Silent pulmonary artery dissection in a patient with old pulmonary balloon valvuloplasty

Percutaneous pulmonary balloon valvuloplasty [PBV] remains the treatment of choice for pulmonary stenosis [PS]. This procedure is effective, safe and gives excellent results. Pulmonary artery [PA] dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study

Mitral regurgitation after percutaneous balloon mitral valvotomy in patients with rheumatic mitral stenosis: a single-center study

Percutaneous balloon mitral valvotomy [BMV] is the gold standard treatment for rheumatic mitral stenosis [MS] in that it causes significant changes in mitral valve area [MVA] and improves leaflet mobility. Development of or increase in mitral regurgitation [MR] is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients. We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association [NYHA] functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient [MVPG and MVMG], left atrial [LA] pressure, pulmonary artery systolic pressure [PAPs], and MR severity before and after BMV, were evaluated. Totally, 105 patients [80% female] at a mean age of 45.81 +/- 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure [p value < 0.001] MVA significantly increased [mean area = 0.64 +/- 0.29 cm[2] before BMV vs. 1.90 +/- 0.22 cm2 after BMV; p value < 0.001] and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 [78.1 %] patients, but it increased in 18 [17.1%] and decreased in 5 [4.8%] patients. Patients with increased MR had a significantly higher calcification score [2.03 +/- 0.53 vs. 1.50 +/- 0.51; p value < 0.001] and lower MVA before BMV [0.81 +/- 0.23 vs. 0.94 +/- 0.18; p value = 0.010]. There were no major complications. In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV

Evaluation of cardiovascular diseases and their risk factors in hospitalized patients in east Azerbaijan province, northwest Iran: a review of 18323 cases

Coronary artery disease [CAD] is accountable for more than 30% of deaths worldwide and is, thus, deemed the most important factor in terms of disease burden around the globe. This study aimed to evaluate CAD and its risk factors in hospitalized patients in the East Azerbaijan Province, northwest Iran, from 2006 to 2007. Data on 18.323 patients hospitalized due to cardiovascular diseases were collected to evaluate the diseases and their risk factors in 15 hospitals in the East Azerbaijan Province, northwest Iran. We assessed the main diagnosis of cardiovascular disease on admission in each hospital. Also, types of interventional and surgical procedures were assessed and all these variables were compared between men and women. The study population consisted of 56.6% male and 43.4% female patients. The median and range between quartile 1 and 3 [Q1-Q3] ages of the males and females were 59 [49-70] and 62 [51-71] years, respectively. Ischemic heart diseases were diagnosed in 68.4%, electrophysiological disorders in 6.5%, and valvular heart diseases in 4.5% of the patients. The frequencies of the studied risk factors were as follows: cigarette smoking [47.5%]; hypertension [66.95%]; diabetes mellitus [35.9%]; and history of cerebrovascular accident [16.4%] and renal disease [13.4%]. Medical therapy was performed in 79.23%, surgery in 6.28%, and cardiovascular interventional therapy in 13.99% of the patients. The in-hospital mortality rate was 1.57% [1.42% in the males and 1.76% in the females; p value = 0.009]. The most frequent known risk factors in the hospitalized patients were smoking, alcohol consumption, and diabetes. In the northwest of Iran, age at hospitalization due to cardiovascular diseases is slightly lower than that in the Western populations; however, sex distribution, diagnoses, and treatment modalities are not significantly different from those reported in Western countries

Echocardiographic findings in thalassemia major: a case report and literature review

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.

Apical hypertrophic cardiomyopathy in association with pulmonaryartery hypertension

Apical Hypertrophic Cardiomyopathy is an uncommon condition constituting 1% -2% of the cases with Hypertrophic Cardiomyopathy [HCM] diagnosis. We interestingly report two patients with apical hypertrophic cardiomyopathy in association with significant pulmonary artery hypertension without any other underlying reason for pulmonary hypertension. The patients were assessed by echocardiography, cardiac catheterization and pulmonary function parameters study.

Isolated right sided anomalous pulmonary venous connection associated with significant right ventricular enlargement and intact interatrial septum

Partial anomalous pulmonary venous connection [PAPVC] is a very rare congenital heart disease where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with inexplicable right ventricular enlargement on transthoracic echocardiography, other modalities such as transesophageal echocardiography, CT angiography or cardiac Magnetic resonance [CMR] imaging are able to diagnosis the anatomical abnormalities. We present a 29-year-old female with moderate right ventricular enlargement and isolated right upper and middle pulmonary vein anomalous return to superior vena cava

Incidence of Cardiovascular Risk Factors in Oskoo (Northwest Iran]: an Approach through WHO CVD-risk Management Package for Low-and Medium-Resource Settings on 37,329 Adults >/=30 Years Old

The aim of this study was to determine incidence of cardiovascular disease [CVD] risk factors [hypertension [HTN], obesity, Dyslipidemia[DLP], diabetes mellitus [DM] and smoking] in Oskoo. This study was planned according to WHO protocol [WHO CVD-risk management package for low and medium-resource settings] and named [East Azerbaijan healthy heart program]. The pilot study of this program was done in Oskoo in 2007-2009. In this study, demographic data and CVD risk factors of 37, 329 adults aged>30 years old living in Oskoo were collected. In addition, blood samples of 17, 388 adults>40 years old were taken [free of charge] for assessment of serum glucose and lipid profile. The study covered 93.52% of Oskoo town population aged>30 years old. We studied 18637 male [M] [91.50% coverage] and 18692 female [F] [95.52% coverage] participants. The incidence of HTN [SBP>140 and DBP>90 mmHg] was 16.25% [M:15.08%, F: 17.29%], pre-hypertension [SBP-120-139 and DBP-80-89 mmHg] -37.78% [M:41.38%, F:34.18%], DM [fast blood glucose [FBS]>126mg/dl] was 7.45% [M:6.35%, F:8.54%], smoking was 9.40% [M: 17.00%, F:1.57%], hypercholesterolemia [>200mg/dl] was 47.64% [M:42.46%, F:52.81%] and obesity [body mass index [BMI] >27] was 50.47% [M:38.79%, F:62.09%]. Considering high incidence of CVD risk factors [except smoking] in Oskoo adults >30 years, it is recommended that this pilot study expanded to all of East Azerbaijan. Free of charge taking blood samples from people > 40 years to evaluate lipid profile and glucose levels is worthy to early detecting the prevalent

Tissue doppler imaging values in hypertrophic cardiomyopathy according to left ventricular outflow gradient

Background: The aim of the present study was to investigate the effects of the left ventricular outflow gradient on tissue doppler imaging [TDI] values in patients with hypertrophic cardiomyopathy [HCM]. Methods: This prospective observational study was conducted in a tertiary referral heart hospital [Tabriz, Iran] from March 2004 to March 2008. Fifty two patients [28 men and 24 women] with definite diagnoses of HCM were selected for the study. 2D, M-mode echocardiography and TDI were performed for all patients. In TDI, the velocities of myocardium was measured at lateral and septal corner of the mitral valve annulus in peak early diastolic [Ea], peak late diastolic [Aa] and peak systolic [Sa]. Then, the TDI velocities were compared in patients with left ventricle outflow gradient less and more than 30 mmHg. Results: The mean age of the patients was 42.13 +/- 12.22 years. All patients were in New York Heart Association functional class I or II. The mean EF was 55 +/- 7%. It was found that TDI velocities are reduced in patients with HCM, compared to normal vaues and Ea in septal corners of the mitral annulus was reduced more in patients with left ventricle outflow gradient > 30 mmHg [5.3 +/- 1.6 vs 7.1 +/- 1.2, P=0.01]. Conclusion: TDI findings specially peak early diastolic [Ea] mitral annular velocity are good parameters in HCM patients assessment

Comparison of serum homocysteine concentrations between smoker and nonsmoker patients with acute coronary syndrome in Tabriz shahid madani hospital during 2008-2009

Background: According to previous studies elevated blood total homosyteine has been suggested to be an independent risk factor for cardiovascular disease. The aim of this study was evaluation of homosyteine serum in smoker and nonsmoker patients with acute coronary syndrome [ACS]. Methods: Eighty five patients were enrolled in this study. Forty eight patients [21smoker and 27non-smoker] diagnosed with acute myocardial infarction [AMI], 37 patients [14smoker and 23non-smoker] with unstable angina [UA] that admitted in Shahid Madani Heart center in Tabriz in 2008-2009. The mean age of patients with AMI and UA were 61.83 +/- 13.78 and 59.90 +/- 11.95 years, respectively. Homocysteine serum Levels were measured by Hitachi Auto analyzer. Results: The mean age of patients with AMI was 61.83 +/- 13.78 years and in patients with UA was 59.90 +/- 11.95 years [p=0.53]. Mean serum levels of homocysteine were not significant difference between AMI and UA patients [17.61 +/- 11.25 µmol/L vs. 22.25 +/- 12.44, p=0.78]. There was also a significant correlation between high levels of homocysteine with AMI and UA diseases in comparison with normal reference values. There were not statistically significant differences in serum homocysteine levels between smoker and nonsmoker patients in both AMI and UA groups. Conclusion: The Mean levels of Homocysteine in AMI and UA groups were not significantly different. Our study showed age of smoker patients in AMI and UA groups were significantly lower than nonsmoker patients

Blue color vision as a rare sign of digitalis toxicity

We report a 73-year-old woman who had taken an amount of 0.25 mg/day of digoxin for an unknown period of time because of chronic congestive heart failure and chronic atrial fibrillation. She was admitted due to nausea, vomiting, abdominal pain, atrial fibrillation with a slow ventricular rate and with a short corrected Q-T interval in an electrocardiogram of 345 milliseconds, high serum digoxin level of 4.2 nmol/L, and interestingly color vision disturbances: blue colored vision. After discontinuation of the digitalis treatment, all signs of digitalis toxicity, including blue color vision, disappeared within five days

Evaluation of systolic and diastolic function of left ventricle by using velocities of mitral annulus in patients with first acute anterior MI and their one month follow up

To evaluate systolic and diastolic dysfunction of left ventricle in patients with first anterior myocardial infarction and its relation to one month mortality after myocardial infarction; in this study mitral annulus motion velocity that was recorded by Tissue Doppler Imaging [TDI]. The study included 111 consecutive individuals, 81 patients with first anterior myocardial infarction, [in wich 72 patients who survived and 9patients dead one month after admission], 30 individuals which matched with the studying group selected as a control group. Longitudinal function of left ventricle was evaluated by the use of mitral annular velocities in this study. Patients with myocardial infarction showed significant reduction in peak systolic, early diastolic and late diastolic annular mitral velocities comparing with control group in all studied segments. There was a good correlation between Left Ventricle Ejection Fraction [LVEF] and all mitral valve annular velocities. Also Myocardial Performance Index [MPJ more than 0.8 and [Regional Wall Motion Scoring Index [RKMSJ more than 1.77 had high sensitivity [0.94 and 0.96 respectively] in predicting death in follow-up period. Reduced peak systolic mitral annulus velocity is an expression of regionally reduced systolic function. Reduced peak early and late diastolic velocities reflect regional diastolic dysfunction. Also Regional wall motion score index and myocardial performance index can be useful in predicting death after myocardial infarction

complicated radial artery pseudoaneurysm

This report presents a case of right radial artery pseudo aneurysm complicated by arterio-venous fistula and absence of ulnar artery the patient had history of deep vein thrombosis 18 months earlier and was receiving oral warfarin anticoagulation therapy. Doppler study and angiography finding showed poor collateral supply to distal arterial bed. The etiology of this complication and its treatment is controversial

Serum levels of copper and zinc in patients with acute coronary syndrome

Previous studies suggest a protective role of the essential trace elements against cardiovascular disease, whereas wistful epidemiological data remains controversial. We aimed to investigate the serum concentration of zinc [Zn] and copper [Cu] in patients presented with acute coronary syndrome [ACS] considering status of cigarette smoking. Baseline Zn and Cu concentrations were measured in 100 individuals [50 with unstable angina [UA] and 50 with acute myocardial infarction [AMI]; then these parameters were compared with normal reference values. Current smoking status of patients in each group was analyzed considering values of serum trace elements concentration. In those patients who were admitted with ACS, mean serum Zn [62.1 +/- 13.4 [micro]g/dL] and Cu [66.5 +/- 14.1 [micro]g/dL] levels were lower compared to normal reference values [p < 0.001]. No significant differences were observed between AMI and UA patients in serum Zn [59.6 +/- 2.9 vs. 65.7 +/- 14.2 [micro]g/dL; p=0.28] and Cu [64.9 +/- 13.3 vs. 68.1 +/- 15.0 [micro]g/dL; p=0.79] levels. Also there were not any statistically significant differences in Cu and Zn levels between smoker and non-smoker patients in each study group [p values> 0.05]. Lower Zn and Cu serum concentration was found in patients with ACS but these relatively low levels are not significantly different between AM1 and UA patients. Also, it seems that cigarette smoking dose not considerably affect serum levels of Zn or Cu in ACS patients

Chronobiological rhythms in onset of massive pulmonary embolism in iranian population

To investigate whether there is any chronobiological rhythms in onset of massive pulmonary embolism in Iranian population and to study any time variation in occurrence of this disease in patients' subgroups. This study was conducted in an emergency department of a referral teaching hospital from March 2003 to March 2007. All medical records of patients with definite diagnosis of massive pulmonary embolism were reviewed for chronobiological rhythms in hourly, daily, monthly and season periods. One hundred and twenty patients [49 women and 71 men] included in the study. The mean age of patients was 63.63 +/- 17.21 years. Massive pulmonary embolism showed a statistical increase in onset in the morning period [p=0.004] with peak of occurrence between 9:00 to 10:00, in the first three day of the week [p<0.001], and during winter [p=0.003]. In addition, hourly and weekly rhythms in onset of massive pulmonary embolism in diabetic patients is different from non-diabetic patients and occur most frequent in evening hours and in the end of week. Our findings revealed that massive pulmonary embolism has a peak of onset during morning hours and in the winter. We also found that massive pulmonary embolism also has a weekly rhythm. Circadian and weekly rhythms of massive pulmonary embolism were different in diabetic patients and this is a novel finding of this study

Study of the association between activity level at onset of symptoms and patient outcome of first acute myocardial infarction

This study sought to compare the clinical features and outcome of a first acute myocardial infarction [AMI] with onset of symptoms during or within 30 minutes of exercise, at rest and in bed.Information collected using a standard questionnaire was used to relate activity at the onset of symptoms and in-hospital outcome in 500 consecutive patients admitted to our heart center with a first AMI between 2000-2002.Patients with exercise-related onset were more likely to be younger and male. Those with onset in bed were more likely to be older and have a history of stable or unstable angina. By way of comparison between patients whose symptoms began at rest and exercise, those with exercise-related onset had lower in-hospital mortality after adjusting for age and gender [odd's ratio [OR] 0.53, 95% confidence interval [CI] 0.39-0.93 [p= 0.03]]. Compared with patients whose symptoms began at rest, patients with onset in bed had a higher mortality rate [OR 1.42, 95% CI 1.03 - 1.98 [p= 0.028]].The incidence of moderate or severe left ventricular dysfunction was also lower for exercise-related onset [OR 0.79, 95% CI 0.6-1.01 [p=0.32-but not statistically significant]] and higher when onset was in bed [OR 1.5, 95% CI 1.2-1.77 [p= 0.039]].There is an association between activity at onset and outcome of AMI. Differences in pathophysiology or in the population at risk could explain this observation