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The aim of this case report is to draw attention at the potential severity of presentation of these associated pathologies. Prevention through early screening of colorectal cancer in patients with coronary artery disease and vice versa is the guarantee of a better management of the two pathologies. Cardiovascular disease and cancer are the two leading causes of death worldwide. Emerging evidence suggests associations between cardiovascular disease and several cancers, including colorectal cancer. Many cases have reported severe coronary artery disease (CAD) in association with colorectal cancer including triple vessel disease. To the best of our knowledge this is the first case reporting a total occlusion of the left main coronary artery in such patients. We report the case of a 52 years old woman presented to our cath lab for severe angina (Class III of the Canadian classification) and impairment of left ventricle function. Six months before the patient was diagnosed with a metastatic colorectal cancer. Coronary angiography showed absence of anterograde opacification of the left coronary system. Selective right coronary artery angiography showed a retrograde filling of the left coronary system by collaterals issued from proximal and distal dominant right coronary artery. Several studies have reported the association between colorectal neoplasm and CAD but Isolated left main coronary artery disease is extremely uncommon. Patients with left main coronary artery disease have always a grim prognosis and without prompt revascularization 60% will die after 5 years while survivors live with severe angina; heart failure or both.

Learning Objectives: Learn how to identify and differentiate the shark fin EKG pattern from other EKG patterns and abnormalities. Explore the potential diagnostic and prognostic implications of the shark fin EKG pattern, including its association with increased risk of arrhythmias and sudden cardiac death. Background: The Lambda-wave ECG, also known as the Shark fin or Thombostone pattern, has been linked to ST-elevation myocardial infarction's (STEMI) hazardous implications. It is characterized by merged QRS, ST, and T waves, forming a 'triangular QRS-ST-T waveform' or 'giant R waves.' This treacherous signature poses an alarming risk, with chances of cardiogenic shock and ventricular fibrillation leading to fatality. To tackle this peril, implementing swift thrombolysis or percutaneous intervention for reperfusion is critical for successful treatment. For optimal outcomes, the preferred setting to utilize ventricular assist devices is the ICU. Misdiagnosis can happen and be seen as either wide complex tachycardia or ECG changes induced by hyperkalemia. Imperative to prevent severe complications, early detection and treatment are crucial. We are reporting three cases of this Ekg pattern.

Chronic heart failure (HF) is a major problem of public health in Morocco with few studies exploring HF particularities in this country where the prevalence of HF is estimated to be around 2.2%. Objective: The aim of this study was to evaluate the correlation between frequency of rehospitalization in our population with age, left ventricular ejection fraction (LVEF), heart rate (HR), and QRS duration, Since the number of rehospitalizations is strongly correlated to mortality as shown by many studies. Materials and Methods: Patients with HF were enrolled in this retrospective case control study regardless of their LVEF, patients with recent (

LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.

Background: Ischemic stroke following thrombolysis for ST-segment elevation myocardial infarction(STEMI) is a rare and perplexing complication. We present an intriguing case of ischemic stroke following fibrinolytic therapy with tenecteplase for a STEMI. This is an extremely rare condition, and our case appears to be the third one reported in our departement. The three cases had one thing in common: ST-segment elevation in the inferior leads. Case Presentation: We describe the case of a 50-year-old north-african woman who suffered an acute inferior STEMI 6 hours after chest pain onset. Thrombolysis with tenecteplase was performed and few hours later an extensive right sylvian artery stroke occurred with subfalcine herniation. Decision-Making: The refractory intracranial hypertension despite medical therapy compelled a decompressive craniectomy. On the follow up, neurological deficits had increased, congestive heart failure developed, and finally the patient died on the tenth day in the intensive care unit. Conclusion: Hemorrhagic complications are not the only one, ischemic stroke can also occur after thrombolysis even if it is extremely odd. The pathophysiology is still poorly established. The prevalent implication of the inferior territory in the three cases described in the literature may open to future research prospects.

Acute aortic dissection on bicuspid aortic valve (BAV) type 0 is a rare especially in young masculine. Risk factors like smoking and intensive sport activities can hasten their apparition especially in non-diagnosed population. Trans thoracic echocardiography is very important in the diagnosis of BAV whereas Angio CT scan helps to confirm acute aortic dissection. Treatment is based on surgery for type A Stanford classification for acute aortic dissection. We report a rare case of acute aortic dissection masquerading a rare type of BAV, type 0 in a young sportive male with no history of heart disease who presented for the first-time with acute chest pain after lifting a heavy weight metal at the complex sport center. Patient was initially placed on medical treatment before surgery for heart valve and root replacement (Bentall procedure).

Wellens syndrome is described asbiphasic or deeplyinverted T waves in the precordialleads thatis indicative of criticalstenosis of the leftanteriordescendingartery. It isseenin a subset of patients withunstableanginaduring the pain-free interval. . Similar characteristic ECG changes associated with causes other than LAD stenosis have been described as pseudo-Wellens syndrome. In this case report, we present a young 31-year-old man who presented with characteristic Wellens ECG changes in the setting of pulmonary embolism with right ventricular strain., biphasic T waves in the setting of pulmonary embolism are rare. Pulmonary embolism was seen in our patient three weeks after starting risperidone. There is a reported association between antipsychotic drugs and increased risk of thromboembolism. Risperidone could have potentially contributed to the pulmonary embolism in our patient given the temporal association and absence of risk factors.

Myocardial injury is one of the important pathogenic features of COVID-19. As a surrogate for myocardial injury, multiple studies have shown increased cardiac biomarkers mainly cardiac troponins I and T in the infected patients especially those with severe disease. Myocarditis is depicted as another cause of morbidity amongst COVID-19 patients. The exact mechanisms of how SARS-CoV-2 can cause myocardial injury are not clearly understood. The proposed mechanisms of myocardial injury are direct damage to the cardiomyocytes, systemic inflammation, myocardial interstitial fibrosis, interferon mediated immune response, exaggerated cytokine response by Type 1 and 2 helper T cells, in addition to coronary plaque destabilization, and hypoxia. This is a 62-year-old M.K with a poorly monitored type 2 diabetes and hypertension as ATCDS who was admitted to the emergency department for syncope, a complete AVB responding to the bolus of atropine and the sternal punch. After electro systolic training probe we were able to find a regular sinus rhythm with gradual recovery of consciousness Evidence of myocardial injury is common among adults hospitalized with COVID-19. Possible causes of myocardial injury in patients with COVID-19 include myocarditis, hypoxic injury, stress (Takotsubo) cardiomyopathy, ischemic injury caused by cardiac microvascular damage or coronary artery disease, right heart strain (acute cor pulmonale) and systemic inflammatory response syndrome. COVID-19 infection has been associated with myocardial injury, which has been implicated with more severe disease courses and even death. Remarkable efforts are being done to elaborate underlying mechanisms of myocardial injury. Due to the acuteness of this pandemic, the scientific world currently lacks randomized controlled trials in order to fully elucidate the pathophysiological mechanisms and therapeutic measures. &nbsp

Mitral regurgitation in conduction disorders is a rare feature of functional valve regurgitation. In patients with high-grade atrioventricular block, the onset of ventricular ejection may shift with atrial telesystole; in this case, the rise in left ventricular filling pressure after atrial systole, especially in the case of complete atrioventricular block leading to an inversion of the LA-LV gradient during the supraventricular relaxation phase and diastolic mitral insufficiency can gradually set in , as well as secondary tricuspid regurgitation Here we report the observation of a patient admitted for a complete atrioventricular block, with reversible mitral and tricuspid regurgitation after implantation of a pace maker.

Background: Still's disease in adults is a systemic inflammatory pathology of unknown aetiology, characterized by clinical manifestations associating feverish peaks, arthritis or arthtralgia, transient rashes and hyperferritinemia. Currently, this disease remains a multisystemic disease with generally poor outcome, poorly described in the literature with very few studies unlike other rheumatic diseases, probably underdiagnosed due to its clinical polymorphism. Cardiac forms are quite rare and among the manifestations described, pericarditis remains the most reported entity, myocardial involvement is exceptional. The aim of our observation is to report an exceptional case of discovery of stille disease following a myo-pericarditis mimicking a coronary Sd initially.

Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia,affecting between 1-4% of the general population and responsible for 10-20% of strokes. New technologies are now available for screening for AF,but their implementation in real clinical settings has not yet been fully investigated. Purpose -evaluate the electrocardiogram recordings on smartphones intended for screening for AF using the KardiaMobile device, with a dedicated mobile application. - Highlight the prevalence of AF in a moroccan hypertensive population -Evaluate the effectiveness of computerized screening for AF in therapeutic management Methods Prospective screening for AF in patients aged 55 or over,known to be hypertensive for at least 5 years, was performed at the cardiology consultation services between June 2019-July 2020.A single lead ECG was acquired by placing the fingers of each hand on the electrodesThe diagnosis of the Kardia app was assessed by the consultation cardiologist,and a baseline ECG was performed for each suspected arrhythmia.CHA2DS2-VASc score was collected from each patient. Results A total of 160 ECGs were performed.The diagnosis of the Kardia app was provided in 93% of cases.A heart rhythm described as normal was detected in 120 consultants,AFwas suspected in 8.1% of the patients described by the device as ‘possible AF’,and confirmed by a baseline ECG in 7.5% of the patients screened. Anti-coagulation was started in 6.2% of patients. Conclusion Mobile Device for screening for atrial fibrillation in a population at risk is a promising, inexpensive tool with significant prognostic benefit for the prevention of cardiovascular complications The Kardia app is able to quickly filter and detect atial fibrillation with high sensitivity and specificity.

Introduction Infective endocarditis (IE) is a rare serious disease for which diagnosis and treatment and prophylaxis continue to develop. Purpose The aim of our work were to analyze evolution in its epidemiologic, clinical, and microbiologic characteristics, as well as the outcomes. Methods This study compare data from a retrospective study conducted by Bennis and Al based on 157 cases of infectious endocarditis admitted in tertiary care Hospital between January 1983 and December 1994, theses cases are referred as Group A; and 103 cases of infective endocarditis according to Duke criteria admitted to the same center three decades afterwards from december 2013 to January 2020, which are referred as Group B. Results The mean age of the patients has became older over decades, with a mean of 27.5 years (11–65 years) in the group A versus 39.2 years [13–84] in the group B, with preservation of the male predominance (62.8% in group A vs 62.1% in group B). Infectious endocarditis secondary to rheumatic valvular heart disease has significantly decreased from 63.% of patients in group A to 27.5% in group B. Mitral or mitro-aortic valve involvement stayed predominant in both groups with a increase of mechanical prosthetic valve involvement with 9.7% in group B. A portal of entry of the infection was identified in 63% of patients in group A versus 41% in group B, we noted a significant decrease of dental-related cases from 64% in group A to 29% in group B, and a predominance of invasive procedure/devices cases in group B with 36% of identified cases. In group A Blood cultures were positive in 42% of cases with a predominance of Staphylocci (30%) and coagulase-negative Staphylococci (25.7% of cases) whilst in group B blood cultures were positive in 30% of cases with a predominance of Staphylococci (36.6%) and Streptococci (20% of cases). Echocardiography as a useful diagnostic tool demonstrated specific lesions of infectious endocarditis (abcess or vegetations) in 73.2% of cases in group A and 82% in group B. The clinical course in group A was complicated by congetive heart failure CHF (47.8%) or neurological lesions (11.5%) while in group B CHF was noted in 35% of cases and 8% of neurological lesions and The global mortality went from 28.7% in group A to 15% in group B related mostly to cardiogenic shock. Conclusion Our work demonstrated changes in the epidemiologic characteristics of IE that parallel changes in demographic and risk factors. The progress of diagnosis and treatement options in developing countries explains the better prognosis for this condition today. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Assessment of longitudinal left ventricular (LV) function has a major clinical significance for the early detection of contractile LV dysfonction. The measurement of the MAPSE (Mitral annular plane systolic excursion) and the systolic peak velocity of the edge of the mitral ring (Sm) allow an accurate assessment of longitudinal systolic performance Objective The aim of this study was to compare the impact of isolated type 2 diabetes and the coexistence of hypertension and diabetes on LV longitudinal systolic performance. Patients and Methods The study included 170 diabetic patients, of whom 85 had both hypertension and diabetes, and 50 controls. The systolic mitral annulus (Sm) velocity by tissue Doppler and the Mitral annular plane systolic excursion (MAPSE) by M mode were measured in all subjects. Results The mean age was 52.8 ± 15 years with a sex ratio M / F 0.23 in diabetic patients, and a mean age 60.8 ± 8 years with a sex ratio M / F 0.45 in control subjects. The mean MAPSE value was reduced in diabetics (11.5 ± 2.6 mm) and even more in hypertensive diabetics (10.5 ± 3.0 mm) compared to controls (16.1 ± 2.4 mm ) (p = 0.02). Similar results were found for Sm (controls, 12.4 ± 2.5 cm / s; diabetics, 9.0 ± "3.3 cm / s; diabetic hypertensive, 7.3 ± 2.0 cm) (p = 0.04). Conclusions diabetics present a depression of the LV longitudinal systolic indices compared to healthy controls; the coexistence of diabetes and hypertension results in further impairment of LV longitudinal systolic function in an additive manner.

Funding Acknowledgements Type of funding sources: None. INTRODUCTION STEMI gets complicated very often by a heart failure (HF), which it is important to know associated factors. The aim of this study was to determinate the predictor factors of onset of de novo HF after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS A retrospective, descriptive study from 1 center in Morocco, including 210 patients hospitalized in a cardiology intensive care unit for STEMI from September 2019 to November 2020. The main outcomes were HF Killip class at hospital presentation and intra-hospital mortality. RESULTS The main age was 59.3 ± 7.02 and Sex ratio: 2, 86. The incidence of de novo HF at admission was higher in women (40, 4% vs. 29.5%, [OR 1, 61; 95%, [CI] 0, 83-3, 11). Forty-nine point eight percent were in Killip≥ 2. The method of early revascularization was Thrombolysis in 82, 3% compared to primary coronary angioplasty without significant difference in onset of the novo HF. There was no association of age, comorbidities, delay to hospital presentation and coronary involvement with incidence of onset of de novo HF. Women had higher mortality than men with the novo HF (28, 6% vs. 20.5%; OR: 1, 55; 95%). CONCLUSION Gender has appeared associated to onset of de novo HF after STEMI with a superiority of the female sex after controlling for others factors described in the literature. Anterior studies have related this to the increased prevalence of microvascular disease in women predisposing them to heart failure after STEMI.

Funding Acknowledgements Type of funding sources: None. Background : Patients with cardiovascular diseases use often multi-drugs regimen , which can often be associated with use of potentially inappropriate medications PIMs especially in elderly , which may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among this population . Methods A Prospective study was conducted in a tertiary care hospital in Morocco where home medications of out patients were reviewed during follow-up consults and analyzed over three months, from October till December 2020. Inclusion criteria were age of 65 years and above, history of cardiovascular disease. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. Results A total of 214 patients were included in the study and were taking a total of 1498 medications at home, an average of 7 ± 3 medications per patient. The proportion of PIMS was 32 % of all medications reported, with an average of 2.2 PIM per patient, and 84% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, self medication , and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, rheumatological diseases, cerebrovascular accident, and insomnia/depression . The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (27.3%), NSAIDs use in patients under anticoagulants (21.2%) , use of proton pump inhibitors (PPIs) > 8 weeks in non-high-risk patients (10.5%), and benzodiazepines (5.7%). Conclusions A high prevalence of PIMs in older patients with cardiovascular disease was observed. Health care giver’s education and detailed assessment of medication lists upon follow-up consults or hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

Funding Acknowledgements Type of funding sources: None. Background Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration. Aims To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration. Methods This was a retrospective analysis of cases of IE discharged from a tertiary hospital between December 2013 and september 2019. The 10% lowest CRP concentration ( Results Of the 105 patients, 16 (16%; median age 41 [15–76] years) had definite (n = 12) or possible (n = 4) left-sided valvular IE with CRP The main presentations were heart failure (n = 10; 62%) and stroke (n = 1; 6%). Transthoracic echocardiography (TTE) showed vegetations (n = 12) or isolated valvular regurgitation (n = 4). Overall, nine patients (56%) had severe valvular regurgitation on transoesophageal echocardiography (TOE), and seven patients (43%) underwent cardiac surgery. 68% of patients survived at 1-year follow-up. Bacterial pathogens were documented only in four patients (streptococci, coagulase-negative Staphylococcus, gamella morbillorum) using blood cultures solely , due to lack of disponibility of specific serology / valve culture and/or polymerase chain reaction analysis Conclusions Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration.