Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A Veterans Affairs study.

Background: Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD).

Methods: Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included.

Coronary slow flow--prevalence and clinical correlations.

Background: Coronary slow flow phenomenon (CSFP) is defined as delayed coronary opacification in the absence of obstructive coronary artery disease. In the present study, we sought to define its prevalence and clinical features.

Methods And Results: The 1,741 consecutive patients who underwent coronary angiography (CAG) were identified.

Sertraline-induced ventricular tachycardia.

Sertraline is a selective serotonin reuptake inhibitor, which is a commonly used drug for major depressive disorder. Most frequently reported adverse effects of sertraline in patients receiving 50-150 mg/d are dry mouth, headache, diarrhea, nausea, vomiting, sweating, and dizziness. We hereby report one of the few cases of sertraline-induced ventricular tachycardia, which has been for the first time objectively assessed by the Naranjo scale.

Fluoroscopy vs. traditional guided femoral arterial access and the use of closure devices: a randomized controlled trial.

Objective: To compare the effectiveness of accessing the common femoral artery (CFA) using fluoroscopic guidance (FG) versus traditional anatomic landmark guidance (TALG) during cardiac catheterization and to determine the effect of the two modalities on the appropriateness for use of vascular closure devices (VCDs).

Background: Previous studies have shown a consistent relationship between the head of the femur and the CFA, yet there is no prospective data validating the superiority of fluoroscopy-assisted CFA access.

Methods: A total of 972 patients were randomized to either FG or TALG access.

HFE mutations in heart disease.

Given the reported association of cardiac complications with hereditary hemochromatosis and the high carrier frequency of HFE gene mutations in the natural population, it seems reasonable that such mutations might appear more frequently than expected among symptomatic cardiac patients. Thus, H63D, C282Y, and S65C mutations and their possible associations were examined in 477 Caucasian males undergoing coronary angiography. Genotypes were analyzed for differences between ferritin and transferrin levels, coronary artery disease (CAD), cardiomyopathy (CM), and cardiovascular disease (CVD) mortality.

Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature.

We report a case of coronary slow flow phenomenon (CSFP) in a patient who underwent coronary angiography due to anginal chest pain and recurrent syncope with complete normalization of flow after intracoronary adenosine. He was noted to have multiple episodes of nonsustained ventricular tachycardia on holter monitor and increased QTc dispersion on surface electrocardiogram (EKG). He responded very well to oral dipyridamole therapy with complete resolution of his symptoms and no episodes of ventricular tachycardia on the event recorder at 3 months.

Dose indices of radiation to skin in fluoroscopically guided invasive cardiology procedures.

Tissue injury depends on the extent as well as the intensity of the assault. It would be helpful to develop skin dose indices that are more descriptive of the skin area receiving radiation above a threshold value of potential injury. For monitoring radiation exposure to patients, radiochromic film was placed close to the skin of a patient undergoing cardiac catheterization procedures.

Relationship of the 1793G-A and 677C-T polymorphisms of the 5,10-methylenetetrahydrofolate reductase gene to coronary artery disease.

Numerous studies have investigated the relationship between polymorphisms, in particular 677C-T and 1298A-C, of the methylene-tetrahydrofolate reductase (MTHFR) gene and coronary artery disease (CAD) with conflicting results. This study investigates the potential association of two point mutations in MTHFR, 677C-T and 1793G-A, along with other risk factors, with CAD. This is the first hospital-based study to investigate 1793G-A in this context.

Transfemoral venous access through inferior vena cava filters for interventions requiring large sheaths.

The presence of a filter in the inferior vena cava (IVC) to prevent pulmonary embolism from lower extremity deep vein thrombosis has traditionally been a contraindication for venous catheterization from the femoral vein. Certain interventional procedures require femoral access and occasionally, patients with IVC filters require these procedures. The authors report two such patients, one with a Greenfield filter requiring balloon mitral valvuloplasty and one with a Trapease filter requiring atrial septostomy.

Neural network predictions of significant coronary artery stenosis in men.

Objective: A neural network system was designed to predict whether coronary arteriography on a given patient would reveal any occurrence of significant coronary stenosis (>50%), a degree of stenosis which often leads to coronary intervention.

Methodology: A dataset of 2004 records from male cardiology patients was derived from a national cardiac catheterization database. The catheterizations selected for analysis from the database were first-time and elective, and they were precipitated by chest pain.

Primary PCI for ST-segment elevation myocardial infarction in a patient treated with subcutaneous enoxaparin utilizing point-of-care Enox test.

The superiority of enoxaparin compared with unfractionated heparin in the medical management of patients with non-ST elevation acute coronary syndromes (NSTE ACS) has been demonstrated in clinical trials. Further, enoxaparin has been shown to be safe and effective during PCI, including in combination with glycoprotein IIb/IIIa inhibitors. Whether enoxaparin is superior to unfractionated heparin in patients with NSTE ACS under-going early invasive strategy is currently being tested in a large clinical trial.