The interventionist mindset: The ten eyes rule in cath lab.

This article addresses the skillfulness role of the interventionist in the Cath lab. It argues that the interventionist plays a crucial role and should possess certain mental-manual dexterity and hand-eye coordination skills. The article suggests a series of measures that collectively determine the successful role of the interventionist in the Cath lab. This is of utmost importance given the sensitive nature of the cardiovascular procedures, the potential costs of its failure for the patient, and the key action played by the interventionist in determining the failure or success of the procedure.

Estimation of apolipoprotein A in early onset ST-segment elevation myocardial infarction.

AIMS: The role of apolipoprotein A in early onset ST-segment elevation myocardial infarction is not clear. This study sought to assess the apolipoprotein A in cohort of patients diagnosed with early onset acute ST-segment elevation myocardial infarction and to corelate it with major traditional cardiovascular risk factors. METHODS: A total of 50 such patients and 40 age and sex-matched healthy controls, both aged less than 50 years with their baseline demographic, clinical characteristics and cardiovascular risk factors were studied. Apolipoprotein A was estimated for all enrollees. RESULTS: The mean age of cases was 43.37 ± 5.85 years. The levels of apolipoprotein A among cases were not significantly lower compared to controls (P = 0.52). They were lower among the male, current smokers and the dyslipidemia (P's < 0.05). Considering the apolipoprotein A as the dependent factor, the early onset ST-segment elevation myocardial infarction was associated significantly with the male and the dyslipidemia in linear regression (P < 0.001 and 0.030), respectively. CONCLUSION: Lower levels of apolipoprotein A are significantly related to conventional risk factors in early onset ST-segment elevation myocardial infarction. This apolipoprotein A that particularly develops in young patients with clustering of traditional cardiovascular risk factors should be targeted. Further studies are warranted to determine the diagnostic and prognostic indicators of this apolipoprotein in ST-segment elevation myocardial infarction.

Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq.

BACKGROUND: Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq. METHODS: Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male <45 years and female < 55 years) and mature coronary artery disease (MCAD). RESULTS: The prevalence of the angiographically documented PCAD was 31 %. The PCAD had higher rates of hyperlipidemia (p = 0.04), positive family history of coronary artery disease (p = 0.002), type A lesions (p = 0.02), single vessel disease (p = 0.01) and medical treatment (p = 0.01) than the MCAD. Logistic regression model indicated that male sex (OR 3.38, C.I 1.96-7.22), smoking (OR 2.08, C.I 1.05-4.12), hypertension (OR 1.58, C.I 1.25-2.03), hyperlipidemia (OR 1.89, C.I 1.17-2.42) and positive family history of coronary artery disease (OR 2.62, C.I 1.38-9.54) were associated with the PCAD. Sensitivity analysis showed highest specificity (94.2 %) and positive predictive value (96.5 %) in patients with coronary stenosis >70 % compared to lesser obstruction. CONCLUSIONS: Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.

Echocardiographic evaluation of thalassemia intermedia patients in Duhok, Iraq.

BACKGROUND: Cardiac complications are among the most serious problems of thalassemia intermedia patients. The current study was initiated to address the latter issue through the study of the echocardiographic findings and correlate it with clinical characteristics of thalassemia intermedia patients in Duhok, Kurdistan region, Iraq. METHODS: An echocardiographic assessment of 61 beta-thalassemia intermedia cases was performed. It included 30 males and 31 females, with a mean age 19.6 ± 7.5 years. The standard echostudy of two-dimension and M-mode measurements of cardiac chambers were done. The continuous doppler regurgitant jet of tricuspid and pulmonary valves were recorded. Left ventricle diastolic function was assessed by pulsed doppler of mitral valve inflow. To correlate the clinical with echocardiographic findings, patients were divided, according to tricuspid regurgitant velocity, into three groups (<2.5 m/sec, 2.5-2.9 m/sec and ≥3 m/sec). RESULTS: Tricuspid regurgitant velocity <2.5 m/sec, 2.5-2.9 m/sec and ≥3 m/sec occurred in 42(69%), 11(18%) and 8(13%) respectively. Comparing to other groups patients with tricuspid regurgitant velocity ≥3 m/sec were older and included more males. They had lower hemoglobin levels, but higher ferritin levels. Their age at diagnosis and the age of the initiation of blood transfusion were later. Most of them had significant exertional dyspnea. They also had relatively lower left ventricle ejection fraction values. Right ventricular diameter and right atrial size were larger in the same group. Tricuspid regurgitant velocity as a continuous predictor was associated positively with age, cardiac volumes and pulmonary regurgitation though negatively associated with ejection fraction. CONCLUSIONS: Echo-derived right and left side cardiac complications are not uncommon in thalassemia intermedia patients. Therapeutic trails targeting these complications are indicated, and echocardiographic assessment is necessary to be offered early for thalassemia intermedia.