Open Access Case Study

Which Graft must be Preferred in Firearm Injury of the Axillary Artery

Aşkın Ender Topal

Cardiology and Angiology: An International Journal, Page 76-80
DOI: 10.9734/CA/2014/9328

Aims: Interposition graft technique is used mostly in firearm wounds of axillary artery, because of excessive defect of the vessel. Autologous vein has been preferred in general application, even though there is a mild size discrepancy between native artery and autologous vein. However, in many series, prosthetic graft infection risk has been reported as low.

Presentation of Case: I am presenting a patient with a gunshot wound to the right upper chest. As a first choice I preferred saphenous vein which was occluded by thrombosis at the post-repair third week in spite of anticoagulant therapy and was replaced with prosthetic graft which was patent at the eight month follow-up.

Discussion: Although the theoretical risk of infection of prosthetic grafts, many previous reports have demonstrated that prosthetic grafts are nearly as safe as autologous grafts and they have high long-term patency rate.

Conclusion: There is no point in insisting on autologous grafts in cases of the diameter discrepancy between native artery and autologous graft, prosthetic graft may be used more frequently in axillary artery trauma, and post-repair anticoagulants may be administered in the consequences of size discrepancy between the native artery and the graft.


Open Access Case Study

Central Venous Catheter in Obese Patient May Even Cause Cor Pulmonale

Aşkın Ender Topal

Cardiology and Angiology: An International Journal, Page 81-86
DOI: 10.9734/CA/2014/9329

Introduction: Sometimes the needless usage of central venous catheter, conflicting with indications, has been witnessed. Unfortunately, incidence of axillary-subclavian venous thrombosis has risen gradually because of increased use of the subclavian vein for central venous access. Furthermore obesity is common among patients with deep vein thrombosis, with a prevalence of 20-25%.

Presentation of Case: I am presenting a 35-year old morbidly-obese woman with cor pulmonale resulting from post-catheterization thrombosis of jugular, axillary, subclavian veins, and superior vena cava.

Discussion: Obese individuals have higher levels of factor VIII and factor IX. Obesity promotes deep vein thrombosis by inducing plasma viscosity and erythrocyte aggregation as well. Obesity causes, via leptin, increasing activity of coagulation cascade and decreasing fibrinolysis. Also it increases inflammation, oxidative stress and endothelial dysfunction. Obesity together with central venous catheter use may increase the risk for the development of deep vein thrombosis and subsequent cor pulmonale.

Conclusion: Requirement of central venous catheter must be reconsidered before introducing, especially in an obese patient.


Open Access Short Research Article

Evaluation of Arterial Pulse Amplitude Ratio and Valsalva Ratio in Different Age Groups

Yesar M. H. AL-Shamma, Ahlam K. A. AL-Hamdany, Amir S. AL-Mu’min

Cardiology and Angiology: An International Journal, Page 102-108
DOI: 10.9734/CA/2014/8482

Aims: To construct normal values of Valsalva ratio for heart rate responses during Valsalva maneuver (VM) and arterial pulse amplitude ratio as reference values for different age groups, and to investigate the effect of aging alone ,  without , the presence of  risk factors, on autonomic nervous system. This is a case control study, performed in Marjan teaching hospital, in Hilla city, from February 2012 to June 2012.

Methodology: 40 subjects were included in this study, all were healthy males, group 1 (G1) mean age 28.3±9.7 years, group 2 (G2) mean age 48.4±7.1 years. Strips of lead II of ECG were recorded during performance of VM for calculation R-R intervals and measurement of blood pressure during phase I and phase II by mercury sphygmomanometer. Calculation of Valsalva ratio for heart rate and arterial pulse amplitude ratio for both groups were done.

Results: The systolic and diastolic blood pressures of G2 were significantly  higher than values of systolic and diastolic blood pressures of G1 at phase I and phase II of VM (P=0.05). Pulse pressure for the two groups at phase I (G1:51±11, G2: 53±13mmHg) and phase II (G1:41±5, G2:41±3.99) of VM were not significant (P>0.05). Valsalva ratio for G1 was (1.5±0.3) and for G2 was (1.39±0.29), pulse amplitude ratio for G1 was (0.80±0.19) and for G2 was (0.77±0.19). There were no significant differences between the two groups (P>0.05). All values were expressed as mean±SD.

Conclusions: The results showed that the autonomic nervous system is intact in the older group. The aging process, without the presence of risk factors, does not affect the autonomic nervous system.


Open Access Original Research Article

Cost-effectiveness Analysis of Interventions to Improve Control of High Blood Pressure in Low Resource Settings: The Case of Nigeria

Obinna I. Ekwunife, Cletus N. Aguwa

Cardiology and Angiology: An International Journal, Page 87-101
DOI: 10.9734/CA/2014/10292

Objectives: Prevalence of hypertension is on the rise in most African countries while control remains poor. In the literature, there are effective interventions which could be implemented in hospitals of low resource setting such as Nigeria to improve control of blood pressure. This study aimed to evaluate the cost-effectiveness of three of such interventions namely: self-monitoring; health professional led care; and organization driven care interventions.

Methods: A Markov model was used to represent a life cycle of Nigerian hypertensive female patients in low risk of having a cardiovascular event. Health care costs were obtained from existing databases and calibrated to Nigerian setting or derived through a cost analysis using a Nigerian hospital. Costs were presented in 2013 US dollars value. Uncertainties in the input parameters used in the analyses were captured using distributions appropriate for each parameter. Probabilistic cost-effectiveness analysis was performed using Markov Chain Monte Carlo simulation, and presented as cost-effectiveness acceptability frontiers. Population expected value of perfect information analysis was conducted.

Results: Compared to null scenario (i.e. no intervention), professional led care intervention will require $190/QALY to emerge the most cost-effective option. The Population Expected Value of Perfect Information (EVPI) analysis showed that the opportunity cost surrounding the  choice of professional led care intervention as the most cost-effective option does not amount to very much.

Conclusions: The result of this study shows that among the interventions compared health professional led care through a pharmaceutical care model or nurse led care is the most cost-effective option for ensuring that patients with high blood pressure are adequately followed for better control of blood pressure.


Open Access Original Research Article

Assessment of a Cardiac Rehabilitation Program Based on the Borg RPE Scale by Six-minute Walk Test: A Pilot Study

Herbert F. Jelinek, Thomas Collins, Megan Smith, Hosen Kiat

Cardiology and Angiology: An International Journal, Page 109-117
DOI: 10.9734/CA/2014/8936

Aims: The ability of cardiac rehabilitation to reduce mortality in those with cardiovascular disease is well established. Despite its widespread use in the clinical setting, the Borg Rating of Perceived Exertion (RPE) scale is yet to be validated for its ability to lead to improvements in functional capacity.

Study Design: A closed cohort pilot study.

Place and Duration of Study: Department of Physiotherapy, Albury Base Hospital and School of Community Health, between November 2008 and November 2009.

Methodology: Fifteen participants were assessed prior to and following completion of a cardiac rehabilitation program. Exercise was prescribed according to the Borg RPE scale. Pre and post Six-Minute Walk Test (6MWT) scores were obtained to determine the impact of the cardiac rehabilitation program.

Results: Fifteen cardiac rehabilitation participants completed all requirements of the study after an initial enrolment of 22 patients. Wilcoxon signed-ranks test showed statistically significant improvements in 6MWT scores following participation in the cardiac rehabilitation program (p=.033) from a median value of 412 metres to 475 metres.

Conclusion: In this pilot study, cardiac rehabilitation programs based on the Borg RPE scale may improvefunctional capacity measured by 6MWT during a 6-week period.