Cardiovascular Biomedicine Journal
Volume:2 Issue: 2, Summer and Autumn 2022

The coronavirus disease is due to Acute Respiratory Syndrome Coronavirus2 (SARS-CoV-2). COVID-19 mainly affects the respiratory and immune systems and other organs like the cardiovascular and nervous systems, lungs, and kidneys (1). Several studies have reported COVID-19 patients with persistent symptoms for months after the initial phase. The most common symptoms are fatigue, headaches, cough, anosmia, arthralgia, and chest pain (2). Studies have shown this modality to diagnose, follow up, and evaluate response to treatment in chronic COVID-19 complications using 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT), pulmonary involvement with  99mTc-MAA perfusion lung scan, renal involvement with 99mTc-DTPA, and 99mTc-DMSA renal scintigraphy (3). Myocardial perfusion imaging with 99mTc-MIBI provides meaningful data to predict prognosis, risk of annual cardiac events, and evaluation of myocardium viability (4). Conventional SPECT Myocardial Perfusion Imaging (MPI) needs a viable metabolically active myocardial cell to extract the radiotracer. A review of articles shows that 99mTc-MIBI myocardial perfusion scintigraphy could be helpful in the timely acute myocardial infarction (MI)  diagnosis and myocardial viability in COVID-19 patients. It is also beneficial in managing COVID-19 patients with heart failure by myocardial injury evaluation and choosing the best therapeutic choice, prognosis, and treatment response.

High blood pressure (HBP) is a persistent and widespread condition, and increasing numbers of patients are taking medication to reduce HBP symptoms and control blood pressure. Patients taking specific antihypertensive medications have been reported to experience oral lichenoid reactions. Various antihypertensive drugs have entered the market, and it is essential to study how they may affect the occurrence of oral lichenoid reactions. This study aimed at assessing the frequency of drug-induced oral lichenoid responses in patients receiving antihypertensive medications. Four hundred fifty patients who took hypertension medications referring to Seyed al-Shohdai Hospital in Urmia in 2021 were the subject of this cross-sectional study. After the patient's first visit to the hospital, a thorough medical history was obtained from them. The type, dose, and duration of antihypertensive medications taken at the study's time were questioned and documented together with demographic data. The diagnosis of the oral lichenoid reactions was then made by examining the patients. Chi-square and Spearman's correlation tests were used in SPSS version 26 to evaluate the data. Oral lichenoid reaction was observed in about 3.3% of patients. The average age of patients who showed oral lichenoid reaction was 53.7 ± 7.1, they had taken medicine for an average of 1 to 30 months, and 66.7% were female. Patients taking antihypertensive drugs, e.g., hydrochlorothiazide, methyldopa, metoprolol, and propranolol, should be examined and followed up regarding oral lichenoid reactions.

Takotsubo cardiomyopathy (TCM) is a transient left ventricular wall motion abnormality commonly following physical and emotional stress that can be resolved entirely. Recent case reports and some case-control studies have suggested a likely close association between thyrotoxicosis and TCM. It was shown that resolving thyroid functional status led to resolving TCM symptoms leading to normal cardiac function without a significant sequela, emphasizing a triggering role of thyrotoxicosis for flaring TCM. Here, the literature on the association between thyroid dysfunction and the likelihood of TCM is reviewed to describe the likely pathophysiology of TCM associated with thyroid dysfunction.

Syncope is defined as a sudden and transient loss of consciousness followed by complete spontaneous recovery. This study describes the syncope evaluation in patients referred to the Heart Clinic. This descriptive cross-sectional study was conducted on 60 syncope patients referred to Afshar Heart Clinic of Yazd, Iran, from September 2016 to March 2017. After performing clinical workups, the etiology of syncope was diagnosed in each patient. Electrocardiography and blood pressure measurements were done for all patients. Additional clinical tests, including echocardiography, Holter Monitoring, Head-Up tilt table test (HUTT), electroencephalography, and Magnetic Resonance Imaging, were performed for some patients based on the cardiologist's opinion. The distribution of patient's clinical records, such as age, sex, diabetes, hypertension, history of ischemic heart disease (IHD), duration of syncope, postdrome, prodromal symptoms, and clinical test results according to causes of syncope in patients, were reported. Sixty patients with a mean age of 50.7 ± 20.4 years were evaluated (55% male). Thirty-five patients (58.3%) had Neurally Mediated Syncope, 18 patients (30%) had arterioventricular (AV) Block induced syncope, and 7 (11.7%) patients had Sick Sinus Syndrome (SSS) induced syncope. Age, hypertension, prodromal symptoms, history of IHD, ECG, Holter monitoring, and HUTT results were associated with the cause of the syncope. Cardiac syncopes (AV-Block induced and SSS induced) were related to older age, hypertension, abnormal electrocardiogram, and abnormal Holter monitoring results. Neurally mediatedsyncope was associated with younger age, prodromal symptoms, and abnormal HUTT results.

Opium addiction is one of the fundamental public health problems today that could influence cardiovascular disease outcomes. Recent studies have shown that opium addiction may increase the risk of postoperative complications in patients undergoing on-pump coronary artery bypass graft surgery. In this retrospective cross-sectional study, we aimed to assess whether opium addiction may affect the postoperative complications of off-pump coronary artery bypass graft surgery (OPCAB) (1). In this cross-sectional study, we searched the clinical records of all patients who underwent OPCAB surgery from 2017/03/21/ to 2018/03/19/ at Afshar and Seyed Al-Shohada Hospitals in Yazd, Iran. We evaluated the patients for postoperative complications. Complete patient demographic and clinical data collected through a review of patient records. Finally, the collected data were analyzed using SPSS software version 18. A total of 889 patients (667 (76.2%) non-addicted, 127 (14.3%) opium addicts, and 86 (9.6%) smokers and opium addicts) met our criteria and were included in the study. The average age of the participants was 62.09 ± 9.8 years. Frequency distribution of the most postoperative variables such as intubation duration, intensive care unit (ICU) stay, postoperative bleeding volume, pack cell count, need for fresh frozen plasma (FFP), platelet injection volume, need for reoperation, need for intra-aortic balloon pump, as well as Atrial fibrillation (AF) rhythm showed no significant difference between the three groups. However, the only significant difference between the three groups reported the need for postoperative use of inotropic drugs (p=.001). According to the results, the only complication that differed significantly in the three patient groups after OPCAB was the need for inotropic drugs.

Subcutaneous emphysema occurs when air is trapped between subcutaneous tissues and manifests as sudden swelling, dysphonia, and sore throat. In many severe cases, subcutaneous emphysema causes dysphagia, pain, and breathing difficulty. The current study reports two cases of successful management of extensive subcutaneous emphysema after cardiac surgery.The first patient was a 60-year-old man with a history of coronary artery disease who underwent coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. He was transferred to the intensive care unit (ICU) in good condition. Twelve hours after the surgery, he was extubated in a stable condition. On the second day after the surgery, his face, neck, and chest began to swell due to extensive subcutaneous emphysema, and he experienced decreased SPO2 and severe respiratory distress.The second patient was a 65-year-old woman with a history of myocardial infarction (MI) who had CABG off-pump surgery. After surgery, the patient was transferred to the ICU in a favorable and stable condition and was extubated 6 hours after the surgery. Her face, neck, and chest started swelling three days after the surgery, and she had severe respiratory distress and decreased blood saturation due to extensive subcutaneous emphysema.In both cases, despite conventional treatment, the patient's symptoms escalated despite re-intubation and mechanical ventilation.In the operating room, the chest tubes were removed, two new chest tubes were inserted, and the area damaged by the old tubes was repaired. Shortly after the insertion of the chest tubes, the patient's emphysema symptoms decreased significantly.

Numerous recent studies have emphasized the role of kidney failure in developing ischemic heart disease (IHD) and the resulting adverse consequences. The purpose of the present study was to quantitatively assess the effect of kidney failure based on glomerular filtration rate (GFR) in predicting clinical outcomes in patients with unstable angina (U/A). This retrospective cohort study included 129 patients with unstable angina with preserved left ventricular function. Serum creatinine levels were specified at the beginning of their admission. The GFR at admission time was determined based on the MDRD index. Based on the GFR value, patients were classified into two groups, i.e., normal GFR (>60) and decreased GFR (<60). The frequency of one-month mortality in <60 GFR and >60 GFR was 3.2% and 0.0%, respectively. Furthermore, the prevalence of 6-month mortality in <60 GFR and >60 GFR was 8.1% and 0.0%, respectively. The frequency of readmission in <60 GFR and >60 GFR was 29% and 11%, respectively. Likewise, the frequency of revascularization through coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in <60 GFR and >60 GFR was 25.8% and 8.9%, respectively. According to the multivariate logistic regression model, <60 GFR increased the risk of 6-month mortality up to 0.2 times (probability ratio of 2.081, P-value of 0.023). Regarding readmission, <60 GFR increased the need for readmission up to 2.4 times (probability ratio of 2.433, P-value of 0.049). On the other hand, the risk of CABG or PCI recurrence following initial intervention was 2.8 times higher in patients with <60 GFR than in the >60 GFR group (probability ratio 2.882, p-value .03. The study revealed that <60 GFR compared to higher values ​​of GFR is associated with an increased risk of 6-month mortality, increased readmission, and increased revascularization in patients with unstable angina.

Cardiovascular diseases are the primary cause of death all around the world, and the complications of heart disease can reduce the patient's quality of life.Adherence to a therapeutic plan can reduce surgical complications and promote the healing process. This study aimed to survey the relationship between adherence to a therapeutic plan and quality of life in discharged patients after a coronary artery bypass graft (CABG). Descriptive correlational research was carried out to discover relationships among variables. The study was conducted in Hamadan hospital in 2014. Seventyone patients undergoing CABG surgery were selected by convenience sampling method. Before discharge, the patients completed the Mac New Quality of Life Questionnaire and adherence to therapeutic plan questionnaire that included medicine adherence, recommended care, diet and exercise orders, and incentive spirometry. After five weeks, patients again completed the questionnaires, and the data were analyzed. There was a positive and significant relationship  between patients' quality of life and adherence to the treatment plan. As the treatment program increased, the patients' quality of life also increased (r= 0.695, p <0.05). More adherence to treatment plans in patients undergoing CABG surgery leads to the enhancement of the quality of life in patients.