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Cardiovascular disease (CVD) poses a significant health challenge in both developing and developed nations, with unparalleled morbidity, mortality, and economic tolls. Primary prevention of CVD through lifestyle modifications has been emphasized to address this issue. Yoga, an ancient practice dating back thousands of years with roots in the Harappan and Mohenjo-Daro civilizations, offers a potential solution. Hatha yoga, which includes physical movements and breathing techniques, is the most commonly practiced form today. The health benefits of yoga have recently gained attention and are being researched globally. Yoga is beneficial in both primary and secondary prevention of diseases, particularly CVD and its risk factors.
This review aims to explore the physiology of yoga, recent studies on its effect on the prevention and control of CVD, and the clinical implications of these findings.

Background: Hemodynamic disorders during anesthesia lead to complications. To reduce hemodynamic complications, this study was conducted to compare midazolam, etomidate, and propofol following anesthesia induction in patients undergoing coronary artery bypass grafting surgery (CABG).
Methods: A double-blind, randomized clinical trial was conducted involving 90 patients with coronary artery disease. These patients were randomly assigned to 1 of 3 groups receiving propofol, etomidate, or midazolam. Hemodynamic variables, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), and heart rate (HR), were measured at baseline, before intubation, and 1 and 5 minutes after intubation.
Results: Ninety patients with coronary artery disease (mean age: 60.83 y) were included in the study. Women and men comprised 74.4% and 25.6% of the study population. HR, SBP, DBP, and MABP exhibited significant decreases in all 3 groups after intubation. The etomidate group demonstrated the least change in SBP (P<0.001) and MABP (P<0.001), followed by the midazolam group. Concerning HR, the least change was observed in the midazolam group, followed by the propofol group (P=0.688). After intubation, blood pressure increased almost equally in the etomidate and midazolam groups compared with the levels during intubation. In contrast, the propofol group exhibited a downward trend in blood pressure during intubation, a significant difference across all 3 groups (P<0.001).
Conclusion: This study, conducted on candidates for CABG, demonstrated that anesthesia induction with etomidate and midazolam resulted in less variation in hemodynamic variables compared with propofol.

Background: Maintaining an optimal mean arterial pressure (MAP) is vital for cerebral blood flow and the overall health of patients undergoing coronary artery bypass graft (CABG) surgery. This study investigated the impact of low MAP on cerebral blood flow and in-hospital clinical outcomes in CABG candidates at our hospital.
Methods: We compared a convenience sample of 55 patients with a low MAP (55 mmHg) and 54 patients with a high MAP (75 mmHg) who underwent CABG at Tehran Heart Center in 2023. We recorded the patients' demographic and clinical characteristics by measuring cerebral oximeter readings and lactate levels pre- and post-operation. We then compared the baseline and postoperative characteristics between the 2 groups and determined the impact of MAP on their postoperative changes.
Results: The groups were statistically similar at baseline, except for a lower pH in the low MAP group (55 mmHg) (P=0.016). The preoperative and postoperative measurements (including lactate levels and cerebral oximeter readings) did not differ between the groups. However, heart rate was significantly higher in the high MAP group (75 mmHg) (P=0.034). The adjusted effect of baseline MAP on selected postoperative characteristics showed that it could significantly but inversely influence heart rate (β coefficient=-5.952; P=0.017) and had a borderline effect on troponin (β coefficient=1.734; P=0.051) and HCO₃ (β coefficient=0.785; P=0.062).
Conclusion: MAP did not significantly influence clinical outcomes in our study. Nonetheless, maintaining an optimal MAP is essential for preventing cerebral injury and ensuring adequate cerebral oxygenation in CABG patients.

Background: Over the past decade, Iranian households have experienced a decline in dairy product consumption. This study aimed to evaluate the population-attributable risk of prevalent non-communicable diseases related to dairy product consumption.
Methods: This cross-sectional analytical study involved 628 adults over 18 years old in Hamadan City in 2021. Clusters were selected based on comprehensive urban health centers. The standardized Iranian version of the food frequency questionnaire was used. Participants were categorized into 3 levels of dairy product consumption: >1 serving per day, 1–2 servings per day, and ≥3 servings per day.
Results: The mean age of the 628 participants was 38.05 (SD: 12.5), with 42.36% being male. Cheese (54.5%), yogurt (39.7%), and milk (30.4%) were consumed most frequently. The prevalence of insufficient dairy product consumption was 48.6%, higher than that reported in previous studies. Insufficient dairy product consumption was associated with hypertension (9.3%), cardiovascular disease (5.6%), and osteoporosis (5.1%).
Conclusion: Individuals with lower education levels, female gender, lowest quartile of socioeconomic status, and those diagnosed with cardiovascular disease were more likely to have insufficient dairy product consumption. Insufficient dairy product consumption was associated with hypertension, cardiovascular disease, and osteoporosis.

Background: The concurrence of acute myocardial infarction (AMI) with COVID-19 can complicate the clinical conditions of patients and affect the patterns of hospital resource utilization. This study aimed to investigate and analyze the direct treatment costs of AMI patients with concurrent COVID-19.
Methods: This cross-sectional study collected and analyzed clinical data, including symptoms, readmission, and interventions, and treatment cost data for all patients at Tehran Heart Center using SPSS26 software. The mean medical costs of patients from January through May 2022 were also calculated.
Results: The COVID-19 group was composed of 72.9% male and 27.1% female patients, whereas the non-COVID-19 group consisted of 67.3% male and 32.7% female patients. Most of the patients in the COVID-19 group (60%) were in the elderly age group (>65 y). The length of stay was 8.70±5.84 days for the COVID-19 group and 6.31±4.42 days for the non-COVID-19 group. The mortality rate in the COVID-19 group was 24%, higher than the 5% rate in the other group. Additionally, the average total treatment costs were $6384.54±$6760.13 in the COVID-19 group and $6362.49±$4343.07 in the non-COVID-19 group (P>0.78 and P>0.050).
Conclusion: The study found that the COVID-19 group had a significantly higher in-hospital mortality rate than the non-COVID-19 group. During the follow-up period, the incidence of complications (chest pain and heart failure) was higher in the non-COVID-19 group. It also showed that longer hospital stays resulted in higher treatment costs.

Background: Cardiomyopathy, characterized by heart stiffness, can lead to heart failure. This study aimed to investigate aortic stiffness in children with dilated cardiomyopathy (DCM) to better understand its contribution to disease severity.
Methods: This case-control study compared 48 children with DCM with 96 healthy children over a 10-year period starting in 2011. Aortic strain, aortic stiffness index, aortic distensibility, and pressure strain elastic modulus were measured. These parameters, along with several echocardiographic measures, were compared between the DCM and control groups. Statistical analyses were performed using SPSS 18, with a significance threshold set at a P value below 0.05.
Results: The participants included 57.6% boys, with 58.3% in the DCM group and 57.35% in the control group (χ²=0.014, P=0.905). The age range was 2 to 18 years, with mean ages of 11.08±4.63 years for the DCM group and 10.77±2.82 years for the control group (P=0.691). Significant differences between groups were observed in aortic distensibility (P=0.004), aortic stiffness β index (P=0.001), and pressure strain elastic modulus (P=0.004). Post-treatment analyses based on ejection fraction and fractional shortening cutoffs indicated no changes in elasticity parameters except for the aortic stiffness β index, which varied according to the Ross classification.
Conclusion: Children with DCM exhibited reduced aortic strain and aortic distensibility, as well as elevated aortic stiffness β index and pressure strain elastic modulus.

Background: This study aimed to determine postoperative cardiac and noncardiac complications and their association with the use of cardiopulmonary bypass (CPB), surgical outcomes (length of hospital and ICU stays), dependence on mechanical ventilation, and mortality.
Methods: This retrospective cross-sectional study was conducted on pediatric patients aged 0 to 18 who underwent open or closed cardiac surgery over a 1-year period. The use of CPB support, CPB duration, cardiac surgery complexity according to the risk-adjusted classification for congenital heart surgery (RACHS-1), and demographics were examined as potential risk factors associated with an increased number of postoperative complications. The study was performed at the Children’s Medical Center, a teaching hospital affiliated with Tehran University of Medical Sciences in Iran.
Results: A total of 283 surgeries were included in our study. Seventy-six (26.9%) of the study population experienced at least 1 complication. Our analysis revealed that increased CPB durations were associated with higher odds of cardiac complications, with an odds ratio of 1.02 (P=0.002). Moreover, higher RACHS-1 levels were significantly associated with greater numbers of cardiac and noncardiac complications. Additionally, prolonged mechanical ventilation and open-heart surgery intensive care unit (OH-ICU) stays were significantly associated with cardiac and noncardiac complications. Our logistic regression analysis found no association between demographic and clinical risk factors, the number of complications, and mortality.
Conclusion: Postoperative complications occurred in 27% of pediatric heart surgeries. Prolonged mechanical ventilation and OH-ICU stays were significantly associated with cardiac and noncardiac complications. However, no significant association was found between postoperative complications and mortality.

The coexistence of aortic coarctation, Ebstein’s anomaly, and transposition of the great arteries is an extremely rare occurrence. In this case report, we present a unique instance of complex congenital heart disease in a neonate who exhibited respiratory distress and cyanosis at birth. Echocardiography revealed several significant findings: congenitally corrected transposition of the great arteries, Ebstein’s tricuspid anomaly, moderate-to-severe tricuspid regurgitation, a small muscular ventricular septal defect, and an abnormal left arch with severe coarctation of the aorta. Due to the patient’s unstable hemodynamic status, balloon angioplasty was performed. Subsequent long-term clinical follow-up confirmed the efficacy of this intervention.

Various ECG patterns can help determine the location of the occluded coronary artery and the extent of threatened myocardium. The reported positive predictive value for de Winter ECG in predicting acute left anterior descending artery occlusion is inconsistent. Additionally, the morphology of ST depression and other ECG findings may have varying degrees of severity and prognostic significance. This case demonstrates the importance of integrating multiple ECG findings, such as ST elevation, Q waves, and the R/S ratio, with the location of the de Winter pattern on various ECG leads to accurately predict the culprit artery and assess the anatomical extent of myocardial ischemia.

Few cases of transcatheter aortic valve implantation (TAVI) following infective endocarditis (IE) have been reported. In this presentation, we discuss the feasibility of TAVI in a degenerated bioprosthetic valve affected by IE.
We examine a rare case involving an elderly man with a degenerated bioprosthetic aortic valve complicated by IE 6 months after a COVID-19 infection. The patient was successfully treated with valve-in-valve intervention following antibiotic therapy for the acute phase of the infection. This resulted in excellent outcomes with no complications in the early postprocedural period and during follow-up visits.
For patients with a destructed bioprosthetic aortic valve due to IE and residual dysfunction after healing, valve-in-valve intervention can be a safe and effective treatment option, particularly for those at high risk for surgery.

Brugada phenocopy is considered when a Brugada-type ECG pattern is present but with a low likelihood of true Brugada syndrome, as indicated by negative family history, genetic testing, or provocative testing with drugs, or ECG normalization after the removal of precipitants. Brugada phenocopy has been reported due to various causes such as fever and electrolyte imbalance. We describe a 22-year-old man who presented with aluminum phosphide poisoning, resulting in severe metabolic acidosis, myocarditis, and profound myocardial depression. He developed transient Brugada-like ECG changes and multiorgan dysfunction, requiring intensive management, including mechanical ventilation and inotropes. Brugada phenocopy is a rare manifestation of aluminum phosphide-associated toxic myocarditis. After a week of treatment, there was a significant improvement in cardiac function and overall clinical status.

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