AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 58 Submission ID: 1090 SURVIVING COMPLICATED STEMI: A 41-DAY JOURNEY Aiman GHRAB, Zine Elabidine Ben Ali, Ali khorchani, ridha fekih, ala eddine dali, amine bahloul, wiem feki, Sami MILOUCHI habib bourguiba university hospital of medenine, Tunisia. Hedi Chaker Unversity Hospital of Sfax Introduction: Myocardial infarction related mechanical complication is a rare event nowadays thanks to early revascularisation. We describe a series of complications that happened in the same patient. Case summary: Sixty-five-year-old male with multiple cardiovascular risk factors: age, sex, and smoking. He had a delayed presentation of STsegment elevation myocardial infarction: arrived 12 hours after pain onset to the emergency department rapidly complicated by a cardiac arrest. His electrocardiogram was in normal sinus rhythm, with the presence of Q wave and persistent ST segment elevation in the anterior leads. Urgent Coronary angiogram showed proximal left anterior descending artery occlusion treated with direct stenting. A TIMI 3 flow was restored. A transthoracic echocardiogram showed a severely depressed left ventricular ejection fraction, and it was estimated at 20%, spontaneous contrast was present accompanying an apical thrombus. At the time, a mild pericardial effusion was present. Two days later, the patient developed hemodynamic instability, a transthoracic echocardiogram showed a significant cardiac effusion with heart collapse indicating urgent pericardiocentesis. It was a bloody pericardial effusion. Cardiac MRI showed a small free wall rupture adjacent to the apical thrombus. The thrombus was occluding the rupture stopping intrapericardial bleeding. Anticoagulation was stopped for four days and reintroduced after an important increase in the thrombus size with strict surveillance after discussing it with the heart team. The treatment was well tolerated, and the patient was discharged after 41 days. He received triple antithrombotic therapy for a month: vitamin K antagonist, aspirin and clopidogrel. He also received ACE inhibitors, betablockers, aldosterone inhibitor and furosemide. Transthoracic echocardiogram before discharge, showed a regression of apical thrombus. No pericardial effusion was effusion. Conclusion: Managing mechanical complication of myocardial infarction can be very challenging and needs a good clinical judgement since there is not a codified management strategy specially in associated forms. Submission ID: 1107 SUDDEN CARDIAC DEATH DUE TO TAKOTSUBO SYNDROM AFTER POLICE POURSUIT A FORENSIC CASE REPORT Asma Azouz, Said Saadi, Meriem Grayaa, SamiBen Jomaa, Achraf Hadroug, Nidhal Haj Salem DEPARTMENT OF FORENSIC MEDICINE OF MONASTIR, Tunisia Introduction: Tako-Tsubo stress cardiomyopathy (TS) mimics coronary syndrome acute and is defined by a reversible astonishment of the myocardium, occurring on more often after stress. It could be responsible for sudden cardiac death. In this work, we report a case of sudden death in an adult female of cardiac origin related to tako-tsubo syndrome and medico-legal implications. Observation: A 32-year-old woman suddenly lost consciousness then suffered a cardiovascular arrest during a police chase. She is previously known to be healthy. The cardiovascular risk factors that this patient had are alcoholism, and active smoking. A forensic autopsy was performed. It did not show any traumatic injuries explaining death. During autopsy, the heart, weighing 237g, had a globular tip,. The examination of the valves and coronary arteries was without abnormalities. Lungs, weighted 430g each, were congestive. The myocardium was homogeneous with a slight asymmetry at the level of the postero-septal wall of the left ventricle. A troponin I test was performed on peripheral blood and pericardial fluid. Troponin I was high in both peripheral blood and pericardial fluid at 6675 ug/l and 11255 ug/ respectively. Fragments of organs, eventually the myocardium were sent for pathological examination. It had only shown vascular congestion associated in places with alveolar edema in the lungs. Conclusion: TS is triggered by emotional or physical stress, but it is relatively unknown in the forensic literature. The occurrence of TS has often been described after physical or emotional stress. Finally, although TS represents a usually reversible heart failure syndrom the major cardiac adverse events is sudden death. The discussion of the accountability of the stressful event is necessary in this case; engaging the responsibility of the authority in the occurrence of this sudden cardiac death. MODERATED POSTER SESSION 4 among women. Many studies have reported worse results in women after STEMI. Many factors, including age and co-morbidities, particularly diabetes mellitus, and renal failure, may contribute to excess mortality women after STEMI. In this study we aimed to analyze the clinical profile of Tunisian female patients presenting for STEMI. Methods: In our study, we investigated retrospectively a total of 111 female patients collected within the cardiology department at the “Mongi Slim” university hospital in Tunisia, for a period of 3 years, between January 1, 2016 and January 31, 2019, hospitalized in the acute phase (within the first 24 hours) of an acute coronary syndrome with ST segment elevation and all treated with urgent primary angioplasty. Results: Our analysis showed that among of these 111 female Tunisian patients, 69 patients (62,16%) were known as having diabetes mellitus. It was non-insulin-dependent (type II) diabetes mellitus in 60,3% of cases and 52,2% were not insulin requiring. Hypertension was noted in 60 patients (54,05%) and it was more frequent in elderly patients (75% in those over 75 years old versus 59,1% in those under 75 years old). Dyslipidemia was found in 44 patients (39.6%), it was hypercholesterolemia in 23.4% of cases, a mixed dyslipidemia in 11.7% of cases and isolated hypertriglyceridemia in 4.5% of cases. Renal failure was found in 21 patients (18,.91%). The notion of early familial coronary artery disease was noted in 8 patients only (7.2%). Smoking was found in 21.6% of patients. Its incidence was more significant in patients less than 50 years old, 92.6% versus. 65.5% in those over 50 (p <0.0001). Conclusion: As shown in our study, diabetes mellitus, hypertension, dyslipidemia, smoking cigarettes and renal failure are the major cardiovascular risk factors on which we must act early in order to prevent the occurrence of major cardiovascular events.
RkJQdWJsaXNoZXIy NDIzNzc=