Table of Contents

Letter to the Editor

The History of Cardiac Services and the Establishment of a Dedicated Cardiac Centre in the Kingdom of Bahrain

Resan H Al-Badran1*

Pages: 1-4

The Rise of Lung Ultrasound in the Era of COVID-19

Shailendra Kumar Motwani1, Helen Saunders2*

Pages: 5-8
  • Abstract
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  • The current global pandemic caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) presents a huge challenge for physicians. Rapid diagnosis, triage and clinical management of these patients is a challenge for physicians but may be aided using lung ultrasound. Lung ultrasound has been in use for over 10 years mainly by critical care practitioners and emergency physicians with variable uptake, but it has gained popularity during the Coronavirus disease-2019 (COVID-19) pandemic as a diagnostic tool and can be easily learned compared to the other ultrasound techniques. Image interpretation is based on identifying artefacts generated by the pleural surface. This technique is non-invasive and can be performed rapidly at the patient’s bedside. It has higher accuracy in diagnosis than auscultation and Chest X-ray (CXR) combined. In this article the authors describe the interpretation of lung ultrasound images, particularly in patients with COVID-19 and discuss indications for this technique. Physicians are recommended to gain familiarity with this technique and use of online resources for guidance.

    Keywords: COVID-19, Lung, SARS-COV-2, Ultrasonography, Triage.

Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Centre: The Centre of Excellence for Electrophysiology

Adel Khalifa Sultan Hamad*

Pages: 9-11

Original Articles

Referral patterns and Outcome of Children with Perceived Arrhythmia to a Tertiary Cardiac Service

Suad R Al Amer1, Abhinav Agarwal2*, Vimalarani Arulselvam3, Abdulla Faisal Alshaiji4, Neale Nicola Kalis5

Pages: 12-18
  • Abstract
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  • Background & Objectives: Arrhythmias are common in pediatric population and is suspected in patients presenting with palpitations and/or syncope. These patients are commonly referred to Pediatric Cardiology for further evaluation either after identifying rhythm abnormality or based on clinical suspicion only. The objective of this study was to assess the yield of pediatric cardiology referrals for arrhythmia evaluation.

    Methods: This is a single-center retrospective observational descriptive study. A total of 486 patients referred to the pediatric cardiology department from the year 1998 to 2020 were included. Patients were grouped based on referral, Group 1 consisted of patients referred with documented arrhythmia and Group 2 had patients referred on clinical suspicion. Patient’s age at presentation, gender, reason for referral, type of arrhythmias, any associated structural heart disease, interventions, and outcomes were analysed.

    Results: Group 1 had 156 (32.1%) patients and group 2 had 330 (67.9%) patients. The most common diagnosis in group 1 was atrioventricular re-entry tachycardia and in group 2 was premature ventricular contractions. There was no variability for the type of arrhythmia between the two groups. Among patients in group 2, 315 (95.4%) had no evidence of electrophysiological abnormalities. Positivity rates for arrhythmia were only 3.2% for palpitations and 9% for syncope. 28 (5.8 %) patients required interventions; all from group 1.

    Conclusion: Clinically significant arrhythmias were mostly diagnosed at the point of first contact. Patients referred on clinical suspicion were mostly normal electro-physiologically. Inappropriate referrals increase the workload on pediatric cardiology services. There is an urgent need to regularise referrals.

    Keywords: Cardiac arrhythmia, Heart diseases, Referral and consultation, Syncope, Tachycardia

Case Reports

A Case Series of Direct Oral Anticoagulants Use in Post-Infarction Left Ventricular Thrombus

Tarique S. Chachar1, Nooraldaem Yousif2, Khurshid Ahmed3, Tajammul Hussain4, Haitham Amin5*

Pages: 19-23
  • Abstract
  • Full-Text PDF
  • Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI). Vitamin K antagonists such as Warfarin showed a reduction in associated mortality and morbidity and are indicated as anticoagulants of choice in current guidelines. Since their approval for clinical use, there has been a dramatic increase in off-label use of direct oral anti-coagulants (DOAC) for LVT. In this case series, the authors share their successful experience with DOAC in the treatment of LVT.

    Keywords: Anti-coagulants, Heart diseases, Heart ventricles, Myocardial infarction, Thrombosis

Hypertrophic Cardiomyopathy and Arrhythmias as Phenotype Spectrum of Emery Dreifuss Muscular Dystrophy: First Case Report in Bahrain

Mary Lynch1*, Vinayak Vadgaonkar2, Rajesh Jayakumar3, Cristina Skrypnyk4

Pages: 24-28
  • Abstract
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  • Muscular dystrophies are a heterogeneous group of inherited disorders characterized by progressive wasting and weakness of the skeletal muscles. The clinical spectrum ranges from early presentation with severe clinical features in childhood to onset in adulthood with less severe clinical symptoms and slow progression. This frequently raises difficulties in diagnosis. The predominant features may be cardiac, and this may lead to a complex diagnosis. Emery Driefuss Muscular dystrophy (EDMD) is a rare form of limb girdle muscular dystrophy. The prevalence is less than 1:100,000 individuals. The condition may be associated with significant muscular cardiac abnormalities which is responsible for mortality in these patients. The authors describe a case of hypertrophic cardiomyopathy in which limb girdle muscular dystrophy was suspected and subsequently confirmed by genetic studies as part of the phenotypic spectrum of Xlinked EDMD. This is the first diagnosed case of EDMD in Bahrain.

    Keywords: Bahrain, Hypertrophic Cardiomyopathy, Limb-girdle muscular dystrophies, Muscular dystrophies, Skeletal muscles

Acute Myopericarditis in a Pediatric Patient after First Dose of Pfizer BioNTech COVID - 19 Vaccination: First Case Report in the Kingdom of Bahrain

Ghada Al Qassim1 , Vimalarani Arulselvam2, Suad R Al Amer3, Salah Al Ghanem4, Neale Nicola Kalis5

Pages: 29-32
  • Abstract
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  • Coronavirus disease 201 9 (COVID - 1 9 ) vaccination for children over 12 years of age began on May 2021 in the kingdom of Bahrain. Very limited data is available regarding the adverse events related to COVID -19 vaccination in children. This is a case report of a 12-year-old previously healthy boy with acute myopericarditis who presented on day 5 after the first dose of Pfizer COVID - 19 vaccination. Other causes of acute myopericarditis were ruled out. He was treated with non - steroidal anti-inflammatory drugs and recovered fully. This case of vaccine-induced myocarditis was reported to the national task force of Bahrain for combating COVID - 19.

    Keywords: Pfizer-BioNTech, COVID-19 vaccine, mRNA vaccine, Myocarditis, Pericarditis, Troponin I

Apical Hypertrophic Cardiomyopathy With Aneurysm Formation: Potential For Underdiagnosis And Value Of Contrast Echocardiography

Vinayak Vadgaonkar1, Suddharsan Subbramaniyam2, Nooraldaem Yousif3, Sadananda Shivappa4, Fuad Abdulqader5, Leena Sulaibikh6*

Pages: 33-37
  • Abstract
  • Full-Text PDF
  • Apical hypertrophic cardiomyopathy (Apical HCM) with apical aneurysm formation is a relatively rare variant of hypertrophic cardiomyopathy. In this case report, the authors share their experience in the diagnosis of this challenging case, in view of the rarity of such peculiar clinical condition accompanied with a variable presentation and clinical course that render the diagnosis of this high-risk HCM phenotype commonly delayed or missed.

    Keywords: Cardiomyopathy, Contrast Media, Echocardiography, Heart Aneurysm, Hypertrophic

Congenital kinking of aorta – A rare aortic arch anomaly

Suad Rashid Al Amer1, Vimalarani Arulselvam2*, Rajesh Jayakumar3, Abhinav Agarwal4, Neale Nicola Kalis5

Pages: 38-42
  • Abstract
  • Full-Text PDF
  • Congenital kinking of aorta or pseudocoarctation is a rare anomaly of the aortic arch with elongation and kinking of aorta at the level of ligamentum arteriosum. This anomaly is not a true coarctation as there is no significant hemodynamic obstruction or pressure gradient across the lesion. We report two cases with this anomaly diagnosed during the evaluation for incidental finding of murmur. Both patients had flow gradient across the kinked segment of aorta by echocardiography but did not require any intervention. Long term complication is aneurysmal dilatation and rupture beyond the kinked segment. Computed tomography of the aorta is a simple noninvasive diagnostic modality for the definitive diagnosis. Surgical repair should be performed for all symptomatic individuals. Regular periodic follow up is mandatory for all asymptomatic patients.

    Keywords: Aortic arch syndromes, Aortic coarctation, Congenital heart defects, Echocardiography, Thoracic aorta