International Cardiovascular Research Journal
Volume:2 Issue: 1, Nov 2008

It has been known for some decades that chronic alcoholism can lead to dilated cardiomyopathy. Although excessive drinking is known to result in alcoholic ardiomyopathy and light-to-moderate drinking may confer some cardiovascular benefits, recent studies suggest that it is not only the quantity, but also drinking patterns and genetic factors, that may influence the relation between alcohol consumption and cardiovascular disease. Alcoholic patients consuming > 90g of alcohol a day for > 5 years are at risk for the development of asymptomatic alcoholic cardiomyopathy. Those who continue to drink may become symptomatic and develop signs and symptoms of heart failure. We summarize the experimental and clinical evidence regarding the role of alcohol in pathophysiologyof alcoholic cardiomyopathy.

Patients with ischemic left ventricular dysfunction are increasingly referred for the assessment of myocardial viability. The issue of identifying dysfunctional but viable myocardium has crucial clinical importance,since revascularization increases survival only in patients with viable myocardial tissue. The aim of this study was to compare resting two-dimensional visual assessment of myocardial viability with dobutaminestress echocardiography and strain rate imaging.Patients and In this cross-sectional study, thirty-two consecutive patients (age: 55.3 ± 22.7, 4 females) with ischemic left ventricular dysfunction were referred for myocardial viability assessment. Viability was evaluated using resting two-dimensional echocardiograms, dobutamine stress echocardiography and strain rate imaging. Viability was defined by the absence of brightness and thinning (<6 mm thickness) in akinetic segments, improvement by at least one grade or a biphasic response during dobutamine stress echocardiography or an increase in the peak systolic strain rate (more than –0.23 1/s). A total of 254 segments were studied. Seventy- nine segments by dobutamine stress echocardiography,70 segments by two-dimensional visual assessment, and 63 segments by strain rate were classified as non-viable (P< 0.001). There was an almost perfect agreement among these diagnostic methods. Two-dimensional visual assessment with measurement of wall thickness is simple and practical methods for viability assessment, with almost perfect agreement with dobutamine stress echocardiography and strain rate imaging.

Any unfavorable effect of β-Thalassemia major on aortic distensibility will contribute to the adverse effects of β-Thalassemia major on the cardiovascular system. To evaluated aortic distensibility in patients with β-Thalassemia major. Patients and The study comprised eighty (46 males) consecutive β-Thalassemia major patients and 80 control subjects matched for age and gender were selected. Aortic distensibility was approximately two-fold lower in patients compared with control subjects [aorticdistensibility: 1.4 ± 0.8 vs 3.6 ± 1.2, cm2 dyn-1 10-6, P = 0.01). β-Thalassemia major causes significant decrease in aortic distensibility.

The fatty acids of omega-3 family have high nutritional value and can prevent coronary heart disease. These fatty acids are found in various fish and sea foods. To investigate the level of omega-3 fatty acids in different kind of fish head, muscle and liver from 30 species of fish collected from Persian Gulf. In this experimental study, the fish were collected by hunting from Boushehr and Hormozgan sea ports. Their head, muscle and liver fatty acids were determined on their methylated fatty acids dissolved in N-hexin. Quantitative analysis of fatty acids was performed by gas chromatography (GC) with methylmyristate used as the reference material in this analysis and the qualitative analysis of fatty acids was done by gas chromatography and mass spectrometer (GC- mass) and cod liver oil which contained all of omega-3 fatty acids used as standard. Our study showed that some fish were good sources of omega-3 fatty acids and Trout (Ghezel-ALA),Bartail flathead (Zaminkan-e-domnavari), Malabar blood snapper (Sorkhoo malabari) had maximum levels of omega-3 in all body tissues. Other types of fish were rich in omega 3 fatty acids in separate organs, such as liver in Bartail flathead (Zaminkan-e-domnavari), head in Sillago Sihama (Shoort) and muscle in Trout (Ghezel-ALA). In contrast, lesser amount of omega 3 fatty acids is found in tissues of other species of fish such as Silver pomfret (Halva sefid), Longfin trevally (Gish-e-derazbale) and Xiphophorus Hellerii (Dom-shamshiri). This research showed that the liver of fish had the highest level of omega-3 fatty acids and fish muscle contained more omega-3 fatty acids than the head. Thus for having maximum levels of omega-3 fatty acids in the diet, all fish tissues can be served. As liver and head of fish are not usually consumed, it is recommended that such organs be used for preparation of omega 3-containing cardio supportive supplements.

Increased inspired oxygen fractions (FiO2) have significant hemodynamic effects on conscious volunteers. These changes may be of great importance in cardiac surgery. The inspiratory gas during open heart surgery with on-pump technique usually consists of 100% oxygen without any N2O because the risks of bubble embolism during these procedures. We sought to establish whether the cardiovascular effects of increased FiO2 are also present in cardiac surgery patients.Patients and The present study was a randomized double- blind clinical trial on sixty adult patients (40-70 years) with the cardiac ejection fraction (EF) of more than 40% and ASA II or III undergoing elective onpump coronary artery bypass. They received either a mixture of 50% O2 with 50% air (case group=30) or 100% oxygen (control group=30) throughout the anesthesia. Cardiac index (CI) was measured by non- invasive cardiac output (NICO) technique using end tidal PCO2. Measurements of systolic, diastolic and mean blood pressure as well as heart rate (HR) and central venous pressure (CVP), PaO2, arterial PH and CI were obtained at pre-bypass,post bypass, end of surgery and 2 hours after ICU admission. Intra- operative requirements for inotropic drugswere also evaluated. Data were analyzed by SPSS software using t-test and Q-square as well as non parametrictests wherever appropriate. No differences were found between the two groups with regard to age, gender, pump time, operation time and body mass index and preoperative EF. The mean values of systolic, diastolic and mean blood pressure as well as HR and CI were similar in the case and control groups (p>0.05) at all times of measurement. The meanPaO2 was significantly higher in the control group (p<0.05). The mean pH was statistically higher in the control group but not clinically noticeable. The control group required more inotropic drug support than the case group (16 vs. 8 patients respectively; P < 0.05). Likewise, the mean CVP was higher in the control group compared withthe case group (P < 0.05). Hyperoxia increased CVP and inotropic requirements during cardiac surgery in anaesthetized patients.Therefore exposing patients during and after coronary artery surgery to hyperoxia induced significant hemodynamic changes which required more extensive studies with invasive CI measurements and larger groups.

Atrial fibrillation is the most common arrhythmic complication after coronary artery bypass grafting. Ischemic preconditioning has proved to be a potent endogenous factor in suppressing ischemia- reperfusion induced arrhythmia.Patients and In this prospective study, 101 patients were randomly selected and divided into two groups including 50 patients with ischemic preconditioning protocol and 51 patients in the control group. Data were collected from 24 hour electrocardiogram from 1 day before the operation to 3rd post-operative day. Atrial fibrillation was registered as positive, if it lasted longer than 30 seconds. The postoperative atrial fibrillation was significantly lower in the ischemic preconditioning group thatwas 8% in ischemic preconditioning and 23.52% in control groups (P=0.033). Control group had a longer stay in intensive care unit and longer mechanical ventilation support. This study suggests that ischemic preconditioning is a useful prophylactic protocol to decrease the prevalence of post-cardiac surgery atrial fibrillation.

After cardiac surgery, the chest tubes cause pain and their removal is painful and unpleasant for patients. The aim of this research was to study and compare the analgesic effect of fentanyl and sufentanil on pain relief during chest tube removal in post-cardiac surgical patients.Patients and A total of 80 patients scheduled for elective cardiac surgery, were recruited in prospective, randomized and double-blind study. Patients received 1.5μg/kg fentanyl or 0.15μg/kg sufentanyl, intravenously 10 minutes before removal of chest tube. Pain intensity was assessed by measuring visual analog scale (VAS) pain score, 10 minutes before, during, and 5 and10 minutes after removing chest tubes. Level of sedation, heart rate, arterial blood pressure, and oxygenation saturation were recorded at each stage by a blinded observer. Mean pain intensity scores 10 minutes before removal of chest tube in fentanyl, and sufentanil groups were 29.5±12.1 and 31±11.2 respectively. Pain scores during chest tube removal were 38.5±11.6 in fentanyl group and 44.7±12.8 in sufentanil group (P =0.02). In addition, pain scores during chest tube removal were significantly (P value=0.02) more reduced in fentanyl (17.21±7.5) than in sufentanil group (21.51±11.2). Sedation scores remained low in two groups. None of the patients showed any adverse side effects of opioids. No differences were seen in the heart rate or arterial blood pressure, but oxygenation saturation was significantly greater in sufentanil group than in fentanyl group. Both fentanyl and sufentanil provide adequate analgesia for chest tube removal without increasing untoward side effects.

The spectrum of heart diseases among pediatric age group may be different between communities and, in this connection there is no documented report from Iran.Patients and We studied cardiac problems among Iranian pediatric age group referred to the pediatric cardiology and cardiac surgery out-patient clinic, in a tertiary center for possibility of heart disease. Of 2341 patients, aged from 1 day to 16 years referred, during 2001 and 2003, to the above center, 1817 (77.6%) patients had cardiac diseases. The most common reason for referrals was abnormal heart sounds on routine physical examination (49%). Congenital heart diseases (CHD) were the most frequent cardiac problems (76.1%), followed by mitral valve prolaps (8.3%) and rheumatic cardiac involvement including sub-clinical findings(7.9%). Other significant disturbances were associated chromosomal abnormalities, genetic disorders, andelectrical and conduction problems. Although rheumatic carditis has very low incidence compared with congenital heart diseases (nearly 1/10), it is still a significant problem in this region and a planning for its better prevention is essential.

A 64-year-old woman referred with a 4-month history of intractable chest pain. Coronary angiography was performed and showed normal left coronary arteries. Posterior descending coronary artery was filled via distal left circumflex artery. The right coronary artery injection showed prompt filling of the distal circumflex through prominent collaterals. There was no evidence of proximal obstructive disease or spasm. We present a case inwhich a large collateral artery was seen in angiographically normal coronary arteries.

A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophageal echocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of the anterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valve repair.

A 27 –years-old man presented with malaise, fatigue and atypical chest pain. Transthoracic echocardiography was performed and revealed a single large and well defined intra-myocardial cystic mass in the inter-ventricular septum. The cystic mass was thin-walled and contained some small daughter cyst. Although the echocardiographic diagnosis was straightforward, serologic test (Hydatid cyst antibody) with Eliza was performed whichwas positive for echinococcal infection. Other works up showed no involvement of other organ system. Albendazolwas started for him and he referred to cardiac surgeon for resection of cystic mass but the patient refuse for operation.