Asian Journal of Cardiology Research

The Silent Ventricle: Late Diagnosis of Single Ventricle in an Asymptomatic 50-Year-Old Man

Sat, 03 Jan 2026 00:00:00 +0000

Aims: To report an exceptional case of a previously undiagnosed single ventricle congenital heart disease presenting in the fifth decade of life, and to discuss the challenges of late diagnosis in the context of established, inoperable pulmonary hypertension.

Introduction: Single ventricle physiology represents a complex spectrum of congenital heart diseases typically diagnosed and palliated in infancy. Survival into adulthood without prior surgical intervention is exceedingly rare and poses unique diagnostic and management challenges, often complicated by irreversible pulmonary vascular disease.

Case Presentation: A 50-year-old man with no prior medical history presented to the emergency department with acute-onset dyspnea and cyanosis. He was a father of four and had been gainfully employed without functional limitation. Electrocardiography revealed atrial flutter. Echocardiography and subsequent advanced imaging diagnosed a complex single ventricle anomaly (likely a double-inlet left ventricle with transposition) with severe, fixed pulmonary hypertension. Despite medical management of acute heart failure, he was deemed ineligible for surgical palliation due to advanced pulmonary vascular disease and was discharged on guideline-directed medical therapy and anticoagulation.

Discussion: This case underscores a profound failure of the healthcare system, where a life-threatening congenital anomaly remained undetected for five decades. The patient's remarkable adaptation and compensation highlight the body's physiological reserve, but also mask a condition where timely, childhood surgical intervention (e.g., Fontan procedure) could have offered a survival pathway. The development of irreversible pulmonary hypertension is the direct consequence of delayed diagnosis, transforming a potentially palliable condition into an inoperable one. This emphasizes the critical, non-negotiable importance of neonatal and childhood cardiac screening.

Conclusion: The asymptomatic survival of an adult with unoperated single ventricle physiology is a medical curiosity that carries a sobering message. It serves as a powerful reminder that the window for successful surgical palliation in complex congenital heart disease is often narrow and defined by the status of the pulmonary vasculature. Early diagnosis is not merely beneficial—it is a prerequisite for curative or palliative surgical strategy.

Bradbury–eggleston Syndrome in a Hypertensive Patient: A Therapeutic Challenge

G. BENNIS, M. ALAOUI YAZIDI, S. HAFID, M. ELEULJ, F.Z. MERZOUK, M.G. BENOUNA — Wed, 14 Jan 2026 00:00:00 +0000

Background: Pure autonomic failure, historically known as Bradbury–Eggleston syndrome, is a neurodegenerative disorder of the autonomic nervous system characterized by orthostatic hypotension. When associated with supine hypertension, its management becomes particularly challenging due to the need to balance symptomatic relief with blood pressure control.

Case Summary: We report the case of a 69-year-old woman with a history of arterial hypertension who presented with exertional dizziness. She exhibited supine systolic hypertension at rest, along with orthostatic hypotension without a compensatory tachycardic response, suggestive of autonomic dysfunction. Neurological examination was normal. Cardiovascular autonomic testing revealed beta-sympathetic impairment associated with neurogenic orthostatic hypotension. Secondary causes of dysautonomia were excluded, leading to the diagnosis of pure autonomic failure. Although the management of coexisting hypertension and orthostatic hypotension is challenging, a significant improvement in the patient’s functional status and blood pressure control was achieved through a personalized therapeutic approach.

Discussion: The aim of this case report is to emphasize the importance of assessing autonomic function and blood pressure variations in hypertensive patients presenting with orthostatic symptoms, in order to implement appropriate and individualized therapeutic strategies patients.

A Giant Asymptomatic True Aneurysm Following Silent Myocardial Infarction: A Case Report in an Octogenarian

Mon, 19 Jan 2026 00:00:00 +0000

Background: Large ventricular aneurysms (LVA) are now rare as the result of the widespread availability of percutaneous coronary intervention. Yet it presents adverse events such as recurrent angina, reduced ventricular stroke volume with congestive heart failure, mitral regurgitation, thromboembolism, and ventricular arrhythmias.

Case Presentation: We report the case of an 84-year-old woman who presented with generalized weakness and was subsequently noted to have impressive findings of a chronic large LV true aneurysm with thrombus, which was managed conservatively with medical therapy in the absence of complications.

Conclusion: Left ventricular aneurysms can present with nonspecific symptoms yet carry a high risk of serious complications. This case highlights the importance of comprehensive multimodal imaging in addition to accurate clinical history for diagnosing ventricular aneurysms and guiding appropriate management strategies, particularly in elderly patients.

Acute Stanford Type a Aortic Dissection Revealed by Isolated Acute Confusion: A Case Report and Review of the Literature

Tue, 20 Jan 2026 00:00:00 +0000

Background: Acute Stanford type A aortic dissection is a life-threatening condition that classically presents with abrupt chest or back pain and requires immediate surgical management. However, atypical presentations are frequent and may complicate diagnosis. Neurological manifestations occur in up to 30% of cases and are associated with diagnostic delay and increased mortality. Among these, isolated acute confusion as the initial presentation is exceptionally rare and remains poorly recognized.

Case Presentation: We report the case of a 59-year-old woman with Hypertension who initially presented to the emergency department with retrosternal chest pain that resolved spontaneously and was followed five days later by isolated acute confusion. On readmission, she had no chest pain, focal neurological deficits, hypotension, shock, or signs of internal bleeding, but exhibited severe hypoxemia. Initial neurological investigations, including brain imaging, were unremarkable. Chest X-ray revealed mediastinal widening, and contrast-enhanced computed tomography confirmed an acute Stanford type A aortic dissection extending from the origin of the left subclavian artery to the celiac trunk, without involvement of the supra-aortic vessels. Emergency surgical replacement of the ascending aorta under cardiopulmonary bypass was promptly performed.

Results: The postoperative course was overall favorable despite minor complications, with rapid hemodynamic stabilization and complete resolution of neurological symptoms. No postoperative delirium or neurological deficits were observed. The patient was discharged in good clinical condition and scheduled for outpatient cardiology follow-up.

Conclusion: This case highlights that acute aortic dissection may present with isolated acute confusion in the absence of chest pain or focal neurological signs. Clinicians should maintain a high index of suspicion for aortic dissection in patients with unexplained acute confusional states, particularly when cardiovascular risk factors are present. Early thoracic imaging remains essential to prevent diagnostic delay and improve clinical outcomes.

PASCAL-Rope Score–Guided Patent Foramen Ovale Closure after Cryptogenic Stroke in a Very Young Adult: A Case Report

Tue, 27 Jan 2026 00:00:00 +0000

Patent foramen ovale (PFO) is frequently identified in young patients with cryptogenic stroke; however, establishing a causal relationship remains challenging. Contemporary management relies on probabilistic stratification integrating clinical profile and high-risk interatrial anatomy like the presence of a highly mobile atrial septal aneurysm. The PFO-associated stroke causal likelihood (PASCAL) classification provides a structured framework to guide therapeutic decision-making, including percutaneous closure.

Case Presentation: A 23-year-old woman with no conventional cardiovascular risk factors, except active smoking and progestin-only contraception, presented with transient aphasia, frontal headache, and photophobia following physical exertion. Neurological symptoms resolved rapidly (NIHSS 0). Brain magnetic resonance imaging demonstrated a recent superficial left M3 middle cerebral artery infarction with an intraluminal thrombus. Intravenous thrombolysis was administered with favorable clinical and radiological evolution. Etiological assessment revealed a highly mobile atrial septal aneurysm on transthoracic echocardiography and a patent foramen ovale with a strongly positive right-to-left shunt on transesophageal contrast study. No alternative embolic source was identified on vascular imaging or prolonged rhythm monitoring.

Oral anticoagulation was initiated. Based on a high RoPE score combined with high-risk interatrial anatomy, the patient was classified as PROBABLE according to the PASCAL system, supporting a causal relationship between PFO and stroke. At five-month follow-up, successful percutaneous PFO closure was performed. Anticoagulation was discontinued and dual antiplatelet therapy initiated. Clinical follow-up remained uneventful, with no recurrent neurological events.

This case illustrates the clinical value of PASCAL-guided stratification in selecting very young patients with cryptogenic stroke for PFO closure and supports individualized secondary prevention strategies.

Parasinusal Atrial Tachycardia Mimicking Inappropriate Sinus Tachycardia: Successful ECG-Guided Ablation without Three-Dimensional Mapping: A Case Report

Sat, 31 Jan 2026 00:00:00 +0000

Background: Parasinusal atrial tachycardia (AT) is an uncommon form of focal supraventricular tachycardia that may closely mimic inappropriate sinus tachycardia (IST), creating diagnostic and therapeutic challenges. Differentiating these entities is crucial, as IST is primarily managed medically, whereas focal AT is amenable to curative ablation. Although three-dimensional (3D) electroanatomical mapping facilitates precise localization, it is not universally available, making surface electrocardiography (ECG) analysis essential.

Case Summary: We report the case of a 54-year-old woman presenting with recurrent palpitations and dizziness. Initial ECG demonstrated a narrow-complex tachycardia with a ventricular rate of approximately 130 bpm. Detailed P-wave analysis revealed biphasic P waves in leads V1 and aVL, suggesting a right atrial origin. Electrophysiological study induced a parasinusal atrial tachycardia with earliest activation near the sinus node region, reproducing the patient’s symptoms. No evidence of accessory pathway or sinus node dysfunction was found. Despite beta-blocker therapy, symptoms persisted. Radiofrequency ablation was successfully performed using fluoroscopic guidance and ECG-based localization, without 3D mapping, resulting in complete arrhythmia suppression.

Conclusion: This case highlights the diagnostic value of meticulous P-wave morphology analysis in distinguishing parasinusal AT from IST. Even in the absence of advanced mapping technologies, systematic ECG-guided localization can enable accurate diagnosis and effective curative ablation, particularly in resource-limited settings.

Mitro-aortic Infective Endocarditis on Bicuspid Aortic Valve Complicated by Pseudoaneurysm of the Left Coronary Sinus: A Case Report

Mon, 09 Feb 2026 00:00:00 +0000

Infective endocarditis (IE) remains a severe disease associated with high morbidity and mortality despite advances in diagnostic imaging and antimicrobial therapy. Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, is a well-recognized predisposing factor for IE and its complications. Peri-annular extension of infection may lead to abscess formation, fistulization, or, more rarely, pseudoaneurysm of the sinus of Valsalva, a condition associated with life-threatening consequences. We report the case of a 36-year-old man with mitro-aortic infective endocarditis occurring on a bicuspid aortic valve, complicated by a pseudoaneurysm of the left coronary sinus and systemic embolization that underwent a surgical approach. This case highlights the importance of early detection and prompt surgical management of complicated infective endocarditis on a bicuspid aortic valve, and illustrates the key role of multimodality imaging in guiding treatment.

Diagnostic Challenges in Infero-Basal STEMI with Double Coronary Occlusion: Two Clinical Cases and Literature Review

Fri, 13 Feb 2026 00:00:00 +0000

Background: Determining the infarct-related artery (IRA) in inferior ST-elevation myocardial infarction (STEMI) is generally guided by electrocardiographic (ECG) and angiographic characteristics. Diagnostic uncertainty increases when both the right coronary artery (RCA) and left circumflex artery (LCx) are diseased or occluded, particularly in the presence of chronic total occlusion or heavy calcification.

Case Presentations: We describe two patients presenting with infero-basal STEMI and severe multivessel coronary artery disease. In the first case, dual occlusion of the RCA and LCx occurred in a patient with prior in-stent LCx revascularisation. ECG and echocardiography yielded discordant territorial patterns, whereas angiography revealed diffuse calcification. Selective guidewire probing demonstrated that the RCA lesion was chronic, whereas the in-stent LCx occlusion was acute and thrombotic, restoring TIMI 3 flow. In the second case, an apparently thrombotic RCA occlusion with full collateralization co-existed with a severe proximal LCx stenosis. Progressive wire escalation confirmed chronic RCA occlusion and acute LCx occlusion, both successfully revascularized.

Discussion and Conclusion: These cases illustrate the limitations of isolated ECG or angiographic interpretation for culprit lesion identification in complex inferior STEMI. Contemporary evidence confirms that the RCA is the most frequent culprit artery, although LCx occlusion remains under-recognised. We integrate two complementary diagnostic strategies: an ECG-based algorithm derived from Fiol et al., and an angiography-guided algorithm incorporating selective wire probing when diagnostic ambiguity persists. Accurate IRA identification in infero-basal STEMI with dual occlusions requires a structured multimodal diagnostic approach.

Prosthetic Aortic Valve Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus with Multisystem Embolic Complications: A Case Report

Mon, 16 Feb 2026 00:00:00 +0000

Background: Prosthetic valve infective endocarditis (PVE) caused by Staphylococcus aureus is associated with high morbidity and mortality, particularly when complicated by peri-annular abscesses and systemic embolization.

Case Summary: We report a 70-year-old male with a history of ischemic heart disease, coronary artery bypass grafting, and aortic valve replacement with a bioprosthesis. The patient presented with syncope, fever, and bilateral knee trauma. Blood cultures grew methicillin-susceptible Staphylococcus aureus, and a diabetic foot ulcer was identified as the likely portal of entry. Echocardiography revealed prosthetic valve thickening, an 8-mm mobile filamentous structure (vegetation), and peri-annular abscess. PET/CT confirmed prosthetic valve infection and involvement of both knee prostheses. MRI showed multiple cerebral embolic lesions and probable cervical spondylodiscitis. The patient received prolonged intravenous cefazolin and rifampicin. Multidisciplinary evaluation indicated early surgical intervention.

Discussion: This case illustrates the aggressive nature of MSSA PVE, highlights the value of repeated and multimodal imaging including PET/CT, and emphasizes the importance of early multidisciplinary decision-making for surgical intervention.

Identification Profile of Aortic Endocarditis with Complications of a Coronal-aortic Triangle Abscess in a Stemi Patient

Mon, 16 Mar 2026 00:00:00 +0000

We report the case of a 44-year-old man, a chronic smoker with a 28 pack-year history, regular consumer of alcohol, cannabis, and hashish, followed for coronary artery disease and having undergone two angioplasties, who was admitted for typical chest pain with ST-segment elevation, suggestive of an acute ST-elevation myocardial infarction (STEMI). Coronary angiography performed during hospitalization revealed severe stenosis of the ostium of the proximal left anterior descending artery and the first marginal branch, severe stenosis of the mid-left anterior descending artery and distal right coronary artery, as well as a proximal occlusion of the circumflex artery. Given the atypical clinical course, notably persistent inflammatory syndrome, fever, and the appearance of a new murmur, transthoracic and then transesophageal echocardiography were performed. These examinations revealed heterogeneous, hypoechoic thickening at the mitro-aortic trigone compatible with a partially ruptured abscess, as well as a mobile image on the aortic annulus. Overall, the findings suggested aortic infective endocarditis complicated by a partially ruptured mitro-aortic trigone abscess, occurring in the context of rheumatic mitral and aortic heart disease. Initially unnoticed, it was first revealed by a STEMI presentation.

The patient received comprehensive treatment for his ischemic heart disease, including dual antiplatelet therapy, anticoagulation, statins, an ACE inhibitor, and a beta-blocker, in addition to empirical penicillin-based antibiotic therapy, later adjusted according to the antibiogram. A surgical bypass was planned, but the patient’s prognosis rapidly worsened with the onset of septic shock and hemodynamic failure, leading to death.

This case highlights the importance of considering an infectious or structural cause in young patients presenting with STEMI and normal coronaries, and underscores the critical diagnostic value of transesophageal echocardiography in detecting perivalvular complications.

Permeable Oval Foramen and Cerebral Vascular Accident in a Young Person: A Case Study in Chad

Sat, 21 Mar 2026 00:00:00 +0000

Stroke is a real public health problem with a significant socio-economic impact and a high mortality risk. Its frequency in young people is between 10 and15% of all strokes. The persistence of a patent foramen ovale is one of the causes of cerebral ischaemia in young people, most commonly through paradoxical embolism. We report the case of a 17-year-old girl who presented with cerebral ischaemia with hemorrhagic transformation, revealing an 11 mm PFO with right-to-left shunting. In light of this clinical case, two hypotheses emerge: either our young girl has a right-to-left shunt responsible for cerebral ischaemia that has reached the stage of haemorrhagic infarction, or she has a cerebral haemorrhage following vascular ischaemic softening secondary to an inflammatory flare-up, which would explain why our patient had flu-like symptoms one week before her admission.

Hypertensive Retinopathy Associated with Polycythemia in a Young Adult without Prior Comorbidities: A Case Report

J. Saranraj, Anu Benedict, Jomol Varghese — Fri, 10 Apr 2026 00:00:00 +0000

Aim: This case study aims to emphasize the importance of maintaining a broad differential diagnosis when evaluating young hypertensive patients with retinal manifestations. The case emphasizes the need for early identification of secondary causes of hypertension such as polycythemia.

Case Presentation: A 33-year-old male with no prior comorbidities presented with blurred vision and severe hypertension (200/150 mmHg). Initial treatment with amlodipine was ineffective, requiring intensive care management with nitroglycerin infusion and a combination of oral antihypertensives, including cilnidipine, metoprolol, and prazosin. Laboratory evaluation revealed polycythemia (hemoglobin 19.9 g/dL) and hypercholesterolemia (266 mg/dL). Treatment included therapeutic venesection of 450 ml and lipid-lowering therapy. Following intervention, the patient’s blood pressure stabilized at 130/80 mmHg, and visual symptoms improved.

Discussion: Polycythemia increases blood viscosity, which elevates systemic vascular resistance and contributes to severe, refractory hypertension. This increased pressure causes mechanical and ischemic injury to retinal arterioles, manifesting as hypertensive retinopathy with hemorrhages and cotton wool spots. Management required a multi-drug regimen to address augmented sympathetic tone and hyperviscosity. Diagnostic workup included JAK2 mutation screening to differentiate between primary and secondary polycythemia, and negative autoimmune markers excluded inflammatory etiologies.

Conclusion: Hypertensive retinopathy in young adults without prior comorbidities should prompt immediate investigation for underlying hematological disorders like polycythemia. Early recognition and aggressive, integrated management of hypertension, lipids, and blood viscosity are vital to prevent permanent vision loss and systemic complications such as stroke or myocardial infarction.

An Ischemic Stroke Revealing an Aneurysmal Dilation of the Ascending Aorta and Atheromatous Ectasia of the Descending Thoracic Aorta

Sat, 11 Apr 2026 00:00:00 +0000

We report the case of an acute embolic-appearing ischemic stroke that led to the diagnosis of a complex aortic pathology combining an ascending aortic aneurysm, defined as a permanent pathological dilation of the proximal aorta conferring a major risk of dissection or rupture, and an atheromatous ectasia of the descending thoracic aorta, characterized by the accumulation of fibrolipidic deposits within the aortic wall and constituting a potential embolic source, as illustrated in the present case. Identification of this atypical emboligenic substrate prompted a multidisciplinary management strategy.

Early Onset Atherothrombosis: Sudden Cardiac Arrest Complicating Anterior STEMI in a 25-year-old Patient with Elevated Lipoprotein A: A Case Report

Oumaima Chmali, Souad Abbi, Guillaume Lucas — Mon, 11 May 2026 00:00:00 +0000

Background: Lipoprotein A is a genetically determined low-density lipoprotein like particle bound covalently to apolipoprotein. It is increasingly recognized as a highly atherogenic and prothrombotic molecule, contributing to the development and progression of atherosclerotic cardiovascular disease through its pro-inflammatory and pro-oxidative properties, as well as its impairment of fibrinolysis. Randomized studies demonstrate that it is a causal risk factor for atherosclerotic cardiovascular diseases and also it is associated with greater thrombus burden in younger patients with STEMI.

Case Presentation: We report the case of a 25-year-old man with no cardiovascular risk factors except family history of coronary artery disease on the maternal side, who was brought to the emergency department after experiencing acute chest pain during a Padel session. Soon after admission he developed sudden cardiac arrest due to ventricular fibrillation successfully resuscitated. EKG post- resuscitation showed anterior ST-segment elevation. Emergent coronary angiography revealed a thrombotic occlusion of the bifurcation LAD II -diagonal treated initially with tirofiban, then etiological work-up identified significantly elevated lipoprotein A levels suggesting possible genetic predisposition to premature coronary thrombosis.

Conclusion: Lipoprotein A is a significant yet often under-recognized risk factor for premature coronary artery disease, especially in patients without conventional cardiovascular risk factors. Its measurement should be considered in the diagnostic evaluation of early-onset coronary events.

Uncommon Heartache: The Surprising Discovery of a Cardiac Neuroendocrine Tumor in a Young Adult

Soukaina Zagdan, Ilyas Atlas, Rim Belmelyani, Meryem Haboub, Abdenasser Drighil — Fri, 15 May 2026 00:00:00 +0000

Background: The rare cardiac involvement of neuroendocrine tumors (NETs), uncommon neoplasms with neuroendocrine differentiation that typically arise in the gastroenteropancreatic and pulmonary systems but may present with constitutional symptoms, arrhythmias, thromboembolic events, or hemodynamic compromise depending on tumor size and location.

Aims: This report highlights a rare case of cardiac metastasis from a neuroendocrine tumor, emphasizing its diagnostic challenges and important clinical implications.

Presentation of Case : We report the case of a 22-year-old male who presented with abdominal distension, dyspnea and significant lower limb edema. Initial investigations revealed a hepatic mass consistent with a neuroendocrine tumor. Further imaging demonstrated an unusual cardiac metastasis located in the right atrium, initially suggestive of a thrombotic process but later confirmed as tumoral extension. The clinical course was complicated by extensive deep vein thrombosis and a right lobar pulmonary embolism. The patient was managed through a multidisciplinary approach considering both oncological and cardiovascular complications.

Discussion : Cardiac involvement in neuroendocrine tumors is extremely rare and often reflects advanced disease. The diagnosis may be challenging due to non-specific clinical manifestations and overlap with thromboembolic disease. In this case, the presence of right atrial metastasis associated with thromboembolic complications significantly increased the complexity of management. This highlights the importance of comprehensive imaging and careful evaluation for cardiac involvement in patients with neuroendocrine tumors.particularly to differentiate tumor extension from intracardiac thrombus.

Conclusion : This case emphasizes the need to consider cardiac metastasis in patients with neuroendocrine tumors, particularly in the presence of unexplained cardiovascular or thromboembolic manifestations. Early recognition and a multidisciplinary approach are essential to optimize management and improve outcomes.

Ischemic Stroke Revealing Previously Undiagnosed Wolff-Parkinson-White Syndrome: Suspected Role of Undocumented Paroxysmal Atrial Fibrillation

I. Abbassi, M. Gouraguine, S. Anwar, M. Bouziane, M. Haboub, A. Drighil — Wed, 20 May 2026 00:00:00 +0000

Background: Wolff–Parkinson–White (WPW) syndrome is a cardiac conduction disorder characterized by the presence of an accessory atrioventricular pathway responsible for ventricular pre-excitation and predisposition to supraventricular tachyarrhythmias. Although frequently diagnosed in younger individuals, some patients remain asymptomatic until adulthood. The occurrence of ischemic stroke in association with WPW syndrome is uncommon and may suggest an underlying cardioembolic mechanism related to atrial fibrillation, particularly when paroxysmal and undocumented.

Case Presentation: We report the case of a 58-year-old man with a history of type 2 diabetes mellitus and chronic tobacco use who presented with hemodynamic instability caused by rapid supraventricular tachycardia. Two months before admission, the patient had experienced an ischemic stroke involving the left middle cerebral artery territory without an identified etiology despite extensive evaluation. He also reported recurrent exertional palpitations and transient syncopal episodes. Emergency electrical cardioversion restored sinus rhythm. Electrocardiography subsequently revealed a short PR interval and delta waves consistent with Wolff–Parkinson–White syndrome. Transthoracic echocardiography demonstrated mildly reduced left ventricular systolic function without intracardiac thrombus. Although 24-hour rhythm monitoring failed to document atrial fibrillation, the clinical presentation strongly suggested intermittent paroxysmal atrial fibrillation as the probable mechanism of cardioembolism. Anticoagulation therapy and antiarrhythmic treatment were initiated, and catheter ablation was planned.

Discussion: This case highlights the potential relationship between WPW syndrome and ischemic stroke through undocumented paroxysmal atrial fibrillation. Short-duration cardiac monitoring may fail to detect intermittent arrhythmias, particularly in patients with embolic stroke of undetermined source. Current guidelines emphasize the importance of prolonged rhythm monitoring in cryptogenic stroke patients to improve arrhythmia detection and optimize secondary prevention strategies.

Conclusion: Previously undiagnosed WPW syndrome may rarely be revealed by ischemic stroke. In patients with cryptogenic stroke and suggestive symptoms such as palpitations or syncope, prolonged cardiac rhythm monitoring should be considered to identify occult atrial fibrillation and guide appropriate therapeutic management.

Preserved Conduction in Ebstein’s Anomaly Revealed by Dual Accessory Pathway Ablation

Ashitha Sasikumar, Harikrishnan Venu Sudha, Anees Thajudeen — Thu, 28 May 2026 00:00:00 +0000

Background: Ebstein’s anomaly is frequently associated with complex arrhythmogenic substrates, particularly multiple accessory pathways and concealed intrinsic conduction abnormalities. However, preservation of native right-sided conduction following successful accessory pathway ablation remains exceptionally uncommon and sparsely reported in literature.

Aims: To report a unique case of Ebstein's Anomaly (EA) where successful radiofrequency catheter ablation of two accessory pathways revealed a remarkably preserved native conduction system, and to discuss the role of thyrotoxicosis as a metabolic trigger in destabilizing congenital substrates leading to acute symptomatic presentation.

Case Presentation: A 13-year-old female with underlying EA and Wolff-Parkinson-White syndrome (baseline QRS 170 ms) presented with palpitations exacerbated by thyrotoxicosis. EPS and 3D mapping identified two distinct right-sided bypass tracts. Following successful radiofrequency ablation (RFA) utilizing an irrigated catheter (25 Watts, temperature – limited for 45 seconds), the post-procedural ECG revealed a narrow QRS of 78 ms with a striking absence of the expected right bundle branch block (RBBB).

Discussion: EA is classically coupled with severe intrinsic right-sided conduction system disease. This case challenges the "universal" RBBB paradigm. Thyrotoxicosis served as a metabolic "second hit," increasing myocardial excitability and triggering symptomatic tachycardia.

Conclusion: Conduction system disease in EA displays remarkable clinical heterogeneity. Clinicians must remain vigilant for extracardiac metabolic triggers when a previously stable arrhythmic substrate becomes acute, and long-term surveillance is necessary given the high recurrence risk associated with remodelled tricuspid rings.

Is Hypocalcaemia Secondary to Iatrogenic Hypoparathyroidism a Possible Cause of Dilated Cardiomyopathy? A Case of Reversible Hypocalcemia-induced Cardiomyopathy

Sat, 30 May 2026 00:00:00 +0000

Dilated cardiomyopathy (DCM) is a heterogeneous myocardial disorder frequently linked to ischemic, hypertensive, or idiopathic etiologies. However, metabolic causes such as hypocalcemia, though rare, can lead to reversible myocardial dysfunction. Hypocalcemia-induced cardiomyopathy (HIC), particularly secondary to iatrogenic hypoparathyroidism, is an underrecognized but treatable condition.

We report the case of a 51-year-old woman with a history of breast and thyroid cancer, who developed recurrent symptomatic hypocalcemia following total thyroidectomy, consistent with iatrogenic hypoparathyroidism. She presented with paresthesias, muscle cramps, and positive Chvostek and Trousseau signs, repeatedly requiring hospitalizations. Her poor adherence to calcium and vitamin D therapy was identified as the main cause of recurrent hypocalcemic episodes. She was admitted for decompensated heart failure with a left ventricular ejection fraction (LVEF) of 25%. Cardiac MRI excluded ischemic, valvular, or toxic causes of cardiomyopathy. Severe hypocalcemia (serum calcium 54 mg/L) was again noted during admission. Following intravenous calcium replacement and optimized oral supplementation, her LVEF improved to 55% at three months, confirming the diagnosis of HIC.Hypocalcemia should be considered in the differential diagnosis of unexplained DCM, especially in patients with a history of thyroidectomy. The pathophysiology involves impaired myocardial excitation-contraction coupling due to calcium deficiency. If recognized early, HIC has an excellent prognosis with normalization of cardiac function upon calcium correction.

This case underscores the importance of identifying reversible metabolic causes of DCM. Hypocalcemia secondary to hypoparathyroidism, although rare, should not be overlooked, particularly in non-compliant patients. Prompt recognition and correction of calcium levels can lead to full recovery of cardiac function.

Clinical and Procedural Outcomes of Left Main PCI in Indian Population: A Single-center Observational Study

Praveen Jeya Arul Raj, Arun Arul David, Anand Gnanaraj — Thu, 29 Jan 2026 00:00:00 +0000

Introduction: Randomized trials and longer follow-up studies have demonstrated comparable outcomes between PCI and CABG in appropriately selected left main disease, particularly when contemporary techniques and stent platforms are used. The outcomes in this real-world cohort are broadly consistent with contemporary published evidence supporting unprotected left main PCI in appropriately selected patients.

Aim: The present study evaluates the clinical, angiographic, and procedural characteristics and outcomes of left main (LM) percutaneous coronary intervention (PCI) in Indian population.

Study Design: Retrospective observational study.

Place and Duration of Study: Department of Cardiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India; January 2025 to December 2025.

Methodology: A total of 100 consecutive patients undergoing unprotected LM PCI were included. baseline clinical data, angiographic characteristics, procedural strategies, and in-hospital as well as follow-up outcomes were collected. The primary endpoint was procedural success. Secondary endpoints included in-hospital, 30-day, and 1-year major adverse cardiovascular events (MACE), acute kidney injury (AKI), stent thrombosis, and restenosis.

Results: The mean age was 65.7 ± 12.4 years, and 50% of patients were female. Diabetes mellitus was present in 64%, and mean BMI was 28.4 ± 3.3 kg/m². Distal LM bifurcation disease was the predominant anatomical pattern (64%), with a mean SYNTAX score of 30.6 ± 7.5. Femoral access was used in 86% of procedures. Intravascular imaging was utilized in 40% (OCT 30%, IVUS 10%). A two-stent strategy was employed in 47% of cases, with proximal optimization technique performed in 78%. Procedural success was achieved in 88%. In-hospital MACE occurred in 5%, while 30-day and 1-year MACE rates were 11% and 16%, respectively. AKI was observed in 10%, stent thrombosis in 1%, and restenosis in 11%.

Conclusion: In this real-world Indian cohort with high clinical and anatomical complexity, unprotected LM PCI achieved high procedural success with acceptable short- and mid-term outcomes. Contemporary drug-eluting stents, selective intravascular imaging, and consistent stent optimization strategies supported favourable results in routine clinical practice.

Comparative Diagnostic Performance of Remote Dielectric Sensing and Lung Ultrasound for Detecting Pulmonary Congestion in Stable Ambulatory Heart Failure Patients

Vikhyath L. Bhat, Sudhir Lakamsani, Palani Kannan, Rajeshwari Nayak — Sat, 28 Feb 2026 00:00:00 +0000

Aims: To compare the diagnostic accuracy of remote dielectric sensing (ReDS) and lung ultrasound (LUS) for detecting pulmonary congestion in stable ambulatory patients with chronic heart failure using a blinded composite clinical–biomarker reference standard.

Study Design: Prospective single-center diagnostic accuracy study.

Place and Duration of Study: Single center, conducted between March and November 2024.

Methodology: A total of 112 stable outpatients with chronic heart failure underwent sequential clinical assessment, ReDS measurement, and standardized eight-zone LUS during the same visit. Congestion status was adjudicated by a blinded senior cardiologist using a pragmatic composite clinical score combined with NT-proBNP ≥1500 ng/L as the reference standard. The prespecified ReDS threshold was >35%. The LUS threshold of ≥24 B-lines was derived using the Youden index and considered exploratory. The primary outcome was area under the receiver operating characteristic curve (AUC). Secondary outcomes included sensitivity, specificity, likelihood ratios, agreement, and correlation.

Results: Fifty-nine patients (52.7%) met criteria for pulmonary congestion. ReDS demonstrated an AUC of 0.831 (95% CI 0.748–0.899), and LUS demonstrated an AUC of 0.845 (95% CI 0.764–0.909), with no significant difference (P = .80). At >35%, ReDS sensitivity was 71.2% and specificity 81.1%. At ≥24 B-lines (exploratory), LUS sensitivity was 69.5% and specificity 83.0%. Overall accuracy was 75.9% for both methods. Inter-method concordance was 83.0% (κ = 0.65). Continuous measures correlated modestly (r = 0.36, P < .001). Inter-observer agreement for thresholded LUS classification was substantial (κ = 0.75).

Conclusion: ReDS and LUS demonstrated comparable discrimination for detecting pulmonary congestion in stable ambulatory heart failure patients. Modest correlation and clinically relevant discordance suggest complementary physiological information. The pragmatic composite reference standard and absence of invasive validation represent limitations. Further multicenter validation is warranted.

Predictors of Elevated Total Cholesterol among Hypertensive Patients in Edo State, Nigeria: A Cross-sectional Study

Mon, 13 Apr 2026 00:00:00 +0000

Background: Cardiovascular diseases remain the leading cause of death globally, with hypertension and elevated total cholesterol as key modifiable risk factors. Their coexistence markedly increases cardiovascular risk. In Nigeria, both conditions are common among hypertensive patients, yet data on the predictors of elevated total cholesterol remain limited. This study aimed to identify predictors of elevated total cholesterol among hypertensive patients in Edo State, Nigeria.

Methodology: A retrospective hospital-based cross-sectional study was conducted. A total of 826 medical records of adult hypertensive patients were reviewed at the Medical Outpatient Clinic (MOPC), University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Elevated TC was defined as ≥200 mg/dL. Data on sociodemographics, anthropometrics, and clinical parameters were extracted. Descriptive statistics and multiple binary logistic regression (Enter method) were used to identify independent predictors, reporting Adjusted Odds Ratios (AOR) and 95% Confidence Intervals using IBM SPSS version 27.0.

Results: The prevalence of elevated TC was 38.4% (n = 317). Increasing age (AOR = 1.019 per year, p = 0.001), higher body weight (AOR = 1.027 per kg, p = 0.002), secondary education (AOR = 1.596, p = 0.027), and no formal education (AOR = 2.500, p < 0.001) were significantly associated with higher odds of elevated total cholesterol. Being married (AOR = 0.322, p < 0.001) was protective. Haematuria was also associated with increased odds (AOR = 1.970, p = 0.034), while impaired glucose tolerance (AOR = 0.484, p = 0.002), proteinuria (AOR = 0.712, p = 0.040), and elevated serum creatinine (AOR = 0.405, p < 0.001) were associated with lower odds.

Conclusion: The high prevalence of elevated TC among hypertensive patients in Edo State necessitates aggressive clinical management. Targeted interventions should prioritise female, older, and obese patients alongside robust public health campaigns aimed at those with low educational attainment and stringent lipid management for patients with concurrent chronic kidney disease. The observed inverse association with impaired glucose tolerance should be interpreted with caution, as it may reflect the effects of active lipid lowering therapy in this high-risk group rather than a true protective relationship.

Drug-Eluting Balloon Usage in Contemporary Real-world Percutaneous Coronary Intervention: A Retrospective Analysis from South India

Arun Arul David, Praveen Jeya Arul Raj, Ajeet Arulkumar — Thu, 30 Apr 2026 00:00:00 +0000

Background: Drug-eluting balloons (DCBs) have emerged as an important alternative to stent-based strategies in percutaneous coronary intervention (PCI), particularly in clinical scenarios where permanent metallic implantation may be undesirable. While randomized trials have demonstrated efficacy in selected lesion subsets, contemporary real-world data on DCB utilization and outcomes from India remain limited.

Aims: To evaluate indications, utilization patterns, procedural characteristics, and short-term clinical outcomes associated with DCB use in routine PCI practice in South India.

Study Design: Retrospective observational study.

Place and Duration of Study: Department of Cardiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India; January 2024 to June 2025.

Methodology: This retrospective, observational, single-centre study included all consecutive adult patients who underwent PCI involving at least one DCB between January 2024 and June 2025. Clinical, angiographic, and procedural data were collected and analyzed. The primary outcome was procedural success, defined as achievement of TIMI grade 3 flow without bailout stenting. Secondary outcomes included procedural complications and short-term (1-month) major adverse cardiac events (MACE).

Results: A total of 46 patients were included (mean age 60.4 ± 8.8 years; 82.6% male). DCBs were used in de novo lesions (67.4%) and in-stent restenosis (32.6%), with a high prevalence of small-vessel disease (<2.5 mm, 60.9%) and complex lesions (73.9% ACC/AHA type B2/C). Procedural success was achieved in 87.0%, with bailout stenting required in 6.5%. No major in-hospital complications were observed. At 1-month follow-up, no MACE, including death, myocardial infarction, or target lesion or vessel revascularization, was recorded.

Conclusion: In this real-world South Indian cohort, DCB-based PCI demonstrated high procedural success and excellent short-term safety, including in complex lesion subsets such as small-vessel disease and in-stent restenosis. These findings support the feasibility of DCB strategies in routine clinical practice, although larger prospective studies with longer follow-up are needed to establish long-term outcomes.

Atherogenic Risk Indices as Predictors of Cardiovascular Disease in HIV Patients Receiving Highly Active Antiretroviral Therapy in a Nigerian Tertiary Hospital

Tarila Ngowari Aleruchi-Didia, Ejesi Kelechi Ihuoma, Ijioma Nwamaka Nicole — Tue, 05 May 2026 00:00:00 +0000

Human immunodeficiency virus (HIV) infection remains a significant global health challenge. While the introduction of highly active antiretroviral therapy (HAART) has greatly improved survival and quality of life, it has also been associated with metabolic complications, including dyslipidaemia and increased cardiovascular risk. This study aimed to evaluate lipid profiles and cardiovascular risk markers among HIV-positive patients receiving treatment at Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria.

A total of 150 participants were enrolled, comprising 90 HIV-positive individuals on HAART and 60 HIV-negative controls. Blood samples were collected and analyzed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) using standard enzymatic methods. Cardiovascular risk indices, including Castelli’s Risk Index I (CRI-I), Castelli’s Risk Index II (CRI-II), Atherogenic Index of Plasma (AIP), and Atherogenic Coefficient (AC), were subsequently calculated. Data were analyzed using SPSS version 23, with statistical significance set at p < 0.05.

Results revealed that HIV-positive participants had significantly higher mean levels of total cholesterol (6.27 ± 0.51 mmol/L), triglycerides (2.28 ± 0.34 mmol/L), and non-HDL cholesterol (5.30 ± 0.61 mmol/L) compared with controls, while LDL-C levels were lower (0.97 ± 0.18 mmol/L). Additionally, atherogenic indices (CRI-I, CRI-II, AIP, and AC) were markedly elevated among HIV-positive individuals, particularly in older adults and smokers.

In conclusion, HIV-positive patients receiving HAART exhibit an increased burden of dyslipidaemia and cardiovascular risk. These findings highlight the importance of routine lipid monitoring and comprehensive cardiovascular risk assessment in the management of HIV to reduce long-term therapy-related complications.

Short-term Outcomes and Prognostic Determinants in Hospitalized HFrEF Patients: A Single-Center North African Cohort Study with International Benchmarking

Mon, 11 May 2026 00:00:00 +0000

Background: Short-term outcomes in HFrEF, including in-hospital mortality and 30-day rehospitalization, reflect the quality of acute care and the adequacy of discharge management. Data from North African settings remain scarce.

Aim: The study aims to evaluate in-hospital outcomes and 30-day post-discharge status among patients hospitalized with HFrEF at a tertiary care center in Morocco, and to identify clinical predictors of short-term adverse outcomes while benchmarking findings against international registries.

Methods: A retrospective cohort study was conducted among 173 HFrEF patients admitted to the Avicenne Military Hospital of Marrakech between December 2021 and December 2023. In-hospital mortality, causes of death, 30-day follow-up adherence, and rehospitalization rates were assessed and benchmarked against international registries.

Results: In-hospital stabilization was achieved in 94.7% of patients. In-hospital mortality was 5.3% (9 deaths): 4 due to sustained ventricular tachycardia and 5 due to refractory cardiogenic shock. At 1 month, 76.3% maintained regular follow-up, 12.7% were lost to follow-up, and 5.7% were rehospitalized for decompensation. Predictors of adverse outcomes included severe LV dysfunction, right ventricular failure, and renal impairment.

Conclusion: Mortality rates are comparable to international registries, but the high lost-to-follow-up rate and low rehospitalization tracking underscore the need for structured post-discharge HFrEF management programs in Morocco.

Heart Failure with Reduced Ejection Fraction in North Africa: Clinical Characteristics and Paraclinical Findings Compared to International Registries

Fri, 15 May 2026 00:00:00 +0000

Introduction: Heart failure with reduced ejection fraction (HFrEF), defined as LVEF ≤ 40%, is a major public health problem due to its high morbidity and mortality, affecting approximately 64.3 million individuals worldwide, of whom nearly 50% present with reduced ejection fraction.

Objectives: To analyze the clinical and paraclinical profile of HFrEF patients hospitalized in the Cardiology Department of the Avicenne Military Hospital in Marrakech, and to compare our findings with international registry data.

Patients and Methods: Retrospective descriptive study of 173 patients hospitalized between December 2021 and December 2023 with a confirmed diagnosis of HFrEF (LVEF ≤ 40%).

Results: Mean age was 67.9 ± 8.7 years with male predominance (80%). Main cardiovascular risk factors were physical inactivity (85%), smoking (53%), diabetes mellitus (45%), hypertension (33%), and dyslipidemia (33%). Dyspnea was the predominant symptom (98.2%), with 45% in NYHA class II. Electrocardiography revealed intraventricular conduction abnormalities in 58% of patients, predominantly left bundle branch block (LBBB, 32.3%). Mean LVEF was 32%. Anemia was present in 45% of patients and BNP was elevated in all patients (mean 427 ± 87 pg/mL). Coronary angiography demonstrated significant lesions in 56.6 % of explored patients.

Conclusion: This study highlights the epidemiological, clinical, and paraclinical features of HFrEF in our context, broadly comparable to international data, and underscores the need for optimized multidisciplinary diagnostic and therapeutic management. The main limitation of this work is its retrospective single-center design, which may limit generalizability.

Risk Stratification and Peri-procedural Optimization in Complex Percutaneous Coronary Interventions: Evidence-based Insights for Improved Patient Outcomes

AbAbolore Aminat Ajakaye, Onome Olajide — Thu, 19 Feb 2026 00:00:00 +0000

Complex percutaneous coronary intervention (PCI) is increasingly performed in patients with advanced coronary artery disease, multiple comorbidities, and high procedural risk, making accurate risk stratification and peri-procedural optimization essential to improving outcomes. Contemporary risk assessment integrates anatomical complexity scores such as the SYNTAX and residual SYNTAX scores with clinical models including GRACE, ACEF, and registry-based prediction tools to guide procedural planning and clinical decision-making. Beyond risk prediction, peri-procedural optimization strategies have evolved to include physiological lesion assessment using fractional flow reserve and instantaneous wave-free ratio, intravascular imaging guidance with intravascular ultrasound and optical coherence tomography, and refined antithrombotic and vascular access strategies to minimize ischemic and bleeding complications. Hemodynamic support devices such as intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation have expanded the therapeutic window for high-risk PCI in patients with impaired ventricular function or cardiogenic shock. Additionally, advances in patient selection, multidisciplinary heart team approaches, and tailored peri-procedural pharmacotherapy have contributed to improved procedural safety and long-term outcomes. Despite these advancements, challenges remain in integrating complex risk models into routine practice and defining optimal strategies for specific high-risk subgroups. This review synthesizes current evidence on risk stratification frameworks and peri-procedural optimization techniques in complex PCI, highlighting emerging tools and future directions to enhance personalized interventional cardiology care and improve patient-centered outcomes.

Multiparametric Cardiac MRI In Myocarditis, Non-ischaemic Cardiomyopathies and Silent Myocardial Ischaemia: Diagnostic and Prognostic Integration in Modern Cardiology

Thu, 19 Mar 2026 00:00:00 +0000

Cardiac magnetic resonance imaging, more precisely cardiovascular magnetic resonance (CMR), has moved from a predominantly morphological tool to a comprehensive method for myocardial tissue characterisation, perfusion assessment, and risk stratification. Its strongest contemporary contribution lies in multiparametric integration, whereby cine imaging, late gadolinium enhancement, T1 mapping, T2 mapping, extracellular volume estimation, and stress perfusion are interpreted together rather than in isolation. This integrated approach is particularly valuable in myocarditis, non-ischaemic cardiomyopathies, and silent myocardial ischaemia, three settings in which symptoms and routine tests often underestimate the true extent or nature of myocardial disease. In myocarditis, CMR has improved non-invasive diagnosis through the updated Lake Louise framework and has also emerged as a prognostic tool through the identification of residual scar, ventricular dysfunction, and persistent tissue abnormality. In non-ischaemic cardiomyopathies, CMR refines phenotyping across dilated, hypertrophic, infiltrative, and inflammatory disorders while adding prognostic information that extends beyond left ventricular ejection fraction alone. In silent myocardial ischaemia, stress perfusion CMR and scar imaging can reveal inducible perfusion abnormalities, microvascular dysfunction, and unrecognised infarction, thereby linking clinically occult disease to future cardiovascular events. The central modern challenge is no longer whether CMR can detect abnormality, but how its multiple qualitative and quantitative signals should be synthesised with clinical data, biomarkers, and sometimes genetics to guide management. This review examines the diagnostic and prognostic value of multiparametric CMR across these three domains and argues that its greatest importance in contemporary cardiology lies in biologically informed integration rather than single-sequence interpretation.

Effectiveness and Safety of Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy in Patients with Acute Coronary Syndrome Following Percutaneous Coronary Intervention: A Narrative Review

Luh Putu Arsita Apriani Wijaya, I Gusti Ayu Suryawati, Kadek Dwi Krisnayanti — Fri, 15 May 2026 00:00:00 +0000

Antiplatelet therapy forms the cornerstone of pharmacological management following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). For decades, dual antiplatelet therapy (DAPT) — conventionally comprising aspirin combined with a P2Y12 receptor inhibitor — has represented the standard of care, underpinned by robust evidence demonstrating reductions in major adverse cardiovascular events. However, sustained dual antiplatelet therapy inevitably increases the risk of clinically significant bleeding, which is itself associated with elevated mortality, prolonged hospitalisation, and impaired quality of life. This tension has catalysed growing interest in strategies that involve earlier transition to single antiplatelet therapy (SAPT), thereby reducing haemorrhagic exposure without substantially compromising ischaemic protection. This narrative review evaluates the comparative effectiveness and safety of SAPT versus DAPT in ACS patients following PCI, drawing on evidence from major randomised controlled trials, meta-analyses, and contemporary clinical guidelines. The review examines the pathophysiological rationale for antiplatelet therapy, the pharmacology of relevant agents, the role of risk stratification tools, and the ischaemic and haemorrhagic outcomes associated with abbreviated or single-agent approaches. Evidence from pivotal trials — including TWILIGHT, SMART-CHOICE, STOPDAPT-2, TICO, MASTER DAPT, and HOST-EXAM — is synthesised alongside guideline recommendations from the European Society of Cardiology and the American College of Cardiology/American Heart Association. The available data indicate that, in carefully selected patients — particularly those at elevated haemorrhagic risk — transition to SAPT after one to three months of DAPT can achieve a favourable balance between ischaemic efficacy and bleeding safety. Individual patient characteristics, stent type, clinical presentation, and comorbidities must nonetheless continue to inform clinical decision-making in this nuanced domain. This finding, robust across multiple independent RCTs and confirmed in individual patient data meta-analytic syntheses, represents one of the more substantive advances in post-PCI pharmacotherapy over the past decade.