diagnosis and treatment of paradoxical embolism: a systematic review

One in five adults has patent foramen ovale [PFO], which is typically without symptoms. Because of the low pressure in both atria and the anatomical position of the septum secundum, there is no left-to-right shunting and little right-to-left shunting in the general condition; however, when the right atrial pressure increases, this slit-like flap separates and allows right-to-left shunting. According to the Johnson criteria, simultaneous occurrences of arterial emboli, such as those caused by cerebrovascular accident or pulmonary embolism, demonstrate the presence of paradoxical embolism through a PFO. When a patient presents with multivascular arterial embolism, the clinician should perform a contrast transthoracic echo, a transesophageal [TEE], a real-time three-dimensional TEE, and even an intracardiac echocardiography [ICE] in order to differentiate between PFO, flat atrial septal defect [ASD] and hybrid defects. The randomized trials that have assessed therapeutic interventions for paradoxical embolism have not produced any clear guidelines as to how best to treat this condition. The classic treatment is surgical embolectomy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass. Patients with a history of >/= 1 paradoxical embolism may be indicated for device PFO closure

Hematologic abnormalities in cyanotic congenital heart disease patients

Introduction: Patients with cyanotic heart disease may have an acceptable quality of life. However, they are invariably prone to several complications. The aim of this study is search about hematologic abnormalities in cyanotic congenital heart disease patients

Materials and Methods: In this cross-sectional study, every cyanotic congenital heart disease patients who was referred to the adult congenital heart disease clinic was selected and asked of any possible hyperviscosity symptoms, gingival bleeding, epistaxis, hemoptysis, hypermenorrhagia, and gouty arthritis irrespective of their age, gender and primary diagnosis in a six-month period. In this regard, 02 saturation was obtained via pulse oximetry, an abdominal ultrasound was done in order to discover any gallstones and laboratory tests including CBC, coagulation parameters [bleeding time[BT],clotting time[CT], prothrombin time[PT],international ratio[ INR], Ferritin, blood urea nitrogen [BUN] and creatinine [Cr] were provided as well

Results: A total of 69 patients were enrolled in the present study. The mean age of the patients was 22.44 +/- 5.72. Twenty two [34.4%] of them were female and 45[65.6%] were male. In our research, 23% of the patients had serum levels of uric acid more than or equal to 8 mg/dl. 59%of patients presented with depleted iron storage. Mean hemoglobin [Hg], level was [16.9 +/- 2.5 mg/dl], mean hematocrit [HCT] level was [55.47 +/- 9 mg/dl], mean Ferritin level was [32.5 +/- 0.4]. Our collected data also revealed that plasma creatinine concentration was normal [0.9 +/- 0.2 mg/dl]. Furthermore, thrombocytopenia of less than 160000 was found in 30% of the patients. Hyperviscosity symptoms also found in 1.3% of patients

Conclusion: Our patients had less hyperuricemia, there is no correlation between hyperviscosity symptoms and haematocrit level and an inverse correlation between the Ferritin level and hyperviscosity symptoms were seen

Prevalence of heart failure in the cases of beta-thalassemia major; two years follow-up

Heart failure [HF] is an important cause of morbidity and mortality in the cases of Beta-thalassemia major. The purpose of this study was to estimate HF prevalence in these patients and to assess the survivability of those who were treated with intensive chelating therapy. This cross sectional study included 72 beta-thalassemia major cases, the mean age at the time of referral was 15.7 -/+ 6.2 years [range 6-35 years] and were followed in a prospective 2 year study. A self-reporting symptom questionnaire was administered, a 12-lead ECG was taken and an echocardiography was obtained from all participants. Echocardiography was performed at 6 month intervals or when a new symptom developed. Risk factors [except for iron overload] in the study population were hypothyroidism and diabetes mellitus. The male to female ratio was 0.75.Twelve patients had left ventricular [LV] systolic dysfunction and 57.79% had LV diastolic dysfunction whereas 11,15% had RV failure. Fifty-nine [81%] patients had cardiac disease of which diastolic dysfunction was the most common manifestation .Those with systolic dysfunction were older at presentation [22 -/+ 6 years versus 31 -/+ 4 years; P <0.001], and had the highest mean serum ferritin level [3,355 -/+ 1241 ng/mL versus 6,397 -/+ 1,613 ng/mL; P <0.001]. The 2 year survival rate in patients with beta thalassemia in this study was 98%. Diastolic dysfunction is highly prevalent in even asymptomatic beta-thalassemia major patients. The high prevalence of diastolic dysfunction is indicative of a significant amount of the population who are at a high risk for HF

Acute myocardial infarction in a 17-year-old boy secondary to lightning strike

Although lightning is an uncommon phenomenon in nature; it can cause many destructive incidents. In the event of a lightning strike, multiple organs particularly the cardiovascular systems are at risk of injury. Short-term mortality depends on its cardiac effects. In this paper, the authors report the development of myocardial infarction and pericardial effusion after lightning injury, a typical example of "side splash"