Cardiac failure secondary to hypocalcemia

Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very atypical and rare circumstance, which is usually intractable to conventional therapy for cardiac failure, but responds satisfactorily to restoration of normocalcemia.We describe a young woman who developed clinical signs of hypocalcemia due to hypoparathyroidism, reduced left ventricular ejection fraction and polymorphic ventricular tachycardia as consequences of hypocalcemia.This case underscores the importance of biochemical abnormalities like hypocalcemia as a rare cause of secondary cardiomyopathy and emphasizes on the need for effective and immediate treatment of hypocalcemia and its related causes

Value of Admission HbA1c Level in Non-diabetic Patients With Unstable Angina

Introduction: There have been incompatible evidences about the prognostic value of HbA1c on the adverse outcomes in acute coronary syndrome. Also, these data are so limited in nondiabetic patients with unstable angina.Methods: In this cross-sectional study, HbA1c level of 231 nondiabetic patients admitted with unstable angina, was measured using high performance liquid affinity chromatography (HPLC) at admission. Then transthoracic echocardiography (TTE) was performed for evaluation of ejection fraction (EF) using Simpson method.Results: Our data revealed that HbA1c was significantly higher in patients with EF≤ 50% in comparison with EF>50% group (P value=0.01).Conclusions: HbA1c may be a helpful prognostic marker in nondiabetic patients admitted in emergency department with diagnosis of unstable angina

Acellular pertussis vaccine efficacy: An updated systematic review and meta-analysis

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended

Cost-effectiveness of varicella vaccination program in Iran

Background: Varicella zoster virus is the etiologic agent of primary varicella (chickenpox) during childhood, and varicella vaccination has not been introduced in Iran. The aim of this study is to estimate cost-effectiveness of one- and two-dose Varicella Vaccination Program in Iran. Methods: A decision-tree model was conducted to evaluate the cost-effectiveness of the Varicella Vaccination Program in a cohort of 12 months children in Iran. Epidemiologic parameters of varicella were extracted from local and international sources, and cost of disease was estimated based on societal prospective in 2015 US$. Incremental cost per disability-adjusted life years (DALY) averted calculated as final outcome. Sensitivity analysis was also performed for lower and upper estimate of incidence, DALY, and vaccine efficacy. Results: Considering the vaccine efficacy of 95$41,531 and US$17,280, respectively. ICER has changed between (US$ 6,177–US$167,047) in lower and upper base estimate of epidemiological burden parameters in sensitivity analysis. Conclusions: Varicella vaccination is not cost-effective in Iran in one-dose and two-dose scenario under the assumptions of this study in base case scenario according to the threshold of incremental cost per DALY averted less than three time of GDP per capita in Iran = US$ 14,292. One-dose vaccination program might be cost-effective in upper scenario of epidemiological burden of varicella in sensitivity analysis

Angiosarcoma of the Right Atrium with Extension to SVC and IVC Presenting with Complete Heart Block and Significant Pericardial Effusion

Primary cardiac neoplasms are particularly unusual. Angiosarcoma is the most frequently seen histological subtype and is described by its infiltrating and damaging nature. Inappropriately, primary cardiac angiosarcoma is often missed as a preliminary diagnosis because of its scarcity. We present a 29-year-old previously healthy man with complete heart block and pericardial effusion who was finally diagnosed with angiosarcoma of the right atrium with extension to SVC and IVC

Case Report Cardiac Failure as an Unusual Presentation in a Patient with History of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is the most well-known form of motor neuron diseases in which both upper and lower motor neurons are involved in this disease. We presented an unusual case of ALS whom had presented with chief complaint of dyspnea. Cardiac failure was diagnosed at the final stage of the ALS disease. The pathogenetic mechanism leading to an elevated occurrence of cardiomyopathy in ALS is not comprehensible. Dilated cardiomyopathy has been explained in some previous studies. Based on the collected data, it was hypothesized that cardiomyopathy is underdiagnosed in the ALS population, probably because symptoms are masqueraded as a result of the patients' disability. It was suggested that in all motor neuron diseases a serial cardiological evaluation should be executed, including annual echocardiography

Cardiac Failure as an Unusual Presentation in a Patient with History of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is the most well-known form of motor neuron diseases in which both upper and lower motor neurons are involved in this disease. We presented an unusual case of ALS whom had presented with chief complaint of dyspnea. Cardiac failure was diagnosed at the final stage of the ALS disease. The pathogenetic mechanism leading to an elevated occurrence of cardiomyopathy in ALS is not comprehensible. Dilated cardiomyopathy has been explained in some previous studies. Based on the collected data, it was hypothesized that cardiomyopathy is underdiagnosed in the ALS population, probably because symptoms are masqueraded as a result of the patients’ disability. It was suggested that in all motor neuron diseases a serial cardiological evaluation should be executed, including annual echocardiography

Acutely Onset Amiodarone-Induced Angioedema in a Patient with New Atrial Fibrillation

A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA) with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF). Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field

Cardiac Hemangioma of RVOT in a Patient with Atypical Chest Pain

A 40-year-old man presented with atypical chest pain and fatigue from 15 days ago a suspicious mass in the right ventricle based on a bed side transthoracic echocardiography. Preoperative diagnosis of a cardiac hemangioma comes to mind in a minority of cases. In our case, a cardiac tumor was diagnosed and the vascular nature of the tumor was suggested by vascular blush on the coronary angiography. In addition, right ventriculotomy was the approach of choice in our case because of its inaccessibility and its particular location