mohammadmostafa ansari ramandi

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths in theUnited States. In addition, myocardial infarction (MI) due to CO poisoning in a young, healthy adult is rare.On the other hand, smokeless tobacco, processed in various forms, is a controversial coronary heart disease(CHD) risk factor.

CASE REPORT: 

In this study, we describe a 29-year-old man who presented with acute chest pain followinga night of smoking tobacco and using smokeless tobacco in the presence of carbon monoxide poisoning.ST-segment elevation was observed on an electrocardiogram, and echocardiography revealed akinesia. Inaddition, cardiac markers were elevated. In this particular instance, thrombolytic therapy demonstratedsuccessful outcomes.

We believe the case and discussion could shed light on the emergency departmentmanagement of such individuals. We advise clinicians to consider the possibility of coronary heart diseasein carbon monoxide poisoning patients and to obtain a baseline electrocardiogram and cardiac markers.

Manifestations caused by coronavirus family have presented it in many ways during the previous years. The aim of this systematic review was to gather all possible cardiovascular manifestations of the coronavirus family in the literature. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Scopus, Web of Science, Cochrane and ProQuest which were updated on May 1, 2020 for the last time. Regarding to the novelty and speed of publications on COVID-19, we searched Google Scholar and also references of included studies and review articles in the systematic search results were searched manually. The searched keywords were the combination of the following MeSH terms: "COVID-19", "SARS", "MERS" and "cardiovascular presentation". The systematic review was registered with ID CRD42020180736 in International Prospective Register of Systematic Reviews (PROSPERO). After screening, 28 original articles and ten case studies (five case reports and five case series) were included. Most of the studies were focused on COVID-19 (20 original articles and four case studies) while the only studies about Middle East Respiratory Syndrome (MERS) were a case report and a case series. Almost all the cardiovascular presentations and complications including acute cardiac injury, arrhythmias and the thrombotic complications were more prevalent in COVID-19 than severe acute respiratory syndrome (SARS) and MERS. The cardiac injury was the most common cardiovascular presentation and complication in COVID-19 whereas thrombotic complications were commonly reported in SARS. The cardiac injury was the predictor of disease severity and mortality in both COVID-19 and SARS.Coronavirus 2019 may present with cardiovascular manifestations and complications in signs and symptoms, laboratory data and other paraclinical findings. Also, cardiovascular complications in the course of COVID-19 may result in worse outcomes.

Psoriasis is a chronic inflammatory disease affecting many organs. Recent studies have demonstrated that psoriasis is associated with cardiovascular disorders. We investigated the echocardiographic and conduction system changes in psoriasis patients.

In this case-control study, 36 psoriatic patients and 36 healthy controls were enrolled. Demographic and clinical data, echocardiographic and P wave dispersion (PWD) in 12-lead electrocardiogram were evaluated in both groups. We recruited patients with confirmed diagnosis via biopsy and have not been under recent systemic treatment. Patients with underlying cardiovascular disease were excluded from the study.

Mean age was 41.56±16.20 and 39.67±13.85 year in case and control groups, respectively. There was no significant difference in the baseline characteristics of the two groups. PWD was significantly higher in the case group (p<0.05). High pulmonary artery pressure was observed in 14 psoriatic patients and 1 individual in the control group (p<0.001). Left ventricular diastolic dysfunction was significantly higher among individuals who were above 60 years of age (p<0.01) but not significantly different between the two groups.

Psoriatic patients are more susceptible to future development of atrial fibrillation because of higher PWD. There is no significant difference between the diastolic function in these patients.

Although people with less critical symptoms should not visit hospitals in order to reduce exposure during a pandemic, it is of utmost importance that those experiencing risky symptoms visit in early stages to prevent delayed consequences. In this article, we reported three ST-segment Elevation Myocardial Infarction (STEMI) patients who would have benefited from visiting the hospital earlier while they were experiencing low threshold angina.

Patient symptoms and primary investigational methods may be misleading at some points in patient management and can consume a lot of time. Sarcomas are rare malignancies and contribute 1% of all cancers of adult.

A rare case of primary cardiac angiosarcoma is presented, who was first treated because of lung tuberculosis and then with only slight improvement in symptoms, further investigations were done showing right ventricular enlargement and pericardial effusion. Eventually, after ruling out pulmonary embolism and constrictive pericarditis, investigations lead to the diagnosis of primary cardiac angiosarcoma. The patient went under surgery to remove the tumor but he still had residual mass left, leading to chemotherapy and then radiotherapy. Although the tumor has a poor prognosis, our patient has managed to survive a year by now and is doing good for 6 months after radiotherapy.

The case describes the importance of having in mind different differential diagnosis in managing patients and the role of multi-modality imaging in guiding diagnosis and treatment.

 The 2019 coronavirus disease (COVID-19) is threatening public health in many ways. The psychological situation of individuals is important and limited data is available from Iran. In this study, we aimed to illustrate the psychological distress of the general population and evaluate factors affecting it. 

 An online cross-sectional survey was done from 29th to 31st March 2020 in South Khorasan province, affected later than other parts of the country. We included sociodemographic questions, Hospital Anxiety, and Depression Scale (HADS) questionnaire and questions addressing various symptoms and diseases. Most questions had multiple choices to be chosen from and some were open questions. Univariate and multivariate analysis in SPSS software were used to find significant relationships.

 A total of 844 responses were collected, from which 788 records were included in the analysis. The mean age of responders was 36.61 ± 10.97 (age range: 18-88) and 484 (61.4%) of them were female. The mean scores in the anxiety and depression subscale of the HADS questionnaire were 7.01±3.68 and 6.72±3.71 respectively. Experiencing cardiovascular and COVID-19 related symptoms was significantly associated with a higher number of individuals having abnormal anxiety and depression results (p value<0.001). Widowed individuals, females and those experiencing above-stated symptoms showed a significant association with increased anxiety and depression in multivariate analysis.

 Although many existing elements influence the psychological well-being of society during a pandemic, experiencing symptoms related to other diseases or having multiple chronic diseases may cause an extra burden on the psychological state of the society.

 Lymphedema is one of the most disturbing complications of breast cancer treatment and some routine medical procedures such as blood pressure (BP) monitoring or injections have been reported to be the major risk factors for lymphedema. This systematic review aimed to shed light on the safety of some medical procedures among breast cancer survivors with and without lymphedema.

 An electronic systematic search in Pubmed and Scopus was undertaken from 1 January 1992 to 12 May 2020 and all relevant studies were summarized in a table based on the PRISMA guideline.

 Twenty-three articles were included from which 11 and 8 articles were prospective and retrospective original studies, respectively. The remaining 4 articles were case reports. BP measurement, injections, blood draw, and hand surgeries were the medical procedures of interest. Most of the included studies have reported that these medical procedures did not result in lymphedema initiation or worsening in breast cancer survivors; however, case reports of the harmful effects of these procedures were also included in this systematic search.

 Although recent well-designed prospective studies did not show any significant side effects from medical procedures in breast cancer survivors, concerns exist for both healthcare staff and patients. Additionally, it seems that there are specific aspects that have not been investigated properly in previous studies and should be considered in future studies.

Mortality, morbidity and the burden of the advanced heart failure and also the cost of frequent admissions is high. Several registries were done all over the world to manage the patients with heart failure; however studies about the advanced stage are limited.

The present study aimed to determine the prognostic predictors of patients with advanced heart failure.

In this study 178 (74.2% male) patients with advanced heart failure (stage D) from 2011 to 2016 were selected according to the following inclusion criteria; highly symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction (LV ejection fraction less than 30%) who have been admitted for at least two times in the recent year because of decompensation. The data regarding the clinical findings, readmissions, mortality, laboratory tests, electrocardiography, echocardiography, etc. of patients were all derived from Rajaie Acute Systolic Heart Failure (RASHF) data registry.

In a 5-year follow-up, we realized that more than 70% of the patients died. The rate of mortality were significantly higher in females (P value = 0.006) and there was a significant correlation between anemia and the mortality (P value = 0.002). There was no remarkable association between the serum creatinine, sodium and uric acid levels with the mortality of the patients.

Data about stage D of heart failure are limited. The mortality rate for such patients is relatively high and there’s no clear best treatment approach. Large registries and data acquisition of these patients could be helpful for better management approaches.

Electromagnetic interference can cause damage to cardiac implantable electronic devices (CIEDs). The current guidelines recommend the interrogation of all pacemakers and defibrillators before and after surgery. The objective of the study was to evaluate the safety and outcomes of noncardiac surgeries in patients with CIEDs.

Between January 2014 and January 2019, all patients with CIEDs who underwent noncardiac surgery were included. The patient’s baseline characteristics and data regarding their procedure and postsurgical complications and mortality were extracted from their medical records. The device analysis 6 months after the procedure was also seen.

Of the 54 patients, 16 had permanent pacemaker, 25 implantable cardioverter defibrillator, and 13 cardiac resynchronization therapy device. Most common indication for surgery was inguinal or abdominal hernia (n = 46); three patients underwent surgery for cholecystitis and five for other reasons. Supraventricular tachycardia was reported in one patient during surgery and in another one after surgery. Only one patient experienced intraoperative ventricular tachycardia. There was no device malfunction during and after surgery. During 6-month follow-up, 5.6% mortality rate was reported.

With recommended device programming before surgery, noncardiac surgery is well tolerated in the majority of the patients with CIEDs without significant interference in the device function.

Atrial fibrillation (AF) is one of the most common complications occurring after cardiac surgeries. The incidence of post-operative AF is increasing continuously over the past decades and it is associated with lengthened hospital stay and risk of stroke.
This study was designed to examine the relationship between coronary artery involvement and the occurrence of AF after coronary artery bypass graft (CABG).
This prospective observational study was to assess the relationship between the coronary artery involvement and the occurrence of post CABG surgery AF. Patients with chronic and paroxysmal AF before surgery were excluded. All patients had a complete evaluation by echocardiography, electrocardiography, and laboratory testing. The patients were monitored for 3 days after surgery and any tachycardia monitored as AF was noted. Patients were also divided into two groups of having post-operative AF and not having AF. Coronary artery involvement was defined using the Rentrop system. The coronary arteries were divided into 14 segments for better understanding of the lesions.
In this study 232 patients were selected, from which 106 patients had AF and 126 patients had sinus rhythm. The results of the present study confirmed that the older patients had a more frequent occurrence of AF after CABG (P Although age has been the most important predictor for occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Out of the variables evaluated in this study, higher PAP, proximal LAD lesion, higher levels of BNP, and D dimer as well as single vessel and two vessel coronary artery diseases were noted to significantly predict a higher occurrence of AF after CABG.

Allopurinol used in the treatment of gout has been shown to improve the vascular endothelial dysfunction and reduce the dysfunction of the failing heart. This study was done to evaluate the effect and safety of allopurinol in non-hyperuricemic patients with chronic severe left ventricular (LV) dysfunction.
In this study, 35 consecutive cases of non-hyperuricemic patients with chronic heart failure who had severe LV systolic dysfunction (ejection fraction of less than 35%) and were on optimal guideline directed medical therapies for at least 3 months were included. Allopurinol was administered with the dose of 300 mg po daily for 1 week and then it was up-titrated to a dose of 600 mg po daily for 3 months. Six minute walk test, strain imaging, laboratory testing were done for every patient at baseline and after 3 months treatment with allopurinol.
In this study 30 heart failure (HF) patients with a mean age of 49.3 ± 14.4 years old were evaluated. No adverse effects were reported except for one case of skin rash after 4 days treatment which was excluded from the study. Study showed significant improvement of six minute walk test of the patients from 384.5 ± 81.5 meters to 402.8 ± 89.6 meters and the global longitudinal peak strain (P Allopurinol could be of benefit in non-hyperuricemic patients with severe LV systolic dysfunction without significant adverse effects. Randomized clinical trials are needed in future to confirm the results.

Heart failure (HF) is one of the main causes of death and disability in the world.
The prevalence of HF in developed countries is between 1% and 2% of the adult population and approximately between 6% and 10% in the elderly, giving rise to high costs of care and treatment. Indeed, in the United States, the direct and indirect costs exceeded 23 billion dollars in 2002. HF is typically characterized by periods of acute symptoms followed by returns to nearly asymptomatic periods. As dyspnea and fatigue are considered the signature symptoms of HF, other symptoms such as pain go unnoticed. Awareness of the burden of pain, however, is growing in patients with chronic HF. The past 2 decades have witnessed remarkable technical headway in cardiology and many patients have survived despite the progressive impairment of their cardiovascular function. It is, therefore, of great value to investigate the prevalence and management of pain in patients with HF. To that end, we undertook a comprehensive search using the MEDLINE database for studies and guidelines on the subject of pain and HF and the complications and considerations and finally selected 65 studies for review.

Chronic heart failure (CHF) is associated with unpredictably increased prevalence of hospital admissions. Self-care is one of the most important aspects of management for patients with CHF. Self-care adequacy has led to increased satisfaction, independence in daily activities, reduced stress, and morbidity.. We aimed to assess the relationship between self-care behavior and readmission rate in patients with heart failure..Patients and A total of 287 patients with a diagnosis of systolic CHF with a left ventricular ejection fraction less than 35% admitted for acute heart failure were enrolled. The self-care behavior was assessed using SCHFI questionnaires that have three domains (self-care maintenance, self-care management, and self-care confidence). An acquired score greater than 70 was considered as proper self-care index. The study population was followed over three months after discharge for readmission.. This study showed that self-care behavior was improper in our study population. More than 75% of patients had a score less than 70 in the different domains for self-care. The multivariable regression analyses showed a significant relationship between self-care management (ß = 1.6, P = 0.006, OR (CI) = 2.66 (1.37-5.1) and self-care confidence (ß = 0.9, P = 0.02, OR (CI) = 2.01 (1.1-3.68) and readmission rate.. We concluded that a good administration program such as education and a surveillance plan for the improvement of self-care behaviors would reduce hospital readmissions in patients with heart failure..