Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension: A comprehensive study.

OBJECTIVES: To evaluate the relationship between severity of tricuspid regurgitation (TR) and pulmonary hypertension. METHODS: Cross-sectional study of 118 patients with pulmonary hypertension was carried out at a single center in Jeddah, Saudi Arabia, between 2018-2021. Patients who had pulmonary or tricuspid valves organic diseases, previously undergone tricuspid or pulmonary valve surgeries, had permanent pacemakers or critically ill were excluded. RESULTS: A high proportion of patients were women (n=100, 85%) and obese (n=57, 48%). Patients with more than mild TR had higher systolic pulmonary artery pressure (sPAP) than those with trivial or mild regurgitation (p<0.001). There was a significant association between severity of TR (p<0.001) and right chambers size (p=0.001). Furthermore, pulmonary artery pressure (PAP) was significantly higher in patients with mild right ventricular impairment (p=0.001). CONCLUSION: Increase in degree of TR and right atrial size were predictors of elevated sPAP. Our findings highlight the interplay among TR, right heart size, ventricular function, and PAP. Understanding these associations can aid in risk stratification, monitoring disease progression, and potentially guiding treatment in those patients.

The Practice of Pain Assessment and Management in a Tertiary Oncology Center.

Background Pain is one of the common and devastating symptoms that affects millions of cancer patients globally. Despite published guidelines and education on the assessment and management of cancer-related pain, underestimated or undertreated pain continues to be a considerable worldwide public health concern among cancer patients. In this study, we aimed to assess physicians' adherence to the World Health Organization (WHO) guidelines in the management and assessment of pain in oncology patients based on the available score of pain in the Princess Noorah Oncology Center (PNOC) at the King Abdulaziz Medical City in Jeddah. Methodology This cross-sectional, retrospective chart review study studied 451 patients (selected through computerized random sampling) who were admitted to the PNOC during the study period. Results The pain was assessed using the Brief Pain Inventory in almost all patients (n = 450, 99.8%). The pain was categorized as mild in 386 (85.6%) patients, moderate in 46 (10.2%) patients, and severe in 19 (4.2%) patients. Opioid prescriptions were significantly higher among patients with moderate (76.1%) and severe pain (89.5%) compared to those with mild pain (39.1%; p < 0.0001). Conclusions The practice of pain documentation for cancer patients was adequate as indicated by reporting the pain scores of 99.8% of inpatients. Patients with moderate and severe pain were more likely to receive opioids and a combination of opioids plus non-opioid analgesics, whereas the prescription of analgesics was predicted by experiencing moderate cancer pain.

Effect of Isolated Obesity on Left Ventricular Function and Structure: A Single-Center Experience.

Background and objectives Obesity can increase cardiac mass and affect cardiac performance independently from other risk factors. Several studies have identified an association in patients who already have comorbidities, however, few studies focused on obesity as an isolated risk factor. This study aimed to assess the associations between isolated obesity and heart morphological and functional characteristics. Methods This was a cross-sectional study that recruited 114 patients referred for echocardiographic study in King Faisal Cardiac Center. Adult patients who had a body mass index (BMI) above 25 kg/m2 were included, while patients with comorbidities such as hypertension, diabetes mellitus, dyslipidemia, or those who use medications for chronic diseases were excluded from this study. Variables of interest that we collected were age, gender, weight, BMI, and those related to morphological and functional changes in the heart including left ventricular mass index (LVMI), LV end-diastolic volume, and left ventricular ejection fraction (LVEF). Results Most of the study participants (63.8%) were class II or class III obesity and about 80% were males. The mean ± SD of LVEF was 55.7% ± 2.8%, while the mean of the left ventricular mass index was 28.5±5.84. The mean of LV end-diastolic volume index (LVEDVI) was slightly higher among males than females (48.8±11.6 versus 46.4±11.7 ml/m2), however, this difference was not statistically significant (p-value= 0.395). There was no correlation between BMI and LVMI in females (R - 0.226, R2 0.05, P-value 0.37), while the LVMI was found to have a negative correlation between BMI and male gender that was significant (R - 0.292, R2 0.09, P-value 0.0052). It was found that there is no correlation between LVEF and BMI for males and females (male= R 0.093, R2 0.032, P-value 0.093; female= R 0.172, R2 0.029, P-value 0.434). With regards to the LVEDVI, there was a negative correlation between higher BMI and male gender that was significant (male= R - 0.396, R2 0.157, P-value 0.0001) while it was not significant in females (R -0.0298, R2 0.0009, P-value 0.893). Conclusions We have found that cardiac function is not affected by isolated obesity. However, indexed cardiac parameters like LVM and LV end diastolic volume were negatively correlated with higher BMI and positively correlated with relative wall thickness (RWT) only in males. This negative correlation might be one of the triggers to the development of obesity-induced cardiomyopathy.

Assessment of Different Risk Factors Among Adult Cardiac Patients at a Single Cardiac Center in Saudi Arabia.

Background  Cardiovascular disease (CVD) has remained the leading cause of death in the last 15 years and is one of the main health problems in Saudi Arabia. Our study aims to assess the prevalence of different CVD risk factors and correlate them among King Faisal Cardiac Center patients in King Abdul-Aziz Medical City in Jeddah, Saudi Arabia. Methods We conducted a cross-sectional study using a convenient sampling technique. Data were collected by interviewing adult patients admitted to King Faisal Cardiac Center and diagnosed with hemodynamically stable cardiac disease. We excluded patients with multiple medical conditions that contribute to acute mental disorders. The sample size was calculated to be 200 patients. Results Overall, 163 patients completed the survey. The majority of the participants (49.1%) were between 46-65 years of age, males, non-smokers, and had more than 11 children. Diabetes was found to be the most common risk factor (66.3%). Most participants had mild to moderate anxiety (63.8%) and depression (66.9%). Most of the patients (51.5%) have a high 10-year risk of developing CVD, followed by moderate and low risk (33.1% and 15.3%, respectively). In our study, a high 10-year risk of CVD was significantly associated with age between 46-80 years with a p-value=0.002, male gender with a p-value=0.007, cigarette smoking with a p-value=0.031, and diabetes with a p-value=0.035. Conclusion The study demonstrated a high prevalence of the following CVD risk factors: age, male gender, immobility, obesity, diabetes, dyslipidemia, and hypertension. In addition, a significant association was found between high 10-year risk of CVD and age, gender, smoking, number of children, and diabetes with a p-value<0.05. No significant association was found in the other risk factors such as obesity, body mass index (BMI), immobility, caregiver, dyslipidemia, depression, and anxiety.

Percutaneous Intervention With Balloon-Expandable Covered Stent for the Treatment of Traumatic Aortic Pseudoaneurysm in a Paediatric Patient.

In this report, we describe the case of a 13-year-old male who presented to our hospital after sustaining injuries from a motor vehicle accident (MVA). A full-body CT scan revealed multiple injuries, including subgaleal hematoma, hemorrhagic brain contusion, moderate-size aortic pseudoaneurysm with associated mediastinal hematoma, and multiple stable visceral organ lacerations. Additionally, there were numerous fractures, including in the right femur associated with large hematoma. The patient was deemed at high risk for systemic anticoagulation required for an urgent operative aortic repair. Available percutaneous endograft sizes were deemed too large for his descending aortic diameter, and the associated potential risk of vessel injury from the large sheath required to implant the endograft removed this option from consideration. The decision was made to use a balloon-expandable covered stent, which is routinely used to treat coarctation of the aorta (CoA) as a life-saving alternative. A BeGraft aortic stent (Bentley InnoMed, Hechingen, Germany) measuring 16x38 mm was successfully implanted percutaneously with complete exclusion of the pseudoaneurysm without any procedural complications.

Etiology of Pericardial Effusion and Outcomes Post Pericardiocentesis in the Western Region of Saudi Arabia: A Single-center Experience.

Background Pericardial effusion is the accumulation of blood or excess fluid in the cavity between the heart and the pericardium sac. Pericardial effusion can be caused by several etiologies, including malignant and non-malignant causes. Pericardiocentesis is the gold standard assessment method for pericardial effusion etiology. The aim of this study was to identify the long-term outcome of patients who presented with massive pericardial effusion and underwent pericardiocentesis at King Abdulaziz Medical City, Jeddah, a large tertiary hospital in the western part of Saudi Arabia. Methods This is a single-center retrospective cross-sectional study conducted at King Abdulaziz Medical City Jeddah, Saudi Arabia, between January 2013 to December 2018. Data were collected from patient's charts; the clinical and echocardiographic findings, alongside with pericardial fluid analysis, were collected. Procedure and patients outcomes were obtained and reported. Results Of the 107 patients with pericardial effusion, 39 patients had moderate to severe pericardial effusion requiring pericardiocentesis. The mean age was 52 years, and 56.4% were females. The most common chronic disease was hypertension and the presence of metastasis. The most common cause of pericardial effusion was a malignancy. A majority of patients had severe pericardial effusion. Many patients had tamponade (69.6%). Patients with malignant pericardial effusion had a median survival of 54 days. Conclusion Etiologies of pericardial effusion requiring drainage depend on the population studied. Patients with malignant effusions have worse outcomes than non-malignant effusion. Pericardiocentesis is required to ascertain the cause and risk-stratify patients.

An Adult Patient With a Tetralogy of Fallot Case.

Tetralogy of Fallot (ToF) is considered the most frequent cyanotic congenital heart abnormality with a low adulthood survival rate if kept untreated. The majority of cases are symptomatic during infancy and mandate early treatment. Few instances of survival to asymptomatic middle-age patients have been reported, and they are decreasing due to early detection. We reported a case of a middle-aged man who was asymptomatic during his life and recently diagnosed with ToF. The patient underwent surgical repair with excellent outcomes. The case represents the possibility of diagnosing such cases in a relatively old patient despite medical development and advances.

Percutaneous Device Closure of Patent Ductus Arteriosus in Adult Patients with 10-Year Follow-up.

OBJECTIVES: We report our 10-year experience with transcatheter closure of patent ductus arteriosus (PDA) in adult using different closure devices. BACKGROUND: Transcatheter closure of PDA in adults can be challenging because of frequently associated comorbidities. Reports on immediate and intermediate-term results of PDA closure are excellent. This study aimed to provide the outcomes of PDA closure using different devices on long and very long term follow-up in adults. MATERIALS AND METHODS: Between September 2009 and December 2018, data were retrospectively reviewed from 27 patients who underwent transcatheter closure of PDA. Outcome parameters were procedural success, procedure-related complications, evidence of residual shunt, and improvement in the signs/symptoms for which the procedure was performed. The mean follow-up interval was 72 months. RESULTS: A device was successfully implanted in 27 of 27 patients (15 females). Median age and weight were 24 years (range: 18-57 years) and 69 kg (range: 53-102 kg), respectively. The mean PDA diameter was 4.1 ± 2.1 mm. Devices used were Amplatzer Duct Occluder (19/27), Occlutech Duct Occluder (6/27), and PFM Nit-Occlud (2/27). Doppler transthoracic echocardiography (TTE) demonstrated 92.6% of full occlusion at day 1, rising to 96.3% at 1 month. Three procedure-related complications occurred with no death. Among symptomatic 26 patients (96.3%), there was marked improvement in symptoms. Among 22 patients (81.5%) for whom the procedure was performed to address left ventricular (LV) enlargement, there was reduction or stabilization in LV size on serial TTEs. CONCLUSIONS: Transcatheter closure of PDA in the adult patient appears to be safe and effective.

Uncommon cause of complicated myocardial infarction with normal coronary arteries in a Saudi patient.

A case of a young Saudi patient with a previous diagnosis of bronchial asthma, nasal polyps, and chronic smoker, presented with atypical chest pain, elevated serum troponin and borderline ischemic electrocardiogram (ECG) changes, with no significant regional wall motion abnormalities at bedside echocardiography is reported. The patient was admitted to the coronary care unit for continuous monitoring as possible acute coronary syndrome, non-ST elevation myocardial infarction (STEMI). One hour after admission, the patient had ventricular fibrillation (VF) cardiac arrest that required three DC shocks and amiodarone bolus before returning of spontaneous circulation, which followed the fourth shock. The resuscitation took 15 minutes of cardiopulmonary resuscitation (CPR). An immediate 12-leads ECG showed significant ST elevation in precordial leads that mandate an urgent coronary angiogram that revealed patent coronary arteries, therefore spasm of normal coronary arteries was postulated as the operative factor. The cardiac magnetic resonance image (MRI) showed a picture of transmural anterior myocardial infarction, which correlates with the follow up echocardiogram reporting hypokinetic anterior wall. A complete history was taken and no use of illicit drugs or alcohol was found. The unusual presentation in such a patient with evidence of extensive anterior STEMI and normal coronary arteries raise the thought of considering uncommon causes. In view of previous medical history and laboratory evidence of eosinophilia, Kounis syndrome was considered dominant in the differential diagnosis.

Prevalence of Undiagnosed Cardiovascular Risk Factors in Adults Aged 20 - 40: A Cross-Sectional Study in 2016 in Jeddah, Saudi Arabia.

BACKGROUND: Cardiovascular diseases (CVDs) are the first leading cause of death worldwide. In Saudi Arabia, CVDs are the major killers with a mortality rate of 46%. CVD risk factors are not exclusive to old populations. Thus, the purpose of this study was to approximately find the prevalence of these risk factors, particularly high blood pressure (HBP), high blood glucose (HBG), obesity, and smoking. METHODS: This cross-sectional was conducted in May 2016 and took place in the Ambulatory Care Center of King Abdulaziz Medical City, Jeddah. We used a non-probability convenience sampling technique where only individuals aged 20 - 40 who were free of medical illnesses were included. We excluded pregnant women and people on medications that might interfere with our measurements. We obtained a brief history and measured blood pressure, blood glucose, height and weight. Data analysis was done in form of frequencies. Chi-square test was utilized to compare qualitative variables. P < 0.05 was used to determine statistical significance. RESULTS: A total of 507 participants were included (76.3% males and 23.7% females). All participants were between 20 and 40 with a mean age of 31.6 ± 6.06 SD. We found the prevalence of undiagnosed HBP to be 8.3% and males showed a significantly higher percentage (P < 0.001) when compared to females. HBG prevalence was only 0.6%. Regarding body mass index, the prevalence of overweight and obesity together was 66.3% and males showed significantly higher percentage in falling in this category (P < 0.001). Smoking prevalence was 37.9% with a significantly higher percentage among males (P < 0.001). CONCLUSION: CVD risk factors are apparently quite common in young adults. Efforts must be made to increase the public awareness regarding these risk factors. CVDs are not exclusive to old people. Thus, the public should appreciate this fact in order to prevent these risk factors by establishing healthy life-styles.

STEMI vs NSTEACS management trends in non-invasive hospital.

OBJECTIVES: To compare the clinical features, management, and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTEACS), in the Western Region of Saudi Arabia. METHODS: A total of 71 patients were enrolled in a longitudinal study at a tertiary hospital without cardiac catheterization facility. These data were collected from Saudi Project for Assessment of Coronary Events registry. RESULTS: Twenty-three patients with STEMI were compared to 48 patients with NSTEACS. Mean age for STEMI was younger, 57.4±13.7 years compared to 63.2±13.9 years respectively (p=0.19). Forty-four percent arrived at the hospital by ambulance. History of hypertension and hyperlipidemia were more frequent in NSTEACS (p=0.05), while both groups showed no difference in diabetes mellitus, 17% vs 22% and smoking, 30% vs 17%. In-hospital medications were: Aspirin (100%) both groups, Clopidogrel (91% vs 100%) (p=0.03). There was more aggressive use of beta-blockers (74% vs 95%) (p=0.01) and statins (87% vs 100%) (p=0.01) in NSTEACS. In-hospital outcomes showed one recurrent myocardial infarction and one death in NSTEACS group (2%). Other outcome in the two groups showed recurrent ischemia (13% vs 29%) (p=0.14) and cardiogenic shock (9% vs 2%) (p=0.17). No stroke or major bleeding was reported in both groups. CONCLUSION: NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors.

ST-Segment Elevation Myocardial Infarction: Door to Balloon Time Improvement Project.

BACKGROUND: The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC)). Primary PCI has developed as an effective treatment strategy for acute STEMI, the survival rate and patient outcome are however dependent on the time to treatment. The international benchmark for all programs dealing with acute coronary syndrome patients suffering from STEMI has been established as 90 minutes or less from the time the patient arrives at the hospital to the opening of the affected vessel in the cardiac catheterization laboratory "door-to-balloon time" or D2B. In KFCC during the year 2014, the STEMI, D2B time of ≤ 90 minutes was achieved in 25%. METHODS: We conducted a single center prospective data collection for consecutive patients presenting with STEMI within 24 hours of the onset of chest pain between January 2015 and December 2015. The boundaries of the process began when the patient entered the emergency department and ended when the balloon was inflated during the PCI. Certain well-defined metrics were chosen to drive the change and identify the defect. RESULTS: A total of 37 patients presented with STEMI. The number of patients who achieved the target D2B time ≤ 90 minutes was 20 (54%). Nine patients (24.4%) had D2B time between 91 and 120 minutes and eight patients (21.6%) beyond 120 minutes. The delays were due to late identifications of patients with chest pain as well as in obtaining ECG, activation and transport to the catheterization laboratory. CONCLUSION: There was a measurable improvement up to 54%. Several factors have contributed to the delays in achieving the goal standard of above 90%; these include late identifications of patients with STEMI, delays in obtaining the ECG, activation of the catheterization laboratory and delay of patients' transportation.

Percutaneous Intervention of a Persistent Left Superior Vena Cava Draining Into Left Pulmonary Vein and Coarctation of the Aorta.

We describe a 54-year-old male with history of type II DM, hypertension and dyslipidemia during admission for bronchopneumonia discovered to have coarctation of the aorta and a persistent left superior vena cava (PLSVC) draining into the left atrium through the left superior pulmonary vein. The latter was thought to contribute to a transient ischemic attack and an episode of chest pain resulting in ST-segment elevation in the inferior leads. He was treated with coarctation stenting and percutaneous exclusion of the PLSVC with a vascular plug.