Iranian Heart Journal
Volume:13 Issue: 3, Fall 2012

Several pro-inflammatory single nucleotide polymorphisms have been associated with the development of atherosclerosis and coronary artery disease (CAD). CD14+ monocytes are one of these molecules due to their ability to produce variable cytokines. Association betweenCD14+ monocytes and carotid intimal-medial thickness has been previously identified. In this study، we tried to evaluate the relation between CD14 polymorphism and CAD. We evaluated 200 patients divided into two matched groups based on the result of their coronary angiography: 100 patients who had significant lesion (s) in their coronary arteries were allocated to the case group، and the other 100 without CAD were categorized as the control group. The polymorphism of CD14 was determined via allele-specific polymerase chain reaction (PCR). The frequency of the genotypes (CC، TT، and CT) was 45%، 7%، and 48% in the case group and 24%، 38%، and 38% in the control group: there was a significant difference in the allele genotype frequency between the two groups (p value <0/001). CD14 polymorphism was associated with CAD.

Pregnancy is associated with structural and functional changes in the cardiovascular system as well as obesity، high blood triglyceride concentration، and increased risk of metabolic syndrome. The aim of this study was to compare parity between women with established coronary heart disease and normal women in general population. Totally، 105 women referred for coronary artery bypass grafting surgery during a period of more than one year were enrolled. Total fertility rate (TFR) was evaluated in this group of patients and we also compared TFR of these women with that of normal women. Based on the results، 884 pregnancies were occurred in total of 105 patients (mean parity = 8. 34). There was a significant difference between the TFR of the CABG patients and the TFR of the normal women in 1966 (p value =0. 038)، the TFR of the normal women in the past 40 years (p value <0. 001)، the TFR of the normal women in province of Sistan and Baluchistan (p value <0. 001). Our findings suggest that the number of pregnancy is an independent risk factor associated with coronary artery disease.

Syncope is a relatively frequent medical event and its assessment is deemed an important aspect of medical practice in general medicine and cardiology. The present study had two main first، to assess the clinical history and characteristics of patients referred to our cardiology department with syncope or presyncope symptoms and second، to analyze the results of the head-up tilt test (HUTT) and its relations with other study parameters. The present cross-sectional study was performed on 210 consecutive patients with unexplained syncope or presyncope referred to our cardiology department between 2002 and 2011. After history taking and physical examination، including age، sex، presenting symptoms، underlying disorders، history of drug taking، and orthostatic blood pressure measurements، holter monitoring، electrophysiological study، and neurological evaluation were performed in the patients with structural cardiovascular or cerebrovascular disease. The HUTT was performed using an electrically controlled tilt table with a footboard for weight bearing. Among the study participants، 193 (92. 38%) patients had a positive result and among them، vasodepressor and mixed type were the common types. Study variables had no significant differences between the patients with positive or negative HUTT results. Although the HUTT is suitable in syncope management، our study variables had no significant impacts on the results of this test and could not predict its results.

The aim of this study was to determine thyrotoxicosis frequency in patients with heart failure hospitalized in Ekbatan Cardiac Hospital، Hamadan. In this cross-sectional، descriptive study، patients with heart failure hospitalized in a cardiac hospital were characterized on the basis of physical examination (the Framingham criteria) and evaluation of hospital records. The patients were thereafter assessed for the presence of thyroid dysfunction. For all the patients، T3، T4، and TSH tests were done via the ELISA method. For every patient، a questionnaire was completed، including the results of the tests and also data on age، sex، duration of cardiac disease، and medical history. From 200 patients in this study، 90 (45%) patients were male and 110 (55%) were female. From these patients، 3 (1. 5%) had thyrotoxicosis، 2 (1%) had hypothyroidism، 13 (6. 5%) had sub-clinical hyperthyroidism، 12 (60%) had sub-clinical hypothyroidism، and 170 (85%) had no thyroid dysfunction. The mean time of heart failure (history of cardiac disease) in the patients with thyrotoxicosis was 4 ± 1 years and in the other patients (without thyrotoxicosis) was 5. 43 ± 2. 4 years. The mean age in the patients with thyrotoxicosis was 73. 33 ± 5. 77 years and in the other patients was 63. 98 ± 11. 86 years. Five patients with heart failure used Amiodarone and none of them had thyroid dysfunction. This evaluation showed that the frequency of thyrotoxicosis in our patients with heart failure was of low prevalence. Also، the frequency of thyrotoxicosis was not associated with sex، age، and duration of cardiac disease.

High sensitive C-reactive protein (hs-CRP) is an available measured serum marker for detecting blood vessel inflammation and endothelial dysfunction. It has been demonstrated that these two mechanisms have a pivotal role in the pathogenesis and progression of hypertension. We conjecture and confirm in this study that the level of hs-CRP is higher in hypertensive patients. We enrolled 77 hypertensive patients with the following distribution in the case group (male: 27. 7%، female: 72. 3%، mean age: 58. 1 years، mean systolic blood pressure: 15. 4 mm Hg، mean diastolic blood pressure: 90. 4 mm Hg) and 77 matched normotensives، in the control group. Patients with heart failure، renal failure (cr >2mg/dl،) diabetes mellitus، infective disorder، severe systemic disorder and malignancies were excluded. Blood pressure was measured using the same digital Richter sphygmomanometer (ceo124 Ri-fit.) The hs-CRP was measured using CRP HS ELISA (enzyme immunoassay for quantitative determination of CRP in human serum). The normal range was 0. 068–8. 2 mg/l. Finally، the data were analyzed using SSPS-10 software. The mean levels of hs-CRP in the case and control groups were 4. 29 and 2. 43 respectively (p value <0. 001). Our study showed that the level of hs-CRP was elevated in the hypertensive patients، which reflected the role of the inflammatory process in the pathogenesis of hypertension.

Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass graft surgery (CABG) and a major cause of increased hospital costs. Dispersed atrial refractoriness is thought to be the primary mechanism، whereas myocardial inflammation has an important role in altering atrial conduction. We evaluated the preventive effect of an intravenous combination of Digoxin، Hydrocortisone، and Amiodarone as antiinflammatory and anti-arrhythmic agents on AF after off-pump CABG. One hundred fifty patients who underwent off-pump CABG between March 2010 and April 2011 and met our inclusion criteria were enrolled. The patients were randomized into two groups: the study group received 300 mg Amiodarone، 0. 5 mg Digoxin، and 200 mg Hydrocortisone before the induction of anesthesia، but the control group did not. Surgical and anesthetic techniques were identical in both groups. Patient characteristics and surgical variables were similar in both groups (p value<0. 05). POAF was observed in 6 (8%) patients in the case group and in 18 (24%) of the controls. There was a significant difference between the two groups in the prevalence of new-onset POAF (p value=0. 03). A preoperative dose of a combination of Digoxin، Hydrocortisone، and Amiodarone is a safe and feasible method to reduce POAF prevalence، produce a better outcome، and reduce the duration of hospital stay and hospital costs.

Case Report: The differentiation between left ventricular pseudo-aneurysm and true aneurysm is sometimes difficult and there are some pitfalls in the process of making the right diagnosis. Correct diagnosis has considerable effect on the outcome and management of the patients. We report the case of 59-year-old man who referred to the emergency department with complaints of lower extremity edema and dyspnea on exertion. In his past medical history، he had been diagnosed with post-myocardial infarction and apical true aneurysm four months before his arrival at the emergency ward. The patient was under strict medical follow-up for his condition. Echocardiography was conducted in the emergency ward، and it revealed a huge apical pseudo-aneurysm، which had been miss-diagnosed in the past echocardiographic examination. We herein seek to address this issue and underscore the pitfalls in making the correct and necessary distinction between these two not so uncommon entities.

Case Report: Of all antidepressants، tricyclic antidepressants (TCAs) are the most toxic drugs and they are often used for suicide attempts. An 18-year-old female was admitted to the emergency department after having taken 30 tablets of Nortriptyline 50 mg in a suicide attempt. A twelve-lead electrocardiogram revealed right bundle branch block in leads V1، V2، and V3 as well as deep S in leads?، V5، and V6، and tall R in AVR، which meant extreme right axis and ST elevation in leads V2 and V3: that raised the suspicion of the Brugada syndrome. ST elevation after TCA toxicity is a rare medical condition، and our literature review failed to find any relevant reports.

Case Report: A 55-year-old man with aortic aneurysm dissection was candidated for surgery. His blood pressure was low and he had chest pain. After sternotomy and extraction of clots، cardiac collapse occurred and deep hypothermic circulatory arrest (DHCA) was started with all of the methods for brain protection. After the operation، the patient was completely alert and conscious without any problems.