The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffered with the illness, a myriad of symptoms emerged in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations encountered. Pericarditis with pericardial effusion requiring medical or interventional treatments have been previously reported in the acute setting. However, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date. A patient with COVID-19 associated constrictive pericarditis three years following the viral infection requiring pericardiectomy is reported. Descriptions of the clinical, diagnostic, and therapeutic features are illustrated. This case adds to the spectrum of COVID-19 related cardiac conditions and its treatment is believed to be the first reported of its kind.

An electrocardiogram (ECG) measures the electrical activity of the heart in order to diagnose cardiac conditions. These medical tests are noninvasive and cost-effective, simply requiring the clinician to place electrodes in various anatomical positions on the patient. The general ECG testing process has not changed over time; however, novel ECG technology is starting to see use in clinical practice. Therefore, the purpose of this literature review is to provide an overview of the effectiveness of advanced ECG technology and practical implications for clinicians.

Introduction: Deep vein thrombosis (DVT) of the lower limbs and pulmonary embolism (PE) are two clinical expressions of the same disease, venous thromboembolism (VTE). DVT and PE share the same risk factors and curative anticoagulant treatment. The aim of our study is to contribute to the knowledge of venous thromboembolic disease (VTE) in its epidemiological, diagnostic and therapeutic aspects in the cardiology department of the Amirou Boubacar Diallo National Hospital in Niamey. Methodology: This was a retrospective and descriptive study from 01 January 2016 to 31 December 2021 in its first phase, prospective and descriptive from 01 January 2022 to 30 June 2022 in its second phase i.e. 78 months. Our study included patients hospitalized with imagingconfirmed VTE. Results: One hundred and sixty-five (165) cases of venous thromboembolic diseases were retained over this study period out of all hospitalized patients, which was 4885 patients, i.e. a hospital frequency of 3.37%, the female sex was predominant, i.e. 55% (90 cases) of the sample with a sex ratio of 0.88. The mean age of our patients was 54.07 ± 16.25 years with extremes of 22 and 83 years. The 55.0 - 64.0 age group was the most represented. Risk factors for VTE were dominated by prolonged bed rest with 23.6% of cases, followed by obesity with 14.5% of cases. Dyspnea was the clinical leader with 79.49% of cases in pulmonary embolism (PE) and leg pain in 76.4% of cases in deep vein thrombosis (DVT). One hundred and thirty-two (132) patients had deep vein thrombosis (DVT), of which 108 had proximal DVT (81.81%) and 24 had distal DVT (18.19%). On CT angiography, of the 39 cases of pulmonary embolism (PE), localized obstruction on the right was predominant with 46.15%; it involved the left pulmonary artery in 23.07% of cases. Right axial deviation was the majority electrical abnormality accounting for 36.35% of cases, followed by right ventricular hypertrophy with 27.27% of cases. Pulmonary arterial hypertension, right cavitary dilation and right intra-cavitary thrombi and were the most frequent ultrasound abnormalities, with 12.72% respectively; 9.1% and 9.1% of cases. The death rate was 10.9% of cases.’ Conclusion: Venous thromboembolic disease is a common reason for hospitalization. It can be serious with an often guarded prognosis, hence the need for rigorous management and prevention in patients at risk.

Introduction: Guidelines recommend that physicians reduce levels of low-density lipoprotein cholesterol (LDL-c) in patients with high cardiovascular risk. However, the achievement of these targets is low. It is paramount to know the success rate of lipid control to improve therapy and reduce cardiovascular events. Objective: To assess the efficacy of lipid-lowering therapy in the achievement of LDL-c goals for each cardiovascular risk group in public outpatient ambulatory in Brazil. Methods: Cross-sectional, observational, retrospective study in the Cardiology outpatient clinic of a referral hospital in Brazil. We included all patients with a history of dyslipidemia who were attended between May and June 2022. We excluded patients who had their first consultation at the time of recruitment. Data were obtained from medical records and the success rates for LDL-c goals were analyzed across cardiovascular risk groups. Statistical analyses were made by Pearson’s chi-square test, unpaired Student’s T-test and ANOVA One-Way test. Differences among groups were considered to be statistically significant if p-values were lower than .05. Results: We included 431 patients; 207 (48.0%) were classified as very high risk, 159 (36.9%) as high risk, 46 (10.7%) as intermediate risk and 19 (4.4%) as low risk. 82.8% received statins, 30.4% received high-intensity statin therapy (HIST), 6.7% received ezetimibe and none received PCSK9 inhibitor. The LDL-c goal had been reached in different proportions among risk groups: 15.9% of very high risk patients, 31.4% of high risk patients, 54.3% of intermediate risk patients and 73.7% of low risk patients (p=.0001 for comparison among groups). Conclusions: Our study showed poor success rates in achieving LDL-c goals, with the lowest success rate in the very-high risk group, despite the more frequent use of HIST and ezetimibe. These results demonstrate challenges in achieving LDL-c targets in real world.

Radiofrequency ablation is currently used for the treatment of several arrhythmias, including premature ventricular complexes (PVCs) in cases of persistent symptoms despite optimized medical treatment and arrhythmia-induced-cardiomyopathy. The most common complications are those related to the vascular access, followed by cardiac tamponade. Atrioventricular blocks, coronary lesions and neurological alterations may also occur. We report a case of a fifty-year-old female referred for catheter ablation of PVCs, who evolved with cardiac tamponade and cardiorespiratory arrest during procedure. After pericardiocentesis and return of spontaneous circulation, a persistent anterior wall ST-segment elevation was noted. Immediate coronary angiography showed occlusion of the left anterior descending artery, probably secondary to extrinsic compression by the pigtail catheter in the pericardial sac during chest compressions, a mechanism not yet described of myocardial infarction during ablation. Primary percutaneous coronary intervention was successfully performed. The patient had favorable evolution after the complications, with no ventricular dysfunction, and was discharged from hospital after seven days.

Background: Mobile catheterization laboratories offer a relatively rapid equipment option for hospitals with the potential benefit to maintain patient access of needed percutaneous procedures. One concern is the Xray equipment may not be contemporary, resulting in higher radiation exposure to staff and patients. The aim of the study was to compare radiation exposure with procedures performed in a mobile versus a fixed catheterization laboratory. Methods: Absorbed dose measured in milligray (mGy) was measured from the Xray equipment in the mobile lab (manufactured in 2008) and the fixed laboratory (manufactured in 2016). The effective dose measured in millisievert (mSv) was measured after each case from dosimeters worn by the operators. A total of 61 cases were reviewed, 30 in the mobile and 31 in the fixed laboratory. Data were collected from each case, including mGy, mSv, number of frames, fluoroscopy time, type of procedure, vascular access location, horizontal radiation absorbing pads (HRAP), body mass index (BMI) and contrast volume. Results: There were no significant differences in BMI, access site, number of HRAP, contrast volume, frames per case and fluoroscopy time. The mobile lab measured mGy greater than 2.7 times higher (p<0.005) and the mSv was great than 2 times higher (p<0.05) versus the fixed catheterization laboratory. Conclusions: While mobile catheterization laboratories provide maintenance of percutaneous procedures for hospitals, they may have older Xray equipment, which can result in over two times the radiation exposure to both patients and staff.

This treatment requires getting the patient to a hospital equipped with an available catheterization laboratory.

Myo-pericarditis is characterized by inflammation that affects the myocardium and extends to the pericardium. This heart condition can vary in severity and requires a comprehensive diagnostic approach due to numerous potential causes. This is particularly challenging in the context of coronavirus disease (COVID-19) infection, due to the related potential complications that may emerge. In response to COVID-19, the immune system has already been associated with an explosion of powerful inflammatory alarm signals that trigger inflammation. Multisystem inflammatory syndrome in adults (MIS-A syndrome) is an under-recognized hyperinflammatory condition that occurs during or after the infectious period of COVID-19. This manifestation can affect multiple organs, including the heart, and can also cause myo-pericarditis. We present a complex case marked by intricate clinical presentation, extensive diagnostic evaluation, and multiple therapeutic interventions, highlighting the need for ongoing re-assessment of the diagnosis. Additionally, a brief literature review examines the pathologies complicating our diagnostic approach, aiming to elucidate the challenges inherent in diagnosing febrile myo-pericarditis. Given the diverse manifestations and overlapping symptoms, a refined diagnostic strategy is essential for accurate identification and effective management.

Background: Atrial septal defect (ASD) is the second most prevalent congenital heart diseases (CHD) encompassing 8-10% of all CHDs beyond neonatal period. Although relatively benign, if left untreated can amount to several adverse outcomes. Trans-catheter Device closure of ASD is a preferred therapy for a hemodynamically significant shunt. Despite multitude of septal occluders being available these days, paucity of literature concerning appropriateness of device sizing, and various adaptations of techniques for device deployment in large ASDs with deficient rims and their outcomes in children up to 10 kg weight nevertheless still exists. Aims and Methods: A retrospective multi-centric observational study, was conducted in a cohort of children who underwent ASD device closure weighing up to 10 kg conducted over a period of 4 years, to assess its safety and feasibility. Results: Of the included 85 patients, 63% were females and 37% were males with mean age at intervention being 32 months. The mean weight and height were 9.17 Kg and 88 cm respectively. Mean of maximum ASD dimension was 14.92mm. Hemodynamic assessment with invasive PA pressures recordings suggested normal PA pressure in 82%, while 18% had pulmonary arterial hypertension. Mean Qp/Qs and PVR was 2.58 and 1.8 Wood units respectively. Average device: weight ratio was 1.9. Arrhythmias occurred in 6 children, five had Adenosine sensitive SVTs and one had persisting CHB necessitating surgical device retrieval and Permanent pacemaker implantation. No mortality occurred in this study. Conclusion: Trans-catheter closure of ASD is indeed safe and effective procedure if performed in children weighing up to 10 Kg, in a hemodynamically significant shunt, adopting modified techniques, even in presence of flimsy or deficient rims with device weight ratio up to 3:1.

Background: Atrial septal defect (ASD) is the second most prevalent congenital heart diseases (CHD) encompassing 8-10% of all CHDs beyond neonatal period. Although relatively benign, if left untreated can amount to several adverse outcomes. Trans-catheter Device closure of ASD is a preferred therapy for a hemodynamically significant shunt. Despite multitude of septal occluders being available these days, paucity of literature concerning appropriateness of device sizing, and various adaptations of techniques for device deployment in large ASDs with deficient rims and their outcomes in children up to 10 kg weight nevertheless still exists. Aims and Methods: A retrospective multi-centric observational study, was conducted in a cohort of children who underwent ASD device closure weighing up to 10 kg conducted over a period of 4 years, to assess its safety and feasibility. Results: Of the included 85 patients, 63% were females and 37% were males with mean age at intervention being 32 months. The mean weight and height were 9.17 Kg and 88 cm respectively. Mean of maximum ASD dimension was 14.92mm. Hemodynamic assessment with invasive PA pressures recordings suggested normal PA pressure in 82%, while 18% had pulmonary arterial hypertension. Mean Qp/Qs and PVR was 2.58 and 1.8 Wood units respectively. Average device: weight ratio was 1.9. Arrhythmias occurred in 6 children, five had Adenosine sensitive SVTs and one had persisting CHB necessitating surgical device retrieval and Permanent pacemaker implantation. No mortality occurred in this study. Conclusion: Trans-catheter closure of ASD is indeed safe and effective procedure if performed in children weighing up to 10 Kg, in a hemodynamically significant shunt, adopting modified techniques, even in presence of flimsy or deficient rims with device weight ratio up to 3:1.

What is new in ESC and ACC revascularization guidelines. Why we need to embrace it in everyday practice. When we can use different antiplatelet therapeutic options in those patients. How can we implement mode of artificial intelligence after primary PCI. When and What is the right new definition of ACS. ESC 2023. new guideliness and urge for complete revascularization. ACC 2021. Main pathways Why and how to assess High Bleeding Risk (HBR), seen in about 20% of ACS patients. Can we measure periprocedural risk in ACS and what types of de-escalation antiplatelet therapy can be used. CCS – Chronic coronary sydrom (stable angina) ESC 2019. guidelines. ACC 2023. What are patient risk profiles number 1, 2 and 3. Why we should use Guideline Directed Medical Therapy, the proven benefit in CCS. Different types of revascularization therapies, OMT (Optimal Medical Therapy) vs PCI vs CABG (Coronary Artery By Pass). What is OPTIMUM Registry and who are the patients ineligible for surgical revascularization. The role and definition of Prehabilitation. All those new aspects through intertwined evidence based cardiology facts concerning revascularization, across both side of the ocean.