In-hospital complications and 1-year outcome of acute coronary syndrome in patients with hypertension: findings from the 2nd Gulf registry of acute cardiac events

Using data from the 2nd Gulf Registry of Acute Coronary Events [Gulf RACE-2] in 2008-09 we investigated the in-hospital complications and 1-year outcome of acute coronary syndrome [ACS] in patients with systemic hypertension from 6 Gulf countries. Of 7847 consecutive patients admitted with ACS, 3746 [47.7%] had hypertension. Hypertension was more prevalent in women, in Arabs than non-Arabs and in older age groups. Patients with hypertension were more likely than those without hypertension to present with dyspnoea and advanced Killip class. Among hypertensive patients, the mortality rate was higher only among those admitted with ST-elevation myocardial infarction. After adjustment for baseline variables, hypertension was an independent predictive factor for heart failure [OR = 1.31] and stroke [OR = 2.47]. There were no significant differences in mortality in hypertensive ACS patients when stratified by sex, age or ethnicity

Infective endocarditis at a tertiary care centre in Saudi Arabia: review of 47 cases over 10 years

To describe the pattern of infective endocarditis in a tertiary hospital in Riyadh, Saudi Arabia, a retrospective review was made of all cases admitted between 1993 and 2003. Of 47 patients, a native valve was involved in 37 [78.7%] and a prosthetic valve in 10 [21.3%]. Predisposing cardiac conditions were present in 27 patients: rheumatic and congenital heart disease were the most common. Blood cultures were positive in 76.4% of patients: the most commonly isolated organisms were Staphylococcus spp. in 20 patients [12 Sta. aureus and 8 coagulase-negative staphylococci] and Enterococcus spp. [6 patients]. The complication rate was 78.7% and hospital mortality rate was 8.5%

Acute rheumatic fever in Jordanian children

Rheumatic fever remains a significant health problem in Jordan. We retrospectively reviewed medical charts of 28 boys and 22 girls [mean age at presentation 10.5 +/- 2.6 years] with confirmed diagnosis based on modified Jones criteria at Queen Alia Heart Institute from February 1999 to February 2002. Arthritis was the commonest major manifestation [88%; 68% migratory], carditis was second commonest [48%; 8% silent carditis] and chorea was seen in 6%. None had subcutaneous nodules or erythema marginatum. The mitral valve was most commonly affected [80%]; both mitral and aortic valves were affected in 25%. Pericarditis was seen in 12.5% and acute congestive heart failure in 4%. Practitioners should be aware of diverse clinical presentations and emphasize strict adherence to prophylaxis guidelines

New biochemical markers in chronic heart failure

We investigated the plasma levels of tumour necrosis factor-alpha [TNF-alpha], leptin and insulin, and their relation to body mass index [BMI] in 80 male patients who presented with chronic heart failure [mean age: 47 +/- 4 years] at Tanta University Hospital. Plasma leptin, TNF-alpha and insulin were significantly increased and BMI significantly decreased in New York Heart Association classes III and IV patients. TNF-alpha, leptin and insulin were positively correlated, and TNF-alpha and BMI and leptin and BMI were negatively correlated in stages III and IV of heart failure. We conclude that cytokine neuroendocrine activation may form part of advanced stage heart failure. It may also be responsible for worsening cachexia, and can be used as a marker to determine disease severity