Successful closure of pulmonary artery aneurysm in a patient with Hughes-Stovin syndrome

Hughes-Stovin syndrome is a syndrome of unknown etiology characterized by thrombophlebitis and pulmonary aneurysms. Less than 40 cases have ever been reported in the English medical literature. We are reporting a 38-year-old man with a history of right ventricular thrombus and also deep vein thrombosis who presented with massive hemoptysis. Initial work-up revealed a round opacity on chest roentgenogram which later was diagnosed as a pulmonary artery aneurysm on subsequent imaging studies. Based on the history of thrombophlebitis with this newly diagnosed pulmonary artery aneurysm a diagnosis of Hughes-Stovin syndrome was made. The patient was treated with endovascular coiling of the aneurysm. A sixteen-month follow up was uneventful. To our knowledge, this is the first case of HSS ever reported from Iran and the fourth to have a cardiac chambers involvement in the course of the disease

High-Sensitive Troponin I and Re-Hospitalization in Patients With Decompensated Congestive Heart Failure

Patients with heart failure (HF) are frequently admitted for episodes of decompensation. Cardiac troponins are easily accessible biomarkers role of which for risk stratification of re-hospitalization among HF patients is less certain. We aimed to evaluate high-sensitive cardiac troponin I (hs-cTnI) levels among re-hospitalized patients with decompensated heart failure (D-HF). Consecutive subjects admitted with D-HF to 2 hospitals in Tehran, during the year 2014 were recruited. Excluded ones were patients with a suspected acute coronary syndrome or myocarditis/pericarditis, those with cardiopulmonary resuscitation/DC shock delivery, or major complications during or after hospitalization. Along with echocardiography parameters, level of hs-cTnI was checked at the first hour of hospitalization and 3 months after discharge. The patients were then categorized according to having or not having re-hospitalization during 3 months post discharge. A total of 97 patients were finally recruited. Among re-hospitalized patients, Left ventricular (LV) ejection fraction was significantly lower (38±14 % vs. 50 ± 12%; P=0.001), and LV end-systolic dimension was significantly higher (44±9 mm vs. 38±11 mm; P=0.012) compared to the other group. Moreover, levels of hs-cTnI were significantly higher among the re-hospitalized patients, both at initial visit (0.66±0.43 ng/ml vs 0.51±0.14 ng/ml, respectively; P=0.017) and at 3 months (0.59±0.48 ng/ml vs 0.48±0.23 ng/ml, respectively; P=0.030). This prospective study demonstrated that levels of hs-cTnI (both at the base and at follow up) are higher among patients who readmitted during 3 months of hospitalization for D-HF

Comparison of N-Terminal Pro B-Natriuretic Peptide and Echocardiographic Indices in Patients with Mitral Regurgitation

Introduction Echocardiographic indices can form the basis of the diagnosis of systolic and diastolic left ventricular (LV) dysfunction in patients with Mitral regurgitation (MR). However, using echocardiography alone may bring us to a diagnostic dead-end. The aim of this study was to compare N-Terminal pro B-natriuretic peptide (BNP) and echocardiographic indices in patients with mitral regurgitation. Methods 2D and Doppler echocardiography and BNP serum level were obtained from 54 patients with organic mild, moderate and severe MR. Results BNP levels were increased with symptoms in patients with mitral regurgitation (NYHAI: 5.7 ± 1.1, NYHAII: 6.9 ± 1.5, NYHAIII: 8.3 ± 2 pg/ml, P < 0.001). BNP plasma level were significantly correlated with MPI (myocardial performance index) (r = 0.399, P = 0.004), and following echocardiographic indices: LVEDV (r = 0.45, P < 0.001), LVESV (r = 0.54, P < 0.001), LVEDD (r = 0.48, P < 0.001), LVESD (r = 0.54, P < 0.001), dp/dt (r = −0.32, P = 0.019) and SPAP (r = 0.4, P = 0.006). Conclusion The present study showed that BNP may be useful in patients with MR and may confirm echocardiographic indices

Evaluating the Association Between Insulin–Like Growth Factor-1 Values and Short-Term Survival Rates Following Acute Myocardial Infarction

Backgrounds In recent years, low levels of Insulin-like Growth Factor-1 (IGF-1) have been suggested to be associated with higher risks of developing heart failure and higher long-term mortality rates following Acute Myocardial Infarction (AMI). However, the effect of IGF-1 levels on short-term survival has been rarely studied. In this study we aimed to assess any possible association between serum IGF-1 concentration following AMI and short-term survival rates. Methods In this study, serum total IGF-1 levels were measured in 56 patients within 24 hours following AMI and were compared to 56 individuals with no cardiovascular disease. Patients were followed up to death or discharge from hospital (median = 6 days) and survival curves were compared based on median IGF-1 value. Results Mean (±SD) of serum IGF-1 levels were 232.73 ng/ml (±81.74) and 211.00 ng/ml (±58.22) in survived and expired patients respectively and the difference was not statistically significant ( P value = 0.501). The difference between survival curves was also not statistically significant ( P value = 0.246). Conclusion According to findings of this study, serum total IGF-1 concentration does not seem to be associated with short-term survival rates

The value of wrist circumference for predicting the presence of coronary artery disease and metabolic syndrome

Background: Recently, the value of various structural body components have been proposed for predicting cardio-metabolic risk. The present study aimed to assess the wrist circumference (WrC) as an alternative measure for differentiating patients with CAD and METs from those without CAD and METs. Methods: We studied 228 consecutive subjects who underwent coronary angiography. Those with and without evidence of coronary artery involvement at angiography were considered as the coronary artery disease (CAD) group (n = 139) and the non-CAD group (n = 89), respectively. WrC was measured; and metabolic syndrome (METs) was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results: WrC was significantly higher in CAD compared to non-CAD patients (17.85 ± 1.29 mm vs 17.43 ± 1.29 mm, P = 0.017). The overall prevalence of METs was significantly different between the CAD and non-CAD subjects (74.3% vs 58.8%, P = 0.016). Although there was a tendency for association, no statistically significant association between the mean of the WrC and the severity of CAD was found (P = 0.065). WrC had a weak positive correlation with triglyceride (r = 0.172, P = 0.011) and cholesterol (r = 0.141, P = 0.038) level and a weak negative association with high-density lipoprotein level (r = −0.279, P < 0.001). In multivariate logistic regression models, WrC could predict neither presence of CAD nor METs. Conclusion: Although correlated with METs-type lipid profile, WrC may not be a valuable index for predicting the presence of CAD or METs

A Rare Electrocardiographic Manifestation of A Rare form of Multiple Electrolyte Disturbances: Hyperparathyroid Crisis

The surface electrocardiogram (ECG) has been used as a useful method for detection of metabolic disturbances for a long time. However, it may be difficult to distinguish the exact disturbance when more than one metabolic abnormality exists in a patient simultaneously. Although, "classic" ECG characterizations of common electrolyte disturbances are well described, multiple concurrent electrolyte disturbances may lead to ECG abnormalities that may not be easily detectable. This ECG concerns a 60-year-old male presented with general fatigue, weakness, epigastric pain, anorexia, nausea and extreme hypercalcemia (serum total and ionized calcium levels 20.5 mg/dL and 12.02 mg/dl, respectively), hypokalemia and hypomagnesemia associated with elevated parathyroid hormone (1160 pg/ml) and normal serum vitamin D level (97 ng/ml) . This rare manifestation of primary hyperparathyroidism has been named hyperparathyroid crisis in the literature. Hyperparathyroid crisis is an emergency form of multiple electrolyte abnormalities that manifest as a life-threatening hypercalcemia and simultaneous hypokalemia and hypomagnesemia; these two later are believed to be caused by diuretic effect of calcium on the renal tubules. The unique pattern of ECG in our patient first was misdiagnosed as prominent T waves with prolongation of the QT corrected (QTc) interval, which has been reported several times in patients with hyperparathyroidism crisis, compatible with our patient. But more investigation revealed that, the QTc interval not only is not prolonged, it is shortened as it is expected from the effect of hypercalcemia on electrocardiogram. The exact pattern of the patient`s ECG (figure 1) can be interpreted as it follows: (1) Flattening of the T wave, (2) a prominent U wave, (3) prolongation of the descending limb of the T wave such that it overlapped with the next U wave (4) virtual absence of ST segment and (5) shortening of the QT corrected interval. In conclusion, it should be emphasized when the T and U waves are separated by a very short segment they can mimic the appearance of a prolonged QT interval. However, more investigation can demonstrate the exact electrocardiographic pattern especially in multiple electrolyte disturbances, when "classic" ECG patterns are not expectable

Right Ventricular Thrombus in a 36-Year-Old Man with Factor V Leiden

Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients

Endovascular repair of the left sinus of valsalva pseudoaneurysm in a 33-year- old man with wegener's granulomatosis

Introduction: Pseudoaneurysm formation is a rare complication. If this condition remains untreated, it can lead to morbidity and mortality. Pseudoaneurysmcan be a consequence of iatrogenic trauma, vasculitis, infection, and sometimes it forms spontaneously. This condition was treated by surgery in the past. However, nowadays an interventional procedure is mentioned as an alternative for surgical treatment. Case Presentation: Here, wereport an unusual case of Wegener's granulomatosis complicated by pseudoaneurysmof the left sinus of Valsalva causing complete collapse of the left main coronary artery. The pseudoaneurysm was closed percutaneously using a membranous device. This study presented a patient with the rare large artery involvement inWegener's granulomatosis and tried to repair that without surgery. Long-term follow-up demonstrated that the procedures were successful

Pulsatility Index in Aortic Coarctation: A Possible Way to Evaluate Factors Affecting Stenting Outcome

Background: The pulsatility index (PI) shows continuous blood flow to the end organs and is a significant factor believed to decrease in aortic coarctation. Correction of this factor is of great importance in the treatment of stenotic lesions of the aorta. However, there are minimal data regarding the trend of changes in the PI after stent implantation. Furthermore, the association between the PI and other echocardiographic indices in patients undergoing stent implantation is unclear. This study was designed to evaluate changes in the PI following stenting and its correlation with other echocardiographic indices. Methods: Twenty-three patients with a diagnosis of aortic coarctation consecutively underwent two-dimensional and Doppler echocardiographic imaging modalities twice (before and after stenting). The patients were divided into two groups based on the percentage of increase in the PI after stenting ( < 50% or ≥ 50%). The relation between the post-stenting PI and the baseline echocardiographic indices was assessed. Results: The PI was increased from 0.89 (SD = 0.30) to 1.75 (SD = 0.51) after stenting (p value < 0.001). Baseline diastolic/systolic velocity (D/S velocity) ratio of the abdominal aorta (p value = 0.013), mean velocity (p value = 0.033), and peak gradient of the descending aorta (p value = 0.033) were significantly higher in the patients with ≥ 50% increase in the PI after stenting. Conclusion: Our findings showed that elevation in the PI after stenting was a predictable criterion in patients with aortic coarctation: it was predicted by some baseline clinical and echocardiographic indices. Baseline D/S ratio velocity of the abdominal aorta, mean velocity and peak gradient of the descending aorta, and baseline systolic blood pressure were the statistically significant indices to predict ≥ 50% increase in the PI in our patients

Left Ventricular Mass index and Pulmonary Artery Pressure in Patients with the Obstructive Sleep Apnea Syndrome

Background: Sleep apnea is accompanied by some cardiovascular complications. It has even been hypothesized that sleep apnea, itself, can induce some of these complications. Given such controversies, we assessed the left ventricular mass index (LVMI) and systolic pulmonary artery pressure in patients with sleep apnea. Methods: Through convenience sampling, 56 patients with the obstructive sleep apnea syndrome (OSAS) were included in the present descriptive cross-sectional study. Patients with any past history of hypertension and diabetes mellitus were excluded. The apnea severity was assessed via the polysomnography-derived apnea-hypopnea index (AHI). All the patients underwent transthoracic echocardiography. In this cross-sectional study - data regarding age, gender, smoking, systolic and diastolic blood pressures, polysomnographic parameters (AHI, severity of disease, mean heart rate, mean oxygen saturation [SaO2], lowest SaO2, and duration of SaO2 below 90% [d.SaO2 < 90%]), and  echocardiographic parameters (systolic pulmonary artery pressure and LVMI) were accumulated and processed. Results: Fifty-two men and 14 women at a mean age of 49.29 ± 11.79 years participated in this study. Systolic and was significantly high in the severe group compared with the mild group (128.21 ± 9.73 mmHg vs. 119.23 ± 12.5 mmHg; p value = 0.007). The LVMI was increased parallel to an increase in the severity of the OSAS, but that increase was not statistically significant (p value = 0.161). The d.SaO2 < 90% was positively correlated with the LVMI, and this relationship remained true after adjustment for the body mass index (r = 0.27; p value = 0.042). Conclusion: Severe OSAS was accompanied by a higher blood pressure. The LVMI did not differ significantly between the patients with the OSAS and those who did not suffer from other risk factors of cardiac diseases