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  • ISSN: 2333-6676
    Volume 4, Issue 2
    Case Report
    Peter Rodgers-Fischl, Andrew R. Kolodziej*, Vincent L. Sorrell and Sarah S. Rugg
    We present a case of a patient with a two-month history of night sweats, nausea and vomiting, fatigue and shortness of breath on exertion as well as significant weight loss. Prior to arrival at our facility he was diagnosed with apical aneurism and was offered an evaluation with cardiac catheterization but the patient decided on a second opinion and thus came to our facility. The apical aneurism turned out to be apical variant hypertrophic cardiomyopathy, which is a common echocardiographic misinterpretation and thus necessitating additional imaging modalities such as cardiac MRI.
    We perform a comprehensive and up to date literature review of apical variant hypertrophic cardiomyopathy as it relates to epidemiology, diagnosis, prognosis and treatment as some variants portend poorer prognosis and it is often misdiagnosed on initial Echocardiography as described in our case presentation.
    Muzaffar Ali* and Zubair Akram
    Coronary artery fistulas are rare congenital abnormality. Coronary artery fistula draining into left atrium is a rare entity.In this case report we describe the patient whosewith a large coronary artery fistula (CAF) draining into left atrium.As patient was having symptoms of chest pain and dyspnea on effort despite of normal coronaries.We decided to close fistula. It was successfully treated with coil embolization using glide catheter 4F via extra backup 6F Guiding catheter, leading to improvement of symptoms. Coil embolization is readily accessible, relatively inexpensive and acceptable alternative to surgery.
    Jeanne E. Maglione*, Navaid Iqbal, Meredith A. Pung, Hermineh Aramin, Minal V. Patel, Elizabeth L. Lee, Fatima Iqbal, Brian Knight, Yang Xue, Khwaja Alim, Kevin S Shah, Laura Redwine, Barry H. Greenberg, Alan Maisel and Paul J Mills
    Objective: Little is known about the relationship between early, asymptomatic heart failure HF and depression. We examined associations between echocardiogram measurements and depressive symptoms in male Veterans with American Heart Association/American College of Cardiology Stage B HF.
    Methods: Male participants with Stage B HF were recruited from an echocardiography clinic after receiving a transthoracic echocardiogram n=176 Depressive symptoms were assessed with the Beck Depression Inventory BDI-Ia. Participants were grouped: BDI<10: fewer depressive symptoms, and BDI≥10: probable depression. Logistic regression models were used to estimate odds ratios [OR] for probable depression for each echocardiogram measurement.
    Results: Our cohort had a 30.1% rate of probable depression. In univariate models, each standard deviation increase in diastolic interventricular septum thickness IVSD; OR=7.9, p=0.021was associated with significantly increased odds of probable depression. This association remained significant in models adjusted for age, BMI, presence of comorbid medical conditions, self-reported current alcohol use, and cardiac medications.
    Conclusions: These data suggest that even in asymptomatic HF, rates of depressive symptoms are high and there is a relationship between echocardiographic measurements of cardiac structural pathology and depressive symptoms.
    Research Article
    Knut Fredrik Seip, Bjørg Evjenth, Anders Hovland, Knut Dybwik, Harald Thidemann Johansen, Hilde Fure, Tom Eirik Mollnes and Erik Waage Nielsen*
    Bradykinin is an important mediator in blood pressure regulation, ischemic precondition and capillary leakage, allergy, anaphylaxis, inflammation, and nociception, at least partly via the generation of nitric oxide (NO). Macrophages are particularly abundant in the porcine lung circulation. Upon bradykinin binding macrophages release cytokines and endothelial cells increase plasma leakage. Both cells produce NO. The complement, hemostatic, fibrinolytic and kinin plasma cascade systems crosstalk and interacts with many inflammatory systems. In the present study we investigated the effect of the shock induced by intravenously infused bradykinin on the cascade systems, cytokines, plasma leakage and exhaled NO in pigs. The metabolite of bradykinin, BK1-5, was measured in plasma by a sensitive, specific and reliable liquid chromatography-mass spectrometry method to verify exposure and in vivo metabolism of bradykinin. We show for the first time in vivo how bradykinin exposure induced shock and increased exhaled NO, activated complement and hemostasis and induced cytokine production and capillary leakage. The results broaden our understanding of how bradykinin activates endothelial cells and macrophages to induce shock and inflammation. This should encourage further studies.
    Review Article
    Cuneyt Narin*, Ilker Kiris and Burcin Abud
    Coronary artery bypass grafting (CABG) is the optimal surgical treatment for multi-vessel coronary artery disease. CABG operation has successful short- and intermediate-term results, but the long-term results are variable. The variability of results in long-term particularly depends on the nature of the vascular grafts used. Angiographic studies in long-term have showed that patency rates of arterial grafts were superior to patency rates of vein grafts. Numerous studies documented an incremental survival and events free benefit by utilizing increased number of arterial grafts during CABG. Long survival has improved by total arterial revascularization compared to using left internal thoracic artery (LITA) and saphenous vein grafts (85% to 90% at 10 years versus 75% to 80%, respectively). Total arterial revascularization patients also have lower rate of cardiac-related events including new myocardial infarction, recurrence of angina, severe arrhythmia, congestive heart failure requiring hospitalization and reoperations.
    Thus, total arterial revascularization for CABG may be beneficial for long-term outcome. The LITA, the right internal thoracic artery (RITA), the radial artery (RA), the right gastrepiploic artery (RGEA) and the inferior epigastric artery (IEA) can be used as arterial conduits. In this paper we review these arterial conduits and clinical results associated with their use in CABG.
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