Successful treatment of a left main thrombus by intracoronary eptifibatide infusion in a 36-year-old patient

The acute coronary syndrome due to the left main coronary artery [LMCA] thrombosis is a clinically rare and catastrophic event. We describe a young man [smoker, alcoholic, and drug abuser] with a history of recent surgery and typical chest pain who had non-occlusive LMCA thrombosis in coronary angiography. The thrombosis was successfully treated with two 180 micro/kg intracoronary boluses of eptifibatide, which was continued through an intravenous infusion at 2 micro/kg/min for 48 hours postprocedurally. Control angiography, performed 3 days later, revealed that the LMCA was free of thrombosis. The patient had no complaints, including chest pain, and remained completely asymptomatic during the next 30 days' follow-up

Acute myocardial infarction in a 35-year-old man with coronary artery aneurysm most probably caused by Kawasaki disease

We present a 35-year-old man with history of Kawasaki disease who referred with myocardial infarction, and angiography, revealing aneurysm of left main and left anterior descending coronary arteries. The patient underwent percutaneous coronary intervention and thrombectomy and was discharged after 6 d. Coronary artery sequels of Kawasaki disease should be considered as one of the underlying causes of acute myocardial infarction in young adults.

[ quality of life after first acute myocardial infarction]

Improvement in the management of patients who are afflicted with acute myocardial infarction [AMI] has resulted in the increase of their survival after heart attacks. The purpose of this study was to determine the quality of life [QOL] after first AMI among patients who referred to teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences. This cross-sectional study was performed with the participation of 300 patients. The inclusion criteria were age between 32 to 79, first AMI, 6 to 30 months after AMI and consent for participation. These patients had been admitted in Shahid Modares, Loghmane Hakeem, Taleghanee and Shahid Labafeenejad hospitals, affiliated to Shahid Beheshti University of Medical Sciences, for AMI and they had written medical records in these hospitals. The participants were enrolled in the study when they referred for routine follow-up visits at outpatient clinics. Data was collected by interviewing the patients. For measuring QOL, The Short Form Health Survey [SF-36] was used. The mean age of patients was 56.6 +/- 9.6 years from which 57.5% were men and 42.3% women. The mean scores of QOL in various aspects were 67.2 for physical function, 52.9 for role limitation due to physical health problems, 71.1 for bodily pain, 48 for general health, 52.6 for vitality, 71.3 for social function, 59.2 for role limitation due to emotional problems and 57.2 for mental health. In comparison with the general population, QOL in this study was reduced in all scales but the amount of reduction was not the same. With increasing age, QOL of patients decreased in all aspects. QOL in women after AMI, 9% to 23% more than men was reduced. The study showed that QOL of patients 6 to 30 months after the first AMI. The QOL decreased in physical scales more than mental and emotional scales. Decrease in QOL was related to increasing age and in women was more than men

Pre-participation cardiovascular screening of elderly wrestlers

Sudden death of a competitive athlete is a tragedy that is usually caused by a previously unsuspected cardiovascular disease. The aim of this study was to clarify the role of noninvasive testing in pre-participation cardiovascular evaluation of elderly wrestlers. We included 63 Iranian elderly wrestlers who participated in Tehran international elderly wrestlers' preparation camping by census method. A questionnaire including past medical and family history as well as coronary risk factors was filled out and then a complete physical examination of the cardiovascular system was done by an internist for all wrestlers. Electrocardiogram [ECG], complete echocardiographic examination and then symptom limited exercise test were performed and reported by the cardiologists who did not know the other examinations results. Exertional dyspnea and typical chest pain [FC=I or II] were present in 5% and 1.7% of the examinees, respectively. There were one or more risk factors in 64.5% of the cases. Cardiovascular examination revealed abnormal heart sounds in 27.1%. ECG showed ischemic changes in 13.6% and premature atrial contractions and premature ventricular contraction in 11.4%. echocardiography showed mild left ventricular systolic dysfunction in 3.4%, regional wall motion abnormality in 8.5%, valvular disease in 32.3%, diastolic dysfunction in 45.7%, and left ventricular hypertrophy in 16.9% of the cases. Exercise test results were negative, equivocal, positive and highly positive in 70.4%, 15.8%, 5.2%, and 8.6% of cases, respectively. Beside physical examination, pre-participation screening of elderly wrestling athletes with ECG and exercise testing is feasible and recommended in the presence of coronary risk factors or cardiac symptoms. Echocardiography can also be recommended to detect other relevant abnormalities when there is a clue in the standard history, physical examination or ECG

Changes of left ventricular mass index among end-stage renal disease patients after renal transplantation

The aim of this study was to determine left ventricular [LV] mass index via echocardiography in end-stage renal disease patients [ESRD] before and after renal transplantation, and its association with one-year survival. Forty-seven patients with ESRD who were candidate for renal transplantation were evaluated with echocardiography before and 4 months after the operation. Left ventricular ejection fraction [EF], LV mass, and LV mass index were determined. All of the patients were followed up for 1 year. Mean LVEF was 51.6% which increased to 53.7% after renal transplantation [P = .001]. Mean LV mass was 209 gr before the operation which decreased to 189 gr after the operation [P = .001]. Mean LV mass index before the operation was 120 gr/m2 which decreased to 110 gr/m[2] following the operation [P = .002]. All of the patients survived during 1-year follow-up, and no death was reported. Renal transplantation had beneficial effects in terms of LV function in young patients with ESRD