P865 Ecstasy s use an unusual cause of dilated cardiomyopathy a case report

Background

3,4-methylenedioxymethamphetamine is a stimulant used illegally around the world, including Morocco. Cardiomyopathy and heart failure may occur following chronic MDMA use and may cause many other acute cardiac complications.

Case report

A 30-year-old man, with a history of MDMA use, 2 tablets/week since 2 months, and 6 tablets the week before admission, presentedwith severe dyspnea at rest. The first evaluation shows a sinus tachycardia with tachypnea and signs of global heart failure, loud systolic murmur heard over the apex andcrackles at the base of the lungs were observed.

The blood tests performed, including erythrocyte sedimentation rate, blood picture, liver function and kidney function tests, protein, iron, phosphocalcic balance, glucose, and thyroid hormones,were within normal range. Moreover, immunological assays [immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-Epstein–Barr virus] and toxoplasmosis were negative. Cytomegalovirus IgM was also absent, and IgG titer value was also absent.

Electrocardiogram (ECG) tracing showed a complete left bundle branch block (LBBB)with a regular sinus rhythm (100 bpm). Transthoracic echocardiography showed dilated cardiomyopathy with severe systolic dysfunction (12% by Simpson’s method) (Fig. 1).

Additional evaluation in the hospital excluded other etiologies of the cardiomyopathy. Thus, his condition was referred to the MDMA use.

The patient now is a heart transplant candidate.

Conclusion

There are several reports that show an increase in frequency of MDMA use, suggesting that cardiomyopathy and acute heart failure secondary to the Ecstasy use may be a new medical concern. Thus, proper history of illicit drug intake is crucial in the diagnosis of unexplained cardiomyopathies.

[Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk]

INTRODUCTION

Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease.

METHODOLOGY

This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied.

RESULTS

Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin.

CONCLUSION

PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk.

[Short and medium term cardiotoxicity of anthracyclins: a prospective study]

There is evidence that anthracyclins may affect the heart and ventricular function. This cardiac toxicity is frequent and serious. It is the first study in Morocco to investigate the frequency of anthracyclins cardiotoxicity. It has for objective to analyze the cardiotoxicity connected to anthracyclins, these risk factors as well as the echocardiographic parameters, which deteriorate prematurely. We led a forward-looking study between October 2008 and December 2009. With 90 patients followed in the service of oncology-radiotherapy and put under chemotherapy with anthracyclins. We conducted a study of various ultrasound parameters of cardiac function, before with anthracyclins, the third cure of chemotherapy, then in the 6th cure of treatment. Only 70 patients have been assessable. Average age was of 47 years (20-68 years); 91% were female. The cardiac function was preserved in 40% of the cases. Among our patients, 56% developed a decrease moderated in light of the cardiac function and 4% of cases developed a severe cardiotoxicity. The echocardiographic parameter most significant in our series was LVEF, followed by TEI index. We found a cardiotoxicity was strictly correlated with the cumulative dose, anthracyclins type and associated comorbidity. The anthracyclins cardiotoxicity is quite common in our series, which requires more thorough preventive measures including monitoring by echocardiography.

[Tamponade reveals an intra-pericardial hydatid cyst - a case report]

INTRODUCTION

Hydatid disease is a parasitic infection caused by the development of the larval form of the Teania of Echinococcus granulosus. It is endemic in many regions of the world such as the Mediterranean basin. Location without pericardial cardiac involvement is extremely rare. In this case study, we will elaborate the case of an intra-pericardial hydatidosis disease without cardiac location revealed by a tamponade.

OBSERVATION

AA is a 60-year-old man with no pathological history and who was admitted for a tamponade assessment. Indeed, the cardiovascular examination showed a muffling of the heart sound and signs of a right heart failure. Besides, the ECG shows a microvoltage, and the chest radiography shows cardiomegaly. Moreover, the transthoracic echocardiogram confirmed the presence of an abundant pericardial effusion along with signs of a tamponade. It also reifies the presence of, at the intra-pericardial level, a multiple vesicular formation giving a cluster of grapes highly suggestive of an intra-pericardial hydatid disease. An emergency surgical drainage allowed removing about two liters of suspicious fluid along with cysts and white membranous. The pathological examination of the membranous confirmed the diagnosis of a pericardial hydatid cyst. The performance of a chest CT and an abdominal ultrasound's scan to identify other locations shows no further anomalies. The patient was put under medical treatment (Albendazole(®)) and is showing a good clinical improvement.

CONCLUSION

The intra-pericardial hydatid disease is another cause of tamponade not to fail despite its rareness, as it is endemic to North African countries.

[Cardiac hydatid cysts: report of 10 cases]

Authors report 10 observations of cardiac hydatid cyst collected to cardiovascular unit of Ibn Rochd hospital in Casablanca during last 7 years. Clinical investigation included in all cases chest X ray, ECG and ultrasonography (US). A computed tomography (CT) scan was performed in 6 cases, magnetic resonance imaging in four cases, transoesophageal US in two cases. Examination for other hydatic sites was realized in all cases, and brain CT was performed in 5 cases. The hydatid cyst was variably localized in the left ventricle in 6 cases, the pericardium in 4 cases, the interventricular septum in 2 cases, the right auricle in 2 cases and multiple locations in one case. The existence of other cardiac hydatid sites was found in 7 cases. Seven patients have been operated (2 cases to closed heart). Outcome was favorable in 6 cases with a mean of three years survey. Two patients died and 2 others have been lost of view. The diagnosis of the cardiac hydatid cyst has benefits from the combination USCT scan that allowed a precise topographical inventory, reducing the need for MRI to the complicated cases and to the rare cases of inconclusive results by US-CT scan.

[Aneurysm of the posterior sinus of Valsalva ruptured into right atrium]

Sinus of Valsalva aneurysm is rare malformation, which takes origin from one of the three aortic sinuses. Diagnosis of this abnormality is usually made when rupture has occurred. Our observation underlines the severity of the posterior sinus of Valsalva aneurysm ruptured into right atrium, and emphasizes the utility of transthoracic and transoesophageal echocardiography for diagnosis.