BACKGROUND Atrial myxomas are benign cardiac tumors that can embolize and cause arterio-occlusive complications associated with substantial morbidity and mortality. Recurrence after surgical resection is uncommon, and distant metastasis is exceedingly rare. We describe a young patient who concomitantly experienced 2 rare and serious manifestations of atrial myxoma: tumor recurrence after many years and cerebral metastasis. CASE REPORT A 33-year-old man with a history of left atrial myxoma resection at age 19 presented with sudden onset of right facial paresthesia and right arm weakness. Brain imaging revealed bilateral ischemic strokes in the middle cerebral artery territories, leading to suspicion of embolic etiology. Echocardiography confirmed recurrence of the left atrial myxoma; repeat surgical excision was necessary. Several months after surgery, the patient developed new neurologic symptoms. Brain magnetic resonance imaging demonstrated multifocal hemorrhagic lesions with associated vasogenic edema, suggesting metastatic disease. Surgical resection of a left frontal lesion revealed organizing hemorrhage with rare calretinin- and S100-positive cells, implying myxomatous origin. One year later, the patient underwent right parietal craniotomy and gamma knife radiosurgery; pathology confirmed myxomatous tissue intermixed with hemorrhagic and inflamed brain parenchyma. Follow-up echocardiography showed no intracardiac recurrence, indicating that cerebral seeding likely occurred before the second cardiac surgery. CONCLUSIONS This case highlights 2 rare complications of atrial myxoma in a single patient: delayed recurrence and cerebral metastasis. It underscores the need for long-term surveillance, even decades after initial resection, and the consideration of central nervous system metastatic disease in patients with neurologic symptoms and a history of cardiac myxoma.

Background: Despite guideline‐recommended routine screening and iron deficiency (ID) treatment among heart failure (HF) patients, these practices are often underutilized. Currently, limited data are available on the outcomes of pharmacists' programs to enhance ID screening and management. Accordingly, we sought to describe the frequency and yield of screening for ID and intravenous (IV) iron replacement rates among our cohort of HF patients and examined the impact of implementing a pharmacist‐led protocol (PLP) aimed at enhancing these rates.Methods: We conducted a retrospective study involving HF patients with left ventricular ejection fraction (LVEF) <45% at a quaternary care hospital in the Middle East/Gulf region. The PLP was introduced in August 2022. Data on demographics, comorbidities, echocardiographic parameters, laboratory findings (including ID screening and its findings), and rates of treatment with IV iron replacement were analyzed and compared between the pre‐implementation group (n = 432, October 2015–February 2020) and the post‐implementation group (n = 154, August 2022–January 2023).Results: Before the PLP, 63.2% (n = 273) of eligible patients underwent ID screening, with 80.6% (n = 220) found to have ID. Following the implementation of the PLP, screening rates significantly increased to 86.4% (n = 133) (p = 0.03), with 53.4% (n = 71) diagnosed with ID. The rate of IV iron replacement in ID patients improved from 30.4% (n = 67) in the pre‐PLP group to 73% (n = 52) in the post‐PLP group (p < 0.001). Multivariable logistic regression identified baseline glomerular filtration rate (GFR) and hemoglobin levels as significant predictors of IV iron replacement in the pre‐PLP cohort.Conclusions: Implementing a pharmacist‐led protocol was significantly associated with enhancing the screening and treatment of ID in patients with HF and LVEF <45%. This study demonstrates the crucial role of pharmacists in optimizing guideline‐directed therapies, which can be replicated in various healthcare settings.

An infectious aortic aneurysm is a rare disease entity. We report a challenging case of a 29-year-old male presenting with chest pain and constitutional symptoms. The patient was found to have three pseudoaneurysms of the aorta on imaging, significant pathological findings of necrotizing granulomatous lymphadenitis from a supraclavicular lymph node biopsy, and a highly suggestive clinical picture of tuberculous aortitis. He was referred to vascular surgery for intervention and discharged on antituberculous therapy for 6 months. To the best of our knowledge, only five cases of tuberculous aortic aneurysms have been reported from the Middle East and North Africa (MENA) region, all with favorable outcomes. A high index of suspicion, early detection, and prompt intervention are essential in managing such cases.

1.0 Hypertension is a pervasive and modifiable risk factor for cardiovascular disease, stroke, and mortality, particularly among the elderly population (1). As the global demographic shifts toward ...

Background: Treprostinil has demonstrated effectiveness in treating Pulmonary Arterial Hypertension (PAH) and Pulmonary Hypertension associated with Interstitial Lung Disease (PH-ILD). However, tolerability remains a clinical challenge. Identifying factors influencing tolerability is important, given the adverse outcomes of PAH and PH-ILD and the potential of treprostinil to slow disease progression. Objective: This study was undertaken to identify tolerance factors and develop a predictive scoring system. Methods: A retrospective analysis of 65 patients (37 PAH, 28 PH-ILD) was conducted using patient history, pulmonary function tests (PFTs), transthoracic echocardiograms (TTEs), and right heart catheterizations (RHCs). Of these, 67.7% (n = 44) tolerated treprostinil, while 32.3% (n = 21) were intolerant. Results: Patients who tolerated treprostinil had better pulmonary function, with a higher forced expiratory volume in one second/forced vital capacity (FEV₁/FVC) ratio (82.27 ± 16.06 vs. 72.86 ± 17.76, p = 0.037) and superior right ventricular function, as indicated by higher tricuspid annular plane systolic excursion (TAPSE: 2.05 ± 0.37 vs. 1.64 ± 0.42, p < 0.001), higher cardiac index (CI: 2.51 ± 0.67 vs. 2.03 ± 0.53, p = 0.003), and improved functional status (p < 0.001). The Inhaled Treprostinil Intolerance Score (ITIS), incorporating TAPSE < 1.6, CI < 2, FEV₁/FVC < 70%, and WHO functional class (FC) 3 or 4, demonstrated strong predictive accuracy (cutoff ≥ 2, AUC = 0.884 ± 0.048, p < 0.001). Predictive performance was stronger in PAH patients (AUC = 0.921 ± 0.053) than PH-ILD (AUC = 0.833 ± 0.093, p < 0.001). Conclusions: These findings demonstrate the importance of clinical parameters in predicting treprostinil tolerance. Further investigation is warranted to refine the scoring system, particularly for PH-ILD patients.

Manla Y, et al. Int J Heart Fail. 2024 Jul;6(3):137-139. https://doi.org/10.36628/ijhf.2023.0065