Comparison of the length of hospital stay between the patients with atrial fibrillation treated with amiodarone and patients with normal sinus rhythm after coronary artery bypass graft

Postoperative atrial fibrillation occurs in 20% to 40% of patients undergoing coronary artery bypass grafting [CABG] and contributes to increasing length of stay and hospital cost. The purpose of our study was to compare the length of hospital stay between patients of postoperative atrial fibrillation treated with amiodarone [experimental] and those with normal sinus rhythm [NSR] [Control] after CABG. From October of 2008 to October 2010, our experimental group including 26 patients was treated with amiodarone in Tabriz Madani Heart Center. The background variables, length of atrial fibrillation, and length of hospital stay were recorded. The experimental group was compared with a control group of 50 patients. The two groups were the same in terms of age, gender, ejection fraction, vascular diseases and risk factors. The hospital stay duration was 8.0 +/- 1.6 and 7.4 +/- 1.4 days [p = 0.08] for experimental, and control groups respectively. Atrial fibrillation occurred mainly [60%] on the second postoperative day. 25 patients out of 26 patients [96%] returned to NSR after starting the amiodarone protocol and the length of hospital stay in the experimental group was not significantly different from that of the control group. Thus, treating with Amiodarone in postoperative atrial fibrillation can reduce hospital stay duration compared to that of normal sinus 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

Transplanted renal artery stenosis: a case report and review of literature

Transplant renal artery strenosis [TRAS] is a relatively frequent, potentially curable cause of refractory hypertension and allograft dysfunction and usually becomes apparent between 3 months and 2 years after transplantation. Depending on the hemodynamic significance of stenosis it can be treated conservatively or revascularization. Here we describe a case of TRAS which was treated successfully with angioplasty and stenting and then we will have a review on its etiology, natural history, diagnosis and therapy

Non invasive assessment of myocardial perfusion after first myocardial infarction with transthoracic echocardiography

Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow [CSBF] is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography [TTE] in patients with acute myocardial infarction [AMI] and to assess its relation with left ventricular ejection fraction [LVEF], wall motion scoring index [WMSI], and in-hospital mortality. This case-control study evaluated 20 patients [pts] with anterior AMI and 20 healthy individuals as controls over a 6-month period [in 2005] in Madani Heart Center in Tabriz [Iran]. All the patients received the same drugs for AMI treatment [e.g. fibrinolytic]. CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Baseline variables were similar between the two groups [P>0.05]. CSBF in the AMI group was 287.8 +/- 128 ml/ min and in the control group was 415_127 ml/min [P=0.001]. There was a significant correlation between CSBF and LVEF [r=0.52, P=0.01], between CSBF and WMSI [r=-0.77, P=0.0001], and between CSBF and in-hospital mortality [r=0.58, P=0.03]. Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality

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