Iranian Heart Journal
Volume:14 Issue: 1, Spring 2013

Tumors of the heart can cause significant morbidity and mortality. Transesophageal echocardiography (TEE) provides better visualization of cardiac structures. The aim of this study was to investigate the distribution of cardiac masses in the Iranian population and the diagnostic accuracy of TEE. In a descriptive study, medical records of 175 cases confirmed by echocardiography as a cardiac mass from October 1998 to March 2008 were used. Clinical presentation, echocardiographic, and histopathological findings were collected. Then, the diagnostic accuracy of TEE for the detection of cardiac masses was evaluated. Among the 175 patients, the mean age was 47.5 ± 1.15 years and 64% were female. Malignant cardiac tumors were seen in 1.7% and benign cardiac masses in 98.3% of the patients. Twenty percent of the cardiac masses were intracardiac thrombus. Most of the cases had myxoma (75.4%) and were located in the left atrium (81.5%). Sensitivity, specificity, positive and negative predictive value, and likelihood ratio of TEE for the detection of the tumoral cardiac masses were 71.6%, 94.4%, 98.1%, 44.7%, and 12.8, 0.3, respectively. TEE is an accurate method for the diagnosis of cardiac masses and differentiation of benign tumors form malignant ones and intracardiac thrombi.

Coronary artery ectasia (CAE) is a clinical entity characterized by localized or diffused dilatation of at least 1.5 times that of the normal adjacent segments of the vessel. It was once thought of as a variant of atherosclerosis. The role of inflammation in atherosclerosis is increasingly well known; however, the association between inflammation and CAE has been controversial. The aim of this study was to investigate the possible relationship between leukocyte count and other leukocyte subtypes, the plasma levels of high sensitive C-reactive protein (CRP), and interleukin-6 (IL-6) and the coronary ecstatic process and compare these markers between obstructive coronary artery disease (CAD) patients and normal controls. We enrolled 29 patients with CAE and non-obstructive CAD, 29 with obstructive CAD, and 30 normal epicardial coronary according to coronary angiography results. The peripheral blood was taken, and white blood cell count (WBCC) as well as leukocyte subtypes, including neutrophils, lymphocytes, and monocytes cell count, was measured. The plasma levels of high sensitive CRP and IL-6 were determined using the ELISA as well. A higher number of neutrophils and monocytes were found in the patients with CAE as well as obstructive CAD compared with the normal controls (p value = 0.021). Moreover, levels of plasma high sensitive CRP and IL-6 were also significantly higher in the patients with CAE and in the patients with obstructive CAD than those without CAD (p value < 0.001). This study demonstrated and expanded prior limited findings showing that significant chronic inflammation may have a relationship with the pathogenesis of CAE, which was associated with not only increased inflammatory markers but also inflammatory cells in the patients with CAE.

As the newly published studies come into the literature, it would become more evident that kidney diseases can result in vascular disorders and ominous events. However, despite the higher prevalence of cardiovascular risk factors in dialysis patients well-described by the Framingham study, the augmented risk of cardiovascular diseases in this patient population cannot merely be explained by traditional risk factors. Several studies have shown that the effects of non-traditional risk factors, especially malnutrition and inflammatory factors, are even more eminent in dialysis patients. Improvement in nutritional status and inflammation through drug administration and life style modification has been suggested to decrease the risk of atherosclerotic cardiovascular disorders; however, data on the clinical relevance and feasibility of them is scarce in the dialysis population. Consequently, we recommend prospective cohort studies, as well as randomized controlled trials, to evaluate the feasibility of drug administration in tandem with improvements in the atherosclerosis risk profile in the cardiovascular morbidity and survival of patients under maintenance hemodialysis.

Report: This is the summery report of the first national recommendations on prevention, evaluation and management of high blood pressure. The full report is available at http://crc.mui.ac.ir & http://hrc.mui.ac.ir Hypertension (HTN) is a major cause of disability and is known as an independent risk factor for cardiovascular disease (CVD). It is also and recognized as a leading risk factor for death in the world, causing an estimated 7.5 million deaths per year (13% of all deaths).1 The current national picture of Iran suggests a high prevalence of HTN in 17.8% of adults aged 25-64 years and 12.7% in children and adolescents.2,4 According to available data from Iran, awareness, treatment, and control of HTN are generally unsatisfactory. Many studies have estimated the awareness and treatment of HTN in Iranians to be approximately 50% and 35%, respectively, while the control rate of HTN is around 16%.3,4 However, strategies such education of patients, their families, and health professionals as well as the implementation of the national guidelines can increase the awareness and improve control levels among Iranian hypertensives.

Shoulder pain and disability in the implantation site is a common complication of cardiac rhythm device implantation, yet very little information is available on cardiac pacing-related complications, with most of the existing data no longer valid for current practice and recent reports focusing on some specific complications and other early complications. This prospective study recruited 404patients who received permanent endocardial devices between October2011 and 2012 in our tertiary center. The demographic and clinical characteristics of the study population as well as the complications of the devices implanted, namely the permanent pacemaker (PPM), the implantable cardioverter defibrillator (ICD), and ICD- cardiac resynchronization therapy (ICD-CRT), were evaluated and followed up. Totally, 404 patients, including 239(59.2%) males, at a mean age of 62.2± 16.7 years were enrolled. Pain was reported by 202(84.5%) of the male and 151(91.5%) of the female. Of the 353 patients, who reported pain, 336(95.2%) had horizontal incisions (p<0.001) and 332(94.1%) did not use anti-anxiety drugs (p=0.003). There were 55 smokers, among whom 53(96.4%) had pain (p=0.03). Addiction was reported by 39 (9.7%) patients. Suture line pain was reported by 295(73%), hematoma by 105(26%), pneumothorax by 3(0.7%), infection by 5(1.2%), and shoulder immobility by 110(27.2%) patients. No significant relationship was found between pain and the device type (p=0.1), pain and pneumothorax (p=1), pain and hematoma (p=0.07), pain and addiction (p=1), and pain and neurological disorders (p=0.7).The PPM was implanted in 167(41.3%), the ICD in 146(36.1%), and the ICD-CRT in 87(21.5%) patients. Suture line pain was reported by 127(76%) of the PPM patients and165(70.8%) of the ICD and the ICD-CRT patients (p=0.2). Shoulder pain was reported by 37(22.2%) of the PPM patients and 39(16.8%) of the ICD and ICD-CRT patients (p=0.1). Among those with shoulder pain, 87.2% had pain during12 hours, 84.4% during 24 hours, and 94.2% after 24 hours of immobility (p=0.2). Shoulder pain was reported in 31.4% of the patients with immobility lasting for more than 24 hours. Also,201(23%) of the patients with impaired shoulder mobility for 12 hours reported no pain. There were 241 cases with shoulder immobility lasting for 12 hours; of this total, 235 (97.5%) patients reported no movement limitation (p<0.001). Totally, 352 (99.7%) cases reported pain at 2 weeks’ follow-up (p<0.001), 198(56.3%) at one and 2 months’ follow-up (p<0.001), and 280 (79.3%) at 6 months’ follow-up (p<0.001). Shoulder pain and other disabilities often occur following cardiac rhythm management by device implantation. Understanding pain incidence related to device implantation can confer an earlier and better detection of complications.

Congenital heart disease (CHD), the most common congenital anomalies in newborns, is the leading cause of death during the first year of life and is also associated with significant mortality and morbidity. Thus, paying special attention to the diagnosis and appropriate and timely treatment of CHD decreases its complications and burden on health services. In this hospital-based study, 1000 medical files were reviewed and the data were analyzed to identify the pattern and complications of diagnostic/interventional catheterization of CHD in Hamedan, western Iran, between 2006 and 2012. There were 362 (36.2%) cases of interventional catheterization. Mortality rate was 0.3% (3 cases in 1000).Transient major and minor complications were seen in less than 20% of the cases. The most common intervention was patent ductus arteriosus occlusion, followed by atrial septal defect occlusion, valvuloplasty, coarctation angioplasty, ventricular septal defect occlusion, coarctation of aorta, and stenting. The findings of this study can help establish not only valuable improvement in health policies for proper diagnostic and therapeutic facilities but also a database for future studies. Because with the appropriate team and skilled operator, the risk of the procedure is very low, we propose omitting cardiac catheterization from the list of invasive and high-risk procedures.

Case Report: Blunt or non-penetrating cardiac trauma is a relatively common body injury in industrialized communities. We report a young man who sustained a heavy non-penetrating chest trauma and developed ventricular tachycardia, atrioventricular block, and right bundle block with ST elevation in the right precordial lead. He was treated successfully and was discharged home. The true incidence of blunt chest injury (myocardial contusion) after chest trauma is not known. Severe myocardial injury can occur with little evidence of external chest trauma. Blunt cardiac trauma may be mild with only epicardial ecchymosis. More severe contusion causes muscle injury and infarction,1-2 and the injuries that are likely to occur include contusion and valve injuries, especially in the aortic valve, which is the most frequently involved valve in blunt cardiac trauma. Injury of the mitral valve is less common and involves the rupture of the papillary muscle or the chordal apparatus. Injury to the tricuspid valve is second to the aortic valve.3 Atrial or ventricular septal defect or frank cardiac rupture, not least in the right ventricle, can also occur.

Case Report: Although pulmonary arteriovenous malformation is not a common condition, it is one of the causes of paradoxical embolism presenting with neurological manifestation. Therefore, pulmonary arteriovenous malformation should be considered in any patient with an arterial embolism, especially patients with cerebrovascular accident from an unidentified source. We report a case of paradoxical embolism of the brain due to an isolated pulmonary arteriovenous malformation