Prevalence and risk factors of clopidogrel non-response among Saudi patients undergoing coronary angiography.

Objectives: To estimate the prevalence of clopidogrel non-response and identify its risk factors among Saudi patients. 

Methods: This cross-sectional study was conducted at Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia between January and June 2013, to assess the degree of platelet inhibition using the VerifyNow assay (Accumetrics, San Diego, CA, USA) after receiving clopidogrel standard loading dose. Clopidogrel resistance was defined as ≤15% platelet inhibition or greater than 213 P2Y12 reaction units (PRU).

Predictors of radial artery size in patients undergoing cardiac catheterization: insights from the Good Radial Artery Size Prediction (GRASP) study.

Background: Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter.

Management of retained intervention guide-wire: a literature review.

Percutaneous coronary angioplasty is increasingly employed in the treatment of patients with complex coronary artery disease. Different steerable guide wires used to open occluded vessel and facilitate balloon and stent deployment. However, the guide-wire itself is not without hazard: it may perforate or dissect the vessel, but fracture or entrapment is uncommon.

Efficacy of a single dose intravenous heparin in reducing sheath-thrombus formation during diagnostic angiography: A randomized controlled trial.

Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized complications of cardiac catheterization but the occlusion is extremely rare. Heparinized saline flushes are used during diagnostic coronary angiography to prevent thrombus formation within the sheath lumen. However, the use of prophylactic intravenous heparin following the femoral arterial sheath insertion is controversial.

Left main approach for retrieval of retained guidewire fragment.

Entrapment and detachment of guidewire fractures during percutaneous coronary intervention (PCI) are very rare, but can lead to life-threatening complications such as embolization, thrombus formation, and perforation. Surgical extraction of the remnant fragments is recommended if the percutaneous retrieval is not possible. We present a case of remnant guidewire into the left anterior descending artery (LAD) and aorta that led to acute coronary thrombosis following primary angioplasty.

Monitoring metformin in cardiac patients exposed to contrast media using ultra-high-performance liquid chromatography tandem mass-spectrometry.

Background: There is no evidence that the use of contrast media (CM) in diabetic patients with serum creatinine <130 μmole/L leads to metformin accumulation and subsequent lactic acidosis. Therefore, the objective of this investigation was to monitor cardiac patients for the effects of CM on their metformin plasma concentration and serum creatinine clearance (ClCr).

Methods: Metformin plasma concentrations were measured by a new, fully validated specific, precise, and accurate ultra-high-performance liquid chromatography tandem mass-spectrometric assay.

Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy.

Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfunction of one or more components of the mitral valve apparatus occurs in 39-74% and affects almost all heart failure patients. Survival is decreased in subjects with more than mild mitral regurgitation irrespective of the aetiology of heart failure.

Allergic reaction to abciximab with atypical manifestations.

Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had been approved for treatment of acute coronary syndrome undergoing coronary interventions. It is a chimeric monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor with a potential for the development of an immune response to variable portions within the antigen binding site following its administration. We describe a 58-year-old man who developed sudden headache, short of breath, choking and restlessness after receiving Abciximab for coronary intervention.

The clinical significance of cardiac troponins in medical practice.

Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid sequences of cardiac troponins differentiate them from that of skeletal muscles, allowing for the development of monoclonal antibody-based assay of troponin I (TnI) and troponin T (TnT). Along with the patient history, physical examination and electrocardiography, the measurement of highly sensitive and specific cardiac troponin has supplanted the former gold standard biomarker (creatine kinase-MB) to detect myocardial damage and estimate the prognosis of patients with ischemic heart disease.

Libman-Sacks endocarditis with an unusual presentation.

Systemic lupus erythematosus is relatively common medical disorder with female predominance. This disorder can affect any organ system. Cardiac involvement is variable which can include pericardium, myocardium and endocardium.