Acute myocardial infarction in a patient with post-splenectomy thrombocytosis: A case report and review of literature

Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis (RT) is usually considered a benign process without thrombotic complications. We describe a case of acute myocardial infarction in a young heavy smoker with RT following splenectomy. Coronary angiography showed a linear filling defect at mid-part of left anterior descending artery. We performed balloon angioplasty and stenting for this lesion. Aspirin and clopidogrel were administered. His in-hospital course was uneventful and platelet count returned to the normal range at four month follow-up. We concluded that RT may not be an entirely benign process, especially in patients with a history of smoking. Regular monitoring of platelet count, and possibly antithrombotic agents like aspirin prescription for high risk patients with moderate thrombocytosis, may be useful. (Cardiol J 2010; 17, 1: 79-82

Aneurysmal coronary arteriovenous fistula closing with covered stent deployment: A case report and review of literature

Coronary arteriovenous fistula (CAVF) is a rarely encountered congenital coronary anomaly, in which coronary artery blood flow bypasses the myocardial capillary network and usually drains to a heart chamber or great vessel. It is usually asymptomatic. However, the risk of symptoms and complications increases with age. High output heart failure, pulmonary hypertension, myocardial ischemia and infective endocarditis may complicate the course of this anomaly. The appearance, and even rupture, of a saccular aneurysm is one of the even rarer complications of CAVF. Here we describe a 57 year-old patient with incidental finding of an aneurysmal CAVF which was treated successfully using covered stent. (Cardiol J 2011; 18, 5: 556–559

Abnormal heart rate recovery after exercise predicts coronary artery disease severity

Background: Slow heart rate recovery (HRR) after exercise is considered to represent impaired parasympathetic tone and to be a predictor of all-cause and cardiovascular mortality, but the independent value of abnormal HRR in predicting the presence and severity of coronary artery disease (CAD) is unknown. The aim of this study was to evaluate these relationships in our patients. Methods: This prospective cross-sectional study included 208 patients (67.3% men), aged 34 to 74 (mean 53) years. Patients who had an ischemic response during symptom-limited exercise testing underwent selective coronary angiography. The value for HRR was defined as the decrease in heart rate from peak exercise to one minute after the exercise ceased. Eighteen beats per minute was defined as the lowest normal value for HRR. Results: Significant CAD was detected in 140 (67.3%) patients. There were 66 (31.7%) patients with an abnormal HRR. In multivariable logistic regression analysis adjusted for established CAD risk factors, abnormal HRR was independently correlated with the extent of major epicardial coronary involvement (p = 0.04). The sensitivity, specificity, positive and negative predictive values, and accuracy of abnormal HRR for predicting extensive CAD were 48%, 83.3%, 72.7%, and 63.4%, respectively. There was also a significant correlation between HRR one minute after exercise and smoking (p = 0.004), chronotropic variables (p = 0.001), and the calculated risk score for the exercise test (p = 0.03). There was no significant correlation between HRR and other risk factors including age and gender, left ventricular systolic function, and history of myocardial infarction. Conclusions: There is a significant correlation between abnormal post-exercise HRR at one minute and the extent of major epicardial coronary involvement. (Cardiol J 2011; 18, 1: 47-54

Transpulmonary closing of left internal mammary artery to pulmonary artery fistula with polytetrafluoroethylene covered stent: A case report and review of literature

Internal mammary artery (IMA) to pulmonary vasculature fistula is a rare condition that can be congenital or associated with coronary artery bypass grafting surgery (CABG), trauma, inflammation, or neoplasia. This complication may cause myocardial ischemia. CABG with an IMA conduit accounts for most iatrogenic cases, thus this problem may be encountered more in the future as the number of patients undergoing CABG and redo-CABG increases. The natural history of IMA-to-pulmonary artery (PA) fistulas is unknown and therefore optimal treatment remains controversial. We describe a case of left IMA-to-PA fistula treated with balloon expandable covered stent with a transpulmonary approach, and we review previously reported cases

Zamknięcie tętniakowato poszerzonej przetoki tętniczo-żylnej naczyń wieńcowych z użyciem stentu powlekanego: opis przypadku i przegląd piśmiennictwa

Przetoka tętniczo-żylna naczyń wieńcowych (CAVF) jest rzadko spotykaną wrodzoną wadą naczyń wieńcowych, w której krew omija układ włośniczek miokardium i wpływa bezpośrednio do komór serca lub dużych naczyń. Najczęściej nie powoduje żadnych objawów, ale ryzyko ich pojawienia się oraz wystąpienia powikłań wzrasta wraz z wiekiem. Do głównych powikłań zalicza się niewydolność serca, nadciśnienie płucne, chorobę niedokrwienną serca oraz infekcyjne zapalenie wsierdzia. Powstanie, a nawet pęknięcie, tętniaka workowatego stanowi jedno z najrzadszych powikłań CAVF. W niniejszej pracy opisano 57-letniego pacjenta z przypadkowo wykrytym tętniakiem CAVF skutecznie leczonym wszczepieniem stentu powlekanego (Folia Cardiologica Excerpta 2012; 7, 2: 115-119

The value of serum osteoprotegerin levels in patients with angina like chest pain undergoing diagnostic coronary angiography

Background: Osteoprotegerin (OPG) is a member of the tumor necrosis factor superfamily.Recent evidence supports a relationship between serum OPG level and atherosclerosis. Theaim of this study was to evaluate the possible association of OPG with the presence of coronary artery disease (CAD), its severity and prognosis in patients with chest pain and suspected coronary stenosis.Methods: In this cross-sectional analytic study, 180 candidates of elective coronary artery angiography were recruited. Serum level of OPG was measured by ELISA method in all patientsand its relation with presence and severity of CAD based on a coronary atherosclerosis score (CAS) was assessed. Patients were followed for a mean period of about 24 ± 3.2 months andthe relationship between OPG levels and future cardiac events were evaluated.Results: The mean serum level of OPG was 1637 ± 226 pg/mL in those with CAD and 1295 ± 185 pg/mL (nonparametric p = 0.001) in those without it. There was a significant directcorrelation between the level of serum OPG and CAS (rho = 0.225, p = 0.002). The optimalcut-off point for predicting a significant coronary artery obstruction was a serum level of ≥ 1412 pg/mL with a sensitivity and specificity of 60% and 57.8%, respectively. Major adversecardiac events (MACE) including cardiovascular death, admission with acute coronary syndrome,or heart failure, was significantly higher in those with higher OPG levels (22 [34.3%]vs. 15 [16%], p = 0.012).Conclusions: There was a direct and significant correlation between the serum level of OPGand CAS. MACE occurred more commonly in those with higher baseline OPG levels

Electrocardiographic left ventricular hypertrophy is not associated with increased in-hospital adverse events in patients experiencing first non-ST segment elevation myocardial infarction: A single center study

Background: There is conflicting data about prognostic implication of electrocardiographic (ECG) left ventricular hypertrophy (LVH) in patients with first non- ST-segment elevation myocardial infarction (NSTEMI). We aimed to examine the association of left ventricular hypertrophy (LVH) on admission electrocardiogram with adverse outcomes in patients with NSTEMI. Methods: In the present study, 460 patients (77.5 males with mean age of 65.44±13.15 years) with first NSTEMI were evaluated. ECG left ventricular hypertrophy (LVH) was diagnosed based on Sokolow-Lyon voltage criteria. Baseline laboratory and clinical results, angiographic data, as well as in- hospital adverse events were compared between the patients with and without LVH. Results: Electrocardiographic LVH was observed in 74 (16.1) patients. Patients with LVH had higher admission systolic blood pressure (132.91±21.08 vs 125.80±21.78; P=0.01) and higher peak troponin (6.42±1.03 vs 4.41±0.28; P=0.004), but less likely to undergo coronary angiography (54.1 vs 66.8; P=0.03) .Patients with electrocardiographic LVH had similar in-hospital mortality (5.4 vs 3.6, P=0.5) and heart failure/ pulmonary edema (2.7 vs 2.07, P=0.6) compared to patients without LVH. Conclusion: The present study showed that among the patients with first NSTEMI, electrocardiographic LVH was not associated with increased in-hospital adverse events

Association of Significant Mitral Regurgitation and Left Ventricular Dysfunction With ALCAPA Syndrome in a Young Patient

Anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) is not a common anomaly in adulthood. Its early diagnosis requires physician suspicion and the early treatment of disease can prevent its serious side effects. In this article, we presented a young female with pansystolic murmur and heart failure with final diagnosis of ALCAPA syndrome

Atherosclerosis preventive effects of marrubiin against (TNF-α)-induced oxidative stress and apoptosis

Introduction: Atherosclerosis is a complicated cascade of inflammatory processes, oxidative stress, and apoptosis, making it the most prevalent cardiovascular disease. The onset and progression of cardiovascular diseases are greatly influenced by oxidative stress. Targeting oxidative stress is an effective strategy for treating such diseases. Marrubiin is a bioactive furan labdane diterpenoid acts as a strong antioxidant to protect against oxidative damage. This study aimed to investigate the protective effects of marrubiin against oxidative stress and apoptosis in a cellular model of the vascular system. Methods: Human umbilical vein endothelial cells were treated with varying concentration of marrubiin and its IC50 value was determined. The antioxidant potential of marrubiin was assessed by measuring the intracellular level of glutathione (GSH) using a colorimetric technique. Since apoptosis plays a significant role in the plaque rupture, the study also evaluated the protective effects of marrubiin on the expression of key genes involved in apoptotic pathways. Results: Cells treated with marrubiin showed increased GSH levels compared to cell therapy control cells, indicating marrubiin’s ability to counteract the effects of TNF-α’s on GSH levels. Furthermore real-time PCR analysis demonstrated that marrubiin upregulated Bcl-xl while downregulating caspase3 and Nox4 in treated cells. These findings suggest that marrubiin protects against apoptosis and oxidative stress. Conclusion: Based on our findings, marrubiin is recommended as a preventive/therapeutic treatment for diseases caused by elevated intracellular reactive oxygen species levels in cardiovascular diseases