Massive hemoptysis in a pregnant woman: the first rare presentation of mitral valve stenosis.

Massive hemoptysis is one of the rare manifestations of mitral valve stenosis. Massive hemoptysis is considered as a potentially life threatening that frequently needs emergency procedures. A 43- year-old pregnant woman presented with coughing and massive hemoptysis. She was diagnosed severe rheumatic mitral stenosis. The patient underwent percutaneous transluminal mitral valvuloplasty (PTMC). Before ICU admission and hospitalization, she was healthy, without any past medical history and complaints.

Late presentation of iatrogenic dissection of right coronary cusp: A case report.

Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation. To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.

Effect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension.

Using different drug regimens has been proved to have effective effects on lowering blood pressure, but the adverse effects of long-term usage such medications is evident. According to recent trend in suing herbal and traditional medicines, researchers have been focused on evaluating the effect of different herbals on managing hypertension. The aim of the present study is the evaluation of the antihypertensive effect one of these herbs, sour tea (Hibiscus sabdariffa), on stage one hypertension. Patients with stage one hypertension who were diagnosed by a cardiologist has been included in the present clinical trial after giving informed consent. The patients were divided into two groups. The control and case group received the same lifestyle and dietary advices for controlling blood pressure. The case group received two standard cup of sour tea every morning for 1 month. The blood pressure of both groups was documented at baseline and at the end of the study and the results were analyzed using SPSS software. A total of 46 patients participated in this study and there was no significant difference in terms of age and body mass index between groups. There was a significant reduction in systolic blood pressure in both groups, but the mean reduction in systolic and diastolic blood pressure was significantly higher in the case group (P = 0.004 and P < 0.001, respectively). Using H. sabdariffa as sour tea two times a day can be effective in managing blood pressure in stage one hypertension along with lifestyle and dietary modification.

Value of pathologic Q wave in surface electrocardiography in the prediction of myocardial nonviability: A cardiac magnetic resonance imaging-based study.

In surface electrocardiography (ECG), Q wave is often considered as a sign of irreversibly scarred myocardium. Cardiac magnetic resonance (CMR) imaging is an accurate mean for the detection of myocardial viability. Herein, we study the predictive value of Q wave in nonviable (scarred) myocardium by CMR study. Retrospective analysis of the ECG and CMR data of 35 coronary artery disease patients was performed. The delayed enhancement CMR protocol was used for the detection of viability. The presence of a pathologic Q wave in surface ECG was negatively related to myocardial viability with a kappa measurement of agreement of -0.544 and P < 0.0001. Pathologic Q wave in surface ECG can be used as a simple tool for myocardial viability prediction.

QT interval and P wave dispersion in slow coronary flow phenomenon.

BACKGROUND: Slow coronary flow (SCF) phenomenon is an angiographic finding which is defined as slow contrast passage through coronary arteries which may predispose patients to serious cardiac complications such as fatal arrhythmias. P-wave and QT-interval dispersion are electrocardiographic findings which are related to atrial fibrillation and ventricular tachyarrhythmias. In the present study, the relation between SCF and presence of P-wave and QT-interval dispersion in electrocardiography has been evaluated. METHODS: 47 patients with normal coronary arteries and SCF and 40 patients with normal coronary artery flow without SCF were enrolled in this case control study. Standard electrocardiogram (ECG) was analyzed for P-wave and QT-interval dispersion. SCF was identified in normal coronary vessels by use of Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method (TFC > 27). Corrected TIMI frame count (CTFC) of coronary vessels as well as mean CTFC along with QT-interval and P-wave dispersion were compared between 2 groups. The study data were analyzed by SPSS software and P value less than 0.050 was considered to be significant. RESULTS: QT-interval [76.17 (35.23) ms versus 39.25 (19.26) ms] and P-wave [39.74 (17.48) ms versus 19.50 (8.54) ms] dispersion were significantly higher among patients with SCF phenomenon (P < 0.050). In addition, there was a positive significant linear correlation between TFC and P-wave and QT-dispersion (r = 0.857, r = 0.861, respectively, P < 0.050). CONCLUSION: According to the results, increasing TFC among patients with SCF will result in P wave and QT interval dispersion and therefore this finding can be considered as an indicative marker for cardiac events.

Anomalous Left Coronary Artery from the Pulmonary Artery Presenting with Atypical Chest Pain in an Adult: A Case Report.

The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases, the collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. We describe a 49-year-old woman presenting with atypical chest pain during physical exertion. The exercise tolerance test and then coronary angiography by indication revealed an anomalous origin of the left coronary artery. The patient underwent surgical treatment, whereby a pulmonary artery tube graft from the aorta to the left coronary artery was created and the main pulmonary artery was reconstructed with a bovine pericardial patch. The patient was discharged from the hospital without any chest pain and dyspnea and was symptom free during a follow-up period of 18 months. Clinicians should consider ALCAPA as a differential diagnosis in adults with presentations similar to exercise-related asthma.

Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial.

BACKGROUND: Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. OBJECTIVE: The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. METHODS: This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015. Subjects were randomly assigned to intervention group who received propranolol and fluoxetine (both at 10 mg/day) and control group who received 10 mg/day propranolol. Assessments included echocardiography and GAD-7 questionnaire and rating of chest pain, that were performed at baseline and then weekly for 4 weeks. Analysis was performed using the Mann-Whitney U test and Two-way Repeated Measures Analysis of Variance (ANOVA). RESULTS: Sixty patients (25 male/ 35 female) with a mean age of 22.9 ± 2.5 years were studied in two groups of intervention (n = 30) and control (n = 30). GAD score was significantly higher in the intervention group (17.37 ± 1.61) compared with the control group (14.17 ± 0.83) (p<0.001). No significant difference was observed for changes in left atrium diameter, mitral annular diameter, left ventricular diameter or ejection fraction (p>0.05). Pain severity was reduced significantly more in control group (3.27 ± 1.26) compared to intervention group (2.80 ± 0.85) after treatment (p<0.001). CONCLUSIONS: This study revealed that the co-administration of fluoxetine and propranolol may not only have no effective in improving echocardiographic changes of MVP but may also aggravate subjective findings of patients with MVP and GAD. TRIAL REGISTRATION: The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2014102819721N1. FUNDING: This research has been financially supported by Research Council of Sabzevar University of Medical Sciences.

A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide.

BACKGROUND: The most effective and accurate treatment of hypertensive patients reduces cardiovascular events and improves the quality of life. OBJECTIVE: This study compared the efficacy and safety of combined (combination therapy) with an angiotensin-receptor blocker (ARB) a calcium-channel blocker (CCB) (Losartan / Amloidipine 50/10mg) vs maximal combination doses of ARB with hydrochlorothiazide (Losartan /HCTZ 100/25 mg) and maximal combination doses of CCB with HCTZ (Amlodipine /HCTZ 10/25 mg) in the management of stage 2 hypertension. METHODS: This randomized clinical trial (RTC) comprised 478 hypertensive patients with mean age 50.5±5.21 years, and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar. Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position ≥ 160 and <200 mmHg in systole and ≥ 100 and <110 mmHg in diastole were randomized into three groups: Losartan / Amlodipine 50/10 mg (n =164) , Losartan / HCTZ 100/25 mg (n =155) and Amlodipine / HCTZ 10/25 mg (n =159). The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group. RESULTS: There was a significant difference in systolic blood pressure reductions between treatment groups (P<0.001) and also there was a significant difference between groups in reducing diastolic blood pressure (P<0.01). The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group. The ANCOVA analysis revealed that only treatment regimen had a significant effect (P=0.01) and other factor including Age, Gender, Diabetes Mellitus, Smoking and High serum cholesterol didn't have significant effect on blood pressure reduction. CONCLUSION: ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study.