Accuracy of the TIMI and GRACE scores in predicting coronary disease in patients with non-ST-elevation acute coronary syndrome.

Introduction: The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease.

[Plastic repair of tricuspid valve: Carpentier's ring annuloplasty versus De VEGA technique].

Tricuspid valve disease has been neglected for a long time by cardiologists and surgeons, but for some years now leakage of tricuspid valve has been demonstrated as a prognostic factor in the evolution of patients with left heart valve disease undergoing surgery. Several techniques for plastic repair of tricuspid valve have been developed and the published studies differ on the results of these techniques; we conducted this study to assess the results of plastic repair of tricuspid valve in a population of patients with a high prevalence of rheumatic disease and to compare Carpentier's ring annuloplasty techniques with DEVEGA plasty. We conducted a retrospective study of patients undergoing plastic repair of tricuspid valve in the Department of Cardiology at the Medicine University of Sfax over a period of 25 years.

Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre.

Background: Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available.

Aim: To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia.

Methods: This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013.

[Statins Use in Elderly Patients].

The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients <80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain.

Midventricular Obstructive Hypertrophic Cardiomyopathy during Pregnancy Complicated by Pulmonary Embolism: A Case Report.

Hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO) is a rare condition occurring in 1% of HCM patients. It is characterized by asymmetric left ventricular hypertrophy with MVO and elevated intraventricular pressure gradients. Pulmonary embolism has been associated with mid-ventricular obstructive HCM.

Myocardial infarction and normal coronary arteries: the experience of the cardiology department of Sfax, Tunisia.

Objective: The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed.

Methods: Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries.

Intracardiac thrombus in a young man: don't forget Behçet's disease!

Intracardiac thrombosis is an exceptional complication of Behçet's disease. The management of this involvement is difficult due to the risk of recurrence. We present the case of a young man admitted to our hospital for intermittent fever.

A neovascularized left atrial mass.

Background. The discovery of a large left atrial mass through echocardiography obliges the clinician to perform a differential diagnosis to distinguish tumor from thrombus. The neovascularization of the mass could be helpful to predict the type of the malformation and whether it is in favour of a vacular tumour rather than a thrombus .

Brucella myocarditis: a rare and life-threatening cardiac complication of brucellosis.

This case report represents the difficulties in diagnosing brucellosis, which is an enigma with unusual cardiovascular complications. A 32-year-old Caucasian man with acute chest pain was examined at Sfax Hedi Chaker's Hospital. He had a night fever, although his cardiac examination was normal.

Infective endocarditis complicated by fatal cerebral hemorrhage revealing an unrepaired univentricular heart in a 19-year-old woman.

Univentricular heart is a complex and rare cyanotic congenital heart disease. When not operated, affected patients exceptionally reach adulthood. We report the unprecedented case of a 19 year-old young woman, admitted to the hospital for a severe deterioration of general status and ultimately diagnosed to have an infective endocarditis with multiple vegetations in a previously undiagnosed univentricular heart of left ventricular morphology, subsequently rapidly complicated by fatal cerebral hemorrhage.

Clinical and electrophysiological profile of Brugada syndrome in the Tunisian population.

Background: Most clinical studies of the clinical profile of Brugada syndrome (BS) have been conducted in either Asia, Europe, or America and their applicability to North African populations is largely unknown. The aim of the study was to analyze the clinical profile of BS in Tunisian patients.

Methods: The clinical and follow-up data of 24 patients (22 men, mean age: 40.

Potential danger of ocular compression in paroxysmal supraventricular tachycardia in patients with latent preexcitation.

The vagal maneuver is the first line of therapeutic available for patients with paroxysmal supraventricular tachycardia. It increases vagal tone and includes the traditional ocular compression, carotid sinus massage, and Valsalva maneuver. A 40-year-old man was admitted because of 180 beats/min regular narrow QRS-complex tachycardia.

Short- and long-term outcomes of surgery for active infective endocarditis: a Tunisian experience.

From January 1997 to December 2006, all patients with a Duke criteria-based definite diagnosis of infective endocarditis (IE) operated on during the active phase in a Tunisian high volume tertiary-care centre were included. Among the 186 patients with IE identified during the study period, 88 (48.35%) required surgery in the active phase.

Infective endocarditis in hemodialysis patients: clinical features, echocardiographic data and outcome: a 10-year descriptive analysis.

Background: Infective endocarditis (IE) is a dreaded complication in hemodialysis (HD) patients and is strongly associated with morbidity and mortality.

Objectives: Our aim was to investigate clinical and echocardiographic characteristics, microbiological profile, management and outcome of patients on HD in a Tunisian (Tunisia, North Africa) high-volume tertiary-care centre.

Methods: Among 182 patients who fulfilled the modified Duke criteria for infective endocarditis between January 1997 and December 2006, 16 were on chronic HD and were included in the study.

Rapid occurrence of giant left ventricular pseudoaneurysm after mitral valve replacement.

Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively.

Unusual cause of syncope in a 17 year-old young woman: left ventricular hydatid cyst.

Cardiac involvement in echinococcosis remains a singular finding, possibly associated with confusing symptomatology. We report the original case of a 17 year-old young woman, referred to our cardiology department for repeated exertion syncopes, and ultimately, proven through echocardiography, serologies and magnetic resonance imaging to have a massive hydatid cyst developing inside the left ventricular cavity towards the outflow tract. The cyst has been surgically completely removed with excellent results.

Left main coronary thrombosis: unusual complication after radiofrequency ablation of left accessory atrioventricular pathway.

Radiofrequency ablation (RFA) has established itself as a first-line therapy for the curative treatment of many patients with supraventricular or atrioventricular tachycardias and has exhibited a generally low incidence of serious sequelae (N Engl J Med. 1991;324:1612; Lancet. 1991;337:1557).

Total absence of ST-segment resolution after failed thrombolysis is correlated with unfavorable short- and long-term outcomes despite successful rescue angioplasty.

Introduction: ST-segment resolution (STR) is a well-established and simple tool for assessing the efficacy of reperfusion therapy in myocardial infarction. An incomplete (<50%) STR is a recognized marker of failed thrombolysis and a suitable recruitment criterion for rescue angioplasty.

Objective: We sought to determine the predictive value of the total absence of STR after thrombolysis in rescue angioplasty (percutaneous coronary intervention [PCI]).

Myofibroblastic tumor of the right ventricle causing bilateral pulmonary embolism in a 31 year-old woman.

The myofibroblastic tumor (MFT) is a very rare tumor, initially described in the lungs, and which involves exceptionally the heart. We report the unusual case of a 31 year-old female patient, in whom the tumor produced a bilateral pulmonary embolism and whose unique clinical demonstration was a longstanding fever. The tumor, located in the right ventricle, has been surgically completely excised with excellent results.

[Short coupled variant of "torsades de pointes" and sudden death].

A case report of 38 year old man who experienced syncope and torsade de pointes is presented with the short coupled variant. The patient had a normal QT interval (QTC: 0.37 seconds) and multiform ventricular premature beats on the resting electrocardiogram.

[Results of coronary angioplasty in coronary bifurcation. Report of 61 cases].

These are the results of 61 bifurcations treated by percutaneous coronary angioplasty in 50 patients (41 males, 9 females) between 1998 and 2003. Bifurcation stenosis, dominated by type I of bifurcation classification. Global restenosis rate was 20% and didn't concern any case of kissing balloon.

[Use of an implantable defibrillator for the prevention of sudden death in hypertrophic cardiomyopathy].

Hypertrophic cardiomyopathy is an inherited muscle disorder disease. Sudden death is the most dreaded complication, risk stratification is of critical importance and patients with high risk should receive an implantable cardioverter defibrillator (ICD). We report the case of 26 years old man affected by a severe form of hypertrophic cardiomyopathy.

[Radiofrequency ablation of periatriotomy atrial flutter after interatrial defect surgical repair].

We report a successful ablation of reentrant atrial tachycardia complicating atrial septal defect repair. This tachyarrhythmia was poorly tolerated hemodynamically and difficult to control with antiarrhythmic drug therapy and atrial pacing. Ablation therapy has focused on extending a line of block from the surgical incision to the inferior veno cava.