Gauranga Majumdar, Surendra Agarwal, Shantanu Pande, Bipin Chandra, Aditya Kapoor
Radial artery is now increasingly used as vascular access site for diagnostic and therapeutic procedures in cardiology practice. Though successful, it may be associated with vascular complications necessitating intervention. We report two cases of radial artery pseudo aneurysm one each arising out of diagnostic and therapeutic cardiac intervention. Though rare, successful management of such a complication is easier with radial artery as vascular access site as compared to femoral artery that is conventionally used access site for cardiac intervention procedures.
Sandeep Kumar Kar, Deepanwita Das, Chaitali Sen Dasgupta
Coronary artery aneurysm is an uncommon complication after balloon angioplasty and stent insertion but not rare. A sixty three years old male presented with acute onset chest pain after 1 year of stent insertion in RCA (Right coronary artery). Investigations revealed RCA aneurysm with stent thrombosis. This was managed successfully by surgical resection of aneurysmal sac and removal of the occluded stent with ligation of RCA followed by distal RCA anastomosis under femoro- femoral bypass during meticulous dissection of the aneurismal sac followed by CABG under cardiopulmonary bypass.
Wissam Alajaji, Atallah Baydoun, Nathan Morris, Leslie Henry, Brian D. Hoit
Background: Conflicting evidence exists on the ideal choice of non-invasive pharmacologic stress imaging for coronary artery disease (CAD) diagnosis in patients with left bundle branch block (LBBB). The aim of this meta-analysis is to compare data that examine the sensitivity and specificity of non-invasive pharmacologic stress imaging in patients with LBBB for obstructive CAD diagnosis. Methods: We performed a literature search in MEDLINE, embase.com and Cochrane (CENTRAL) without publication type or language restrictions. Both pharmacologic stress echocardiography (SE) and nuclear myocardial perfusion imaging (MPI) searches were restricted to the period between January 2004 and review time. Exclusion criteria included studies that lacked sensitivity and specificity data. The primary objective was to compare the sensitivities and specificities of all pharmacologic SE, MPI, myocardial contrast echocardiography (MCE), stress cardiac magnetic resonance (CMR) and positron emission tomography (PET) for identifying significant CAD in patients with LBBB.
Results: 10 studies met the inclusion criteria for analysis. The sensitivity and specificity odds ratio of MCE was 92% (95% CI 81-97%), 93% (95% CI 86- 97%); Dobutamine (D)-CMR 64% (95% CI 42-82%), 94% (95% CI 85-98%); pharmacologic SE 73% (95% CI 55-86%), 84% (95% CI 75-91%); and pharmacologic MPI 83% (95% CI 72-91%), 56% (95% CI 42-70%).
Conclusion: MCE and D-CMR appear to have improved diagnostic accuracy in comparison to pharmacologic SE and MPI in patients with LBBB. Additional MCE and D-CMR studies are warranted given their potential to become the non-invasive gold standard for the diagnosis of CAD in this population.
Ferroni F, Bordese R, Veglia S, Agnoletti G
We present the case of a 45-year-old woman with recent onset of dipnea and atrial fibrillation. She was referred to our center for treatment of an associated ventricular septal defect. Echocardiography confirmed the presence of a membranous ventricular septal defect, but also showed signs of constriction. Cardiac computed tomography displayed a severe, diffuse calcified pericarditis. We show that, in adult patients, a minor congenital heart disease can catalyze the clinician’s attention and, like in this case, mask major signs of acquired heart disease.
Qishu Li, Xianfeng Wu, Weiping Tu
Background: Relationship between intradialytic hypotension (IDH) and residual urine volume (RUV) in hemodialysis (HD) patients remained unclear. In the present study, we aimed to evaluate the risk of intradialytic hypotension in hemodialysis patients with different residual urine volume.
Method: This work was a prospective observational study of incident and prevalent HD patients. From January 1, 2013 to February 28, 2014, patients were recruited from a single HD center of the Second Affiliated Hospital of Nanchang University. Eligible patients were categorized into three groups: group A (RUV > 400 ml/24 hours), group B (RUV of 100-400 ml/24 hours) and group C (RUV < 100 ml/24 hours). A Logistic regression model was used to examine patient characteristics associated with predictive odds of RUV with 100-400 ml/24 hours and < 100 ml/24 hours. Hazard ratio (HR) of IDH was calculated by the Cox proportional hazards model for three groups.
Results: Totally, 150 HD patients were enrolled in this study, with mean follow-up of 9.9 ± 5.1 months. Older age, longer HD vintage and lower levels of hemoglobin were independently associated with RUV with 100-400 ml/24 hours, whereas thrice-weekly HD, longer HD vintage, diabetes and lower levels of phosphate were independently associated with RUV < 100 ml/24 hours in the study patients by multivariate Logistic regression analysis. During the follow-up period, 17.3% (26/150) patients developed IDH events, including 8.2% (5/61) in the group A, 15.9% (7/44) in the group B and 31.1% (14/45) in the group C. IDH incidence was significantly difference among three groups. Patients with RUV < 100 ml/24 hours had higher risk of IDH than those with RUV > 400 ml/24 hours, even when extensive demographics, comorbidities and lab adjustments were made. Similarly, in a maximally adjusted model, risk of IDH in patients with RUV of 100-400 ml/24 hours was 2.36 times than that in those with RUV > 400 ml/24 hours (95% CI 1.75-7.47, p=0.043).
Conclusion: HD patients with lower RUV may have an increased risk of presenting IDH, which suggested that preserving RUV may be conducive to preventing of IDH occurrence.
J. Mauricio Sanchez, Thomas Kurian, Amit Doshi, Stephen Pieper
Early repolarization (ER) syndrome is characterized by ≥1 mV J-point elevation in 2 contiguous inferior and/or lateral ECG leads in a patient resuscitated from otherwise unexplained VF or polymorphic VT. J-point elevation in these patients may have slurring or notching of the end of the QRS complex. While alterations in temperature have been known to effect other arrhythmia disorders, it has not been described with ER syndrome. We report a patient with ER syndrome which manifest VF after febrile response to severe burns resulting from occupational accident.
Noam Fink, Ashraf Hamdan, Ori Vatury, Orly Goitein, Sagit Ben Zekry
In the current case presentation, a patient with prosthetic mechanical mitral valve developed brain hemorrhage following head trauma. Cessation of anticoagulation treatment resulted in left atrial thrombus; patient presented with recurrent emboli events to major arteries that required recurrent embolectomy. This case highlights the clinical conflict of restarting vitamin K anticoagulation following brain hemorrhage in a high risk patient and demonstrates the importance of multimodalities imaging in assessing those patients.
Burton M Altura, Nilank C Shah, Gatha J Shah, Bella T Altura
The authors present evidence for a novel, new hypothesis whereby magnesium deficiency (MgD) acts as a genotoxic agent which probably causes numerous, hertofore, unrecognized consequences, even over a short-term, on the physiological, molecular and biochemical machinery of cardiovascular tissues and cells. The end result of these genotoxic effects of MgD probably plays important roles in the etiology and generation of diverse cardiovascular diseases, atherosclerosis, inflammation, and strokes via alterations in the epigenome of cardiovascular tissues and cells. The importance of adequate water-borne and dietary levels of Mg is emphasized.
Baena López M, Raigón Ponferrada A, Guerrero Orriach Jose L, Ramirez Fernandez A, Ramirez Aliaga M, Loras P, Gallego M, Bermudez L, Biteri A, Rodriguez Capitan MJ, Rubio Navarro M, Cruz Mañas J
Dexmedetomidine is a new drug often used in the treatment of neurological disorders in intensive care unit thanks to its effects α2. In our case we needed to use dexmedetomidine in a patient with a heart failure after cardiac surgery in which respiratory function was supported with noninvasive mechanical ventilation. Dexmedetomidine was given successfully after has tried the treatment with opioids, opening the door as alternative treatment in patients with heart failure and noninvasive mechanical ventilation with α2 agents.