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 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

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

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

Correlation of Hematologic Indices with CT-pulmonary Arterial Obstruction Index in Patients with Acute Pulmonary Emboli

Introduction: Acute Pulmonary thromboembolism (PTE) is an imperative medical condition with a considerable global impact. Inflammation is deemed to take a notable part in the pathophysiology of this potentially fatal disorder. The aim of the current study was to predict acute PTE severity in helical pulmonary CT-angiography using easily accessible hematological complete blood count (CBC) indices.Methods: After exclusion of inflammatory conditions that may affect CBC parameters, a total of 69 consecutive patients with definite diagnosis of acute PTE according to pulmonary helical CT –angiography were recruited. Laboratory tests, including CBC parameters were performed on admission in the emergency unit, before initiation of any therapy. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and RDW to platelet ratio (RPR) were calculated in each case of acute PTE. Ultimately, CT pulmonary arterial obstruction index (PAOI) was assessed subsequent to pulmonary helical CT-angiography for each patient.Results: We found that NLR is positively correlated with acute PTE severity according to CT pulmonary arterial obstruction index (PAOI) (P < 0.01, r = 0.56); however, PLR, RDW and RPR did not appear to show such correlations (P > 0.05).Conclusions: NLR could be an easily calculated and capable index to predict severity of acute PTE in pulmonary CT-angiography. Consequently, NLR might be used in precise risk stratification when suspicious for acute PTE and in accurately triage of patients who would benefit greatly from urgent diagnostic and therapeutic interventions

Stent-assisted coiling of large common femoral artery pseudoaneurysm following coronary artery catheterization: an uncommon and novel approach

The femoral artery pseudoaneurysm is a disturbing groin complication associated with the femoral arterial access site used for invasive cardiovascular interventions. We present a 39 year old man who developed a huge right common femoral artery pseudoaneurysm, following diagnostic coronary artery catheterization, which was successfully managed with stent-assisted coiling, an emerging and narrative option in invasive percutaneous approaches to femoral artery pseudoaneurysm

Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention

A new approach to cardiac fat volume assessment and the correlation with coronary artery calcification

Background. Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD

AV nodal reentrant tachycardia with a 2:1 right bundle branch block missed as bidirectional ventricular tachycardia in the first superficial evaluation

A 95-year old woman was admitted to our emergency unit because of acute abdominal pain. After urgent surgery according to the acute abdomen, she was referred to intensive care unit (ICU) of the emergency unit as she was intubated. It was developed a run of new arrhythmia which was diagnosed by cardiology resident as bidirectional ventricular tachycardia due to beat to beat changing the axis of the QRS. However, a second and more precise evaluation of the abnormal ECG suggested a narrow supraventricular tachycardia, most probably AV nodal reentrant tachycardia with a 2:1 right bundle branch block

Comparison of coronary risk factors and angiographic findings in younger and older patients with significant coronary artery disease

Background. Coronary artery disease (CAD) is uncommon among young adults and may have certain characteristics that are different from those in older patients. The aim of the current study was to determine the risk factors of CAD, important laboratory data and angiographic findings in young patients with CAD and to compare them with the old patients