Molecular study of vascular endothelial growth factor gene in Iranian patients after myocardial infarction

Stimulation of collateral artery growth [arteriogenesis] and/or capillary network growth [angiogenesis] would be beneficial to the patients with myocardial infarction. To understand the central role of vascular endothelial growth factor [VEGF] in biological angiogenesis, we performed molecular analysis of the VEGF gene in patients afflicted with acute myocardial infarction [AMI]. Forty patients with AMI were divided into two groups according to the presence or absence of created collateral blood vessels in ischemic myocardial region. In these patients we also evaluated the possible relationship of plasma levels of VEGF and its growing ability of new blood vessels. The molecular characterisation of VEGF gene may highlight the presence of natural genomic variants which could facilitate the formation of new vessels in the ischemic area. The genomic analysis of VEGF gene did not reveal any mutations in the coding region, but showed the presence of four and one single nucleotide substitutions in the intronic region and 5'UTR respectively. The C to T nucleotide transition at position -7 of 5'UTR is located in a potential binding site for Sp-1 transcription factor, which could probably affect the VEGF gene transcription. The molecular study of VEGF gene showed that its coding region is highly conserved. Therefore, variations of angiogenesis could be due to the regulatory elements participating in this mechanism

Pacemaker twiddler's syndrome

A 76-yr-old man with unipolar ventricular pacemaker, previously implanted in the right ventricular apex, presented with syncopal attack and twitching of the right pectoralis muscle. He finally was diagnosed as having Twiddler's syndrome. The patient had a pulse rate of 36/min and cannon waves in the neck veins. Chest radiography showed a dislodged pacing lead completely wrapped around the pulse generator. After uncoiling the lead it was positioned in the right ventricular apex and the pulse generator implanted and sewed tightly in a smaller pocket. After six months follow-up there was no further twiddling or pacemaker dysfunction

serum thyrotropin level and subclinical hypothyroidism predisposing factors for coronary artery disease?

Overt hypothyroidism has been found to be associated with cardiovascular diseases. Whether or not subclinical hypothyroidism is also a risk factor for cardiovascular disease is controversial. The aim of this study was to investigate serum thyrotropin levels and subclinical hypothyroidism in relation to presence and extent of coronary artery disease [CAD]. In a sample of 390 persons [239 men and 151 women] with mean age of 55.12 +/- 10.52 years who had referred for coronary angiography, data on general health, thyroid status, medications and previous myocardial infarction were obtained at baseline. They were screened for impaired thyroid function using a sensitive immunoradiometric assay for thyrotropin. Subclinical hypothyroidism was defined as an elevated serum thyrotropin level [>/= 4. 0mU/L] and a normal serum free thyroxine level. A single-, two- or triple vessel disease or normal vessels was documented by coronary angiography. Subclinical hypothyroidism was present in 6.4% of persons and was not associated with a higher frequency [P=0.51] or greater severity [x2=2.172; P=0.70] of CAD. The mean serum thyrotropin level was significantly higher in women [P<0.001]. There was neither correlation between serum thyrotropin level and the presence of CAD [P=0.37] in either sex [men: P=0.67 /women: P=0.97] nor with the extent of CAD [P=0.30] in either of the two groups [men: P=0.70 /women: P=0.34]. Also, serum thyrotropin level was not higher significantly in patients who had has previous myocardial infarction [P=0.95]. There was no correlation between thyrotropin levels or subclinical hypothyroidism and presence or severity of CAD in a cohort of patients who referred for coronary angiography.cohort of patients who referred for coronary angiography