فهرست مطالب babak kazemi

Autonomic changes play an essential role in the genesis of neurally mediated syncope (NMS). The aim of this study was to compare the changes of the autonomic nervous system (ANS) by measuring spectral indices of beat-to-beat systolic blood pressure and heart rate variability (SBPV and HRV) in ranges of low frequency (LF), high frequency (HF), and the LF/HF ratio during head-up tilt test (HUTT) in patients with and without a syncope response.

In this case-control study of 46 patients with a suspected history of unexplained syncope, data were recorded separately during the typical three phases of HUTT. Patients who developed syncope were designated as the case group and the rest as the control group.

Thirty one patients experienced syncope during HUTT. Resting HRV and SBPV indices were significantly lower in cases than controls. After tilting in the syncope group, both HF and LF powers of SBPV showed a significant and gradual decrease. LF/HF in HRV increased in both groups similarly during the test but in SBPV, mainly driven by oscilations in its LF power, it increased significantly more during the first two phases of the test in syncope patients only to paradoxically decrease during active tilt (P< 0.001).

Our findings show an abnormal autonomic function in patients with syncope, both at rest and tilting. Fluctuations of spectral indices of beat-to-beat SBPV, a potential noval index of pure sympathetic activity, show an exaggerated response during tilt and its withdrawal before syncope.

Heart failure (HF) is one of the major problems of health system in the countries. In a subgroup of these patients, cardiac resynchronization therapy defibrillator (CRT-D) improves the quality of life by enhancing the function of the left ventricle (LV) and preventing of arrhythmias. The present study intends to discuss the effect of CRT-D on the QRS dispersion, as a predisposing factor to arrhythmias.
45 patients treated with CRT-D during 2012-2015 were enrolled in this study. QRS dispersion in various V-V delays was measured and its association with the incidence of arrhythmias, at least six months after insertion, was assessed.
The results showed that QRS dispersion in the intrinsic mode was significantly lower than the other modes of the CRT-D device (P

QT dispersion (QTd) and Tp-e interval show controversial results in incidence of sustained ventricular arrhythmias (SVA) in patients with heart failure (HF). In patients with implanted cardiac resynchronization therapy (CRT) device, there is a unique opportunity to record SVAs. The aim of this study was to evaluate the effects of QTd and Tp-e interval on the incidence of SVAs after simultaneous biventricular (Biv) pacing.
In the present study, 31 consecutive patients with advanced HF and implanted CRT device were evaluated one year for possible SVAs, corrected QT (QTc), QTd, and Tp-e interval. Patients were divided into two groups; with (group 1) and without (group 2) SVAs.
Among the studied patients, 5 (16%) experienced SVAs. The intrinsic and Biv pacing QTd were 70.74 ± 18.00 and 89.26 ± 28.00 msec, and 95.09 ± 44 and 88.09 ± 33 msec in group 1 and group 2, respectively (P = 0.18 and P = 0.16, respectively). Tp-e was not different between the two groups. In group 1, QTc increased from 438.83 ± 64 msec to 488.24 ± 48 msec (P = 0.13), and in group 2, it decreased from 499.70 ± 65.00 msec to 480.00 ± 31.00 msec after simultaneous Biv pacing (P = 0.13).
QTd, Tp-e, and QTc did not differ significantly after Biv pacing to show any positive effect on the incidence of SVAs in part due to the severity of changes which already occur in patients with advanced HF. QTc, QTd, and Tp-e showed little changes after Biv pacing and probably do not have a significant role in the incidence of SVAs.

Electrical cardioversion (ECV) is a safe method for the treatment of atrial fibrillation. It seems that left atrial volume index (LAVI) could be a good marker in predicting the success of ECV. The purpose of this study is to assess of the significance of LAVI measurement before ECV in predicting the recurrence of the AF.
Fifty-one patients with AF, selected for ECV were studied in the cardiology department of Tabriz University of medical sciences. The clinical and demographic data of all the patients were obtained. Echocardiography was performed before and also three months after ECV. Patients were separated into two groups: those who maintained SR and those with relapse of AF diagnosed by clinical manifestations and electrocardiography (ECG).
Sinus rhythm (SR) was maintained in 76.5 percent of the patients following the three months after ECV. The age, sex and the body mass index (BMI) were not significantly different between SR and AF groups. Two groups showed no significant differences considering pre-ECV medical history including medications and systemic diseases. The initial LAVI of SR group was 42.21±12.4 mL/m2 and AF group was 96.08±52.21 mL/m2, the initial LAVI was significantly different between two groups (P = 0.000). The LAVI of SR group decreased significantly (5.69±0.74 mL/m2) after three months, LAVI decreased from 42.21 ± 12.4 ml/m2 to 37.51 ± 10.52 mL/m2. (P = 0.000). The cut-off point of LAVI value in predicting the maintenance of SR was 55 mL/m2.
The present study indicates that LAVI is a powerful forecaster of the recurrence of AF after ECV. The LAVI measurement could be a useful method in the selection of the patients with AF for ECV.

Context: Coronary artery diseases are mostly detected using angiographic methods demonstrating arteries status. Nevertheless, Myocardial Infarction (MI) may occur in the presence of angiographically normal coronary arteries. Therefore, this study aimed to investigate the prevalence of MI with normal angiography and its possible etiologies in a systematic review.
Evidence Acquisition: In this meta-analysis, the required data were collected from PubMed, Science Direct, Google Scholar, Scopus, Magiran, Scientific Information Database, and Medlib databases using the following keywords: “coronary angiograph”, “normal coronary arteries”, “near-normal coronary arteries”, “heart diseases”, “coronary artery disease”, “coronary disease”, “cardiac troponin I”, “Myocardial infarction”, “risk factor”, “prevalence”, “outcome”, and their Persian equivalents. Then, Comprehensive Meta-Analysis software, version 2 using randomized model was employed to determine the prevalence of each complication and perform the meta-analysis. P values less than 0.05 were considered to be statistically significant.
Totally, 20 studies including 139957 patients were entered into the analysis. The patients’ mean age was 47.62 ± 6.63 years and 64.4% of the patients were male. The prevalence of MI with normal or near-normal coronary arteries was 3.5% (CI = 95%, min = 2.2%, and max = 5.7%). Additionally, smoking and family history of cardiovascular diseases were the most important risk factors. The results showed no significant difference between MIs with normal angiography and 1- or 2-vessel involvement regarding the frequency of major adverse cardiac events (5.4% vs. 7.3%, P = 0.32). However, a significant difference was found between the patients with normal angiography and those with 3-vessel involvement in this regard (5.4% vs. 20.2%, P Although angiographic studies are required to assess the underlying etiology of MI, physicians facing patients presenting with the clinical features of MI in presence of normal or near-normal coronary arteries should consider the prevalence and risk factors of MI with normal or near-normal coronary arteries.

To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.
In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region (n= 98) and non-earthquake (n= 34) region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias (VAs), or supraventricular tachycardias (SVTs) and triggered ICD therapies, either shock or anti-tachycardia pacing (ATP). The state version of the State-Trait Anxiety Inventory (STAI-S) was used to assess general symptoms of anxiety in both groups.
Males comprised 81.1% of the participants. Mean age of the participants was 59.7 ±15 years. The frequency of patients with sustained VAs increased significantly after the earthquake (p=0.008). There were more VAs (mean 2.16 vs. 6.23; p=0.008) and they occurred earlier (6th vs. 16th day; p= 0.01) in the earthquake area. The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups. Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety (p=0.07) and the relative severity of anxiety (p=0.08) in the earthquake area.
In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events.

Atrial fibrillation (AF) is the most common arrhythmia in patients with mitral stenosis (MS) and it may increase complications and decreases success rates of percutaneous balloon mitral valvotomy (PBMV). This study aimed to investigate the short and long term results of PBMV in patients with AF compared to sinus rhythm (SR).
In this cross sectional study, 1000 patients with MS who had undergone PBMV between 1999 and 2013 were enrolled including 585 and 415 patients with AF and SR respectively. Patients were followed for a mean of 7.27 ± 3.16 years. Clinical, echocardiographic and hemodynamic data were collected. Procedure success, in-hospital and long-term outcome were evaluated.
Patients with AF were older and had greater symptoms, mitral regurgitation, mitral echocardiographic score, and mitral pressure gradient before PBMV. PBMV success rate were significantly lower in AF group (P AF leads to worse in-hospital and long-term outcome and lower PBMV success rate. Repeated assessment and early decision to PBMV in patients with MS to reduce AF and AF related complication seems necessary.

Toll-like receptors (TLR) are well known components of the innate immune system. Among them, TLR4 is related to the inflammatory processes involved in atherosclerotic plaque formation. Our purpose was to compare the monocytic expression of TLR4 following implantation of drug-eluting (DES) and bare stents (BMS).
In this study, patients with chronic stable angina undergoing elective percutaneous coronary intervention (PCI) in ShahidMadani Heart Hospital, Tabriz, Iran were included. Ninety-five patients receiving DES and 95 patients receiving BMS were selected between 2012 and 2014.Everolimus eluting stents were implanted for DES group. Both groups received similar medications and procedure. Blood samples were taken before PCI, 2 hours and 4 hours after termination of PCI. Expression of TLR4 on monocytes was measured using flowcytometry. Patients were matched for age, sex and coronary artery disease risk factors, but not for TLR4 expression rate before PCI.
A significant difference was seen between DES and BMS in TLR4 expression before (21.3±2.8% vs. 15.5±2.7%; P Our findings suggest thateverolimuseluted from the stents can decrease PCI induced increase in the TLR4 expression on the surface of monocytes.

The most common diagnostic modality for pulmonary emboli is CT angiography (CTA). Because of the availability and inexpensiveness, taking an electrocardiogram (ECG) is the first step in patients suspicious to pulmonary emboli. However, ECG does not provide any sensitive or specific manifestations for diagnosis of pulmonary emboli. We aim to evaluate the correlation between severity of pulmonary emboli in CTA and ECG changes. In this study, 102 patients diagnosed with massive or submassive pulmonary emboli due to Qanadli index in CTA studies were evaluated. ECG was taking in all patients. There are 35 previously reported pathologic changes in ECG which were all evaluated in these patients. The correlation between ECG findings and pulmonary emboli severity in CTA was evaluated. Massive emboli were present in 56.9% and submassive emboli in 43.1% of cases. In 76.5% of cases, pathologic changes in ECG considering emboli were present. In cases with massive emboli compared to submassive emboli, ECG changes (86.2% vs. 63.6%) and mean pathologic findings in ECG (5.82±2.95 vs. 4.25±2.84) were significantly higher. Prevalence of S1O3T3, S1&SaVL>1.5 mm, ST depression in V1-V3, ST elevation in V1-V3, Negative T wave in V1-V3, Right axis deviation, RVH criteria, P-pulmonale, QR pattern in V1 were significantly higher in massive emboli group. ECG changes and number of pathologic findings were higher in massive emboli group. Most significant changes were negative T and ST depression or elevation in V1-V3 and right heart involvement findings and could predict severity of pulmonary emboli.

Natriuretic peptides are secreted from the heart in response to increased wall stress. Their levels are expected to be increased in patients with mitral stenosis (MS) due tohigh left atrium (LA) pressure and pulmonary artery pressure (PAP). Percutaneous transvenousmitral commissurotomy (PTMC) if successful is pursued by a rapid decrease in LA pressure andsubsequent decrease in pulmonary artery pressure. The concurrent changes in natriuretic peptidelevels could be affected with heart rhythm. Forty five patients with severe rheumatic MS undergoing PTMC were enrolled. Weevaluated the serum NT-Pro BNP levels before and 24 hours after PTMC. BNP levels were alsomeasured from the blood samples obtained from LA before and 20 minutes after the procedure.Changes in biomarkers were assessed based on heart rhythm and success of the procedure. While serum NT-Pro BNP levels showed significant decrease 24 hours after theprocedure (P= 0.04), BNP levels taken 20 minutes after PTMC from LA were similar to theirbaseline concentrations (P= 0.26). NT-Pro BNP levels decreased 51.7±182.86 pg/ml for SR and123.4±520 pg/ml for AF (P= 0.68). Immediate changes in BNP levels did not predict the success of procedure probablydue to the additional balloon inflation attempts in LA in several patients and half-life of BNP. BNPlevels obtained later may be of more value considering the half-life of this marker. Heart rhythmwas not found to influence the changes in biomarker levels. BNP and NT-pro BNP changes werenot found to predict success of the procedure.

Prevalence of post-coronary bypass grafting surgery (post-CABG) atrial fibrillation (AF) is high, and it’s complications are serious. Prediction of this problem and prophylactic or presumably curative managements may be helpful not only in post-CABG AF, but also in other conditions that predispose patients to AF. The aim of this study was finding relationship between right atrial (RA) dyssynchrony and post-CABG AF occurrence.
One hundred patients who were candidates for CABG and they had sinus rhythm was evaluated. We measured RA dyssynchrony in tissue Doppler imaging (TDI) using initiation of P wave in the electrocardiogram to peak A wave (on TDI) in mid of RA free wall and mid of inter-atrial septum (IAS). The time difference from the onset of the P wave to the onset of the A wave at the right atrium (P-RA) and the IAS (P-IAS) was measured. RA dyssynchriny was defined as the difference between P-IAS and the P-RA. Patients were followed for occurrence of AF 72 h after CABG through Holter monitoring, the relation between AF occurrence and RA dyssynchrony was determined.
AF developed in 24 patients (24%), based on statistical analysis, lower LVEF and RA dyssynchrony had relationship with AF occurrence. RA dyssynchrony was significantly increased in patients with postoperative AF (36.67 ± 14.93 ms vs. 14.27 ± 13.77 ms,P We demonstrated that RA dyssynchrony based on TDI could be a predictor for the occurrence of post-CABG AF.

Percutaneous coronary intervention (PCI) may be associated with Thrombotic complications. Unfractionated heparin (UFH) is a potent and preferable antithrombotic agent during this procedure. Activated clotting time (ACT) is a good assay for accurate titration of UFH during PCI. The aim of this study was to evaluate ACT levels 10 minutes after administration of 100U/kg IV heparin and determining its associated factors. This study was performed in Madani hospital, Tabriz, Iran between January 2013 to January 2014. One hundred and two patients candidates for elective PCI were enrolled in the study. Data including demographic and risk factors were collected. The range of ACT was between 165 to 750 seconds (mean 319.8 seconds), 52 (51%) patients had ACT levels lower than 300sec and 12 (11.8%) patients had ACT levels between 300 to 350 seconds which is known optimal range and 38 (37.2%) cases had ACT levels above this value. Major risk factors had no effect on ACT value, but there was a trend to higher levels with increasing age (P=0.06). There was no difference in the rate of major or minor bleeding with respect to ACT levels (P=0.52). There was a trend to higher rate of minimal bleeding in those with ACT >350 sec (P=0.06). Weight based UFH injection may result in suboptimal anticoagulation during the procedure. Routine ACT measurement may be necessary to ascertain adequate anticoagulation. Major risk factors had no effect on ACT level and it was not associated with the rate of bleeding.

Prognostic differences between anterior and inferior wall Myocardial Infarction (MI) has been extensively investigated, but there is limited information about similar comparison between inferior wall MI caused by right coronary artery (RCA) and left circumflex artery (LCX) occlusion. The aim of present study was to compare prognostic differences between LCX- and RCA-related acute inferior wall ST-segment elevation MI (STEMI) treated by routine adjunctive angioplasty after receiving thrombolytic therapy (TLT). Between March 2012 and June 2013 one hundred fifty consecutive patients with acute inferior wall STEMI were studied. Patients were divided into two groups according to the infarct related artery (LCX vs. RCA). All patients underwent routine adjunctive angioplasty after TLT during the index hospitalization and clinical characteristics and outcomes were compared. RCA and LCX arteries were occluded in 97 (64.7%) and 53 (35.3%) of patients, respectively. Two groups were similar in baseline characteristics except multiple-vessel disease was more prevalent with LCX occlusion (p= 0.008). There was a higher cardiac enzyme release (p< 0.001), more significant mitral regurgitation (MR) (p= 0.015), and lower left ventricular ejection fraction (LVEF) (p= 0.01) in patients with LCX occlusion. Multivariate analysis showed cTn-I release, occurrence of MR, and lower LVEF as independent factors leading to poor outcome. There were higher cTn-I release, MR occurrence, and lower LVEF in LCX-related acute inferior wall STEMI, all associated with poor outcome. Therefore, patients with ECG finding in favour of LCX occlusion should be considered as high risk and an invasive approach should be planned.

Patients with hemodynamically significant mitral stenosis (MS) have prolonged P-wave duration and increased P-wave dispersion (PWD) that decreases after successful percutaneous balloon mitral valvotomy (PBMV). The purpose of this study was to investigate if the changes in these indices may predict a successful procedure. Fifty two patients with MS in sinus rhythm underwent PBMV (90.4% female; mean age 38±10 years). Mitral valve area (MVA), valve score, mean diastolic mitral gradient (mMVG), mitral regurgitation severity, and systolic pulmonary artery pressure (sPAP) were evaluated by echocardiography before PBMV and repeated after one month. P-wave duration (Pmax / Pmin) and PWD were measured before and immediately after PBMV, at discharge, and at the end of the first month after discharge. Among all procedures 38 (73.1%) were defined as successful. Mean age, valve score, mMVG, and MVA before PBMV were similar for both groups. MVA was significantly greater in the successful PBMV group (1.65±0.27 vs. 1.41±0.22; p= 0.003). sPAP was reduced after PBMV in all patients and there were no significant differences in the mean sPAP before and after PBMV in both successful and unsuccessful groups. Pmax and PWD were significantly decreased immediately after the procedure (p= 0.035), the next day (p= 0.005) and at one month (p= 0.002) only in patients with successful PBMV. Pmin did not change significantly in either group.Only successful PBMV was associated with a decrease in Pmax and PWD. These simple electrocardiographic indices may predict the success of the procedure immediately after PBMV.

Fenestrations of the aortic valve rarely produce significant valvular regurgitation. These are typically described as incidental findings with little clinical significance because they generally lie above their closing edges. Rarely however, when unusually large or multiple, they can lead to massive aortic regurgitation (AR), mostly in patients with chronic hypertension and/or aortic annular dilation. We operated a 52 year old normotensive male with chronic rheumatic AR and found large fenestrations in all three aortic cusps, hardly ever reported in rheumatic valvular involvement in the literature.

Arterial sclerosis has been extensively described but reports on venous sclerosis are very sparse. Phlebosclerosis refers to the thickening and hardening of the venous wall. Despite its morphological similarities with arteriosclerosis and potential morbid consequences, phlebosclerosis has gained only little attention. We report a 72 year old male with paralysis and atrophy of the right leg due to childhood poliomyelitis who was referred for coronary artery bypass surgery. The great saphenous vein, harvested from the left leg, showed a hardened cord-like obliterated vein. Surprisingly, harvested veins from the atrophic limb were normal and successfully used for grafting.

Autonomic dysfunction (AD) is a common and important complication in Guillain-Barré syndrome (GBS) and may be the cause of significant morbidity or death. Limited studies have evaluated this complication in childhood GBS. Our objectives were to show the prevalence of AD in children with GBS and investigate its association with the severity of the disease. Study included 28 children admitted with a diagnosis of GBS. Heart rate variability (HRV), motor function disability of the upper limbs and GBS disability scores were measured at admission and the results were compared with 20 healthy age/gender matched subjects (2-13 years; 43% male). GBS subtypes were defined by electromyography: acute inflammatory demyelinating polyneuropathy (AIDP) or acute motor axonal neuropathy (AMAN). The mean age was 5.5±3.4 years (range 1.5-14 years; 50% male). AIDP and AMAN subtypes comprised 57.1% and 42.9% of cases, respectively. In the upper limbs, 85.7% and in the GBS disability grading, 50% of patients had ≤ 3 scores, implying less severe motor dysfunction. There was no difference in the mean heart rate between patients vs. controls (103.9 vs. 98.2 bpm; P= 0.16), but half of patients showed AD and HRV was significantly reduced in patients compared to controls. Of the 16 patients with AIDP, 11 (68.8%) showed reduced HRV compared to 3 (25%) out of 12 AMAN cases (P= 0.02). There was no significant relation between HRV and motor disability scores. AD was present in half of children with mild GBS and it showed no significant association with disease severity.

Primary pericardial malignant mesothelioma is an extremely rare tumor even among all mesotheliomas with about 350 cases reported in the literature so far. Typically, it has an insidious presentation, with nonspecific signs and symptoms, and usually results in constrictive pericarditis, cardiac tamponade or congestive heart failure through either a massive effusion or direct tumurous constriction or invasion to the heart. With the exception of several case reports, the outcome is uniformly dismal and patients typically die within six months of diagnosis. We report a 24 year old male with long history of pleuretic chest paint and admissions with a diagnosis of idiopathic pericarditis, eventually presenting with increasing symptoms of heart failure and a large mobile ball like mass in the heart at echocardiographic and computed tomography studies. At operation, an atypical invasive cardiac tumor was discovered. Complete resection of the tumor was impossible and the patient died from progression of the disease 4 months later.

Limited information is available regarding the relationship between coronary vessel dominance and atherosclerotic involvement. Rheological factors have been implicated in the pathogenesis of coronary lesions. More than 90% of the coronary blood flow enters the left coronary if it is the dominant artery. The main purpose of this study was to determine the relation between left coronary dominance and atherosclerotic involvement of left anterior descending artery (LAD) origin. In addition, the prevalence and degree of associated ischemic mitral regurgitation (MR) in these patients were assessed. The study included 678 consecutive patients with an indication for coronary angiography. One hundred and twenty two patients with right dominant and 61 patients with left dominant arteries were randomly selected for analysis. All demographics, risk factors, coronary dominancy and involvement, left ventricular ejection fraction (LVEF), and MR were recorded. One hundred and eighty three patients (mean age of 57.7 years) were studied. The types of coronary circulation included right, left, and balanced in 78.6%, 8.9%, and 12.5%, of the patients respectively. In 64 patient with significant LAD lesions, 22 (34.9%) had ostial while the remainder had non-ostial involvement. Ischemic MR was present in 5 (2.7%) patients. There was no difference in demographics, risk factors, LVEF, MR, extent of coronary artery disease, and LAD ostial involvement between left and right dominant circulations. In this study, left coronary dominance was not associated with atherosclerotic involvement of LAD ostium and ischemic MR.

Epidemiologic studies on civilian vascular trauma in developing countries are rather few. Although Iran encounters vascular injury far more frequently than developed countries, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper retrospectively reviews a tertiary referral center experience of extremity vascular trauma. All individuals who presented to the Imam Khomeini Hospital, Tabriz/Iran, with a vascular injury between March 1998 and February 2000 were retrospectively identified from a trauma database. The aim was to study the etiology, signs and symptoms, pattern of injuries, the implemented treatment strategies, and the mortality and morbidity rates due to vascular trauma in our population. During the study period, 124 patients (5 female) with a mean age of 23 years (7-65 years) sustained vascular injuries. The most common injury was arterial and isolated venous injuries were seen in only 15 cases. Penetrating injuries were the causes in 63% of patients, blunt trauma in 21%, and both in 16% of the rest. The commonest injured artery and vein were the femoral artery and the popliteal vein, respectively. All of the patients underwent surgical repair in 1-48 hours (mean 9.5 hours) after trauma, with the most common procedure being the end-to-end anastomosis. Three underwent primary amputation and 3 required secondary amputation, mostly due to infection. The mortality rate was 3.2% (4 cases) with a median hospital stay of 13 days. Most vascular injuries due to limb trauma can be managed successfully unless associated with severe damage to bones, nerves or soft tissues. The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.

To make a review of the immediate results of coarctation of the aorta (CoAo) operation, between March 1993 and October 2003 at Madani Heart Center, Tabriz-Iran. The following data were investigated: age at the time of surgery, gender, symptoms, clinical and paraclinical findings, associated cardiac lesions, and type of surgical technique, and immediate surgical outcome, particularly focusing on the presence of hypertension. Fifty three patients underwent surgical repair of CoAo. Enrolled patients had an age between 12 months to 49 years (mean 17 years), and 30 (56.6%) were male. Twenty five (47%) patients were asymptomatic. The most common presenting symptoms were palpitation (45%) and dyspnea on exertion / early fatigue (41%). The most common signs were a systolic murmur (96%), and weak lower limb pulses (86%). In electrocardiogram, 96% had signs of LV hypertrophy. The chest-X-ray was normal in only 54%. The location of coarctation was post-ductal in 78% and pre-ductal in the rest. The associated defects were present in 30 (56.6%) patients, most common being patent ductus arteriosus (26.4%) and aortic valve disease (22.4%). Among the various surgical techniques employed end-to-end anastomosis was used in 26 (49%) and Dacron patch aortoplasty in 23 patients (43.3%). During discharge BP was reduced in 75% and unchanged in 25% with respect to preoperative values. Fifteen percent of patients had some complications and one death was observed in the immediate postoperative period. There is a high rate of associated cardiac lesions with CoAo and despite a delayed diagnosis in our region; corrective surgery has a relatively good short term outcome with low morbidity and mortality.

The initial electrocardiographic evaluation of every tachyarrhythmia should begin by addressing the question of whether the QRS complex is wide or narrow. The most important cause of wide complex tachycardia (WCT) is ventricular tachycardia (VT). However, supraventricular tachycardia (SVT) can also manifest with a wide QRS complex. The ability to differentiate between SVT with a wide QRS due to aberrancy or preexcitation and VT often presents a diagnostic challenge. The identification of whether WCT has a ventricular or supraventricular origin is critical because the treatment for each is different, and improper therapy may have potentially lethal consequences. When all QRS complexes in the precordial leads are either upright or negative (positive or negative concordance, respectively), VT is strongly suggested. Negative concordance is virtually diagnostic of VT generated from the anteroapical left ventricle. We report an extremely rare case of SVT presenting with a WCT and negative concordance.

One of the most important challenges in today’s practice of cardiology is prevention of sudden cardiac death (SCD) in high risk patients with coronary heart disease (CAD). Hemodynamically-tolerated sustained ventricular tachycardia (HTVT) comprises up to 30% of all cases of monomorphic ventricular tachycardia (MMVT) in patients with CAD. While there is a consensus on treatment of hemodynamically-unstable sustained VT in patients with CAD, some controversies regarding the proper treatment of HTVT exist. We re-examined existing clinical evidence, controversies and current guidelines on the treatment of HTVT in patients with CAD and demonstrated that compared to implantable cardioverter-defibrillators, amiodarone is not an acceptable therapeutic option in patients with ischemic heart disease who suffer from HTVT