Acute Myocardial Infarction in a Patient With Elevated ST-Segment in aVR Lead and Diffuse ST Segment Depression in Other Leads: A Case Report

ST elevation in aVR in conjunction with diffuse ST depression in precordial leads may indicate occlusion of very proximal portion of the left anterior descending artery. We present a 54-year old man, with crushing retrosternal pain and ST-segment elevation only in aVR lead and diffuse ST-segment depression in inferior, lateral and precordial leads. The patient was scheduled for emergent coronary angiography, which showed that left anterior descending (LAD) artery was cut off at very proximal portion and urgent CABG was performed for the patient

The Effect of Hyperuricemia on the Rate of Contrast-Induced Nephropathy in Patients with Coronary Angiography

Introduction: There is little information about the relationship between hyperuricemia and contrast induced nephropathy. The present study aimed to evaluate the relationship between hyperuricemia and contrast induced nephropathy among patients, who had undergone coronary angiography.Methods: In the current study, 200 consecutive patients with coronary artery disease, who underwent coronary angiography in Modarres hospital, were enrolled. According to the available data, the upper limit normal level of uric acid was defined as 7 mg/dl in males and 6.5 mg/dl in females. By increasing level of serum creatinine to 0.5 mg/dl (or 25% enhancement) from basic level of creatinine during 48 hours of introduction of contrast agent, diagnosis of Contrast Induced Nephropathy (CIN) was established. The relationship between hyperuricemia and CIN was then assessed.Results: There is a significant difference between normouricemic patients and hyperuricemic patients, in aspect of weight (P = 0.011) and uric acid (P = 0.001); however, other quantitative and qualitative variables including age, volume of contract agent, creatinine level after angiography, hemoglobin level, gender, arterial access type, number of involved vessels, were insignificant between the two groups (P > 0.05). Moreover, as an essential finding, CIN was shown in 9% of normouricemic patients and 10% of hyperuricemic  patients with no significant difference between the two groups (P = 0.6).Conclusions: Our study suggests that hyperuricemia may not significantly increase the rate of the contrast-induced nephropathy in patients, who had undergone angiograph

A Mysterious Case of ST-Elevation Myocardial Infarction; an Old Man with Weight Loss and Dyspepsia

We present a 65-year-old man who developed retrosternal compressive chest pain. A 12-lead electrocardiography demonstrated ST-segment elevation in leads II, III and aVF. Emergent coronary angiography showed significant thrombus in the distal portion of the left main coronary artery. Abdomino-pelvic computed tomography scan, which was performed the next day, confirmed a pancreatic mass with peritoneal seedings, compatible with peritoneal carcinomatosis. This case underscores the importance of malignancies that may lead to a catastrophic ST-elevation myocardial infarction due to a hypercoagulable state and following thrombosis in the left main coronary artery

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

Syncope during pregnancy in a patient with permanent cardiac pacemaker, due to increased pacing threshold.

A 22-year-old pregnant woman referred with syncope due to pacemaker malfunction. During the second trimester of pregnancy, the right ventricular (RV) lead pacing threshold increased and led to early generator depletion. We believe that this might happen due to lead micro-dislodgement or less probably effect of hormonal changes during pregnancy on electrode-myocardium interface

The Correlation between Serum Level of N-Terminal Pro-B-type Natriuretic Peptide and Gensini Score in Patients with Acute Coronary Syndrome

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker for developing the diagnosis and prognosis of cardiovascular diseases, as several studies have shown that serum levels of NT-proBNP elevate in acute coronary syndrome (ACS) and coronary artery disease (CAD). We performed this study to find any possible correlation between serum levels of NT-proBNP and Gensini score in patients diagnosed with ACS.Methods: In a cross-sectional study, 100 consecutive patients with ACS who were candidates of angiography were recruited and their serum levels of NT-proBNP, Gensini scores, lipid profiles and troponin I levels were measured.Results: Sixty six male and 34 female patients with a mean age of 57.5 years, including 44 with unstable angina, 33 with ST-elevation myocardial infarction, and 23 with non-ST-elevation myocardial infarction were enrolled. The mean serum NT-proBNP level and the Gensini score were 1987.16 pg/mL (17.9-8841) and 31.09 (6-92.5), respectively. The serum NT-proBNP levels and Gensini scores were significantly correlated with a Spearman correlation coefficient of 0.953 (P < 0.001). Serum levels of NT-proBNP were not different in patients with single-vessel disease, 2-vessel disease and 3-vessel disease (P = 0.257). NT-Pro-BNP levels were also correlated positively with troponin I levels (correlation coefficient = 0.779) and negatively with left ventricular ejection fraction (correlation coefficient = -0.55). Smoker patients had higher NT-proBNP levels (P = 0.047). Neither Gensini scores nor NT-Pro-BNP levels had significant correlation with lipid profile or blood sugar.Conclusions: NT-proBNP is directly correlated with Gensini score in patients with ACS and might be used as an important marker for risk stratification in those patients

Cardiac failure secondary to hypocalcemia

Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very atypical and rare circumstance, which is usually intractable to conventional therapy for cardiac failure, but responds satisfactorily to restoration of normocalcemia.We describe a young woman who developed clinical signs of hypocalcemia due to hypoparathyroidism, reduced left ventricular ejection fraction and polymorphic ventricular tachycardia as consequences of hypocalcemia.This case underscores the importance of biochemical abnormalities like hypocalcemia as a rare cause of secondary cardiomyopathy and emphasizes on the need for effective and immediate treatment of hypocalcemia and its related causes

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Introduction: The present study aimed at assessing the role of lesion length in predicting Fractional Flow Reserve (FFR) value for physiological evaluation of intermediate coronary lesions.Methods: In the current study, 68 patients with 83 coronary lesions were enrolled. All of the patients in this study underwent routine coronary angiography, according to appropriate indications. To evaluate physiologically significant intermediate coronary stenosis (defined between 40% and 70% on visual estimation), the Fractional Flow Reserve (FFR) study was performed and the Quantitative Coronary Angiography (QCA) data were also assessed for measurement of lesion length. The correlation between QCA data and FFR values was also examined.Results: Eighty-three lesions were evaluated from 68 patients. Stenosis was considered physiologically significant when FFR was lower than 0.75. The FFR was significant in twelve lesions (14.5%). There was a negative correlation between FFR value and lesion length (r = -0.294 and P = 0.013). Moreover, lesion length in physiologically significant FFR group (21.07 ± 6.9) was greater than that of the non-significant FFR group (15.23 ± 6.5) (P value < 0.05). Furthermore, the correlation between QCA data and FFR values was also investigated, yet, there was only a positive correlation between FFR and Minimum Luminal Diameter (MLD) values (r = 0.248 and P value = 0.04). The Receiver Operating Characteristic (ROC) curve analysis for predicting the significant FFR value demonstrated that a lesion length greater than 17.5 mm was the best cut-off point for prediction of the significant FFR value with acceptable sensitivity and specificity of 83.3% and 68.8%, respectively.Conclusions: There is a negative correlation between lesion length and FFR value in intermediate coronary lesions. In addition, a lesion length greater than 17.5 mm is the best cut- off point for prediction of significant FFR values

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