Elemental analysis of ten plant species at three phenological stages.

Livestock rearing is a common practice in Tehsil Takht-e-Nasrati by the locals to earn their livelihood. Low productivity due to poor health of livestock is major consideration in the study area. In order to know whether this low productivity and poor health might be due to poor quality of forage, ten plant species were analyzed for micro mineral quantification at three phenological stages. Mineral compositions of plants are used to diagnose probable deficiencies in food and forage and nutritional status of plants. Comparison among at vegetative stage of test species and micro nutrients showed that the amount of manganese was found high (64.4mg & &Kg-1) in Chrozophora obliqua. Comparison among at reproductive and post reproductive stages of test species and micro nutrients pointed out that the amount of nickel was found high (67.24mg & Kg-1) and (80.4mg & Kg-1) respectively in Vitex trifolia. It is concluded that micro-minerals concentrations available in these forage plants to the grazing livestock were very low, hence this may be, one of the causes responsible for the pitiable health and productivity of the grazing animals in investigated area.

The Utility of Systolic and Diastolic Echocardiographic Parameters for Predicting Coronary Artery Disease Burden as Defined by the SYNTAX Score.

BACKGROUND: Early identification of high-grade ischemia based on echocardiographic diastolic abnormalities may be clinically useful in the acute coronary syndrome (ACS) setting. This could provide the clinician with an awareness of the burden of coronary artery disease (CAD) before angiography is performed to allow for early intervention of suspected ischemic lesions. The objective of the study was to assess whether 2D transthoracic echocardiography (TTE)-derived tissue Doppler imaging parameters can predict the severity of CAD in comparison with the cardiac catheterization-derived SYNTAX score. METHODS: A retrospective study of 74 stable angina or patients with ACS was performed in 2012 at a single tertiary care center. In all study subjects, TTE and angiography were performed within 6 months of each other without revascularization in the interim. RESULTS: The study population included a total of 74 patients (mean age 67 ± 12 years) with 77% presenting with an ACS. The median SYNTAX score was 24.0 (6.0-35.0). The E-wave velocity was higher, and deceleration time (DT) was lower in the high SYNTAX group in comparison with the low/intermediate SYNTAX group (P = 0.045 and P = 0.001, respectively). Septal mitral annular S' was lower in the high SYNTAX group (P = 0.02). After multivariate analysis, E/A ratio (OR 0.03, 95% 0.00-0.36, P = 0.0067), DT (OR 0.93, 95% CI 0.89-0.97, P = 0.0001) and septal annular S'-wave velocity (OR 0.34, 95% CI 0.16-0.71, P = 0.0038) remained strong predictors of a high SYNTAX score. CONCLUSION: Early identification of systolic and diastolic dysfunction based on echocardiographic parameters may be of important clinical significance for predicting CAD burden prior to invasive angiography.

Short Communication: Pharmacognostic and Pharmacological evaluation of Ruellia tuberosa L.

Ruellia tuberosa Linn. of family Acanthaceae was studied to investigate the microscopical, vein islet and vein termination numbers, palisade ratio, stomatal index and different chemical parameters. The antibacterial, antifungal and phytotoxic activities of the crude extract of the plant were also determined. Five bacterial species were used, of which, Salmonella typhi, Escherichia coli, and Pseudomonas aeruginosa were the most susceptible bacterial species to crude extract with MICs 10, 4.0 and 14mg/ml, respectively. Among the tested fungal species Fusarium solani and Aspergillus niger were more susceptible to crude extracts with MICs 1.34, 2.78 and 1.45µg/ml, respectively. At the concentration of 1000µg/ml the methnolic extract exhibited significant activity, at 100µg/ml the activity was good and at 10µg/ml the activity was moderate against Lemna minor. The above selected plants were shown by in vitro assays to be a potential source for natural antifungal, antibacterial and phytotoxic agents.

Proximate and elemental analysis of five selected medicinal plants of family Solanaceae.

The proximate analysis revealed the presence of ash, moisture, protein, fiber, fats and carbohydrate. ANOVA showed that ash and moisture contents was non significant between the plant parts and phenological stages. Crude protein was non significant between the plant parts and phenological stages except for Datura innoxia parts but not for its phenolgical stages, while crude fats were non significant between the plant parts and phenological stages except for Solanum nigrum and Solanum surattense parts but not for their phenolgical stages. Crude fiber was non significant between the plant parts and phenological stages except for Datura innoxia parts but not for its phenolgical stages. And carbohydrates was non significant between the plant parts and phenological stages except for the phenolgical stages of Solanum surattense and Withania coagulans. The mineral analysis showed the presence of Cr, Zn, Cu, Mn, Fe, Ca, K, Mg and Na in the roots, stems, leaves, flowers and fruits of the plants in three different phenological stages. Only the micro-minerals were present in traces while the macro-minerals were present high quantities as compared to the micro-minerals.

Cytotoxic activity of plants of family zygophyllaceae and euphorbiaceae.

The methanolic and n-hexane extracts of studied plants showed significant toxicity to brine shrimps. The methanolic extract of Fagonia cretica had highest LD50 (117.72) value, while Peganum harmala showed low LD50 value (41.70) compared to n-hexane extract. The methanolic and n-hexane extracts of Tribulus terrestris showed similar LD50 values. The methanolic extract of Chrozophora tinctoria showed low LD50 value than the n-hexane extract. The methanolic extract of Ricinus communis showed highest LD50 value while the n-hexane extract showed lowest LD50 value. The LD50 value less than 100 was obtained for n-hexane extracts of Fagonia cretica, Peganum harmala and Ricinus communis. The n-hexane extracts of these plants also showed the highest toxicity as compare to methanolic extracts. The chemical constituents detected in the present investigation might be responsible for cytotoxic activity.

Effect of phenological stages on nutritional assessment of ten plant species in Tehsil Takht-e-Nasrati, District Karak, Pakistan.

The proximate analysis of ten plant species from Tehsil takht-e-Nasrati, district Karak was conducted at three phenological stages using standard techniques. The species showed variable results. In the test species, the moisture content varied from 2.11-14.12 %, 1.85-11.51 and 1.12-11.51%; the ash contents varied from 3.08-17.16%, 5.09-18.12% and 6.13-19.09%; the fibre contents varied from 2.14-11.09%, 2.43-12.31% and 2.78-13.01%; the carbohydrate contents varied from 54-85.1%, (50-84.1) and 47.1-81.1%; the fat contents varied from 1.06-5.46%, 1.09-5.98% and 1.56- 6.57 %; the protein contents varied from 2.11-12.41%, 3.14-15.87% and 4.12-18.54%; the energy value varied from 305.12-394.23 KCal/100g, 314.21-423.13 KCal /100g and 321.23-434.26 KCal /100g at vegetative stage, reproductive stage and post reproductive stage respectively. Proximate analysis of such plant species can help us to determine the health benefits achieved from their use in society. It is concluded that the poor livestock productivity in research area is partially due to insufficient amount of available poor quality forage that requires attention of the range mangers to improve the habitat and livestock breeds.

A "no-option" left main PCI registry: outcomes and predictors of in hospital mortality-utility of the logistic EuroSCORE.

BACKGROUND: Although high-risk left main PCI populations have been previously described, there is little data describing outcomes and the role of the logistic EuroSCORE in surgical turndown cohorts or patients in extremis due to acute infarction or cardiogenic shock from left main ischemia. METHODS: Consecutive patients with unprotected LM PCI who were surgical turndowns or in extremis were included in this retrospective cohort from 2004 to 2009 at two tertiary centers. Predictors of in-hospital mortality were identified utilizing routine and stepwise logistic regression. RESULTS: There were a total of 56 patients with mean age of 69 (±13). There were 23 (41%) patients with cardiogenic shock. The mean logistic EuroSCORE was 23.5% ± 21%. In-hospital death occurred in 12 (21%) patients, largely restricted to the shock subgroup (11/12). Univariate predictors of mortality included peak CK levels (P = 0.01), transfusion (P = 0.01), cardiogenic shock (P < 0.002), male gender (P = 0.027), and logistic EuroSCORE (P = 0.01). Stepwise logistic regression yielded logistic EuroSCORE (P = 0.04, OR: 1.25 (95% CI: 1.01-1.56) for every 5% increase) and peak CK level (P = 0.001, OR: 1.23 (95% CI: 1.09-1.40) for every 500 unit increase) as independent predictors of in-hospital mortality. The AUC ROC for logistic EuroSCORE was 0.73; and for logistic EuroSCORE plus peak CK level was 0.89. CONCLUSION: PCI appears to be a reasonable option in the high risk "no option" LM population, with the logistic EuroSCORE and peak CK levels being independent predictors of in-hospital mortality. Specifically, the logistic EuroSCORE and peak CK level combined discriminate in-hospital mortality with a high degree of certainty.

Crude extract from Euphorbia prostrata extended curative period of glibenclemide in alloxan-induced diabetic rats.

OBJECTIVES: Euphorbia prostrata is traditionally used alongside antidiabetic agents to manage diabetes. Bioactive ingredients of medicinal herbs may alter the overall pharmacokinetics of antidiabetic agents. METHODS: We assessed hypoglycemic activities of ethanolic plant extract (EPE) singly and its effects on antidiabetic properties of gliclazide, glibenclemide and metformin in allaxonized rats. Varying concentrations of EPE (250 and 500 mg/kg) with or without metformin (10 mg/kg), glibenclemide (2 mg/kg) and gliclazide (5 mg/kg) were orally administered to evaluate herb-drug interaction. RESULTS: The levels of blood glucose declined significantly after treatment with metformin, glibenclemide and gliclazide singly (p<0.01) or concomitantly with EPE (p<0.001). Concentration dependent mild to moderate reduction (5.2 and 10.0%) was registered in blood glucose for 250 and 500 mg/kg of EPE respectively. The overall reduction in blood glucose due to combined treatment with EPE and standard agents was additive. On the other hand, synergistic herb-drug interaction was registered for insulin levels in rats that received glibenclamide and gliclazide alongside EPE. Extract with metformin had antagonistic insulin outcome. Regarding the duration of hypoglycemic activities, periodical changes were similar in case of glibenclamide and gliclazide separately or in combination with EPE. However, in case of metformin with extract, the blood glucose continued to decline for 14 h and retained at 15.0% below the baseline values even after 24 h of treatment. CONCLUSIONS: In conclusion, the extract itself had weak hypoglycemic effects but prolonged the therapeutic duration of metformin to more than 24 h when administered combinedly.

Anatomical and histochemical characterization of some highly medicinal plants as a tool for quality control.

Medicinal plants are richest source of chemical compounds that can be used to evolve novel drugs. According to World Health Organization (WHO), in developing countries more than 3.5 billion people relay on herbal drugs for their primary health care. In the present study, an attempt was carried out to authenticate some selected medicinal plants (Fagonia cretica L., Peganum harmala L., Tribulus terrestris L., Chrozophora tinctoria L. Raf. and Ricinus communis L.) from family Zygophyllaceae and Euphorbiaceae using light and scanning electron macroscopic techniques. Macroscopic evaluation and comparative anatomy (Light Microscopy) of the root and fruits revealed great diversity in macro and microscopic features. Scanning electron microscopy (SEM) of root powder showed non-glandular trichomes, stellate trichomes, parenchyma cells and vessels. Fruits SEM exhibited non-glandular trichomes, glandular trichomes, stellate trichomes, peltate trichomes and mesocarp cells. Both macroscopic and microscopic evaluation plays a crucial role in the correct substantiation and validation of novel sources. These findings can serve as an essential source of information to accomplish the authenticity and to appraise the quality and purity of the herbal drugs in accordance to WHO guidelines. These parameters can be used to distinguish the selected plants from their commonly used adulterants. RESEARCH HIGHLIGHTS: In the current work, five plants (Fagonia cretica L., Peganum harmala L., Tribulus terrestris L., Chrozophora tinctoria L. Raf. and Ricinus communis L.) from Zygophyllaceae and Euphorbiaceae were investigated for macroscopy and microscopy (LM & SEM) for the first time. Macroscopic and microscopic evaluation disclosed great diversity in morphology and histology. Microscopy is the backbone of standardization process. Current study helped in correct identification and quality assurance of the plant materials. Their statistical investigation may possess great potency for plant taxonomists to further appraise the vegetative growth and tissue development which is requisite especially for fruit to enhance the yield of herbal drugs and their formulation. Further molecular studies, compounds isolation and characterization are required to deepen the knowledge of these herbal drugs.

Spontaneous dissection of the coronary and vertebral arteries post-partum: case report and review of the literature.

BACKGROUND: Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period. CASE PRESENTATION: This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery. CONCLUSION: We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.

The acutely occluded left main coronary artery culprit in cardiogenic shock and initial percutaneous coronary intervention: a substudy of the Manitoba "no option" left main PCI registry.

We aim to describe the in-hospital outcomes of the first reported Canadian cohort of patients with cardiogenic shock and acute myocardial infarction (MI) due to acute and total occlusion of the left main coronary artery, treated with initial percutaneous coronary intervention (PCI). Acute left main thromboses with cardiogenic shock were identified (N = 8) from a retrospective consecutive cohort of high risk left main PCI (N = 56) performed at our institution from 2004-2009. The mean age was 62.3 ± 13.2 years, with 6 (75%) male patients. Successful PCI was performed in all patients, with thrombectomy utilized in 4 patients (50%), stenting in 7 patients (88%), and intra-aortic balloon pump augmentation in 7 patients (88%). Two patients (25%) required extracorporeal membrane oxygenation (ECMO) and 2 other patients required ventricular assist devices. Post-PCI coronary artery bypass grafting (CABG) was performed for 2 patients (25%). The mean SYNTAX score was 26.6 ± 10.5. The mean logistic EuroSCORE was 30.4 ± 12.6%. In-hospital mortality occurred in 3 patients (38%). Acute left main occlusion is a rare but devastating presentation of myocardial infarction, invariably with cardiogenic shock. Emergent PCI may be an effective method to acutely revascularize this subset of patients; however, aggressive post-PCI care including ECMO, CABG, and ventricular support may be required to improve patient survival.

The ability to achieve complete revascularization is associated with improved in-hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic SHOCK Registry investigators.

OBJECTIVES: To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort. BACKGROUND: Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization. METHODS: A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in-hospital survival were identified utilizing logistic regression. RESULTS: ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization (P = 0.013, OR = 0.26 (95% CI: 0.09-0.76), hyperlactatemia (P = 0.046, OR = 1.14 (95% CI: 1.002-1.3) per mmol increase), baseline renal insufficiency (P = 0.043, OR = 3.45, (95% CI: 1.04-11.4), and the presence of anoxic brain injury (P = 0.008, OR = 8.22 (95% CI: 1.73-39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population (N = 101), independent predictors of survival to discharge included complete revascularization (P = 0.03, OR = 2.5 (95% CI: 1.1-6.2)) and peak lactate (P = 0.02). CONCLUSIONS: The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.

Multimodality Imaging of a Saphenous Vein Graft Aneurysm.

The use of multimodality cardiac imaging including echocardiography, cardiac computed tomography and cardiac catheterization for the diagnosis of a saphenous vein graft aneurysm is described. (Echocardiography, ****;**:E1-E2).

The utility of dobutamine stress echocardiography for the diagnosis of coronary artery disease in the HIV population.

BACKGROUND: The introduction of highly active antiretroviral therapy (HAART) has increased human immunodeficiency virus (HIV) patient longevity by 10-15 years. This increased longevity has habituated new cardiovascular complications, in particular, accelerated coronary artery disease (CAD). Although dobutamine stress echocardiography (DSE) is a highly sensitive and specific test for the noninvasive detection of underlying CAD in the general population, its utility in the HIV population remains unknown. OBJECTIVE: The objective of the current study was to assess the validity of DSE for the noninvasive detection of underlying symptomatic CAD in the HIV population using cardiac catheterization as the gold standard. METHODS AND RESULTS: A total of 40 HIV positive patients (mean 49 ± 8 years; 31 males) between 2006 and 2009 inclusively underwent routine DSE and coronary angiography. A positive stress echo with new wall motion abnormalities was detected in 9 (23%) individuals. Coronary angiography, following DSE, detected obstructive CAD in 12 (30%) individuals. For the diagnosis of obstructive CAD, DSE has a sensitivity of 67%, specificity of 97%, positive predictive value (PPV) of 89%, and negative predictive value (NPV) of 87%. CONCLUSION: In this select HIV population, DSE was highly specific for the noninvasive detection of obstructive CAD.

Stress echocardiography: abnormal tissue Doppler imaging in the absence of cardiac allograft vasculopathy in heart transplant recipients.

BACKGROUND: The most significant predictor of long-term survival in heart transplant patients is the development of accelerated cardiac allograft vasculopathy (CAV). Several studies have demonstrated the usefulness of dobutamine stress echocardiography (DSE) for screening CAV, by detecting regional wall motion abnormalities. Tissue Doppler imaging (TDI)-derived indices during DSE allow for the early detection of ischemic heart disease (IHD), prior to a reduction in regional or global systolic function. These indices include a reduction in annular systolic velocity (S'), a decrease in early diastolic annular velocity (E'), and prolongation of time to E'. In cardiac transplant patients, the application of these TDI abnormalities during DSE remains unknown. OBJECTIVE: The objective of this study was to evaluate the pattern of (TDI-derived indices of systolic and diastolic function during DSE in cardiac transplant patients without evidence of CAV. METHODS: A retrospective evaluation of 30 patients (mean age 54 +/- 11 years) who had both DSE and coronary angiography was performed. The control group consisted of 15 patients referred to rule out coronary artery disease while the study group consisted of 15 cardiac transplant patients referred for routine annual follow-up. During each stage of DSE, tissue Doppler measurements of systolic (S'), early (E'), and late (A') diastolic velocities of the lateral annulus were taken. RESULTS: All 30 patients had normal DSE based on systolic regional function and normal coronary angiograms with no stenosis >50%. There was no difference in hemodynamic parameters during the DSE at baseline and with stress. Despite normal coronaries, cardiac transplant patients demonstrated lower S', E', and A' velocities at peak stress compared to the control patients. CONCLUSION: Dobutamine-induced augmentation of TDI velocities of the lateral annulus, normally observed in the absence of ischemia in nontransplanted adults, is reduced in cardiac transplant recipients.

Clinical utility of tissue Doppler imaging in patients with acute myocardial infarction complicated by cardiogenic shock.

BACKGROUND: Echocardiography is widely used in the management of patients with cardiogenic shock (CS). Left ventricular ejection fraction (EF) has been shown to be an independent predictor of survival in CS. Tissue Doppler Imaging (TDI) is a sensitive echocardiographic technique that allows for the early quantitative assessment of regional left ventricular dysfunction. TDI derived indices, including systolic velocity (S'), early (E') and late (A') diastolic velocities of the lateral mitral annulus, are reduced in heart failure patients (EF < 30%) and portend a poor prognosis. In CS patients, the application of TDI prior to revascularization remains unknown. OBJECTIVE: To characterize TDI derived indices in CS patients as compared to patients with chronic CHF. METHODS: Between 2006 and 2007, 100 patients were retrospectively evaluated who underwent echocardiography for assessment of LV systolic function. This population included: Group I) 50 patients (30 males, 57 +/- 13 years) with chronic CHF as controls; and Group II) 50 patients (29 males, 58 +/- 10 years) with CS. Spectral Doppler indices including peak early (E) and late (A) transmitral velocities, E/A ratio, and E-wave deceleration time were determined. Tissue Doppler indices including S', E' and A' velocities of the lateral annulus were measured. RESULTS: Of the entire cohort, the mean LVEF was 25 +/- 5%. Cardiogenic shock patients demonstrated significantly lower lateral S', E' and a higher E/E' ratio (p < 0.01), as compared to CHF patients. The in-hospital mortality in the CHF cohort was 5% as compared to the CS group with an in hospital mortality of 40%. In the subset of CS patients (n = 30) who survived, the mean S' at presentation was higher as compared to those patients who died in hospital (3.5 +/- 0.5 vs. 1.8 +/- 0.5 cm/s). CONCLUSION: Despite similar reduction in LV systolic function, CS patients have reduced myocardial velocities and higher filling pressures using TDI, as compared to CHF patients. Whether TDI could be a reliable tool to determine CS patients with the best chance of recovery following revascularization is yet to be determined.

Quantitative study of medicinal plants used by the communities residing in Koh-e-Safaid Range, northern Pakistani-Afghan borders.

BACKGROUND: The residents of remote areas mostly depend on folk knowledge of medicinal plants to cure different ailments. The present study was carried out to document and analyze traditional use regarding the medicinal plants among communities residing in Koh-e-Safaid Range northern Pakistani-Afghan border. METHODS: A purposive sampling method was used for the selection of informants, and information regarding the ethnomedicinal use of plants was collected through semi-structured interviews. The collected data was analyzed through quantitative indices viz. relative frequency citation, use value, and family use value. The conservation status of medicinal plants was enumerated with the help of International Union for Conservation of Nature Red List Categories and Criteria (2001). Plant samples were deposited at the Herbarium of Botany Department, University of Peshawar for future reference. RESULTS: One hundred eight informants including 72 male and 36 female were interviewed. The informants provided information about 92 plants species used in the treatment of 53 ailments. The informant reported maximum number of species used for the treatment of diabetes (16 species), followed by carminatives (12 species), laxatives (11 species), antiseptics (11 species), for cough (10 species), to treat hepatitis (9 species), for curing diarrhea (7 species), and to cure ulcers (7 species), etc. Decoction (37 species, i.e., 40%) was the common method of recipe preparation. Most familiar medicinal plants were Withania coagulans, Caralluma tuberculata, and Artemisia absinthium with relative frequency (0.96), (0.90), and (0.86), respectively. The relative importance of Withania coagulans was highest (1.63) followed by Artemisia absinthium (1.34), Caralluma tuberculata (1.20), Cassia fistula (1.10), Thymus linearis (1.06), etc. This study allows identification of novel uses of plants. Abies pindrow, Artemisia scoparia, Nannorrhops ritchiana, Salvia reflexa, and Vincetoxicum cardiostephanum have not been reported previously for their medicinal importance. The study also highlights many medicinal plants used to treat chronic metabolic conditions in patients with diabetes. CONCLUSIONS: The folk knowledge of medicinal plants species of Koh-e-Safaid Range was unexplored. We, for the first time, conducted this quantitative study in the area to document medicinal plants uses, to preserve traditional knowledge, and also to motivate the local residents against the vanishing wealth of traditional knowledge of medicinal flora. The vast use of medicinal plants reported shows the significance of traditional herbal preparations among tribal people of the area for their health care. Knowledge about the medicinal use of plants is rapidly disappearing in the area as a new generation is unwilling to take interest in medicinal plant use, and the knowledgeable persons keep their knowledge a secret. Thus, the indigenous use of plants needs conservational strategies and further investigation for better utilization of natural resources.

Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry).

Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8-47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.

Happiness can break your heart: a rare case of takotsubo cardiomyopathy after good news.

Takotsubo cardiomyopathy (TTC) mimics acute myocardial infarction on electrocardiography and is characterized by transient left ventricular dysfunction and positive cardiac biomarkers in the absence of significant coronary disease. In the majority of cases, TTC affects postmenopausal women and is commonly incited by a recent negative emotional stressor, although the pathophysiological mechanism of this process is incompletely understood. In contrast, we describe a case in which TTC developed after a recent positive emotional event in a postmenopausal woman.

Multimodality cardiac imaging of a left ventricular thrombus: a case report.

BACKGROUND: Left ventricular thrombus (LVT) formation occasionally complicates patient recovery post myocardial infarction, conveying a significant risk of systemic embolism. Accordingly, thrombus detection and subsequent anticoagulation is imperative in order to minimize patient morbidity and mortality. Transthoracic echocardiography (TTE) is the imaging modality most widely used to screen for thrombus formation despite its suboptimal sensitivity and specificity. CASE PRESENTATION: This report describes the discordant imaging findings of a LVT in a 56 year old Caucasian male with an anterior ST elevation myocardial infarction. Left ventriculography revealed a filling defect, suggestive of a potential left ventricular (LV) thrombus, which could not be confirmed by TTE. Cardiac magnetic resonance imaging (MRI) demonstrated evidence of a full thickness scar involving the mid to distal anterior wall and apical regions, with confirmation of a small LV apical thrombus. CONCLUSIONS: This case illustrates the limitations of TTE when used as a tool to screen for thrombus formation. It highlights the importance of multimodality cardiac imaging for the detection of post myocardial infarction (MI) complications, in the context of a high clinical suspicion.