reza hassanzadeh-makoui

Clopidogrel, a selective thienopyridine, is used for secondary prevention of major adverse cardiovascular events. Some studies have reported inflammatory arthritis as a rare adverse effect of Clopidogrel. A 47-year-old male underwent percutaneous coronary intervention and was subsequently prescribed a 600 mg loading dose of Clopidogrel, followed by a daily dose of 75 mg. After six days of taking Clopidogrel, the patient presented to the emergency department with right knee pain. The knee joint exhibited swelling, warmth, and tenderness, although there was no redness or crusting. After two and six days of hospitalization, despite receiving antibiotics and Indomethacin, he developed arthritis of the metacarpophalangeal and metatarsophalangeal joints, respectively. According to the laboratory investigation, cultures, synovial fluid analysis, and imaging, infectious, rheumatologic, and crystallopathy diseases were ruled out for the patient. Clopidogrel was discontinued, and the patient was switched to ticagrelor 90 mg twice daily. All symptoms and signs of joint inflammation had improved within five days of stopping the Clopidogrel. After one week and one and six months of follow-up, there has been no recurrence of symptoms.

Heart Failure is a pathophysiologic state in which the cardiac output is not able to supply the body with enough oxygen and nutrients. The prevalence of heart failure has increased dramatically over the last decades. Vitamin D levels in patients with chronic heart failure are lower than healthy controls, and vitamin D deficiency has a direct relationship with mortality.

This study aimed to evaluate the effect of vitamin D on the improvement of left ventricular ejection fraction in patients with systolic heart failure.

In this case-control clinical trial, 142 patients with chronic systolic heart failure were identified. Based on the inclusion and exclusion criteria, 114 patients were enrolled in the study and randomly divided into two groups. One group (n = 58) received 50,000 units of vitamin D capsules weekly for eight weeks, and the patients in the other group (n = 56) received a placebo. After excluding 15 patients from the placebo group and 17 patients from the intervention group during the study, according to the exclusion criteria, 41 patients were evaluated in both groups for ejection fraction changes after two months.

According to the results of this research, there were no statistically significant differences in the baseline parameters between the two studied groups. The intervention group consisted of 18 female and 23 male patients with a mean age of 61.68 ± 19.8 years. Moreover, the placebo group included 21 female and 20 male patients with a mean age of 62.12 ± 18.2 years. After a 2-month follow-up, the intervention group showed statistically significant changes in ejection fraction, end-diastolic volume, and heart failure class compared to the placebo group. Also, the serum level of albumin and vitamin D in the intervention group was significantly higher than the placebo group.

The results of this study show that vitamin D treatment can improve the ejection fraction and functional ability of patients with vitamin D deficiency. If more comprehensive studies support this hypothesis, vitamin D deficiency assessment and correction in patients with chronic heart failure may be recommended.

Coronary artery disease is the main cause of death in most societies, which is fatal symbol of acute myocardial infarction. Early diagnosis and treatment of this disease is the greatest impact on survival. But the diagnosis of acute myocardial infarction has always been a challenge, particularly in elderly patients due to atypical manifestation. Since a large proportion of deaths is due to unawareness of the symptoms and delay in diagnosis Therefore, this study have been done to determine the clinical manifestation of acute myocardial infarction in elderly and non-elderly patients. In this cross-sectional study of 65 elderly patients and 65 non-elderly patients were studied who had been hospitalized in the coronary care unit Ayatollah Mousavi Hospital of Zanjan after acute myocardial infarction. Checklist includes demographic, anthropometric and clinical symptoms were completed. The data were analyzed using the software SPSS23. In elderly patient, the frequency of atypical chest pain is 39.3% and absence of pain is 14.3%. This results for non-elderly patient is 15.6% and 6.3%, respectively (P-value=0.02). The frequency of atypical pain in elderly women is more than elderly men, significantly (P-value=0.057). The frequency of atypical pain in the diabetic elderly and non-elderly patients is more than non-diabetic patients. The prevalence of atypical pain or absence of chest pain is more in women than in men, the elderly compared to non-elderly and in patients with diabetes than in non-diabetic patients.

Coronary artery disease is one of the most common causes of mortality around the world. The association between vitamin D deficiency and the incidence of diseases, such as hypertension, diabetes, and metabolic syndrome, has been demonstrated previously. There have been studies concerning the relationship between vitamin D deficiency and cardiovascular diseases, which have shown different results. Therefore, this study aimed at determining the association between serum levels of vitamin D and acute coronary syndrome.
In this case-control study, serum levels of vitamin D were compared between 50 patients with acute coronary syndrome and 50 individuals without this syndrome. A checklist, including demographic data of patients, comorbidities, vitamin D levels, lipid profiles, Electrocardiogram (ECG) changes and echocardiography results, was completed during hospitalization.
Mean age in the case and control group was 63.26 ± 10.76 and 61.22 ± 10.71 years, respectively. The prevalence of diabetes and high blood pressure in the case group was 32% and 54% versus 10% and 8% in the control group, respectively. Overall, 70% and 18% of subjects were smokers in the control and case groups, respectively. Mean concentration of vitamin D in serum was 20.63 ± 13.90 ng/mL, which was significantly lower than the control group with a mean concentration of 29.54 ± 16.8 ng/mL (P-Value = 0.002). Finally, it was shown that for every one unit increase in vitamin D levels, the risk of acute coronary syndrome was reduced by 7% (P-Value = 0.005).
The results of this study showed that the serum levels of vitamin D were significantly lower in patients with acute coronary syndrome compared to those without this disease.