Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial).

Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic-guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU-PACT trial or CWD in the GIFT trial. COAG trial did not show differences between GWD and CWD.

Acute Triple Coronary Artery Occlusion Leading to Cardiogenic Shock and Cardiac Arrest Emphasizing the Role of Mechanical Circulatory Support (Escalate before It's Too Late).

We report a case of cardiac arrest in a 38-year-old male with no past medical history who presented as a case of ST-segment elevation myocardial infarction, and coronary angiography showed triple coronary artery thrombosis complicated with cardiogenic shock (CS) that warrants starting on inotropic support and insertion of intra-aortic balloon pump. CS diagnosis with a high likelihood of deterioration was established based on hemodynamics assessment; hence, an early prompt decision for escalation of mechanical circulatory support to Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was made, which helped to prevent the patient's further deterioration and organ damage. The patient had uneventful VA-ECMO decannulation and was transferred to the ward and discharged after 28 days in stable condition on oral medical therapy and was following up regularly in the cardiology clinic.

A practical guide to the management of immune thrombocytopenia co-existing with acute coronary syndrome.

Introduction: Immune thrombocytopenia (ITP) management with co-existing acute coronary syndrome (ACS) remains challenging as it requires a clinically relevant balance between the risk and outcomes of thrombosis and the risk of bleeding. However, the literature evaluating the treatment approaches in this high-risk population is scarce.

Methods And Results: In this review, we aimed to summarize the available literature on the safety of ITP first- and second-line therapies to provide a practical guide on the management of ITP co-existing with ACS.

Evaluation of warfarin management in primary health care centers in Qatar: A retrospective cross-sectional analysis of the national dataset.

Background: Warfarin management is associated with severe complications, highlighting the critical need to evaluate the quality of its administration.

Objectives: To evaluate the quality of warfarin management for patients managed in primary healthcare centers by measuring the percentage of Time in Therapeutic Range (TTR) and the proportion of extreme out-of-range international normalized ratio (INR) values.

Methods: This is a cross-sectional study.

Percutaneous coronary intervention can be safely performed with left ventricular thrombus without increasing stroke risk: A 5-year retrospective review using real-world data.

Introduction: Left ventricular thrombus (LVT) increases the risk of ischemic stroke. However, it remains uncertain if the percutaneous coronary intervention (PCI) in the confirmed LVT setting further augments the stroke risk. Therefore, in this study, we evaluated the risk of stroke among patients with LVT undergoing CAG +/- PCI.

Acute Myocardial Infarction Secondary to Triple Coronary Arteries Dissection in a Patient With Takayasu Vasculitis.

Synchronous spontaneous triple coronary artery dissection with Takayasu arteritis has not been previously reported in the literature. We describe the case of a young man with acute inferior wall myocardial infarction secondary to triple-vessel coronary artery dissection. Takayasu arteritis was diagnosed upon further investigation.

Atrioventricular Conduction Disorders as a Complication of Inferior ST-Elevation Myocardial Infarction in Patients with COVID-19 Infection.

This case series demonstrates how COVID-19 infection might affect the heart in the context of acute myocardial infarction. Atrioventricular (AV) block might appear as one of the significant cardiac complications of acute MI in patients who tested COVID-19 PCR positive regardless of the presence of CVOID-19 infection symptoms. In our series, conduction disorders as a complication of acute inferior STEMI are more common in patients who tested positive for the COVID-19 infection.

Left main and two vessels calcified coronary aneurysms presented as out of hospital cardiac arrest in young patient.

A 37-year-old patient was admitted secondary to ventricular fibrillation induced out of hospital cardiac arrest. Coronary angiogram revealed left main, left anterior descending, and right coronary arteries aneurysms. The patient underwent bypass surgery with four grafts.

Gender Association with Incidence, Clinical Profile, and Outcome of Out-of-Hospital Cardiac Arrest: A Middle East Perspective.

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. However, there is limited information on the outcome of the OHCA in the Middle East population, and limited studies have been carried out in the Arab Gulf countries. Hence, we aim to study the incidence and rate of survival in the OHCA setting and to assess the impact of gender on the clinical outcome following OHCA.

Effect of CYP2C19 genetic variants on bleeding and major adverse cardiovascular events in a cohort of Arab patients undergoing percutaneous coronary intervention and stent implantation.

Introduction: One-third of patients have clopidogrel resistance that may lead to major adverse cardiac events (MACEs). By contrast, it was found that some clopidogrel-treated patients have hyperresponsive platelets that are associated with higher bleeding risk. Several studies have shown that polymorphisms in the gene encoding the CYP2C19 contribute to the variability in response to clopidogrel.

Out-of-Hospital Cardiac Arrest in the Young: A 23-Year Middle Eastern Experience.

Background: Worldwide, limited data are available about young patients (≤40 years) who present with out-of-hospital cardiac arrest (OHCA). We compared demographic characteristics, clinical presentation, and outcome in younger patients (≤40 years) versus older patients (>40 years) with OHCA.

Materials And Methods: This was a retrospective analysis of a registry of patients hospitalized with OHCA over a 23-year period (1991-2013) in Hamad Medical Corporation, Doha, Qatar.

The Impact of SARS-CoV-2 on ST-Elevation Myocardial Infarction Volume, Time to Presentation, and Door-to-Balloon Time: A Report from a High-Volume Statewide Primary Percutaneous Intervention Program.

Background: The novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) outbreak has affected ST-elevation myocardial infarction (STEMI) care worldwide. Reports from China, Europa, and North America showed a significant decline in STEMI volume with a simultaneous increase in time from symptoms to hospital presentation.

Aim: The aim of the study was to study the effect of the SARS-CoV-2 outbreak on primary percutaneous coronary intervention (PPCI) volume performed for STEMI, symptom onset to hospital presentation time (symptom-to-door [S2D]), and door-to-balloon time (D2B) at the main nationwide PPCI center in Qatar.

Isolation Unit: A New Way to Practice at Heart Hospital, Qatar during the Corona Virus -2019 Pandemic.

Background: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21 century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital.

Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block.

We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( = .

Mobitz Type II Atrioventricular Block following Tramadol and Fentanyl in a Patient with Acute Coronary Syndrome and Systolic Heart Failure.

Serotonin syndrome is a potentially fatal condition allied with increased serotonergic activity in the central nervous system. There are published data reporting serotonin syndrome induced by either tramadol or fentanyl in combination with selective serotonin reuptake inhibitors in adult patients; however, there are no reports of serotonin syndrome resulting from the combination of tramadol and fentanyl. We report a case of a 52-year-old woman who was admitted to cardiology service and who developed Mobitz Type II atrioventricular (AV) block after administration of oral tramadol and intravenous fentanyl.

Inotropic agents use in patients hospitalized with acute decompensated heart failure: a retrospective analysis from a 22-year registry in a Middle-Eastern Country (1991-2013).

Background: Data about the use of positive inotropic agents in patients hospitalized with acute decompensated heart failure (ADHF) is limited.

Methods: The records of 8066 patients with ADHF who were hospitalized at Hamad Medical Corporation, Qatar from 1991 to 2013 were analyzed to explore demographics and clinical characteristics of the patients according to inotropic agents use.

Results: Eight hundred fifty eight patients [10.

Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry.

Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB.

Congestive Heart Failure With Apparently Preserved Left Ventricular Systolic Function: A 10-Year Observational Study.

We analyzed the clinical presentation and outcomes (from 2003 to 2013) of heart failure (HF) with apparently normal systolic function (HFPEF). Based on the echocardiographic left ventricular ejection fraction (LVEF), patients were divided into 2 groups, group 1 (<50%) and group 2 (≥50%). Of 2212 patients with HF, 20% were in group 2.

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program.

In this article, we outline the plans, protocols and strategies to set up the first nationwide primary Percutaneous Coronary Intervention (PCI) program for ST-elevation myocardial Infarction (STEMI) in Qatar, as well as the difficulties and the multi-disciplinary solutions that we adopted in preparation. We will also report some of the landmark literature that guided our plans. The guidelines underscore the need for adequate number of procedures to justify establishing a primary-PCI service and maintain competency.