Risk Factors and Prevention of Pulmonary Embolism in Young Adults

Objective: Pulmonary thromboembolism (PTE) importance is due to some reasons, first, it is one of the most common cardiovascular diseases, second it has high mortality and morbidity especially in some situations and third, prevention of this event is applicable and effective in most cases. The aim of this study was evaluation of predisposing factors of pulmonary emboli in young patients and defining preventive strategies in this age group. Materials and Methods: In this retrospective study, recorded data including age, sex, presentation month, chief complaint, vital signs at admission, positive findings of physical examination, venous thromboembolism (VTE) risk factors, laboratory and imaging findings of patients with pulmonary embolism diagnosis who had 45 years old or less from March 2008 to March 2014 in Shahid Madani Heart hospital, Tabriz, Iran were evaluated. Statistical analysis was done via SPSS version 21. Results: Eight hundred seventy patients had pulmonary emboli diagnosis during study period, 101 of them were ≤ 45 years old. Fifty-three patients were men and 48 of them were women. Mean age of patients was 33.6 years. Abnormal lower limb was the most frequent positive finding at physical examination. The important risk factor in women was hormonal change due to pregnancy or oral contraceptive pill use which was present in 50% of females. Smoking and immobilization due to surgery or trauma were the most common risk factor in men. Women had higher pulse rate (113.53± 21.84 vs 101.33 ± 20.27, P = 0.005) and lower hemoglobin (11.76 ± 2.00 vs 13.52 ± 2.21, P = 0.000) than men. The overall mortality rate was 10.8%. Conclusion: Although all the risk factors of pulmonary emboli were not evaluated in our patients but the determined ones seem to be modifiable in majority of cases

Heart failure: a prevalence-based and model-based cost analysis

IntroductionHeart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively.MethodsThis study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I–IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables.ResultsThe total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power.ConclusionThis study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients

Associated factors with delayed door to balloon time in STEMI patients

Introduction: The time interval from hospital arrival to the balloon inflation of catheter in coronary arteries is defined as Door to Balloon Time (DBT). Door to balloon time is a marker of primary Percutaneous Coronary Intervention (PCI) timeliness. Door to balloon time duration, associated factors and it’s relation to outcomes are not similar in various centers. Herein we aimed to define these issues in our region. Methods: In this study, 188 patients with ST Elevation Myocardial infarction (STEMI) diagnosis eligible for primary PCI were included. Demographic, clinical and time intervals from arrival in hospital to catheterization data of patients were recorded. Patients were followed for six-month in terms of mortality and admission. Results: After excluding patients with missed data, 174 patients were entered in the study. Mean age of patients were 60.8±11.81 years and 78% of patients were male. Median DBT was 70 minutes (IQR 25-75: 55-97 minute). One hundred and twenty three patients (71%) had timely door to balloon time. Patients with delayed door to balloon time had lower age, lower prevalence of typical chest pain and higher prevalence of PCI on Left Circumflex Artery (LCX) than timely group but these differences were not significant. (p values were 0.068, 0.074 and 0.070 respectively). Delayed DBT was evident in three segments of door to ECG, ECG to code and code to cath times (p values were, < 0.0001, 0.009 and < 0.0001 respectively) but the cath to balloon time was not significantly different between two groups (p value: 0.159). Although in-hospital mortality was higher in delayed group than timely group but the difference was not meaningful. (11.7% vs 4.9%, p value: 0.103) Six-month mortality and admission rate were not different between two groups. Conclusion: Door to balloon time was acceptable in this study and was comparable to developed countries. Albeit there is room for improvement due to modifiable delayed parts

Cardiovascular Risk Factors in Women of Reproductive Evaluation of Acute Coronary Syndrome and Age in Northwest Iran

Introduction Cardiovascular disease is the leading cause of death among women, regardless of race or ethnicity. For Coronary Heart Disease (CHD) specifically, mortality rates fell in both men and women by 44% from 2000 to 2002. Approximately 47% of this decrease was due to the influence of evidence-based medicine [post-myocardial infarction (MI) secondary prevention, initial treatment of Acute Coronary Syndrome (ACS), heart failure treatment, revascularization for chronic angina, and use of antihypertensive and lipid-lowering therapy] and approximately 44% to a reduction in several risk factors (hypertension, dyslipidemia, smoking, and low physical activity ) in the general population (1). Although overall mortality among women decreased, mortality among young women (between 35 and 44 years of age) increased by 1.3% per year from 1997 to 2002 (2). Whether there are fundamental differences between men and women in mortality after MI, or whether such observed differences reflect corresponding variations in baseline characteristics, has long been a topic of discussion. In addition to differences in patient related factors, studies suggest that mortality may differ among women and men according to the type of ACS at presentation (3). Incidence of ACS in women of reproductive age is reported to be low (25-57 per 100,000 per year) (4,5). Rates of CHD are consistently lower in women as compared to men. The established risk factors of elevated blood pressure, high cholesterol levels and cigarette smoking appear to increase the risk of CHD in women in the same manner as in men. At younger ages lower levels of risk factors could explain the sex difference observed in CHD. In the past cigarette smoking was considerably lower in women as compared to men; however recent cohorts have shown the reversing of this trend. Thus with increase in the prevalence of cigarette smoking in women, some of the evident protection that women may have from CHD decreases considerably and even exceeds that in men. CHD is the leading cause of death in women in industrialized countries and preventive interventions need to be targeted at women as well as men. The huge international variation in mortality and incidence rates in women, together with time trends and findings from migrant studies, show that a significant percentage of CHD in women Abstract Objectives: Acute Coronary Syndrome (ACS) is rare in women of reproductive age; however with increase in risk factors of Coronary Artery Disease (CAD) in this age group, the possibility of ACS in young women is expected to rise and become a significant problem in future. It seems that pattern of risk factors and disease course may be different in this group. This study was conducted to determine the status of ACS in women of reproductive age. Materials and Methods: This is a descriptive study of women aged between 15-45 years who were admitted with ACS during the past five years from 21 March 2008 until 20 March 2013. The definition of ACS was designed to be compatible with current guidelines. Statistical analyses were performed with SPSS version 17.0. Results: Women of reproductive age who were admitted with ACS diagnosis were 1.16% of all ACS cases. Significant number of patients (22 patients who are 42% of all patients) had atypical chest pain and 17 (32%) had unusual symptoms. Unstable Angina (UA) was the most common type of ACS. Most of the patients had one or more CAD risk factors. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG) was performed in 25(42%) of the female patients with documented ACS. In recent years, the prevalence of CAD has increased considerably in in this specific group. Conclusion: ACS is rare in women of reproductive age but may occur. The clinical presentation of the women of this study is compatible to other similar investigations

Right atrial dyssynchrony and atrial fibrillation after coronary bypass grafting surgery

Introduction: Prevalence of post-coronary bypass grafting surgery (post-CABG) atrial fibrillation (AF) is high, and it’s complications are serious. Prediction of this problem and prophylactic or presumably curative managements may be helpful not only in post-CABG AF, but also in other conditions that predispose patients to AF. The aim of this study was finding relationship between right atrial (RA) dyssynchrony and post-CABG AF occurrence. Methods: One hundred patients who were candidates for CABG and they had sinus rhythm was evaluated. We measured RA dyssynchrony in tissue Doppler imaging (TDI) using initiation of P wave in the electrocardiogram to peak A wave (on TDI) in mid of RA free wall and mid of inter-atrial septum (IAS). The time difference from the onset of the P wave to the onset of the A wave at the right atrium (P-RA) and the IAS (P-IAS) was measured. RA dyssynchriny was defined as the difference between P-IAS and the P-RA. Patients were followed for occurrence of AF 72 h after CABG through Holter monitoring, the relation between AF occurrence and RA dyssynchrony was determined. Results: AF developed in 24 patients (24%), based on statistical analysis, lower LVEF and RA dyssynchrony had relationship with AF occurrence. RA dyssynchrony was significantly increased in patients with postoperative AF (36.67 ± 14.93 ms vs. 14.27 ± 13.77 ms, P < 0.001). Conclusion: We demonstrated that RA dyssynchrony based on TDI could be a predictor for the occurrence of post-CABG AF

Targeted treatment in viral‐associated inflammatory cardiomyopathy

Abstract Detection of viruses like HHV‐6 in endomyocardial biopsy or serum serology of patients with myocarditis or heart failure features unresponsive to conventional heart failure therapies could be a potential targeted treatment especially in refractory cases

Aberrant Right Subclavian Artery: A Rare Cause of Dysphagia in a Child

Introduction: Although aberrant right subclavian artery (ARSA) is a rare abnormality but it is the most common anomaly of aortic arch. Compressive effects of the artery are responsible for the patients’ symptoms. Association of this disorder with other anomalies and necessity of treatment in symptomatic patients are the important aspects of this condition. Case Presentation: Here we describe a 12 years old girl with dysphagia and ultimate diagnosis of ARSA. The ligation procedure of the artery was successful without any complications. Conclusion: Dysphagia could be the main symptom of the ARSA in children as same as old adults