Cardiovascular Diseases & Diagnosis

Background: Cardiac implantable devices are now an established effective treatment for patients with heart block and advanced heart failure. The most common complications related to pacemaker insertion are lead displacement and device related infection. An optimal technique for placement of the RA lead could improve outcome of device implantation and reduce complications.

Objective: To test the impact of applying certain steps during pacemaker implantation on reducing of the percent of atrial lead dislodgment. 166 patients who were candidate for cardiac device implantation underwent complete general and local examination; conventional 2D echo and 12 leads ECG. They were followed up in the pacemaker clinic for at six months for pacemaker lead complication with emphasis on atrial lead dislodgment. The patients were classified into two groups randomly, the first group underwent conventional pacemaker implantation with the standard traditional technique for the atrial lead insertion and the other group underwent the same procedure with the addition of certain technical steps during atrial lead implantation. These steps include applying minimal traction of the atrial lead before screwing, inserting a straight stylet to the middle of the lead after its fixation, visualization of the atrial lead stability while the patient takes deep breath and cough and providing the patient with arm sling to wear for 2 weeks.

Results: No statistically significant difference in the demographic, clinical or ECG characteristics between group A with traditional technique of RA lead insertion and group B with applying the previously described additional steps during atrial lead implantation. Early atrial lead dislodgment occurred in 3 cases (3.9%) in the traditional group while no cases (0%) occurred in the other group (p=0.057).

Conclusion: Applying certain simple maneuvers during pacemaker insertion could help in reducing the pacemaker related complications by reducing the percent of atrial lead dislodgment.

Background: Chronic hepatitis C Virus (HCV) infected patients are at higher risk for pulmonary arterial hypertension (PAH) due to treatment with interferon (IFN) and ribavirin. The establishment of novel direct-acting antiviral agents (DAA) has revolutionized the HCV therapy. However, hardly any data exist evaluating the evidence of DAA-induced PAH. Therefore, the goal of this study was the evaluation of systolic pulmonary artery pressure (sPAP) in patients undergoing DAA-therapy for chronic HCV infection.

Methods: We prospectively enrolled forty-nine patients at our hospital undergoing 8-12 weeks of DAA-therapy for chronic HCV infection according to HCV genotype and co-medication. A transthoracic echocardiogram (TTE) was performed for assessing sPAP and right ventricular (RV) function before therapy, 8 weeks after DAA-therapy was started and 8 weeks after completion of the total treatment regimen.

Results: Mean patient ’ s age was 51 years and 39% of the population consisted of women. Human immunodeficiency virus (HIV) coinfection was present in 12% of the population. There was no significant difference between sPAP before, during and 8 weeks after treatment (26.4 ± 6.6 mmHg, 27.6 ± 6.4 mmHg respectively 28.4 ± 5.4 mmHg, p= 0.32). The results were sex-independent in subgroup analysis. In addition, the RV function before and after treatment was normal without significant differences (fractional area change (FAC) 50.4 ± 7.3% before, 51.9 ± 6% during and 50.2 ± 7.3% after treatment, p=0.9).

Conclusion: DAA-therapy for chronic HCV infection is not associated with PAH or RV dysfunction in a follow-up of 16-20 weeks.

Background: To evaluate the differences in radiation dose and contrast volume between the femoral approach (FA) and the left (LRA) and right (RRA) radial accesses separately during coronary angiography (CA).

Background: CA is crucial in the diagnosis of coronary artery disease (CAD). Two access sites are usually used for angiography - femoral and radial.

Methods: We retrospectively analyzed 8978 patients who underwent coronary angiography in our hospital between January 1, 2014 and December 31, 2016. Patients with prior coronary artery bypass grafting were excluded from the analysis.

Results: A total of 7302 patients were included in the statistical analysis. The smallest amount of contrast agent was used in cases of RRA (103.3 ml; SD 42.5); larger in cases of LRA (112.6 ml; SD 54.6) and FA (119.2 ml; SD 55.8). The differences were statistically significant between each of the groups (p<0.001). The lowest radiation dose was used in cases of RRA (365.1 mGy; SD 262.4); larger in cases of LRA (390.1 mGy; SD 282.9) and FA (382.6 mGy; SD 317.5). The differences between LRA and FA (P=0.007) as well as RRA and LRA (P=0.001) were responsible for the statistical validity (p=0.001). No statistically significant difference in radiation dose was seen between RRA and FA. A comparative analysis was also applied to femoral access versus both radial access groups together. Statistically significant differences in the amount of contrast agent used was observed (p<0.05), but no for radiation dose (p=0.45).

Conclusion: RRA was associated with a significantly reduced amount of contrast agent and radiation dose. Our results indicate RRA and LRA access groups should not be considered interchangeable. RAA is responsible for the advantage of both radial accesses, in relation to the classic femoral access.

Background: Chronic heart failure (CHF) is one of the most life-threatening conditions. Patient populations living with the disease experience high rates of mortality and cardiac morbidities. Research examining the compliance of CHF patients to telemonitoring programs such as cardiac rehabilitation programs, reveals that patients, especially of older ages, tend to show less compliance and more drop out of these programs.

Methods: The researcher used 8 out of 16 randomized controlled trials identified from the following databases until April 2019: The Cochrane Library, CINAHL, and Medline. The researcher used various randomized controlled trials identified from the following databases until April 2019: The Cochrane Library, CINAHL, and Medline. The meta-analysis will investigate the various ways to upgrade the compliance of CHF patients. The RCTs from the identified studies were then fully reviewed and included in the meta-analysis if they satisfied the criteria below had prospectively enrolled patients with confirmed congestive heart failure, reviewed patient randomized to access telemonitoring programs, and discusses more than one of the primary and secondary outcomes. To assess the progress of compliance, the patients can be monitored for various factors including self-reporting of daily measurements of healthcare parameters, use of healthcare resources and the actual usage of the technology used in telemonitoring.

Limitations: The reviewed evidence mainly focuses on the compliance of heart failure patients and does not assess the process of telemonitoring.

Conclusion: Currently more innovative technology, other than telephone calls and the use of mobile phone applications is being investigated for possible future use. Accordingly, the use of artificial intelligence is being investigated to support clinical decision making and imaging interpretations by the patient. Socio-economic factors, patient related factors such as age and were also reported to implicate compliance. Accordingly, elderly was more likely to suffer cognition and physical impairments implicating their ability to effectively understand and interpret the processes involved in the telemonitoring program.

Ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. Prompt diagnosis with noninvasive imaging is key and surgical repair, though challenging remains the treatment of choice. We describe a rare case of inferior wall AMI complicated with VSR and posterior true ventricular wall aneurysm.

Background: Myocarditis and acute Myocardial Infarction pose a daily diagnostic dilemma. Magnetic resonance imaging and endomyocardial biopsy are the gold standard for definite diagnosis but are rarely performed routinely. Troponin and Creatine phosphokinase (CPK) are elevated in both diseases and could not be used for proper discrimination. We analyzed the dynamics of these serum markers during acute setting by analyzing the tangent slope of their level curve over time.

Methods: We conducted a retrospective cohort study in our medical center. Records of approximately 1,300 patients hospitalized from January 2011 to December 2016 were examined. A total of 193 patients were found to be eligible for the study and were divided into two groups: Myocarditis group (n=133, 69%) and non-ST elevation myocardial infarction group (n=60, 31%).

Results: The non-ST elevation myocardial infarction group was significantly older than the myocarditis group (mean age 68.7 vs 35.6 years, p<0.001). Median troponin and CPK levels were significantly higher in the myocarditis group (p<0.001). The tangent slope of troponin curve was significantly lower and CPK curve significantly higher in the myocarditis group (p=0.02 and p<0.001, respectively). Troponin-to-CPK ratio was lower within the first 48 hours from admission in the myocarditis group.

Conclusion: Our study demonstrates a unique discriminating pattern of serum markers curve in acute Myocarditis and acute Non-ST myocardial infarction. In acute myocarditis, troponin progress moderately while CPK progress steeply, both to higher peak, resulting in lower troponin to CPK ratio in the first 48 hours of admission.

Background: Hypertension is an overwhelming global challenge. Appropriate lifestyle changes are the cornerstone for the prevention of hypertension. The study aimed to assess knowledge and practice of lifestyle modification among hypertensive patients in Nekemte Specialized Hospital, West Oromia, Ethiopia, 2018.

Methods: Institutional based cross-sectional study was conducted at the chronic adult Out Patient Department of Nekemte Specialized Hospital and Wollega university referral and teaching hospital from December 2018 to January 2019. A structured interviewer-administered questionnaire was used for data collection. Consecutive sampling was used to collect data and Questions are categorized to elicit participants' demographic characteristics, economic characteristics, knowledge, and the practice of various lifestyle-modification measures. The data could be analyzed by SPSS software version 20, and the result could be presented by statement, table, graph, and charts. The result could be disseminated to Wollega University, Nekemte specialized Hospital, Wollega University Referral hospital and other stakeholders.

Results: The study included 222 respondents with a 100% response rate; 112 (50.5%) were female, and the mean age of the respondents is 44.00 years. The general respondents' knowledge of lifestyle modifications was 79.28%, but only 68.92% of them have a good practice. Males have better knowledge and practice (80.9%, 36.4%), respectively. From respondents with comorbidity, 68.8% of them and 69% of those without comorbidity have good knowledge respectively.

Conclusion and Recommendations: The results of this study, indicates that although patients do receive advice on lifestyle modification, it is not enough and effective in changing patient knowledge and practice. Therefore, clinicians should give adequate time to provide relevant information on the value of lifestyle modification in the control of their blood pressure.