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Nutritional status assessment of the elderly patients with congestive heart failure by mini nutritional assessment test
Shirin Hosseini, Seyed Ali Keshavarz, Ahmad Amin, Hooman Bakshandeh, Majid Maleki, Alireza Shahinfard, Shadi Hosseini, Mona Heidarali
January 2017, 6(1):1-1
Background: Malnutrition is a common problem among elderly patients, especially those with heart failure, and is known to increase mortality rates. Objectives: The current study evaluated nutritional status to identify changes in the elderly patients with congestive heart failure (CHF) during hospital stay. Patients and Methods: This cross-sectional study recruited 225 CHF hospitalized elderly patients, comprised of 154 males (68.4%) and 71 females (31.6%) at ameanage of 71.1±7.35 years. The mini nutritional assessment (MNA) was performed to estimate functional, cognitive and nutritional status. The MNA, an18-item tool to evaluate subjective and objective findings, including anthropometric measurements for nutritional risk, is found to be sensitive, specific and accurate in identifying elderly people at nutritional risk. Results: According to the MNA questionnaire, 9.8% of the elderly were malnourished, 80.9% at risk of malnutrition and 9.3% well nourished.Weight loss, bedsore, and level of knowledge and income had a significant relationship with nutritional status based on the MNA (P value < 0.05). Conclusions: Considering the high percentage of elderly patients with malnutrition or at risk of malnutrition, the need for nutritional intervention is obvious. The MNA seems to be a reliable tool to identify individuals at risk of malnutrition. To decrease hospital stay duration and cost, application of the MNA is suggested.
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Liver enzymes and uric acid in acute heart failure
Farveh Vakilian, Abbas Ali Rafighdoost, Amir Hossein Rafighdoost, Ahmad Amin, Maryam Salehi
November 2015, 4(4):1-1
Background: Acute heart failure (AHF) is defined as the new onset or recurrence of gradual or rapidly worsening signs and symptoms of heart failure, requiring urgent or emergent therapy. Objectives: This study attempts to assess the association of liver function tests (LFT) and uric acid level with in hospital outcome and echocardiography parameters, in patients with acute decompensated heart failure. Patients and Methods: A total of 100 patients (aged 16 - 90 years, 60% men) admitted with AHF were enrolled. LFTs and uric acid levels were assessed on first day and before discharge, and patients were followed for 3 months. Results: In-hospital outcomes were considered. Mean Left Ventricular Ejection Fraction (LVEF) was 35% (20 - 45%). Mean Uric acid level was 8.4 mg/dL, significantly higher than chronic HF and normal groups (P < 0.02). Elevated liver enzymes were seen in 52% patients, mostly (87%) in transaminases. Liver enzymes were decreased in 85% patients before discharge. LFT and uric acid levels were inversely and significantly correlated with LVEF on echocardiography (P = 0.02), but not with diastolic parameters. Although there was no significant correlation between uric acid level and in-hospital mortality, risk of intubation and rehospitalization in 3 months, enzyme levels increased in these groups. Increased aspartate transaminase (AST level) was associated with inotrope infusion in AHF patients (42 vs. 82 mg/dL, P = 0.03). Conclusions: Abnormal transaminases and uric acid levels are seen in AHF patients. Increased AST levels may be a predictor of the need for inotrope during hospital course in these patients.
[ABSTRACT]   Full text not available  [PDF]
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Prenatal and cardiovascular outcome in pregnant patients with dyspnea
Fateme Tara, Farveh Vakilian, Fateme Moosavi-Baigy, Maryam Salehi, Toktam Moghiman
May 2015, 4(2):1-1
Background: Pregnancy is a physiologic phenomenon in women, which leads to significant hemodynamic changes in cardiovascular system. Many patients reach reproductive age due to improvements in diagnosis and treatment of cardiac diseases. Dyspnea is a common complaint in pregnant women and can be a sign to refer patients for an easy and feasible workup such as echocardiography. Objectives: We aimed to evaluate dyspnea as a common complaint in pregnant women and its prenatal outcome. Patients and Methods: Pregnant patients with dyspnea NYHA class > II were included. A thorough physical examination and routine lab tests were performed. Echocardiography was performed to rule out previous cardiac and lung diseases, anemia and thyroid disorders. It was repeated monthly till one month after delivery. Collected data was analyzed after one year. Results: Fifty patients were enrolled with a mean age of 30.49 ± 6.34 years. 58% of them, had NYHA class II, 40% III and 2% IV. Pulmonary rales were diagnosed in 8% and palpitation in 80%, while all had normal lab tests. Mean EF value was 52.26 ± 6.80; 54% had valvular diseases and 12% had pulmonary hypertension. Cesarean section was performed in 26, preeclampsia occurred in 7 and 21 had preterm labor. Three neonates had anomalies and six had an Apgar score below six. Mean birth weight was 2897 ± 540.00 grams. A significant association was found between NYHA Class with valvular disease (P = 0.007) and sys PAP (P = 0.036); however, it had an inverse correlation with LV EF (P = 0.06). Conclusions: Dyspnea may coincide with cardiac dysfunction and poor prenatal outcome in pregnant patients. In such cases echocardiography is a feasible screening tool.
[ABSTRACT]   Full text not available  [PDF]
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Ruptured left ventricular pseudoaneurysm: A complication of power injector assisted ventricular angiography
Amer Hawatmeh, Ahmad Abu Arqoub, Ashraf Jmeian, Ahmad Isbitan, Fayez Shamoon
January 2017, 6(1):12-12
Introduction: Left ventricular pseudoaneurysm; also referred to as contained left ventricular wall rupture, is a rare complication that is reported in about 0.2 to 0.3 percent of all myocardial infarction patients. Since it has a high risk of fatal rupture, early surgical repair is recommended once pseudoaneurysm is diagnosed. Case Presentation: In this case report, we are describing a case of a left ventricular inferior wall pseudoaneurysm which was diag- nosed by angiography, and was complicated by rupture and cardiac tamponade shortly after the patient received a powered assisted left ventricular angiogram. Conclusions: This case exemplifies that pseudoaneurysm represents a part of the ongoing process of ventricular rupture, that begins with a small tear in the endocardium and then extends to the myocardium and the pericardial cavity, causing hemoperi- cardium and cardiac tamponade. Therefore, earlier recognition and urgent surgical repair can be lifesaving.
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Hostility, anger, and cardiovascular mortality among blacks and whites
Shervin Assari
January 2017, 6(1):2-2
Background: Despite the well-known impact of baseline hostility and anger on subsequent cardiovascular mortality, few studies have tested whether predictive role of hostility and anger on mortality varies as a function of race and gender. Objectives: Current study explored role of race and gender in modifying the effects of baseline hostility and anger on cardiovascular mortality in a nationally representative sample in U.S. Materials and Methods: We used data from the Americans’ changing lives study, a nationally representative longitudinal cohort of U.S. adults. The study followed 1,593 Blacks or Whites for 10 years from 2001 to 2011. Independent variables were baseline hostility and anger (anger-in, and anger-out), measured at 2001, using 4 item Cook-Medley cynical hostility scale and Spielberger Anger Expres- sion scales, respectively. Dependent variable was time to death due to cardiovascular disease since 2001. Covariates were baseline socio-demographics (age and education), behaviors (smoking and drinking), and health (number of chronic medical conditions, self-rated health, and depressive symptoms) measured at 2001. We used Cox proportional hazard models in the pooled sample and specific to race, in the absence and presence of health variables. Results: In the pooled sample, baseline hostility and anger-out predicted cardiovascular mortality in the next 10 years. We found significant interactions between race and baseline hostility and anger-in on cardiovascular mortality, suggesting that these associ- ations are stronger for Whites than Blacks. Race did not interact with baseline anger-out on cardiovascular mortality. Gender also did not have any interactions with baseline hostility, anger-in, or anger-out on cardiovascular mortality. Conclusions: Hostility and anger-in better predict cardiovascular mortality among Blacks than Whites in the United States. Black - White difference in the associations of hostility and anger with cardiovascular mortality suggest these factors may have some role in shaping health disparities across racial groups.
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Two different methods of determining B-type natriuretic peptide, either from fingertip’s capillary blood or antecubital vein; A comparison regarding diagnostic accuracy in patients with chronic heart failure in NYHA class I-III
Renato De Vecchis, Carmelina Ariano
January 2017, 6(1):4-4
Background: In recent years, several systems have been implemented to achieve quick and non-invasive measurements of B-type natriuretic peptide (BNP). Among them, Alere™ heart check (AHC) BNP test represents the most recent advancement. It is a rapid point of care immunoassay (POC), projected for measuring BNP directly from a capillary whole blood sample. Objectives: This study aimed to compare analytical and clinical performances of this new POC to our reference method (Abbott architect system). Patients and Methods: 111 patients with stable chronic heart failure (CHF) referred to two cardiac rehabilitation centers were en- rolled from December 2013 to January 2015. These patients were subjected to a simultaneous capillary (AHC) and plasma (Abbott) BNP measurements. Clinical and analytical performance of AHC were assessed and compared to the reference method. Results: Capillary BNP showed a good correlation with the reference method (r = 0.94, P < 0.0001), although the values diverged when BNP was higher than 1500 pg /mL. Indeed, the AHC had a relatively poor precision and the coefficient of variability was 10.1% and 18% for low and high controls, respectively. However, both methods showed similar diagnostic performances in discriminating patients with heart failure in NYHA class I from those belonging to NYHA classes II-III, with values of area under the curve (AUC) of 0.983 and 0.984, respectively, and equivalent sensitivity, specificity and positive and negative likelihood ratios. Conclusions: The AHC BNP test is a good POC able to provide reliable information about hemodynamic status of CHF patients, especially of those belonging to NYHA classes I-III.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
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Long-term clinical outcomes of patients undergoing left ventricular aneurysm repair: A single-center experience in Syria
Alwaleed Al-Dairy, Yousef Rezaei, Imad Sultan, Saeid Hosseini
January 2017, 6(1):9-9
Background: Left ventricular aneurysm (LVA) is a common complication of myocardial infarction (MI); however, the optimal sur- gical technique for LVA repair has remained controversial. Methods: In this retrospective study, we analyzed the long-term outcomes of 65 patients, who underwent LVA surgical repair be- tween January 2005 and December 2009. The LVA repair approaches comprised of patch plasty (n = 16), linear (n = 23), and plication (n = 26) repair techniques. Results: Male gender was predominant (89%), and the patients’ mean age was 56 ± 7.1 years. The rate of in-hospital mortality was 4.6%, 4.6%, and 9.2% in the plication, linear and patch plasty repair groups, respectively (P = 0.077). The amount of increase in early postoperative LV ejection fraction was 4.5%, 7% and 9.5%, in the plication, linear and patch plasty techniques, correspondingly (P < 0.001). During the follow-up period (50.6 ± 15.6 months), there were seven (16.7%) cardiac deaths: five deaths in the linear repair group, one in the plication, and one in the patch plasty repair group (P= 0.057). There was no significant difference regarding the survival rate between the patients undergoing different surgical repairs (P = 0.098). Conclusions: Despite having relatively high in-hospital and long-term mortality, LVA after MI could be repaired with similar out- comes using different surgical techniques, including linear, patch plasty, and plication techniques.
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Coronary-subclavian steal syndrome following CABG: A case report and literature review
Alireza Rostami, Mehrzad Sharifi, Yazdan Ghandi
January 2017, 6(1):10-10
Introduction: Coronary-subclavian steal syndrome (CSSS) is not a common complication but it can cause recurrent angina following coronary artery bypass grafting(CABG). CSSS results from proximal subclavian artery stenosis causing reversal of blood flow in apatent in situ internal thoracic artery utilized as a conduit in CABG, leading to myocardial ischemia. Case Presentation: We present a case of CSSS successfully treated with carotid-subclavian bypass (CSB). A review of articles on the subject has also been conducted. Conclusions: Although CSSS is not a common condition, it should be strongly considered as a possibility in CABG patients presenting with recur- rent chest pain not to be confused with perioperative myocardial infarction (PMI). If indicated, carotid-subclavian bypass maybe performed as an effective treatment option with acceptable outcomes.
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Two undesired conditions resulting from T-Wave oversensing in two patients with hypertrophic cardiomyopathy: Inappropriate ICD shocks and pacemaker dysfunction
Filiz Kizilirmak, Gultekin Gunhan Demir, Oguz Karaca, Umeyir Savur, Fethi Kilicaslan
January 2017, 6(1):11-11
Introduction: T-wave oversensing (TWOS) is generally seen in patients with hypertrophic cardiomyopathy (HCM) and is a rare cause of inappropriate implantable cardioverter defibrillator (ICD) shocks. TWOS rarely causes pacemaker dysfunction. Case Presentation: In this paper, we present two patients with hypertrophic cardiomyopathy (HCM). One patient had several in- appropriate ICD shocks, and the other experienced pacemaker dysfunction due to TWOS. ICD interrogation revealed that TWOS occurred only during high heart rates in the first patient. Attempts to fix TWOS, including a higher beta blocker dose, electrophysi- ology study, and ICD re-programming, were unsuccessful. Conclusions: We replaced the previously implanted ICD generator (Medtronic Maximo II DR) with a new one that has a specific diagnostic algorithm to prevent TWOS (Medtronic Protector). After replacement, the patient did not have any inappropriate shocks due to TWOS. The second patient had bradycardic pacemaker rhythm due to TWOS. Although we reposed, the ventricular lead did not stabilize with an adequate threshold, and thus we decided to replace the lead with a new one. The pacemaker dysfunction disappeared after the lead replacement. Patients with HCM must be observed carefully for these undesired conditions.
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Accuracy of cardiogoniometry compared with electrocardiography in the diagnosis of coronary artery disease
Behshid Ghadrdoost, Majid Haghjoo, Ata Firouzi
February 2015, 4(1):1-1
Background: Cardiogoniometry (CGM) is a novel spatiotemporal electrocardiographic method utilizing computer-assisted three- dimensional data on cardiac potentials. Objectives: This study compares the accuracy of CGM and electrocardiography (ECG) by detecting coronary artery disease (CAD) with reference to angiography as a well-known gold standard. Patients and Methods: A total of 390 patients undergoing coronary angiography with CAD were enrolled. CGM was performed a few hours prior to coronary angiography. A standard 12-lead ECG was recorded after the CGM. The CGM and ECG results were recorded and analyzed by an independent investigator blinded to all patient data and the results of the coronary angiography. Results: The coronary angiography showed a normal coronary artery in 263 patients (67.4%). A median of CGM score was 1 (0-2), the minimum score was 0 and maximum score was 8. A total of 90 patients (31%) showed predefined ST-segment/T-wave changes in the resting 12-lead ECG. CGM yielded a sensitivity of 84% and specificity of 81% and the ECG yielded a sensitivity of 29% and specificity of 67% when compared with the coronary angiography. Conclusions: CGM is a non-invasive technique recently developed for quantitative three-dimensional vectorial analysis of myocardial activity and detection of ischemia and infarction. This technique is clearly more sensitive and more specific than a standard resting 12-lead ECG.
[ABSTRACT]   Full text not available  [PDF]
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Predictors of Clinical Anxiety Aggravation at the End of a Cardiac Rehabilitation Program
Mozhgan Saeidi, Saeid Komasi, Behzad Heydarpour, Hossein Karim, Mehdi Nalini, Parvin Ezzati
February 2016, 5(1):1-1
Background: Anxiety is one of the most primary and common reactions to a cardiac event can lead to hypertension, tachycardia, and high cardiac output. Objectives: To investigate the predictors of clinical anxiety aggravation at the end of a cardiac rehabilitation (CR) program. Patients and Methods: This retrospective study used a database of a CR ward of a hospital in Iran. The demographic and clinical information of 574 patients participating in the CR program from April 2005 through April 2010 were analyzed. In order to determine the predictors of anxiety, binary logistic regression was performed. Results: After adjustment for gender, age and education, the results showed that 16.7% of the patients completed their CR program with increased levels of clinical anxiety. The following study variables were independently predictive of increased anxiety at the end of the CR program: male gender (OR = 2.04, 95% CI = 1.11 to 3.33, P = 0.048), no history of diabetes (OR = 4.24, 95% CI = 172 to 10.44, P = 0.002), family history of cardiac disease (OR = 2.63, 95% CI = 1.03 to 6.74, P = 0.043), and not quitting smoking (OR = 3.29, 95% CI = 1.38 to 7.85, P = 0.007). These variables could explain 9% - 15% of the variance in the dependent variable. Conclusions: It is possible to predict higher anxiety levels at the end of the CR program and implement preventive measures to control anxiety by considering certain demographic and clinical variables. Future studies should assess the predictive power of other variables .
[ABSTRACT]   Full text not available  [PDF]
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Comparison of the effect of two left internal mammary artery harvesting techniques (skeletonization and pedicled) on post coronary artery bypass surgery pain and bleeding
Pooya Derakhshan, Mahmood Hosseinzadeh Maleki, Tooba Kazemi, Amir Rahmanian Sharifabad, Hamid Reza Mashreghimoghadam
January 2017, 6(1):3-3
Background: Recent evidence suggests that skeletonization of the left internal mammary artery (LIMA) can improve the flow and length of the flow, reduce deep sternal infections and postoperative pain. Objectives: The present study aimed to investigate the effect of two LIMA harvesting techniques (skeletonization and pedicled) on postoperative pain and bleeding. Methods: This randomized double blind clinical trial study on patients undergoing LIMA harvest in Birjand was conducted dur- ing years 2012 to 2014. The patients were divided to two (skeletonization N: 30 and pedicled N: 30) groups according to the LIMA harvesting method. Their demographic information and other relevant data were collected by means of a questionnaire. Results: In total, 60 cases, who were candidates for coronary artery bypass grafting (CABG) at the cardiac surgery department of Valiasr hospital in Birjand, were studied. In the skeletonized group, the conduit length was significantly longer (17.96 vs. 17.27, P < 0.001), yet there was no significant difference between early and mid-term pain scores (P values: 0.32 and 1.0, respectively) and early postoperative bleeding (782.26 vs. 903.16, P = 0.657). Conclusions: The IMA skeletonized collection resulted in the reduction of postoperative pain and increased conduit length. Skele- tonization could not decrease postoperative bleeding.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
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Protective effects of high-intensity versus low-intensity interval training on isoproterenol-induced cardiac injury in wistar rats
Soheil Aminizadeh, Hamid Marefati, Hamid Najafipour, Siyavash Joukar, Shahriar Dabiri, Beydolah Shahouzehi
January 2017, 6(1):5-5
Background: Cardiovascular diseases are among the major causes of mortality in industrialized countries. Prevention of cardio- vascular diseases and increasing stress tolerance are two of the main goals of physical training. Objectives: This study was designed to compare the effects of two exercise programs of different intensities on rat hearts with isoproterenol-induced myocardial injuries. Methods: Animals were randomly divided into four groups (n = 8 per group): control group (CTL); ISO group, administered iso- proterenol (85 mg/kg subcutaneously) for two consecutive days; low-intensity interval training + isoproterenol group (LIIT+ ISO: 5 minutes warm up at 40% VO2 max,5 x 10 minutes at50% -60% VO2 max [about 20-24 m/min]); and high-intensity interval training + isoproterenol group (HIIT+ ISO: 5 minutes warm-up at 40% VO2 max, 5 x 5 min at 95% -105% VO2 max [45 -50 m/min]). The train- ing groups performed high- and low-intensity interval training programs (5 days/week) on a motor-driven treadmill for 16 weeks. Seventy-two hours after the last training session, isoproterenol (85 mg/kg) was injected on two consecutive days. On the third day, hemodynamic parameters were recorded, blood samples were taken, and hearts were removed for laboratory analysis. Results: ISO-induced heart injury raised cardiac troponin I levels, significantly decreased + dp/dt max(P< 0.05) and-dp/dt max(P < 0.05), and significantly increased serum CTnI and tissue TNF α levels (P < 0.05). Exercise training had no significant effects on HR, LVSP, and LVEDP. Impairments of + dp/dt max and-dp/dt max were significantly improved in the HIIT+ ISO and LIIT+ISO groups (P < 0.05 for both groups versus ISO). In addition, exercise training groups especially HIIT + ISO to some reduce exacerbated the myocardial lesions induced by ISO (P < 0.05). Conclusions: These biochemical and histopathological findings suggest there is a protective role provided by both high- and low- intensity interval training protocols on ischemic hearts.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
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Racial differences in the predictive role of high depressive symptoms on incident heart disease over 18 years: Results from the health and retirement study
Shervin Assari, Amanda Sonnega
January 2017, 6(1):6-6
Background: Studies have investigated racial differences in the relationship between depression and CVD mortality. Objectives: This study tested the hypothesis that race moderates the effect of baseline depressive symptoms on subsequent heart disease among a nationally representative sample of Black and White older Americans. Patients and Methods: Data came from ten waves of the health and retirement study (HRS), a nationally representative longitudi- nal study of US adults over age 50. The present study followed 7,444 Black and White individuals without a diagnosis of heart disease at baseline for up to 18 years for incident heart disease. Elevated depressive symptoms at baseline was the independent variable, time to incident heart disease was the dependent variable, while baseline sociodemographics, health risk behaviors, obesity, and chronic medical conditions were controls. We used Cox proportional hazards models in the pooled sample and stratified by race to test the effect of elevated depressive symptoms on the outcome net of other risk factors. Results: In the pooled sample, a significant positive interaction was found between the effect of elevated depressive symptoms and Black race (hazard ratio, 1.29; 95% CI = 1.01 -1.65), suggesting a stronger effect for Blacks compared to Whites. In fully adjusted race- stratified models, elevated depressive symptoms increased the risk of developing heart disease for Blacks (hazard ratio, 1.47; 95% CI = 1.04 - 2.07) but not Whites (hazard ratio, 1.13; 95% CI = 0.97 -1.32). Conclusions: Black and White older adults differ in the effect of depressive symptoms on subsequent heart disease over a long period of follow up. Elevated depressive symptoms are associated with a larger risk of incident heart disease among Black but not White older individuals.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
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Effect of dexmedetomidine infusion on hemodynamics and stress responses in pediatric cardiac surgery: A randomized trial
Ziae Totonchi, Hengameh Rezvani, Masoud Ghorbanloo, Forouzan Yazdanian, Mohammad Mahdavi, Nima Babaali, Shirin Salajegheh, Mitra Chitsazan
January 2017, 6(1):7-7
Background: Infants and children compared with adults have intensified stress responses that lead to increased morbidity and mortality. Stress control reduces the incidence of complications and improves recovery. In clinical and experimental studies, dexmedetomidine reduces the inflammatory and neuroendocrine responses. Objectives: This prospective randomized double-blinded clinical trial was conducted to assess the role of dexmedetomidine in reducing stress responses. Materials and Methods: According to convenient sampling method, 40 patients in two groups (case under treatment with dexmedetomidine and control, each including 20 patients) were selected from whom admitted for open heart surgery. Anesthe- sia was induced and maintained by fentanyl and midazolam. After central venous and arterial catheter insertion, patients were randomly allocated into one of two equal groups (n = 20 each). In the dexmedetomidine group, patients received an initial loading dose (0.5 μg/kg) during10 minutes immediately followed by a continuous infusion of 0.5 μg/kg. In the control group, normal saline solution with similar volume was infused. Results: Changes in heart rate, systolic and diastolic blood pressures and central venous pressure before administration of dexmedetomidine, in 10, 20 and 30 minutes after the operation, after skin incision, after sternotomy, after separation from the pump and at the end of procedure showed no significant difference between the two groups (P = 0.860, 0.067, 0.888 and 0.482, respectively). Changes in lactate, interleukin 6, tumor necrosis factor, C-reactive protein concentrations before administration of dexmedetomidine, after separation of pump and 24 hours after intensive care unit entrance showed no significant difference be- tween the two groups (P = 0.525, 0.767, 0.868 and 0.840, respectively). Conclusions: According to our findings, using dexmedetomidine as an adjuvant anesthetic medication with initial loading dose of 0.5 μg/kgand maintenance dose of 0.5 μg /kg in pediatric heart surgeries is a safe choice. However, further studies are needed to clarify the role of dexmedetomidine to reduce stress responses.
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Oral iron therapy with polysaccharide-iron complex may be useful in increasing the ferritin level for a short time in patients with dilated cardiomyopathy
Sepideh Taghavi, Afsaneh Amiri, Ahmad Amin, Amirreza Ehsani, Majid Maleki, Nasim Naderi
January 2017, 6(1):8-8
Background: Iron deficiency (ID) is one of the most common comorbidities in patients with heart failure (HF). The preferred form of iron supplementation is intravenously. Polysaccharide-iron complex (PIC) is an oral iron supplement that has a bioavailability of 100%; gastrointestinal complaints are absent or less frequent with PICs. Objectives: In this study we aimed to investigate if oral PIC was effective at increasing the ferritin level over 12 weeks in dilated cardiomyopathy patients with an absolute iron deficiency and to determine the incidence GI side effects with this type of treatment. Methods: Thirty patients with a diagnosis of non-ischemic dilated cardiomyopathy (left ventricular ejection fraction (LVEF) < 35%) and absolute iron deficiency (serum ferritin level < 100 mcg/L) were recruited. For all study participants, one capsule of Feramax-150 was prescribed on a daily basis for 12 weeks. All patients were asked to report any GI side effects, including heartburn, abdominal pain, nausea, vomiting, diarrhea, constipation, and bloating. Results: The mean (SD) age was 43.2 (13.4) years. The mean LVEF was 23%. The mean(SD) ferritin level was 48.8 (27.7) at baseline. After 12 weeks of treatment with Feramax-150, the mean(SD) ferritin level had increased to 69.9 (42) (P< 0.001). No patients reported any gastrointestinal side effects. Conclusions: PICs could be a good and well-tolerated medicine in the treatment of iron deficiency in patients with heart failure. It is recommended that PICs be prescribed to maintain body iron stores after IV iron therapies in HF patients.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]
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A rare complication of primary percutaneous coronary intervention: Left atrial dissection and hematoma
M Fikri Yapici, Nihat Ozer, Arda Sanli Okmen, Altug Sagir, Tarik Bugra Denizalti, Azmi Ozler
November 2016, 5(4):9-9
Introduction: Left atrial dissection and hematoma are a life threatening condition, which are rarely seen following percutaneous coronary interventions. Diagnosis of these complications may sometimes be difficult, despite the use of the latest imaging techniques. The case presented in this paper is the first case of left atrial dissection and hematoma as complications following primary percutaneous coronary intervention. Case Presentation: A 65-year-old male patient was admitted to the emergency department and acute inferolateral myocardial infarction was diagnosed. The left atrial hematoma as a rarely complication is developed in patients undergoing primary percutaneous coronary intervention. Conclusions: Preoperative echocardiography, applied before elective and emergency percutaneous coronary interventions, plays a key role in detecting many intervention-related complications in the post-intervention period.
[ABSTRACT]   Full text not available  [PDF]
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Billowing of endologix powerlink stent mimicking endoleaks
Alex Wu, Karunakaravel Karuppasamy, Weiping Wang
May 2016, 5(2):1-1
Introduction: Endoleaks remains one of the primary concerns of endovascular aortic aneurysm repair (EVAR) and is routinely followed with CT angiography (CTA). However, certain imaging findings can mimic endoleaks. Case Presentation: A 65-year-old woman who had endovascular aortic repair (EVAR) of an abdominal aortic aneurysm with Endologix Powerlink system developed marked new circumferential cauliflower-like bulging of contrast-filled sacs at mid-stent-graft with enlargement of the excluded aneurysm at 3-year follow-up. Conclusions: Considering the unique construct of the Powerlink stents, this is thought to represent aneurysmal degeneration of the outer fabric material from the metal struts and may potentially pressurize the excluded sac with risk for rupture.
[ABSTRACT]   Full text not available  [PDF]
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Influenza H1N1 infection leading to cardiac tamponade in a previously healthy patient: A case report
Robinder S Sidhu, Abhinav Sharma, Ian D Paterson, Kevin R Bainey
August 2016, 5(3):6-6
Introduction: The cardiac manifestations of influenza A are broad, ranging from self-limited pericarditis to fatal cardiomyopathy. The 2009 H1N1 influenza A (H1N1) strain is a rare cause of pericarditis, and its role in developing a pericardial effusion leading to tamponade has infrequently been reported. Case Presentation: We describe a case of a young female with no prior cardiovascular history who presents with a pericardial effusion and shock secondary to cardiac tamponade from pericarditis due to H1N1 influenza A. Conclusions: This case highlights the potential severity of H1N1 infections and the utility of considering cardiac tamponade in patients presenting with influenza symptoms and circulatory collapse.
[ABSTRACT]   Full text not available  [PDF]
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Concurrence of pleural effusion and inferior vena cava thrombus in antiphospholipid syndrome complicated by intra-cardiac thrombus
Amin Bagheri, Jamshid Bagheri
November 2016, 5(4):11-11
Introduction: Antiphospholipid syndrome (APS) associated with intra-cardiac thrombus and pulmonary embolism is infrequent. However, the presence of pleural effusion is extremely rare. Case Presentation: A 42-year-old woman, admitted with palpitation, dyspnea and history of stroke and thrombocytopenia is described. Doppler sonography revealed deep vein thrombosis. Moreover, subsequent investigation confirmed the presence of right atrial thrombus, pulmonary arteries embolism and bilateral pleural effusion. Inferior vena cava thrombosis was confirmed during cardiac surgery and all thrombi were removed subsequently. Laboratory studies revealed the diagnosis of APS. The patient experienced deep vein thrombosis one year later and no evidence of recurrent disease was documented after three years follow up. Conclusions: APS complicated by inferior vena cava thrombosis coexistence of pulmonary embolism and intra-cardiac thrombus is not previously reported. Moreover, presence of pleural effusion with these conditions describes a unique case of APS.
[ABSTRACT]   Full text not available  [PDF]
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Failure to reach the optimal temperature during cryoablation due to refrigerant cylinder problem
Narendra Kumar, Trang Dinh, Mohamed Magdi Abbas, Kevin Phan, Randolph Manusama, Suzanne Philippens, Jos Maessen, Carl Timmermans
February 2015, 4(1):8-8
Introduction: Pulmonary vein (PV) isolation is considered as a key to atrial fibrillation (AF) treatment. Cryoballoon ablation is an effective therapy for PV isolation for AF with minimal side effects and was approved by the US Food and Drug Administration (FDA) several years ago. Successful isolation of PVs during cryoablation depends on the balloon temperature and helps in early identification of noneffective cryoballoon applications. A lower balloon temperature has been associated with long-term success in isolation of PVs. Case Presentation: At the start of the procedure, the cryoconsole displayed “low refrigerant level”. After a few cycles of successful cryoballoon applications, for a fresh application for a new PV the optimal temperature was not obtained in spite of obtaining good grade of occlusion and ostial positioning for right inferior pulmonary vein (RIPV). Later, immediately after changing the refrigerant cylinder, suitable temperature was obtained. We faced this situation thrice in a span of eight months. Conclusion: Low refrigerant level may cause nonoptimal temperature during cryoablation, which can be resolved by premature change of a gas cylinder.
[ABSTRACT]   Full text not available  [PDF]
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Tuberculous constrictive pericarditis
Gary Tse, Aamir Ali, Francisco Alpendurada, Sanjay Prasad, Claire E Raphael, Vassilis Vassiliou
November 2015, 4(4):3-3
Introduction: Constrictive pericarditis is characterized by constriction of the heart secondary to pericardial inflammation. Cardiovascular magnetic resonance (CMR) imaging is useful imaging modality for addressing the challenges of confirming this diagnosis. It can be used to exclude other causes of right heart failure, such as pulmonary hypertension or myocardial infarction, determine whether the pericardium is causing constriction and differentiate it from restrictive cardiomyopathy, which also causes impaired cardiac filling. Case Presentation: A 77-year-old man from a country with high incidence of tuberculosis presented with severe dyspnea. Echocardiography revealed a small left ventricle with normal systolic and mildly impaired diastolic function. Left heart catheterization revealed non-obstructive coronary disease, not felt contributory to the dyspnea. Anatomy imaging with cardiovascular magnetic resonance imaging (CMR) showed global, severely thickened pericardium. Short tau inversion recovery (STIR) sequences for detection of oedema/ inflammation showed increased signal intensity and free breathing sequences confirmed septal flattening on inspiration. Late gadolinium imaging confirmed enhancement in the pericardium, with all findings suggestive of pericardial inflammation and constriction. Conclusions: CMRwith STIRsequences, free breathing sequences and late gadolinium imaging can prove extremely useful for diagnosing constrictive pericarditis.
[ABSTRACT]   Full text not available  [PDF]
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Automatic Mode Switch (AMS) causes less synchronization
Mohammadvahid Jorat, Mohammadhossein Nikoo
May 2016, 5(2):9-9
Introduction: Cardiac resynchronization devices are part of modern heart failure management. After implantation, we analyze and program devices in an attempt to ensure their success. Biventricular pacing should be 98% or more for the lowest mortality and best symptom improvement. Case Presentation: In this case series, we present a combination of far field sensing and automatic mode switching (AMS) in six patients. It is found that this combination causes ventricular sensing (VS) episodes with wide QRS and no synchronization. We turn off the AMS and alleviate the problem. Conclusions: Switching AMS off may increase biventricular pacing in some patients.
[ABSTRACT]   Full text not available  [PDF]
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Persistent isolated right atrial standstill associated with left atrial tachycardia
Mohammad Vahid Jorat, Mohammad Hosein Nikoo, Aida Yousefi
November 2014, 3(4):4-4
Introduction: Atrial standstill is a rare condition, characterized by absence of atrial electrical and mechanical activity evident in surface electrocardiography echocardiography, or fluoroscopy, which is associated with unresponsiveness of atria to maximal output electrical stimulation. This condition can be present with thromboembolic complication, low cardiac output, and sometimes palpitation. Case Presentation: Here we presented a woman with right atrial stand still and left atrial tachycardia. It was confirmed by electrocardiogram, echocardiography, and intracardiac electrogram in basal state and during maximal output electrical stimulation. We treated her by implanting pacemaker to control bradycardia, oral calcium channel blocker to control palpitation episodes, and anticoagulation. Conclusions: Atrial standstill can be present partially that can be localized in one atrium and is associated with tachycardia in the other atrium.
[ABSTRACT]   Full text not available  [PDF]
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Mitral valve replacement in a young pregnant woman: A case report and review of literature
Mhonchan Kikon, Krishnanu Dutta Choudhury, Neeraj Prakash, Anubhav Gupta, Vijay Grover, Vijay Kumar Gupta
May 2014, 3(2):3-3
Introduction: Cardiac diseases occur in 2-4% of pregnancies and rheumatic mitral disease is the most common acquired heart disease in pregnancy. Cardiac surgery carries significant maternal and fetal complications. Cardiac operation during pregnancy is indicated only when medical management fails. Although emergency cardiac surgery during pregnancy increases fetal mortality, sometime urgent cardiac surgery is inevitable. Cardiac surgery can be performed with relative safety during pregnancy by adopting normothermic, high flow rate circulation and continuous fetal activity monitoring. Case Presentation: We reviewed English literature of a pregnant patient undergoing cardiac surgery during pregnancy. We presented a 25-year-old woman admitted with massive hemoptysis. Discussion: The patient underwent a successful mitral valve replacement during the third trimester. The aim of our study was to propose a practical guideline for similar situations.
[ABSTRACT]   Full text not available  [PDF]
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