Iranian Heart Journal
Volume:17 Issue: 1, Spring 2016

In ST-elevation myocardial infarction (STEMI), the use of ECG in the acute phase contains useful information, including the lesion location, and it contributes to the appropriate treatment. We sought to evaluate the culprit artery in patients with STEMI through ECG variations and its relation with the culprit lesion identified on angiography.
Patients referring to Rajaie Cardiovascular, Medical, and Research Center between September 2011 and September 2012, due to acute MI accompanied by STEMI were chosen. Based on the ECG, the culprit artery was determined and the amount of ST- elevation in every lead was recorded. On angiography, the exact location of the closure in the main coronary vessels and/or side branches was identified. The findings were adjusted to the ECG, and its ability in the prediction of the culprit lesion was assessed.
We studied 100 patients, comprising 17 female and 83 male patients, at an average age of 57.64±11.31 years. The introduced model of ECG was useful for the prediction of the lesion in the proximal right coronary artery (RCA), mid left anterior descending artery (LAD) before D1 after S1, and proximal LAD and the least predictive ability was for the distal LAD and the distal RCA. The relationship between the proximal LAD and ST-elevation >2.5 mm in V1 was significant, and the relationships between the mid LAD before D1 after S1 and QAVL, Q in V4-V6, ST-depression >1 mm in III and no ST-depression in II and AVF were significant as well.
Our results demonstrated that in patients with STEMI, ECG was able to reliably predict the location of the culprit lesion in most vessels such as the proximal RCA and the mid LAD before D1 after S1.

Incessant atrial tachycardia (AT) is a kind of sustained supraventricular tachycardia. P-wave morphology in surface ECG is a useful criterion to recognize anatomical origination of AT. In the present study, the origination of incessant AT on the basis of P-wave morphology before electrophysiology study (EPS) and echocardiographic criteria alteration before and after ablation were assessed.
In this case series, 185 patients (mean age =43±18 y; age range =16 to 87 y) with AT were enrolled. Of these patients, 37 (10% of all cases of AT) had incessant AT. The P-wave morphology of all 12 leads acquired surface ECG was recorded before EPS, and the origin of incessant AT was diagnosed. Alterations in echocardiographic characteristics such as ejection fraction (EF), end-diastolic diameter (EDD), and end-systolic diameter (ESD) were all measured before and after ablation.
The study of surface ECG showed that the negative P wave in lead I was a characteristic parameter for AT originating the left atrial appendage with 100% sensitivity and 96.8% specificity. A negative or positive/negative P wave in lead V1 was seen in right atrial appendage AT with 100% sensitivity and 79.3% specificity, and a negative or positive/negative P wave in lead V1 originating the crista terminals had 80% sensitivity and 68.8% specificity. In AT originating the coronary sinus, a negative P wave in the inferior leads (sensitivity of 100%, specificity of 97%) and a positive P wave in lead aVR were the characteristic parameters. The mean value of left ventricular ejection fraction before and after ablation was 41.76±12.5 and 48.5±8.15, respectively (P A significant relationship was seen between P-wave morphology and the origin of incessant AT. The ablation of incessant AT conferred improvement in EF, LVEDD, and LVESD (P

Arrhythmogenic right ventricular cardiomyopathy dysplasia (ARVCD) is a common cause of sudden cardiac death among young adults and athletes. The currents study sought to evaluate clinical characteristics, echocardiographic and ECG diagnostic criteria, and follow-up results in patients with ARVCD.
In the present case series, the ECG, imaging, and echocardiography records of all patients referring to our tertiary care center between 2000 and 2015 were assessed. Sex, age, cardiovascular risk factors, drug history, and family history of cardiovascular diseases were considered as the study variables. The frequency of all baseline and clinical data and the correlations between those and implantable cardioverter defibrillator (ICD) indication and survival were evaluated.
In this case series, 68 patients with ARVCD (mean age =39.48±15.83 y; 45 male) were evaluated. The most frequent symptom was palpitation, followed by syncope, and the most prevalent ECG findings was T-wave inversion in the precordial leads (P In our patients with ARVCD, the most common symptoms were palpitation, syncope, and T-wave inversion in the precordial leads. The correlations between appropriate ICD therapy and dyspnea, peripheral edema, ascites, and severe LV dysfunction were significant. Dyspnea and secondary ICD indication were the predictors of appropriate ICD therapy.

Oral contraceptives (OCP) have been previously reported to be a risk factor for venous thromboembolism and pulmonary embolism. However, their effects on cardiovascular disease (CVD) and stroke are still controversial. In this study, we aimed to clarify whether there is an increased risk of future CVD in women with a history of OCP use.
This cohort study was conducted between 2001 and 2011 in a group of women ≥35 years of age. The participants were divided into 2 groups: with a history of OCP use and without a history of OCP use. A questionnaire containing demographic data, history of OCP use, and other risk factors of CVD was completed by the participants. Body mass index, hypertension, and blood biochemistry markers (including fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein) were determined at the beginning of the study. Stroke, myocardial infarction (MI), sudden cardiac death, and total CVD were assessed during the study. Finally, all the gathered data were analyzed using SPSS, version 15. The chi-square test and the independent t-test were used to compare the groups. The Cox regression model was utilized to evaluate the association between CVD event and OCP use.
Out of 3,254 women aged ≥35 years in this study, totally 1,391 (42.7%) individuals had a history of OCP use and 1,863 (57.3%) women had no history of OCP use. There were differences between the groups (OCP users and nonusers) in terms of age (P≤0.001), hypertension (P≤0.001), and waist circumference (P=0.009), as there were no differences as regards diabetes mellitus (P=0.353), fasting plasma glucose (P=0.177), and dyslipidemia (P=0.368). None of the events, comprising MI (HR: 0.514 [0.288–0.919]), stroke (HR: 0.803 [0.501–1.287]), sudden cardiac death (HR: 0.39 [0.156–0.97]), and CVD events (HR: 0.802 [0.642–1.003]), showed a significant relationship between the event and OCP use in the comparison between the OCP users and nonusers. Even after adjusting for the demographic data and risk factors, the same results were obtained.
In contrast to previous studies, our data revealed no increased risk of future stroke and CVD events, consisting of MI, stroke, and sudden cardiac death, due to a history of OCP use. A historyof OCP use for a longer period of time compared with a shorter period of time showed no difference concerning the prevalence of future CVD.

Some studies have shown that prediabetes may be associated with a greater incidence of coronary artery disease (CAD). Since there is a conflict concerning the relationship between CAD and optimal glucose level, this study focused on the relationship between CAD in different groups of diabetes, prediabetes (impaired fasting glucose [IFG]), and normal through fasting blood glucose classification.
This is a case-control study carried out on 98 patients in each group of prediabetes, diabetes, and normal glycemia referred to the coronary angiography clinics of Chamran and Khorshid hospitals in 2014. The multiple logistic regression tests were used for statistical analysis in SPSS, version 20.
Comparison of CAD between the groups showed a higher risk of CAD in the diabetic group than in the normal group (P Our results provide further strong evidence that glucose evaluation should be a part of standard testing for the prevention of cardiovascular diseases.

The lack of accurate and timely diagnosis and treatment of mitral stenosis (MS) during pregnancy can lead to irreparable consequences for mother and neonate. The present study aimed to determine maternal and neonatal outcomes of pregnant patients with MS due to rheumatic heart disease.
This prospective cohort study was performed on 35 pregnant women with MS as a result of rheumatic heart disease referred to the prenatal clinic at Shariati Hospital in Tehran in 2015. On first admission, fetal growth status was evaluated with ultrasound and clinical examination. The mothers were also examined in terms of symptoms and complications, and their New York Heart Association functional capacity was determined. The severity of MS was determined using clinical and transthoracic echocardiographic assessments.
Maternal mortality and pulmonary edema each occurred in 2.9% of the patients. Termination of pregnancy was required in 17.1%. Mean area of mitral valve was significantly lower in the women with post-delivery complications than in the other women. All the women with post-delivery complications had severe MS, while this defect was revealed only in 53.1% of those without complications (P=0.046). All the neonates delivered as a result of the termination of pregnancy suffered severe MS, as this anomaly was detected in 48.3% of the neonates with normal delivery (P=0.044).
MS can predict maternal post-delivery events (pulmonary edema and need for mitral replacement therapy) and neonatal complications (termination of pregnancy). The progressive reduction in functional capacity during pregnancy can also predict adverse post- delivery events in patients with MS.

Stress cardiac magnetic resonance imaging (MRI) has emerged as an attractive noninvasive method in the detection of coronary artery disease (CAD). The accuracy of qualitative perfusion dipyridamole stress cardiovascular magnetic resonance(CMR) for the detection and localization of obstructive CAD was re-evaluated in the present study.
The study group comprised 30 patients candidated for coronary angiography with possible stable ischemic heart disease between 2013 and 2015 in our tertiary care center. Rest and stress perfusion CMR was performed before coronary angiography with dipyridamole infusion (0.14 mg/kg/min for 4 min). The presence of regional perfusion defects was assessed visually, and the results of stress CMR were compared with those of conventional coronary angiography as the gold standard.
Among 25 patients (18 men, mean age =54.3 y; age range =36–83 y) who were included in the final comparison, angiography showed 24 significant (> 70%) lesions in 13 patients (P Qualitative stress perfusion CMR has high accuracy in both detection and localization of obstructive CAD. (Iranian Heart Journal 2016; 17(1): 51-56)

The relative importance of different risk factors of stroke may vary between various etiologies and countries. We sought to describe the cardiac risk factors of ischemic cerebral infarction in a university hospital in Tehran, Iran.
This prospective, observational study was carried out on 58 consecutive patients admitted to the neurology ward of Baharloo Hospital in Tehran, Iran, with a diagnosis of established ischemic stroke or transient ischemic attack. Data regarding each patient’s demographic profile, clinical presentation, medical history (emphasis on risk factors), results of brain imaging, biochemical profile, and other diagnostic tests were recorded in a structured form. Diagnostic neurological studies comprised computed tomography scan of the head and brain, brain magnetic resonance imaging in ed patients, and Doppler ultrasonography of carotid arteries. Cardiologic studies consisted of standard 12-lead ECG, 24-hour Holter monitoring, and 2D transesophageal echocardiography (TEE) obtained over a 7-day period after the onset of symptoms. The recorded data were statistically analyzed for the percent¬- age, mean, and standard deviation of all the variables. SPSS, ver¬sion 22.0, for Windows was used for all the statistical analyses.
Atrial fibrillation was evident in respectively 6.9% and 15.5% of the ECGs and Holter monitoring cardiograms. The echocardiographic findings of our studied subjects are depicted in detail in Table 2. The most prevalent finding was aortic valve stenosis or calcification in 70.7% of the subjects, followed by aortic arch wall calcification in 55.2%. Patent foramen ovale was observed on the TEE of 14 (24.1%) patients, and 3 patients had mitral annulus calcification. Three patients had rheumatic heart disease. Echocardiography demonstrated simple and severe aortic arch atheroma in 30 (51.7%) and 11 (19.0%) subjects, respectively. Mean left ventricular ejection fraction was 52.67 (SD=5.63) among our participants; 9 (15.5%) of them had impaired left ventricular function (ejection fraction Different cardiac abnormalities were seen among stroke cases of unidentified causes. Because relatively high abnormalities were detected in these patients, the role of immediate cardiologic studies—especially echocardiography and Holter monitoring—in first-time stroke patients should be emphasized.

Rheumatic heart disease is the major cause of cardiovascular death in children and young adults in developing countries. In the present study, we investigated the changes in cardiac biomarker levels before and after percutaneous balloon mitral commissurotomy (PMC).
Patients with severe mitral stenosis undergoing elective PMC were prospectively enrolled. The blood sample was taken for the measurement of cardiac biomarkers (CKMB and CTnI) before and then 6 hours and 12 hours after PMC. The maximum level of the biomarkers after the procedure was determined for analysis.
Of a total of 56 patients (mean age =44.0±14.1 y), 91.1% were female. Except for 1 patient, all the other patients had cardiac biomarkers before the procedure in normal ranges. The serum levels of CTnI and CKMB increased significantly after the procedure. The patients who underwent complex septostomy had a significantly higher rise in CKMB (9.4±9.34 IU/L vs. 3.17±12.39 IU/L; P=0.03) and CTnI (0.15±0.20 µg/L vs. 0.07±0.12 µg/L; P=0.002).
The serum levels of CTnI and CKMB increased significantly following the procedure, especially in patients who underwent complex septostomy.

A 35-year-old woman was admitted because of organophosphate pesticide self-poisoning. At the time of admission in the emergency department of clinical toxicology, she was agitated. Evaluation of vital signs revealed a pulse rate of 148/min, systolic/diastolic blood pressure of 109/88 mm Hg, and respiratory rate of 20/min. She was afebrile and had plenty of oral secretions. Her pupils were mydriatic and reactive to light. Examination of the chest showed bilateral rales. Other organs revealed no pathologic sign or symptoms on physical examination. Computed tomography scan of the brain was normal. Serum cholinesterase level was 5%, and red-cell acetylcholinesterase activity was 0.3. She had no premorbid illness. After the injection of 4 mg of atropine, all muscarinic signs disappeared. This was followed by the infusion of atropine at a rate of 0.5 mg/h; the dose was titrated as per her clinical response and signs of atropinization. Over the next 2 days, she did not need further atropine. On day 4 after admission (i.e., after she had not need any atropine infusion or other treatments for organophosphate poisoning for 2 days), she suddenly developed hypertension crisis with systolic/diastolic blood pressure of 230/150 mmHg, cold sweating, tachycardia, and tachypnea. Chest examination revealed basilar wet rales. Chest X-ray presented diffuse bilateral alveolar infiltration. ECG was normal. Considering the clinical diagnosis of acute cardiogenic pulmonary edema, we started an intravenous infusion of nitroglycerin and furosemide and an intravenous injection of morphine. Twelve hours later, blood pressure was controlled and the rales disappeared. Bedside echocardiography showed normal left ventricular systolic and diastolic functions and normal right ventricular size and function. There was no significant valvular heart disease. Psychiatric consultation confirmed anxiety disorder and panic attack. Treatment with fluoxetine and clonazepam was commenced. During the course of her hospital stay and after her hospital discharge, outpatient follow-up showed no hypertension crisis. We conclude that panic attack and its hypertensive crisis may be severe enough to develop pulmonary edema even in young healthy adults with no comorbidity and with structurally normal heart.