The case is reported of a 30-year-old multigravida, with insignificant history and stable vital signs, admitted to the labour room for normal vaginal delivery of twins. She received combined spinal epidural analgesia (bupivacaine plus fentanyl) for 3 h. Following uneventful delivery she received 0.2 mg methylergonovine maleate, intramuscularly. Nausea and vomiting occurred 70 min after placenta delivery, heart rate decreased, arterial blood pressure increased and there was chest pain. After excluding cardiac ischaemia, 0.5 mg atropine sulphate was administered intravenously. Chest pain improved but heart rate and blood pressure increased more than expected. The patient had mild headache and nausea, and antiemetic 4 mg ondansetron was given intravenously. Continuous monitoring for 4 h showed spontaneous chest pain relief and blood pressure improvement. In conclusion, serious delayed side-effects arising from methylergonovine maleate can occur in young, normal patients and close monitoring is required. Intravenous atropine sulphate following methylergonovine maleate administration may lead to severe hypertension and tachycardia.

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation. The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and evaluation of rheumatic diseases and permits optimal management in daily practice.

Nonalcoholic liver disease is a global public health problem that increases cardiovascular morbidity and mortality in these patients. This paper discusses endothelial dysfunction among patients (adolescents and young adults) with nonalcoholic liver disease. On the one hand, evidence suggests that cardiovascular disease is the leading cause of mortality in patients with advanced nonalcoholic liver disease and that nonalcoholic fatty liver is associated with an increased risk of cardiovascular disease independent of the presence of cardiovascular risk factors and metabolic syndrome components. On the other hand, nonalcoholic liver disease, especially the non-inflammatory form of nonalcoholic steatohepatitis, may not only be a marker of cardiovascular damage but also a factor involved in its pathogenesis. Such patients are candidates not only for the treatment of liver disease but also for the early treatment of cardiovascular risk factors because many of them, especially those with severe nonalcoholic liver disease, will develop major cardiovascular events and may eventually die of cardiovascular disease before the advanced liver disease occurs.

Psychosocial and work stress, socioeconomic status, and environmental health directly impact the onset and progression of cardiovascular diseases, irrespective of sex or conventional cardiovascular risk factors (cCRFs). On the other hand, the impact of cCRFs on health-related quality of life (HRQoL) is not well known, and the psychological socioeconomic environmental somatic health interaction is often neglected. Accordingly, we aimed to: (i) compare the self-reported HRQoL using the WHOQOL-BREF questionnaire between healthy subjects and those with cCRFs; and (ii) evaluate the interplay between HRQoL, cCRFs, and cardiovascular treatment adherence. We prospectively included 90 working adults (46 healthy and 44 with cCRFs age- and sex-matched adults) evaluated by clinical examination, 12-leads electrocardiography, and transthoracic echocardiography as part of a cardiovascular diseases screening program, that also filled in the WHOQOL-BREF questionnaire. Subjects with CRFs were less satisfied with their own individual health. The presence and the number of CRFs, as well as the need for cardiovascular treatment and the number of drugs taken correlated with reduced scores at the majority of HRQoL domains. The results in the social relationships domain were the best predictor of cardiovascular treatment adherence. Finally, the results of all HRQoL domains were strongly correlated to each other demonstrating the psychological socioeconomic environmental somatic health interaction.

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