Lipid Profile Parameters and Coronary Artery Disease in Young Patients Undergoing Diagnostic Angiography

Introduction: It is vital to understand the association between lipid profile and the severity of coronary artery disease (CAD) in young patients with suspected CAD. The clinical presentation, lipid profile and severity of CAD may differ in patients who develop CAD at young age and those at older age. Friesinger (FR) index is an important tool to assess the extent and severity of coronary artery lesions.Methods: This study was a single center retrospective study involving patients below 40 years who underwent diagnostic coronary angiography. Demographic variables, lipid profile and FR index were estimated. Patients were divided into four groups based on the FR index scores of 0, 1–4, 5–10 and 11-15, respectively.Results: A total of 158 patients (Mean ± SD of age; 35.65 ± 3.81 years) were included in the study. Among demographic variables, gender (P = 0.03) and body mass index (BMI) (P < 0.001) were found to be associated with FR index. In addition, total cholesterol (P < 0.001), low density cholesterol (LDL) cholesterol (P < 0.001), non-high density cholesterol (non-HDL) (P < 0.001) and ratio of triglycerides (TG) /non-HDL cholesterol (P = 0.004) showed significant differences between the FR groups. Logistic regression analysis showed that only diabetes (P = 0.02) and BMI (P = 0.004) were significant predictors of the extent and severity of coronary artery lesions in terms of FR index.Conclusions: A strong direct relationship was observed between total cholesterol, LDL and non HDL cholesterol while a negative correlation with the TG/non HDL ratio. Diabetes and BMI also play a very significant role

Prevalence of Coronary Artery Disease and Its Risk Factors in Patients Undergoing Permanent Pacemaker Implantation

Introduction: Some pacemaker implanted patients have an atherosclerotic disease which promotes conduction system ischemia and conduction disturbances. The aim of this study was to determine prevalence of coronary artery disease (CAD) and its risk factors in patients undergoing permanent pacemaker implantation (PPI).Methods: This prospective, single-center hospital based study examined patients older than 40 years who required PPI. Presence of atherosclerotic risk factors and CAD was examined.Results: Of 258 patients undergoing PPI, CAD was present in 50 (19.37 %) patients. CAD was more common among middle age and elderly patients (P = 0.03). Patients older than or equal 76.5 years had specificity of 78.8% for an association with CAD. Multivariate analysis showed that age (odds ratio: 1.042; 95% confidence interval: 1.009–1.075; P = 0.01) and diabetes (odds ratio: 3.437; 95% confidence interval: 1.618–7.303; P = 0.001) had a statistically significant association with CAD. Of 169 patients with involvement of the atrioventricular (AV) node, 28 (16.6 %) had associated left anterior descending artery (LAD) involvement with P = 0.01, suggesting an association between LAD disease and chronic degenerative changes in the AV node.Conclusion: CAD was present in 19.4% of patients undergoing PPI. Age and diabetes had a strong association with CAD. LAD stenosis was significantly more prevalent in AV nodal/ infra-hisian disease compared with sinus nodal disease

Takotsubo cardiomyopathy: A hype or a hypo?

A 51-year-old female was admitted with subarachnoid hemorrhage (SAH) secondary to aneurysmal rupture of the anterior communicating artery (ACoA). Initial echocardiogram was normal. She underwent aneurysmal clipping and the initial postoperative period was uneventful. On the 9th postoperative day, she developed sudden-onset hypotension. Electrocardiogram (ECG) was performed suggestive of acute anterior wall myocardial infarction. Echocardiogram revealed apical ballooning with basal hypercontractility consistent with stress cardiomyopathy. To confirm the diagnosis, coronary angiography was performed, which was normal. She was treated conservatively; however, on the 11th postoperative day she had a sudden cardiac arrest and succumbed to death