Focal Myopericarditis as a Rare but Important Differential Diagnosis of Myocardial Infarction; a Case Series

Distinguishing ST-elevation myocardial infarction (STEMI) differential diagnoses is more challenging. Myopericarditis is one of these differentials that results from viral involvement of myocardium and pericardium of the heart. Myopericarditis in focal form can mimic acute STEMI in its electrocardiogram (ECG) features and elevated cardiac enzymes.Myocarditis patients may face thrombolytic related complications such as intracranial bleeding, myocardial rupture, and hemorrhagic cardiac tamponade. Furthermore, re-administration of streptokinase (a common thrombolytic agent in our country) is banned for at least six months of previous administration; however, it can save patients’ lives in emergency conditions such as massive pulmonary embolism. It seems that, when dealing with a young patient presenting to emergency department with acute chest pain and ST segment elevation on ECG, we should consider focal myocarditis as an important but rare differential diagnosis of STEMI. In this report, we describe three cases of focal myocarditis, primarily misdiagnosed as STEMI

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

Shock Following Percutaneous Coronary Intervention as a Manifestation of Diabetes Insipidus: A Case Report

The shock syndrome following percutaneous coronary intervention (PCI) is a life-threatening complication, accompanied by poor outcomes. The most common causes are bleeding and severe left ventricular systolic dysfunction; albeit rare complications, they are still challenging. We herein report a 47-year-old man who suffered from complications following PCI, manifested as unexplained shock, which was resistant to conventional management.Overestimating the role of the patient’s underlying disorder as the cause of the hypotension led to delay in diagnosis and treatment; however, obtaining a thorough familial history revealed diabetes insipidus (DI) as the most probable cause of the hypotension despite normal electrolyte levels at the time of admission. The patient dramatically responded to DI management.  Persistent hypotension or shock after PCI can result from an unusual or rare etiology. Meticulous history taking and attention to clinical findings are essential for an accurate diagnosis and timely treatment of this life-threatening condition

Neutrophil to lymphocyte ratio as an inflammatory marker in patients with lone coronary artery ectasia in comparison with stenotic coronary artery disease

Background: Coronary artery ectasia (CAE) is an uncommon but known finding in coronary angiography. We compared the neutrophil to lymphocyte ratio in patients with sole CAE and coronary artery disease (CAD) patients as well as normal coronary individuals who presented to our center. Methods: In this case-control study, we compared patients with lone coronary ectasia with two other groups: patients with CAD and normal coronary individuals. Demographic and clinical data of the ectatic patients were retrieved from the databank of our center and all variables, particularly neutrophil to lymphocyte ratio compared between the study groups. Results: A total of 233 patients with coronary ectasia met our criteria and were compared to 433 stenotic CAD patients and 466 normal coronary individuals. The neutrophil to lymphocyte ratio was significantly lower in the normal coronary individuals (P < 0.001). However, there was no significant difference between the coronary ectasia group and the CAD group. This difference was significantly lower in the normal coronary group (P < 0.001), while no difference was observed between the ectasia and the CAD group (P = 0.127). Conclusion: Higher neutrophil to lymphocyte ratio was present in patients with CAE and CAD patients than the normal coronary individuals

Effect of Elective Percutaneous Coronary Intervention on Left Ventricular Function in Patients with Coronary Artery Disease

Coronary artery disease is one of the most common causes of mortality and morbidity across the world. Its treatment includes medical treatment, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). The purpose of this study was to investigate the effect of PCI on echocardiographic findings of left ventricular (LV) systolic and diastolic function. 115 patients with coronary artery disease candidate for PCI were enrolled to our study. Echocardiography was done before PCI, the day after and 3-6 months later. LV systolic and diastolic function were measured and recorded. Echocardiographic finding compared with repeated measurement analysis. Mean age of the patients was 57.8±8.38 years. The mean Ejection Fraction (EF) was (%40.52±6.36) before, (%41.83±7.14) the day after, and (%44.0±7.89) 3-6 months after PCI. Diastolic dysfunction were mild to moderate before PCI, which in %74 (86 patients) were improved to mild dysfunction the day after PCI but not changed 3-6 months later (P<0.0001). PCI improved LV ejection fraction, and LV diastolic function in our patient&apos;s population

Mean Platelet Volume as a Predictor of One-Year Major Adverse Cardiac Events following Elective Percutaneous Coronary Interventions

Background: Mean platelet volume (MPV) correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention (PCI) has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. Methods: The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV 10 fL, and they were assessed for developing major adverse cardiac events (MACE), comprising death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) over a one-year follow-up. Results: Of 2539 patients, major adverse cardiac events (MACE) at one year occurred in 77 (3.0%) patients, including mortality in 26 (1.0%). The patients in the highest tertile (MPV > 10 fL) had no increased frequency of MACE compared to those in the mid (9.1 to 10 fL) and lowest ( < 9.1 fL) tertiles (3.3%, 2.2%, and 3.8%, respectively; p value = 0.14).No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE (OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68), death (OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74), and non-fatal MI (OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19) at one year's follow-up but MPV did not remain in the model in any of the cases.In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% (4 patients) in the highest tertile, 0.8% (2 patients) in the mid tertile, and 0.5% (one patient) in the lowest tertile. Conclusion: There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI

GENDER DIFFERENCES IN EXTENT OF CORONARY ARTERY DISEASE AND LEFT VENTRICULAR FUNCTION IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

Abstract &nbsp;&nbsp; BACKGROUND: Coronary angiography allows a direct evaluation of coronary artery. The aim of this investigation was to evaluate the coronary artery stenosis among males and females underwent coronary angiography (CAG). &nbsp;&nbsp; METHODS: This randomized clinical trial was performed on 620 (425 males and 195 females) patients from March 2006 to September 2007 in the coronary angiographic registry of Imam Khomeini Hospital. The patients were selected for CAG according to the clinical criteria. Hypertension, diabetes, current medication, socio-demographic data, smoking, age and sex were recorded according to medical history and laboratory data. &nbsp;&nbsp; RESULTS: Ejection fraction of left ventricle was significantly higher in women in comparison with men (P = 0.01). No significant differences in the extent of coronary artery disease between men and women were observed. Women with coronary artery disease were older than men (P &lt; 0.001).&nbsp; &nbsp;&nbsp; CONCLUSION: Although our study does not show any gender differences in the number of diseased vessels, it shows higher prevalence of risk factors such as diabetes mellitus and hypertension in women. &nbsp; &nbsp;&nbsp; Keywords: Coronary artery disease, Stenosis, Gender differences</p

Opium Consumption and Mid-Term Outcome of Percutaneous Coronary Intervention in Men

Background: Controversy persists over the potential benefits/harms of opium consumption in coronary heart disease. This study investigated the association between 12 months' major adverse cardiac events (MACE) and pre-procedural opium consumption among patients undergoing percutaneous coronary intervention (PCI). Methods: Retrospectively, 1545 consecutive men who underwent PCI between 21st  June 2009 and 20th June 2010 at Tehran Heart Center and were registered in the PCI Databank were entered into this cohort study. The occurrence of MACE, defined as cardiac death, non-fatal myocardial infarction, and need for target vessel revascularization (TVR) or target lesion revascularization (TLR), was compared between two groups of opium consumers and non-consumers in 350 (22.7%) patients. Results: Sixty-four (0.86%) patients expired within 12 months. After adjustment for potential confounders, analysis revealed that opium consumption had no significant relationship with 12 months' MACE [11(3.1%) vs. 53(4.4%); p value= 0.286, among opium users vs. non users, respectively].Furthermore, the different components of MACE, including target vessel revascularization, target lesion revascularization, coronary artery bypass graft, and non-fatal myocardial infarction, were not significantly related to opium use. Conclusion: Pre-procedural opium usage in patients undergoing PCI was not associated with 12 months' MACE