Showing papers in "Heart Views in 2013"
TL;DR: The available treatment option makes prevention the corner stone of management, although dialysis may be required in some cases, and several biomarkers of tubular injury are under evaluation.
Abstract: Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures resulting from the administration of contrast media (CM). It is the third most common cause of hospital acquired acute renal injury and represents about 12% of the cases. CIN is defined as an elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl (44 μmol/l) from baseline within 48 h. More sensitive markers of renal injury are desired, therefore, several biomarkers of tubular injury are under evaluation. Multiple risk factors may contribute to the development of CIN; these factors are divided into patient- and procedure-related factors. Treatment of CIN is mainly supportive, consisting mainly of careful fluid and electrolyte management, although dialysis may be required in some cases. The available treatment option makes prevention the corner stone of management. This article will review the recent evidence concerning CIN incidence, diagnosis, and prevention strategies as well as its treatment and prognostic implications.
132 citations
TL;DR: This chapter reviews the great diversity of healing practices found around the world and represented in most urban centres and a general model of healing is presented that includes both the physiological processes central to biomedical theory and practice and the symbolic aspects of healing that have physiological, psychological and social effects.
Abstract: This chapter reviews the great diversity of healing practices found around the world and represented in most urban centres. A general model of healing is presented that includes both the physiological processes central to biomedical theory and practice and the symbolic aspects of healing that have physiological, psychological and social effects. Work on the theory of metaphor in cognitive science provides a way to understand the transformation of experience across levels of sensory, affective and conceptual meaning. Healing rituals and other symbolic action can thus have effects on physiology, experience, interpersonal interaction and social positioning. Complementary medicine and traditional forms of healing are attractive to many individuals both because of the limitations of biomedicine and their metaphoric logic of transformation, which promises wholeness, balance and well-being. Participation in specific healing traditions may also contribute to individual and collective identity.
59 citations
TL;DR: Different aspects of stent fracture are reviewed, including incidence, classification, predictors, outcome, diagnosis, and management.
Abstract: In spite of there being several case reports, coronary stent fracture is not a well-recognized entity and incidence rates are likely to be underestimated. In this article, we review different aspects of stent fracture, including incidence, classification, predictors, outcome, diagnosis, and management.
20 citations
TL;DR: Multivariate analysis found that Lp (a) was considered an independent predictor for severity of CAD and Lp levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis.
Abstract: Background: Lipoprotein (a) [Lp (a)] is an established risk marker of coronary artery disease which is independent from other risk factors. Objective: The aim was to address the association between Lp (a) and CAD risk in North Indians. To evaluate whether high levels of lipoprotein (a) [Lp (a)] is a predictor of risk and is related to the severity of CAD. Materials and Methods: This was a cross-sectional study done on 360 patients presenting with chest pain. Coronary angiography revealed CAD in 270 patients and 90 patients without CAD. Lipoprotein (a) level, lipid profile, fasting blood glucose, anthropometric and clinical parameters were analyzed. Results: Lipoprotein (a) 21.0 mg/dL is associated with the presence of coronary lesions ( P = 0.0001). A highly significant difference in Lp (a) levels was observed between normal coronaries vs. single-vessel disease, double-and triple-vessel disease ( P Conclusion: Multivariate analysis found that Lp (a) was considered an independent predictor for severity of CAD and Lp (a) levels 21.0 mg/dL are associated with severe patterns of coronary atherosclerosis.
16 citations
TL;DR: The contributions of Islamic scientists in the various fields of knowledge from the 8th to the 16th centuries were astonishing, however, after the16th century, the Islamic world experienced several tumultuous events that contributed to its political and economic decline leading to poverty in many Islamic countries.
Abstract: The contributions of Islamic scientists in the various fields of knowledge from the 8th to the 16th centuries were astonishing. After the 16th century, however, the Islamic world experienced several tumultuous events that contributed to its political and economic decline leading to poverty in many Islamic countries. These events were the Crusades, Mongol invasions, natural disasters, loss of international trade, the capitulations of the Ottoman Empire to Western interests, and the rise of European imperialism.[1,2] The famous Arab historiographer and historian, Ibn Khaldun (1332-1406) said: “Science thrives only in affluent societies.”[2] This is so true. History has repeatedly shown that science has indeed flourished only when an empire or a nation became mighty and rich, because it depends on the infrastructure provided by the existence of affluence. In the 7th century, Islam emerged from the desert of the Arabian Peninsula, conquering the old Egyptian, Persian, Roman, and Near Eastern Empires.[3] Islam integrated elements of these cultures into its own, and between the 7th and 12th centuries, it became the center of a brilliant civilization and of a great scientific, philosophic, and artistic culture.[4] Its language was Arabic, but it absorbed and added its culture to the heritage of Greece, Rome, Judaism, Christianity, and the Near East.[5] The medieval Islamic world spanned the outer edge of the Latin world, in Spain, Sicily, and North Africa, and surrounding Byzantium in Egypt, Palestine, and Syria.[3,6] Medicine was a central part of medieval Islamic culture. Islamic medicine was built on the legacies left behind by Greek and Roman physicians and scholars.[7] Islamic physicians and scholars were strongly influenced by Galen and Hippocrates, as well as by the Greek scholars of Alexandria, Egypt. Islamic scholars translated their voluminous writings from Greek into Arabic and then produced new medical knowledge based on those texts. In order to make the Greek tradition more accessible, understandable, and teachable, Islamic scholars ordered and made more systematic the vast and sometimes inconsistent Greco-Roman medical knowledge by writing encyclopedias and summaries.[7] It was through reading Arabic versions that Western doctors learned of Greek medicine, including the works of Hippocrates and Galen. Medieval and early modern scholars in Europe drew upon
15 citations
TL;DR: Evidence is shown that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and an association between chronic oral infections and myocardIAL infarctions is suggested.
Abstract: Objectives: To assess the periodontal status among the patients suffering from acute myocardial infarction (AMI) and to investigate whether periodontitis is a risk factor for AMI or not. Materials and Methods: A cross-sectional study of 60 subjects, 30 subjects in each AMI group and control group was conducted. Details of risk factors like age, sex, smoking, and alcohol consumption were obtained through a personal interview. Medical history was retrieved from the medical file. The oral hygiene status was assessed by using a simplified oral hygiene index (OHI-S) and the periodontal status was assessed by community periodontal index (CPI) and loss of attachment (LOA) as per World Health Organization (WHO) methodology 1997. Chi-square test was used to analyze qualitative data whereas t-test and one way analysis of variance (ANOVA) test was used for quantitative data. Multiple regression model was applied to check the risk factors for AMI. Results: The mean OHI-S score for case and control group was 3.98 ± 0.70 and 3.11 ± 0.68, respectively, which was statistically highly significant ( P Conclusion: The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.
12 citations
TL;DR: Intracardiac thrombi are commonly found in patients with ischemic stroke and represent an indication to long-term anticoagulation, in order to reduce the risk of new stroke.
Abstract: Intracardiac thrombi are commonly found in patients with ischemic stroke. The echocardiographic identification of thrombi is important in decision-making since it represents an indication to long-term anticoagulation, in order to reduce the risk of new stroke. Intracardiac thrombi can develop during the time course of several cardiac pathologies that favor blood stasis and/or predispose to the aggregation of thrombotic material. Examples of cardiac pathologies that favor the formation of thrombus are illustrated and discussed.
10 citations
TL;DR: Although some new instruments have been innovated, which can measure different parameters of pulse, yet sphygmology can be one of the most commonly usable diagnostic methods in future, not only applicable by cardiologists but also by all the physicians.
Abstract: Sphygmology is a 2000-year-old method that is still used in some traditional medicine systems, mainly Iranian, Chinese and Ayurveda. Ibn Sina is one of the most popular physicians in the history of Sphygmology, who had made great contributions to this method, but few meticulous studies have been made on his concepts. In this article, his standpoints on Pulsology are studied. Ibn Sina has mentioned 10 parameters for pulse palpation, and 13 compound pulses, as well. Besides, some pulse patterns applicable for differentiating similar diseases have been introduced. Nowadays some concepts on pulse patterns, such as pulse change in sleep and pregnancy have been studied; but unfortunately many of the ideas on Pulsology have not yet been examined. Sphygmology, as an accessible and inexpensive means, having a substantial diagnosis yield, has been accepted by the people since its rise, and its development over centuries ago. Although some new instruments have been innovated, which can measure different parameters of pulse, yet sphygmology can be one of the most commonly usable diagnostic methods in future, not only applicable by cardiologists but also by all the physicians.
10 citations
10 citations
TL;DR: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure.
Abstract: Background: Heart failure is an important cause of morbidity and mortality in developing nations like Nigeria. Sleep apnea and snoring has recently been recognized to be a cardiovascular risk factor. Sleep apnea is yet to be well studied among Africans with heart failure. We aimed to determine the prevalence of snoring and high risk for obstructive sleep apnea among Nigerians with stable heart failure. Materials and Methods: We studied 103 subjects that included 62 patients with heart failure and 41 control subjects. Demographic parameters and clinical examination were performed on the participants. The Berlin score and the Epworth Sleepiness Scale were administered for each participant. Echocardiography was done on all participants. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 17.0. Results: Snoring was reported in 48.4% of subjects with heart failure compared to 22.0% of control subjects ( P Conclusion: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure. Assessment for sleep disordered breathing should be incorporated into their routine clinical workup.
9 citations
TL;DR: The case of an 86-year-old male who presented with a large distended hiatal hernia causing electrocardiographic findings of new onset ST segment elevation of the inferior leads without reciprocal changes is described.
Abstract: The investigators review the electrocardiographic manifestations of hiatal hernia and describe the case of an 86-year-old male who presented with a large distended hiatal hernia causing electrocardiographic findings of new onset ST segment elevation of the inferior leads without reciprocal changes. After decompression, the patient's electrocardiogram demonstrated resolution of the ST segment elevation.
TL;DR: “When you see symptoms, or some of the worst of them, then you may be assured that the eruption of one or the other of these diseases in the patient is nigh at hand; except that there is not in the measles so much pain of the back as in smallpox.
Abstract: “When, therefore, you see these symptoms, or some of the worst of them (such as pain of the back, and the terrors of sleep, with the continued fever) then you may be assured that the eruption of one or the other of these diseases in the patient is nigh at hand; except that there is not in the measles so much pain of the back as in smallpox; nor in the smallpox so much anxiety and nausea as in measles, unless the smallpox be of a bad sort; and this shows that the measles came from a very bilious blood.” Al-Razi, Treatise on Smallpox and Measles
TL;DR: A 23 year-old-male, who presented to the hospital with complaints of pleuritic chest pain and exertional dyspnea, with suspicion of congenital absence of the pericardium is presented, who was misdiagnosed as having pulmonary embolism.
Abstract: Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography (CT), and/or cardiac magnetic resonance imging (MRI). We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a 'seagull' or a 'boomerang'. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis.
TL;DR: The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction.
Abstract: Introduction: Right ventricle (RV) dysfunction may be secondary to left ventricle (LV) dysfunction in patients of isolated left ventricle anterior myocardial infarction as a consequence of Ventricular Interdependence. As RV dysfunction is associated with high in-hospital morbidity and mortality, early recognization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. Aims and Objectives: Our aim in the present study was to compare Simpson's right ventricle ejection fraction (RVEF) with right ventricle myocardial performance index (RV-MPI) to predict RV function in patients with isolated left ventricle anterior myocardial infarction (LV-AMI). Materials and Methods: We conducted the present study at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer. The control group comprised of twenty five. Age, sex, BMI, pulse and blood pressure matched healthy subjects without history of heart disease, systemic hypertension, diabetes, any other systemic illness and with normal findings in resting and exercise ECG, Echocardiography and Coronary Angiography. Sub-group-1 consisted of 25 patients with hemodynamically significant stenosis of proximal left anterior descending artery (LAD) with patent first septal perforator (S 1 ). Sub-group-2 was composed of s5 patients with hemodynamically significant stenosis of both LAD and left circumflex artery (LCx.). Both subgroups had fully patent right coronary artery (RCA) from proximal to distal end. Results: RV-MPI value determined using pulsed doppler echocardiography was 0.40 ± 0.19 in healthy subjects. However RV-MPI was increased in both subgroups of LV-AMI with significant increase in subgroup-2 ( P 0.05). Conclusion: The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction. Early detection of RV dysfunction is important to reduce morbidity and mortality in these patients.
TL;DR: It was found that only FEV 1/FVC was having a statistically significant regression coefficient with HF the R-value was found to be 0.425 while with other parameters, it was not significant.
Abstract: Context: Though many studies have been conducted on the effect of chronic smoking on pulmonary function test (PFT) and heart rate variability (HRV), no study has found a correlation between the pulmonary function test and heart rate variability parameters so far. Aim: The aim was to study if there was a correlation, if any, between PFT and HRV. Settings and Design: Thirty male subjects who were chronic smokers of at least 10 pack years and another 30 nonsmoking healthy males were included in the study and were matched for age, height, weight, and body surface area. Materials and Methods: PFT and HRV were performed on these subjects and a correlation was statistically derived. Statistical Analysis Used: Spearman's correlation coefficient was used for the analysis of HRV and PFT. Multiple stepwise regression analysis was used subsequently. Results: HF and LF showed correlation coefficients of 0.378 and-0.383 with forced expiratory volume in the first second (FEV 1 ) and peak expiratory flow rate (PEFR), respectively. It was found that only FEV 1 /FVC was having a statistically significant regression coefficient with HF the R-value was found to be 0.425 while with other parameters, it was not significant. Conclusion: We conclude that smoking affects all the parameters of PFT and HRV. Since there is a correlation between PFT parameters (PEFR and FEV 1 ) and HRV parameter (LF and HF), this can help us in predicting cardiac morbidity in chronic smokers. So HRV should be included as a routine test along with PFT in chronic smokers for early diagnosis of cardiac involvement.
TL;DR: PTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma.
Abstract: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. However, chest computer tomography shows negative finding of pulmonary thromboembolism. Serum D-dimer level may be elevated. Echocardiography reveals a dilated right ventricle and feature of pulmonary artery hypertension. Establishing this diagnosis can be very difficult, and most cases are diagnosed during autopsy, although a history of cancer may be a predictor. PTTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma and most of all, the clinical manifestation is very rapidly progressive.
TL;DR: There was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD, and Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST.
Abstract: Background: In patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty, abciximab reduces major adverse cardiac events (MACE). Most clinical trials have studied mainly intravenous administration. Intracoronary (IC) bolus application of abciximab causes very high local drug concentrations and may be more effective in reducing acute and sub-acute stent thrombosis (ST). We studied whether IC bolus administration of abciximab is associated with a reduced ST and target vessels revascularization (TVR); therefore, less MACE rate compared with the standard intravenous IV bolus and infusion application. Materials and Methods: This was a single-center observational study conducted between June 2007 and 2009. We studied a total of 447 patients admitted with either acute coronary intervention (PCI) and stenting. Patients with bleeding disorder, recent major surgery and high blood pressure were excluded. Patients were divided into two groups: Group I (n = 199) patient received IC bolus of abciximab (reopro) 0.25 μg/kg during the PCI in cath lab. Group II (n = 248) received the standard dose of reopro-a bolus intravenous 0.25 μg/kg and maintenance dose of 0.125 μg/kg over 12 h. Results: There were no differences between the groups with regard to diabetes mellitus, group I (56%) vs. group II (58%), P = 0.613; ACS, group I (38%) vs. group II (44%), P = 0.175; Dietthylstilbestrol Drug eluted stent (DES) in group I (66.5%) vs. (57.6%) group II, P = 0.056; Bare Metal Stent (BMS) in group I (33%) vs. (40.7%) group II, P=0.093; target vessel revascularization (TRV) was seen in 9 patients (4%) in group I vs. 16 patients (6%) in group II. ST elevation was seen in 4 patients (2%) in group I vs. 7 patients (2.8%) in group II, all presented with STEMI. Conclusion: In this study, there was a trend toward less ST and TVR in patients who received IC reopro vs. intravenous route both in ACS and stable CAD. The percentage of DM was high in both groups (56%), especially in Saudi patients. In-stent restenosis (ISR) was less in group I than in group II, this was mainly associated with BMS usage. The percentage of BMS was more than 30% in both groups, either due to STEMI cases or large vessel size. Randomized controlled trials are warranted to further assess IC application of abciximab in reducing ST.
TL;DR: An elderly male who underwent temporary pacemaker lead implantation without fluoroscopic guidance for cardiac arrest was found to be in the non-coronary aortic sinus, but still capturing the myocardium, and the post-pacing electrocardiography was mimicking atrial pacing.
Abstract: Inadvertent placement of pacing leads into abnormal locations is potentially very dangerous. However, in emergency situations and without fluoroscopic guidance, these complications do occur. We report a case of an elderly male who underwent temporary pacemaker lead implantation without fluoroscopic guidance for cardiac arrest, but later the pacemaker lead was found to be in the non-coronary aortic sinus, but still capturing the myocardium. Interestingly, the post-pacing electrocardiography was mimicking atrial pacing.
TL;DR: Type and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non taperedGWs, and 4%.
Abstract: Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending (LAD) specifically is associated with improved long-term 5 year survival as compared to PCI failure.The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. Aim: To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. Methods: A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. Results: A total of 30 patients with LAD CTO lesions (100%), were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW) success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases) while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%), 36% were Soft Non Tapered Pilot 50 (28%), whisper (8%), while 16% were Stiff Non tapered GWs; Miracle 12 (8%), Miracle 6 (4%), Miracle 3 (4%), and 4% were Stiff Tapered GWs; Progress 200 (4%). Conclusions: Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.
TL;DR: A case of a 70-year-old female with a history of hypertension, atrial fibrillation, pacer implantation for symptomatic bradycardia, and a prior cerebrovascular accident, and had developed persistent methicillin-sensitive Staphylococcus aureus bacteremia is reported here.
Abstract: A case of a 70-year-old female with a history of hypertension, atrial fibrillation, pacer implantation for symptomatic bradycardia, and a prior cerebrovascular accident, and had developed persistent methicillin-sensitive Staphylococcus aureus bacteremia is reported here. As part of her evaluation, a transesophageal echocardiogram was performed, and even though no vegetations were seen on either pacer wires or cardiac valves, a massive homogeneous thickening of the superior portion of the interatrial septum extending to the posterior and roof portions of the right atrial wall as well as to the superior vena cava causing proximal compression of this vessel was noted. Computed tomographic examination of the chest helped to determine that this mass density was not a tumor but in fact intrapericardial fat. Imaging findings and existing literature on this topic are reviewed.
TL;DR: The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity.
Abstract: Introduction: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. Objectives: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. Materials and Methods: Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB), antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV) and functional capacity (using a validated self-administered questionnaire), at baseline and after 4 months of ivabradine therapy. Results: Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus). Patients were on optimal medical regimen of aspirin (100%), β-blocker (100%), statins (100%), clopidogrel (90%), nitrates (35%), anti-metabolics (90%), and ACE-I or ARB (95%). At baseline, the majority of patients (90%) were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm ( P Conclusion: The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity.
TL;DR: This case requires an awareness regarding coexistence of HIV with PPCM and dreaded clinical sequences and patients suffering from HIV should be treated well and their CD4 count should be improved before conception to avoid such complications in pregnancy.
Abstract: Peripartum cardiomyopathy (PPCM) is a rare cause of pregnancy-related heart failure, which affects a woman during the last months of pregnancy or first months of parturition. Its etiopathogenesis is still unclear. Coexistence of PPCM with human immunodeficiency virus (HIV) has been scarcely analyzed. A low CD4 count is proposed to be one of the predictors of dilated cardiomyopathy in HIV. Here, a pregnant woman with HIV presented with signs of congestive heart failure for the first time during her last trimester. Echocardiography revealed a dilated cardiomyopathy with ejection fraction of 34% which proved the diagnosis of PPCM. She underwent cesarean section for impending previous scar rupture. Her status deteriorated subsequently in spite of all efforts and she succumbed due to ventricular tachycardia. This case necessitates an awareness regarding coexistence of HIV with PPCM and dreaded clinical sequences. Patients suffering from HIV should be treated well and their CD4 count should be improved before conception to avoid such complications in pregnancy.
TL;DR: STS on admission is independent predictor while hs- CRP is not in resource constrained settings, as compared with other prognostic indicator in acute ST segment elevated myocardial infarction in central rural India.
Abstract: Context: The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events. Aims: The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India. Settings and Design: Cross sectional study, rural hospital in central India. Material and Methods: In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission. Statistical analysis used: We used Student's t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value Results: STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively. Conclusions: STS on admission is independent predictor while hs- CRP is not in resource constrained settings.
TL;DR: The ECS recognizes that the present statement is non-binding, but anticipates that it will serve as a guide to relevant authorities and institutions in the licensing and privileging of physicians who implant such devices in the UAE.
Abstract: The Emirates Cardiac Society (ECS) is a professional organization operating under the Emirates Medical Association. The ECS represents cardiologists, cardiovascular surgeons, and other health-care providers and allied professionals dedicated to the management and treatment of cardiovascular disease in the United Arab Emirates (UAE). In its efforts to promote safe and effective cardiovascular care in the UAE, the ECS recognizes the importance of ensuring sufficient and homogeneous training and qualifications in the management of patients with heart rhythm disorders, particularly as it involves invasive procedures. In January 2013, the ECS Board of Directors commissioned the Arrhythmia and Cardiac Electrophysiology Working Group of ECS to draft a clinical statement of the minimum requirements to achieve and maintain sufficient competency in the implantation and management of heart rhythm devices (permanent pacemakers, implantable cardioverter defibri l lators (ICD) and cardiac resynchronization therapy (CRT) devices). The Working Group established a writing committee of four certified cardiac electrophysiolgists in the UAE. Based on extensive literature review including relevant documents from other professional societies [Table 1], and taking into account the working experience of the writing committee members both in the UAE and abroad, the Working Group generated an advanced draft that was circulated for comment and feedback to ECS members. The present document is the official statement generated after incorporating relevant feedback, and approved by the ECS Board of Directors. The statement is endorsed by the Gulf Heart Association and the Gulf Heart Rhythm Society. This document represents the collective professional position of the ECS as it relates to standards in the implantation and management of permanent pacemakers, ICD and CRT devices. The ECS recognizes that the present statement is non-binding, but anticipates that it will serve as a guide to relevant authorities and institutions in the licensing and privileging of physicians who implant such devices in the UAE.
TL;DR: The case of a postmenopausal female with documented severe esophageal spasms who presented with atypical angina and recurrent Tako-tsubo cardiomyopathy is presented.
Abstract: Transient apical cardiomyopathy, also known as Takot-tsubo-like left ventricular dysfunction, is a clinical syndrome characterized by reversible left ventricular dysfunction at the apex with preserved basal contractility, in the setting of new ST and T wave changes suggestive of ischemia but no evidence of obstructive coronary artery disease on angiography. The main mechanism appears to be intense neuroadrenergic myocardial stimulation with endothelial dysfunction of the coronary vasculature. It has been noted that patients with esophageal spasms also have a tendency for coronary spasms. We present the case of a postmenopausal female with documented severe esophageal spasms who presented with atypical angina and recurrent Tako-tsubo cardiomyopathy.
TL;DR: The diagnosis and the treatment of coronary steal syndrome is discussed in a patient hospitalized due to decompensated cardiac insufficiency.
Abstract: Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery, causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. In the present case, we discussed the diagnosis and the treatment of coronary steal syndrome in a patient hospitalized due to decompensated cardiac insufficiency.
TL;DR: It appears that each peak and nadir component of the constantly moving annulus not only is useful in characterizing RV systole and diastole, but also would be invaluable to assess the functional relationship that exists between the right atria and ventricle; particularly, when annular motion directly reflects the contribution of both cardiac chambers.
Abstract: Background: Maximal systolic tricuspid annulus (TA) descent by M-mode (MM) is a well described and accepted standard reference of right ventricular (RV) systolic function; however, the contribution of each individual TA contour during the cardiac cycle has not been well characterized. Therefore, the aim of this study was to define each peak and nadir component of the constantly moving annulus. Material and Methods: Standard echocardiographic data was collected from 35 patients over a wide range of both normal and abnormal RV systolic function. Time to onset and total duration of each recognizable component of the TA tissue Doppler imaging (TDI) signal was measured and correlated to each individual change in contour of the TA, obtained by MM, during the cardiac cycle. Results: In this heterogeneous patient population, careful measurement of each recognizable component of the TA TDI signal corresponded to conformational changes in the TA contour. Furthermore, these TA TDI intervals were imprinted into the TA MM tracing and precisely identified specific systolic as well as diastolic events, regardless of RV systolic function or pulmonary hypertension severity. Conclusions: Careful observation of the constant dynamic motion of the TA, aided by high temporal resolution MM, allows better understanding of each individual component of annular motion. It appears that each peak and nadir component not only is useful in characterizing RV systole and diastole, but also would be invaluable to assess the functional relationship that exists between the right atria and ventricle; particularly, when annular motion directly reflects the contribution of both cardiac chambers.