Acute Thrombotic Occlusion of proximal Left Anterior Descending Artery without ST-elevation (de Winter sign) in Electrocardiogram: A Case Report

Introduction: ST-elevation in precordial leads is diagnostic for acute transmural myocardial infarction (MI) related to acute occlusion of left anterior descending artery (LAD). Case presentation: In this case report, a 54-year-old man was admitted to the emergency department (ED) due to chest pain. ST-depression with tall T waves in precordial leads was detected in surface electrocardiogram (ECG). Angiography showed acute total occlusion of proximal LAD and ad hoc percutaneous coronary intervention (PCI) was performed successfully. Conclusion: This case highlights that total occlusion of LAD may present without typical ST-elevation pattern in ECG

Flash pulmonary edema in the cardiac catheterization laboratory: a case report

Flash pulmonary edema is a potentially fatal condition that can suddenly deteriorate a patient's status in a variety of settings, including the catheterization laboratory. We describe a 51-year-old woman with a history of hypertension who was admitted for a second valve operation for degenerated aortic bioprosthesis. Before undergoing coronary angiography, she looked a little worried, she experienced respiratory distress and a significant increase in blood pressure in favor of acute flash pulmonary edema, which was immediately and successfully managed by respiratory support and administration of high-dose intravenous nitroglycerine and loop diuretic therapy. The present scenario highlights the significance of being aware of the warning signs of acute flash pulmonary edema to make a prompt diagnosis and initiate the appropriate treatment to prevent catastrophic consequences

The Role of Insulin-Like Growth Factor-1 and Pregnancy-Associated Plasma Protein-A in Diagnosis of Acute Coronary Syndrome and Its Related Morbidities

Introduction: Pregnancy-associated plasma protein-A (PAPP-A) is a metalloproteinase that plays a role in atherosclerotic plaque destabilization. In recent studies, insulin-like growth factor-1 (IGF-1) has been introduced as a mediator of atherosclerosis. PAPP-A and IGF-1 level may be important diagnostic indicators of acute coronary syndrome (ACS). Objective: The present study tried to assess the diagnostic role of IGF-1 and PAPP-A biomarkers in ACS spectrum. Methods: The serum level of IGF-1, PAPP-A and troponin I was determined in 121 consecutive patients with ACS. Relationships were assessed by t-test, ANOVA and the non-parametric equivalent. Accuracy of biomarkers was measured by the area under the ROC curve (AUC) and optimal cut-off points to diagnose STEMI and NSTEMI using Youden index. Results: In patients with acute ST segment elevation myocardial infarction (STEMI), all of these three biomarkers were significantly higher than those in patients with unstable angina (P= 0.028 for IGF-1, P<0.001 for PAPP-A and Troponin-I). Mean level of IGF-1 in patients with renal failure was significantly higher than that in patients without renal failure (137.9±35.1 vs 105.1±46.9, P=0.003), but PAPP-A and serum Troponin-I level had no significant difference in renal failure groups (P>0.05).  ROC curve analysis showed that after Troponin-I, PAPP-A was a good discriminator between patients with STEMI and patients with unstable angina (AUC=0.79). Optimum cut-off value for PAPP-A was found to be 89.2 ng/ml, with sensitivity and specificity of 66.7% and 83.8%, respectively. Conclusion: PAPP-A can be a novel biomarker for both identification of patients with STEMI and risk stratification in patients with ACS

Cardioprotective Effects of Coenzyme Q10 Supplementation on Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background: We assessed the potential efficacy of Coenzyme Q10 (CoQ10) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: Seventy STEMI patients who presented ≤12 hours after the onset of symptoms and were scheduled for PPCI were randomly assigned to the standard treatments plus CoQ10 or placebo. In the intervention group, CoQ10, as an oral capsule at a dose of 400 mg, was loaded immediately before PPCI and continued at 200 mg twice daily for 28 days. The control group received a matching placebo, similarly. The study endpoints were the proportion of patients with complete myocardial reperfusion, defined as thrombolysis in myocardial infarction (TIMI) flow and myocardial blush grade (MBG) 3 at the end of PPCI, the proportion of patients with complete ST-segment elevation resolution (≥70%) assessed 60 minutes after PPCI, the plasma levels of creatine kinase myocardial band isoenzyme (CK-MB) and troponin I (TnI) at 12, 24, 48, and 72 hours after PPCI, and left ventricular ejection fraction (LVEF) at day 28. Results: The study groups were comparable regarding baseline clinical and procedural characteristics. The proportion of patients with TIMI flow grade 3, MBG 3, and complete ST resolution after completion of PPCI was similar between the groups. Whereas at all-time points after PPCI (12, 24, 48, and 72 hours), the plasma levels of CK-MB and TnI were significantly lower in the CoQ10 group than in the control group. Further, at day 28, CoQ10-treated patients exhibited better LVEF than placebo-treated patients, and the proportion of patients with LVEF less than 50% was lower in the intervention group than in the control group. Conclusion: Our study provided evidence that CoQ10 supplementation might reduce myocardial ischemia-reperfusion injury after PPCI and help to preserve left ventricular function. However, further studies are required to validate these results

Myocardial Infarction in a Patient with Prosthetic Aortic Valve

A 45- year old man with a history of Aortic Valve replacement presented with acute chest pain which was diagnosed to be anterior wall myocardial infarction. He received thrombolytic therapy with streptokinase. Echocardiography and fluoroscopy showed normally functioning ball and cage aortic prosthesis. Coronary arteriography showed globular filling defect in midportion of left anterior descending coronary artery, most probably embolized thrombus. The patient underwent medical treatment especially warfarin with higher range of INR without any intervention. He had a smooth in-hospital course and uneventful recovery

Evaluation of Drug-Drug Interactions in Chronic Kidney Disease Patients: A Single-Center Experience: Drug-drug Interaction in Nephrology Ward

Drug-drug interactions (DDIs) result from the simultaneous consumption of two or more drugs that alter the patient’s response to the initial drug. The treatment regimen in patients with kidney disease is very diverse and may be associated with several diseases that increases the risk of DDIs. This study was carried out to investigate the DDIs incidence in patients with chronic kidney disease (CKD) in the nephrology ward. This descriptiveanalytical study was performed in a 4-month period in 2017. The patients’ information, such as age, sex, list of drugs during hospitalization, and kidney disease stage were recorded from patients’ medical records. Drug-drug interactions were extracted using LexiComp Online. In this study 48.55% of patients were male, 51.45% were female, and 53.2% of patients were in stage 5 of kidney disease. There was a significant correlation between the incidence of drug-drug interactions with stage 5 of disease (P=0.02). The highest number of interactions was categorized as type C and interaction between atorvastatin and pantoprazole was the most frequent interaction. The maximum range of prescription drugs was between 6 and 10 items by 49.7% of patients. There was a significant correlation between the incidence of drug-drug interactions and the number of prescribed drugs (P=0.03). Drug-drug interactions are common in patients with chronic kidney disease. Based on the results, the number of prescribed drugs and the stage of the disease are effective in drug-drug interactions incidence. It is possible to reduce drug complications and to increase the life span of patients by recognizing drug-drug interactions

One-Stage Angioplasty and Stenting of Ostium of Left Common Carotid Artery and Stenting of Left Internal Carotid Artery

Our aim was to report techniques and our experience in One-stage angioplasty and stenting of ostium of left common carotid and left internal carotid arteries in an octogenarian man with transient ischemic attack, who was completely recovered from neurologic insults short time after the procedure. An 81-year-old man presented with a transient ischemic attack. Neurologic examination showed left side transient visual obscuration or amaurosis fugax and right hemiparesis. Carotid duplex imaging revealed an 80% stenosis of the left internal carotid artery (LICA) and 95 % of the ostium of left common carotid artery (left CCA). Immediate brain MRI wasn’t possible. Angioplasty and stenting of both lesions (left CCA and LICA ) was performed successfully without complications in one session. Stenting of common carotid artery ostial lesion and internal carotid artery (due to significant lesion) in one session could be done even in acute neurologic phase and also in very old patients, provided that, considering technical ways for neuroprotection and avoidance of other complications

Clinical pharmacy services in an Iranian teaching hospital: Type, severity, resolution, and accuracy

Objective: Clinical pharmacy services are improving in hospitals. For assessing the impact of these services, first it is important to exactly describe them by categorizing into types, severity, resolution, and accuracy. The objective of this study is to provide a detailed analysis of the clinical pharmacists′ services performed on in-patients in a teaching hospital during 28 months. Setting: Masih Daneshvari hospital, Tehran, Iran. Methods: This is a descriptive study. The authors retrospectively reviewed the notes of all services and entered them in a designed SPSS sheet. Documentation was carried out based on the "findings, assessment, resolution, and monitoring" method. The data were descriptively analyzed. Main outcome measure: Types, subtypes, severities, resolutions, and accuracies of services were defined, documented, and analyzed. Findings: In total 3152 records (2227 interventions and 925 visits with no intervention) were classified and analyzed in this study. Among all types of interventions, "improper medication use" (36.2%) was the most frequent intervention and among categories (subgroups) of "improper medication use," "untreated indication" was the most frequent (23.7%). From the aspect of severity, 75.4% of interventions were estimated as of minor potential inconvenience to the patient (severity degree 1). Most interventions (78%) were finally recommended to the prescriber and 97.6% of interventions were considered accurate on further evaluation. Conclusion: Clinical pharmacists′ interventions are highly demanded in the hospitals. Based on the results of this study, conditions needing medication to prevent later complications in the course of therapy are sometimes ignored, which emphasizes the positive role of the clinical pharmacists′ involvements in clinical teams to improve outcome

Left ventricular strain echocardiography in advanced uremic cardiomyopathy compared to dilated cardiomyopathy

Abstract Background Cardiac involvement is common in end-stage renal disease patients. The presenting study aimed to evaluate the global and segmental longitudinal strain in patients with advanced uremic cardiomyopathy (AUCM) and compare it to dilated cardiomyopathy (DCM). Results The mean global longitudinal strain (GLS) was significantly lower in AUCM (P value = 0.045). Comparing segmental strain showed a lower strain in mid inferoseptal (P value = 0.048), base and mid anterolateral (P value = 0.026, 0.001 respectively), base and mid anteroseptal (P value = 0.005, 0.009 respectively), base and mid inferior (P value = 0.015, 0.034 respectively) and mid anterior (P value = 0.015) in patients with AUCM compared with DCM. In both groups, the segmental strain increased from base to apex. Conclusions Segmental and GLSs in advanced uremic cardiomyopathy were significantly lower than those of dilated cardiomyopathy. In both groups, the segmental strain increased from base to apex