Iranian Heart Journal
Volume:15 Issue: 2, Summer 2014

Uncontrolled hypertension state is a major public health problem that may influence different quality of life aspects in hypertensive patients. The present study aimed to assess the effect of hypertension control status upon quality of life in Iranian hypertensive patients. Hypertensive patients in the present case-control designed study were identified from a district-wide, population-based register [Isfahan Healthy Heart Program (IHHP)]. Patients in two case groups had a diagnosis of controlled (n=314) or uncontrolled (n=1346) hypertension and those in the control group were healthy without symptomatic diseases or treatments (n=7718). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess general quality of life. The score of all four physical, psychological, social, and environmental components were far lower in the uncontrolled group compared to the controlled hypertensive group and healthy group, with no apparent difference between the patients with controlled hypertension and those with healthy status. The value of systolic blood pressure was adversely correlated with the physical component score. A negative association was revealed between the value of diastolic blood pressure and physical, psychological, and environmental component scores. According to the linear regression model, poorer quality of life could be predicted by uncontrolled hypertension status (Beta = -2.074, Standard Error = 0.798; P= 0.009). Uncontrolled hypertensive patients are faced with lower physical, psychological, environmental, and social domains of quality of life, as compared to normal controls or to those with controlled hypertension.

Early reperfusion therapy is a life-saving treatment for patients with ST-segment elevation myocardial infarction. Primary percutaneous coronary intervention (PCI) is the preferred method of re-perfusion. A previous meta–analysis of patients undergoing primary PCI has shown the benefits of stenting over balloon angioplasty alone in terms of reducing target vessel revascularization (TVR), although no definite impact on death and re-infarction was present. Several randomized trials have been conducted so far on the drug-eluting stent (DES) in ST-elevation myocardial infarction (STEMI), and long-term follow-up data have recently been published. According to these studies, the use of the DES in comparison to the bare-metal stent (BMS) has reduced TVR without a significant impact on reducing mortality and myocardial re-infarction. In this historical cohort study, patients with STEMI were randomly assigned to either DES (n=51) or BMS (n=333) implantation and the results were evaluated. The primary clinical end points were death, myocardial re-infarction, and need for TVR including coronary artery bypass graft surgery (CABG) or repeat PCI either at the time of the initial procedure or during the subsequent 6 months. In this study, 384 patients with STEMI undergoing primary angioplasty and stent implantation between January 2010 and 2011 were enrolled. The patients were divided into BMS (n=333), DES (n=51) groups. Eight patients had in-hospital mortality and 7 patients had death at 6 month's follow-up, all of them in the BMS group. In the DES group, 5 (9.8%) patients had stent thrombosis and re-infarction, 4 had repeat PCI, and one underwent CABG. From the entire 333 patients in the BMS group, 24 (7.2%) had myocardial infarction, 20 (6%) had in-stent re-stenosis, and 15 (4.5%) had stent thrombosis. The TVR rate in the DES group was 9.8% (5 patients) as opposed to 9% (31 patients) in the BMS group. Over all, the MACE rate was 19.6% in the DES group and 21% in the BMS group. There were no significant differences between the DES and BMS groups in terms of TVR and MACE. Over 6 months of follow-up, no significant differences were found between the two groups with respect to death, re-infarction, and TVR and MACE.

Vascular stiffening is a progressive, pathologic process and a well-established risk predictor of cardiovascular morbidity, mortality, and end-organ damage. The purpose of this study was to determine the degree of arterial stiffness and compare it with the severity of coronary artery disease in each patient.

Two hundred twenty-eight patients admitted for coronary catheterization at a tertiary care cardiology center were included in this study and underwent assessment of the arterial stiffness index (ASI) by a computer-assisted oscillometric method (CardiovisionMS-2000) before coronary angiography. Patients with acute coronary syndromes, decompensated heart failure, unstable clinical findings, or those who did not wish to participate were excluded from the study. The groups were compared according to their ASI and coronary artery disease using the Student t-test, correlation and the chi-squared tests.

The study population consisted of 147 males (64.5%) and 81 females (35.5%).Those with higher ASI as calculated by our method were found to be more likely to have coronary artery disease (P=0.001). Those who had higher cardiovascular risk estimates by the Framingham risk scoring system were also found to have a higher ASI (P=0.002).The majority (64%) of the patients with arterial hypertension had a high or very high ASI (180- 300 and above 300 mmHg). Those with a history of smoking, greater body mass index, or familial history of premature coronary artery disease were not found to have a higher ASI.

The ASI as assessed by a brachial pressure-volume relation could be used to ascertain the cumulative effect of cardiovascular risk factors on the arterial system and at-risk populations. In our study, the ASI had a good correlation with the presence of coronary artery disease. (

Due to the early identification of high-risk patients in the triage process by nurses, it is essential to understand the relationship between early symptoms and acute coronarysyndrome. This study aimed to determine the relationship between the reported symptoms of acute coronary syndrome and ST elevation or the absence thereof. This cross-sectional study randomly recruited 446 patients with a primary diagnosis of acute coronary syndrome who were admitted to the cardiac intensive care units of 8 hospitals in Tehran. Data collection instrument was a checklist of the presenting symptoms of acute myocardial infarction. The chi-squared test was used to determine the association between the symptoms of acute coronary syndrome based on ST elevation or non-ST elevation and logistic regression was performed to determine the odd ratios of early symptoms based on ST elevation or non-ST elevation using SPSS (version 16). Mean age was 67.13 ± 8.79 years, 256 patients (58.4%) were male, 238 patients (41.29%) had acute coronary syndrome with ST-segment elevation, and 208 patients (58.71%) had acute coronary syndrome without ST-segment elevation. Chest symptoms were more reported in acute coronary syndrome with ST elevation, and diaphoresis was more in acute coronary syndrome without ST-segment elevation. Among the atypical symptoms, the frequencies of nausea /vomiting and palpitation were higher in acute coronary syndrome without ST elevation. The odd ratios of chest symptoms, diaphoresis, and nausea / vomiting were higher in acute coronary syndrome with ST elevation, and palpitation was more frequent in patients without ST elevation. Emergency nurses should know that the reported symptoms in acute coronary syndrome patients differ based on ST elevation or non-ST elevation.

Part1: Coronary artery anomalies are reported in 1.3% of patients undergoing coronary angiography1 and may be associated with sudden death, myocardial ischemia, arrhythmia, and syncope. Some anatomic presentations of coronary anomalies are considered to be high-risk;2,3 however, many patients are asymptomatic. Part2: Before the presentation of sudden cardiac death, early detection of potential lethal cases is difficult.4 We report an anomalous origin of the right coronary artery (RCA) from the left coronary cusp with a malignant course, leading to ischemic symptoms for the patient. A 42-year-old woman with a past medical history of diabetes mellitus presented with angina pectoris. She had a history of chest pain of 2 month's duration, which was sometimes precipitated by effort. On admission, her electrocardiogram and cardiac enzyme levels were normal. Her echocardiography was within normal limits, and cardiac catheterization showed that the cannulation of the left main coronary artery displayed was normal. Part3: The course of the left main artery was normal without significant lesion in the left system. Attempts to cannulate the RCA with the right Judkins catheter were unsuccessful. Aortography revealed an anomalous origin of the RCA. Cannulation of the RCA was done successfully with a left Amplatz catheter and demonstrated an anomalous origin of the RCA from the left coronary cusp and mild narrowing of its proximal portion (Figures 1 and 2). Coronary computed tomography angiography was done to determine the RCA course, and it showed a malignant inter-arterial RCA course (Figures 3 and 4). The patient was referred to the cardiac surgery department and underwent surgery. The right internal mammary artery was grafted to the RCA. The patient was symptom-free after surgery and was discharged from hospital with good condition.(

Case Report: We describe a 72-year-old woman who suffered from old inferior posterior transmural myocardial infarction complicated by a true posterior left ventricular aneurysm. We describe the clinical course, diagnosis, and surgical management of this type of complication of myocardial infarction and also illustrate the early clinical follow-up and outcome.

Case Report: Primary cardiac tumors are quite rare among children. The incidence of cardiac tumors during fetal life and among children according to echocardiography has been reported to be between 0.14% and 0.08%, respectively. Rhabdomyomas are the most common primary cardiac tumors in children. They comprise more than 60% of all primary cardiac tumors during childhood. Most frequently, they exist in the ventricular walls or cavities. Sometimes they involve the atria or atrioventricular junction. Location in the atrioventricular junction may predispose the patient to arrhythmia and pre-excitation. These tumors are multiple in 90% of the cases. The presenting manifestation depends on the size and site of the mass. Echocardiography is the most accessible diagnostic method, but biopsy has remained the “gold standard” for the proof of the diagnosis. Surgical repair should be considered only for sick patients with unstable hemodynamic because most of these tumors regress spontaneously. In this case report, we describe a 2-year-old boy with atrioventricular junction single mass and progressive mitral regurgitation without any arrhythmia who underwent complete mass resection.

Friedreich's Ataxia (FA) is an autosomal recessive multisystem disease that leads to mitochondrial dysfunction, affecting nerve tissue and heart muscle. According to previous studies, cardiac dysfunction, predisposing to congestive heart failure and supraventricular arrhythmias, is the most frequent cause of death. We describe an 18-year-old female who presented with progressive weakness and vertigo and loss of lower-limb muscle force of one year's duration. The patient had had occasional respiratory distress over the previous 6 months, exacerbated by activity and improved by rest. She had atypical chest pain too. According to neurological findings, she had a familial history of neurodegenerative disease. She also had type 1 diabetes mellitus and cardiac involvement. Following echocardiography, FA diagnosis was suggested and was subsequently confirmed by a neurologist. FA is an autosomal recessive, spinocerebellar, degenerative disease characterized clinically by the ataxia of the limbs and trunk, dysarthria, loss of deep tendon reflexes, sensory abnormalities, skeletal deformities, diabetes mellitus, and cardiac involvement [1]. FA is generally associated with concentric hypertrophic cardiomyopathy. Cardiac death occurs primarily in those developing dilated cardiomyopathy [2]. These patients tend to do poorly with rapid progression to end-stage congestive heart failure [3].

Case Report: Left atrial appendage rupture is a rare complication of cardiac surgery. We describe a 62-year-old woman who developed the complication after multiple surgeries for her mitral valve. The diagnosis was established with transesophageal echocardiography. (