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Resistant Kawasaki Disease in an Infant Causing Giant Coronary Aneurysms with Thrombosis
Abstract
Giant coronary artery aneurysms that occur in 0.5 to 1% of patients with Kawasaki disease can be fatal if associated with thrombosis. Some patients may show persistent inflammation and fever despite treatment with repeated doses of intravenous immunoglobulin (IVIG), steroids, and aspirin. This report describes an infant boy with resistant Kawasaki disease who presented with extensive coronary artery involvement and coronary thrombosis. His inflammation was not controlled with multiple doses of IVIG, parenteral and oral steroids, or high-dose aspirin, and he finally needed infliximab, a monoclonal antibody against tumor necrosis factor alpha.
Read More About This Article: https://irispublishers.com/ojcrr/pdf/OJCRR.MS.ID.000595.pdf
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Lung Transplant Consideration: Anesthesiologist Perspective
Abstract
Lung transplant has seen a significant progress since 1963 till this era. Worldwide lung transplant indications have broadened with time. Alpha 1 antitrypsin deficiency used to be the most common reason for transplant but now conditions like idiopathic pulmonary fibrosis, Cystic fibrosis, Non Cystic fibrosis bronchiectasis, lymphangioleiomyomatosis have become leading indications towards lung transplant. Relaxation of donor selection criteria management protocol preserving and optimizing lung function with development ex vivo perfusion techniques to recondition suboptimal lung has improved lung transplantation success. Post-transplant survival still poses challenge as median survival stands low around five years.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/lung-transplant-consideration-anesthesiologist-perspective.ID.000594.php
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Online Journal of Cardiology Research & Reports Wishing you Happy Thanksgiving Day!
Thanksgiving day is a jewel, to set in the hearts of honest men; but be careful that you do not take the day, and leave out the gratitude.
Happy Thanksgiving Day?
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Normal P, QRS & T Axis on an Electrocardiogram (ECG) as Seen in Plateau Specialist Hospital, Jos. Central Nigeria
Abstract
Background: In making cardiovascular diagnosis, ECG stands out. QRS axis determination is the only considered axis. The P and T axis are most often ignored. Normal values of these axis need further scrutiny.
Materials and Methods: This was a secondary analysis carried out on a study on normal adult ECG in the ECG room of the Plateau State Hospital, Jos Nigeria. A number of normal ECG were reviewed over a 3-month period considering sex, age, PR interval, QTc and the P, QRS and T axis were analyzed. The axis was analyzed in relation to gender and age.
Results: A total of 81 normal ECG recordings with about 70% women with a mean age of 41 years with no significant gender difference were analyzed. Normal P axis (y = 0.07x +49.64) and normal T axis (y = 0.23x =30.08) had a positive relationship with age, while that of the normal QRS axis (y = -0.38x +55.37) was negative.
Conclusions: The normal P, QRS and T axis did not differ with gender. The normal P and T axis appear to increase slightly with age, the QRS axis which is the commonly observed axis appear to decrease with age.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/normal-pqrs-&-axis-on-an-electrocardiogram-ecg-as-seen-in-plateau.ID.000593.php
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Inspirational Muscle Training with Linear Device in Post-Operative Myocardial Revascularization: Systematic Review
Abstract
Introduction: Human isborn, lives and dies in the Earth’s natural magnetic field (EMF), however the enormous intensities of EMF i.e. anomalous magnetic fields (AMF-s) produce pathological conditions when various diseases can occur. Cardiovascular diseases (CVD) are diseases of the heart and blood vessels. “The main cause of CVD in 95% of cases is atherosclerosis, and the symptoms appear when the process is in an advanced stage”.
Goal: The goal of this work is to prove that the etiopathogenesis of CVD occurs under the influence of enormous intensities of EMF, altered natural values, ie. AMF. To explain how AMFs act pathogenically causing diseases. To explain the development of atherosclerosis, arteriosclerosis, varicose veins and aneurysms, cardiomyopathy, and other diseases. To explain how and why diabetics, smokers and people with more iron in their blood are predisposed to CVD. Explain the official risk factors (high blood pressure, physical inactivity, smoking, alcohol, sugar, LDL cholesterol, obesity) that are a consequence of the presence of AMF and explain their role in the body. It is also necessary to explain the electrophysiological interpretation of the heart as a pump, because from physiology it is not clear and there are many ambiguities in the explanation of the heart, such as how the potential difference up to about 100 mV in the heart, then how the nervous system stimulates heart vagus brakes and sympathetic stimulates the heart). To explain the therapeutic possibilities of the stay of patients in natural EMF. To briefly explain the work of the immune system and the development of autoimmune diseases.
Methodology: In order to determine the connection between AMF and CVD, the intensity of EMF and AMF was measured in the beds of patients with a proton magnetometer with an accuracy of 100 nT (nano tesla) and the results are shown in the sketches. The influence of AMF on the organ of the patient was discovered and then it was removed outside the influence of AMF and the health condition was monitored. Then, CVD was studied from the scientific literature, which is 95% caused by atherosclerosis. Some unexplained physiological interpretations of heart function have been singled out. The risk factors that are not the root causes of CVD but a consequence of the present AMF are explained, and they influence the acceleration or slowing down of the pathological process.
Results: In order to achieve the right results, an objective assessment of the applicability of the used geophysical method was necessary. On that occasion, a synthesis of two groups of data was performed. By processing the first group of data, a correlation was established between the present AMF and the region of the body affected by CVD. The second group of data are theoretical explanations of the ambiguities found in the CVD literature from the aspect of knowledge of magnetic and electrical properties. Matching of practical measurement results and theoretical explanations of many ambiguities has been established. Atherosclerosis is a disease where fat and calcium are deposited in the wall of one part of the blood vessel, where the fibril cells of the blood vessels of increased division under the influence of AMF contributed to the formation of plaque that narrows the lumen of the blood vessel. An explanation of several physiological ambiguities is given among which arteriosclerosis and atherosclerosis are explained. Arteriosclerosis and aging of the organism occur due to the complete clogging with calcium and lipids of all blood vessels, which become smaller in volume and brittle (less elastic) and deliver less oxygen and food to cells which results in faster aging. Staying of patients in natural EMF leads to recovery of patients and slowing down of aging.
Conclusion: The root cause of cardiovascular diseases are abnormal magnetic fields from the external environment, which in 95% first allow atherosclerosis to occur and it enables heart and brain infarction, cardiomyopathy, aneurysms, and varicose veins and other diseases can also occur. The same location of the anomalous magnetic field from the outside environment and in the body of many diseases was determined by measurement. A clear proof of the measured increased values of AMF is the predisposition of people for the development of CVD in the body with increased irons content in the blood of patients because it is a consequence of the presence of AMF from the environment and iron is magnetic. All official factors of difference are a consequence of the main cause of CVD, which is AMF from the external environment in people’s living spaces. Risk factors are not the root causes of CVD but the consequence of the existence of AMF from the environment, and can only slow down the formation of CVD, when they are regulated and vice versa accelerate the development of CVD and only when staying in AMF from the environment The measured potentials in the heart up to 100 mV are caused by the difference of the electric potential between the left heart negatively charged arterial blood and the right heart in which the venous blood has a lower electric potential and this difference of electric potential is up to 100 mV when the chambers are full of blood. Stimulating currents in the heart are created in the brain, which stimulate the work of the heart with the vagus (inhibits the work of the heart) and the sympathetic nervous system (increases the work of the heart). This work explains the occurrence of atherosclerosis, the root cause of which is body viscous magnetization that occurred in an anomalous magnetic field from the external environment. Arteriosclerosis occurs, with the aging of the organism, the work of the immune system enables the difference in the magnetic forces of leukocyte cells and pathological agents. Occurrence of autoimmune diseases is a product of anomalous magnetic fields from the external environment that increase the magnetic properties of cells that are located in the anomalous magnetic field where autoimmune diseases occur. The greatest help to a patient with cardiovascular diseases is to stay in a natural EMF, which is an aid in treatment and prevention to prevent the disease.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/anomalous-growth-of-the-magnetic-field-is-the-root-cause-of-cardiovascular-diseases.ID.000621.php
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Improving the Tolerability and Efficiency of Electrocardiograms in Psychiatric Hospitals: A Pilot Study
Abstract
Many of the anti-psychotic drugs have the side-effect of corrected QT interval (QTc) prolongation. QTc prolongation is associated with ventricular arrhythmias, Torsade de pointes and sudden death. Therefore, before starting anti-psychotics, it is important to perform an ECG to measure the QTc. Furthermore, drugs such as clozapine have common side-effects such as tachycardia. Due to this, NICE guidelines have stated it is good practice to have an ECG “performed at the earliest opportunity, within a 24 hour period”.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/Improving-the-tolerability-and-efficiency-of-electrocardiograms-in-psychiatric-hospitals.ID.000597.php
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Peripheral Venous Bullet Embolization To The Heart – A Case Study
Abstract
A bullet embolism is a rare complication following penetrating gunshot injury which can present challenges in diagnosis and management. If the projectile has been unsuccessfully removed or remains left in situ, there is a risk that the missile may have gained access to the vascular system from where the flow of blood migrates the foreign body to any number of large vascular beds. Arterial embolization is more common and is often accompanied with symptoms associated with end-organ damage and peripheral ischemia. Venous embolization is less common with few, or no symptoms reported, unless vascular injury, pulmonary embolism or oedema related venous flow obstruction is experienced which may require urgent attention. We present the incidental findings of a bullet within the right ventricle following a gunshot injury to the right upper thigh eleven years prior. To our knowledge, this is the first reported incidence identified in the United Kingdom.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/peripheral-venous-bullet-embolization-to-the-heart-a-case-study.ID.000624.php
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Fetal Speckle Tracking Echocardiography: A Comparison Between Fetuses with Normal Heart and Those With Heart Disease
Abstract
Objective: The aim of our study was to compare left ventricular function in normal fetal hearts and those with cardiac abnormalities using 2D and 4D e-STIC approach.
Methods: We recruited 63 fetuses between 20- and 40- weeks, including twenty-nine affected by heart disease. All measurements were performed by two sonographers experienced in fetal echocardiography. We compared different parameters obtained by 2-dimensional and 4D e-STIC method in normal fetal hearts and those with cardiac defects. We focused on left ventricular global strain, left ventricular ejection fraction, left ventricular length and area in end-systole and end-diastole, and left ventricular fractional area change. Differences between categorical variables were analyzed by using Chi-Quadro Test, while continuous variables by one-way ANOVA Test.
Results: Firstly, no differences were proved between healthy and affected fetuses, regardless of the applied technique. Similarly, fetal strain values did not differ between the affected fetuses distinguished according to the kind of pathology.
Conclusion: In our cohort, 2D and 4D e-STIC imaging techniques have shown similar results for each parameter. We did not find differences between healthy fetuses and those with heart disease because congenital heart disease included did not affect left ventricular systolic function.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/fetal-speckle-tracking-echocardiography-a-comparison-between-fetuses-with-normal.ID.000579.php
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From Strict Glycemic Control to Improving Cardiovascular Outcomes: A Shift in the Management Strategies for Type 2 Diabetes
Abstract
Newer classes of agents targeted to enhance glycemic control have been the focus of attention for their demonstrated reduction of cardiovascular (CV) events. In the latest 2020 American Diabetes Association (ADA) Standards of Medical Care in Diabetes, specific recommendations are made regarding improvement of CV outcomes in patients with diabetes. For those patients with type 2 diabetes (T2DM) who have established atherosclerotic cardiovascular disease (ASCVD) or indicators of high-risk for CVD, established kidney disease, or heart failure (HF), a sodium-glucose cotransporter 2 inhibitor (SGLT2i) or glucagon-like peptide 1 receptor agonist (GLP-1 RA) with demonstrated CV benefits can be recommended as part of the regimen independent of glycosylated hemoglobin (HgbA1c) while considering patient-specific factors. In addition, for patients with T2DM who need to achieve better control than with existing oral medications, GLP-1 RAs are preferred to insulin, when feasible. Similar to the ADA recommendation, the 2020 Management Algorithm from American Association of Clinical Endocrinologists (AACE) & American College of Endocrinology (ACE) also suggests the addition of a GLP-1 RA or SGLT2i independent of glycemic control, if there is established ASCVD or high risk for CVD, chronic kidney disease (CKD), or reduced ejection heart failure.
This review aims to interpret the CV outcomes demonstrated for the SGLT2i and GLP-1 RA agents that currently have FDA approved indications for reduction of risk of major adverse cardiovascular events (MACE) in T2DM patients with established CVD or CV risks. The information in this article will suggest overlapping effects on the heart, kidney while achieving glycemic control.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/from-strict-glycemic-control.ID.000577.php
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Prognostic Value of Serum Uric Acid Levels to the Cardiovascular Events in Hypertensives
Abstract
Aim: The aim of the study was to investigate the association of serum uric acid (SUA) levels with the major cardiovascular events (MACE) in hypertensive patients.
Methods and Materials: This is a prospective analysis including 652 hypertensive patients (52,6% female) of mean age at the entry: 57,2±13,1 years, mean office systolic/diastolic blood pressure (S/DBPo): 152,3±19,1/94,4±11,83 mmHg, mean office heart rate (HRo): 76,0±12 beats/min, treated or newly diagnosed untreated. The median follow-up period was 9 years. SUA were measured at the entry of the study. Major cardiovascular events (MACE) (myocardial infarction, unstable angina, transient ischemic attack or stroke, peripheral vascular intervention, heart failure events, cardiovascular death) were registered. We estimated the prognostic value of SUA to the MACE. Cox proportional hazard model was employed to determine the prognostic value of uric acid.
Result:The median follow-up period was 9 years. There were 264 (40,5%) MACE at the end of the study. Cox regression statistical analysis revealed that SUA was a strong predictor of MACE (HR: 1,14, 95%CI: 1,06 – 1,2 p-value=0,000)
Conclusion: SUA levels have statistically significant prognostic value to MACE in hypertensive patients.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/prognostic-value-of-serum-uric-acid-levels-to-the-cardiovascular-events-in-hypertensives.ID.000600.php
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Successful Delivery of A Full-Term Pregnant Patient with Acute Stanford A Aortic Dissection: A Case Report
Abstract
Aortic dissection occurring during pregnancy is a rare but potentially lethal condition for both the mother and the fetus. We report a case of Stanford An aortic dissection in a full-term pregnant woman with no risk factors who was admitted for an elective caesarean section. The patient underwent emergent ascending aorta replacement immediately after caesarean section with a favorable maternal and fetal outcome.
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Features of Hypertension and Coronary Heart Disease Secondary Prevention in the Population of Veliky Novgorod Russia
Abstract
To assess regional features of secondary prevention, as well as compliance with modern standards of treatment of patients with hypertension and coronary artery disease.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/features-of-hypertension-and-coronary-heart-disease-secondary-prevention-in-the-population-of-veliky-novgorod-russia.ID.000507.php
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A Comparison of Cardiac Ultrasound Instructional Methodologies in Undergraduate Medical Education
Abstract
A growing part of medical education is ultrasound as it allows students to integrate basic sciences with the clinical. Recently, there has been an increasing effort among medical schools to integrate ultrasound technology into preclinical medical education. Many medical schools are developing POCUS (Point of Care Ultrasound) based ultrasound curriculums. The objective of this study was to determine the most effective method of teaching 1st year medical students cardiac anatomy and clinical skills through POCUS. We hypothesized that the best way of learning cardiac POCUS is by an in-person demonstration by a sonographer, when compared to watching video demonstrations. The participants included 20 1st-year medical students from the California University of Science and Medicine - School of Medicine (CUSM - SOM). Students were divided into two groups: video group and the in-person demonstration group. There were 10 students in each group. The participants had no previous experience with POCUS. Results showed that a more effective method of teaching 1st-year medical students cardiac POCUS is through in-person demonstrations, rather than watching online modules, as students in this group were better able to identify correct probe placement and heart chambers in short axis.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/a-comparison-of-cardiac-ultrasound-instructional-methodologies-in-undergraduate-medical-education.ID.000612.php
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Rare and Unpredictable Cardiac Complication After Successful Elective Percutaneous Coronary Intervention: A Case Report
Abstract
Left ventricular pseudoaneurysm is a rare yet potentially fatal complication observed usually in cases of ST-elevation myocardial infarction without timely reperfusion. We report a case of successful elective percutaneous coronary intervention that evolved into left ventricular apical pseudoaneurysm with pericardial effusion and cardiac tamponade, despite absence of reasonable cause for the complication, such as acute stent thrombosis or coronary perforation.
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A Case of Heart Failure with Preserved Ejection Fraction Secondary to Long-Term Clozapine Use
Abstract
We present the case of a 55-year-old female, on very low dose Clozapine treatment for Schizophrenia, who presented with shortness of breath and in atrial fibrillation and with no previous history of cardiac failure. Chest X Ray showed evidence of bilateral pulmonary oedema and bilateral pleural effusion, and a diagnosis of acute heart failure with preserved ejection fraction was made based on echocardiographic findings and raised brain naturetic peptide (BNP) levels. This was the patient’s first presentation to hospital with heart failure related symptoms. Initial medical management included diuretics which did not improve her symptoms. With no other aetiology obvious her clozapine was stopped. Following this intervention her clinical status improved. Numerous case reports and systematic reviews have described cardiomyopathy associated with Clozapine use, but we describe below what we believe is the first documented case of Heart Failure with preserved Ejection Fraction (HFpEF) caused by Clozapine use.
Read More About This Article: https://irispublishers.com/ojcrr/fulltext/a-case-of-heart-failure-with-preserved-ejection-fraction-secondary-to-long-term-clozapine-use.ID.000601.php
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Strategies of Handling a Stenotic Unprotected Left Main Coronary Artery by Multi-Artery Fractional Flow Reserve Method
Abstract
Background and aims: By present guidelines, unprotected stenotic LMCA that requires revascularization is revascularized in most cases by a coronary artery bypass graft (CABG) operation whereas only select groups of patients that are contraindicated for CABG operation are treated by percutaneous transluminal coronary angioplasty (PTCA). A possibility of a CABG operation is never taken lightly, therefore ways of avoiding it within the LMCA-LCx-LAD stenotic configuration are explored in this article.
Methods and results: A numerical simulation of intracoronary pressures combined with the multi-artery FFR method is applied to the stenotic 3-artery configuration LMCA-LCx-LAD under conditions of stable and minimal microvascular resistance. In this method a clear distinction is made between the familiar FFRtrue which is the FFR of an artery in its virtually stand-alone position and its actual FFR (denoted FFRreal) when the artery is part of an arterial configuration in which the stenosis-stenosis interaction with other arteries impedes and reduces its blood flow (and therefore FFRreal ≤ FFRtrue ). The kind of treatment that the artery needs is now determined by its FFRreal numerical value, not by its FFRtrue. From the initially measured intracoronary pressures the method can yield the current status of the LMCA-LCx-LAD configuration (namely FFRreal and FFRtrue of each artery). Also, from the very same data, outcomes of all possible future revascularizations can be predicted. From the predicted future outcomes one can figure out if LMCA revascularization is required and also what effect would a LMCA revascularization, or lack of it, have on the current treatment decision for LCx and/or LAD arteries. The numerical examples in the article clearly show the interdependence of treatment decisions for the various arteries through inter-arterial stenosis-stenosis interactions. It turns out that in the intermediate stenosis severity range the FFRtrue of an artery may be satisfactory but its FFRreal is sometimes lower by about 0.3 indicating in most of such cases that revascularization is mandatory.
Conclusion: The first step in the multi-artery FFR method is to measure the intracoronary pressures at particular locations in the arterial configuration. The intracoronary pressures yield the present status of the configuration as well as the outcomes of all possible future revascularizations of the arteries of the configuration (provided that no revascularization-induced stenosis anatomy changes take place). This unique property yields eventually the optimal resolution of the stenotic LMCA-LCx-LAD configuration.
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Autopsy Findings of Coronary Artery Dissection Occurring during Coronary Angiography
Abstract
The authors present autopsy findings from a case of catheter-induced coronary artery dissection during angiography. This adverse outcome is an uncommon but potentially devastating complication of coronary catheterization. The report will describe the clinical course and autopsy of an elderly woman with multiple comorbidities who had a coronary artery dissection during a coronary angiography procedure.
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