Journal of Tehran University Heart Center最新文献

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are common hypertension medications. We aimed to investigate the association between treatment with ACEIs/ARBs and disease severity and mortality in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19). Methods: Information from the medical records of 180 hospitalized patients diagnosed with COVID-19 infection admitted in 2020 to Loghman Hakim Hospital, Tehran, Iran, was collected. Clinical histories, drug therapies, radiological findings, hospital courses, and outcomes were analyzed in all the patients. The demographic and clinical characteristics of the patients were also analyzed, and the percentage of patients with hypertension taking ACEIs/ARBs was compared between survivors and nonsurvivors. Results: The study population consisted of 180 patients at mean±SD age of 67.76±18.72 years. Hypertension was reported in 72 patients (40.0%). Patients with hypertension were older than those without it (mean±SD age =72.35±12.09 y). Among those with hypertension, death occurred in 33 patients (45.8%), of whom 60.6% were men. Fifty-three patients (73.6%) with hypertension were on ACEIs/ARBs. The ACEIs/ARBs group had a significantly lower mortality rate than the non-ACEIs/ARBs group (37.7% vs 68.4%; OR: 0.192; 95% CI: 0.05-0.68; P=0.011). Conclusion: This single-center study found no harmful effects associated with ACEIs/ARBs treatment. Patients on ACEIs/ARBs had a lower rate of mortality and disease severity than the non-ACEIs/ARBs group. Our study supports the current guideline to continue ACEIs/ARBs in patients with hypertension.

Background: Pain management after sheath removal is one of the most significant points in patient care. The use of a simple, practical, and combined method in this field is essential. The purpose of this study was to evaluate the efficacy of an intervention program for pain intensity reduction in patients undergoing arterial sheath removal after coronary artery angioplasty. Methods: This semi-experimental study was conducted in 2020 on 90 eligible patients selected via the purpose-based method and randomly assigned to experimental and control groups. The intervention program for the experimental group included training to relax the abdominal muscles, deep and slow breathing, and precise pressure on the femoral pulse. Pain intensity was measured before, during, and several times after arterial sheath removal. The independent t, Fisher exact, and χ2 tests were used to analyze the data. Results: Women comprised 66.6% of the study participants, who had a mean age of 58.20±8.70 years. No significant differences were observed concerning pain intensity, bleeding, pseudoaneurysm formation, and hematoma between the 2 groups before the intervention (P=0.531). However, during the intervention and in the fifth and tenth minutes after the intervention, pain intensity was lower in the experimental group (P<0.050), whereas no such differences were observed regarding bleeding, pseudoaneurysm formation, and hematoma. Conclusions: Given the effectiveness of our intervention program in ameliorating pain intensity and vasovagal response after arterial sheath removal, we suggest that this program, along with prescription drugs, be used for the management of patients' pain.

The basic components of energy drinks include caffeine, guarana, taurine, ginseng, and sugar. The excessive consumption of energy drinks has been associated with cardiovascular events such as tachycardia and myocardial infarction in the literature. We herein describe a 24-year-old man admitted to the emergency department. The patient's medical history and family history were unremarkable. It was, however, learned that he had consumed 8 to 10 cans of energy drinks per day (3.5-4 Lit/d) in the 2-week period leading to the hospital admission. Physical examination revealed bilateral diffuse rales and 2+ pretibial edema. Echocardiography showed a left ventricular ejection fraction of 25% with global left ventricular hypokinesia and dilated left ventricular dimensions. Coronary angiography demonstrated normal coronary arteries. On cardiac magnetic resonance imaging, the left ventricle was dilated, and the systolic function was reduced. No pathological enhancement was observed. This case report and many previous studies support a possible link between caffeinated energy drinks and cardiovascular events.

Longitudinal stent deformation (LSD) is a recently reported problem with newer generation stents. The modification of stent materials and designs to make them more deliverable and conformable, as well as a focused approach in retaining their radial strength, has compromised longitudinal strength in currently available stents. Additionally, enhanced stent radiopacity, improved fluoroscopy, and heightened awareness have led to an increased incidence rate of the potentially under-recognized problem of LSD. Although originally described in deployed stents, LSD is being recognized in undeployed stents too. With available data to suggest an increased rate of adverse cardiac events like stent thrombosis and in-stent restenosis with LSD in deployed stents, an attempt to retrieve an undeployed deformed stent appears justified. We report 3 cases of LSD in undeployed stents and discuss its recognition. We also discuss the retrieval and visual inspection of retrieved stents and the simultaneous completion of coronary interventions via a double guide technique.

Tricuspid valve myxomas are very uncommon tumors that could be found after the occurrence of pulmonary thromboembolism, symptomatic tricuspid obstruction, and right-sided heart failure. Herein, we describe a 42-year-old woman evaluated for an abdominal mass. In preoperative consultation, a tricuspid valve mass was detected in echocardiography. She underwent the removal of a benign uterine myoma and a myxoma of the tricuspid valve. Tricuspid valve myxomas constitute a scarce diagnosis. They could be asymptomatic, occurring in unusual locations and in association with benign tumors in other organs. Our patient was asymptomatic, underscoring the significance of the early diagnosis of this type of tumor to prevent further catastrophic events.

A 43-year-old man presented to the emergency department with atypical chest pains. Physical examinations yielded no significant findings. Serial electrocardiography and high-sensitivity troponin measurements were normal. Transthoracic echocardiography in the emergency department revealed increased septal wall thickness; therefore, the patient was referred to the echocardiography ward for further evaluation. The echocardiographic findings were normal, except for an intramyocardial mass with an echo-free center in the base-to-mid portion of the inferior and inferoseptal walls (Figures 1. A, B & C). Additionally, the base and mid portions of the anteroseptal wall were hypertrophied. Cardiac magnetic resonance imaging demonstrated myocardial hypertrophy in the base and mid portions of the anteroseptal, inferoseptal, and inferior walls (Figures 2. A, B, C, D & E), as well as a patchy mid-wall appearance of late gadolinium enhancement, at the anterior and posterior junction of the right ventricle to the left ventricle (Figures 2. F, G & H). The findings were typical of hypertrophic cardiomyopathy. What was revealed in the late gadolinium-enhanced images was compatible with the echo-free space in echocardiography. Otherwise speaking, the cardiac magnetic resonance images delineated the background pathology (hypertrophic cardiomyopathy) and revealed fibrosis as the etiology of the echo-free space in echocardiography. Holter monitoring of electrocardiography was unremarkable. To our knowledge, intramyocardial masses with echo-free centers as an echocardiographic presentation of hypertrophic cardiomyopathy have not been reported yet. Accordingly, in the differential diagnosis of the aforementioned echocardiographic findings, hypertrophic cardiomyopathy should be included. Cardiac magnetic resonance imaging in this condition is helpful.

Background: Calculating the burden of diseases is essential for their monitoring. The burden of cardiovascular diseases in Kurdistan Province has not been reported. This study aimed at calculating the burden of cardiovascular diseases in the Kurdistan Province from 2011 through 2017. Methods: In this cross-sectional study, incidence data were extracted from registration systems. The methods of the World Health Organization (WHO) were employed to calculate disability-adjusted life years (DALYs) of cardiovascular diseases in the Kurdistan Province. DALYs were calculated by summing the years of life lost (YLLs) and the years of life lived with disability (YLDs) for sex, age group, and year. Results: The burden of cardiovascular diseases increased from 18569.1 DALYs in 2011 to 34929.8 DALYs in 2017. The highest increase and the largest decrease in DALY according to the all age-standardized DALYs index were related to acute myocardial infarction and heart failure in women, respectively. The highest DALYs in both sexes were in the age group of over 80 years. Conclusion: The burden of cardiovascular diseases is increasing in the Iranian province of Kurdistan. It is, therefore, essential to implement appropriate and adequate interventions such as lifestyle modification, extensive screening, public education promotion, and operational plan development. We hope our results will aid decision-makers in performing urgent interventions.

A 54-year-old woman with a history of unknown childhood cardiac surgery underwent dual-chamber pacemaker implantation due to an advanced atrioventricular block in our center. One week later, we were asked to further evaluate tricuspid regurgitation via transthoracic echocardiography (TTE). The postoperative TTE demonstrated a left ventricular ejection fraction of 45%, as well as moderate mitral regurgitation, a severely dilated right atrium, a moderately dilated right ventricle, a dilated main pulmonary artery (38 mm), a mildly stenotic pulmonary artery (peak gradient=30 mmHg), and moderate-to-severe tricuspid regurgitation, with a right ventricular systolic pressure of 40 mmHg. The right atrial pacemaker lead was in its proper place, the ventricular lead in the right ventricle was undetectable due to very poor TTE views. Electrocardiography (ECG) showed a pacing rhythm with no other abnormalities (Figure 1).