Journal of Cardio -Thoracic Medicine
Volume:11 Issue: 3, Summer 2023

Instruction : 

Palliative care units aim to improve the quality of life and alleviate symptoms in patients with serious illnesses. Dyspnea, a distressing symptom, can significantly impact patients' quality of life. While various methods are used to manage dyspnea in palliative patients, surgical interventions may be overlooked or underutilized due to patient-specific considerations. This study investigates the effects of pleural interventions on quality of life, dyspnea, and pain scores in palliative care patients.

This retrospective case series analyzed data from 213 patients treated in a palliative care service between May 2022 and May 2023. Patients who underwent pleural interventions for dyspnea control were included. Data on patient characteristics, pleural pathologies, type of intervention (thoracentesis, indwelling pleural catheter or tube thoracostomy), complications, modified Borg dyspnea scale, Karnofsky Performance Scale (KPS), and visual analog scale (VAS) scores were collected.

A total of 21 patients met the inclusion criteria. Thoracentesis was the most commonly performed intervention. After pleural intervention, Borg dyspnea scale scores significantly decreased (5.9-3.2, p<0.001), while KPS scores significantly increased (32.4-40.9, p<0.001). No significant difference was observed in VAS scores (3.1-3.4, p:0.25). Complications were minimal, with a small number of patients experiencing iatrogenic pneumothorax or catheter infection.

This study highlights the importance of pleural interventions in managing dyspnea and improving symptom control-related performance in palliative care patients. Therapeutic thoracentesis, pleural catheter insertion, and chest tube placement have demonstrated effectiveness in alleviating dyspnea. Therefore, pleural interventions should not be avoided if indicated in palliative care patients accompanied by dyspnea. However, potential complications and limitations must be considered, and patient-specific factors should guide decision-making.

Pathological Q waves in an electrocardiogram (ECG) are robust prognostic markers in patients with ST-segment elevation myocardial infarction (STEMI), a leading global cause of death. Accurately identifying high-risk patients with STEMI is essential to provide tailored management, thereby improving patient outcomes. Thus, this study aims to evaluate the relationship between the number of leads with pathological Q wave in the first ECG and left ventricular ejection fraction (LVEF) before discharge.

This retrospective study reviewed the records of 152 STEMI patients meeting inclusion criteria at Taleghani Hospital from April 2014 to August 2018. The initial ECGs, angiography, and echocardiography data were extracted, read by cardiologists, and prepared for analysis.

The majority of patients (87.5%) were males, and 69.7% had a pathological Q wave at the first ECG. The median of LVEF was significantly lower in patients with a pathological Q wave than in patients without a pathological Q wave (45 versus 50, p-value < 0.001). In addition, there was a mild negative correlation between the number of pathological Q waves and LVEF (r = -0.318, p-value < 0.001).

This study reveals the presence of a mild negative linear relationship between LVEF and the number of pathological Q waves in STEMI patients.

 Serum vitamin D levels are related to a wide spectrum of factors including low sunlight exposure, high oxidative stress, low physical activity and sleep disorders. In this paper we are going to investigate the most crucial parameters associated with serum vitamin D levels in survey of ultraviolet intake by nutritional approach (SUVINA) study with a data mining approach. Data including demographic, anthropometric, clinical and laboratory information were extracted from the SUVINA dataset comprising 289 subjects who were enrolled into our study. The XGBoost algorithm was used to define the most important features related to vitamin D level in our population. Applying XGBoost modeling for vitamin D level showed that the presented scheme can determine the most important determinants of serum vitamin D level with an accuracy of 91%. Pro-oxidant anti-oxidant balance (PAB), body fat percentage, physical activity level (PAL), age, restless leg syndrome (RLS), and dietary inflammatory index (DII) density were the most important variables correlated with vitamin D deficiency. Using XGBoost and with an accuracy of more than 90%, we showed that the six most important risk factors for vitamin D deficiency are PAB, PAL, age, body fat percentage, RLS and DII density, respectively.

Pituitary apoplexy following cardiac surgery is a very rare complication and can be a potentially life-threatening clinical syndrome. It could be caused by acute infarction, hemorrhage or edema and sudden enlargement of a pre-existing and unknown pituitary adenoma. We report a case of hemorrhagic apoplexy of a pituitary gland macro-adenoma successfully managed by urgent trans-sphenoidal tumor resection in a patient after elective  coronary artery bypass grafting (CABG).

Superior vena cava thrombosis with its extension into the right heart chambers can be commonly seen in the presence of chronically inserted catheters, coagulation disorders, malignancy, deep venous thrombosis (DVT), obesity, pregnancy, or trauma. Right atrial thrombi generally forms on injured endothelium due to implanted devices or foreign bodies, including tumors, pacemakers, and chronic right atrial catheters like triple-lumen catheters used for hemodialysis, giving chemotherapy, intravenous fluids or parenteral nutrition. It can lead to severe consequences, which may result in pulmonary or septic embolism and even systemic embolization as seen in the case of an atrial septal defect or patent foramen ovale. We report a case of a 49-year-old female who presented with complaints of mild to moderate dyspnea for 1 month with a past history of DVT and pulmonary embolism. She has undergone a gastric band procedure. Her imaging studies revealed a 42 x 20 mm intraluminal lesion within the Superior Vena Cava (SVC) extending into the right atrium. The patient's huge mass was removed by surgery, and pathological evaluation confirmed it to be thrombosis.

"Ball valve thrombus" which is a spherical free-floating clot in left atrium is an often quoted, but uncommonly encountered complication in patients with severe mitral stenosis of rheumatic origin, who are in atrial fibrillation. We describe the case of a 48-year-old man with rheumatic heart disease, severe mitral stenosis, and severe aortic regurgitation. The patient presented with an episode of non-exertional syncope resulting in CVA 1 month back and breathlessness on exertion of 6 months duration and was in normal sinus rhythm. Echocardiography facilitated ante-mortem diagnosis and prompt institution of surgery was lifesaving.