A case of Libman–sacks endocarditis and the challenges of differentiating it from infective endocarditis

Libman–Sacks endocarditis is a form of cardiac complication affecting patients with systemic lupus erythematosus, especially those with secondary antiphospholipid syndrome. In this case report, we present a case of Libman–Sacks endocarditis and discuss key features that differentiate it from infective endocarditis.

Frequency of Cardiovascular Complications in Coronavirus-19 infected Patients during the second wave in a tertiary care Hospital of Lahore, Pakistan

Coronavirus 2019 (COVID-19) affects the cardiorespiratory systems by causing inflammation of the circulatory systems, hence, causing more cardiac complications in COVID-19 patients Objective: To observe the frequency of cardiac complications in COVID-19 patients during the second wave Methods: 235 COVID-19 patients presenting with cardiac complication to the Cardiology Department of Mayo Hospital, Lahore during 6 month periods of second wave of COVID-19 were included. Data regarding the medical history, age, gender was taken and the observed cardiac complication were noted Results: There were 76.6% male patients and 23.4% female patients. 56.2 % patients were already hypertensive, 37.9% were diabetic, 18.3% had familial history of cardiac diseases. The cardiovascular manifestations observed were, myocardial infarction (57.82%), 7.3% had angina, 21.3% had acute coronary syndrome and 12.3% had non ST elevation myocardial infarction. Conclusions: Our study suggests that there is a prevalence of cardiovascular diseases in COVID-patients which is a major concern as they are at increased risk for severe infection.

Clinically suspected myocarditis complicating dengue shock syndrome: a case report and literature review of cardiac complication in dengue-affected pediatric patient

We report a case of dengue shock syndrome complicated by clinically suspected acute myocarditis in pediatric patient at a limited-resources hospital in a rural area and review the literature. A 12-year-old boy who experienced dengue shock syndrome developed bradycardia on day 7th of illness. His electrocardiogram during the bradycardia showed sinus bradycardia with a rate of 50 beats per minute. Atropine sulfate and dobutamine, alongside supportive management, were administered. The patient recovered 4 days later. We found a total of seven articles involving pediatric patient with dengue illness and cardiac complications by PubMed search. Clinical manifestations of cardiac involvement in pediatric patient with dengue varied and were mostly transient from tachy-bradyarrhythmia, sinus node dysfunction, low blood pressure, decreased ejection fraction, lower cardiac output, and increased cardiac enzyme. Transient cardiac abnormality can be an important presentation, and physician should have high awareness of cardiac complication in dengue-affected pediatric patients to manage them accordingly.

Primary Hyperparathyroidism Presenting With Atrial Fibrillation and Calcified Pericardial Effusion

Background: Primary hyperparathyroidism is the most common cause of hypercalcemia and is frequently associated with skeletal and renal complications. It affects the older population and female gender more commonly. Cardiovascular complications due to altered calcium homeostasis are not well recognised or studied but recently cases of calcification of the pericardium, myocardium, valves and dysrhythmias have been reported. Case: A 47-year old female presented to her GP with atrial fibrillation. Initial blood tests revealed an incidental hypercalcaemia; an adjusted calcium of 2.77 (normal 2.20-2.60mmol/L), raised PTH level of 14.0 (normal 1.6–6.9pmol/L), normal phosphate level and thyroid profile. 25-OH vitamin D level was low 39 (normal 50-120nmol/L). Autoantibody screens and CRP was normal. She was initiated on edoxaban, bisoprolol, and cholecalciferol and treated with a short course doxycycline for a presumed chest infection. There was no history of previous pericarditis but she had long standing hypertension and was obese with BMI of 37kg/m2. Retrospectively patient had sustained a recent wrist fracture and reported classic symptoms of hypercalcemia including fatigue, polydipsia, nocturia, constipation, depression in the endocrinology clinic. Further blood tests found a high C-terminal telopeptide (CTX) level of 0.68 (0.10-0.50ug/L) indicative of high bone turnover.24 urinary calcium/creatinine clearance ratio was 0.0189mmol/mmol (R>0.01 for exclusion of FHH). She was prepped for DC cardioversion and Echocardiogram demonstrated Moderate sized pericardial effusion with some organisation but good biventricular function and dilated LA. Subsequent localisation studies with SPECT CT neck revealed a 9mm parathyroid adenoma along with calcified persistent moderate pericardial effusion putting the patient at risk of pericardial constriction. Patient was referred to the parathyroid surgeon for consideration of urgent parathyroidectomy and will be followed up by the cardiologist to see the impact of normalisation of hypercalcemia on the cardiac complication. It is thought that already established calcification of pericardial effusion is unlikely to resolve but achieving normocalcemia could slow the progression of pericardial calcification and improve bone turnover makers by switching off the excess parathyroid hormone. Patient will be followed up with repeat Echocardiogram post parathyroidectomy to elucidate the effects. Conclusion:Cardiac complications of primary hyperparathyroidism are increasingly becoming more evident with the advent and use of SPECT-CT for localising parathyroid adenomas. Simple screening tests like electrocardiogram may potentially point towards a cardiovascular complication and should be considered routinely in hypercalcaemic patients. Further studies to understand the mechanism of developing cardiac complication in such patients are needed.

Assessment of cardiac complication in diabetic patient of rural India

Background: Diabetes mellitus (DM) is a common endocrine disorder affecting approximately 382 million people worldwide. Diabetes mellitus (DM) is group of metabolic disorder in which glucose is underutilized, thus producing hyperglycemia resulting from a defect in insulin secretion, action, or both. Cardiovascular disease is the most common cause of death and disability among people with diabetes. The cardiovascular disease that accompany diabetes include angina, myocardial infarction (heart attack), Stroke, peripheral artery disease and congestive heart failure. In people with diabetes, high blood pressure, high cholesterol, high blood glucose and other risk factors contribute to the increased risk of cardiovascular complications.Method: This study was conducted to determine the cardiac complication in diabetic patient of rural India. It was Cross sectional retrospective study, done in between period of January 2018 to December 2019.Result: In the present study authors found that 47.7% patients have Coronary artery disease (CAD), Silent 21.6% have myocardial ischemia (SMI), 36% Diastolic dysfunction (DF), 28.8% have Systolic dysfunction (SDF).Conclusion: In this study authors found that wide spectrum of cardiac complications in diabetic patients ranging silent myocardial ischemia to heart failure. CAD was the most common complication including silent myocardial ischemia (SMI) which is the one of the major concern of rural diabetic population which need proper screening by exercise treadmill test.