Validity of Initial Clinical Diagnosis of Unstable Angina Based on the Invasive and Noninvasive Studies

Introduction: A few studies have focused on diagnostic performance of residents for controlling the patients with acute chest pain referring to chest pain units. We aimed to assess diagnostic performance of cardiology residents for controlling the patients with acute chest pain, considering invasive and non-invasive diagnostic modalities as the key standards to confirm or refuse diagnosis of unstable angina.Methods: One hundred and twenty nine patients with chest pain or angina referring to chest pain unit of Modarres hospital between 2013 and 2014 were assessed. The patients were categorized into two subgroups. The first group included 23 patients who were discharged by the resident in initial evaluation because of ruling-out diagnosis of unstable angina, but were assessed non-invasively by exercise test or SPECT as key standards. The second group included 106 patients who were hospitalized and admitted to CCU by residents’ order and also were assessed invasively by coronary angiography or noninvasively by exercise test or SPECT.Results: Overall, of 129 patients, 23 were initially diagnosed not to be necessarily hospitalized and thus were discharged by resident’s order. Of those, assessing by SPECT indicated positive result in five of 19 patients and by exercise test indicated positive result in 1 of 4 patients yielding a sensitivity of 83.3%, a specificity of 17.6%, a PPV of 26.3%, a NPV of 75.0%, and an accuracy of 34.8% for assessing disease by resident. The remaining 106 patients were admitted to CCU ward in accordance with the resident’s order. Among those patients, 85 underwent coronary angiography with positive results in 53 patients. Also, SPECT was positive in 10 of 19 patients and exercise test was positive in one of two patients yielding a sensitivity of 95.3%, a specificity of 0.0%, a PPV of 59.2%, a NPV of 0.0%, and an accuracy of 57.5%.Conclusions: For patients with suspicion to unstable angina, the decision of residents in chest pain units for discharging or admitting patients suspected to unstable angina is accompanied with high sensitivity but unacceptable specificity and thus using supplement diagnostic tools such as exercise test or SPECT can be very helpful for diagnosing unstable angina

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

The effect of visual, proprioception and vestibular systems manipulation on postural control in boys with 4-16 years-old

زمینه و هدف: توانایی کنترل موقعیت های مختلف بدن در فضا ناشی از تعامل پیچیده سیستم های عصبی، حسی و اسکلتی- عضلانی است که به طور کلی به عنوان سیستم کنترل پاسچر تعریف می شود. هدف تحقیق حاضر بررسی تأثیر دستکاری سیستم های بینایی، حس عمقی، و دهلیزی بر کنترل پاسچر پسران 16-4 سال بود. روش بررسی: در این مطالعه مقطعی از نوع تحلیلی 240 پسر 16-4 سال در 4 گروه سنی و 60 مرد بزرگسال انتخاب شدند. جهت ارزیابی کنترل پاسچر آزمودنی ها از آزمون سازماندهی حسی دستگاه پاسچروگرافی پویای کامپیوتری استفاده شد. یافته‌ها: نتایج تحلیل واریانس یک راهه تفاوت معنی داری در کنترل پاسچر گروه ها نشان داد (05/0>P). براساس نتایج آزمون تعقیبی بونفرونی، در وضعیت اول و سوم، پسران تا سن 16 سالگی به کنترل پاسچری مشابه با افراد بزرگسال دست نمی یابند (p0.05)؛ اما تفاوت میان گروه های دیگر معنی دار بود (05/0>P). در وضعیت چهارم پسران 16-13 سال به کنترل پاسچری مشابه با افراد بزرگسال دست یافتند به طوری که تفاوت معنی داری میان این دو گروه مشاهده نشد (p>0.05). در وضعیت پنجم و ششم نیز پسران مورد مطالعه نتوانستند به کنترل پاسچری مشابه با افراد بزرگسال دست یابند (

Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO) have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78) and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8%) and 5 (10.6%) of the cases, respectively. Seven complications (all including coronary dissection) occurred. In-hospital major adverse cardiac events (MACE) rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05); in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05).Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast consumption and fluoroscopy time are recommended to be monitored during the procedure and thresholds should be defined to enhance safety and efficacy

Cardiac Failure as an Unusual Presentation in a Patient with History of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is the most well-known form of motor neuron diseases in which both upper and lower motor neurons are involved in this disease. We presented an unusual case of ALS whom had presented with chief complaint of dyspnea. Cardiac failure was diagnosed at the final stage of the ALS disease. The pathogenetic mechanism leading to an elevated occurrence of cardiomyopathy in ALS is not comprehensible. Dilated cardiomyopathy has been explained in some previous studies. Based on the collected data, it was hypothesized that cardiomyopathy is underdiagnosed in the ALS population, probably because symptoms are masqueraded as a result of the patients’ disability. It was suggested that in all motor neuron diseases a serial cardiological evaluation should be executed, including annual echocardiography

Case Report Cardiac Failure as an Unusual Presentation in a Patient with History of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is the most well-known form of motor neuron diseases in which both upper and lower motor neurons are involved in this disease. We presented an unusual case of ALS whom had presented with chief complaint of dyspnea. Cardiac failure was diagnosed at the final stage of the ALS disease. The pathogenetic mechanism leading to an elevated occurrence of cardiomyopathy in ALS is not comprehensible. Dilated cardiomyopathy has been explained in some previous studies. Based on the collected data, it was hypothesized that cardiomyopathy is underdiagnosed in the ALS population, probably because symptoms are masqueraded as a result of the patients' disability. It was suggested that in all motor neuron diseases a serial cardiological evaluation should be executed, including annual echocardiography

Successful Implantation of Coronary Sinus Lead after Balloon Angioplasty of a Coronary Vein Stenosis

A 55-year-old man referred for cardiac resynchronization therapy (CRT) due to severe heart failure. A severe stenosis in the coronary sinus vein after the posterior branch disallowed the insertion of the lead. Nevertheless, the stenosis was dilated and the left ventricle (LV) lead was implanted in the lateral marginal branch

Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study

Background. Obstruction of the access vein following cardiac pacemaker and defibrillator implantation is a common complication. However, the exact incidence and contributing risk factors are unknown. The aim of this study is to determine the incidence and analyze the contribution of each risk factor. Methods. 57 consecutive patients candidate for their first transvenous pacemaker, implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy device implantation were enrolled. After implantation, venography of the ipsilateral peripheral arm was performed. Patients underwent their second venography after the follow-up period of 3 to 6 months. Results. 42 patients (13 females, mean age 59.71 ± 12.33) completed the study. The followup venography showed significant venous obstruction (more than 50%) in 9 (21%) patients, but in none of the individuals, venography revealed total occlusion of the veins. Patients with obstruction had more leads in their veins (2.56 ± 0.53 vs 1.58 ± 0.71, P = 0.001). Venous obstruction was significantly more prevalent in patients with implanted cardiac resynchronization therapy device compared with an ICD or pacemaker (p = 0. 01). Age, gender, diabetes mellitus, hypertension, ischemic heart disease and antiplatelet consumption did not reveal any other contribution to the risk of thrombosis. In multivariate analysis, total lead number was a positive predictor for venous occlusion (P = 0.015, OR:19.2, and CI: 1.7-207.1). Conclusion. Venous obstruction is relatively frequent after pacemaker or ICD implantation. This study also shows that pacemaker and ICD leads have a similar risk for lead-related venous obstruction. However, patients with multiple leads are associated with an increased risk

A Combined Approach to Severe Multi-Organ Atherosclerosis

Severe coronary artery disease often coexists with peripheral vascular atherosclerosis. The assessment of the supra-aortic circulation is, therefore, of clinical relevance. We herein describe a case of coronary artery disease treated with surgical revascularization using the internal mammary artery and thereafter the progressive atherosclerotic disease of the native coronary arteries as well as the left subclavian and left renal arteries. We also describe and discuss the clinical presentation, the diagnostic procedures, and the therapeutic approach with respect to the percutaneous transluminal angioplasty of the subclavian, renal, and right coronary arteries