Open Access Case Study

Primary Percutaneous Coronary Intervention in a Patient with Acute Inferior Myocardial Infarction and Agenesis of Right Coronary Artery. "In Search of a Coronary Ostium"

Gabriele Giacomo Schiattarella, Fabio Magliulo, Vito Di Palma, Giovanni Esposito, Plinio Cirillo

Cardiology and Angiology: An International Journal, Page 157-161
DOI: 10.9734/CA/2015/17719

Coronary arteries with anomalous origin from the aorta may represent a trouble for interventional cardiologist, in particular in setting of acute coronary syndromes. Research of coronary ostium may cause crucial delay in reperfusion with important consequences for myocardial salvage. We described a case of inferior ST-elevation myocardial infarction (STEMI) complicated by bradyarrythmia and hypotension, and treated with primary percutaneous coronary intervention (PCI) in a patient with agenesis of right coronary ostium. The patient had only a single left coronary artery occluded at the distal portion before a bifurcation with a huge branch that encompassed the theoretical territories of right coronary artery.


Open Access Case Study

Nstemi “But” Stemi-De Winters Sign

Prem Krishna Anandan, Subramanyam K, Shivananda Patil, R. Rangaraj, Cholenahally Nanjappa Manjunath

Cardiology and Angiology: An International Journal, Page 162-166
DOI: 10.9734/CA/2015/17599

Anterior ST elevation myocardial infarction can present with a specific electrocardiographic (ECG) pattern without ST segment elevations, known as De Winter sign. Recognizing this ECG pattern is important since it is considered an equivalent to ST elevation myocardial infarction (STEMI), hence may require thrombolysis when primary PCI facilities are not available or delayed. We report a28 year old male who presented to us with de winters ecg pattern. Subsequent coronary angiogram showed Proxmial left anterior descending (LAD) artery occlusion.


Open Access Original Research Article

Comparison of In-Hospital Outcome of Acute Myocardial Infarction in Patients with vs without Diabetes Mellitus in Durres Population

Eliverta Zera, Sonela Xinxo, Mimoza Lezha

Cardiology and Angiology: An International Journal, Page 130-136
DOI: 10.9734/CA/2015/17024

Background: Diabetes mellitus (DM) is a worldwide epidemic and a major public health problem and the mortality of diabetic patients is twice higher than that of with non-diabetic patients. The in-hospital outcomes in diabetic patients with acute myocardial infarction (AMI) are less known in Albania.

Aim: To compare in-hospital outcomes of AMI in diabetic vs non-diabetic patients in Albania.

Methods: A prospective, observational study. Patients with AMI between September 2012 and October 2014 were involved in the current study. Traditional risk factors for CAD, serum creatinine levels, and coronary angiographic results were recorded. In-hospital mortality of patients with and without DM was compared. P value of <0.05 was considered statistically significant.

Results: From 420 enrolled patients with AMI, 281 (66.9%) were with DM, and 139 (33.1%) were non-diabetic. Baseline hypertension and cerebral vascular disease were more prevalent in diabetic than in non-diabetic patients. Diabetic patients also demonstrated a higher mean serum creatinine level than non-diabetic individuals (creatinine: 2.3±1.24 vs1.76±0.98 mg/dl P<0.05). Older age, multi-vessel diseases, poor renal function and higher killip class were associated with in-hospital mortality in patients with AMI. In-hospital mortality was higher in diabetic than non-diabetic patients (13.7% vs.7.9%, P<0.05).

Conclusion: The present study suggests that in Albania, the in-hospital mortality rate in diabetic patients with AMI was higher than that in non-diabetic patients, which may be related to more comorbidies in diabetic patients. Hence, early aggressive treatment in the course of diabetic patients with acute AMI is important.


Open Access Original Research Article

Sex Hormones and Their Relationship with Leptin and Cardiovascular Risk Factors in Pre and Post-Menopausal Nigerian Women with Metabolic Syndrome

U. A. Fabian, M. A. Charles-Davies, A. A. Fasanmade, J. A. Olaniyi, O. E. Oyewole, M. O. Owolabi, J. R. Adebusuyi, O. Hassan, B. M. Ajobo, M. O. Ebesunun, K. Adigun, K. S. Akinlade, O. G. Arinola, E. O Agbedana

Cardiology and Angiology: An International Journal, Page 149-156
DOI: 10.9734/CA/2015/15236

Metabolic Syndrome (MS), which affects 33.1% of Nigerians, predisposing them to cardiovascular disease (CVD) risk, has been associated with the female gender. The cardioprotective effect of oestradiol against CVD is now controversial and was investigated in premenopausal with MS (PRMMS) and postmenopausal women with MS (POMMS). 

A total of 191 women (44 PRMMS, 126 POMMS and 21 premenopausal women without MS (PRM) (controls) with mean (s.d) age of 40.0 (6.9), 57.0 (8.8), 29.0 (6.8) years were participants of this study. Demography, blood pressure (BP), anthropometry, hormones, fasting plasma glucose (FPG) and lipids were obtained by standard methods. Data were significant at (P<.05). 

Age, parity, all anthropometric measures, FPG, leptin, ET ratio and FSH were significantly higher while HDLC, testosterone and prolactin were significantly lower in PRMMS compared with controls (P<.03).  In comparison of POMMS with PRMMS, age, parity, WHR, systolic BP, TG, FSH and LH were significantly higher while body weight, HC, and leptin were lower in POMMS compared with PRMMS (P<.05). DBP positively predicted oestradiol in PRM only (P=.044) while oestradiol positively predicted testosterone in PRMMS only (P<.001). In POMMS only, DBP positively predicted testosterone; testosterone, ET ratio and FSH positively predicted oestradiol while LDLC and oestradiol positively predicted the ET ratio (P<.03).

Metabolic syndrome may predispose both pre and postmenopausal women to the risk cardiovascular disease and type 2 diabetes mellitus. Oestradiol may protect against cardiovascular diseases in women without metabolic syndrome only.


Open Access Review Article

Approaching Long Term Cardiac Rhythm Monitoring Using Advanced Arm Worn Sensors and ECG Recovery Techniques

William D. Lynn, Omar J. Escalona, David J. McEneaney

Cardiology and Angiology: An International Journal, Page 137-148
DOI: 10.9734/CA/2015/16768

According to recent British Heart Foundation statistics, one in six men and more than one in ten women die from coronary heart disease (CHD) in the UK. This equates to almost 74,000 deaths per annum from CHD alone.  More worryingly, every week, 12 apparently fit and healthy young people aged 35 and under, die from undiagnosed cardiac conditions. In both circumstances, monitoring is preformed only when triggered by an event. Unfortunately, this may be too late in the large majority of cases. For instance, there is evidence suggesting that most indiscernible cardiac abnormalities are made detectable by ECG through the act of suddenly standing upright. This infers that the condition would be detectable during the course of everyday ambulatory activity and highlights the need for a long term monitoring device. Current diagnostic equipment consists of the Holter monitor for extended periods up to 36 hours and the implantable loop recorder (ILR) for monitoring up to 3 years. The diagnostic yield of the ECG monitoring strategy is greatly increased as the monitoring period increases. Therefore, for subjects that exhibit symptoms of cardiac involvement that are transient in nature, the ILR offers the best opportunity for diagnosis. However, the ILR is inserted under the surface of the skin in the upper chest area and requires a surgical procedure, with associated risks, which makes ILR’s a costly and inconvenient option in many cases.

The need for a non-invasive long term monitoring device, which is comfortable to wear along the arm and able to provide reliable ECG monitoring, has been addressed by many, in several lines of approach to a solution. This review details the current state of the art and any pending limitations. It then presents key multidisciplinary solutions on the different aspects of the problem, which will still require integration in order to realise such a device.