Methaemoglobin is a form of haemoglobin in which the ferrous (Fe) ion contained in the iron-porphyrin complex of haem is oxidised to its ferric (Fe) state. Methaemoglobinaemia, the presence of methaemoglobin in the blood, is most commonly treated with methylene blue. However, methylene blue cannot be used in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency as it is ineffective in such patients and it can worsen G6PD deficiency haemolysis. We report the case of a 30-year-old man who presented with clinical features of G6PD deficiency-associated haemolysis and was found to have severe methaemoglobinaemia (35%). He was administered blood transfusions and intravenous ascorbic acid. His methaemoglobinaemia resolved within 24 hours. This case demonstrates the successful management of a patient with severe methaemoglobinaemia in the setting of G6PD deficiency haemolysis. Emergency physicians should be aware of the possible co-occurrence of severe methaemoglobinaemia in a patient with G6PD deficiency haemolysis.

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Introduction: Left ventricular thrombus (LVT) is a well-established risk for ischemic stroke. Nevertheless, it remains uncertain if percutaneous coronary intervention (PCI) in the setting of LVT further augments the risk of stroke. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing PCI. Methods: This retrospective observational cohort study included the patients admitted with LVT to Heart Hospital in Qatar between April 1, 2015 and March 31, 2020. The study population was divided into two groups: (1) patients with LVT who underwent PCI; (2) patients with LVT who did not undergo PCI. The primary outcome evaluated was stroke during the index admission, and the secondary outcomes were in-hospital mortality, all-cause mortality, and stroke at 12 months post discharge. Logistic regression was used to determine the risk of stroke associated with PCI among patients with LVT. A p<0.05 indicated statistical significance. Results: Of the 210 patients included, 119 underwent PCI, while 91 patients did not undergo PCI. Most of the patients were Asian (67%), male (96%) with a mean age of 56 yearsIschemic cardiomyopathy was the main etiology of LVT in both groups (96% in the PCI group and 80% in non-PCI group). Around 70% of the patients in the PCI group underwent intervention to the left anterior descending artery. During the index admission, stroke among patients with LVT did not differ between the PCI and non-PCI groups (5% versus 3.3%; odds ratio (OR) 1.6, 95% confidence interval (CI) 0.34-6.4, p=0.539; adjusted OR 0.9, 95% CI 0.09-10.6, p=0.968. Similarly, in-hospital mortality, all-cause mortality, and stroke at 12 months did not differ between the study groups. Conclusion: Performing PCI among patients with LVT was not associated with increased risk of stroke during admission or at 12 months in comparison to patients who did not undergo PCI, which may reassure cardiologists to safely perform PCI among patients with LVT and defer delaying the procedure among patients with acute coronary syndrome due to presumed risk of stroke.

Introduction Post-ST elevation myocardial infarction (STEMI) course can be complicated with mitral regurgitation (MR) which has significant impact on in-patient outcomes and post-discharge course. MR in the setting of STEMI can be due to left ventricular dilatation, papillary muscle rupture or chordal rupture. Purpose In this retrospective study, we aimed to evaluate the impact of MR on readmission within one year after percutaneous coronary intervention (PCI) in STEMI patients. Methods We conducted a single-center retrospective observation cohort study. We included all patients admitted to the hospital with diagnosis of STEMI, underwent PCI during the same admission (index admission) and discharged alive in the period between Jan 1st, 2016 and Sep 30th, 2018. Factors associated with readmission due to heart failure within 1 year of discharge were evaluated using multivariate logistic regression and results were reported as odds ratio (OR) with p-value &lt;0.05 indicating statistical significance. Results A total of 1257 patients were included in our retrospective analysis. The mean age of the study population was 51±10 years. Around 16% (n=206) of the study population had mitral regurgitation (MR) during their admission for STEMI. Among them, 195 patients had newly discovered MR. MR severity was mild in 196 (95%) patients with MR. Unplanned readmission due to cardiac reasons within 1 year of discharge occurred in 103 (8.2%) patients. Among them, 37 (3%) were readmitted due to heart failure. MR was found to increase the likelihood of readmission due to heart failure within one year after PCI among patients with STEMI by three times (aOR=3.13, 95% CI 1.39–7.03; p-value 0.006). As demonstrated in table 1, other positive predictors for readmission due to heart failure were female gender (aOR=3.80, 95% CI 1.22–11.86; p-value 0.021), chronic kidney disease (aOR=4.56, 95% CI 1.22–17.03; p-value 0.024), and clinical heart failure during the index admission (aOR=4.82, 95% CI 1.53–15.15; p-value 0.007). Interestingly, reduced left ventricular ejection fraction was not a significant predictor of heart failure readmission. Conclusion Mitral regurgitation is relatively common in STEMI and most frequently presents with mild severity. In our study, MR was found to be a strong predictor for readmission due to heart failure within one year after PCI among patients with STEMI, which may warrant frequent follow-up for these patients and proper initiation of and titration of guideline-directed medical therapy (GDMT). Funding Acknowledgement Type of funding sources: None.