Arya Atherosclerosis
Volume:7 Issue: 2, Summer 2011

Pulmonary hypertension (PH) is a condition that,not only by itself causes many problems for those suffering from it,but also, it can exacerbate and complicate many other disease. PH can be responsible of mortality in many patients.Tackling PH is not exclusively related to the field of cardiovascular diseases. Many other disease in other fields of medicine may interfere with PH. Pulmonary diseases, renal,hepatic,collagen vascular disease,infectious and hematologic disease may be deal with PH. In patients’ suffering from aforementioned diseases, PH can exacerbate primary disorder and even cause mortality. Pregnant women afflicted with PH have 30%-50% mortality rate.(1) Newborns and children with pulmonary or cardiovascular disorder can be later afflicted by PH. PH drastically increases risk in surgeries and in anesthesia and can be the cause of mortalities.(2) or detoriated outcome of patients after surgery.(3)According to the latest guidelines,(4) there are 5 categories of PH(table1): 1-Pulmonary arterial hypertension 2-Pulmonary venous hypertension(previously named pulmonary hypertension due to left heart disease) 3-Pulmonaey hypertension associated with hypoxemic lung disease 4- Pulmonary hypertension caused by chronic thromboembolic disease 5-Pulmonary hypertension from conditions with uncertain mechanismsFor a long time, the science of medicine had no remedy for PH and physicians could only stand by and watch PH patients die. After some time factors which complicate PH are known and it were shown that control of these factors are helpful. Patients are advised, for instance, to refrain from heavy exertion, to avoid pregnancy, and to be vaccinated against flu and pneumococcal infections. PH patients’ life expectancy has increased drastically as a result of this newly acquired knowledge.As PH was becoming better known, symptomatic cures came to patients’ help. Diuretic drugs were used to control edema and anticoagulants were used to put tromboembolic attacks in check.Then,It was time of revolution in pulmonary hypertension management,With the emergence of Advanced PH treatment science of medicine became able to seriously deal with PH.This new strategy were showed to be able preventing mortality in PH patients’(5),Figure1Prostacycline showed that it is possible to enhance PH patients’ chance of survival. Phosphodiasterase inhibitor drugs, which were used for treating impotency for a long time, were demonstrated to be effective for reducing pulmonary pressure. Eventually, endotheline receptors were targeted.By the advent of endothelin receptor blockers such as Brosentan, physicians’ chances of helping PH patients were further improved.Today, with advanced PH treatment, PH is not counted as before and the science of medicine as a failed discipline.It is important to not forgetting PH in patients,especially ill patients or intractable to traditional treatment, in surgery wards or obstetric,pediatric,internal medicine,ICU or CCU wards of hospitals.

This study aimed to evaluate the effects of streptokinase on left ventricular ejection fraction and mortality rate of patients with inferior acute myocardial infarction (AMI without right ventricular myocardial infarction (RVMI). Fifty five consecutive patients with the diagnosis of inferior AMI without RVMI in the coronary care unit (CCU) of Shariati Hospital in Isfahan were selected for this study. Patients who had a history and/or electrocardiogram (ECG) evidence of previous myocardial infarction, evidence of bundle branch block, historical or clinical findings of valvular or other non-coronary heart diseases or heart failure were excluded. Participants were divided into two groups. Group one (n = 28) had no contraindication for taking thrombolytic therapy and group two (n = 27) had at least one contraindication for this treatment. Patients in group one took 1,000,000 units streptokinase for one hour. Three days later, LVEF of all participants was measured by an experienced cardiologist using 2-dimentiona1 echocardiography. Patients were followed up until four weeks to assess the mortality rate. One death in the first 24 hours was reported in group one. However, no death was reported in any group until four weeks after discharge. There was no significant difference in mortality rate during the first 24 hours and four weeks after discharge between the two groups. Mean LVEF in the two groups did not show any significant difference (P = 0.21). Probably streptokinase has no effects on one-month mortality rate and LVEF in patients with inferior AMI without RVMI. Therefore, streptokinase side effects must be taken into consideration when being administered for this group of patients.

Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan. Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard. Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%. Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.

The role of novel biomarkers like homocystein as a risk factor of coronary artery disease (CAD) is being increasingly recognized. There is a marked geographical variation in plasma homocystein concentration. In spite of importance of hyperhomocysteinemia in CAD risk, there is a paucity of studies in Iran that evaluate it. Consequently, we evaluated the association between plasma total homocystein (tHcy) concentration and CAD risk in an Iranian population. In a case-control study, we compared the level of tHcy of forty five patients with angiographically proved CAD with forty five age and gender matched subjects without CAD as control group. The patients with diabetes, hypertension, thyroid dysfunction, chronic renal failure, hyperlipidemia and obesity and other conventional CAD risk factors were excluded from the study. Plasma tHcy was measured using immunoturbidimetry. Homocystein level was higher in men than women (16.7 ± 5.2 versus 14.3 ± 3.9 micromol/lit, P = 0.019). CAD patients had higher mean plasma tHcy than control group (17.1 ± 5.3 versus 14.2 ± 3.8 micromol/lit, P = 0.004). This study denoted that high plasma homocystein concentration is associated with CAD risk in Iranian people.

The current study aims to determine the relation between ankle–brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan. In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI ≤ 0.9 (ABI+) was considered as peripheral vessel disease and ABI > 0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI+ and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis. In this study, 125 patients were investigated. ABI ≤ 0.9 was seen in 25 patients (20%). The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P = 0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABIones (P < 0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P < 0.05). The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.

Stroke is a leading cause of death and long-term disability worldwide. Although a minority of ischemic strokes in the community affect younger adults, up to 40% of acute ischemic strokes in young adults are cryptogenic in nature, that is, no cause is determined. Underlying pathologies of stroke of unknown cause are multiple, including patent foramen ovale (PFO). The PFO is the most common defect of atrial septum of the heart. This study evaluated the frequency of PFO in brain stroke with unknown etiology in patients younger than 50 years of age in Kerman. This cross-sectional study was done in Shafa Medical Center of Kerman University of Medical Sciences in 2008. For detection of the PFO, we used agitated saline test with transcranial Doppler sonography in brain stroke patients with unknown etiology and also a control group (normal persons). PFO was found in 53% of patients. No significant difference was observed between sexes. The rate in the control group was 20%. Patients with large PFO had 2 or more attacks of stroke. Subjects in the control group did not have large PFO. One of the most important underlying causes in young adults with cryptogenic stroke is PFO. It is better to prescribe antiplatelet drugs in patients with the first attack of stroke, but as for patients with recurrent stroke, closure of PFO must be considered.

Cardiovascular diseases (CVD) are the most important causes of human mortality in the world. Higher intakes of choline and betaine have been shown to be associated with lower plasma homocysteine levels (the putative CVD risk factor). This study aimed to review the evidence on the association between dietary intakes of choline and betaine and traditional/novel CVD risk factors. We searched in PubMed website from 1990 to 2009, with the use of following keywords: "dietary choline and betaine, cardiovascular diseases, metabolic syndrome, inflammation". The cross-sectional and prospective studies as well as the clinical trials were recruited in this investigation. Dietary intakes of “choline”/“choline and betaine” were not significantly associated with CVD risk; however, the higher intakes of choline and betaine were associated with higher serum concentrations of CRP, IL-6 and TNF-5. Individuals with high plasma choline levels were obese and had elevated plasma triglycerides, HDL and non-HDL cholesterol levels; whereas high plasma betaine levels were inversely associated with these biochemical markers. Both choline and betaine supplementation resulted in increased blood lipid profiles. Although dietary intakes of choline and betaine were not significantly associated with CVD incidence, the long-term consumption of these nutrients have been shown to prevent CVD mortality by decreasing inflammation and other risk factors.

The Holt-Oram Syndrome (HOS) or the Heart-Hand syndrome is considered as an overt autosomal hereditary disease with a complete influential effect and variable expression that emerges due to a genetic mutation. It can be vividly characterized by heart disorders and deficiencies in hand structure. Despite the existing genetic heterogeneity, the variable integration between HOS and the T-BX5 gene from the T-BOX Gene Complex has been observed during which various mutations have been reported in the affected patients. The TBOX Gene Complex is located on chromosome 12 (12 q 24.1), and is able to encode a copying factor. That has a conservative motive with 180 amino acids. The deficiencies in only 1/3 of patients have been observed caused by the mutation of this gene.CASE REPORT: This case was a 10-year-old child with hand disorders, incompletegrowth of clavicle, moving problems in elbow joint and shoulder, disorder in ventricle andauricle walls. The disease was diagnosed as HOS, based on clinical examination and drawing the family tree diagram. It was impossible to investigate molecular mutation due to inaccessibility to the patient. By investigating the family members and their deficiencies and imaging disorder variables according to different reports as well as parents’ state of health, the HOS can be defined as an overt heredity resulting from a new mutation in the germinating layer of sexual cells in one of the parents. There is a weak possibility that the disease results from a mosaic mutation in the male parent’s testicle or the female parent’s ovum. In this case, the probability for the disease to be repeated in parents’ next children will be guessed between 1 and 50%.