Effects of early ivabradine therapy in patients with acute heart failure: A meta-analysis and systematic review

BACKGROUND: Although ivabradine is the agent of choice for reducing heart rate, its use in acute heart failure patients remains unclear. OBJECTIVES: To evaluate the potential of in-hospital ivabradine administration in reducing heart rate, the risk of rehospitalization, mortality, and clinical profile in acute heart failure patients using a meta-analysis approach. METHODS: The study was designed as a meta-analysis conducted from August to September 2024. We selected several database sources for the search strategy, including PubMed, Google Scholar, ProQuest, British Medical Journal, and American Journal of Cardiology. Data on the outcomes of ivabradine treatment compared to standard therapy were collected to determine cumulative point estimates. For statistical analysis, we used the Mantel–Haenszel test for categorical data or inverse variance for continuous data. RESULTS: We included 11 articles in the study. Our findings indicated that, in comparison to the standard therapy group, the ivabradine group was associated with improvements in resting heart rate, a reduction in the risk of rehospitalization, a decrease in cardiovascular mortality, a reduction in all-cause mortality, a shorter length of stay, improvements in New York Heart Association (NYHA) classification, better Left Ventricular Ejection Fraction (LVEF), and improved B-type Natriuretic Peptide (BNP) / N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels. CONCLUSION: In conclusion, this study has revealed the beneficial effects of using ivabradine for the treatment of acute heart failure.  TRANSLATE with x English Arabic Hebrew Polish Bulgarian Hindi Portuguese Catalan Hmong Daw Romanian Chinese Simplified Hungarian Russian Chinese Traditional Indonesian Slovak Czech Italian Slovenian Danish Japanese Spanish Dutch Klingon Swedish English Korean Thai Estonian Latvian Turkish Finnish Lithuanian Ukrainian French Malay Urdu German Maltese Vietnamese Greek Norwegian Welsh Haitian Creole Persian     TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Bac

The relationship between atrial myopathy with and without atrial fibrillation to cryptogenic stroke

Background: Ischemic stroke is the second most common cause of mortality globally, with some cases classified as cryptogenic strokes (CS) where the cause is unknown. Traditionally, atrial fibrillation (AF) has been considered the primary cause of ischemic stroke, but recent clinical trials and the occurrence of CS have led to the concept of atrial myopathy (AM). AM not only serves as a substrate for AF, promoting thrombus formation, but also causes blood stasis in the atrium, resulting in stroke without AF. Objective: The relationship between AM with and without AF to CS incidences at Saiful Anwar Hospital, Malang was evaluated in this study. Methods: Retrospectively analyzed medical records of patients from January 2023 to December 2024. Univariate analysis for baseline characteristic, bivariate analysis with Chi square, t-test and Mann Whitney u-test and multivariate analysis for predictive model using logistic regression were used for determine the relationship among variable in this study. Result: 112 patients were included in this study. AM has a statistically significant (OR 31.762, 95% CI: 3.965-254.427, p=0.001) as a predictor of CS, but AF did not (OR: 1.666, 95% CI: 0.414-6.707, p=0.473). A better predictive value was achieved with CHA2DS2-VASC ≥2 combined with AM (OR 7.948, 95% CI: 2.628-24.034, p<0.001), compared with CHA2DS2-VASC ≥2 alone (OR 1.909, 95% CI: 0.651-5.598, p=0.239) or CHA2DS2-VASC ≥2 combined with AF and AM (OR 3.600, 95% CI: 0.985-13.159, p=0.050). Conclusion: Atrial myopathy with and without atrial fibrillation had association to increasing the risk of cryptogenic stroke. Combining AM with the CHA2DS2-VASC score can improve stroke cryptogenic risk predictio

Rapid heparinization as a decisive strategy for acute upper limb ischemia: a case report

Background: Acute upper limb ischemia is a rare clinical presentation of thromboembolism, mostly known in patients with atrial fibrillation. Both conservative and surgical procedures are available as alternatives to therapy. In this case report, a patient who had been diagnosed with acute upper limb ischemia received immediate heparin administration in order to protect the upper limb and restore its functional capabilities. Case Illustration: A 60-year-old male presented with acute pain and numbness, along with bluishness and a cold sensation in the right hand. He has unrestricted arm mobility. The patient has a medical background of atrial fibrillation for over 11 years. The right hand exhibited reduced peripheral saturation, pulselessness, pain, pallor, and poikilothermy, but neither paresthesia nor paralysis. Duplex ultrasonography showed no detectable blood flow from the right brachial artery up to the distal arteries. However, the vein remained audible. The patient received heparinization immediately. Conclusion: Immediate identification and administration of heparin in instances of acute upper limb ischemia (AULI) are crucial for achieving favorable outcomes and a good prognosis. Continued treatment with anticoagulants is necessary for the therapeutic intervention in order to enhance limb preservation, minimize complications, and ensure patients have an excellent quality of life subsequent to conservative treatment

Periodontitis and venous thromboembolism risk: Investigating the connection through a systematic review and meta-analysis

BACKGROUND: The relationship between periodontitis and venous thromboembolism (VTE) remains controversial. Some studies show an association, while others do not show an association between periodontitis and VTE. OBJECTIVES: This study aims to determine the relationship between periodontitis and the risk of VTE using a meta-analysis approach. METHODS: A meta-analysis study, registered in PROSPERO, was conducted from August to September 2024. The sources for article searches in this study were Scopus, Embase, and PubMed. Data on the proportion of VTE occurrences in the periodontitis and non-periodontitis groups were collected from each article, and pooled point estimates were calculated using the Mantel-Haenszel test. RESULTS: We identified 40,397 VTE cases and 2,215,063 controls from six articles. Among these six articles, three showed an association between periodontitis and an increased risk of VTE. Additionally, we identified one article reporting that periodontitis was associated with a decreased risk of VTE. Furthermore, two articles revealed that periodontitis had no association with VTE occurrence. Our calculations using the Mantel-Haenszel test showed that, overall, an increased risk of VTE was found in individuals with periodontitis compared to those without (RR: 1.61; 95% CI: 1.09 – 2.39; Egger\u27s p: 0.7917; Heterogeneity p: <0.0001; p: 0.0200). CONCLUSION: We have identified that periodontitis is an important factor in the occurrence of VTE

Analysis of activated clotting time in patients receiving unfractionated heparin with and without continuous infusion during elective percutaneous coronary intervention

  Background: Percutaneous coronary intervention (PCI) involves a risk of thrombotic events. Unfractionated heparin (UFH) remains a preferred antithrombotic agent during PCI, though the optimal administration method is still under debate. Given its narrow therapeutic range, UFH requires careful monitoring through the measurement of activated clotting time (ACT) Objective: The aim is to compare ACT value and the outcomes of administering a bolus of UFH at 70–100 IU/kgBW, with and without a continuous infusion of 2000 IU/hour Methods: An observational retrospective study was conducted on 133 patients who underwent elective PCI by meeting the inclusion and exclusion criteria during the period of July 2022–July 2024. Clinical information, ACT value and the outcome were gathered from medical records. Statistical analyses were performed using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations. Result: The range of ACT results of administering an UFH bolus of 70-100 IU/kgBW with continuous infusion 2000 IU/hour was 191 to 426 seconds (mean 281.9 seconds). Among the 44 patients, 66.6% exhibited ACT levels below 300 seconds, 15 patients (22.7%) had ACT levels ranging from 300 to 350 seconds, while 6 patients (8.3%) had ACT levels exceeding this range. The percentage of patients who attained therapeutic success in the unfractionated heparin (UFH) infusion group (22.7%) was significantly higher than the UFH bolus group (5.9%) with statistically significant results (p = 0.000). Complications were observed in both groups, with 1 patient in each group experiencing acute thrombosis (p = 1.000) and no patients experienced bleeding complications. Conclusion: Administering a UFH bolus of 70-100 IU/kgBW with continuous UFH infusion at 2000 IU/hour achieved better optimal ACT values. No significant results were found regarding the risk of acute thrombosis with no bleeding complications.

Use of SAPS 3, APACHE IV, and GRACE as prognostic scores for acute coronary syndrome patients in the cardiovascular care unit

A grading system based on disease severity has been widely used in intensive care units (ICUs) since around 1980. These systems are used to predict mortality and assess severity in clinical trials. Simplified Acute Physiology Score 3 (SAPS3) and Acute Physiology and Chronic Health Evaluation Score (APACHE IV) are prognosis ratings that can predict in-hospital mortality within the first hour of ICU care. Although these technologies have been widely employed in the ICU, they have yet to be commonly deployed in the cardiovascular care unit (CVCU) due to different patient populations. Intensive care doctors typically employ the standard prognostic scores, SAPS3 and APACHE IV, which were generated from diverse populations of critically ill patients. Although these scores are the most widely used early versions, APACHE IV and SAPS 3 do not include acute coronary syndrome patients. The Global Registry of Acute Coronary Events (GRACE) score has performed the best; this may be because of its straightforward design, which does not distinguish between individuals with SCA and those without ST-segment elevation. Our review article attempts to evaluate the performance of standard predictor scores, namely SAPS 3, APACHE IV, and GRACE, on patients with cardiovascular emergencies. Thus, these score systems can precisely assess the relationship between mortality prediction scores and outcomes of patients admitted to the CVCU rapidly and comprehensively.  

Unprovoked transformation of saddle back to coved ST-segment elevation ECG pattern

Background  Brugada syndrome (BrS) is a heritable arrhythmia that is clinically characterized by spontaneous coved ST segment elevation and a negative T wave in the right precordial lead. Some psychotropic medications, anesthetics, cocaine, excessive alcohol consumption, and fever have been identified as potential causes of VF and SCA in BrS. Case Illustration A 35-year-old man was hospitalized after experiencing unexplained syncope. It was felt 3 times within an hour and was preceded by lightheadedness, nausea, and vomiting. He did not experience palpitations, chest pain, or shortness of breath prior to the syncope. Prior to syncope, he had no history of fever, dehydration, drinking, or taking any medications. There was no family member died suddenly because of heart disease. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range, but the electrocardiogram showed a coved ST segment elevation with an inverted T wave at V1-V2, as well as a saddle back ECG pattern two weeks later with a J point of 2 millimeters at V2. The combination of symptoms and ECG findings led to the BrS diagnosis. He underwent ICD implantation at RSUD Dr Saiful Anwar Malang for secondary prevention. After several months of ICD check-ups, there were no VT/VF events or ICD shock therapy. Conclusion A change in the ecg of the brugada pattern from type 2 to 1 is often accompanied by known ethiologies. But an unprovoked conversion of the BrS type is possible in rare cases

Rapid degradation of left ventricular function after permanent right ventricular pacing in patients with high-grade atrioventricular block

Background: Permanent right ventricular (RV) pacing is a standard for high-grade atrioventricular (AV) block treatment. However, it may result in left ventricular (LV) dilatation, systolic dysfunction, and heart failure (HF) as a consequence of ventricular dyssynchrony and an abnormal myocardial contraction pattern. Pacing-induced cardiomyopathy (PICM) can develop months or years after implantation of a permanent pacemaker (PPM) in patients who have long-term and high-burden RVP. Case Illustration: We reported a case of a 56 years old Asian female having a record of PPM on VVIR mode implantation due to a high grade AV block presented with shortness of breath and bilateral leg swelling. Conclusion: Echocardiography showed a significant decrease in LV systolic function less than two years after PPM implantation. Coronary angiography showed widely patent vessels; subsequently, His-Bundle Pacing (HBP) was scheduled on the patient

Interventricular septal dissection in a patient with atrial septal defect and pulmonary hypertension

Background: Interventricular septal dissection (IVSD) is a sporadic disorder. Previous literature has reported cases of IVSD caused by sinus valsalva aneurysms, post-myocardial infarction patients, congenital abnormalities, or post-thoracic trauma. However, no prior literature has reported IVSD cases caused by an atrial septal defect (ASD) accompanied by pulmonary hypertension. This case report aims to initiate the discussion of recognizing the association between ASD-PH and IVSD. Case presentation: A 48-year-old female with ASD was brought to Dr. Sardjito General Hospital with complaints of fatigue. In 2013, the patient experienced attacks of hemoptysis, which was then revealed to be caused by an increase in pulmonary pressure. Transthoracic echocardiography (TTE) examination results concluded that the patient had a high probability of pulmonary hypertension (PH), secundum atrial septal defect (ASD), which was 22-25 mm in diameter, a bidirectional shunt, and mid-apical interventricular septum dissection with flow. The patient underwent a right heart catheterization examination on September 3rd, 2015, at Dr. Sardjito General Hospital and was confirmed with pulmonary hypertension. The patient underwent computed topography (CT) scan with contrast on March, 2024, for evaluation, where we found a rupture of the interventricular septal muscle. Conclusion: The incidence of interventricular septal dissection is rare. Various causes are suspected, such as sinus of Valsalva rupture, post-myocardial infarction events, or associated congenital abnormalities. From this report, we present an IVSD case that is concurrent with ASD-PH. ASD and pulmonary hypertension, through combination of myocardial injury and hypertension, can cause interventricular septal dissection

Challenge case of ventricular arrhythmia in young women

Background: Torsade de pointes (TdP) and ventricular fibrillation can cause rapid mortality. The etiological cause the ventricular arrhythmia must be detected and treated early, especially in the ER. Objective: We report a patient with severe hypokalemia and TdP following the administration of Amiodarone in QT-interval prolongation Case Report: A 32-year-old girl with diarrhea and vomiting for two days arrived to the ED with a seizure with her hand flexed and leg straight down. Her family reported she didn\u27t take prescriptions regularly. She was GCS 224, hemodynamically stable, typical ECG showed extended QTc and her head CT was normal. During observation at the ED, she had seizure and the monitor revealed a Torsade de Pointes (TdP) ) with a pulse rate of 160-180 bpm. She was given Amiodarone and peroral Bisoprolol 5 mg. She returned to sinus rhythm with PVC bigeminy and was admitted to the ICU Laboratory data showed hypokalemia (1.9) improved (2.9) after treatment. Eight hours later, she experienced a TdP without pulse palpability for less than 1 minute, then Ventricular Fibrillation, began CPR, and the doctor in charge gave her a defibrillation operation once. She returned with sinus tachycardia 110-130 bpm. The next day, she was having recurring TdP episodes without a pulse. The doctor conducted CPR and defibrillation and returned with 120-130 bpm sinus tachycardia. The patient consulted a cardiologist and was prescribed lidocaine 1 mg/hour and continued Bisoprolol 5 mg for long QT problem. Observation The seizure ended 12 hours later, the patient was alert, GCS 456, and the ECG showed sinus rhythm with extended QTc. Over the days before discharge, electrocardiography demonstrated reduced QT-interval prolongation. Conclusion: Life-threatening ventricular arrhythmia in a young female can be caused by QT-interval prolongation. It must be diagnosed and treated immediately to avoid mortality