Non-hodgkin's lymphoma presenting as constrictive pericarditis: a rare case report

Constrictive pericarditis [CP] is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin's lymphoma [NHL] presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP [cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab] chemotherapy. Three months later, there was significant improvement in the patient's symptoms and considerable decrease in pericardial thickness

Infective Left Atrial Dissecting Flap after Cardiac Surgery

Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography.

comparison of selenium concentrations between congestive heart failure patients and healthy volunteers

Selenium [Se] is an essential trace element mainly obtained from seafood, meat, and cereals. Se deficiency has been identified as a major contributing factor in the pathogenesis of certain congestive heart failure [CHF] syndromes. Since there is controversy over the prevalence of Se deficiency among patient with CHF, the aim of this study was to assess the serum Se concentrations in patients with CHF and compared them with the Se status of healthy controls. The study included 77 patients [age, 68.4 +/- 10.4 years old; 40.3% female] and 73 healthy volunteers [64.9 +/- 4.7 years old; 35.6% female]. A complete medical/drug history and physical examination were performed for all patients and healthy volunteers. All patients had symptoms and signs of CHF and had a left ventricular ejection fraction [EF] of < 40% obtained by echocardiography. The Se concentration was assessed by atomic absorption spectrometer with the Graphite Tube Atomizer. The limit of measurement was 5 microg/L. The Se concentrations in CHF patients did not show a significant difference from those of healthy controls [185.9 +/- 781.2 microg/L vs. 123.3 +/- 115.5 microg/L, respectively; p value = 0.499]. There was no correlation between serum Se concentrations and EF in both the normal group and the patients with heart failure [p value = 0.96 and 0.99; r = 0.006 and 0.002 for patients and healthy volunteers, respectively]. In this study, serum Se levels in CHF patients were similar to those of controls and the Se concentrations did not correlate with the degree of left ventricular dysfunction

[ relation between BMI with exercise test in individuals with cardiac ischemic pains]

Prevalence of over weight and obesity is increasing in the world. Those over weight are more susceptible to cardiovascular diseases than other individual's. Studies indicate that body fat distribution has a determining role in the identification of risk factors. Also, the relation between BMI, cardiac ischemic pains and exercise test condition in such patients, is in need further investigation. The aim of this study was to determine the relation between BMI with exercise tolerance test in patients with cardiac ischemic pains, who were referred to the Cardiac Center of Mazandaran Province, in Sari Township. In this case control study considering the BMI in ischemic patients, 65 were selected as case and 65 persons as control using Tread mill and according to Bruce Protocol, results and tolerance test time was recorded. Independent T test was used for comparison of quantitative indexes mean, while x[2] test using SPSS software was used for comparison of the ratio of persons with the qualitative features. Data indicated mean weight of 57.1 kg and height of 1.64m in the case group. Also, 58.5% had history of hyperlipidemia [Cholesterol higher than 200mg/dl] and 78.8% with history of blood sugar [higher than 120mg/dl [P<0.001]. Even 63.6% had hypertension of 140/90 mm Hg. Our findings showed that BMI in the case and control groups were [26.95 +/- 3.94] and [25.95 +/- 3.49] respectively. Moreover, a significant relationship between high BMI with cardiac ischemic pains and exercise tolerance test [P<0.001] were demonstrated. Cardiac ischemic pains in individuals with high BMI is common. Exercise tolerance test as one of the non invasive and less expensive procedures, can be an indicator of cardiac ischemic disease

[Recurrent myocardial infarction after very late stent thrombosis, report of one case]

Stent thrombosis as a complication of percutaneous coronary intervention frequently is associated with deadly events such as myocardial infarction and sudden death. Definitions of stent thrombosis have hot been in a uniform manner in different clinical studies. Two episodes of acute ST elevation myocardial infarction nearly two years after implanting a drug -eluting stent in a 58-year-old male patient is reported here. The presence of stent thrombosis was confirmed by coronary angiography

[Comparison of non-HDL cholestrol level with LDL, cholesterol and other lipids markers level regarding investigation of lipoproteins disorder in hospitalizedpatients in Mazandran Heart Hospital]

Considering some restrictions of serum low density lipoprotein [LDL] as a marker for Coronary Artery Disease [CAD] risk factor and also the importance of apo B as a signinificant risk factor for CAD, measurement of non-HDL cholesterol has great value as a risk factor for CAD. Non-HDL cholesterol [total cholesterol minus HDL cholesterol] contains all lipoproteins including apo-lipoproteins. In this study, 200 hospitalized patients [100 men and 100 women] with the diagnosis of CAD, documented by coronary angiography and 100 persons with normal angiography were recruited as case and control groups, respectively. Non-HDL cholesterol non-HDL-c was compared with LDL- cholesterol as a risk factor for CAD. Measured levels of triglyceride, total cholesterol, lipoprotein atherogenic a [Lpa] and non-HDL-c were significantly higher than those in control group. HDL level was lower in patients group. Correlation analysis showed that non-HDL-c [and not LDL cholesterol] had a higher reverse correlation triglyceride level. Measurement of non-HDL-c could be a good marker in atherogenic lipoproteins. Furthermore, due to potential power of its other atherogenic lipoproteins, it cannot be measured by LDL alone

Depression in heart failure patients and the influence of age, gender and severity of depression on heart failure patients

Depression is common in chronic medical illnesses including HF. It has been established that depression has different rates in different races and the reported depression rates among hospitalized patients range from 13% to 77%; nevertheless, there is remarkably little information on the prevalence of depression and the impact of demographic and health status in the north of IRAN. The goal of this study was to determine the prevalence of depression in hospitalized heart failure [HF] patients, as well as the impact of age, gender, and functional status on this group of patients. In this study, carried out in one heart center, a total of 196 hospitalized HF patients with New York Heart Association [NYHA] functional classes 2- 3 and 4 and an ejection fraction [EF] <40% were given questionnaires to assess depression. Depression was evaluated with the Beck Depression Inventory [BDI] questionnaire. Depression was defined as a score on the BDI of > 17. A total of 23.5% of the patients scored as depressed. Men were more likely [33%] to be depressed than women and had a higher mean BDI score [p=0.004]. Patients classified as NYHA functional class 3 were more likely to score as depressed than class 2 patients [p= 0.001], and patients with a higher BDI score had a lower EF [r=0.25, p=0.001]. Depression is common in patients with HF. Men and patients with lower health status are more likely to be depressed. Pharmacologic or non- pharmacologic treatment of depression in HF patients should be considered