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This study analyzed the learning curve effect when a new stroke thrombectomy program was initiated in a cardiac cath lab in close cooperation with neurologists and radiologists.Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available.An endovascular treatment program for acute ischemic strokes was established in the cardiac cath lab of a tertiary university hospital in 2012. The decision to perform catheter-based thrombectomy was made by a neurologist and was based on acute stroke clinical symptoms and computed tomography angiographic findings. Patients with a large vessel occlusion of either anterior or posterior circulation were enrolled. The primary endpoint was the functional neurological outcome (Modified Rankin Scale [mRS] score) of the patient at 3 months. A total of 333 patients were enrolled between October 2012 and December 2019.The clinical (mRS) outcomes did not vary significantly across years 2012 to 2019 (mRS 0 to 2 was achieved in 47.9% of patients). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%). Embolization in a new vascular territory occurred in 6 patients (1.8%).When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke in regions where this therapy is not readily available due to the lack of neurointerventionalists.

Objectives To describe, compare and examine self-reported anxiety levels and associated physiological responses of blood pressure, heart rate and respiratory rate of patients undergoing cardiac catheterisation (CATH). Methods Repeated measure design was used to assess a sample of 100 patients who had undergone cardiac catheterisation (CATH) in a major specialised heart institute in Jordan. Results Patients’ anxiety levels differed significantly across the three time periods (baseline, prior to and post CATH). The mean anxiety levels prior to CATH scored with State Anxiety Inventory (M = 52.14, SD = 6.0) was significantly higher than that at baseline (M = 48.35, SD = 5.6) and post CATH (M = 36.27, SD = 9.7). Conclusion Most patients experienced anxiety when scheduled for a CATH. The highest level of anxiety was within two hours prior to the procedure and the lowest was post procedure.

Introduction: Significant obesity is an increasing co-morbidity in pulmonary hypertension (PH). We note many patients with echo features of pre-capillary PH (PrePH) who were being classified as post-capillary PH (PostPH), due to elevated pulmonary wedge pressure (PWP). We wished to assess the impact of intrathoracic pressure (ITP) measurements on haemodynamics during artificial alterations of ITP in obese patients and on classification. Methods: Obese individuals underwent invasive cardiac cath and intra-oesophageal pressure (IOP) measurements. Haemodynamics were measured during end-expiration, Valsalva and external compression of the abdomen. Fluid challenge was administered in selected patients. Results: 17 patients underwent investigation between Jan ‘13 and Dec ’16. There was a direct 1:1 linear relationship between ITP, as assessed by IOP, and wedge pressure (PWP) (Fig 1A). There was a tight relationship between IOB and PWP during manoeuvres (Valsalva, 1B; external compression, 1C). Following fluid, PWP rose by 4 mmHg. 14/17 patients were classified as PostPH, but following correction for expected ITP (4mmHg), only 3/17 were classified as PostPH (1D). Conclusions: ITP has a 1:1 relationship on PWP. We show that this may frequently result in misclassification of patients as PostPH who have echo features of PrePH and whose PWP does not change significant with fluid challenge.

Cardiac hemodynamic assessment during cardiopulmonary exercise testing (CPET) is proposed to play an important role in the clinical evaluation of individuals with cystic fibrosis (CF). Cardiac catheterization is not practical for routine clinical CPET. Use of oxygen pulse (O2pulse) as a noninvasive estimate of stroke volume (SV) has not been validated in CF. This study tested the hypothesis that peak exercise O2pulse is a valid estimate of SV in CF. Measurements of SV via the acetylene rebreathe technique were acquired at baseline and peak exercise in 17 mild-to-moderate severity adult CF and 25 age-matched healthy adults. We calculated [Formula: see text]. Baseline relationships between SV and O2pulse were significant in CF ( r = .80) and controls ( r = .40), persisting to peak exercise in CF ( r = .63) and controls ( r = .73). The standard error of estimate for O2pulse-predicted SV with respect to measured SV was similar at baseline (14.1 vs 20.1 mL) and peak exercise (18.2 vs 13.9 mL) for CF and controls, respectively. These data suggest that peak exercise O2pulse is a valid estimate of SV in CF. The ability to noninvasively estimate SV via O2pulse during routine clinical CPET can be used to improve test interpretation and advance our understanding of the impact cardiac dysfunction has on exercise intolerance in CF.

Use of radiation for medical examinations and test is the largest man-made source of radiation exposure. Interventional procedures are only 2% of all radiological procedures, but contribute to about 20% of the total collective dose per head per year. On average, a left ventriculography and coronary angiography corresponds to a radiation exposure for the patient of about 300, a coronary stent to 1,000, a peripheral artery intervention to 1,500 to 2,500, and a cardiac radiofrequency ablation to 900-1,500 chest x-rays. Invasive cardiology procedures increased tenfold in the last ten years and growth in the field has been accompanied by concern for the safety of the staff. Interventional cardiologists have an exposure per-head per year two- to three times higher than that of radiologists, with an annual exposure equivalent to around 250 chest x-rays per head. A reduction of occupational doses by a factor of ten can be achieved simply by and intensive training program. The awareness of radiation effects may be suboptimal in the medical community. It is recommended by professional guidelines and reinforced by the European law that the responsibility of all physicians is to minimize the radiation injury hazard to their patients, to their professional staff and to themselves.

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females. Key words: Risk factors; Coronary angiography. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9179 Cardiovasc. J. 2011; 3(2): 122-125