Cardiovascular Diseases & Diagnosis

An anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary artery malposition. We describe its surgical re-implantation in a 49-year-old man with marked dilatation of both coronary arteries. We decided to perform surgery based on intraoperative esophageal echocardiographic findings, 15 min after clamping the right coronary artery at its origin. Re-implantation from the main pulmonary artery to the ascending aorta was performed successfully. The dilated left coronary artery had diminished in size. Pathological findings of the excised proximal arterial wall of the ARCAPA showed much amount of elastic fibers in the arterial wall as an elastic artery thought to have originated from the pulmonary trunk.

Background: The axillary route use for cardiac devices implantation has recently expanded either with fluoroscopy or ultrasounds guidance. Few studies included defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures for ultrasound-guided axillary vein puncture (UGVP).

Aim: To assess the feasibility/safety of UGVP for complex cardiac devices implantation including CRT/ICD.

Methods: Consecutive patients eligible for a pacemaker or ICD implantation were included. All procedures were performed by three operators (one experienced and two fellows) in three different centers. Guidewires insertion time (from local anesthesia injection), and complications were systematically studied. A group of patients implanted with alternative routes (cephalic or subclavian) was used for comparison.

Results: In 176 consecutive patients in whom UGVP was used, a total of 68 complex procedures, including 42 ICD, 48 CRT and 16 upgrade procedures, were analyzed (74 ± 8 y, male 61%) with 138 leads implanted. A majority (83%) were under anti-thrombotic therapy. UGVP was successful in 96.8%. Mean insertion time for a mean number of 1.78 guidewires per patient was 4.4 ± 4.4 min. Guidewires insertion time reached its plateau after 10 patients. One pocket hematoma (1.4%) was drained during a mean follow-up of 12 ± 5 months. The control group included 28 patients (12 subclavian, 16 cephalic; 15 ICD, 18 CRT, 4 upgrade procedures), with a mean insertion time of 10 ± 8 min, for 1.95 guidewires per patient (p<0.0005).

Conclusion: UGVP is feasible and safe even for complex device implantations including CRT/ICD and upgrade procedures.

Aim: This study was undertaken to assess the impact of acute hyperglycemia (Admission Hyperglycemia) on short-term outcomes during hospitalization in patients with Non-ST elevation myocardial infarction (NSTEMI).

Patients and Methods: We analyzed 59 consecutive patients admitted for NSTEMI to the Coronary Care Unit of in Tishreen University Hospital. Patients were classified according to their admission blood glucose into two groups, the first group was admission hyperglycemia (defined ≥ 200 mg/dl), whereas the second group was without admission hyperglycemia, to assess its impact on In-hospital mortality and complications (Acute heart failure, Cardiogenic shock and Bleeding).

Results: In univariate analysis, in-hospital mortality was more prevalent in hyperglycemic individuals compared to non-hyperglycemic ones but without statistical significance (9.1% vs. 0%, p=0.07). In addition, patients with admission hyperglycemia developed acute heart failure (54.6% vs. 0%, p=0.0001) and cardiogenic shock (9.1% vs. 0%, p=0.0001) more than patients without admission hyperglycemia. In multivariate analysis, Admission Hyperglycemia was an independent risk factor for in-hospital mortality (OR: 2.3, 95% CI: 2-4.1, p=0.01) and acute heart failure (OR: 4.7, CI 95%:2.3-7.8, p=0.0001).

Conclusion: Admission hyperglycemia was an independent risk factor for in-hospital death and acute heart failure in STEMI patients.

Conventional 24-hour Holter monitoring is the most widely used ambulatory electrocardiographic (ECG) monitoring method to detect cardiac arrhythmias. However, such devices are cumbersome to wear, with multiple wires and patches which limit patients during daily activities.

In a study of 31 participants, we evaluated the effectiveness of QardioCore, a novel electro-cardiographic monitoring device with a convenient design without leads and patches, in generating rhythm strip data that fulfill the requirements of clinical quality and accuracy when evaluated against two comparison devices: A standard three lead Holter monitor (sub-group 1) and an ECG patch (sub-group 2), over 24-hour period.

Contrasting the ECG recordings taken with the QardioCore ECG Monitor and the comparison devices has not highlighted any differences considered clinically relevant or statistically significant. The regression analysis of the RR intervals between QardioCore and the Holter monitor and ECG patch reported a correlation of 0.95 (p<0.05) with a R-squared of 0.90. Patient gender and age did not affect the relative performance of the QardioCore ECG monitor with the two comparison devices. Within sub-group 1, the R-squared of the RR intervals between QardioCore and the Holter monitor was 0.87, while within sub-group 2, the R-squared of the RR intervals between QardioCore and the ECG patch was 0.96.

This study demonstrated that the QardioCore ECG monitor, a small, comfortable and easy to use ECG recording system, is a clinically valid tool that can be used to accurately identify rhythm disorders compared to a standard Holter monitor and ECG patch.

The electronic cigarette (EC) is battery-powered electronic nicotine delivery systems that appear very similar to a conventional cigarette. EC is a rising phenomenon that is becoming gradually more popular among smokers worldwide. Vapers report use of EC helps them to quit smoking, and to reduce cigarette consumption. Although available evidence indicates that EC is safer alternative to smoking there is emerging data that suggests otherwise and that considerable health benefits are likely in smokers who switch from tobacco to EC. The key motivation among most of the vapers is smoking cessation (SC), however some use it for recreational purposes. Progression is often related to EC resembling traditional cigarettes, curiosity, and experimentation. Studies indicate that the content of the nicotine in EC is equivalent to oral nicotine replacement therapy products and causes minimal possibility of poisoning. The inhaled compounds associated with EC results in cytotoxicity and affect various organs. The considerable risk associated with the use and abuse of nicotine refill bottles has been reported. Large scale research will help make EC more effective as smoking substitutes. Although previous data shows that EC can considerably decrease cigarette consumption without causing significant side effects, there is emerging data suggesting the potentially toxic consequences of EC, which necessitates the urgent need for further research in that regard. The focus of the present article is use, the safety of EC and its effectiveness to provide as a long-term substitute for SC.