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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 18 | Issue 2
Page Nos. 41-75

Online since Wednesday, June 21, 2017

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ORIGINAL ARTICLE  

Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf Countries (Gulf COAST Registry) p. 41
Mohammad Zubaid, Wafa Rashed, Alawi A Alsheikh-Ali, Taysir Garadah, Najib Alrawahi, Mustafa Ridha, Mousa Akbar, Fahad Alenezi, Rashed Alhamdan, Wael Almahmeed, Hussam Ouda, Arif Al-Mulla, Fahad Baslaib, Abdulla Shehab, Abdulla Alnuaimi, Haitham Amin
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_113_16  PMID:28706594
Objectives: The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods: Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013. Patient management and outcomes were analyzed and compared between the four countries. Results: A total of 1039 STEMI patients were enrolled in Gulf COAST Registry. The mean age was 58 years, and there was a high prevalence of diabetes (47%). With respect to reperfusion, 10% were reperfused with primary percutaneous coronary intervention, 66% with fibrinolytic therapy and 24% were not reperfused. Only one-third of patients who received fibrinolytic therapy had a door-to-needle time of 30 min or less. The in-hospital mortality rate was 7.4%. However, we noted a significant regional variability in mortality rate (3.8%–11.9%). In adjusted analysis, patients from Oman were 4 times more likely to die in hospital as compared to patients from Kuwait. Conclusions: In the Gulf countries, fibrinolytic therapy is the main reperfusion strategy used in STEMI patients. Most patients do not receive this therapy according to timelines outlined in recent practice guidelines. There is a significant discrepancy in outcomes between the countries. Quality improvement initiatives are needed to achieve better adherence to management guidelines and close the gap in outcomes.
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CASE REPORTS Top

Pseudo-lesions of a tortuous right coronary artery during percutaneous coronary intervention: Accordion phenomena p. 47
Cheikh Ahmed Abool Maaly, Ihsan Rafie, Fahad Alkindi
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_44_17  PMID:28706595
Guidewire-induced pseudo-lesions are referred to accordion phenomenon and are infrequent occurrences during percutaneous coronary intervention of tortuous coronary arteries. Their occurrence can be a diagnostic challenge to the interventionist and might lead to unnecessary intervention. Ischemia and hemodynamic compromise are possible complications, if not managed promptly. The differential diagnosis includes coronary dissection, thrombus, and spasm. We describe a patient who developed pseudo-lesions of the tortuous right coronary artery in multiple segments during PCI. The pseudo-lesions were refractory to intracoronary nitrogycerin.
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Percutaneous retrieval of a knotted provisional pacemaker using proximal electrode cut off and distal end snaring p. 50
Mohsen Mohandes, Natalia Rodríguez, Francisco Fernández, Cristina Moreno, Oscar Palazón, Alfredo Bardaj
DOI:10.4103/1995-705X.208672  PMID:28706596
Although provisional pacemaker implantation can safely be done in many cases, a rare complication such as knotted electrode has been described, especially when the procedure is performed without fluoroscopy guidance. We describe a case of knot creation in a provisional pacemaker which was successfully retrieved using a snare after cutting the electrode proximally.
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An infrequent cause of apical ventricular aneurysm in the United States p. 54
Mohammed M Taleb
DOI:10.4103/1995-705X.208675  PMID:28706597
Chronic Chagas cardiomyopathy (CCC) is a late complication of Chagas disease with various manifestations including arrhythmia, heart failure, thromboembolism, and stroke. In a patient with symptoms of heart failure and left ventricular apical aneurysm unexplained by structural heart or coronary vascular abnormalities, CCC should be strongly considered and inquiry made about exposure status. Typical electrocardiographic findings of bundle branch block, complete heart blocks, and ventricular arrhythmia are helpful clues. A positive trypanosomal immunoglobulin G antibody is supportive. Initiation of stage appropriate guideline-recommended heart failure regimen is the goal with careful attention paid to prevention of sudden cardiac death from ventricular arrhythmias.
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A fractional flow reserve guidewire causing longitudinal stent compression and successful recovery p. 58
Metzdorf Pierre-Adrien, Maigrat Charles-Henri, Popovic Batric, Camenzind Edoardo
DOI:10.4103/1995-705X.208674  PMID:28706598
Longitudinal stent deformation (LSD) is a rare complication but can occur during coronary intervention. We report a case with LSD of the distal edge, documented by an optical coherence tomography investigation and successfully recovered.
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Acute fulminant uremic neuropathy following coronary angiography mimicking guillain–barre syndrome p. 62
Kumari Priti, Bhanwar Ranwa
DOI:10.4103/1995-705X.208673  PMID:28706599
A 55-year-old diabetic woman suffered a posterior wall ST-elevation myocardial infarction. She developed contrast-induced nephropathy following coronary angiography. Acute fulminant uremic neuropathy was precipitated which initially mimicked Guillan–Barre Syndrome, hence reported.
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A PICTURE IS WORTH A THOUSAND WORDS Top

Dissecting aneurysm of aortic root with severe aortic regurgitation p. 64
Jayaprasad Narayanapillai
DOI:10.4103/1995-705X.208668  PMID:28706600
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ART AND MEDICINE Top

Despair and Hope p. 66
Rachel Hajar
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_58_17  PMID:28706601
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HISTORY OF MEDICINE Top

Coronary heart disease: From mummies to 21st century p. 68
Rachel Hajar
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_57_17  PMID:28706602
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LETTER TO THE EDITOR Top

Proximal flow control with a balloon during the treatment of left subclavian artery aneurysmsreply p. 75
Murat Ugurlucan, Metin Onur Beyaz, Didem Melis Oztas, Sena Azamat, Yilmaz Onal, Bulent Acunas, Ufuk Alpagut
DOI:10.4103/HEARTVIEWS.HEARTVIEWS_19_17  PMID:28706603
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