Vol 4 No 3 (2009): J Teh Univ Heart Ctr
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The clinical and economic importance of heart failure is widely recognized. The incidence of heart failure is on the increase, particularly with the aging of the population around the world. It is time for a paradigm shift in heart failure management. Alternative non-pharmacological strategies to remodel the failing ventricle will shape a major portion of heart failure therapy in the decade ahead.
Exposure to heat is widely used as a traditional therapy in many cultures. In this paper, we will review recent data that suggest thermal therapy may be helpful as an adjunctive non-pharmacological treatment for heart failure.
Background: There are some reports on the association between air pollution and myocardial infarction, arrhythmia, and mortality due to cardiac problems in susceptible individuals. We aimed to evaluate the association of air pollution and the emergency visits due to cardiovascular diseases, in a specialized heart hospital in Tehran.
Methods: The study design was cross-sectional. Patients admitted to the emergency ward of Tehran Heart Center were consecutively included. Records of meteorological data for the study period were obtained from Air Quality Control Company that monitors the concentration of air pollutants through its several stations including one near to Tehran Heart Center. The principal component analysis was used to examine the association between daily air pollution level and the number of patients admitted as a result of unstable angina, myocardial infarction, and arrhythmia.
Results: The principal component score -reflecting the daily air pollution level- was higher on the admission date of the patients who died in hospital compared to that of the patients who discharged alive from the hospital and the difference was statistically significant. After adjustment for the effect of age, sex, smoking, hypertension, hyperlipidemia and diabetes, a statistically significant relationship between principal component score and the unstable angina and arrhythmia was detected in patients referred to the emergency department.
Conclusion: Air pollution was associated with the unstable angina and arrhythmia in patients referred to the emergency department of Tehran Heart Center, adjusted for the effect of other risk factors.
Background: There is some evidence indicating improvement in myocardial performance after atrial septal defect closure, either device closure or surgical, but ventricular dyssynchrony has not been evaluated before and after surgical closure. The aim of this study was to evaluate ventricular mechanical dyssynchrony in patients with atrial septal defect before and after surgical closure.
Methods: Twenty patients (mean age: 23±11years) with isolated secundum or sinus venosus type atrial septal defect, unsuitable for device closure, were evaluated before and after successful surgical closure. Interventricular and intraventricular dyssynchrony (using 6 basal and 6 mid-segmental models) were determined.
Results: A significant reduction in the right atrial and right ventricular dimensions and the tricuspid regurgitation peak gradient was noted after atrial septal defect closure (3.6±0.54 cm versus 4.2±0.7, P=0.009; 3.5±0.29 cm versus 4.3±0.41, P=0.02; and 20.4±10.5 mmHg versus 35.3±6.5, P<0.002; respectively).
There was no significant difference in the maximum difference in time-to-peak systolic velocity and the standard deviation of time-to-peak systolic velocity of the l2 left ventricular myocardial segments in the patients with atrial septal defect before and after surgical closure in comparison with the normal subjects (normal: 26±10.64 ms versus before closure:21.0±33.9 versus after closure: 27±29.5, both P=0.68) and the left ventricular asynchrony index after atrial septal defect closure (normal: 14.9±8.7 versusbefore closure:11.46±8.5 versus after closure: 18.12±13.6, both P=0.2). There was a significant positive relation between the tricuspid regurgitation peak gradient and the left ventricular asynchrony index (r=0.67, P=0.03) and an insignificant negative relation between the left ventricular ejection fraction and the asynchrony index before atrial septal defect closure (r=−0.53, P=0.11). No significant relation was found between the total asynchrony index and the atrial septal defect size, the degree of left-to-right shunt, and the tricuspid regurgitation peak gradient.
Conclusion: There was no significant ventricular dyssynchrony in the patients with atrial septal defect before and after surgical closure.
Background: Myocardial infarctions at different locations have been related to different sets of risk factors. This study was designed to examine the association between cardiovascular risk factors and specific coronary artery calcification (CAC).
Methods: The study population comprised 573 postmenopausal women selected from a population-based cohort study. Established vascular risk factors were measured. The women underwent a multi detector-row computed tomography (16-MDCT) (Philips Mx 8000 IDT 16) to assess coronary calcium. The Agatston score was used to quantify coronary calcium. Logistic regression models were utilized to assess the relations.
Results: The prevalence of coronary artery calcification (Agatston score>0) was 61.5% (n=348). CAC was most common in the left anterior descending (LAD) artery with a prevalence of 43.9%; and the rates of prevalence in the right coronary artery (RCA), the circumflex (LCX), the left main artery (LM), and the posterior descending artery (PDA) were 23.1%, 19.4%, 15.8%, and 0.3%, respectively. In the multivariate regression models, age was predominantly related to the calcification in the LAD and LCX, low density lipoprotein to calcification in the LAD, and cholesterol to the calcification of the RCA. Hypertension, systolic and diastolic blood pressures were related to the calcification of the LCX, whereas smoking was predominantly related to the calcification of both LAD and RCA. Finally, age, body mass index, and systolic blood pressure were significantly related to the calcification in the LM.
Conclusion: Our findings showed that the consequences of elevated risk factor levels on the development of atherosclerosis appeared to be different across the segments of the coronary arteries.
Background: Early detection of proneness to hypertension may help an individual to lead a healthy life by altering the life style. Subjects having the predisposing factors of hypertension tend to show higher and prolonged responsiveness to blood pressure following stress.
Methods: Normotensive, non-smoking healthy sedentary male students and staff of Nepal Medical College (n=50, age group 18-35 years) participated in the study, conducted between May 2008 and June 2008. Participants with hypertensive parents, either or both, were considered volunteers from hypertensive families. The cold pressor test was carried out. The changes in blood pressure and heart rate among the volunteers of the hypertensive and normotensive families were compared using Student’s t-test.
Results: In the present study, sympathetic stimulation exerted through the cold pressor test resulted in an elevation of blood pressure and heart rate in all the young male normotensive individuals. Blood pressure and heart rate returned to the baseline 5 minutes after the withdrawal of the stressor in the cases of the volunteers with no history of familial hypertension. On the other hand, the subjects whose parents, either or both, were reported to be hypertensive showed elevated diastolic blood pressure even 5 minutes after the withdrawal of the stressor.
Conclusion: The present study revealed that the normotensive young male subjects who presented prolonged elevated diastolic pressure in response to sympathetic stimulation through the cold pressor test were prone to develop hypertension in the future.
Background: The incidence of stroke after coronary artery bypass grafting (CABG) is between 0.9% and 6.7%, which significantly increases in-hospital and out-hospital costs. This study was designed to evaluate the prevalence of significant carotid stenosis and its risk factors in CABG.
Methods: In total, 2044 consecutive patients undergoing elective CABG were investigated through a pre-operative duplex scanning of the carotid arteries. The relation of age, sex, smoking, hypertension, diabetes, dyslipidemia, and coronary disease with carotid stenosis was evaluated.
Results: The prevalence of carotid stenosis was 7.6%. The multivariate analysis showed that age over 55 and left main coronary disease were significant independent risk factors for carotid stenosis. Female gender, smoking, hypertension, and diabetes were the risk factors in the univariate logistic regression model.
Conclusion: Carotid stenosis is prevalent in CABG candidates. It seems that age ≥55 years and left main coronary disease are the independent risk factors for carotid stenosis in CABG patients.
Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group.
Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups.
Results: The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups.
Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.
Acinetobacter lwoffii, an important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia.
This report presents a case of left radial artery pseudoaneurysm developing at the previous site of invasive monitoring. The patient had prosthetic mitral valve replacement one month earlier, and anti-coagulation therapy had started on the first post-operative day. The patient’s radial artery aneurysm with a 4-centimeter diameter was resected and the radial artery was ligated.
2023 CiteScore: 0.9
pISSN: 1735-8620
eISSN: 2008-2371
Editor-in-Chief:
Abbasali Karimi, MD.
Senior Associate Editor:
Ali Bozorgi, MD.
Section Editors:
Masih Tajdini, MD.
Entezar Mehrabinasab, MD.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
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