Background: Peripheral arterial disease (PAD) is a vascular condition for which many therapeutic decisions are well established; nonetheless, the potential role of trimetazidine (TMZ) in diabetic patients with PAD remains debatable and warrants further investigation. Objective: This study aimed to determine the effect of TMZ on diabetic patients with intermittent claudication. Methods: In this two-center prospective study, 188 diabetic patients with PAD received guideline-directed medical therapy (GDMT) with (n =93) or without (n =95) TMZ. Baseline and 6-month assessments included the 6-minute walk test (6MWT), ankle-brachial index (ABI), duplex ultrasound, and diabetic foot outcomes (P <0.05). Results: The study included 188 diabetic patients with symptomatic PAD. Patients were divided into Group I, which received all GDMT with TMZ as part of chronic coronary syndrome treatment (93 patients), and Group II, which received all GDMT without TMZ (95 patients). All patients were evaluated at baseline and after a 6-month follow-up period for exercise performance via 6MWT, lower limb hemodynamics via ABI, and the incidence of diabetic foot requiring amputation. At the end of the follow-up period, 6MWT and ABI improved significantly from baseline findings in both groups. The TMZ group demonstrated a substantial improvement in 6MWT, a nonsignificant improvement in ABI, and a nonsignificant reduction in diabetic foot requiring amputation compared with the non-TMZ group. Conclusions: TMZ may improve exercise performance in diabetic patients with PAD, while its role in improving limb hemodynamics or ischemia is nonsignificant and uncertain.
Introduction: Transient ST-segment elevation myocardial infarction (TSTEMI) is often associated with better prognosis due to spontaneous reperfusion, yet its progression to Wellens syndrome indicates severe left anterior descending (LAD) occlusion and raises the risk of anterior infarction. Case Presentation: We describe a 61-year-old woman with the initial presentation of typical chest pain (numeric rating scale [NRS]: 6/10) and ST-segment elevation at the extensive anterior leads at the referring hospital. The patient was given dual antiplatelet treatment and referred to our hospital. Upon arrival, her symptoms resolved (NRS: 0/10), and her ST-segment elevation was evolved to biphasic T waves in leads V2-V6 along with ST elevation-T-wave inversion in leads I and aVL, similar to Wellens syndrome. Cardiac biomarkers were markedly elevated, and echocardiography revealed hypokinetic wall motion abnormalities. Coronary angiography revealed proximal LAD occlusion, a feature of Wellens syndrome. Despite the potential for extensive myocardial damage, the patient was managed under a delayed invasive strategy. She remained stable after the intervention and at 3 months' follow-up at the outpatient clinic. Conclusions: Conversion of TSTEMI to Wellens syndrome raises clinical dilemma regarding invasive strategy decision-making. TSTEMI occurs due to spontaneous resolution, which can be partial or total, yet the risk of spontaneous reocclusion is also inevitable. TSTEMI requires an early invasive strategy (< 24 h) with close monitoring of new or worsening ischemic signs; however, the urgency may be individualized on a case-by-case basis.
Introduction: Cardiovascular disease is the most common cause of death globally, and its risk among women with breast cancer (BC) is not fully assessed. This study aimed to evaluate the cardiovascular risk among women with BC using atherogenic indices. Methods: Ninety women were recruited for this cross-sectional study and stratified into BC and controls. Anthropometric measurements were taken, followed by blood collection (5 mL) for lipid profile (TC, TG, LDL-c, and HDL-c) assay. Castelli risk index I and II (CRI-I and CRI-II), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Cholindex (CI), and non-HDL-c (NHC) were calculated to estimate cardiovascular risks. Data were analyzed by SPSS 22 using the Student t test and the Pearson correlation and presented as mean +/- SD. A P value of less than 0.05 was considered significant. Results: Women with BC were significantly younger than controls (51.6 +/- 10.3 vs 59.0 +/- 12.7 y; P = 0.003) and had significantly lower mean waist circumference (90.5 +/- 11.3 vs 96.3 +/- 14.9 cm; P = 0.036). The mean serum TG and HDL-c (1.11 +/- 0.4 vs 1.36 +/- 0.5 mmol/L; P = 0.015 and 1.09 +/- 0.4 vs 1.48 +/- 0.3 mmol/L; P = 0.000) were significantly lower in the BC group. CRI-I, CRI-II, and AC were significantly higher in the BC group than in the controls (4.83 +/- 2.0 vs 3.69 +/- 0.9; P = 0.001 and 3.29 +/- 1.8 vs 2.24 +/- 0.8; P = 0.001 and 3.83 +/- 2.0 vs 2.68 +/- 0.9; P = 0.000), respectively. A higher proportion (80.4%, 38.3%, and 59.6%) of women with BC had a high risk of cardiovascular disease than controls (69.8%, 9.3%, and 27.9%), respectively, except for NHC. Conclusions: In this study, women with BC had a high risk of cardiovascular disease. Estimating the atherogenic indices of women with BC may be beneficial.
Background: Central venous catheters (CVCs) are essential for vascular access but are associated with catheter-related bloodstream infections (CRBSIs), which can cause significant morbidity and mortality, particularly among hemodialysis patients. This study aimed to investigate risk factors for CVC infections, evaluate the role of echocardiography in diagnosis and prognosis, and assess outcomes of different catheter management strategies. Methods: A longitudinal study of 166 patients with confirmed CVC infections was conducted at Rasoul Akram Hospital, Tehran, Iran, from 2014 through 2022. Data included demographics, comorbidities, catheter site/duration, microbiological cultures, echocardiographic findings, and treatment outcomes. Statistical analyses included the chi 2 test, the t test, ANOVA, and regression methods using SPSS, version 26. Results: Participants had a median age of 58 years (IQR, 45-67), and 54.8% were women. Fever was the most common presenting symptom (52.4%). Vegetations were detected in 52 patients (46.4%), most commonly at the catheter site. No significant difference in mortality was found between percutaneous and surgical catheter removal methods (P = 0.26). Vegetation size was not associated with mortality (P = 0.516). Patients with diabetes and transfusion history had longer hospital stays. Recurrence of infection was highest (37.9%) in those managed without catheter removal. Conclusions: Echocardiography plays a critical role in the diagnosis and prognosis of CVC infections. Catheter removal, whether percutaneous or surgical, did not influence in-hospital mortality, even in cases with large vegetations. However, failure to remove infected catheters increased the recurrence risk. (Iranian Heart Journal 2026; 27(2): 54-64)
Background: Risk stratification is the first step to prevent cardiovascular disease. Cardiac training tests perform it with the Duke Treadmill Score (DTS). The limitations and complications that may occur during cardiac training tests require alternative laboratory examinations. High-sensitivity C-reactive protein (hs-CRP) is an independent predictor of cardiovascular events. This study analyzed the relationship between hs-CRP and the Duke Treadmill Score. Methods: This study has a cross-sectional, observational analytical design. Blood samples were taken from 40 patients who underwent cardiac training at Airlangga University Hospital and Telkom Laboratory in Surabaya, Indonesia. Patients' hs-CRP levels were measured by TMS 24i Premium Tokyo Boeki in the clinical pathology laboratory of Airlangga University Hospital. Results: The average age of subjects was 43 years. Most subjects were male (60%) and had an increase in low-density lipoprotein cholesterol (92.5%). Hypertension was found in 22.5% of subjects. Most subjects were nonsmokers (70%), had a normal body mass index (82.5%), and did not have diabetic mellitus (82.5%). The mean hs-CRP level was 6.04 +/- 9.79 mg/L. DTS results showed-5.13 +/- 9.3. There was a correlation between serum hs-CRP and DTS by Spearman analysis (P =-0.85 and P < 0.05). Conclusions: Hs-CRP can be an alternative laboratory examination for stratifying cardiovascular event risks to cover DTS by cardiac training tests.
Background: Cardiovascular diseases remain a leading global cause of mortality, with sudden cardiac death-primarily resulting from arrhythmias-accounting for nearly half of these fatalities. Limited research has explored the impact of p-coumaric acid (P-co) on chemically induced arrhythmias. Given the cardioprotective role of antioxidants, this study aimed to investigate the effects of P-co on oxidative stress, electrocardiographic (ECG) parameters, and cardiac arrhythmias in Wistar rats using a calcium chloride (CaCl2)-induced arrhythmia model. Methods: Forty-eight Wistar rats were divided into 6 groups: (1) Control (normal saline); (2) CaCl2 (normal saline + CaCl2 140 mg/kg); (3-5) CaCl2 + P-co 25, 50, and 100 mg/kg, respectively; and (6) P-co 100 mg/kg. P-co was administered orally for 10 consecutive days, followed by an intravenous injection of CaCl2 via the femoral vein on the final day. Electrophysiological assessment and arrhythmia evaluation were conducted using lead II ECG. Furthermore, biochemical analyses measured oxidative stress and cardiac injury markers, including MDA, CK-MB, LDH, SOD, CAT, and GPx, across all groups. Results: Intravenous injection of CaCl2 led to significant changes in ECG parameters and the development of arrhythmias. Pretreatment with P-co significantly improved the observed changes. Compared with the CaCl(2 )group, P-co pretreatment reduced cardiac damage markers and lipid peroxidation and enhanced antioxidant enzymes. Conclusions: The results of this study suggest that the intravenous administration of CaCl2 induces cardiac arrhythmias and oxidative stress in heart tissue. As a natural polyphenol and antioxidant, P-co exhibited a protective effect against CaCl2-induced cardiac damage. (Iranian Heart Journal 2026; 27(2): 65-80)
Background: Patients with acute coronary syndrome experience fewer major adverse cardiovascular events when receiving ticagrelor as opposed to clopidogrel. Additionally, patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) show better coronary reperfusion and prognosis. This study compared the safety and effectiveness of ticagrelor doses administered early and late in patients with STEMI undergoing PPCI. Methods: This prospective observational cohort study was conducted in a hospital with 350 patients diagnosed with recent STEMI and receiving PPCI. Patients were placed into 2 groups: prehospital (n = 179; loading dose > 60 min) and cath. lab (n = 171; loading dose < 60 min) before PPCI. Results: Following a 6-month follow-up period, the Kaplan-Meier analysis revealed that 85.2% of the cath. lab group and 88.8% of the prehospital group were still clinically free and did not have any adverse events. There was no significant difference between the 2 groups (P = 0.357). The prehospital group had reduced thrombus load, greater post-PPCI ST-segment elevation resolution after 90 minutes, and considerably higher initial Thrombolysis in Myocardial Infarction (TIMI) flow grades II and III in the infarct-related artery than the cath. lab group. Both groups had comparable TIMI flow grades following PPCI. Conclusions: Prehospital administration of ticagrelor with a median time of about 2 hours before PPCI was safe and helped improve angiographic pre-PCI coronary reperfusion in STEMI patients undergoing PPCI, without increasing the risk of bleeding events, but it did not significantly affect the final angiographic results. (Iranian Heart Journal 2026; 27(2): 17-26)
Background: The optimal timing for percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) remains a matter of clinical debate, particularly in high-risk but stable patients. This study aimed to evaluate whether immediate PCI (within the timeframe of primary PCI) improves clinical outcomes compared with standard early PCI (within 24 hours) in high-risk NSTEMI patients. Methods: This prospective, single-center, randomized study included 300 high-risk NSTEMI patients at Ain Shams University hospitals. Patients were randomized to either immediate PCI (n = 150) or standard PCI (n = 150). Baseline characteristics, electrocardiographic (ECG) findings, echocardiographic findings, coronary angiography results, length of hospital stay, and 1-and 6-month major adverse cardiovascular events (MACE) were assessed. Results: Time to angiography was significantly shorter in the immediate PCI group (1.493 +/- 0.288 h vs 13.200 +/- 4.780 h; P < 0.001). Hospital stay was significantly reduced in the immediate PCI group (1.447 +/- 0.651 vs 2.293 +/- 0.765 d; P < 0.001). No significant differences were observed in ECG findings, ejection fraction, infarct-related artery occlusion rates, or vessel distribution (P > 0.05). At 1 month, MACE occurred in 5.33% vs 7.33% (P = 0.477); at 6 months, in 11.33% vs 18.67% (P = 0.075) in immediate vs standard PCI groups, respectively. Conclusions: Immediate PCI does not reduce short-or mid-term MACE compared with standard PCI, but it is associated with a significantly shorter hospital stay, supporting its role in optimizing healthcare efficiency. (Iranian Heart Journal 2026; 27(2): 38-46)
Introduction: Kounis syndrome is an acute coronary syndrome triggered by allergic or hypersensitivity reactions. It is an underdiagnosed clinical entity where mast cell activation leads to coronary vasospasm, plaque erosion, or thrombosis. Hymenoptera stings, such as those from bees, are a rare but well-documented cause. Case Presentation: A 64-year-old man presented to the emergency department with multiple bee stings, manifesting only mild cutaneous urticaria. He was discharged after observation with stable vitals. Approximately 12 hours post-sting, he experienced sudden-onset chest pain, diaphoresis, and syncope. Upon arrival, he was in a gasping state, requiring immediate intubation and mechanical ventilation. He suffered a cardiac arrest, and after 30 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved. Electrocardiography revealed ST-segment elevation in the inferior leads (II, III, and aVF) with reciprocal ST-depression in the anterolateral leads. Emergency coronary angiography demonstrated a complete thrombotic occlusion of the mid-right coronary artery. Successful primary percutaneous coronary intervention with a drug-eluting stent was performed, restoring TIMI grade 3 flow. Conclusions: This case highlights the critical importance of considering Kounis syndrome in patients presenting with acute coronary symptoms following an allergic insult, even with a delayed presentation. A high index of suspicion is necessary for timely diagnosis and management, which must address both the allergic reaction and the acute coronary syndrome concurrently. (Iranian Heart Journal 2026; 27(2): 81-86)
Spondyloarthritis is a chronic systemic inflammatory disease that primarily affects the spine, sacroiliac joints, and tendons. Cardiac involvement is uncommon but may manifest as pericardial effusion, posing diagnostic and therapeutic challenges. This case underscores the significance of recognizing systemic inflammatory diseases as potential causes of pericardial effusion and the role of conservative management in avoiding unnecessary invasive interventions. A 24-year-old man presented with acute dyspnea, orthopnea, and pleuritic chest pain. Clinical evaluation and imaging revealed a massive pericardial effusion without echocardiographic signs of cardiac tamponade. Laboratory workup demonstrated elevated inflammatory markers, leading to a differential diagnosis that included systemic inflammatory diseases. The patient was initially managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine. Nonetheless, persistent pericardial effusion prompted further evaluation, ultimately leading to a diagnosis of spondyloarthritis based on radiographic evidence of sacroiliitis and positive rheumatoid factor. A regimen of corticosteroids and sulfasalazine resulted in complete resolution of pericardial effusion and normalization of inflammatory markers. Inflammatory pericardial effusion can be the initial manifestation of spondyloarthritis, and targeted medical therapy may obviate the need for invasive intervention. Clinicians should consider systemic inflammatory diseases in unexplained pericardial effusion and prioritize individualized treatment approaches.
Background: Acute coronary syndrome is a leading cause of mortality in cardiovascular disease. Red blood cell distribution width (RDW), a component of the complete blood count, has been associated with various clinical outcomes. This study investigated the relationship between RDW and in-hospital prognosis in patients with ACS. Methods: We included 628 consecutive patients admitted with ACS. The RDW level at admission and the following prognostic factors were extracted and recorded: in-hospital mortality, presence of malignant ventricular arrhythmia, reduction in left ventricular ejection fraction, number of major cardiovascular risk factors, presence of diabetes mellitus, duration of hospitalization, number of significantly diseased coronary vessels, type of coronary intervention (percutaneous coronary intervention, coronary artery bypass grafting, or medical follow-up), and troponin positivity (indicative of myocardial infarction). The relationship between RDW level and these parameters was analyzed. Results: Patients were stratified into two groups based on baseline RDW level: an RDW of 14.0% or greater and an RDW of less than 14.0%. The mortality rate was significantly higher in the high-RDW group than in the normal-RDW group. Mean age, incidence of malignant ventricular arrhythmia, number of cardiovascular risk factors, and length of hospitalization were also significantly greater in patients with high RDW. Conclusions: An elevated RDW at admission in patients with ACS is a noninvasive, readily available test that may aid in prognostic assessment and stratifying in-hospital mortality risk. This parameter may warrant consideration in future clinical guidelines. (Iranian Heart Journal 2026; 27(1): 6-16)
Background: ST-elevation myocardial infarction (STEMI) is a severe form of coronary artery disease, marked by myocardial necrosis because of complete coronary artery occlusion. Despite advances in treatment, STEMI remains a leading cause of morbidity and mortality globally. Left ventricular systolic dysfunction is a significant predictor of outcomes after STEMI, with global longitudinal strain (GLS) being a promising prognostic marker. This study investigated the prognostic value of GLS measured by speckle-tracking echocardiography (STE) in patients with STEMI treated within 24 hours of onset. Methods: This prospective observational study included 50 hemodynamically stable patients with STEMI (mean age, 56 [SD, 11] years) admitted to Mansoura University for primary percutaneous coronary intervention or thrombolytic therapy. GLS was measured within 48 hours after revascularization. Patients were followed for 6 months to assess major adverse cardiac events (MACE). Results: The median time to presentation was 3 hours, and 69 patients received thrombolytic therapy. Mean ejection fraction was 54 (SD, 8)%, and mean GLS was-11.5 (SD, 3.5). MACE occurred in 24 patients (48%). Diabetes was significantly more common in those with MACE (52% vs 24%; P = 0.044). No significant differences were found in other clinical or laboratory variables. GLS was a significant predictor of adverse outcomes. Conclusions: GLS measured by 2D STE is a valuable prognostic tool in patients with STEMI, providing insight into future cardiac events and functional recovery. (Iranian Heart Journal 2026; 27(1): 52-62)
Background: Cardiac tumors are extremely rare conditions encompassing a diverse range of mass lesions, including primary tumors originating from the heart and great vessels, metastatic tumors, and tumor-like lesions that do not fit the conventional definition of a tumor or neoplasm. In contrast to metastatic tumors, primary cardiac tumors and tumorlike lesions are rare, with most primary neoplasms being benign. Methods: A histopathological study was conducted among all patients who presented to Rajaie Cardiovascular Institute between 2020 and 2025. Data were collected from surgical pathology records to identify relevant cases. Results: Among 28 patients diagnosed with benign cardiac tumors and tumor-like conditions (excluding myxomas), 15 were male, and 13 were female. The identified benign tumors included rhabdomyoma, fibroma, papillary fibroelastoma, lipoma, lymphangioma, capillary hemangioma, and cavernous hemangioma. Additionally, two cystic lesions-a pericardial mesothelial cyst and a hydatid cyst-were noted, along with a case of a fungal ball. Conclusions: All cardiac tumors should undergo histologic examination to confirm the diagnosis and rule out malignancy, thereby aiding the development of the most effective treatment strategy.
Background: In children, the discrepancy between the cardiopulmonary bypass (CPB) circuit size relative to body size is greater than that in adults. However, hemoglobin and hematocrit levels during and after CPB may lead to hemodynamic and electrolyte disturbances. Methods: This retrospective, descriptive-analytic study included 441 pediatric patients (weight: 5-15 kg) with congenital heart defects who underwent cardiac surgery and met the eligibility criteria. The association between groups with hemoglobin concentrations of 8 to 10 g/dL and greater than 10 g/dL was assessed. Arterial blood samples, recorded every 12 hours for up to 72 hours of ICU admission after open-heart surgery, were entered into the data collection form. Results: The groups showed significant differences in mean age, weight, height, and body surface area, as well as the frequency distribution of sex. The independent samples t test demonstrated that mean lactate concentration (P = 0.014), urinary output (P = 0.001), diastolic blood pressure (P = 0.013), systolic blood pressure (P > 0.001), intubation time (P = 0.003), and mean arterial pressure (P > 0.001) were significantly higher in Group 2 (hemoglobin >= 10 g/dL) than in Group 1 (hemoglobin 8-10 g/dL). Conclusions: In acyanotic pediatric patients with low hemoglobin, mean lactate concentration, urinary output, intubation time, and mean arterial pressure were lower, and these patients received greater blood and blood product transfusions compared with patients with high hemoglobin.
Background: Dilated cardiomyopathy (DCM) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility. Morbidity and mortality in patients with DCM remain high. Data on DCM outcomes in Africa are lacking. This study aimed to determine the clinical characteristics and outcome of DCM at University College Hospital, Ibadan, Nigeria. Methods: Analysis of data collected over 6 years (September 1, 2016, through August 31, 2022). Information included sociodemographics, clinical features, echocardiographic diagnosis, morbidity, and mortality. Results: During this period, 127 cases of DCM were seen: 91 males (71.7%) and 36 females (28.3%) aged 52.0 (SD, 16.0) years (range, 17-86 years). More than 90% had formal education, and 108 (85%) were married. A history of current or past alcohol consumption was documented in 62 (48.5%). At 1-year follow-up, 27 (21.3%) of the 127 patients died. Those who died were older and had higher body mass index and white blood cell count but lower estimated glomerular filtration rate, systolic blood pressure, and sodium level. Decedents were more likely to be male (P = 0.018) and to consume alcohol (P = 0.029). Conclusions: Our data show that male sex and alcohol use are predictors of mortality in patients with DCM seen at UCH Ibadan. (Iranian Heart Journal 2026; 27(1): 26-36)
Background: ST-elevation myocardial infarction (STEMI) is a major cause of heart failure, with left ventricular diastolic dysfunction being a key predictor of adverse outcomes. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for improving both systolic and diastolic functions. This study aimed to determine the effect of primary PCI on the recovery of diastolic dysfunction in patients with STEMI. Methods: This prospective observational study included 100 patients with STEMI at Misr University for Science and Technology Hospital between September 2023 and February 2024. Key echocardiographic metrics, including deceleration time (DT), E/A ratio, and left atrial volume index (LAVI) were documented at three time points: baseline, immediately following PCI, and at the 3-month follow-up. Results: At baseline, 58% of patients had diastolic dysfunction. Post-PCI left ventricular ejection fraction (LVEF) improved significantly from 34.8% to 51.9% at 3 months (P < 0.001). LA volume and LAVI decreased significantly at 3 months (P < 0.001). DT and isovolumic relaxation time showed significant reductions after PCI (P < 0.001). E/A ratio improved significantly at 3 months (P < 0.001), and 32% of patients demonstrated improvement in diastolic function. The prevalence of diastolic dysfunction was significantly higher among patients who experienced chest pain for a period exceeding 4 hours (P = 0.010). Conclusions: Patients with STEMI demonstrated a significant enhancement in diastolic function after undergoing primary PCI, with notable enhancements in echocardiographic parameters, such as LVEF, E/A ratio, and LAVI. Timely intervention is crucial for optimizing diastolic function recovery. (Iranian Heart Journal 2026; 27(1): 63-70)
Background: Coronary artery disease remains the most common cause of death. Because coronary artery calcium (CAC) scores may indicate an increased risk of developing symptomatic coronary artery disease, we sought to determine whether CAC scores correlate with renal artery calcification (RAC) identified on computed tomography (CT). Methods: CT was employed to determine the presence and extent of RAC and CAC in 476 patients without clinical cardiovascular disease, utilizing an Agatston scoring system. Cardiovascular risk factors, including diabetes, hypertension, dyslipidemia, family history of ischemic heart disease, and smoking, were documented for all patients. Results: RAC was present in 24% of patients, with a higher frequency in men than in women (66.7% vs 51.9%; P = 0.006). The RAC score was correlated with the CAC score (r = 0.67). In a multivariable model that included standard cardiovascular disease risk variables, the presence of RAC was associated with age, current smoking, and the CAC score (OR for CAC, 1.24; P < 0.001). Specifically, a CAC score greater than 100 Agatston units (AU) was observed in 73% (84/114) of patients with RAC and 3% (12/362) of patients without RAC. A RAC score of 4 AU had a sensitivity of 87% and a specificity of 99% for predicting a CAC score greater than 100 AU. Conclusions: RAC was correlated with CAC independent of conventional risk factors. RAC scoring may be used to identify patients with a CAC score greater than 100 AU, for whom statin therapy may be beneficial.
Background: Congenital sinus of Valsalva aneurysm (SoVA) is a rare cardiac anomaly that predominantly affects the right coronary sinus. When ruptured, it can result in an aortocardiac shunt with hemodynamic consequences. Associated congenital lesions such as ventricular septal defect (VSD), coarctation of the aorta (CoA), bicuspid aortic valve, and patent ductus arteriosus may compound the clinical picture. Case Presentation: A 12-year-old boy presented with acute chest pain, dyspnea, and palpitations. He was initially misdiagnosed with pneumonia and heart failure (New York Heart Association [NYHA] class III). Further evaluation revealed a congenital SoVA originating from the noncoronary cusp and rupturing into the right atrium (RA), producing a large left-to-right shunt. Transthoracic echocardiography demonstrated a windsock-like structure extending from the noncoronary sinus to the RA. Associated anomalies included severe discrete coarctation of the aorta. Interventions: After stabilization with medical therapy, the patient underwent successful catheter-based CoA stenting. Because of the significant shunt and chamber dilation, open-heart surgery was subsequently performed. Outcome: At postoperative follow-up, the patient reported no clinical symptoms. No residual coarctation or shunt was detected, and the boy remained hemodynamically stable. Conclusions: This case underscores the importance of early recognition and comprehensive management of complex congenital cardiac anomalies, including SoVA, CoA, VSD, and valvular abnormalities. Multimodality imaging, catheter-based intervention, and surgical correction resulted in an excellent clinical outcome in this pediatric patient.
Acute coronary syndrome (ACS) is caused by a thrombotic condition in the coronary arteries. It may present as acute ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation acute coronary syndrome (NSTEACS). Dual antiplatelet therapy (DAPT) is the primary strategy to reduce mortality and prevent future thrombosis in patients with acute STEMI. Nonetheless, allergy to these agents remains a clinical challenge during treatment. We describe a 68-year-old man with inferolateral STEMI who developed an allergic reaction to acetylsalicylic acid and clopidogrel after administration of a loading dose of DAPT. The patient was treated with fibrinolysis, which was considered successful. Angiography was not performed because of the patient's antiplatelet allergy. The DAPT allergy was successfully managed by reintroducing and rapidly desensitizing DAPT through the ADAPTED registry protocol. Alternative strategies are available when desensitization is not feasible.
Objective: This study aimed to identify dyslipidemia patterns and their correlation with the extent of coronary artery disease (CAD) in patients with a first ST-elevation myocardial infarction (STEMI). Methods: This observational cross-sectional study was conducted from January 2023 through December 2023. A purposive, non-probability sampling technique was used to include 230 consecutive patients who presented to the emergency department of a tertiary care hospital with a primary diagnosis of acute STEMI. Demographics, symptoms, indicators, medical history, medication use, and diagnostic tests performed in the emergency department (e.g., ECG and chest X-rays) were recorded. Laboratory investigations, such as troponin-I and lipid profiles, were also extracted from the database. Findings: The mean age of the study population was 60.39 +/- 12.02 years. Of these, 164 (71.3%) patients were male. Multi-vessel disease (including double-vessel and triple-vessel CAD) predominated in the male population. Approximately 30 men in our study had combined hyperlipidemia with triple-vessel disease, followed by 23 men with isolated dyslipidemia and double-vessel disease. The SYNTAX score categories (low, intermediate, and high) demonstrated a statistically significant association with cholesterol levels (P <0.05). Conclusions: We found that the presence of multi-vessel CAD coincided with various patterns of dyslipidemia, and mixed dyslipidemia was the most common pattern observed.
