Open Access Case Study

Hammock Bridge on Fire: Complete AV Block in a Patient with Congenitally-corrected Transposition of the Great Arteries and Wolff-Parkinson-White Pre-excitation Pattern

Jorge A. Brenes-Salazar, Paul A. Friedman

Cardiology and Angiology: An International Journal, Page 19-24
DOI: 10.9734/CA/2015/18045

Aims: To recognize heart block as a complication associated with congenitally-corrected transposition of the great arteries (CCTGA).

Presentation of the Case: A healthy 36 year old male with CCTGA presented with syncope as a manifestation of heart block. A unique feature of this case was the presence of an accessory pathway that served as the atrio-ventricular conducting structure for more than 3 decades.

Discussion: rationale for a cardiac resynchronization device (CRT) as opposed to a simple pacemaker system is emphasized in this case.

Conclusion: clinicians must be aware of heart block a frequent complication of CCGTA. CRT appears as a more favorable option than a single systemic ventricular pacemaker in such patients.


Open Access Case Study

Chasing Complications of Balloon Mitral Valvotomy

Shivakumar Bhairappa, Prakash Sadashivappa Surhonne, Shankar Somanna, Rohit Chopra, Cholenhally Nanjappa Manjunath

Cardiology and Angiology: An International Journal, Page 37-42
DOI: 10.9734/CA/2015/18368

Percutaneous balloon mitral valvotomy (BMV) done for mitral stenosis (MS) though largely improved nowadays can be followed by multiple and rare procedure related complications. We present an interesting case of a 45 year old male with symptomatic severe mitral stenosis of rheumatic origin. Ultimately, though he underwent a successful BMV it was ridden with multiple rare procedure related complications. Intra procedural perforation of left atrium with hemopericardium and pericardial tamponade occurred in the first attempt at BMV while rupture of BMV balloon, multiple clots in left atrium (LA) after the procedure and a large pericardial effusion occurred in the second albeit successful attempt. To the best of our knowledge this is the first case to report multiple LA clots post BMV.


Open Access Original Research Article

Association of Adipose-derived Hormones with Atherosclerosis Indices in Metabolic Syndrome Patients

Sikander Garg, Kanchan Vohra, Sudhir Varma, Harpreet Singh Kalra, Jasmeen .

Cardiology and Angiology: An International Journal, Page 1-9
DOI: 10.9734/CA/2015/17860

Aim: The study was aimed to determine the association of adipose derived hormones, adiponectin, leptin, and adiponectin/leptin (A/L) ratio with presence and degree of atherosclerosis in metabolic syndrome patients.

Study Design: Open label, pilot, case-control study.

Place and Duration of Study: Sadbhavna Medical and Heart Institute, Patiala and, Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab, (INDIA), between January 2013 and December 2013.

Methodology: Metabolic syndrome patients (n=55) with age ≥ 18 years, undergoing angiography for diagnosis and/or interventional treatment of atherosclerosis, and 25 matched control subjects were recruited. Evaluation of traditional and novel cardiovascular risk factors (adipose-derived hormones) and their association with angiographic-derived presence and degree of atherosclerosis indices (number of blocked vessels, severity index, and extent index) was carried out. Continuous variables were expressed as mean ± standard error mean and discrete variables were presented as frequencies and percentages. One way ANOVA was used to assess the difference b/w the groups characterized according to the number of vessels blocked. For each of the indices, the significant univariate predictors were entered into a forward stepwise multivariate regression model (model 1 and model 2) to determine the independent predictors. Statistical significance was accepted at      P≤. 05.

Results: The independent predictors of atherosclerosis for number of blocked vessels were low serum adiponectin and high total cholesterol level. For extent and severity index, low adiponectin level was the only significant and independent predictor. Leptin and A/L ratio could not prove as significant predictors (P≥. 05).

Conclusion: Total cholesterol, adiponectin, leptin and A/L ratio might play a vital pathogenic role not only in the occurrence, but also in the severity, extent, number of vessels blocked complexity in metabolic syndrome patients.


Open Access Original Research Article

Impact of Diabetes Mellitus on Coronary Artery Disease in Women Attending Coronary Angiography in Gaza- Palestine: An Observational Study

Amal Jamee, Yehia Abed, Maryiem Ramadan, Kalid El-Rabia, Ghada Nasser, Mohammed Hijazi

Cardiology and Angiology: An International Journal, Page 10-18
DOI: 10.9734/CA/2015/17940

Aims: It is well know that Diabetes Mellitus (DM) is crucial risk factors for Coronary artery disease (CAD). The present study aimed to investigate characteristics and angiographic profiles of the CAD in diabetic’s women in comparison with non diabetics.

Methodology: Documented CAD was examined in 688 women, attending angiographic examination in El-Hayat cardiology center in Gaza City during period 2010 – 2013.  Cross sectional design was applied in this study where variables of interest are examined at the same point of the women examination, and predisposing risk factors were recording. CAD severity was assessed by the number of arteries 0-3 with more than 50% stenosis.

Results:  420 of study population (61%) were diabetics, the diabetics women were older (P =0.02), had higher prevalence of hypertension, high level of Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) and high level of Triglycerides (TG), the P value for all these variables cited was less than 0.001. The Body mass index (BMI) was the same in the two groups (P =0.76); women with diabetes have higher prevalence of severe stenosis in the angiography, where normal vessel was reported in 36.4%, single vessel 26.9%, double vessels 18.6% and triple vessels 18.1% vs 57.8%, 17.9%, 12.7%, 11.6% in non diabetic’s women respectively with significant statistical difference (P=0.001). Binary logistic regression analysis showed that diabetes mellitus was stronger predictor of CAD.

Conclusion: Our data shows a strong association of diabetes effect more than other factors, on atherosclerosis. Information for future prospective studies is needed for primary, secondary and tertiary prevention of cardiovascular disease in Palestine.


Open Access Original Research Article

Non-linear Analysis of Heart Rate Variability Improves Differential Diagnosis between Parkinson Disease and Multiple System Atrophy

Donatella Brisinda, Francesco Fioravanti, Emilia Iantorno, Anna Rita Sorbo, Angela Venuti, Claudia Cataldi, Kristian Efremov, Riccardo `Fenici

Cardiology and Angiology: An International Journal, Page 25-36
DOI: 10.9734/CA/2015/18110

Aims: Parkinson's disease (PD) and multiple system atrophy (MSA) are neurodegenerative disorders characterized by motor "parkinsonian" symptoms and non-motor symptoms related to autonomic nervous system (ANS) dysfunction. The latter can be quantified with the analysis of Heart Rate Variability (HRVa) and of its complexity. In this study nonlinear (NL) HRV complexity parameters were calculated to assess their predictive accuracy as markers of “disease” useful for early differentiation between PD and MSA in parkinsonian syndromes of uncertain diagnosis.

Study Design: Observational study.

Place and Duration of Study: Clinical Physiology-Biomagnetism Center, Policlinico A. Gemelli, Rome Italy. Patients enrolled from January 2010 to October 2013.

Methodology: 51 patients [25 with “certain” diagnosis of PD, 9 with a “highly probable” diagnosis of MSA and 17 with parkinsonian syndromes of uncertain neurological definition (6 with “undefined parkinsonism” and 11 with “suspected MSA”)] and 40 age-matched healthy control subjects were studied. Short-term NL HRVa was performed during daily activity and during REM/NREM sleep from 24 h ECG recordings. Discriminant analysis (DA) was used to identify which NL HRV parameters (or their combination) were efficient to differentiate between PD and MSA in cases of uncertain diagnosis.

Results: Compared with healthy controls, most NL HRV parameters were significantly altered in patients (p<0.05), during both active and passive awakeness and during sleep. Most evident HRV abnormalities were found during active awakeness in MSA. DA of recurrence plot parameters provided the best predictive accuracy (76.5%) for the classification of parkinsonian patients with uncertain diagnosis.

Conclusion: NL HRVa is efficient in differentiating MSA from PD and may improve earlier diagnosis in patients with parkinsonian symptoms of uncertain nature, useful to address second level diagnostic steps and to guide more individualized drug treatment.