Incidence Rate and Risk Factors of Radial Artery Spasm during Transradial Coronary Angiography

Background: Radial artery spasm (RAS) is one of the most common complications of radial coronary angiography. Several demographic and clinical factors increase the risk of RAS in this procedure. We aimed to evaluate the effect of various risk factors on the incidence and severity of RAS in radial coronary angiography.  Methods: This cross-sectional study was performed on 120 patients who were randomly selected from candidates referred to Shahid Modarres Educational Medical Center for coronary angiography by the radial method. After angiography, radial arteriography was performed to diagnose spasms. The association of some demographic and clinical factors with the incidence and severity of RAS was evaluated. Results: 35 of the 120 patients (29.16%) developed RAS during angiography. Shorter height, shorter radius bone length, less radial artery diameter, longer procedure length, diabetes mellitus, more catheters used, and female sex were significantly associated with higher incidence. The predictive power of these factors for the occurrence of spasms was very good with AUC=0.88. Age, shorter height, higher body mass index, smaller radial artery diameter, longer procedure time, diabetes mellitus, failure of initial effort for puncture, number of catheters used, and female sex were significantly associated with the severity of spasms. Conclusions: The incidence or severity of spasms during the procedure can be reduced by examining the available risk factors for every patient before deciding to perform angiography

Bleeding in Patients with Atrial Fibrillation Plus Coronary Artery Disease under Triple anti-Coagulant Therapy

Introduction: Regarding scarce knowledge about bleeding in non-valvular atrial fibrillation (AF) patients with simultaneous coronary artery disease (CAD) under triple anti-coagulant therapy, this study was carried out to recognize the risk of hemorrhage and preventive programming. Materials and Methods: In this performed prospective, 150 consecutive patients with non-valvular atrial fibrillation and concurrent coronary disease, candidate for triple therapy with Asprin 80 mg, Clopidogrel 75 mg and Rivaroxaban 15 mg (in Shohada, Loghman, Modarres, and Labafinezhad centers, in Tehran, Iran during Jan 2019 to Jan 2020 were enrolled and the incidence rate of bleeding and compliance were evaluated for one month. Results: The results in this study demonstrated that 87.3% had compliance and completely use three drugs. Bleeding occurred in 0.6 % (4 patients), no major bleeding , only one minor bleeding as GIB, three minimal cases (totally 4 bleeding cases), 3 cases with epistaxis, 7 patients with ecchymosis, 6 subjects with hematuria, no one required discontinuation of drug. Diabetes mellitus, hypertension, female sex, older age, higher HASBLED Score, and higher CHADS-VASC Score were related to lack of compliance (P < 0.05). Conclusion: Incidence rate of bleeding in atrial fibrillation plus coronary concurrent patients, candidate for triple therapy with ASA, Clopidogrel and Rivaroxaban is low. Also the bleeding is minor and the compliance is high showing that majority of cases use routinely these triple therapy regimen

Worsened Dysrhythmia after Chemical Cardioversion with Digoxin; a Case of Malpractice

The patient was a 23-year-old man referred to the emergency department (ED) with the chief complaint of palpitation. The patient experienced dizziness, cold sweating, and lightheadedness after getting up which started spontaneously. He had four episodes of the same problems in seven months ago that felt better after taking 10 mg propranolol. But, in the current episode his problem was not solved by the same medication. He had no history of smoking, substance abuse, medication use, congenital heart disease, syncope, previous surgery, chest trauma, or any other known medical problems. As well, he had no any positive history of the same problems in his family. The patients’ on-arrival vital signs were as follow: systolic blood pressure (SBP): 90 mmHg, pulse rate (PR): 150/minute, respiratory rate (RR): 14/minute, oral temperature: 37◦C, oxygen saturation 96% with nasal cannula and 100% oxygen, Glasgow coma scale (GCS) 15/15. He was not experienced any other concomitant problems such as ischemic chest discomfort, shortness of breathing, or sign of circulatory shock such as paleness, mottling, etc. On general physical examination the patients’ lung and heart sounds, four limbs pulses, and capillary refile were normal. As well, focused neurological and abdominal examinations did not have any positive finding. The patient underwent close cardiac, vital sign monitoring and electrocardiography (ECG). Figure 1 shows the on-arrival patients’ ECG. Atrial fibrillation (AF) was diagnosed by the corresponding physician and digoxin (!?) prescribed that led to severe lethargy, weakness, sweating, and bradycardia. Figure 2 shows the post mediation ECG of patient

Electrocardiographic Findings of COVID-19 Patients and Their Correlation with Outcome; a Prospective Cohort Study

Introduction: Being infected with COVID-19 is associated with direct and indirect effects on the cardiopulmonary system and electrocardiography can aid in management of patients through rapid and early identification of these adversities. Objective: The present study was designed aiming to evaluate electrocardiographic changes and their correlation with the outcome of COVID-19 patients. Methods: This Prospective cohort study was carried out on COVID-19 cases admitted to the emergency department of an educational hospital, during late February and March 2020. Electrocardiographic characteristics of patients and their association with in-hospital mortality were investigated. Results: One hundred and nineteen cases with the mean age of 60.52±13.45 (range: 29-89) years were studied (65.5% male). Dysrhythmia was detected in 22 (18.4%) cases. T-wave inversion (28.6%), pulmonale P-wave (19.3%), left axis deviation (19.3%), and ST-segment depression (16.8%) were among the most frequently detected electrocardiographic abnormalities, respectively. Twelve (10.1%) cases died. There was a significant correlation between in-hospital mortality and history of diabetes mellitus (p=0.007), quick SOFA score > 2 (p<0.0001), premature ventricular contraction (PVC) (p=0.003), left axis deviation (LAD) (p=0.039), pulmonale P-wave (p<0.001), biphasic P-wave (p<0.001), inverted T-wave (p=0.002), ST-depression (p=0.027), and atrioventricular (AV) node block (p=0.002). Multivariate cox regression showed that history of diabetes mellitus, and presence of PVC and pulmonale P-wave were independent prognostic factors of mortality. Conclusions: Based on the findings of the present study, 18.4% of COVID-19 patients had presented with some kind of dysrhythmia and in addition to history of diabetes, presence of PVC and pulmonale P-wave were among the independent prognostic factors of mortality in COVID-19 patients

Paradoxical Embolism in a Patient with Patent Foramen Ovale; a Case Report

Patent foramen ovale (PFO) is usually asymptomatic; however, it could be quite dangerous for patients with right side clot in which thrombus can transmit the PFO and paradoxically emboli to systemic circulation. Here we present a patient with ankle fracture and paradoxical embolus to the brain, who was successfully treated with emergent thrombectomy, inferior vena cava (IVC) filter placement and anticoagulation therapy. Despite the high rate of mortality in these patients, fortunately our patient survived with surgical treatment

Evaluation of Association between duration of Hospitalization in-Patient with Deep Venous Thrombosis and the type of Treatment Considering the Effect of Comorbid Diseases

Introduction: Deep vein thrombosis (DVT) is a common disease with serious risks such as pulmonary embolism and there are different anticoagulant therapies for treatment of this condition. In this study, we investigated the association between the duration of hospitalization with different treatment methods and comorbidities. Materials and methods: In this retrospective cross-sectional study, the hospital records of 213 patients with a diagnosis of acute DVT in Shohada-e-Tajrish Hospital in 2019 and 2020 were reviewed. Patients were divided into five main groups and five subgroups based on the type of treatment. Then, the association between the duration of hospitalization and different treatment methods was studied. Results: Treatment with novel oral anticoagulants (NOACs) with an average length of 2.5 days of hospitalization significantly reduces the duration of hospitalization. Combination therapy with low molecular weight heparin (LMWH) and warfarin or LMWH alone, with an average of 8.38 and 8.20 days, is preferable to treatment with unfractionated heparin (UFH) and warfarin, with an average of 9.2 days. Warfarin treatment with an average duration of hospitalization of 8.43 days is in the third place. The use of other methods has increased the duration of hospitalization. History of comorbidities including history of hospitalization, hypertension, smoking, cancer and trauma are the five comorbidities that have the greatest effect on the length of hospitalization of patients, respectively. Conclusion: According to the present study, treatment with NOACs reduces the duration of hospitalization of patients more than the other treatment methods. The second best choice is LMWH injection therapy and continuation with warfarin or starting and continuing treatment with LMWH preferable to injecting treatment with UFH and continuing with warfarin. The type of underlying disease and comorbidities had a significant effect on the duration of hospitalization

Effect of Nocturnal Oxygen Therapy on Electrocardiographic Changes Among Patients with Congestive Heart Failure

Introduction: Nocturnal hypoxia is an important factor in increasing the risk of mortality in patients with chronic heart failure and is associated with atrial and ventricular arrhythmias. In addition, QT dispersion (QTd) is used as a prognostic sign in determining future malignant arrhythmias and sudden cardiac death. In the current study, we investigated the effect of nocturnal oxygen therapy (NOT) on electrocardiographic changes among patients with chronic heart failure.Methods: In this study, a consecutive of 154 patients (87 males and 67 females) known with chronic heart failure (EF ≤ 40%) were enrolled. The patients were administered NOT (oxygen flow of 2 L/min for 8 hours during sleeping). Electrocardiography was takenbefore and after the NOT, and RR interval, PR interval and QTd were measured each time.Results: The mean age of the participants was 61.3 ± 11.4 years. Our results revealed significant reduction in QTd (55.8 ± 7.5 vs. 61.4± 9.1 msec, P = 0.001) and heart rate (79.6 ± 4.7 vs. 76.8 ± 4.3, P = 0.001) in a patient’s electrocardiogram after NOT.Conclusions: In this study, NOT decreased heart rate and QTd in patients with chronic heart failure, but not PR interval, which could consequently decrease the risk of malignant arrhythmias and sudden cardiac death

The Relationship of ST Segment Changes in Lead aVR with Outcomes after Myocardial Infarction; a Cross Sectional Study

Introduction: Among the 12 leads studied in electrocardiography (ECG), lead aVR can be considered as the most forgotten part of it since no attention is paid to it as the mirror image of other leads. Therefore, the present study has been designed with the aim of evaluating the prevalence of ST segment changes in lead aVR and its relationship with the outcome of these patients.Methods: In this retrospective cross sectional study medical profiles of patients who had presented to emergency department with the final diagnosis of myocardial infarction (MI) in a 4-year period were evaluated regarding changes of ST segment in lead aVR and its relationship with in-hospital mortality, the number of vessels involved, infarct location and cardiac ejection fraction.Results: 288 patients with the mean age of 59.00 ± 13.14 (18 – 91) were evaluated (79.2% male). 168 (58.3%) patients had the mentioned changes (79.2% male). There was no significant relationship between presence of ST changes in lead aVR with infarct location (p = 0.976), number of vessels involved (p = 0.269) and ejection fraction on admission (p = 0.801). However, ST elevation ≥ 1 mv in lead aVR had a significant relationship with mortality (Odds = 7.72, 95% CI: 3.07 – 19.42, p < 0.001). Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of ST elevation ≥ 1 for prediction of in-hospital mortality were 41.66 (95% CI: 22.79 – 63.05), 91.53 (95% CI: 87.29 – 94.50), 31.25 (95% CI: 16.74 – 50.13), 94.44 (95% CI: 90.65 – 96.81), 0.45 (95% CI: 0.25 – 0.79), and 0.05 (95% CI: 0.03 – 0.09), respectively.Conclusion: Based on the results of the present study, the prevalence of ST segment changes in lead aVR was estimated to be 58.3%. There was no significant relationship between these changes and the number of vessels involved in angiography, infarct location and cardiac ejection fraction. However, presence of ST elevation ≥ 1 in lead aVR was associated with 8 times increase in in-hospital mortality risk

The Evaluation of the Effect of Hypothyroidism Treatment on Non-Alcoholic Fatty Liver Disease

Introduction: There is still controversy over the existence of a relation between hypothyroidism and fatty liver disease. The scale by which hypothyroidism can affect fatty liver disease progression is also to be determined. Therefore, our study aims to contribute in the determination of this relation. Materials and methods: This observational analytical-before and after study with 53 patients was conducted. The subjects were categorized as having either primary or subclinical hypothyroidism. The serum levels of thyroid stimulation hormone (TSH), free T3 (FT3), free T4 (FT4), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were measured and liver ultrasound was done to screen nonalcoholic fatty liver disease (NAFLD). Results: The study consisted of 41 women and 12 men with the mean age of 48.3 years. The mean TSH levels decreased after hypothyroidism treatment in patients. The mean levels of FT4 did not have a significant increase after treatment, although in patients with subclinical hypothyroidism this increase was significant. T3 levels increased significantly after treatment. Statistical studies showed that there was a significant change in the degree of fatty liver before and after hypothyroidism treatment. Conclusion: There was an explicit relation between hypothyroidism and non-alcoholic fatty liver disease as Hypothyroidism treatment can prevent non-alcoholic fatty liver disease progression

The Effect of Thyroid Hormone Replacement on the Metabolic Control and Insulin Resistance in Patients with Subclinical Hypothyroidism

Introduction: Studying the treatment effect of subclinical hypothyroidism in decreasing metabolic syndrome risk factors and cardiovascular diseases is necessary and can be helpful to control future disorders. In spite of various studies, the relationship between subclinical hypothyroidism and cardiovascular diseases remain controversial. Studies which consider the effects of subclinical hypothyroidism treatment on metabolic control and insulin resistance have not been done in the Islamic Republic of Iran yet. Materials and methods: In this interventional study, 153 patients with subclinical hypothyroidism (thyroid stimulation hormone (TSH) >5, normal T3 and T4 at least 2 times) were selected from Labbafinejad endocrine clinic. Laboratory tests were performed at 8 a.m. after 12-14 hours fasting. Patients were then treated with levothyroxine (25-50 µg daily). To adjust the dose, thyroid function tests (TFT) were checked every 2 months for 6 months. Collected data was used for analysis by spss18 software. Results: After 6 months treatment of subclinical hypothyroidism mean values improved in factors such as insulin resistance profile (fasting blood sugar (FBS), 2 hours post prandial (2hPP), fasting insulin and homeostasis model assessment estimated insulin resistance (HOMA-IR index), lipid profile (total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL), decreased c-reactive protein (CRP) and weight (all had P value<0.05). Treatment did not have significant effect on triglycerides (TG), waist circumference, body mass index (BMI), uric acid ad systolic/diastolic blood pressure (p values>0.05). But the number of cases with high systolic/diastolic blood pressure decreased significantly after 6 months treatment (P values=0.007 and 0.01). Conclusion: Subclinical hypothyroidism treatment is suggested according to mentioned effects, especially in cases with insulin resistance, lipid profile disturbance, obesity, and high blood pressure