Diagnosis and management of cancer therapy-related myocarditis in a young female: A case report and review of literature.

BACKGROUND: The treatment of choice for Extra-osseous Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET), a rare neoplasm, is the VAC/IE regimen. This regimen includes Doxorubicin, Vincristine, Cyclophosphamide, Ifosfamide, and Etoposide, all of which have cardiotoxic effects. Myocarditis, a potentially threatening side effect following cancer therapy, can be accurately managed and diagnosed. CASE PRESENTATION: In the current study, we report the case of a 19-year-old female with a mass on the abdominal wall, diagnosed with ES/PNET. She was treated with the VAC/IE regimen. A month after the last session of chemotherapy, she experienced dyspnea. Upon evaluation, a high level of troponin and a low left ventricular ejection fraction (LVEF) were detected via transthoracic echocardiography. She was treated with anti-heart failure drugs, but the response was unsatisfactory. The possibility of Cancer therapy-related myocarditis was suspected, and cardiac magnetic resonance imaging (CMR) confirmed acute myocarditis. This patient exhibited a significant response to intravenous immunoglobulin (IVIG), with her LVEF improving from 30-35% to 50% within three months. CONCLUSION: In this case, based on negative tests and the absence of viral signs and symptoms, Cancer therapy-related myocarditis is highly suspected as the cause of myocarditis. This case underscores the importance of accurately utilizing CMR as a non-invasive method for diagnosing myocarditis. It effectively highlights the identification of reversible myocarditis with appropriate treatment and the notable response to IVIG, suggesting its potential as a favorable treatment for myocarditis in younger patients.

Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients.

BACKGROUND: Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes. METHODS: In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC. RESULTS: A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007). CONCLUSION: Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.

Effect of resistance exercise on cardiac perturbations and systolic performance: A cross-over randomized trial comparing volumes and techniques.

This study investigated the magnitude and time-course of resistance exercise (RE) technique induced transient cardiac perturbations. Twenty-four participants were assigned to one of four arms: sets to failure or non-failure with 8-10 repetition maximum (RM), and sets to failure or non-failure with 15RM. Echocardiographic and blood pressure (BP) data were recorded at baseline and 30 min, 6 h and 24 h post-exercise. In all groups end-systolic circumferential wall stress (cESS), and ratio of transmitral inflow velocities (E/A) were significantly decreased while posterior wall thickness (PWT), global circumferential strain (GCS), GCS strain rate (GCSR), global longitudinal strain rate (GLSR), and stroke volume (SV) were significantly increased for up to 6 h of follow-up. In the 15RM groups, left ventricular (LV) mass and interventricular septal thickness (IVST) were significantly increased, and left atrial (LA) area was significantly decreased (p < 0.05) compared to the 8-10 RM groups. In the 15RM groups, RE decreased global longitudinal strain (GLS) and increased ejection fraction (EF) (p<0.01). After RE, transient cardiac perturbations, the reduction in LA compliance, and the improvement in LV myofibril geometry were volume dependent and influenced more by sets to failure technique. RE increased GCS and reduced the afterload, thus helping to preserve SV and EF.

Post-revascularization Ejection Fraction Prediction for Patients Undergoing Percutaneous Coronary Intervention Based on Myocardial Perfusion SPECT Imaging Radiomics: a Preliminary Machine Learning Study.

In this study, the ability of radiomics features extracted from myocardial perfusion imaging with SPECT (MPI-SPECT) was investigated for the prediction of ejection fraction (EF) post-percutaneous coronary intervention (PCI) treatment. A total of 52 patients who had undergone pre-PCI MPI-SPECT were enrolled in this study. After normalization of the images, features were extracted from the left ventricle, initially automatically segmented by k-means and active contour methods, and finally edited and approved by an expert radiologist. More than 1700 2D and 3D radiomics features were extracted from each patient's scan. A cross-combination of three feature selections and seven classifier methods was implemented. Three classes of no or dis-improvement (class 1), improved EF from 0 to 5% (class 2), and improved EF over 5% (class 3) were predicted by using tenfold cross-validation. Lastly, the models were evaluated based on accuracy, AUC, sensitivity, specificity, precision, and F-score. Neighborhood component analysis (NCA) selected the most predictive feature signatures, including Gabor, first-order, and NGTDM features. Among the classifiers, the best performance was achieved by the fine KNN classifier, which yielded mean accuracy, AUC, sensitivity, specificity, precision, and F-score of 0.84, 0.83, 0.75, 0.87, 0.78, and 0.76, respectively, in 100 iterations of classification, within the 52 patients with 10-fold cross-validation. The MPI-SPECT-based radiomic features are well suited for predicting post-revascularization EF and therefore provide a helpful approach for deciding on the most appropriate treatment.

Presence and prognostic value of ventricular diastolic function in arrhythmogenic right ventricular cardiomyopathy.

INTRODUCTION: Limited data exist regarding the presence and importance of diastolic parameters in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We sought to evaluate RV diastolic parameters and echo-based diastolic predictors of major adverse cardiovascular events (MACE). METHOD: 48 patients with a definitive diagnosis of ARVC were included and followed for 6-18 months. A comprehensive standard two-dimensional (2D) transthoracic echocardiography (TTE) with precise evaluation of systolic and diastolic indices of both ventricles was done. RV isovolumetric relaxation time (IVRT), RV myocardial performance index (MPI), and right atrial (RA) volume were evaluated. RESULTS: 48 patients (mean age = 38.5 ± 14 years; 79.2% male) were enrolled. 27.3% had grade I, 68.2% had grade II, and 4.5% had grade III RV diastolic dysfunction. In 12-month follow-up, 12 patients (25%, with mean RV3DEF = 24.8 ± 9%) experienced MACE and required hospitalization: ventricular tachyarrhythmia in 7 patients (14.6%), RV clot in 2 subjects (4.2%), and right-sided failure in 3 cases (6.3%). In logistic regression analysis, tissue Doppler velocity of tricuspid annulus (e' TV) (P = .02, OR = 0.581, CI = 0.368-0.917), peak E mitral valve (P = .043, OR = 0.95, CI = 0.913-0.999), tissue Doppler velocity of septal e' (P = .052, OR = 0.733, CI = 0.536-1.003), and MPI (P = .009, OR = 95, CI = 3.083-2942) were powerful predictors of MACE. CONCLUSION: In our study, RV diastolic function parameters including e' TV and e' MV, RA volume and area, and RV MPI were powerful predictors of MACE and may be considered during the baseline and follow-up of the ARVC patients.

Persistence of a pacemaker lead-like "ghost" 6 months after lead extraction.

Residual fibrous structures, referred as "ghosts", are occasionally encountered following lead extraction. Though typically detected in patients with cardiac device infections, their prognostic and therapeutic implications remain speculative. We describe a 62-year-old gentleman with history of sick sinus syndrome who presented atrial fibrillation with rapid ventricular response. The patient had history of transvenous lead extraction following pacemaker pocket infection 6 months earlier. In echocardiography, an echo-dense tubular lead-like structure was seen that followed the route of a pacer lead from superior vena cava to right atrium and then passing through the tricuspid valve into right ventricle.

Assessment of left and right ventricular rotational interdependence: A speckle tracking echocardiographic study.

OBJECTIVE: We sought to investigate the possible interdependence of the left (LV) and right ventricular (RV) rotational mechanics. BACKGROUND: Although myocardial fiber architecture and the effect of various pathologic conditions on LV torsional mechanics have already been investigated through multiple studies using different methods, there is still a significant debate about the actual presence and functional significance of RV rotational mechanics. METHODS: We perform a cross-sectional prospective study of 118 subjects, including 19 normal subjects (NS, 35±7 years), 34 patients with severe aortic stenosis (AS, 44±16 years), 26 patients with nonobstructive hypertrophic cardiomyopathies (HCM, 46±18), and 39 patients with nonischemic dilated cardiomyopathies (DCM, 39±13 years). LV and RV rotational parameters were measured using velocity vector imaging. Total LV and RV apical segment rotations as well as the rotation of the free wall of RV apex were measured separately. Interdependence of the LV and RV rotational mechanics was assessed using the Spearman rho test. RESULTS: Both LV (7.3°±4.1° in NS, 11°±4.6° in AS, 7.7°±5.2° in HCM, and 1.9°±2° in DCM, P=<.0001) and RV apexes (4.7°±2° in NS, 6.1°±4° in AS, 3.2°±3.7° in HCM, and 2.4°±3.6° in DCM, P=<.0001) rotated counterclockwise in all the four study groups. Interventricular apical rotation interdependence was stronger in the AS (Spearman rho [ρ]: .716; P=.000) and in the HCM (ρ: .395; P=.04) subgroups than in the NS (ρ: .26; P=.27) and DCM (ρ: .215; P=.18). In DCM patients, RV apex rotation appeared to be independent of LV rotation. RV free wall apical rotation was larger than its corresponding value for the total apical segments in all studied groups. This difference was significant only in the AS (P=.007). CONCLUSION: Our findings demonstrated a close correlation between RV and LV apical rotation parameters in different cardiac conditions as well as in normal subjects. However, in DCM patients, we also showed some independent rotation of the RV from the LV apex.

The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery.

BACKGROUND: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. MATERIALS AND METHODS: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups. RESULTS: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P = 0.004) and ICU stay (P = 0.007) between the two groups. Inotropes including milrinone (P = 0.04), epinephrine (P = 0.001), and dobutamine (P = 0.002) were used significantly less frequently for patients in the intervention than the control group. CONCLUSION: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.

Silent Pulmonary Artery Dissection in a patient with old Pulmonary Balloon Valvuloplasty.

Percutaneous pulmonary balloon valvuloplasty (PBV) remains the treatment of choice for pulmonary stenosis (PS). This procedure is effective, safe and gives excellent results. Pulmonary artery (PA) dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study.

A rare case of community-acquired native quadruple-valve endocarditis.

We report the case of a male patient with community-acquired quadruple-valve endocarditis on presumed normal native valves. This patient had originally presented elsewhere with generalized edema and malaise and had been diagnosed with suspicious endocarditis and renal dysfunction, for which he unfortunately received incomplete treatment. Transthoracic and transesophageal echocardiographic examinations confirmed quadruple-valve endocarditis and ventricular septal defect.

Trastuzumab in patients with breast cancer and pre-existing left ventricular systolic dysfunction.

BACKGROUND: Trastuzumab is one of the most effective treatments in HER-2 positive breast cancer patients. However, it is associated with development of cardiomyopathy/heart failure (HF) which is often a limiting side effect and associated with overall adverse outcomes. As a result, patients with pre-existing LV systolic dysfunction (LVSD) are often excluded from receiving anti-HER-2 therapy, which may lead to less effective cancer treatment and worse prognosis. OBJECTIVES: The current study aims to evaluate the safety of trastuzumab in patients with HER-2 positive breast cancer and pre-existing LVSD. METHODS: In this retrospective cohort study, 36 consecutive patients at a single center in Iran with HER-2 positive breast cancer with asymptomatic mild LVSD with LVEF 40-53% without heart failure symptoms and those who were closely followed in the Cardio-Oncology clinic before initiating the treatment and then every two cycles of trastuzumab were included. As per the program standard protocol they received a beta-blocker (carvedilol) and ACE-I (Lisinopril), up to the maximum tolerated dose, if there were no contraindications. Patients underwent routine echocardiography with global longitudinal strain (GLS) assessment every 3 months per guideline recommendations and were followed up 6 months after the end of treatment. Primary composite outcomes included myocardial infarction (MI), cardiac arrhythmia, heart failure(HF) symptoms and cardiovascular death. Secondary outcome was ≥ 10% reduction in LVEF or ≥ 15% reduction in GLS compared to baseline. If the LVEF decreased below 40%, the treatment was temporarily interrupted for one or two cycles, and spironolactone was added to the patient's treatment. If the LVEF improved ≥ 40%, trastuzumab was rechallenged. Data analysis was performed using IBM SPSS Statistics 24.0. Software. Patients' characteristics were reported using descriptive statistics, and its association with drop in LVEF or GLS was assessed using Pearson chi-square or Mann-Whitney U test. A p-value of less than 0.05 was considered significant. RESULTS: Thirty-six patients were included in the study. Primary composite outcome was noted in 1(2.8%) patient. LVEF reduction of ≥ 10% occurred in 6(16.7%) of the patients, and a GLS reduction of more than 15% was detected in 4 (11.1%) of the patients. There was a significant association between a ≥ 10% reduction in LVEF and baseline systolic blood pressure (P-value: 0.04). LVEF reduction below 40% was observed in 3 (8.3%) patients, where trastuzumab was interrupted. All of these three patients had obesity (Median BMI 34.11, IQR 9.12) and uncontrolled HTN, and one of them had symptoms of heart failure (NYHA class II), for whom the trastuzumab treatment was discontinued. Among two patients, after the temporary interruption of trastuzumab, and addition of spironolactone, LVEF improved to above 40%, and the treatment was restarted with close cardiac monitoring; therefore, they could complete the entire one-year treatment period. CONCLUSIONS: Treatment with trastuzumab seems to be safe in patients with pre-existing LVSD (LVEF = 40-53%). Such high-risk patients should be strictly monitored and cardiovascular risk factors, such as HTN should be regulated.

TRPA1 as a promising target in ischemia/reperfusion: A comprehensive review.

Ischemic disorders, including myocardial infarction, cerebral ischemia, and peripheral vascular impairment, are the main common reasons for debilitating diseases and death in Western cultures. Ischemia occurs when blood circulation is reduced in tissues. Reperfusion, although commanded to return oxygen to ischemic tissues, generates paradoxical tissue responses. The responses include generating reactive oxygen species (ROS), stimulating inflammatory responses in ischemic organs, endoplasmic reticulum stress, and the expansion of postischemic capillary no-reflow, which intensifies organ damage. Multiple pathologic processes contribute to ischemia/reperfusion; therefore, targeting different pathologic processes may yield an effective therapeutic approach. Transient Receptor Potential A1 (TRPA1) belongs to the TRP family of ion channels, detects a broad range of chemicals, and promotes the transduction of noxious stimuli, e.g., methylglyoxal, ROS, and acrolein effects are attributed to the channel's sensitivity to intracellular calcium elevation or phosphoinositol phosphate modulation. Hypoxia and ischemia are associated with oxidative stress, which activates the TRPA1 channel. This review describes the role of TRPA1 and its related mechanisms that contribute to ischemia/reperfusion. Relevant articles were searched from PubMed, Scopus, Web of Sciences, and Google Scholar electronic databases, up to the end of August 2023. Based on the evidence presented here, TRPA1 may have protective or deteriorative functions during the ischemia/reperfusion process. Its function depends on the activation level, the ischemic region, the extent of lesions, and the duration of ischemia.

Cardiac mass as the primary diagnostic clue of Edheim-Chester disease.

Key Clinical Message: We introduced one of the rare causes of intra-cardiac mass, that is, ECD and a new gene mutation (SLC29A3) that is probably related to this disease, and we noted the importance of using several diagnostic methods to rule out other intra-cardiac causes. Abstract: Edheim-Chester disease is a rare histiocytosis affecting multiple organs. The infiltration of lipid-laden histiocytes characterizes the disease. Most patients experience bone involvement; over 50% of cases involve the cardiovascular system and other extra-osseous organs. In this case report, we present the case of a 42-year-old man who complained of shortness of breath and bone pain. During echocardiography, a large, homogenous, and fixed mass was found in the right atrium free wall. Computed tomography and cardiac magnetic resonance imaging revealed an infiltrative mass in the RA with atrioventricular groove involvement but coronary sinus encasement, right coronary artery, and superior vena cava encasement. Abdominal CT scans also reported aortic wall involvement and bilateral renal cortical and perirenal involvement. A kidney biopsy confirmed the infiltration of histiocytes and the diagnosis of ECD. The treatment was initiated for him, and his symptoms improved. In this case report, we express the importance of considering the rare causes of cardiac tumors.

A challenging transseptal mitral valve in valve case report: Success and safety.

Key Clinical Message: Transcatheter mitral valve implantation (TMVI) is considered a less-invasive approach than open-heart surgery, favored in high-risk patients elected for valve replacement. Although seemingly suitable, this procedure is highly operator-dependent. Abstract: Transcatheter mitral valve implantation (TMVI) is an alternative in high-risk patients. We reported a 72-year-old patient with mitral bioprosthesis degeneration successfully receiving TMVI. The procedure has lower morbidity and mortality rate than the surgical approach but can be accompanied by several complications, especially when conducted by an inexperienced operator.

Cardioprotective Diet to Prevent Anthracycline-Induced Cardiotoxicity in Patients with Breast Cancer: A Randomized Open-Label Controlled Trial.

Objectives: Several studies have indicated that dietary interventions may offer protection against the development of cardiac damage in the case of anthracycline-induced cardiomyopathy (AIC). The goal of this study was to assess whether an evidence-based cardioprotective diet can be effective in preventing AIC in patients with breast cancer. Design: Randomized, open-label, controlled trial. The study period was set for 18 weeks, and the data were analyzed by generalized estimating equation modeling and one-way repeated measures analysis of variance. Setting/Location: Shahid Rajaie Hospital affiliated (Tehran, Iran). Subjects: Fifty anthracycline-treated patients with breast cancer. Interventions: Patients were randomized to receive either a 2-hour training in evidence-based cardio-protective diet or Carvedilol 6.25 mg bid. Outcome Measures: The primary outcome was the number of patients with abnormal left ventricular ejection fraction (LVEF) after 18 weeks. Results: At week 18, 12 (48%) out of 25 participants in the cardioprotective diet group had abnormal LVEF in comparison with 21 (84%) out of 25 in the carvedilol group (p = 0.007). Also, 2 (8%) out of 25 in the cardioprotective diet group compared with 7 (28%) out of 25 participants in the carvedilol group had abnormal global longitudinal strain (p = 0.066). The diet group showed significant improvements in the quality-of-life dimensions named "health change" and "general health" compared with the carvedilol group using the Short Form-36 Health Survey questionnaire. Conclusions: This study suggests that an evidence-based cardioprotective diet can contribute to the prevention of AIC. Although current treatments for AIC can be effective, further research is mandatory for more options.

Lipid-lowering drugs and cancer: an updated perspective.

Statins and non-statin medications used for the management of dyslipidemia have been shown to possess antitumor properties. Since the use of these drugs has steadily increased over the past decades, more knowledge is required about their relationship with cancer. Lipid-lowering agents are heterogeneous compounds; therefore, it remains to be revealed whether anticancer potential is a class effect or related to them all. Here, we reviewed the literature on the influence of lipid-lowering medications on various types of cancer during development or metastasis. We also elaborated on the underlying mechanisms associated with the anticancer effects of antihyperlipidemic agents by linking the reported in vivo and in vitro studies.

Do pediatric patients undergoing cardiac surgeries require larger-size cuffed endotracheal tubes? A prospective study.

BACKGROUND: There is a controversy over using either smaller- or larger-size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula-based sizes. The aim of the present study was to compare proper-size cuffed ETT in children undergoing cardiac vs noncardiac surgeries. METHODS: In an observational prospective study, 80 children planned to undergo noncardiac elective surgeries (NCS group) and 80 children scheduled for cardiac surgeries (CS group) were recruited. For intubation, initial cuffed ETT size was calculated based on the following formula: Tube size (mm ID) = age (year)/4 + 3.5. The estimated ETT size for each age group and the size of final utilized tubes for each age range were recorded. RESULTS: Patients of tube sizes 4.5, 5, and 5.5 in the CS group were of lower age, weight, height, and body surface area compared with the patients of the same tube sizes in the NCS group (P < 0.05). The compatibility of the predicted vs actual required tube sizes was more in the NCS group compared to the CS group (72.5% vs. 56.2%; P = 0.02). Additionally, the cases with underestimated tube sizes were significantly more in the CS group compared with the NCS group (38.8% vs. 18.8%, P = 0.01). CONCLUSION: Children undergoing cardiac surgeries in relation to their age and body size do require larger-size ETTs compared with the children scheduled for noncardiac surgeries.

Role of platelet parameters and haematological indices in myocardial infarction and unstable angina.

OBJECTIVE: To explore the significance of platelet parameters, including mean platelet volume, platelet count and other haematological indices, in patients of acute coronary syndrome. METHODS: In this one-year retrospective cross-sectional study in 2010, a total of 631 patients were enrolled at the Cardiovascular Research Institute, Tabriz University of Medical Sciences, Iran, and classified into three groups: myocardial infarction, unstable angina, and Control. Cardiovascular risk factors such as smoking, diabetes mellitus, hyperlipidaemia and hypertension status were compared. Blood samples were collected for the measurement of platelet count, mean platelet volume and other haematological indices, including prothrombin time, partial thromoplastin time, blood group and Rh, haematocrit, haemoglobin, and erythrocyte sedimentation rate. SPSS 18 was used for statistical analysis. RESULTS: Of the total, there were 210 (33.3%; 163 men, 47 women) with myocardial infarction whose mean age was 62.7 +/- 14.2 years; 211 (33.3%; 110 men, 101 women) had unstable angina with a mean age of 63.5 +/- 3.1 years and 210 (33.3%; 117 men, 90 women) health controls with a mean age of 60.6 +/- 12.8 years. The mean platelet volume values of patients in the first two groups were significantly higher than the control group (10.14 +/- 1.05 fL, 9.82 +/- 0.93 fL and 9.34 +/- 1.14 fL, respectively; p < 0.001). The platelet count was detected to be significantly lower in the patients than the controls (207.92 +/- 58.40 x 109/L, 220.18 +/- 65.81 x 109/L, 23 +/- 56.10x109/L, respectively, p < 0.001). While blood cell count was significantly higher in those with myocardial infarction compared to the unstable angina patients and control group ( P < 0.001). Differences in mean values of mean platelet volume between the two patient groups was not significant, but mean values of platelet count was statistically significant between these two groups ( p < 0.04). CONCLUSION: Mean platelet volume and platelet count may be considered prognostic markers for acute coronary syndrome.

Hypertension in Cardio-Oncology Clinic: an update on etiology, assessment, and management.

Hypertension is one of the most common comorbidity and the leading cause of cancer-related death in cancer patients. The prevalence of hypertension in cancer patients is much higher than that of the general population. In the older population of cancer patients, specific cancer treatments such as new tyrosine kinase inhibitors and Vascular endothelial growth factor inhibitor drugs give rise to hypertension in cancer patients; The aim of present study is to provide a detailed discussion etiologies of cancer treatment-induced hypertension and explore the most innovative diagnostic and management approaches. This review will address the optimal approach to hypertension treatment, covering treatment initiation thresholds, targets, and the selection of anti-hypertensive agents. The lack of evidence in recent guidelines for managing cardiovascular toxicities in cancer patients can create uncertainty in clinicians' therapeutic and clinical decisions. This review aims to enhance our understanding of hypertension etiology in cancer patients and provide a practical guide to current treatment approaches.