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Hypertension complicates 6-8% of pregnancies and includes the following four conditions: hypertension preceding pregnancy or documented before the 20th week of gestation; pre-eclampsia (PE)/eclampsia; chronic hypertension with superimposed pre-eclampsia; and gestational hypertension. The latter is defined as a significant rise in blood pressure after the 20th week of pregnancy in previously normotensive women, to over 140/90 mmHg. When blood pressure remains above 160/110 mmHg, it is considered severe. PE is defined as the presence of proteinuria (> or = 300 mg/24 h) in pregnant women with hypertension. The hypertensive syndromes of pregnancy are among the leading causes of maternal and fetal morbidity and mortality and anti-hypertensive treatment is part of the therapeutic arsenal used to prevent serious complications. Although the role of utero-placental insufficiency due to deficient migration of trophoblasts to the spiral arteries is universally accepted, the pathophysiology of PE remains largely unknown and is the subject of debate. No effective ways of predicting or preventing PE have been found, which highlights the need for further research in this field. This review aims primarily to evaluate recent advances in our understanding of the pathophysiology of gestational hypertension and especially PE, and new ways of predicting PE. Additionally, we present a brief review on the diagnosis, prevention and treatment of PE.

The authors present a case of systemic amyloidosis with cardiac involvement. We discuss the need for a high level of suspicion to establish a diagnosis, diagnostic techniques and treatment options. Our patient was a 78-year-old man with chronic renal disease and atrial fibrillation admitted with acute decompensated heart failure of unknown cause. The transthoracic echocardiogram revealed severely impaired left ventricular function with phenotypic overlap between hypertrophic and restrictive cardiomyopathy. After an extensive diagnostic workup, which included an abdominal fat pad biopsy, the final diagnosis was amyloidosis.

DESCRIPTIONA 53-year-old woman with a known history of hypertension and hypercholesterolaemia, under oral contraception, was admitted to the neurology department due to a lacunar stroke. She presented with a right motor deficit and dysarthria, and recovered in 48 h. The cranial CT scan did not identify acute lesions. The ECG showed sinus rhythm. A transthoracic echocardiography was performed and no significant changes were found. On further evaluation, a transoesophageal echocardiography revealed an oval and pedunculated mass, with welldefined limits, measuring 1.3×1.1 cm, with a 0.2 cm peduncle adherent to the left atrium wall, between the left atrial appendage (LAA) and the upper left pulmonary vein (figure 1). This was highly mobile and very distensible, protruding to the LAA during atrial systole. The hypotheses of an intracardiac thrombus and tumour were placed. Oral anticoagulation was started and the patient underwent cardiac MRI (figure 2). This allowed tissue characterisation of the mass: intermediate signal intensity on T1-weighted and higher signal intensity on T2-weighted sequences (with and without fat suppression), with an intense gadolinium enhancement, excluding thrombus and suggesting myxoma. Owing to its embolic potential, the patient underwent surgical excision of the mass, due to its embolic potential, and the histological evaluation confirmed the diagnosis of atrial myxoma.Primary cardiac tumours are rare (0.05%). 1Atrial myxoma is the most common cardiac tumour (50%), most frequently located in the left atrium (75%), usually attached to the left atrial septum around the fossa ovalis. [1][2][3] In 5% of cases myxoma may be located in the LAA. 1Learning points ▸ This case draws attention to an unusual location for atrial myxoma, which led to confusion with thrombus, challenging the differential diagnosis and the therapeutic approach. ▸ It also highlights the value of transoesophageal echocardiography in studying stroke aetiology at younger age, even when cardiovascular risk factors are present and the transthoracic echocardiography is normal. ▸ MRI was crucial in differential diagnosis by allowing tissue characterisation of the mass.