Articles

Dilated Cardiomyopathy and Severe Functional Valvular Regurgitation in a Young Adult with Prior Childhood Chemotherapy: Progressive Ventricular Dysfunction Despite Surgical Correction and Optimal Medical Therapy

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Background: Late cardiotoxicity is a recognized complication in survivors of childhood cancer treated with potentially cardiotoxic agents, particularly anthracyclines. These therapies may cause progressive myocardial injury through mechanisms involving oxidative stress, mitochondrial dysfunction, and cardiomyocyte apoptosis. Over time, this process can lead to ventricular remodeling, dilated cardiomyopathy, and heart failure. Advanced ventricular dilation frequently results in functional mitral and tricuspid regurgitation, further worsening hemodynamic burden and clinical outcomes.

Case summary: We report the case of a 42-year-old man with a history of non-Hodgkin lymphoma diagnosed in childhood and treated with chemotherapy, without subsequent cardiologic follow-up. From the age of 29, he developed progressive heart failure symptoms. Transthoracic echocardiography revealed severe functional mitral regurgitation with mixed mechanism (Carpentier type I due to annular dilation and type IIIa due to leaflet restriction) and massive tricuspid regurgitation, associated with severe atrial dilation, grade III diastolic dysfunction, and pulmonary hypertension. Left ventricular systolic dysfunction was documented with an ejection fraction of 36% and markedly reduced global longitudinal strain (−11%), consistent with non-ischemic dilated cardiomyopathy.

The patient underwent mitral valve replacement and tricuspid valve repair but developed intraoperative cardiac arrest and postoperative mixed shock. Persistent severe ventricular dysfunction (LVEF 26%, GLS −8%) and multiple complications were observed.

Conclusion: This case highlights the importance of long-term cardiovascular surveillance in childhood cancer survivors and the role of strain imaging in detecting chemotherapy-related cardiomyopathy.

Dilated Cardiomyopathy Following Total Thyroidectomy Complicated by Severe Mitral Regurgitation: A Case Report and Literature Review

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Cardiac dysfunction following thyroid and parathyroid surgery is rare but clinically significant. Hormonal disturbances, including iatrogenic hypothyroidism and calcium metabolism disorders, may adversely affect myocardial function and the mitral valve.

We report the case of a 56-year-old woman who underwent thyroidectomy and parathyroidectomy in 2024. One year later, after discontinuation of thyroid hormone replacement and calcium supplementation, she progressively developed dyspnea, peripheral edema, and heart failure. Transthoracic echocardiography revealed hypokinetic dilated cardiomyopathy (left ventricular ejection fraction [LVEF] 32%) associated with severe functional mitral regurgitation. Laboratory tests showed marked hypothyroidism (TSH 95 µIU/mL, free T4 2.39 pmol/L), hypocalcemia (total calcium 43 mg/L), and elevated NT-proBNP levels (7,850 ng/L).

Management combined guideline-directed medical therapy for heart failure, gradual thyroid hormone replacement, calcium supplementation, and discussion of potential surgical/valvular intervention. After six months of follow-up, a significant improvement in cardiac function and regression of mitral regurgitation were observed.

This case highlights the importance of cardiologic and endocrinologic surveillance after thyroid and parathyroid surgery. Early recognition of hormonal abnormalities and cardiac dysfunction is crucial to optimize management and improve prognosis.

Prevalence and Pattern of Thyrocardiac Disease among Patients with Hyperthyroidism in Ethiopia: A Systematic Review and Meta-Analysis

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Background: Thyrocardiac disease encompasses the spectrum of cardiovascular abnormalities that arise as complications of hyperthyroidism. Despite being clinically significant and potentially life-threatening, its burden in Ethiopia remains poorly defined.

Objective: To determine the pooled prevalence and pattern of thyrocardiac disease among hyperthyroid patients in Ethiopia.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches were carried out in PubMed, Google Scholar, AJOL, Hinari, Europe PMC, Cochrane library, and institutional repositories. Observational studies reporting cardiac outcomes in adults with hyperthyroidism in Ethiopia were included. Analysis was done using STATA version 17. Prevalence data were pooled using a random-effects model, and heterogeneity was assessed using the Cochrane Q and I² statistic.

Results: Seven studies with a total of 1,160 participants were included in the review. Sinus tachycardia (39.32%; 95% CI: 23.34%–55.31%), Heart failure (21.65%; 95% CI: 13.84–29.46%), and Pulmonary hypertension (19.43%; 95% CI: 6.78–32.09%) were the commonest presentations, while Dilated cardiomyopathy (12.35%; 95% CI: 6.16–18.53%) and Atrial fibrillation (16.27%; 95% CI: 12.17–20.38%) were the least common. Toxic multinodular goiter was the most common cause of hyperthyroidism among these patients accounting for 64.8% (95% CI: 53.2–75.3%).

Conclusion: Thyrocardiac disease is a frequent complication among hyperthyroid patients in Ethiopia, with sinus tachycardia and heart failure being the most common presentations. These findings highlight the importance of integrating routine cardiac evaluation into the clinical management of hyperthyroidism.

Response to DOAC Treatment in A Patient with Biventricular Thrombus Secondary to Heart Failure with Reduced LVEF of Ischemic Etiology

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Current evidence regarding the use of direct oral anticoagulants (DOACs) in the presence of left ventricular thrombus is primarily derived from observational studies with positive results in different meta-analyses that suggest a possible role for treatment.

We present the case of a 54-year-old female with a history of arterial hypertension and diabetes mellitus recently diagnosed, who came for medical evaluation due to deterioration of functional class. Electrocardiogram in sinus rhythm with anterior bundle branch block.

The Prevalence of Chest Infection in Patients with Heart Failure in Al-Wahadah Teaching Hospital, Dhamar, Yemen

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Background: Heart failure is a common clinical manifestation of most organic heart diseases that progress to the end stage. Patients with heart failure are often accompanied by secondary conditions such as pulmonary circulatory congestion and pulmonary edema, which can lead to dyspnea, gas exchange disorders, and other consequences, creating certain conditions for pathogens to invade and colonize the lungs. Therefore, patients with heart failure may have higher risk of pulmonary infection.

Aim: This study aimed to assess the prevalence of chest infection among patients with heart failure and to determine the characteristics of the patients with heart failure who had chest infection and the potential risk factors.

Methods: A retrospective, descriptive cross-sectional study was carried out at internal medicine department, Al-Wahdah Teaching Hospital,  Dhamar, Yemen over six months (June – December 2022). A total of 100 patients were enrolled in our study. A semi-structured questionnaire was designed and used for data collection.

Results: A total of 100 heart failure patients including 53 (53%) males, and 47 (47%) females were successfully enrolled in this study. The majority of participated patients were of age group 40 – 60 years (55%), and were of rural residence (83%). Chest infection was documented in approximately two-thirds of included patients (63%). Chest infection was documented in majority of patients who were smokers, Qat chewer, shamma intakes, being obese, had cardiomyopathy, as well as those patients who had dyspnea of NYHA class III & IV, orthopnea, PND, productive cough, high sputum amount, whitish sputum color, peripheral chest pain, fatigue, sweating, fever and  high WBC count, such associations were significant statistically.

Conclusion: This study revealed that, chest infection in heart failure patients was common with overall prevalence of (63%) among included patients this study was. Based on this, an early prevention and intervention measures should be taken to reduce pulmonary infections in patients with heart failure.