Apical Hypertrophic Cardiomyopathy in a Case with Chest Pain and Family History of Sudden Cardiac Death: A Case Report

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, which is caused by a multitude of mutations in genes encoding proteins of the cardiac sarcomere (1). Apical hypertrophic cardiomyopathy (AHCM) is an uncommon type of HCM. The sudden cardiac death is less likely to occur in the patients inflicted with AHCM (2). Herein, we presented the case of a 29-year-old man with AHCM, who had typical exertional chest pain without any cardiovascular risk factors, except for a sudden cardiac death in his older brother at the age of 28 years. After performing complete clinical and paraclinical evaluations, the patient underwent optimal medical treatment with beta-blocker agents without any symptoms

Three Different Imaging Modalities of a Patient with the Aortic Coarctation

The patient was a 19 year-old woman with the diagnosis of resistant hypertension, although she was under treatment of three classes of anti-hypertensive drugs (beta blocker, angiotensin receptor blocker, diuretic) for more than one year. In physical examination there was only a significant difference between the systolic blood pressure of upper and lower extremities (200 vs. 120 mmHg), without any other remarkable finding. Three different imaging modalities (echocardiography (Figure 1), CT angiography (Figure 2), conventional aortography (Figure 3) confirmed the aortic coarctation at 30 mm after left subclavian artery origin, with the 3.5-4 mm diameter of the narrowest segment. She underwent implantation of a self-expanding aortic stent and therefore the systolic pressure gradient decreased from 90 to 15 mmHg. After three months, her blood pressure was stable on 110/80 mmHg, while she received only metoprolol 25 mg twice daily and follow-up echocardiography showed 15-20 mmHg pressure gradient through the stent

Atlas der Alpenflora / Alpen-Grasnelke

Magasság: 1500-2300 M.Előfordulási hely: Schweiz bis Oesterreich und Steiermark, trockene StellenVirágzás: Juni-August

Correlation between Serum Lead Level and Coronary Slow flow Phenomenon

Introduction: There are some reports suggesting a link between lead exposure and cardiovascular disease but understanding the contribution of lead to specific cardiovascular diseases has remained incompletely. Materials and Methods: In this case-control study, serum lead level in 30 patients with diagnosed coronary slow flow phenomenon (CSFP) documented by coronary angiography was evaluated and compared with the values of the control group containing 30 patients with normal coronary angiography. Results: Age, sex, major clinical risk factors for coronary artery disease, laboratory and echocardiographic parameters were similar in patients with and without CSFP (p > 0.05). Significant differences were found between the 2 study groups regarding serum lead level. Conclusion: Lead is a highly poisonous metal (whether inhaled or swallowed), affecting almost every organ and system in the body. Long-term exposure to lead can cause nephropathy and rise in blood pressure. We found it may also contribute to ischemic heart disease and CSFP. The suspected mechanism is oxidative stress and inflammation

Does global longitudinal speckle-tracking strain predict left ventricular remodeling in patients with myocardial infarction? a systematic review

Introduction: Left ventricular remodeling is a relatively prevalent complication of acute myocardial infarction (AMI), and it is associated with higher rates of medical issues and mortality. Left ventricle ejection fraction (LVEF) and wall motion score index (WMSI) are unable to detect accurately minor lesions following AMI. Global longitudinal strain (GLS), which is obtained through 2D-speckle tracking echocardiography (2D-STE), provides an angle-dependent measurement by which the infarcted area can be assessed as a means of identifying potential dysfunction. The main objective of this study was to evaluate whether GLS could adequately predict LV remodeling in AMI patients. Methods: The MEDLINE database from database inception to May 6th, 2015, was searched for relevant keywords and the reference lists of systematic reviews and eligible studies were also screened. All studies involving patients with their first reported case of AMI were examined for GLS by 2D-STE and were evaluated for LV remodeling at a three-month follow-up point.  Four English-language prospective cohort studies were eligible for inclusion in this study.Result: A total of 291 AMI patients (mean age=57.92 years) were investigated across four different studies. The main finding of this study was that the most reliable and consistent measurement for the purposes of predicting LV remodeling in AMI patients is GLS obtained at the time of discharge, especially in STEMI patients.Discussion: In addition to their poor reproducibility, inability to stratify risks, and inter-observer variability, compensatory hyperkinesis of intact myocytes and myocardial stunning after an AMI are among the main reasons why LVEF and WMSI may not be the most effective predictors of LV remodeling in AMI.Conclusion: GLS obtained by 2D-STE at the time of discharge could be used as a reliable predictor of LV remodeling in AMI patients

Comparison between Intracoronary Abciximab and Intravenous Eptifibatide Administration during Primary Percutaneous Coronary Intervention of Acute ST-Segment Elevation Myocardial Infarction

Background: Administration of glycoprotein IIb/IIIa inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. Methods: A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab (0.25 µg/kg) bolus or two boluses of intravenous Eptifibatide (0.180 µg/kg) each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution (STR), and post-procedural thrombolysis in myocardial infarction (TIMI) grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect (arrhythmia) and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Results: Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.61). The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI (µmol/L/hr ), was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 (interquartile range [IQR], 3006.0 to 11112.0) versus 7,294 (IQR, 3795.5 to 11803.5); p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.87). No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. Conclusion: The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI

Investigation of the association between serum uric acid levels and HEART risk score in patients with acute coronary syndrome

Abstract The association between uric acid (UA) and cardio‐metabolic conditions has been recognized for a long time. However, recently, a body of evidence has highlighted the independent role of UA in a series of conditions, including renal and cardiovascular diseases. In this light, data regarding the prognostic role of UA in acute coronary syndrome (ACS) is scarce. A total number of 100 patients, 59 males and 41 females, diagnosed with ACS were recruited in this study. At the time of admission to the hospital, the serum level of UA was measured. In addition, the HEART score was calculated based on each patients' profile. Participants were on average 61.37 ± 12.08 years old. The most prevalent risk factors were hypertension (48%), a history of coronary artery disease (40%), and diabetes mellitus (33%). The average serum level of UA was 5.81 ± 1.81 mg/dl, and the calculated HEART score had a median of six (minimum of two and maximum of ten). A positive yet statistically insignificant correlation was found between the measured UA level and the calculated HEART score (R = 0.375, p = 0.090). However, further studies with larger sample size are required to assess the direct association of UA level with major adverse cardiac events in patients with cardiovascular disease

Morphine Post-Conditioning Effect on QT Dispersion in Patients Undergoing Primary Percutaneous Coronary Intervention on Anterior Descending Cardiac Artery: A Cohort Study

Introduction: QT dispersion is the difference between the maximum and minimum QTc interval in a 12-lead electrocardiogram (ECG). Some researchers have demonstrated the effects of an increase of QT-d in STEMI and its reduction with successful therapy. The aim of this study was to investigate the morphine post-conditioning effect on the QT dispersion in patients undergoing primary percutaneous coronary intervention (PCI) on anterior descending cardiac artery. Methods: This cohort study was conducted on STEMI patients admitted to the Hospital of Imam Reza (AS), Mashhad, Iran, from March 2015 to February 2016 who were undergoing primary angioplasty on the anterior descending cardiac artery. The patients were divided into two groups based on the intake or non-intake of morphine (5 mg morphine for the period of 30 minutes prior to PCI). Parameters, including age, gender, history of diabetes, and blood pressure as well as admission and 24 hours after PCI ejection fraction (EF) and QT-d, were recorded in all patients and compared between the two intervention and control groups. Independent and paired ttests and chi-square test were used to compare the qualitative and quantitative data between the two groups using SPSS version 19 software. Results: The present research was performed on 77 patients (61 males) with mean age of 58.71±11.84 years in the two groups of morphine consumption before PCI (n=46) and control (n=31). No statistical difference was found among the groups in age, gender, diabetes, hypertension, and onset of symptoms until primary PCI. Admission electrocardiogram QT-d value in the positive exposure group showed no significant difference with the control group, but QT-d value at 24 hours after PCI was lower in the positive exposure group than in the control group (morphine versus control: 40.32±6.98 versus 59.64±8.89; p=0.000). QT-d value 24 hours after PCI compared with the admission QT-d value was significantly reduced in both groups. The mean decrease of admission QT-d relative to QT-d 24 hours after PCI was higher in the positive exposure group than in the control group, and this difference was also statistically significant (morphine versus control: 48.65±9.95 versus 25.74±6.66; p=0.000). Conclusion: The findings of the current survey demonstrated that morphine consumption before PCI can further reduce QT-d value in an electrocardiogram for PCI as compared to patients who did not take morphine before PCI

Evaluating the association between opium abuse, blood lead levels, and the complexity of coronary artery disease

Abstract Opium abuse and exposure to heavy metals elevate the risk of coronary artery disease (CAD). Therefore, we aimed to determine the association between opium abuse and blood lead levels (BLLs) and the CAD complexity. We evaluated patients with acute coronary symptoms who underwent coronary angiography, and those with >50% stenosis in at least one of the coronary arteries were included. Furthermore, Synergy between PCI with Taxus and Cardiac Surgery I (SYNTAX I) score and BLLs were measured. Based on the opium abuse, 95 patients were subdivided into opium (45) and control (50) groups. Differences in demographics and CAD risk factors were insignificant between the two groups. The median BLLs were remarkably higher in the opium group than in controls (36 (35.7) and 20.5 μg/dL (11.45), respectively, p = 0.003). We also revealed no significant differences in SYNTAX score between the two groups (15.0 (9.0) and 17.5 (14.0), respectively, p = 0.28). Additionally, we found no significant correlation between BLLs and the SYNTAX scores (p = 0.277 and r = −0.113). Opium abuse was associated with high BLLs. Neither opium abuse nor high BLLs were correlated with the complexity of CAD. Further studies are warranted to establish better the relationship between opium abuse, BLLs, and CAD

The Evaluation of Right Atrial Temporary Pacing for Preventing Postoperative Atrial Fibrillation Following Coronary Artery Bypass Grafting Surgery: prospective observational study

Abstract: Atrial fibrillation (AF) is the most frequent (arrhythmia) complication following coronary artery bypass grafting surgery (CABG). The present study is designed to evaluate the efficacy of temporary atrial pacing in the prevention of AF after off pump coronary artery bypass graft surgery. The patients who had first-time off-pump CABG were enrolled in the study. The exclusion criteria were that the patients had valve dysfunctions. The study group (n = 39) were paced electively and the control group (n = 40) were not paced, and both were monitored for 96 hours postoperative for the occurrence of AF. The end points of the study were occurrence of AF, death during postoperative period, and discharge from hospital. The data analyzed by t-test and chi-squared test for variables. A total of 120 patients enrolled in the study. Forty-one patients were excluded from the study because of intraoperative dysrhythmia, tachycardia or failure of pacing, so the final study subjects consist of 79 patients. AF occurred in 13 of 39 paced group (33.33%) and 13 of 40 non-paced group (32.5%). No statically significant difference in the proportion of patients developing atrial fibrillation was observed between the study and the control group for incidence of AF. Old age (P=0.007), history of myocardial infarction (P=0.001), systolic dysfunction (P=0.003), ejection fraction (P=0.022) and atrial enlargement (P=0.001) were identified as AF predictors. The result of this study shows that prophylactic right atrial pacing had no significant effect on reducing the incidence of AF following off-pump CABG