Correlation between endothelial dysfunction in normal coronary patients with slow flow and aortic ectasia: The first report

Background: Slow coronary flow (SCF) is slow dye progression in the coronary arteries during selective angiography, but there is no such study about greater visceral vessels. Studies have suggested that flow-mediated dilation (FMD) is impaired in SCF. Endothelial function can be assessed by FMD in the brachial artery as ischemia-induced vasodilation. Since inflammation is an underlying pathology in the inflammation of visceral vessels and probably SCF, we studied the correlation of aortic ectasia and SCF by means of FMD. Methods: Patients with normal coronary arteries and SCF formed the case group, and patients with normal coronary arteries and normal coronary flow formed the control group. We measured the diameter of the patients’ brachial artery at rest, after inflation of a sphygmomanometer on the forearm [endothelial-dependent vasodilation (EDV)], and after use of sublingual nitrate (endothelial-independent vasodilation) by sonography. We also measured the diameter of the aorta using sonography before administration of sublingual nitrate. Endothelial dysfunction was defined as EDV significantly less than standard EDV. Results: There were insignificant differences between age, gender, and frequency of cardiac risk factors within the case and control groups, but diabetes mellitus was significantly different between the two groups. The diameter of the aorta was insignificantly different between the case and control groups. The response of the brachial artery to the cuff test and sublingual nitrate were insignificantly different between the case and control groups. Endothelial dysfunction based on cuff test and sublingual nitrate administration was significantly more common in men than women, as the p values for cuff and sublingual nitrate were 0.033 and 0.051, respectively. Conclusions: It seems that there is no correlation between SCFP and aortic ectasia

Can opium abuse be a risk factor for carotid stenosis in patients who are candidates for coronary artery bypass grafting?

Background: Over the centuries, opium has been the most frequent substance abused in the Middle East. There are many controversial aspects about the effects of opioids on the atherosclerosis process, which is still unclear. Methods: All patients who were candidates for coronary artery bypass graft in Tehran Heart Center were registered and evaluated for risk factors such as diabetes mellitus, hypertension, smoking status and duration, opium abuse, involved coronary arteries and left main branch lesion > 50%, carotid stenosis &#8805; 70%. Results: A total of 1,339 patients were enrolled in the study, of whom 400 (29.9%) were female and the other 939 (70.1%) male. Female patients were omitted from analysis due to the low numbers of female opium addicts. Our study revealed that in the addicted population, the risk of diabetes and hypertension was lower than in the non-addicted group (p < 0.05 for each variable) and fasting blood sugar tended to be less in addicted ones, but the number of involved coronary arteries, left main stenosis > 50% and extent of carotid stenosis was not significantly different between the two groups. Conclusions: Our investigations demonstrate that opium is not cardioprotective, as has been claimed by some previous studies, and does not even decelerate atherosclerosis of carotid arteries in opium-addicted patients, but more evidence is still needed to completely prove the case. (Cardiol J 2010; 17, 3: 254-258

Huge ascending aortic pseudoaneurysm 13 years after Bental surgery with tube graft

Pseudoaneurysms of the ascending aorta are rare, disastrous complications of surgical manipulation of the aorta and its surroundings. They frequently require emergency surgical intervention due to a high risk of sudden rupture and hemorrhage. We herein present the case of a pseudoaneurysm (130 mm in diameter) of the ascending aorta with a compressive effect on the left atrium and right coronary artery ostium at the site of a tube graft implanted 13 years previously via the Bental procedure in a 34 year-old man. The susceptibility of these pseudoaneurysms to silently increase in size through the years leads to a delayed diagnosis, with an increased risk of rupture and mortality, necessitating long-term follow-ups with a view to detecting it in the initial stages, when it is easier to perform surgical or endovascular interventions with a lower risk of mortality. (Cardiol J 2011; 18, 2: 185-188

Ogromny tętniak rzekomy aorty wstępującej po 13 latach od operacji Bentalla z wszczepieniem cylindrycznego konduitu

Tętniaki rzekome aorty wstępującej są rzadkimi, katastrofalnymi powikłaniami zabiegów chirurgicznych przeprowadzanych na aorcie i w jej okolicy. Wymagają one często interwencji chirurgicznej w trybie nagłym ze względu na duże ryzyko nagłego pęknięcia i krwotoku. W pracy przedstawiono przypadek tętniaka rzekomego (o średnicy 130 mm) aorty wstępującej u 34- -letniego mężczyzny, który uciskał lewy przedsionek i miejsce odejścia prawej tętnicy wieńcowej, a znajdował się w miejscu cylindrycznego konduitu wszczepionego 13 lat wcześniej podczas operacji Bentalla. Skłonność tych tętniaków rzekomych do niemego klinicznie powiększania się w ciągu wielu lat prowadzi do opóźnienia rozpoznania, co wiąże się ze zwiększonym ryzykiem pęknięcia i zgonu. Konieczna jest więc długoterminowa obserwacja takich chorych, aby można było wykrywać opisane zmiany w początkowych stadiach, kiedy łatwiej wykonywać interwencje chirurgiczne lub wewnątrznaczyniowe z mniejszym ryzykiem zgonu. Folia Cardiologica Excerpta 2011; 6, 2: 135&#8211;13

Aortic dissection type I in a weightlifter with hypertension: A case report

Acute aortic dissection can occur at the time of intense physical exertion in strength-trained athletes like weightlifters, bodybuilders, throwers, and wrestlers

Comparing the effect of cardiac biomarkers on the outcome of normotensive patients with acute pulmonary embolism

Acute pulmonary embolism (PE) is a cardiovascular challenge with potentially fatal consequences. This study was designed to observe the association of novel cardiac biomarkers with outcome in this setting. In this prospective study, from 86 patients with a confirmed diagnosis of PE, 59 patients met the inclusion criteria (22 men, 37 women; mean age, 63.36±15.04 y).The plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), tenascin-C, and D-dimer were measured at the time of confirmed diagnosis. The endpoints of the study were defined as the short-term adverse outcome and long-term all-cause mortality. Totally, 11.8% (7/59) of the patients had the short-term adverse outcome. The mean value of logNT-proBNP was 6.40±1.66 pg/ml. Among all the examined biomarkers, only the mean value of logNT-proBNP was significantly higher in the patients with the short-term adverse outcome (7.88±0.67 vs. 6.22± 1.66 pg/ml; OR, 2.359; 95% CI, 1.037 to 5.367; P=0.041). After adjustment, a threefold increase in the short-term adverse outcome was identified (OR, 3.239; 95% CI, 0.877 to 11.967; P=0.078).Overall, 18.64% (11/59) of the patients had expired by the long-term follow-up. Moreover, adjustment revealed an evidence regarding association between increased logNT-proBNP levels and long-term mortality (HR, 2.163; 95%CI, 0.910 to 5.142; P=0.081). Our study could find evidences on association between increased level of NT-proBNP and short-term adverse outcome and/or long-term mortality in PE. This biomarker may be capable of improving prediction of outcome and clinical care in non-high-risk PE

Diagnosis of aortic interruption by CT angiography

Background: Interrupted aortic arch (IAA) is a rare congenital malformation of the aortic arch, which might be accompanied with other coexisting cardiovascular anomalies. Case Report: Many cases with IAA are diagnosed at their neonatal and newborn period but in rare cases the diagnosis is not established until adulthood. The patients may have no clinical symptoms but the signs of heart failure will gradually appear and may cause death. Results: The development of imaging methods such as computed tomography (CT) and magnetic resonance (MR) imaging has dramatically changed the diagnostics. Here we report a 20-year-old young man with IAA associated with sinus venosus atrial septal defect (SVD) and partial anomalous pulmonary venous connection (PAPVC) referred to our hospital

Acute Respiratory Distress Syndrome Diagnosis after Coronary Artery Bypass: Comparison between Diagnostic Criteria and Clinical Picture

Acute Respiratory Distress Syndrome (ARDS) is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2) less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG) in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB) recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2≤200mmHg) and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases) criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study) was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 %) in the 24 hours and 4 (1.33%) patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937) and sex (P.value=0.533). Duration of intubation in patients with ARDS (14.26 ± 4.25 hours) in the first 48 hours was higher but not statistically different from the group without ARDS (11.60 ± 5.45 hours) (P.value=0.236). ARDS diagnosis based on rapid onset of hypoxemia (PaO2/FiO2≤200 mmHg) and diffuse pulmonary infiltrates and without signs or symptoms of obvious heart failure criteria in patients undergoing CABG could lead to overdiagnosis or misdiagnosis in less than 24 hours follow up. We recommend following patients for more than 24 hours and revise the current ARDS criteria for CABG patients

Effects of Strength Training and Cardiac Rehabilitation Programs on the Biomechanical Parameters of Blood Flow Velocity and Blood Flow Rate and Its Relation With Arterial Stiffness Index in Brachial and Femoral Arteries with Coronary Artery Bypass Grafting Patients (CABG)

Objective: Assuming that cardiac rehabilitation and exercise significantly reduces mortality rate in coronary artery disease and has an important role in secondary prevention, the purpose of this study is to assess the effects of strength training and cardiac rehabilitation programs on biomechanical parameters of blood flow velocity and blood flow rate and these relationships with the brachial and femoral artery stiffness index in patients with coronary artery bypass graft (CABG) in past 2 months. Materials & Methods: This study was performed on 40 women and men, with 50 to 80 years old who were underwent CABG. Training group had 18 patients who participated in strength training and rehabilitation program for two months. There were three sessions in a week and patients trained according to determined level of each patient's functional capacity. The control group had 14 patients who did not participate in the training program. Variables blood flow velocity and arterial diameter in systole and diastole phases measured with Doppler ultrasound and the mean velocity of blood flow rate in arteries and arterial stiffness index was calculated for both groups. For statistical analysis dependent t-test was used in significance level of 0. 05 and Pearson correlation coefficient was applied for measuring the relation between parameters in significant level of 0.01. Results: The significant changes in velocity, blood flow rate and decreased arterial stiffness index in arteries were observed in the training group. Conclusion: According to our results, we can say strength training and cardiac rehabilitation programs can be effective in improvement of peripheral vascular and bleeding tendency in these patients