Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man. The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery [LADA] and spasm of right coronary artery [RCA]. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient

Trend of acute myocardial infarction prevalence toward younger ages in Ahvaz

The aim of this study was comparing the prevalence of ST elevation myocardial infarction in 1997 with the prevalence in 2010 considering age groups in the hospitals of Ahvaz Jundishapur University of Medical Sciences. We considered the patients admitted with acute coronary syndrome at hospitals of Ahvaz Jundishapur University of Medical Sciences and all the patients with ST elevation myocardial infarction were included. We categorized the patients into six groups according their ages. 400 patients in 1997 and 243 patients in 2010 were included in this study. The prevalence of myocardial infarction has increased in patients younger than 35 years. There were no significant changes in the group of 35-45 years and group of 65-75 years. The most important changes in age distribution of myocardial infarction during 2010 were prevalence increasing in age group of 46-55 years and decreasing in age group of 56-65 years. During 1997, 17% of patients were patients older than 75 years while 27% of patients were older than 75 years in 2010. Our data suggest that the prevalence of ST elevation myocardial infarction in age group of 46-55 years old has increased in Ahvaz. This change is especially prominent in male patients

Signal-averaged electrocardiography in patients with advanced heart failure: a better indicator of left ventricular enlargement compared with conventional electrocardiography

The signal-averaged electrocardiograph is a noninvasive method to evaluate the presence of the potentials generated by tissues activated later than their usual timing in the cardiac cycle. The purpose of this study was to demonstrate the correlation between the filtered QRS duration obtained via the signal-averaged electrocardiography and left ventricular dimensions and volumes and then to compare it with the standard electrocardiography. We included patients with advanced systolic left ventricular dysfunction [ejection fraction

QT dispersion: does it change after percutaneous coronary intervention?

Myocardial ischemia is one of several causes of prolonged QT dispersion. The aim of this study was to evaluate the effect that percutaneous coronary intervention has on the depolarization and repolarization parameters of surface electrocardiography in patients with chronic stable angina. We assessed the effects of full revascularization in patients with chronic stable angina and simple-vessel disease who underwent percutaneous coronary intervention. Twelve-lead electrocardiograms were recorded before intervention and 24 hours subsequently. We measured parameters including QRS duration, QT and corrected QT durations, and JT and corrected JT duration in both electrocardiograms and compared the values. There were significant differences between the mean QRS interval [0.086 +/- 0.01 sec vs. 0.082 +/- 0.01 second; p value =0.01], mean corrected QT dispersion [0.080 +/- 0.04 sec vs. 0.068 +/- 0.04 sec; p value = 0.001], and mean corrected JT dispersion [0.074 +/- 0.04 sec vs. 0.063 +/- 0.04 sec; p value = 0.001] before and after percutaneous coronary intervention. No significant differences were found between the other ECG parameters. Our data indicate that the shortening of corrected QT dispersion and corrected JT dispersion in patients undergoing percutaneous coronary intervention is prominent

Heart and athlete

Regular participation in intensive physical exercise is associated with electro-morphological changes in the heart. This benign process is called athlete's heart. Athlete's heart resembles few pathologic conditions in some aspects. So differentiation of these conditions is very important which otherwise may lead to a catastrophic event such as sudden death. The most common causes of sudden death in young athletes are cardiomyopathies, congenital coronary anomalies, and ion channelopathies. The appropriate screening strategy to prevent sudden cardiac death in athletes remains a challenging issue. The purpose of this review is to describe the characteristics of athlete's heart and demonstrate how to differentiate it from pathologic conditions that can cause sudden death

Effect of discharge education on quality of life and hospital readmission in patients with heart failure: is it effective?

A relatively common disease, congestive heart failure has a significant effect on the quality of life. Given that hospital admission is an important problem in patients afflicted with congestive heart failure, we sought to evaluate the effect of discharge education on the quality of life and hospital readmission in this group of patients. Eighty patients admitted with decompensated heart failure were selected and divided into 2 matched groups. The quality of life scores were measured for each patient. Upon discharge and during the first week after that, the intervention group received 3 sessions of education. Both groups were followed for 6 months. Data on the readmission rate and quality of life scores were collected. The baseline quality of life scores in the control and education subjects were similar [p-value: NS]. The quality of life scores showed a significant improvement at 3 and 6 months' follow-up in the education group. The hospital readmission rate, however, was higher in the control group at 3 and 6 months' follow-up. The present study showed that discharge education could enhance the quality of life and reduce the rate of hospital readmission in those suffering from congestive heart failure. It is, therefore, advisable that self-care training and discharge education be incorporated in the heart failure management strategy

Apical ballooning syndrome or Tako- tsubo cardiomyopathy: What we know about it

Apical ballooning syndrome [ABS] is a reversible cardiomyopathy with presentation mimicking an acute coronary syndrome. So in clinical practice, it is essential to consider it in the differential diagnosis of patients presenting with chest pain, especially in postmenopausal women. Coronary angiography is usually indicated to achieve a proper diagnosis. Typically, patients do not have significant coronary artery lesions. Left ventriculography and echocardiography reveal a regional systolic dysfunction with akinesis of the midventricle, apex and compensatory hyperkinesis of the basal ventricular segments. Occurrence of an emotionally or physically stressful event is a feature of ABS but its absence does not exclude this diagnosis. Several pathophysiologic mechanisms had been proposed. The prognosis of ABS is good. In this review, we highlight the clinical manifestations, pathophysiology and management of this syndrome