Nicorandil in patients with acute coronary syndrome and stable angina undergoing percutaneous coronary intervention: literature review

Percutaneous coronary intervention is an option for the treatment of coronary artery disease such as acute coronary syndrome and stable angina.Acute coronary syndrome has two groups including acute myocardial infarction and unstable angina. Periprocedural myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention and can be easily monitored by measuring myocardial enzymes. Coronary microvascular dysfunction in patients undergoing primary percutaneous coronary intervention for the treatment of ST-segment elevation myocardial infarction is associated with poor prognosis. Even after recanalization, reperfusion injury often occurs including no-reflow or slow-flow in which sufficient myocardial blood flow cannot be obtained and results in a poor outcome of cardiac function in the long term. Nicorandil is the opener of the adenosine triphosphate-sensitive potassium channel and is known to have an antiarrhythmic effect and myocardial protective functions such as reduction of the coronary microvascular resistance by relaxing the smooth muscles of blood vessesl and preconditioning.In this literature review, we evaluate articles about acute coronary syndrome and stable angina undergoing PCI

Pentoxifylline decreases serum level of adhesion molecules in atherosclerosis patients

Inflammation is involved in development, progression, and complications of atherosclerotic disease. Clinical studies have indicated that the level of monocyte chemoattractant protein 1 [MCP-1], IL-18, and adhesion molecules correlates with the severity of atherosclerosis and can predict future cardiovascular events. Experimental studies have shown pentoxifylline [PTX] reduces these factors in animal models. The purpose of the present pilot study was to evaluate effect of PTX on a group of inflammatory biomarkers in patients with coronary artery disease [CAD]. Forty patients with angiographically documented CAD, who fulfilled inclusion and exclusion criteria, were entered in the double-blind, randomized, pilot clinical study. The patients were randomly given PTX [400 mg three times daily] or placebo [3 tab/day] for 2 months. Serum concentrations of MCP-1, IL-18, intercellular adhesion Molecule 1 [ICAM-1], and vascular cell adhesion molecule 1 [VCAM-1] were measured before and at the end of intervention by enzyme-linked immunosorbant assay. Our study showed that the serum levels of ICAM-1 and VCAM-1 was decreased in the study population after two-month treatment [P<0.05]. Based on the results of our pilot study, administration of PTX in CAD patients significantly decreases adhesion molecules levels

Depression and anxiety in a cardiovascular outpatient clinic: a descriptive study

Cardiac diseases are psycho-somatic disorders, and psychological aspects play an essential role in their initiation and exacerbation. The aim of this study was to gain appropriate knowledge in the epidemiology of co-morbid depression and anxiety disorder in cardiovascular outpatients. This study is descriptive with a sample of patients attending a cardio-vascular clinic. 238 individuals were included in this study using a consecutive sampling method. The study instrument was Hospital Anxiety and Depression Scale [HADS] questionnaire, which is a clinical scale for assessing anxiety and depression. Of the 238 participants in this study, 93[38.7%] were male and 146 [61.3%] female. 28.5% of patients suffered from anxiety disorders, and 41.9% had depression. Regarding comorbid diseases such as diabetes mellitus, hyperlipidemia and hypertension, the severity of depression was just related to hypertension. There was a meaningful relationship between gender and symptoms of anxiety so that symptoms were more severe in women. Considering the high prevalence of depression and anxiety in patients suffering from cardio-vascular diseases, it is necessary to screen psychological disorders in patients with cardio-vascular diseases and improve their cardio-vascular health and quality of life as mush as possible

[Diagnostic value of standard 12 lead electrocardiography in acute RV myocardial infarction]

Right ventricular infarction [RVMI] is associated with increased morbidity and mortality in patients with acute inferior myocardial infarction [MI]. Although, electrocardiography is probably the most useful, simple, and objective tool for the diagnosis of acute MI, there are no well-defined criteria in the standard 12-lead electrocardiogram to properly identify RVMI in patients with acute inferior MI. The aim of this study was to evaluate the value of ST-segment changes in 12-lead in diagnosing RVMI in patients with acute inferior MI. A total of One hundred sixty seven patients, hospitalized with acute inferior MI, were included in this study. The diagnosis of acute inferior MI was based on the clinical history and the appearance of ST-segment elevation [STE] >/= 1 mm in at least two of the leads [leads II, III, aVF]. RVMI was defined by STE >/= 1 mm in lead V4R during the first 12 hours after the beginning of the symptoms. Then the patients were divided into two groups [RVMI + and -] and ST-segment changes were compared between the two groups. The Ninety patients [51.1%] had RVMI according to lead V4R. ST-segment change 31mm was seen in I, III, aVL, and in aVF; also ST-segment depression >/= 2mm in I+aVL and STE >/= 1 mm in lead III greater than lead II [III>II] was significantly different between the two groups. The high sensitivity-specificity was seen in lead I: 86%-72%; lead aVL: 96%-26%; I+aVL: 84%-71%; and III>II: 82%-74%. More than 1 mm ST-segment depression in lead I, STE in III>II and ST-segment depression >/= 2 mm in I+aVL are possible to identify RVMI in patients with acute inferior MI

[Evaluation of dobutamin stress echocardiography complications in 500 patients referred to Ghaem hospital]

Coronary artery disease is the first etiology of mortality in Western countries and it was predicted, that up to the year 2010 it would be the main cause of human morbidity. With respect to the increasing frequency of coronary artery disease, proper diagnosis, treatment and prevention of complications have a great importance. Many patients with chest pain could not perform diagnostic ETT, so in this group dobutamin stress echocardiography was a suitable low cost, safe, accessible and exercise independent modality of stress. Regarding the recent usage of dobutamine stress echocardiography in our country and especially in khorasan province, the aim of this descriptive study was to present 500 patients whom referred to Ghaem hospital echocardiography laboratory for ischemic diagnosis or viability assessment or both. This study consisted of 500 patients, 273 males [54.6%], and 227 Females [45.4%], 20-80 years old and also were symptomatic for ischemia. These cases were referred to Ghaem echo lab for ischemia/ viability detection between 1385-1386. Our study Patients had: systemic hypertension [46.8%], hypercholesterolemia [39.8%], diabetes [29.5%], smoking [12.6%], previous MI [11.1%] positive family history 8% CRF [8%] and obesity [5%]. Among patients 345 [69%] were referred for ischemia detection, 132 [26.4%] referred for viability assessment, 23 [4.6%] for both of them, the left ventricular systolic function was normal in 168 [26.8%], mildly abnormal in 25.3%, moderate dysfunction in consideration, 402 patients [80.5%] had no complication and in the other patients [19.5%] test complication were occurred as arrhythmia, PVC, palpitation, vomiting, nausea, rigor and the other mild complications. Dobutamine stress echocardiography is an exercise independent stress modality with good safety and low level of complications

Relation Between Capillary Wedge Pressure Measured by Echocardiography Through Tissue Doppler Imaging [TDI] Method and Catheterism in Patients with Mitral Valve Stenosis

Considering suggested formula in the references and PCWP measured by catheterism, in the present study the relation between pulmonary capillary wedge pressure [PCWP] measured the flow velocity of mitral valve and mitral annulus motion through tissue doppler imaging is evaluated. 52 cases of severe MS were admitted for Balloon Mitral Valvolotomy [BMV] are included in this study. Mean age was 35 +/- 5 years consisting of 40 females and 12 males. Valve area, Pulmonary artery systolic pressure [PAP], E [Maximum Velocity of mitral valve at the beginning of diastole] and Em [Maximum rate of mitral annular motion at the beginning of diastole which is recorded through septal or lateral wall cumulus site] velocity and left atrial [LA] size were also measured by echocardiography and PCWP and PAP through catheterism. All patients had normal ejection fraction [EF] and coronary arteries; there was no other valvular diseases and shunts. There was a significant correlation between PAP in echocardiography and catheterism. Mean PAP was 53 +/- 19 mmHg in echocardiography and 53.9 +/- 17.8mmHg in catheterism. There wasn't any correlation between PCWP in echocardiography and catheterism [P=0.33] and also no relation between PCWP and mitral valve area [MVA] or LA size [P=0.2]. E/Em ratio increased in severe MS cases. E/Em ratio and suggested formula would overestimate the wedge pressure so echocardiography is not a reliable method for measuring PCWP in severe MS. Em velocity and E/Em ratio may be used for estimating MS severity