Dyspnea in antiphospholipid syndrome: Beyond pulmonary embolism.

Pulmonary embolism due to primary antiphospholipid syndrome is rarely associated with chronic thromboembolic pulmonary hypertension, and therefore according to the latest guidelines on pulmonary hypertension, routine screening is not recommended. We describe a young patient with a late diagnosis of chronic thromboembolic pulmonary hypertension in the context of pulmonary embolism, primary antiphospholipid syndrome and suboptimal anticoagulation. Of note, mild cardiopulmonary symptoms were consistently misattributed to a depressive disorder because physical examination was normal, serial Doppler echocardiography failed to show pulmonary hypertension, and all other diagnostic tests were normal.

[Analysis of the Cochrane Review: Influenza Vaccines for Preventing Cardiovascular Disease. Cochrane Database Syst Rev. 2015;5:CD005050].

Influenza infections are associated to increased risk of cardiovascular events. The systematic review of Cochrane Collaboration evaluated the role of influenza vaccination on primary or secondary prevention of cardiovascular events. The meta-analysis of four randomized controlled trials with moderate quality, including 1 682 patients with coronary artery disease, showed a 55% risk reduction on cardiovascular mortality.

[Analysis of the Cochrane review: Anticoagulation versus placebo for heart failure in sinus rhythm. Cochrane Database Syst Rev. 2014;3:CD003336].

Thrombotic and embolic events contribute to the morbidity and mortality associated to Chronic Heart Failure (HF). Differently from patients with atrial fibrillation (AF) and HF, in which the benefit of anticoagulation is well documented, the use of these drugs in those with HF in sinus rhythm (without AF history) is controversial. In this systematic review from the Cochrane Collaboration, the authors evaluated the benefits and risks associated with oral anticoagulation (versus placebo) in this population.

Myocardial infarction in a patient with congenital coronary anomaly.

The authors describe the clinical case of a 38-year-old patient, with a history of smoking and hypercholesterolemia, who was admitted for non-Q wave acute myocardial infarction, and in whom coronary angiography revealed severe coronary disease and a congenital coronary anomaly. Unlike many congenital coronary anomalies that are manifested in ischemic disease, the nature of this patient's anomaly may have contributed to its benign clinical evolution, and influenced the therapeutic approach.