Background: The success of pulmonary vein isolation (PVI) is limited with more advanced disease of the atrial myocardium which may develop due to aging, atrial fibrillation (AF), cardiac diseases and comorbidities leading to elevated atrial pressure. Our group has recently reported on long-term decrease in the levels of different biomarkers after PVI, potentially reflecting a reversal of the fibrotic process in the atria with arrhythmia control. Whether the presence of baseline comorbidities has a significant impact on long-term changes in the serum concentration of these substances is unknown. Aim: Herein, we compared the levels of 4 biomarkers (CA-125, Caspase-3, Cathepsin L and Galectin-3) before and 3 years after successful PVI in patients with versus without comorbidities at baseline. Methods: Serum concentrations of the 4 biomarkers were measured prospectively in consecutive patients undergoing PVI with any of 3 different techniques for paroxysmal/permanent AF 24 hours before and 3 years after ablation. Only patients free of AF recurrence at 3-year follow-up were included in this analysis. Results: 28 men and 9 women (age 56.5 +/- 9.2 years) were enrolled. Caspase-3 concentrations decreased significantly by the end of follow-up in patients without (from 500.9 (345.7-719.5) to 340.5 (255.9-387.3); p=0.016 as well as with comorbidities: from 623.8 (476.9-751.4) to 447.7 (327.6-636.9) p=0.039. Caspase-3 concentrations (pg/mL) were higher at 3-year follow-up in patients with versus without comorbidities: 447.7 (327.6-636.9) vs 340.5 (255.9-387.3); p=0.038. For Caspase-3, a significant overall time effect was observed (beta=-0.437, p=0.010), consistent with lower concentrations at 3-year follow-up after adjustment for age, sex, AF type, and ablation technique. No differences were measured with the other biomarkers. Conclusion: Serum levels of Caspase-3 decreased in patients maintaining sinus rhythm after PVI regardless of the presence or absence of comorbidities, suggesting that it might be a sensitive biomarker indicating long-term arrhythmia suppression.
Yasser Mohammed Abdo Ali Al-Shawki Department of Medicine, Faculty of Medicine and Health Sciences, Amran University, Amran, YemenCorrespondence: Yasser Mohammed Abdo Ali Al-Shawki, Department of Medicine, Faculty of Medicine and Health Sciences, Amran University, Amran, Yemen, Email yasseralshowky@gmail.comBackground: Congenital Heart Disease (CHD) remains the most prevalent congenital anomaly globally, with approximately 90% of affected neonates born in low- and middle-income countries (LMICs). Despite significant advances in paediatric cardiac care over the preceding decade, a substantial proportion of CHD cases in resource-limited settings evade timely detection, resulting in avoidable morbidity and premature mortality. This systematic review synthesizes contemporary evidence published between 2019 and 2025 to delineate the prevalence, determinants, and consequences of undiagnosed CHD in LMICs, whilst critically evaluating emerging strategies for diagnostic optimization.Methods: A systematic literature search was conducted across PubMed/MEDLINE, Emblaze, Scopus, and the Cochrane Library for peer-reviewed studies published between January 2019 and January 2025. The review adhered to PRISMA guidelines. Forty-five primary studies met predefined eligibility criteria, comprising observational cohorts, cross-sectional analyses, and health systems research investigations focusing on pediatric populations (neonates to 18 years) in World Bank-classified LMICs. Data regarding diagnostic timing, barrier categorization, screening implementation, and clinical outcomes were extracted and subjected to qualitative synthesis.Results: Analysis of 45 studies encompassing diverse geographical regions—including sub-Saharan Africa, Southeast Asia, the Middle East, and Latin America—revealed consistently protracted diagnostic delays, with median age at CHD confirmation ranging from 4 days for critically cyanotic lesions to 98 months for acyanotic defects. Pooled prevalence estimates indicated that 47– 63% of CHD cases in LMICs are diagnosed following the onset of irreversible complications. Congestive heart failure was present in 49.4% of patients at initial presentation, whilst Eisenmenger syndrome complicated 15.8% of delayed left-to-right shunt diagnoses. Three principal barrier domains were consistently identified: (i) infrastructural deficiencies, including absent or non-functional echocardiography services in peripheral facilities; (ii) workforce shortages, with pediatric cardiologist-to-population ratios reaching 1:8 million in several regions; and (iii) socioeconomic constraints, including prohibitive out-of-pocket expenditure and geographical maldistribution of specialized centres. Contemporary studies evaluating pulse oximetry screening demonstrated high diagnostic accuracy (sensitivity 76– 93%, specificity 99.4%) for critical CHD; however, implementation fidelity was compromised by absent referral infrastructure and inadequate postnatal follow-up.Conclusion: This systematic review confirms that undiagnosed CHD in resource-limited settings constitutes a persisting public health emergency, characterized by predictable diagnostic delays and preventable clinical deterioration. The evidence synthesis identifies actionable targets for health system strengthening, including mandatory pulse oximetry integration, task-shifting to non-specialist providers, and decentralized tele-echocardiography networks. Without urgent, context-appropriate intervention, the diagnostic gap will continue to exact an unacceptable toll on pediatric populations in LMICs.Keywords: congenital heart disease, undiagnosed CHD, resource-limited settings, diagnostic delay, paediatric cardiology, pulse oximetry screening, health systems strengthening, LMICs
Purpose: To explore clinical manifestations and treatment strategies in a patient with dual GLA and MYH7 mutations causing Fabry disease (FD) and hypertrophic cardiomyopathy (HCM), emphasizing the value of comprehensive genetic testing in complex cardiomyopathies. Patients and Methods: We studied a 40-year-old Han Chinese woman with FD and familial HCM due to GLA and MYH7 mutations. Diagnosis involved echocardiography, electrocardiography, cardiac MRI, genetic sequencing, and alpha-galactosidase A activity assays. Treatment included pharmacotherapy (rivaroxaban, sacubitril/valsartan, bisoprolol, spironolactone, torasemide), agalsidase alpha enzyme replacement, and surgery for left ventricular outflow tract obstruction. Results: The patient had severe left ventricular hypertrophy (interventricular septum 35 mm) and significant obstruction (LVOTG 121 mmHg). After 3 months, the 6-minute walk test distance increased from 132 to 369 meters, NT-proBNP levels dropped from 2164 to 1911 pg/mL, and the KCCQ score rose from 30.9 to 85.5, indicating improved quality of life. Conclusion: Comprehensive genetic testing is crucial for diagnosing complex cardiomyopathies. A multidisciplinary approach effectively improves symptoms and quality of life in patients with dual genetic mutations.
Yi-De Chou,1,* Ting-Wei Lu,2,* Shu-I Lin,2 Han-En Cheng,3 Feng-Ching Liao,2 Chun-Wei Lee2 1Department of Ophthalmology, MacKay Memorial Hospital, Taipei, Taiwan; 2Cardiovascular Division, Department of Internal Medicine, MacKay Memorial, Hospital, MacKay Medical College, New Taipei, Taiwan; 3Faculty of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Chun-Wei Lee, Cardiovascular Center and Division of Cardiology, Mackay Memorial Hospital, 92, sec 2, Zhongshan North Road, Taipei, 10449, Taiwan, Tel +886-2-2543-3535 ext. 2456, Fax +886-2-2543-3535 ext. 2459, Email tommylee0624@gmail.comBackground: The coexistence of coronary artery ectasia (CAE) and acute coronary syndrome (ACS) is uncommon and associated with poor clinical outcomes. However, evidence regarding the role of anticoagulant therapy and covered stents in this context remains limited.Methods: To evaluate the potential impact of anticoagulant therapy in patients with CAE and ACS, we conducted a comprehensive systematic review of case reports and case series published up to August 2022.Results: Our findings suggest that anticoagulant therapy may be beneficial in preventing ACS in patients with CAE. The adjunctive use of single or dual antiplatelet therapy should be individualized based on bleeding risk. In addition, covered stents may represent a viable treatment option, particularly for short lesions.Conclusion: Patients with CAE often present with ACS and require tailored management strategies owing to altered vessel morphology and flow dynamics. Evidence from case series suggests that the combination of antiplatelet and anticoagulant therapy may reduce ischemic recurrence without a marked increase in bleeding events. Covered stents offer a viable intervention for short, isolated ecstatic segments.Keywords: coronary artery ectasia, acute coronary syndrome
Background: Studies in various contexts have shown that atrial fibrillation (AF) among hypertensive patients varies in prevalence, clinical features, and associated factors. However, in Uganda, including Fort Portal Regional Referral Hospital (FPRRH), there is limited data on these aspects. This study assessed the prevalence, clinical features, and associated factors of AF among hypertensive patients attending FPRRH. Methods: This hospital-based cross-sectional study was conducted at the medical outpatient clinic of FPRRH from October 2022 to January 2023. Hypertensive patients were consecutively enrolled during clinic visits. Data on sociodemographic, lifestyle, and clinical characteristics were collected. AF prevalence was calculated as the proportion of hypertensive patients diagnosed with AF, and logistic regression was used to identify associated factors. Variables with p < 0.2, odds ratios >= 2 or <= 0.5, or biological plausibility were included in the multivariable model. Significance was set at p < 0.05. Data analysis was performed using Stata version 15.2. Findings: Among 140 hypertensive patients, the prevalence of AF was 10% (n = 14). Most AF patients presented with fatigue (71.4%) and palpitations (71.4%), 28.6% reported syncope, while physical inactivity (29.3%). Physical inactivity (Adjusted Odds Ratio-AOR = 16.3, 95% CI: 2.15-64.30, p = 0.007) and abnormal pulse rates, low (AOR = 9.5, CI: 1.57-36.02, p = 0.008) and high (AOR = 8.7, CI: 2.21-25.09, p = 0.007), were significantly associated with AF. Conclusion: The prevalence of AF at FPRRH was 10%, higher than in many regional studies. Fatigue and palpitations were the most common symptoms. Physical inactivity and abnormal pulse rates were key predictors. Routine screening, promotion of moderate physical activity, and early pulse monitoring are essential to reduce AF burden in hypertensive populations.
Background: Coronary artery spasm (CAS) refers to a sudden and intense narrowing of the coronary arteries caused by vasoconstriction, which can result in myocardial ischemia and potentially lead to acute myocardial infarction (AMI), even in individuals without significant atherosclerotic risk factors. Simultaneous multivessel coronary spasm is a rare clinical presentation that poses significant diagnostic and therapeutic challenges, with the potential for life-threatening complications. Case Report: We report a case of a 42-year-old male with no history of hypertension, diabetes, or dyslipidemia who presented with sudden-onset retrosternal chest pain radiating to the left arm and jaw, associated with diaphoresis. The electrocardiography (ECG) demonstrated ST-segment elevation in the inferior leads with reciprocal changes, while cardiac biomarkers confirmed myocardial injury. Urgent coronary angiography revealed diffuse spasm in both the right coronary artery and obtuse marginal artery without significant atherosclerotic lesions, which resolved after intracoronary nitrate administration. Management included sublingual nitroglycerin, calcium channel blockers, and lifestyle modifications. The patient remained thermodynamically stable during hospitalization, with no recurrence of symptoms. Conclusion: Simultaneous multivessel CAS is a rare but important cause of AMI, particularly in younger patients without typical risk factors. Early diagnosis and treatment are key, and this case underscores the need for greater awareness and research into its management.
Background: Infective endocarditis (IE) is a potentially life-threatening infection of the heart valves, often caused by bacterial pathogens. It can lead to serious complications such as heart failure, embolic events, and myocardial injury. Troponins, cardiac biomarkers released from damaged myocardial cells, are frequently elevated in IE, particularly in cases with myocardial injury. Elevated troponin levels in IE may serve as a prognostic marker of adverse outcomes, including mortality. Case Presentation: A 20-year-old male with no significant medical history presented to the emergency department with chest pain that had progressively worsened over the past week. On examination, the patient was stable, with a pan-systolic murmur at the apex, indicative of severe mitral regurgitation (MR). Laboratory tests revealed elevated troponin levels (5.553 ng/mL), and blood cultures returned positive for Staphylococcus aureus. A transthoracic echocardiogram and transesophageal echocardiogram (TEE) confirmed severe MR with large vegetation on the mitral valve. Despite starting a two-week course of intravenous antibiotics, the patient's condition persisted, with elevated troponin levels (8.6 ng/mL) and ongoing vegetation. Mitral valve surgery was performed due to the failure of medical therapy and the risk of further myocardial injury. Discussion: This case underscores the critical role of elevated troponin levels as a prognostic marker for myocardial injury in infective endocarditis. Persistent troponin elevation, despite appropriate antibiotic treatment, indicates ongoing myocardial injury and suggests the need for urgent surgical intervention. Severe MR in IE contributes to hemodynamic instability and increases the risk of heart failure, necessitating prompt surgical correction. The collaboration between cardiologists, infectious disease specialists, and cardiac surgeons is vital in managing such complex cases. Conclusion: Elevated troponin levels in infective endocarditis, particularly with severe mitral regurgitation, are indicative of significant myocardial injury and may predict adverse outcomes. Timely surgical intervention is crucial to improving patient survival and mitigating further complications.
Purpose: The study aimed to evaluate endothelial dysfunction (ED), assessed through flow mediated dilation (FMD), in individuals with severe coronary artery disease (CAD) scheduled for coronary artery bypass graft surgery (CABG). Additionally, we examined the association between the severity of EDevaluated throughFMD and the extent of atherosclerosis at the coronary arteries level (SYNTAX I score), carotid arteries and peripheral arteries. Methods: The study included 84 participants recruited between January 2020 and June 2021. Doppler ultrasonography was used to assess both FMD and the degree of carotid artery stenosis. SYNTAX I score was calculated based on coronary angiography, and peripheral artery disease (PAD) was evaluated using computed tomography. Results: FMD was used as a surrogate for assessing ED. We found no statistical difference between men and women [4.46 (1.03-6.75) in women versus 2.55 (0.95-6.13 in men; p=0.21). A significant association was observed between FMD and SYNTAX score (p < 0.001). A lower FMD corresponded to a higher SYNTAX score, reflecting an extensive burden of coronary atherosclerosis. Furthermore, ED, as measured by FMD, was indicative of carotid atherosclerosis and PAD, as evidenced by lower FMD in patients with severe carotid plaques (p < 0.001) and severe PAD (p < 0.01). Conclusion: FMD might be a reliable tool to assess systemic atherosclerosis, ED in the brachial artery being related to carotid artery plaque, CAD and peripheral lower limb ischemia.
Introduction: Pulmonary embolism (PE) is a critical condition that can present with diverse and often non-specific electrocardiographic findings. The Aslanger pattern, identified in 2020, is an uncommon electrocardiography (ECG) finding typically associated with acute non-ST-segment elevation myocardial infarction (NSTEMI). Although this pattern is usually linked to myocardial infarction with significant coronary stenosis, we report a rare case where the Aslanger pattern was observed in a patient with acute pulmonary embolism. Case Presentation: A 52-year-old male with Parkinson's disease presented with sudden chest pain, shortness of breath, sweating, and fatigue. Initial ECG showed Aslanger pattern, suggesting acute coronary syndrome. Despite elevated troponin I (1624 ng/mL) and normal coronary angiography, further investigation revealed right ventricular dilation and massive pulmonary embolism confirmed by CT angiography. The patient was treated with thrombolytics and anticoagulation, stabilizing over five days and discharged on rivaroxaban. Conclusion: The Aslanger pattern usually linked to myocardial infarction can also occur in acute pulmonary embolism. This case underscores the need for careful differential diagnosis and timely treatment to prevent complications associated with delayed care.
Background: The association diabetes mellitus - acute heart failure (AHF) is frequent and a source of significant morbidity and mortality. Objective: The present study aimed to determine the impact of type 2 diabetes (T2DM) on the epidemiological-clinical and paraclinical characteristics of acute heart failure (AHF). Methods: This was a retrospective cross-sectional study, carried out over a period of 2 years. The diagnosis of diabetes mellitus was made according to the criteria of the American Diabetes Association. The diagnosis of AHF is established by the signs and symptoms of heart failure; increased levels of brain natriuretic peptide (BNP); and systolic and/or diastolic dysfunction on echocardiography. Results: 63 T2DM and 120 non-T2DM consecutive patients were selected. Age (>= 50 years in men and >= 60 years in women) (OR=2.08 [1.31- 5.14]), dyslipidemia (OR=3.95 [1.82- 8.75]), microalbuminuria (OR=6.06 [1.69- 27.3]) and overweight/obesity (OR=3.32 [1.33- 13.5]) were more frequent in T2DM. The clinical profile of T2DM was marked by the rise in mean systolic arterial pressure (p=0.0368), arterial oxygen desaturation (p=0.0214), New York Heart Association (NYHA) IV breathlessness (OR=2.06 [1.04- 4.08]); and paraclinical by left ventricular hypertrophy (OR=2.67 [1.24- 5.77]), segmental kinetic disorder (OR=1.96 [1.04- 3.67]) and ischemic heart disease (OR=1.98 [1.09- 3.92]). Diabetics received more statin (OR=2.06 [1.05- 4.03]) and less spironolactone (OR=0.29 [0.13- 0.64]). Conclusion: T2DM is associated with poor profile of AHF. Adequate management of cardiovascular risk factors, including diabetes, could thus minimize the occurrence of AHF and improve this profile.
Objective: To explore the influencing factors of left ventricular thrombosis after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI) and construct a column chart model. Methods: A retrospective study was conducted on 331 STEMI patients who underwent PCI between July 2020 and January 2024. According to the principle of approximately 3:1, patients were randomly separated into 245 in the modeling group and 86 in the validation group, and clinical data of patients were collected. Multivariate logistic regression was applied to screen for risk factors. R software was applied to draw column charts. Bootstrap method was applied for internal validation. Hosmer-Lemeshow (H-L) was applied to test the fitting degree of the column chart model. Calibration curve and ROC curve were applied to verify calibration and discrimination, respectively. DCA curve was applied to analyze the clinical practicality of the column chart model. Results: A history of angina pectoris, ventricular aneurysm, alcohol abuse, postoperative TIMI grade <= 2, LVEF, and total ischemic time were influencing factors for left ventricular thrombosis in STEMI patients after PCI (P< 0.05). The predicted probabilities of the internal and external validation calibration curves were highly consistent with the actual probabilities, the concordance index of the ROC curve was 0.962 (95% CI: 0.931-0.994) and 0.958 (95% CI: 0.926-0.990), respectively, indicating high model calibration and discrimination; H-L inspection showed chi(2)=11.977, 9.757 (P=0.152, 0.282). DCA curve showed that when the probability range of the high-risk threshold was 0.02 similar to 0.99, the column chart model performed better and had a higher net return. Conclusion: The column chart model constructed by risk factors such as history of angina, ventricular aneurysm, history of alcohol abuse, postoperative TIMI <= grade 2, LVEF, and total ischemic time has high predictive value and can effectively predict left ventricular thrombosis in STEMI patients after PCI.
Introduction: The coronary slow flow phenomenon (CSFP) is delayed distal vessel opacification in the absence of significant epicardial coronary disease. Methods: A retrospective analysis was conducted on 103 patients' medical records from June 2022 to January 2024 at the Mogadishu Somali Turkish Training and Research Hospital in Somalia. The study focused on patient demographics, risk factors, echocardiography profiles, and variables related to coronary slow flow such as laboratory tests. Results: Slow coronary flow was observed in different combinations of coronary arteries, with isolated slow flow in 17 patients and involvement of all three major arteries in 9 patients. Hypertension was significantly higher in the slow coronary flow group compared to the normal coronary artery group. LDL cholesterol levels and left ventricular ejection fraction were statistically significantly lower in patients with slow coronary flow compared to those with normal coronary arteries. The eosinophil count was found to be statistically significantly lower in the slow coronary flow group compared to the normal coronary artery group. Conclusion: The study on coronary slow flow conducted in Somalia highlights several significant findings. Overall, this study sheds light on the clinical characteristics and potential risk factors associated with coronary slow flow in the Somali population.
Objective: To explore the clinical application of PTEN-induced kinase 1 (PINK1) and acyl-CoA synthetase long chain family 4 (ACSL4) protein levels in patients with acute myocardial infarction (AMI) and the prognosis evaluation after percutaneous coronary intervention (PCI). Methods: 152 AMI patients who underwent PCI at our hospital from October 2021 to February 2023 were selected as the study group. They were divided into a MACE group (31 cases) and a non MACE group (121 cases) based on the major adverse cardiovascular events (MACE) within 28 days after PCI. Additionally, 152 angina pectoris patients admitted during the same period were selected as the control group. Measure and analyze the levels and clinical significance of PINK1 and ACSL4 proteins in all study subjects. Results: The PINK1 protein level in the study group was lower than that in the control group, while the PINK1 protein level in the MACE group was lower than that in the non MACE group (P<0.05), while the ACSL4 protein level was the opposite (P<0.05); PINK1 expression was negatively correlated with SYNTAX score (r=-0.602, P<0.05), while ACSL4 expression was positively correlated with SYNTAX score (r=0.683, P<0.05); Age, LVEF, and ACSL4 were risk factors for poor prognosis in AMI patients after PCI, while PINK1 was a protective factor (P<0.05); The combined prediction of PINK1 and ACSL4 for the postoperative prognosis of AMI patients after PCI was superior to the individual detection of PINK1 and ACSL4 (P<0.05). Conclusion: The expression levels of PINK1 and ACSL4 are related to the occurrence of AMI, and their combined detection has high predictive power for the prognosis of AMI patients after PCI.
Introduction: Heart failure (HF) and atrial fibrillation (AF) are constantly linked together as predictors of a substantial increase in morbidity and mortality. In this study, we investigated the effects of atrial fibrillation in patients with heart failure. Methods: This study was a prospective observational multicenter national registry encompassing 21 health institutes in Jordan, comprising university hospitals, private hospitals, and private clinics. Patients visiting the cardiology clinic or inpatients admitted due to acute decompensated HF were included. The collected variables included age, sex, BMI, comorbidities, HDL, LDL, triglycerides, BNP, Sodium, potassium, hemoglobin, and creatinine. Results: Our study of 1571 patients showed significant differences between those with and without atrial fibrillation (AF). AF patients included more females (49.4% vs 34.0%), had a higher prevalence of hypertension (88.0% vs 78.5%), and were older (57.8% aged >= 70 years). Smoking rates were lower in patients with AF (22.3% vs 37.0%), while dyslipidemia was less common (54.5% vs 65.3%). Patients with AF also had more hospital admissions than those without AF (16% vs 11.6%). In addition, triglyceride levels were notably lower, hemoglobin levels were < 10 g/dL, and eGFR was reduced in patients with AF. In predicting death, the Random Forest Classifier had the highest accuracy (93.02%) and AUC (92.51%), whereas Logistic Regression had higher sensitivity (72.09%). Creatinine, Length of Hospital Stay, and other factors influenced the predictions, with creatinine levels being a strong predictor of patient outcomes. Conclusion: Atrial fibrillation patients were older and had a higher proportion of females compared than non-atrial fibrillation patients. Hypertension, a family history of premature coronary artery disease, and structural heart disease were notably higher in the atrial fibrillation group. Patients with atrial fibrillation had higher rates of hospital admissions than those without atrial fibrillation.
Heru Santoso Wahito Nugroho Health Department, Poltekkes Kemenkes Surabaya, Surabaya, IndonesiaCorrespondence: Heru Santoso Wahito Nugroho, Health Department, Poltekkes Kemenkes Surabaya, Pucang Jajar Tengah-56, Surabaya, Indonesia, Email heruswn@poltekkesdepkes-sby.ac.id
Background: Acute coronary syndrome causes significant mortality and morbidity. Patients with acute coronary syndrome continue to have a significant in-hospital mortality rate. The evidence on factors contributing to in-hospital mortality in resource-limited setups remains scarce. The goal of this study was to assess determinants of in-hospital mortality among patients with ACS at University of Gondar Comprehensive Specialized Hospital; Northwest Ethiopia. Methods: An institution-based unmatched case-control study was conducted on admitted acute coronary syndrome patients from September, 2018 to May, 2022. We performed bi-variable logistic regression analysis followed by multivariable logistic regression analysis. P value < 0.05 and 95% CI were used to determine the association between independent variables and in-hospital mortality. Results: The study was conducted on 159 acute coronary syndrome patients, 53 cases and 106 controls. The mean +/- SD age of the participants was 59.67 years +/- 13.4 and 62.72 years +/- 15.58 for controls and cases respectively. The determinants of in-hospital mortality were patients not initiated on B-blockers (AOR= 11.39, 95% CI: 2.32-55.96), cardiogenic shock (AOR= 7.23, 95% CI: 1.56-33.49), stroke (AOR = 7.61, 95% CI: 1.81-31.92), oxygen saturation < 90% (AOR = 5.31, 95% CI: 1.25-22.57) and hemoglobin level less than 12 g/dl (AOR=3.43, 95% CI: 1.13-10.35). Conclusion: Patients not initiated on beta-blockers, development of cardiogenic shock and stroke, low oxygen saturation, and hemoglobin level below 12 g/dl were the determinants of in-hospital mortality. Therefore, early detection and treatment of complications and comorbidities should be routine practice to decrease the in-hospital mortality of patients with acute coronary syndrome.
Background: Coronary angiography remains the standard diagnostic test for evaluating the extent of coronary artery disease (CAD). Guidelines for triaging patients for invasive coronary angiography (ICA) recommend risk assessment and non-invasive testing. The yield of ICA in patients undergoing elective ICA in Ethiopia is unknown. Methods: The study involved patients who underwent elective ICA at catheterization laboratory of Cardiology unit of Tikur Anbessa Specialized Hospital and Gesund Cardiac and Medical Center between January 2019 and September 2022 G.C. Data on patient risk profile, Chest pain characteristics and ICA finding were collected from electronic medical record, patient's chart and procedure note with the aid of a structured questionnaire. Obstructive CAD was defined as stenosis of 50% or more of the diameter of the left main coronary artery or stenosis of 70% or more of the diameter of a major epicardial vessel. The data was analyzed using SPSS version 26.0. Results: A total 232 patients, with mean age of 59.9 years, were involved. At catheterization 49.6% were found to have obstructive CAD and 43% of patients had normal epicardial coronary arteries. Hypertension and DM were the commonest comorbidity each occurring in 61% and 53% of the patients. The presence of DM, CKD, and smoking and typical chest pain were independently associated with obstructive CAD. Conclusion: In this study only half of the patients undergoing elective ICA for suspected chronic coronary syndrome (CCS) have obstructive CAD. In consecutive patients undergoing elective ICA for suspected CCS in Ethiopian, obstructive CAD was found in 49.6% of patients despite high prevalence of atherosclerotic risk factors like hypertension and Diabetes mellitus. Diabetes, hypertension, typical chest pain and history of smoking were found to be strong predictors of obstructive CAD.
The sinuses of Valsalva are three pouch -like dilations at the root of the aorta, just above the aortic valve. Aneurysms of the sinuses of Valsalva can be congenital or acquired secondary to infective endocarditis. Here, we describe the case of a 41 -year -old male patient who presented to the cardiology department of our hospital with fatigue and dyspnea on exertion for long periods. He had a history of infective endocarditis, smoking and substance abuse, like khat. Cardiovascular examination showed a murmur consistent with aortic regurgitation. Other systemic examinations, including those of the neurological, respiratory and abdominal, were unremarkable. Laboratory investigations were normal. Cardiac imaging, like transthoracic, trans -esophageal and cardiac computed tomography showed an aneurysm of the sinus Valsalva dissecting in to the interventricular septum. The patient was managed with metoprolol 25 mg, perindopril 10 mg and furosemide 20 mg and recommended for surgery but unfortunately it is not available in our country.
Introduction: Mitral valve aneurysm (MVA) is a saccular, bulging structure of the mitral leaflet that expands during systole and collapses during diastole. Morand provided the first description of the MVA case in 1729. There are no symptoms or indicators particular to an aneurysm in MVA; instead, the clinical findings are comparable to those in mitral regurgitation. Tricuspid valve aneurysms are a bulging or outpouching of the septal leaflet of the tricuspid valve and have been documented in the literature less frequently in association with endocarditis, but as congenital anomaly they have not yet been reported.Case Presentation: We present a case of mitral valve aneurysm and tricuspid aneurysm causing progressive dyspnea. To our knowledge this is the first case of an incidental finding of bilateral atrioventricular valve aneurysm. The patient cardiac findings were limited to mild symptoms and were managed with a medical approach.Conclusion: Atrioventricular aneurysm discovery by accident is infrequent. Shortness of breath and increasing dyspnea may result from this. Only a few cases have been described in the medical literature. In this instance, an unexpected cause of dyspnea in an elderly patient is presented.
