Gender differences in the risk of coronary artery disease in Iran

Given gender differences in the risk of coronary artery disease [CAD], the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as post-procedural data were collected. The data were, subsequently, compared between the men and women. Out of the 44,820 patients [16,378 women], who underwent coronary angiography, 37,358 patients [11,995 women] had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar [P< 0.001]. Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients [OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26-2.48, respectively]. Acute coronary syndrome was more prevalent in the men [76.1% vs. 68.6%, P< 0.001], and chronic stable angina was more frequent in the females [31.4% vs. 23.9%, P< 0.001]. With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females [20.1% vs. 18.6%, P< 0.001] Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often

Early outcome of concurrent mitral valve replacement and coronary artery bypass grafting

Concomitant coronary artery bypass surgery [CABG] in patients undergoing mitral valve replacement [MVR] has been shown to be an important risk factor for hospital mortality. We evaluated preoperative characteristics, postoperative complications, in-hospital mortality rate, and length of stay in hospital for patients undergoing concurrent CABG with MVR. Preoperative and postoperative clinical data from 175 patients undergoing concurrent CABG with MVR operation at Tehran Heart Center from 2002 through 2006 were collected and entered into a database. Information was obtained by clinical and case note review as well as detailed questionnaires to physicians and patients. Mean age of patients was 57.95 +/- 10.54 years and 51.4% were male. Mean New York Heart Association [NYHA] score was 2.46 +/- 0.84. Among studied patients, 18.3% and 2.9% underwent aortic and tricuspid valve replacement, respectively. In-hospital mortality was 6.9% and 96.0% of patients were hospitalized >/= 14 days. History of congestive heart failure [P = 0.027] and postoperative brain stroke [P = 0.004] were independent predictors for in-hospital mortality. Exact considering of congestive heart failure and postoperative brain stroke related to in-hospital mortality in concurrent CABG with MVR operation are necessary

Acute pulmonary embolism due to rupture of pulmonary valve hydatid cyst

Cardiac hydatid cyst is rare comprising 0.5-2% of all cases. A 20-year-old man was admitted for acute pulmonary embolism. Echocardiography and magnetic resonance imaging revealed hydatid cyst of pulmonary valve annulus. The cyst was drained surgically, and the patient was discharged with oral albendazole. For fatal complications of cardiac hydatid cyst, surgery is recommended in all patients

Homocysteine level in CAD patients of Iranian population

Coronary flow reserve [CFR] is defined as a maximal [hyperemic] to resting ratio of coronary blood flow. It is a physiologic parameter of coronary circulation and depends on the patency of the epicardial coronary arteries and integrity of the microvascular circulation.CFR measurement has many clinical applications including functional assessment of intermediate stenosis, detection of critical stenosis monitoring of coronary flow in the post angioplasty period, assessment of post infarct blood flow and assessment of coronary graft patency. The aim of this study was to measure CFR in the coronary sinus through the transthoracic echocardiographic approach, in patients who were candidate for coronary artery bypass graft surgery [CABG] before and one month after operation. The present study included 19 patients [mean age=56 +/- 9.1] including 15 males and 4 females, admitted for CABG. All patients had a sinus rhythm, normal wall thickness, normal RV systolic pressure, and tricuspid valvular regurgitation equal or less than grade 2. The antegrade phase of coronary flow in the coronary sinus moving into the right atrium was analyzed in two phases [systolic and diastolic]. Each wave was determined considering the peak velocity and velocity time integral [VTI]. The volumetric blood flow in the coronary sinus calculated at the baseline and then in hyperemic phase was used for determination of CFR both before and after CABG. There was a significant increase in the diameter of the coronary sinus after CABG [9.4 +/- 1.2mm] compared with that of before CABG values [8.6 +/- 1.05mm]. Also there was a trend of increasing the diameter in the hyperemic phase before and after CABG. The absolute increase in mean coronary sinus diameter was 0.5 mm before and 1.5 mm after CABG. Coronary flow reserve [CFR] was significantly higher after surgery, despite a significant increase in systolic velocity ratio [hyperemic/baseline] after CABG. This is also true for systolic velocity time integral [VTI] and diastolic VTI ratios, but there was an insignificant increase in diastolic velocity ratio. Our study in accordance with previous studies, denotes that transthoracic measurement of the coronary flow reserve can be used as a feasible and reproducible method to monitor the changes in cardiac perfusion after revascularization

[Comparison of post extubation complications in 3 different states of filling endotracheal tube cuff with lidocaine 4% in elective surgery patients]

Endotracheal intubation during general anesthesia is necessary to control the ventilation of patients during surgery. Nevertheless, the endotracheal tube as an external object can stimulate the patient's airway during the emergence from general anesthesia and create different reactions and complications. To prevent these reactions, a wide variety of interventions have been examined. In this study, post-extubation endotracheal tube complications are investigated in 3 different states of lidocaine 4% for filling endotracheal tube cuffs. In this quasi-experimental clinical trial study executed in one of Shiraz hospitals during 2005-2006, 200 candidates of elective surgery being in class1 and 2 ASA were randomly divided into 4 groups [N=50]. The endotracheal tube cuffs of each group members were filled with [5-10mI] distilled water, lidocaine 4%, alkalized lidocaine 4% and warmed alkalized lidocaine 4%, respectively. The patients were observed for complications such as cough [for 6 hrs], sore throat, hoarseness [for 24 hrs] and laryngospasm [immediately] after extubation. The data were analyzed by chi square and logistic regression using SPSS. The findings revealed that the frequency of cough, sore throat and hoarseness was more in the control [distilled water] group as compared to the 2 groups of the study [alkalized lidocaine 4% and warmed alkalized lidocaine 4%]. Distilled water and lidocaine 4% groups differed significantly in only the frequency of sore throat. The odds ratio of cough, sore throat and hoarseness was just significant for the distilled water group in comparison to warmed alkalized lidocaine 4%. Furthermore the odds ratio of the above-mentioned complications was significant for the distilled water and lidocaine 4% groups in comparison to the warmed alkalized lidocaine 4% group. Among all the considered variables, the duration of tube existence in trachea was significantly effective in the frequency of complications. Filling endotracheal tube cuffs with alkalized lidocaine 4% and warmed alkalized lidocaine 4% decreases the frequency of the post-extubation complications [cough, sore throat and hoarseness]. The odds ratio for the observed complications is less in the warmed alkalized lidocaine 4% group as compared to other groups