The role of the history of coronary heart disease among second degree relatives for predicting coronary artery disease

Introduction: The history of atherosclerotic disease among second degree family members of patients as a risk factor has not been properly explained. The present study aimed to assess this role in the Iranian population.Methods: This case-control study was performed on 500 consecutive patients, who were candidates for coronary angiography. The presence of Coronary Heart Disease (CHD) history among first and second degree relatives were determined by interviewing the participants.Results: In total, 450 patients were shown to have CHD as the case group and 50 without CHD as the control group. Family history of CHD among first degree relatives was 39.1% for cases and 22.0% for the controls with a significant difference (P = 0.018), however the history of CHD among second degree relatives was not statistically different in the case group and the control group (17.8% vs. 8.0%, P = 0.079). In total, 80 patients had CHD with simultaneous history of disease among their second degree relatives, while 370 with CHD had no history of disease among their second degree relatives. Our study could not find a significant difference between the two CHD groups with and without history of disease among second degree relatives in terms of cardiovascular risk profile.Conclusions: Despite the powerful effect of the presence of family history of CHD in first degree relatives on risk of CHD and its severity, the presence of this history among second degree relatives cannot predict the risk for CHD

Value of Admission HbA1c Level in Non-diabetic Patients With Unstable Angina

Introduction: There have been incompatible evidences about the prognostic value of HbA1c on the adverse outcomes in acute coronary syndrome. Also, these data are so limited in nondiabetic patients with unstable angina.Methods: In this cross-sectional study, HbA1c level of 231 nondiabetic patients admitted with unstable angina, was measured using high performance liquid affinity chromatography (HPLC) at admission. Then transthoracic echocardiography (TTE) was performed for evaluation of ejection fraction (EF) using Simpson method.Results: Our data revealed that HbA1c was significantly higher in patients with EF≤ 50% in comparison with EF>50% group (P value=0.01).Conclusions: HbA1c may be a helpful prognostic marker in nondiabetic patients admitted in emergency department with diagnosis of unstable angina

Comparison of Face to Face vs. Group Training on Self-pulse Rate taking Ability of Patients

Introduction: Determining the rate and regularity of peripheral arterial pulses has a major role in assessing the clinical status of patients with cardiovascular disorders. We compared two training methods on the ability of patients to take their radial pulse rate accurately.Methods: Three-hundred patients were randomly divided into two arms. One arm received individual face-to-face training and the other arm received group training via displaying an animation movie. Immediately after the training and then after 48 hours, the patients were tested by a nurse to find out whether they have learned the correct technique of taking radial pulse rate or not.Results: Immediately after the intervention, 84.9% in face-to-face arm and 81.8% in group training arm were able to correctly count their radial pulse rate (P = 0.536). After 48 hours, 71.7% in face-to-face and 60.8% in group training arm were able to correctly count their radial pulse rate (P = 0.051).Conclusions: Both methods were effective to improve the ability of the patients to count their radial pulse rate correctly though face-to-face method was marginally superior to group training

Predictive Value of Absent Septal q Wave in Patients with Significant Stenosis of Proximal Left Anterior Descending Coronary Artery

Aims: There is conflicting data about the predictive value of absent septal q wave in patients with significant stenosis of proximal Left Anterior Descending coronary artery. To clarify the exact role of this simple electrocardiographic sign we conducted this prospective descriptive study. Methods: Patients who were referred for coronary angiography in Milad Hospital between December 2008 and September 2009 were chosen randomly. Standard ECG was performed and reviewed for presence or absence of septal q wave, and then the coronary angiography was done and reported by another cardiologist. Results: Of 148 patients with absent septal q wave in ECG, 85 patients (57%) had significant stenosis of proximal LAD in coronary angiography. Statistical analysis showed that significant stenosis of proximal LAD could be predicted by absence of septal q wave in ECG with sensitivity of 59% and specificity of 47%. However, Kappa statistic (Kappa = 0.36) showed low agreement between them. Conclusion: Absence of normal septal q wave in ECG could be a low value predictor of coronary artery disease mainly significant proximal LAD stenosis

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05).Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy

Changes of Left Ventricular Mass Index Among End-Stage Renal Disease Patients After Renal Transplantation

Purpose: The aim of this study was to determine left ventricular (LV) mass index via echocardiography in end-stage renal disease patients (ESRD) before and after renal transplantation, and its association with one-year survival. Materials and Methods: Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction (EF), LV mass, and LV mass index were determined. All of the patients were followed up for 1 year.Results: Mean LVEF was 51.6% which increased to 53.7% after renal transplantation (P = .001). Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation (P = .001). Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m2 following the operation (P = .002). All of the patients survived during 1-year follow-up, and no death was reported.Conclusion: Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD

Successful Treatment of a Left Main Thrombus by Intracoronary Eptifibatide Infusion in a 36-Year-Old Patient

The acute coronary syndrome due to the left main coronary artery (LMCA) thrombosis is a clinically rare and catastrophic event.  We describe a young man (smoker, alcoholic, and drug abuser) with a history of recent surgery and typical chest pain who had non-occlusive LMCA thrombosis in coronary angiography. The thrombosis was successfully treated with two 180 µ/kg intracoronary boluses of eptifibatide, which was continued through an intravenous infusion at 2 µ/kg/min for 48 hours postprocedurally. Control angiography, performed 3 days later, revealed that the LMCA was free of thrombosis. The patient had no complaints, including chest pain, and remained completely asymptomatic during the next 30 days' follow-up

Acute myocardial infarction in a 35–year–old man with coronary artery aneurysm most probably caused by Kawasaki disease

We present a 35-year-old man with history of Kawasaki disease who referred with myocardial infarction, and angiography, revealing aneurysm of left main and left anterior descending coronary arteries. The patient underwent percutaneous coronary intervention and thrombectomy and was discharged after 6 d. Coronary artery sequels of Kawasaki disease should be considered as one of the underlying causes of acute myocardial infarction in young adults

Risk of sudden cardiac death

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 BACKGROUND: The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF). METHODS: The study population of this cross-sectional study consisted of 241 patients with SCA or SCD who were admitted to an academic hospital, in Tehran, Iran, from 2011 through 2012. SCD was defined as unexpected death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute changes in cardiovascular status, or an unobserved death in which the patient was seen and known to be doing well within the previous 24 hours. Survivors of aborted SCD were also included in the study. Clinical and paraclinical characteristics as well as emergency department complications of patients were recorded. RESULTS: The mean age of population was 66.0 ± 16.5 (17 to 90 years). Among the patients, 166 (68.9 %) were male, 50 (20.7%) were smoker, 77 (32.0%) had hypertension, 47 (19.5%) had diabetes mellitus, 21 (8.7%) had hyperlipidemia, and 32 (13.3%) had renal insufficiency. According to New York Health Association (NYHA) functional class, 31 (12.9%) patients were asymptomatic, 42 (17.4) and 99 (41.1%) subjects were in NYHA I and II, respectively and only 69 (28.6%) patients were in NYHA III or IV. In this study, presenting arrhythmia was pulseless electrical activity or asystole which was observed in 130 (53.9%) subjects. Ventricular tachycardia (VT) or ventricular fibrillation (VF) was seen in 53 (22%) patients. Cardiopulmonary resuscitation in emergency room was successful only in 46 (19.1%) subjects. CONCLUSION: Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Low ejection fraction (EF) may be an independent predictor of sudden cardiac death in patients, but it is not enough. While implantable cardioverter defibrillators can save lives, we are lacking effective risk stratification and prevention methods for the majority of patients without low EF who will experience SCD.   Keywords: Death, Sudden Cardiac Arrest

The rehabilitation training and antioxidant status in patients with myocardial infarction

Introduction: Myocardial infarction (MI) is associated with increased oxidative stress and reduced antioxidants. Some studies have shown that exercise training increases the serum level antioxidants. Therefore, this study investigated the effect of rehabilitation training on antioxidant status in patients with myocardial infarction. Materials and methods: In this study, 20 patients with myocardial infarction were selected and randomly assigned to training group (n=10) or control group (n=10). Training program included 3 sessions of concurrent training per week for eight consecutive weeks. To measure the values of malondialdehyde (MDA), protein carbonylation (PC) and total antioxidant capacity (TAC), 10 ml of blood were taken pre- and post-training in each patient. The t-test was used to analyze the data. P<0.05 was considered significant in all tests. Results: The data showed that 8 weeks of rehabilitation training significantly reduces MDA (2.37±0.59 µM and 3.74±1.34 µM in training and control groups, respectively; P=0.000) and PC (9.15±1.77 nmol/mg protein and 11.48±1.60 nmol/mg protein in training and control groups, respectively; P=0.006) levels and significantly increases TAC (10.09±1.70 U/ml and 8.34±1.56 U/ml in training and control groups, respectively; P=0.031). Conclusion: Since the findings of the present study show a reduction in oxidative stress markers (MDA, PC) and an increase in total antioxidants capacity, it seems that eight weeks of concurrent training may improve the antioxidant capacity in patients after myocardial infarction