as well as admission National Institutes of Health Stroke Scale (NIHSS) and discharge modified Rankin Scores (mRS) in both sexes for pAFs, in patients that were in sinus rhythm on admission. We also detected a trend for lower gender-adjusted hemoglobin in patients with pAF, although the difference was insignificant. On the other hand, we did not find any significant association of pAF detection with some other previously reported biomarkers: serum magnesium level, leukocyte count, neutrophil/lymphocyte ratio or left atrial dilatation. CONCLUSION: Even though our analysis did not reveal a strong and specific biomarker to predict pAFs after stroke, it identified key risk factors. It may be necessary to consider the possibility of pAFs and perform rigorous evaluation to prevent further events of embolic stroke in female patients older than 75 years, with more severe neurological deficits on admission, higher disability on discharge and also with relatively lower hemoglobin level. This first study from Turkey using clinical data from the MIMIC-3 database also demonstrates the value of publicized clinical data for confirmatory studies on various medical fields across the World.

A 57-year-old male was admitted to the emergency room with chest pain that has been present for 3 hours. His blood pressure was 70/50 mmHg and heart rate was 48 bpm. 12-lead surface electrocardiography revealed inferior myocardial infarction and third-degree atrioventricular (AV) block. An emergency coronary angiography showed a 50% stenosis in the middle segment of the left anterior descending artery and 90% in the proximal circumflex (Cx) artery. The right coronary artery was totally occluded. After the predilatation with a 2.0x15 mm compliant balloon at 10 atm, a 3.5x24 mm bare metal stent was implanted. The third-degree AV block improved and a sinus rhythm of 124 bpm was achieved, but hemodynamic stability was not attained. Percutaneous coronary intervention for the Cx artery was performed. Without predilatation, a 3.5x12 mm low profile BMS was easily advanced over the lesion. Just before the stent implantation, asystole developed, followed by convulsions. Blood pressure and heart rate recovered after the administration of 1 mg of atropine. However, during the seizure, the guidewire and coronary stent device fell to the aortic root. Stent struts were not seen on the balloon catheter in a fluoroscopic examination. Fluoroscopic scanning of the vascular system showed that the coronary stent was in the right posterior cerebral artery. There were no symptoms or signs of neurological disorder. Consultant invasive neuroradiologist recommended medical follow-up. Clopidogrel and acetylsalicylic acid were prescribed indefinitely. Two months after the primary PCI, a successful coronary artery bypass graft operation was performed. After 4 years, the patient remained without any symptoms of neurological problems.

BACKGROUND AND OBJECTIVE: Detecting and accurate determining of vascular embolism dimensions are considered as a challenging issue in CT imaging. Present study aimed to enhance the accuracy of vascular embolism volumetry in managing a proper diagnosis and treatment of the disease. METHODS: In this non experimental quantitative study, firstly we simulated coronary and aorta arteries with normal dimensions in a 4D extended NURBS based cardiac-torso phantom in a matrix sizes of 512×512 with slice thickness of 0.116 mm. Then, twenty five venous thromboembolisms with the diameters ranged 0.1-5 and 5-20 mm were created in the coronary arteries and aorta of the Phantom, respectively. The Medical Imaging Interaction Toolkit was used for localization and volume measurement of the produced venous thromboembolisms on the CT images. Finally, Accuracy of the measured data was compared with the simulated measures in the phantom. FINDINGS: The difference on measures with the software was obtained 0.03±0.021 for embolies less than 4.64 mm (0.1 ml), (r=0.67, p=0.02), and 0.02±0.008 mm for embolies greater than 4.64 mm (r=0.99, p

Aims: Limited contemporary data are available on the clinical and echocardiographic outcomes after surgery for cardiac papillary fibroelastoma (CPF). The aim of this study was to review the clinical manifestations, pathological characteristics, surgical management, and prognoses of patients with histologically verified CPF, who underwent surgery at our cardiac surgery center from 2008 to 2018. Methods and Results: Twelve patients of median age 62 years (28 to 77 years) were treated. Embolic stroke or transient ischemic attack (five patients, 42%) were the only CPF clinical manifestations. Eleven (92%) tumors were localized on the valves, with the aortic valve being the most common tumor site (seven patients; 58%). Multiple factor analysis revealed no independent predictor of CPF-related embolization. Simple shave tumor excision was sufficient in most patients (10 patients, 83%). No operative or tumor-related late mortality during the median follow-up period of 4.7 years (1.1 to 10.2 years) was recorded. Asymptomatic metachronous valve tumor recurrence (in a location different from that of the original tumor) was revealed in two patients (17%) by transesophageal echocardiography (TEE), not detected by transthoracic echocardiography (TTE). One of these two patients underwent repeated surgery for CPF but later suffered a recurrent embolic stroke, due to another tumor recurrence. Conclusion: CPF can be safely and effectively treated surgically. TEE is superior to the TTE option in CPF post-operative recurrence detection. There is a clear need for a prospective study to determine criteria for embolization risk stratification and optimum management in patients with CPF.

Abstract Background Atrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5–0.7 per million population and prevalence of

The development of venous thromboembolism (VTE) in surgical patients is a serious public health problem since it increases morbidity and mortality rates, as well as the costs associated with in-hospital care for this population. Notwithstanding the above, and although their effectiveness has been demonstrated, prophylactic measures are not properly used in these patients in Colombia. A possible cause of this situation is the poor adherence of health professionals to clinical practice guidelines (CPG) addressing the prevention of VTE. In this regard, several methodological approaches to achieve an adequate implementation of thromboprophylaxis by transforming physicians' behaviors have been described. However, to accomplish this, it is necessary to comprehensively consider the multifactorial barriers and sociological conditions that underlie this problem. Better adherence to VTE prophylaxis CPGs is known to lead to better clinical practice. Therefore, the aim of this paper is to carry out a reflective analysis of the causes and possible solutions to the low adherence of Colombian health professionals to these guidelines.

Thrombus in the aortic trunk is a rare complication. We report the case of a 63-year-old patient with a factor V Leiden mutation in whom an aortic arch thrombus was discovered accidentally. Conservative treatment was initiated with therapeutic anticoagulation with low-molecular-weight heparin leading to complete thrombus lysis after 3 months but associated shortly after anticoagulation initiation with a large splenic and limited renal infarctions.

Branch retinal artery occlusion (BRAO) is an acute, painless, vision threatening, ocular emergency among people older than 60 years having cardiovascular disease. Here, we present a case of BRAO which occurred due to embolism as a rare etiology in an otherwise healthy young Asian male without any systemic or ocular disorders. The patient was treated as an ocular emergency with improved vision and retinal perfusion. The patient did not complain of recurrence of symptoms in the 3 months after the treatment.

Massive pulmonary embolism is a well-known cause of sudden cardiac arrest in the adult population. Systemic fibrinolysis can be a life-saving option. Therapeutic hypothermia is highly recommended for nontraumatic sudden cardiac arrest victims to minimize neurological complications. However, there are limited data about the use of therapeutic hypothermia for sudden cardiac arrest victims also treated with systemic fibrinolysis. Concerns about hypothermia-related coagulopathy and a possible tendency to bleeding have limited the use of cooling therapy in such cases. Presently described is a case of sudden cardiac arrest due to a massive pulmonary embolism that was successfully treated with the concomitant usage of systemic fibrinolysis and therapeutic hypothermia.

Background and Objective: Venous thromboembolism is one of the major causes of mortality worldwide. Various environmental and genetic factors are known as risk factors for this disease. Therefore, this study aimed to investigate the frequency of risk factors in patients with venous thromboembolism admitted to Ekbatan and Farshchian hospitals in Hamadan from 2012 to 2017. Materials and Methods: This cross-sectional descriptive study investigated all patients with venous thromboembolism who had medical records regarding risk factors of venous thromboembolism using census sampling method. The obtained data were analyzed in SPSS software (Version 21). Results: According to the results, out of 226 patients under study, 116 (51.3%) ones were male. Moreover, 103 (45.6%), 76 (33.6%), and 47 (20.8%) patients had deep venous thrombosis, pulmonary embolism, and severe lung embolism with deep venous thrombosis, respectively. The mean±SD age of patients was 59.15±19.85 years. Moreover, the most frequent risk factors associated with venous thromboembolism include the history of hypertension (37.2%), recent hospitalization (29.6%), cardiovascular problems (27.5%), history of recent surgery (16.8%), history of intravenous thromboembolism (8.8% 16%), history of smoking (16.8%), statin use (15.5%), history of hyperlipidemia (13.7%), and catheterization (13.7%). Conclusion: Venous thromboembolism is a multifactorial disease in which some risk factors contribute to the increased risk of it directly and indirectly.

Breast cancer is one of the most common cancers in women. As we know, cardiac metastases occur rarely. In this study, a 40-year-old woman referred to the hospital due to severe pain in the right leg. She was diagnosed with deep vein thrombosis (DVT) and received treatment, but, after one month and a half she returned with severe pain, exacerbated shortness of breath, cramping pain, and chest pain. With the diagnosis of lung embolism, she received anticoagulant therapy and discharged after recovery. Then, about two months later, the patient was admitted for the third time, with symptoms of shortness of breath, chest pain, and right foot edema. In Doppler echocardiography, acute to chronic thrombosis was reported in femoral popliteal vein and common femoral vein with external liliac expansion. Based on the computed tomography angiography (CTA) and Echocardiography, the patient was diagnosed with pulmonary embolism with a mass in the right ventricular, so, cardiothoracic surgery consultation was done. During the operation, extensive spread of metastasis was seen on mediastinum, the aorta, and pericardial space. A biopsy was performed and metastatic breast cancer was reported. This study signifies the importance of examining patients with recurrent DVT for malignancy.

Introduction Statins are widely used in stroke patients. The AHA/ASA guidelines recommend aggressive statin therapy in atherosclerotic stroke patients. Their beneficial effects are due to both their hypolipemic and pleiotropic properties. The aim of this study was to establish potential benefits from statin use in ischemic stroke patients with the diagnosis of atrial fibrillation (AF). Material and methods Ischemic stroke patients with AF were enrolled in the study. Group I, the statin group (n = 181), consisted of patients who had been treated with statins before stroke. Group II, the non-statin group (n = 153), consisted of patients who had not received such treatment in the last year. In-hospital mortality and neurological deficit on admission and at discharge were analyzed using the National Institutes of Health Stroke Scale (NIHSS) score. Results Patients from the non-statin group had greater initial and discharge NIHSS scores (10 vs. 11.9, probability value p < 0.05; 7.6 vs. 9.5, p < 0.05 respectively). The improvement in NIHSS score was greater in the statin group (73.5% vs. 59.5%, p < 0.01). In-hospital mortality was more frequent in the non-statin group (9.9% vs. 18.3%, p < 0.05). Conclusions Despite the predominant use of statins in atherothrombotic stroke patients, we demonstrated the beneficial effects of statins in cardioembolic stroke patients. Detailed cardiovascular screening for statin therapy should be carried out in all AF patients with regard to primary and secondary stroke prevention.

Background: Infective endocarditis (IE) occurs with an incidence of about 3–10 per 100,000 person-years globally. Those with infective endocarditis complicated embolic events have worse outcomes. However, whether antiplatelet therapy could prevent the development of ischemic stroke and myocardial infarction remained unknown. Materials and Methods: We conducted a retrospective cohort study using Taiwan National Health Insurance Research Database to access the effect of prior antiplatelet therapy on major adverse cardiac events in patients diagnosed with infective endocarditis. Results: The clinical characteristics and the risk of subsequent major adverse cardiac events in 901 patients with infective endocarditis with prior antiplatelet therapy and a matched cohort without antiplatelet therapy were retrospectively analyzed. The majority (63%) of the patients with prior antiplatelet therapy were male and 568 (57.7%) had a high (≥3) Charlson Cormorbidity Index score. There was no significant difference in the risk of myocardial infarction, ischemic stroke, and major bleeding between the two groups. The tests of interaction showed the risk of myocardial infarction was contingent on heart failure. Conclusions: Prior antiplatelet therapy did not prevent the cerebral and myocardial infarction in those with infective endocarditis. Neither did them increase the risk of major bleeding in patients with infective endocarditis.

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. This clinical heterogeneity makes the diagnosis of AFE difficult based on a beam of clinical and para-clinical arguments. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The present is a case of AFE with a disseminated intravascular coagulation (DIC) and a cardiorespiratory collapse following a vaginal delivery.

Patent foramen ovale is a risk factor for systemic embolic events such as cryptogenic stroke. Far less commonly, patent foramen ovale is associated with non-cerebral systemic embolic events. Paradoxical coronary artery embolism is a rare and underdiagnosed cause of acute myocardial infarction. It should be considered in patients presenting with myocardial infarction and an otherwise low-risk profile for atherosclerotic coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST elevation myocardial infarction. Echocardiography demonstrated patent foramen ovale with a significant shunt. In addition to the treatment of the acute coronary event, patent foramen ovale closure was performed to prevent recurrent paradoxical embolic events.

Embolic events are rare presentation of myxoma, which is one of the most prevalent benign cardiac tumors. Here we report the case of a 53-year-old man with presentation of acute anterior infarction and occlusion of the left anterior descending artery in association with left atrial myxoma. Intracoronary aspiration thrombectomy along with frequent balloon inflation was failed to recover distal coronary blood flow.

Introduction: A strong association between stroke and atrial fibrillation (AF) has been demonstrated. Anticoagulation for the prevention of stroke in high-risk patients has the benefit of improving the life expectancy, quality of life, autonomy and social functioning of the patient. The COVID-19 pandemic poses challenges for stroke patients because of the association between SARS-CoV-2 infection and thromboembolic risk. Case description: We describe the case of an 84-year-old female patient admitted due to an embolic stroke and non-anticoagulated AF. Her admission symptoms were sensory-motor aphasia and severe right limb paresis with an NIHSS score of 24. The diagnosis of embolic stroke (namely, total anterior circulation infarct; TACI) was made. Her stroke was extensive so she was not started on anticoagulation. During hospitalization, new embolic events occurred and a concomitant diagnosis of COVID-19 was made with progressive respiratory dysfunction followed by multiorgan failure. The patient died despite appropriate treatment. Discussion: The prognosis of elderly patients with cardioembolic stroke depends on anticoagulation administration. The NIHSS score on admission of our patient meant anticoagulation therapy was not appropriate. The diagnosis of COVID-19 contributed to the patient’s death.

The review considers a modern state and historic aspects of the compression use therapy for prevention of thromboembolic complications and therapy of symptoms of chronic venous insufficiency related to chronic vein diseases. Pathogenetic aspects of the therapy by graduated compression, fundamentals of use of mechanical means of prevention and therapy, fundamentals of these methods effect on the state of venous return, movement of tissue liquid are discussed. The attention is focused on evidence of effectiveness of compression therapy.

Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases.

An 84-year-old Japanese woman with myelodysplastic syndrome was admitted with pyrexia and dyspnea, but died suddenly during diagnostic evaluation. The autopsy revealed miliary tuberculosis in addition to myelodysplastic syndrome in the bone marrow. The immediate cause of the patient’s sudden death was pulmonary fat embolism derived from bone marrow necrosis. This case shows that the infiltration of the myelodysplastic bone marrow by tuberculosis and consequent bone marrow necrosis and fat embolism can be the cause of sudden death. In this article, we report the autopsy results of this unusual cause of sudden death, and discuss tuberculosis-related sudden death with a review of the literature.

Cholesterol crystal embolism is a rare and easily overlooked cause of colonic ischemia. The gastrointestinal tract is the third most common organ system affected by cholesterol emboli, second only to kidney and skin. Here we present a catastrophic case of gastrointestinal cholesterol crystal embolism leading to extensive post-operative bowel infarction and ultimately death. For a practicing pathologist, careful attention to the vessels of any ischemic bowel and recognition of the subtle but distinct angular imprint of cholesterol crystals facilitates prompt identification of the atheroemboli. In some cases, early identification may help mitigate further tissue damage. In more acute and severe cases, identification of the cholesterol crystal emboli may be important primarily for documentation of procedural complications.