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Background: Pain is one of the common postoperative issues that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. It leads to prolonged recovery and sleep disturbances in patients., Aim: This study was conducted to examine the effect of eye mask use on sleep quality and pain in patients undergoing CABG surgery., Study Design: A double-blind randomized trial design was employed. The study included 60 patients undergoing CABG surgery. They were divided into intervention and control groups through block randomization. Data were collected using a 'Demographic Characteristics Form', the 'Richards-Campbell Sleep Questionnaire (RCSQ)' and a 'Visual Analogue Scale' (VAS) through face-to-face interviews. While patients in the control group received standard care throughout the night, patients in the intervention group received standard care and used eye mask. All patients were followed up for three nights. The CONSORT was used to report the study., Results: The main outcome of the study, the RCSQ score, was higher in the intervention group at baseline. The intervention group had higher RCSQ scores than the control group at time 1 and time 2. There were no differences between the groups in the secondary outcome, pain levels. The control group had higher pain scores at time 1 and time 2 than the intervention group., Conclusion: The use of an eye mask after CABG surgery is an effective, safe and simple nursing intervention to improve sleep quality and control pain., Relevance to Clinical Practice: Because the use of an eye mask is an independent and unique nursing intervention, nurses should be supported and allowed to practise it., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients., Competing Interests: The authors had no funding and have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: This prospective study aimed to investigate the myocardial energy metabolism in severe mitral regurgitation (MR) and explore its effect on postoperative differentiation of ejection fraction (EF)., Methods: A total of 85 patients with severe MR were prospectively enrolled from October 2018 to June 2019. During the study period, a total of 50 patients underwent mitral valve surgery and 49 patients were finally enrolled due to 1 missing data. Left ventricular function, circumferential end-systolic stress (cESS), and myocardial energy expenditure (MEE) were measured by transthoracic echocardiography preoperatively and 3 months after surgery. Patients were divided into 2 groups according to absolute difference of postoperative differentiation of EF., Results: Nine patients underwent mitral valve repair and 40 underwent prosthetic valve replacement. Patients with reduced EF had higher MEE demonstrated with cESS and MEE. Negative correlation between preoperative EF and N-terminal pro-brain natriuretic peptide (NT-proBNP), cESS, MEEs, and MEEm and positive correlation between preoperative EF and effective regurgitant orifice area were found. Complications occurred in 12 patients during hospitalization. Basal NT-proBNP, left atrium (LA), and cESS were significantly higher in postoperatively decreased EF group. Taking into consideration the covariates of multiple logistic regression analysis, LA and cESS were found to be independent predictors of EF reduction postoperatively., Conclusion: Higher LA and cESS are independent predictors of postoperative EF reduction. Preoperative high end-systolic stress could predict postoperative EF reduction and hence could be helpful for determining the timing of mitral valve surgery. Although MEE was higher in postoperatively decreased EF group, it did not reach statistical significance.

Objective: Since visual estimation of the extent of vessel stenosis may vary between operators, we aimed in this study to investigate both inter-observer variability and consistency between the estimation of an operator and quantitative coronary analysis (QCA) measurements., Methods: A total of 147 elective percutaneous coronary intervention patients with 155 lesions between them were consecutively enrolled in the study. These patients were evaluated for visual estimation of lesion severity by three operators. The lesions were also evaluated with QCA by an operator who was blinded to the visual assessments. Reference diameter, minimal lumen diameter, percentage diameter of stenosis, percentage area of stenosis and diameter of lesion length from the proximal lesion-free segment to the distal lesion-free segment were calculated using a computerised QCA software program., Results: There was a moderate degree of concordance in the categories 70-89% (κ: 0.406) and 90-99% (κ: 0.5813), whereas in the categories < 50% and 50-69% there was a low degree of concordance between the visual operators (κ: 0.323 and κ: 0.261, respectively). There was a low to moderate grade of concordance between visual estimation and percentage area of stenosis by QCA (κ: 0.30) but there was no concordance between visual estimation and percentage diameter of stenosis by QCA (κ: -0.061). Also, there was a statistically significant difference between QCA parameters of percentage diameter of stenosis and percentage area of stenosis (58.4 ± 14.5 vs 80.6 ± 11.2 %, p < 0.001)., Conclusions: Visual estimation may overestimate a coronary lesion and may lead to unnecessary coronary intervention. There was low concordance in the categories < 50% and 50-69% between the visual operators. Percentage area of stenosis by QCA had a low to moderate grade of concordance with visual estimation. Percentage area of stenosis by QCA more closely reflected the visual estimation of lesion severity than percentage diameter of stenosis.

Background:: According to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC)., Methods:: We retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system., Results:: Out of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively)., Conclusion:: More than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels., Fundamento:: Há uma crença geral de que a maioria dos infartos agudos do miocárdio (IAM) ocorrem devido à ruptura de placas vulneráveis, não graves, com obstrução < 70%. Dados de ensaios recentes desafiam esta crença, sugerindo que o risco de oclusão coronariana é, na realidade, muito maior após estenose grave. O objetivo deste estudo foi investigar se a presença ou não de IAM com supradesnível do segmento ST resulta de estenoses de alto grau através da avaliação da presença de circulação colateral coronariana (CCC)., Métodos:: Nós incluímos retrospectivamente 207 pacientes consecutivos submetidos à intervenção coronariana percutânea primária devido à ocorrência de IAM com supradesnível do segmento ST. O fluxo sanguíneo colateral distal à lesão culpada foi avaliado por dois investigadores com utilização do sistema de escores de Rentrop., Resultados:: Dos 207 pacientes incluídos no estudo, 153 (73,9%) apresentavam vasos coronarianos colaterais (Rentrop 1-3). Os escores Rentrop foram de 0, 1, 2 e 3 em 54 (26,1%), 50 (24,2%), 51 (24,6%) e 52 (25,1%) pacientes, respectivamente. Triglicérides, volume plaquetário médio (VPM), contagem de células brancas (CCB) e contagem de neutrófilos estiveram significativamente mais baixos no grupo com bons vasos colaterais (p = 0,013, p = 0,002, p = 0,003 e p = 0,021, respectivamente)., Conclusão:: Mais de 70% dos pacientes com IAM apresentaram CCC com escores de Rentrop de 1-3 durante angiografia coronariana primária. Isto demonstra que a maioria dos casos de IAM em nosso estudo originou a partir de estenoses subjacentes de alto grau, contrariamente à sabedoria comum. Níveis séricos mais elevados de triglicérides, maior VPM e elevação na CCB e na contagem de neutrófilos estiveram independentemente associados com comprometimento no desenvolvimento de vasos colaterais.

This case report presents a case with septal occluder device thrombosis which was successfully treated with low dose longer duration of thrombolytic application. Our case showed that the thrombolytic strategy with the lower dose and the longer duration might be a valuable alternative treatment option for the septal occluder thrombosis which is anticoagulation-resistant. This strategy might obviate the need for surgery.

Aim: Radial artery spasm is common during transradial procedures and is the most common cause of procedural failure. The objectives of this study were to assess whether the routine administration of sedation at the beginning of transradial coronary angiography with the use of hydrophilic-coated and smaller sheaths/catheters would reduce the incidence of radial artery spasm., Patients and Methods: Patients undergoing transradial coronary angiography were prospectively randomized to receive midazolam during the procedure or no sedative treatment. The primary endpoint was angiographically confirmed radial artery spasm. Stenosis of the radial artery was measured with a computer-assisted quantification method., Results: In all, 150 patients were randomized into a treatment group and a control group. Spasm occurred in 15 patients of the treatment group (20 %) versus 16 in the control group (21.3 %). There were no differences between the two groups regarding the incidence of spasm and the distribution of spasm severity (p > 0.05). No significant differences were observed between the two groups in terms of 30-day mortality or repeat hospitalization for any cause (p > 0.05)., Conclusion: Routine use of midazolam could not reduce the occurrence of radial artery spasm during transradial coronary angiography.

Objective: In this retrospective study, we investigated the association between air pollution and weather conditions with the incidence of acute myocardial infarction (AMI) in the city of Kutahya., Methods: A total of 402 patients who were admitted with acute ST segment elevation MI and non-ST segment elevation MI were included in the study in 1 year. Daily maximum, minimum, and mean ambient temperature and mean barometric pressure data were obtained from the Kutahya Meteorology Department. Daily air pollution data were obtained from the Web site of National Air Quality Observation Network (http://www.havaizleme.gov.tr)., Results: Increase in ambient air temperature in the day of MI and 2 days before the day of MI according to their control days was correlated with increase in number of MI cases. When we grouped the patients according to ages as 30-54, 55-65, and >65 years, we found that there was a relation between sulfur dioxide (SO2) and the occurrence of AMI for the age group of 30-54 for the same day (D0) (P<.017). The number of AMIs was the lowest in fall season, whereas the number of AMIs was the highest in winter season., Conclusion: There was no statistically significant association between the particulates with diameter b=10 μm, SO2 concentrations, air pressure, and the risk of AMI, but there was statistically significant relation between occurrence of MI and SO2 for the patients under age of 55 years. The number of AMIs was the lowest in fall season, whereas the number of AMIs was the highest in winter season., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to assess the efficacy of WhatsApp application as a communication method among the emergency physician (EP) in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional cardiologist at a tertiary PCI center., Background: Current guidelines recommend that patients with ST-segment elevation myocardial infarction (STEMI) receive primary PCI within 90 minutes. This door-to-balloon (D2B) time has been difficult to achieve in rural STEMI., Methods and Results: We evaluated 108 patients with STEMI in a rural hospital with emergency department but without PCI capability to determine the impact of WhatsApp triage and activation of the cardiac catheterization laboratory on D2B time. The images were obtained from cases of suspected STEMI using the smartphones by the EP and were sent to the interventional cardiologist via the WhatsApp application (group 1, n=53). The control group included concurrently treated patients with STEMI during the same period but not receiving triage (group 2, n=55). The D2B time was significantly shorter in the intervention group (109±31 vs 130±46 minutes, P<.001) with significant reduction in false STEMI rate as well., Conclusion: This study demonstrates that use of WhatsApp triage with activation of the cardiac catheterization laboratory was associated with shorter D2B time and results in a greater proportion of patients achieving guideline recommendations. The method is cheap, quick, and easy to operate., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aim: The Ceraflex atrial septal defect occluder is an alternative device to the Amplatzer septal occluder with some structural innovations including flexible connection, increased flexibility, and minimized amount of implant material. We evaluated the efficiency and safety of the Ceraflex septal occluder device in percutaneous closure of secundum atrial septal defects., Patients and Methods: This was a prospective, nonrandomized, multicenter study of patients undergoing transcatheter closure for an atrial septal defect with the Ceraflex and the Amplatzer septal occluder devices. A clinical evaluation and follow-up transthoracic echocardiography were performed at 1, 6, and 12 months., Results: Between 2010 and 2014, 125 patients underwent atrial septal defect closure with the Ceraflex septal occluder (n = 58) and the Amplatzer septal occluder (n = 67) under transesophageal echocardiography guidance. Patient characteristics, the stretched size of the defect, device size, and fluoroscopy time were similar between the groups. The immediate and follow-up complete occlusion rates for both groups were 100%. There was no device embolization, procedure-related stroke, or pericardial effusion., Conclusions: The Ceraflex septal occluder is a safe and efficient device for closure of secundum atrial septal defects with no procedural complications. The Ceraflex has similar outcomes when compared with the Amplatzer septal occluder device. The advantage of the Ceraflex septal occluder device is that it can be deployed without the tension of the delivery catheter.

An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagulation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient in the present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwent a thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prosthetic valve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C and heterozygous mutations of β-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphisms may be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss.

We present the cases of two adult patients with cor triatriatum due to left atrial membrane with atrioventricular septal defect and right atrial membrane. Two-dimensional and real-time three-dimensional transthoracic echocardiography were performed. These noninvasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly.

Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed after administration of a low dose and short term use of oral amiodarone, in the absence of predisposing factors. We describe the case of a 41-year-old woman admitted to hospital because of a cardiac arrest from TdP. On hospital admission, ECG showed sinus bradycardia 46 bpm with marked QT prolongation.

Background: Prosthetic valve thrombosis during pregnancy is life-threatening for mother and fetus, and the treatment of this complication is unclear. Cardiac surgery in pregnancy is associated with very high maternal and fetal mortality and morbidity. Thrombolytic therapy has rarely been used in these patients. The aim of this study is to evaluate the safety and efficacy of low-dose (25 mg), slow infusion (6 hours) of tissue-type plasminogen activator for the treatment of prosthetic valve thrombosis in pregnant women., Methods and Results: Between 2004 and 2012, tissue-type plasminogen activator was administered to 24 consecutive women in 25 pregnancies with 28 prosthetic valve thrombosis episodes (obstructive, n=15; nonobstructive, n=13). Mean age of the patients was 29±6 years. Thrombolytic therapy sessions were performed under transesophageal echocardiography guidance. The mean dose of tissue-type plasminogen activator used was 48.7±29.5 mg (range, 25-100 mg). All episodes resulted in complete thrombus lysis after thrombolytic therapy. One patient had placental hemorrhage with preterm live birth at the 30th week, and 1 patient had minor bleeding., Conclusions: Low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed is an effective therapy with an excellent thrombolytic success rate for the treatment of prosthetic valve thrombosis in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. Thrombolytic therapy should be considered first-line therapy in pregnant patients with prosthetic valve thrombosis.

Objectives: The aim of this prospective study was to identify the most effective and safest regimen among different thrombolytic treatment strategies., Background: The best treatment strategies for prosthetic valve thrombosis have been controversial., Methods: Transesophageal echocardiography-guided thrombolytic treatment was administered to 182 consecutive patients with prosthetic valve thrombosis in 220 different episodes (156 women; mean age, 43.2 ± 13.06 years) between 1993 and 2009 at a single center. These regimens chronologically included rapid (Group I), slow (Group II) streptokinase, high-dose (100 mg) tissue plasminogen activator (t-PA) (Group III), a half-dose (50 mg) and slow infusion (6 h) of t-PA without bolus (Group IV), and a low dose (25 mg) and slow infusion (6 h) of t-PA without bolus (Group V). The endpoints were thrombolytic success, in-hospital mortality, and nonfatal complication rates., Results: The overall success rate in the whole series was 83.2%; it did not differ significantly among Groups I through V (68.8%, 85.4%, 75%, 81.5%, and 85.5%, respectively; p = 0.46). The overall complication rate in the whole series was 18.6%. Although the overall complication rate was similar among Groups I through IV (37.5%, 24.4 %, 33.3%, and 29.6%, respectively; p > 0.05 for each comparison), it was significantly lower in Group V (10.5%, p < 0.05 for each). The combined rates of mortality and nonfatal major complications were also lower in Group V than in the other groups, with all differences significant except for comparison of Groups IV and V. By multivariate analysis, the predictors of combined mortality plus nonfatal major complications were any thrombolytic therapy regimen other than Group V (odds ratios for Groups I through IV: 8.2, 3.8, 8.1, and 4.1, respectively; p < 0.05 for each) and a history of stroke/transient ischemic attack (odds ratio: 3.5, p = 0.011). In addition, there was no mortality in Group V., Conclusions: Low-dose slow infusion of t-PA repeated as needed without a bolus provides effective and safe thrombolysis in patients with prosthetic valve thrombosis. (Comparison of Different TRansesophageal Echocardiography Guided thrOmbolytic Regimens for prosthetIc vAlve Thrombosis; NCT01451320)., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffness and a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drug refractory HF., Methods: Fourteen cardiac HF patients (53.6 ± 9.1; 39-67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III-IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) < 35% and QRS duration ≥120 ms. Blood samples for norepinephrine and B-type natriuretic peptide were collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition., Results: Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p < 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman., Conclusions: The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves.

Obstruction to a prosthetic cardiac valve is a well-recognized complication of cardiac valve replacement. Malfunction of the mobile component of a prosthetic valve to open or close correctly may occur in consequence of intrinsic or extrinsic causes (thrombus, vegetation, entrapment of left ventricular myocardium, suture entanglement, and pannus formation) that may result prosthetic valve stenosis and/or insufficiency. In the case we report a 48-year-old female with valve dysfunction occurred early after surgery, as one valve leaflet was only able to partially open due to suture entrapment., (© 2011, Wiley Periodicals, Inc.)

We report on a 37-year-old patient who suffered from myocardial stunning after exposure to carbon monoxide, despite having normal coronary arteries. As myocardial ischaemia may be asymptomatic in these patients, close monitoring with serial electrocardiography and of serum cardiac enzymes and troponins is recommended.