Open Access Case Study

Polyarteritis Nodosa in Infancy – Generalized Vascular Problem Diagnosed after Initial Cardiac Manifestation in Emergency Cardiovascular Catheterization

Ireneusz Haponiuk, Maciej Chojnicki, Konrad Paczkowski, Radosław Jaworski, Mariusz Steffens, Katarzyna Gierat-Haponiuk

Cardiology and Angiology: An International Journal, Page 135-138
DOI: 10.9734/CA/2015/21707

Aim: Coronary artery diseases in children are uncommon, but in selected cases general vascular problems also affect the heart.

Case: We present the case of 4-month old girl admitted to Pediatric Intensive Care Unit after the incident of cardiac arrest and ventricular tachycardia, who underwent diagnostic catheterization due to cardiac ischemia. Coronary angiography showed changes in coronary arteries in the form of disseminated aneurysms, mixed with severely stenosed segments. General angiography discovered also changes in the number of peripheral arteries, with the most significant right subclavian and left iliac artery aneurysms.

Results: Upon angiographic images and a history of untreated infection, polyarteritis nodosa (PAN) was diagnosed, with an appropriate administration of intensive treatment.

Conclusion: The case prove the significance of invasive cardiovascular diagnostics (cardiac catheterization) in every unclear clinical course.


Open Access Case Study

A Tough Pill to Swallow- Spontaneous Retropharyngeal Hematoma: A Rare and Unusual Complication of Rivaroxaban Therapy

Ali Naqvi, Dalia Hawwass, Arnold Seto

Cardiology and Angiology: An International Journal, Page 156-159
DOI: 10.9734/CA/2015/22666

Aims: We present the first case of a patient that developed a spontaneous retropharyngeal hematoma as a complication of rivaroxaban therapy.

Case Presentation: A 49-year-old Caucasian male with chronic atrial fibrillation on rivaroxaban presented to the hospital with a rapidly expanding spontaneous retropharyngeal hematoma. He required emergent intubation for airway protection and subsequently was treated with catheter-directed embolization and surgical evacuation.

Discussion: Our report presents a case of a spontaneous retropharyngeal hematoma on rivaroxaban therapy. Unfortunately, most patients with this complication typically present with insidious symptoms including mild neck pain and ear ache, and as a result the diagnosis can easily be overlooked. Therefore, it is of utmost importance that physicians maintain a high index of suspicion, as early recognition and appropriate therapy can reduce morbidity and mortality.

Conclusion: This case highlights a rare but life-threatening hemorrhagic complication of rivaroxaban therapy.

Open Access Original Research Article

Role of Hs-CRP and Exercise Stress Echocardiography in Cardiovascular Risk Stratification of Asymptomatic Type 2 Diabetic Patients

Puneet Aggarwal, Tilak Raj Khurana, Ranjeet Nath, Swati Yadav

Cardiology and Angiology: An International Journal, Page 139-146
DOI: 10.9734/CA/2015/19495

Background: Silent ischaemia is a well known cause of mortality and morbidity in type-2 diabetic patients; however the role of high-sensitive C-Reactive Protein (hs-CRP) and exercise stress echocardiography in early detection of silent ischaemia is still less understood.

Methods: Seventy three asymptomatic diabetic patients were enrolled from Dr Ram Manohar Lohia Hospital, Delhi in year 2013-15 and the baseline characteristics of the patients were studied. All the patients underwent exercise stress echocardiography for screening of coronary artery disease (CAD). All the patients with positive exercise stress echocardiography underwent angiography for confirmation of coronary artery disease. The patients were divided into two groups on basis of exercise stress echocardiography result as positive and negative and the baseline characteristics and risk factors including high-sensitivity C-reactive protein (hs-CRP) concentrations were compared between two groups in cross sectional study.

Results: Silent ischaemia was found in 17.81% in asymptomatic diabetic patients. The positive predictive value of exercise stress echocardiography taking angiography as gold standard was found to be 84.6%. Sensitivity of hs-CRP >3 mg/L in predicting a positive exercise stress echocardiography is 53.8% and specificity is 90%. Negative predictive value of hs-CRP ≤3 mg/L in ruling out CAD is 90.0% and positive predictive value in detecting positive exercise stress echocardiography was 53.8%. Positive exercise stress echocardiography was found to be significantly associated with hypertension (HTN) (P=0.048), smoking (P=0.018), family history of CAD (P=0.002), total cholesterol (P=0.031), serum low-density lipoprotein (LDL) concentrations (P=0.041), serum hs-CRP (P=0.001), strict glycaemic control (glycated haemoglobin <7%) (P=0.028) and final ejection fraction after exercise stress (P=0.01).

Conclusion: hs-CRP and exercise stress echocardiography can be used as simple screening tool for coronary artery disease in asymptomatic diabetic patients.


Open Access Original Research Article

Statin Therapy in Patients with Type 2 Diabetes Mellitus in Hungary

Laszlo Mark, Istvan Reiber, György Paragh, Istvan Karadi, Gyula Pados, Zoltan Kiss, György Jermendy

Cardiology and Angiology: An International Journal, Page 147-155
DOI: 10.9734/CA/2015/22424

Aim: The benefit of statin administration in the secondary prevention of cardiovascular diseases in type 2 diabetes mellitus (T2DM) is well documented. The aim of the study was to evaluate the characteristics of lipid lowering therapy and the attainment of target values.

Study Design: Retrospective data analysis.

Place and Duration of Study: Between 2009 and 2011, Hungary.

Methodology: The study was conducted on the patients with T2DM and established cardiovascular events of general practitioners and specialists from the MULTI GAP (MULTI Goal Attainment Problem) survey in Hungary using standardized, structured questionnaires. Data collection was performed in 2009 (1582 patients, 55.0% men), in 2010 (1159 patients, 58.4% men) and in 2011 (668 patients, 59.1% men).

Results: In this study all patients received statins, the most frequently used was atorvastatin, followed in 2009 by simvastatin and 2011 by rosuvastatin. Fibrates were taken by 9.3–11.3% of patients and ezetimibe by 8.0–15.9% of patients. The total cholesterol (TC) values in 2009, in 2010 and in 2011 were 5.27±1.23 mmol/l, 4.90±1.30 mmol/l, 4.88±1.29 mmol/l, respectively (p>0.05). The LDL-cholesterol (LDL-C) values were 2.94±1.04 mmol/l, 2.73±0.95 mmol/l, 2.69±1.03 mmol/l, respectively (p>0.05). The proportion of patients at LDL-C target value of <2.5 mmol/l was 35.2%, 42.8%, 47.8% (p<0.001 vs values in 2009) while that of <1.8 mmol/l was 10.6%, 15.9% and 16.8%, respectively (p<0.001 vs values in 2009). There was a linear correlation between the patient compliance estimated by the physicians and the LDL-C achievement rate.

Conclusions: In 2009-2011, a slight improvement in serum cholesterol levels and a significant increase of patients at target TC or LDL-C values were documented among patients with T2DM and cardiovascular diseases. Nevertheless, the authors find very important to improve the quality of lipid lowering treatment in order to increase the number of patients achieving their target lipid values.


Open Access Original Research Article

Haemodynamic Responses to Tobacco Smoke Inhalation in Male Adolescents in Lusaka, Zambia

Chikopela Theresa, M. Goma Fastone

Cardiology and Angiology: An International Journal, Page 160-169
DOI: 10.9734/CA/2015/22969

Background: Tobacco smoke is said to cause changes in the levels of catecholamines in the blood, this leads to an increase in blood pressure and heart rate. This is due to nicotine which has also been noted to cause a decrease in vasodilatory activities leading to an increase in both the blood pressure and heart rate.

Aim: To determine the acute effects of tobacco smoke on haemodynamics in black male adolescents in Lusaka, Zambia.

Study Design: This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December, 2014.

Methodology: Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Diasys Ambulatory Blood Pressure Monitoring system (Novacor, France) was used to obtain the Systolic and Diastolic blood pressures (SBP and DBP) and the heart rate. These were obtained 15 minutes before smoking at 5 minute intervals and averaged to obtain the baseline, during the 15 minutes of smoking and on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking.

Results: There was a significant rise in SBP (mmHg) during smoking (127.9±13.80 mmHg) from baseline values (113.5±13.15 mmHg) (P < .001). It took 30 minutes for the SBP to return to baseline after cessation of smoking. DBP (mmHg) also increased from baseline (79.5±8.79 mmHg) to 85.6±10.92 mmHg during smoking (P <.01). It returned to baseline values immediately after cessation of smoking. The heart rate (bpm) was also noted to significantly increase during smoking (95.2±16.72 bpm) from the values noted before smoking (74.3±13.75 bpm) (P < .05). The mean value for heart rate returned to baseline value by the 15th minute of recovery.

Conclusion: The present study demonstrates that smoking may be the cause for the acute increases in SBP, DBP and heart rate in smokers. The smoking caused significant increases in all the haemodynamic indices considered in this study within 15 minutes. Both SBP and DBP increases are indices for stroke and coronary heart disease respectively. The effect of increased SBP was noted to last for 30 minutes while DBP returned to baseline immediately after smoking. A significant increase in heart rate was also noted in the study.