Study of insulin resistance, TNF-α, total antioxidant capacity and lipid profile in patients with chronic heart failure under exercise.

Gluco-metabolic syndrome, oxidative stress and inflammation are common in chronic heart failure (CHF). Exercise training programmes are known to improve oxidative status, insulin sensitivity and endothelial function. In this study, the effects of walking on improving lipid and glucose metabolism in CHF patients, under statin treatment, were investigated. Fasting glucose, serum insulin, tumor necrosis factor-α (TNF-α), total antioxidant capacity (TAC), uric acid (UA), total cholesterol, triglycerides, high-density lipoproteins (HDL), direct low-density lipoproteins (LDL-dir), apolipoprotein-B, apolipoprotein-A1, and lipoprotein-a (Lp(a)) were monitored. Insulin resistance was depicted by fasting insulin resistance index (FIRI) (FIRI≥2.94±1.41). HDL significantly increased with walking and was positively correlated with the non-significant triglyceride decrease and significant Lp(a) decrease. Significant correlations were found in all CHF patients at baseline between FIRI and New York Heart Association (NYHA) functional class, ejection fraction, HDL, triglycerides and TNF-α. All non-diabetic CHF patients were characterized by insulin resistance. Serum insulin and fasting glucose significantly decreased with walking, while decrease in FIRI was positively associated with patients' adherence to the walking program. Elevated uric acid and TNF-α levels also significantly decreased. In conclusion, the present study demonstrated that moderate, unsupervised, everyday physical activity was able to ameliorate the lipid and glycemic profile of CHF patients, with simultaneous attenuation of inflammation and oxidative stress.

Kounis syndrome: a manifestation of drug-eluting stent thrombosis associated with allergic reaction to contrast material.

Stent components acting as potential antigens and promoting intracoronary mast cell activation can lead to catastrophic intrastent thrombosis. Patients with drug-eluting stent (DES) implantation are prone to hypersensitivity reactions from five potential antigens namely, nickel strut, polymer coating, eluted drug, as well as, concomitant drugs clopidogrel and aspirin. These events may be more common than suspected because it is hard to document them, unless they become systemic, in which case they manifest themselves as the Kounis syndrome characterized by the concurrence of acute coronary events with hypersensitivity reactions. This report concerns of a patient with implanted DES who developed an acute myocardial infarction in the stent area following an allergic reaction to contrast material.

Kounis syndrome associated with hypersensitivity to hymenoptera stings.

Hymenoptera stings can induce acute coronary syndromes by different pathogenetic mechanisms including direct action of the venom constituents on the coronary endothelium or allergic reaction with mediators acting on the coronary vasculature. Two patients were stung by wasps and honeybees and developed Kounis syndrome as a consequence of allergic reaction. Kounis syndrome is the concurrence of acute coronary syndromes with mast cell activation induced by allergic or hypersensitivity and anaphylactic of anaphylactoid reactions. It is caused via inflammatory mediators released through mast cell activation. The patients had pre-existing coronary artery disease (type II variant of Kounis syndrome) and the allergic reaction induced by hymenoptera stings seems to have triggered inflammatory mediator release. The pathophysiology and clinical implications of this association are discussed.

Severe thrombocytopenia after heparin therapy in a patient with unstable angina and recent stent implantation.

Heparin-induced thrombocytopenia represents a serious side effect of heparin therapy. Immune-mediated platelet activation results in thrombocytopenia, endothelial thrombin release and development of thrombosis, mainly venous. We report the case of a man with a history of coronary artery disease and recent stent implantation. This patient developed severe heparin-induced thrombocytopenia type II after low molecular weight heparin administration because of unstable angina which occurred two months after stent implantation. The patient was treated with a new anticoagulant regimen, fondaparinux sodium. There were no complications and platelet counts were restored to normal levels.