Hospital-based study on the use of herbal medicine in patients with coronary artery disease in Jordan.

OBJECTIVE: To determine the frequency and pattern of herbal therapy use among patients with chronic coronary artery disease as self remedies. METHODS: This cross-sectional study was conducted by face to face interview of 690 consecutive patients visiting the outpatient department at Queen Alia Heart Institute during the period 1/6/2008 to 1/6/2009. Data was collected using a specially designed questionnaire. RESULTS: Overall frequency of herbal use was 14.1%. The most commonly used herbs in Jordan were hawthorn and ginger. A total of 27 local and one Chinese herbal product were used, while the use of adulterated formulae were absent. Pharmacists were never consulted regarding the quantity or frequency of herb use. Side effects were rare. CONCLUSION: The use of medicinal herbs among cardiac patients in Jordan is not uncommon and consists largely of local herbs. Active role of pharmacists and doctors for counseling patients on the appropriate use of herbal products should prevent toxicity, ensure proper modes of preparation and optimize safety and efficacy.

Successful stenting of total left subclavian artery occlusion post-coronary artery bypass graft surgery using dual left vertebral artery and left internal mammary artery protection.

We report on a 68-year-old male patient (smoker, chronic obstructive pulmonary disease, diabetic for 25 years) who was admitted with acute pulmonary edema 5 months after undergoing coronary artery bypass grafting (left internal mammary artery to left anterior descending artery, saphenous vein graft to posterior descending artery, and sequential saphenous vein graft to obtuse marginal artery). He had no cardiac enzyme leakage and his left ventricular ejection fraction was > 50% on 2-dimensional echocardiography. He proved to have total calcific left subclavian artery occlusion and retrograde flow in both his left internal mammary artery and his left vertebral artery upon left subclavian angiography performed through the left brachial approach. Angiographic vertebral and coronary-subclavian steals were both supported with clinical manifestations. The patient underwent successful stenting to his left subclavian artery using dual protection to his left vertebral artery with filter protection device and to his left internal mammary artery using simple balloon inflation at its mouth before and after each subclavian artery angioplasty step. Three months later, the patient was free from any cardiac or neurologic complaints.

Frequency of renal artery stenosis among cohort of Jordanians undergoing drive-by renal angiography at time of conventional cardiac catheterization.

OBJECTIVE: To determine the frequency of renal artery stenosis (RAS) by performing routine renal angiography in a cohort of patients undergoing clinically indicated non-emergent coronary angiography. A secondary goal was to define potential variables which may predict RAS in this cohort. METHODS: This was a prospective observational cross-sectional study whereby routine drive-by renal angiography was performed in 870 consecutive patients undergoing non-emergent coronary angiography at Queen Alia Heart Institute, Amman, Jordan during a 4-month period extending from January 2006 to April 2006. Patients were evaluated regarding the presence and severity of RAS. Renal artery stenosis has been defined as diameter stenosis >50% on conventional angiography. Univariate analysis and multivariate analysis were then performed to evaluate potential predictors for RAS. RESULTS: Renal artery stenosis was found in 21 patients leading to a very low frequency of 2.4%. In univariate analysis, significant association with RAS was found with age, female gender, coronary artery disease severity, systolic blood pressure and creatinine clearance. In multivariate analysis, the only significant predictors were female gender (odds ratio 6.61, confidence interval 1.73-25.31, and p=0.006) and creatinine clearance in males (odds ratio 1.97, confidence interval 1.21-3.67, p=0.004). CONCLUSION: Low frequency of RAS was noticed in our study. Performing drive-by renal angiography may be not justified in Jordanians except in high risk subgroups for RAS.