Case Report
Relentless Angina of a Scarred Heart
Eslam Abbas*,
Ahmed Mahdy,
Shady Mansy
Issue:
Volume 8, Issue 4, December 2024
Pages:
92-95
Received:
28 August 2021
Accepted:
12 October 2021
Published:
7 December 2024
Abstract: Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and surgical bypass. Accordingly, this subset of patients, who show poor response to medical treatment with the absence of considerable reversible ischemia, bears an additional burden of persistent angina besides the structural and functional complications resulting from their scarred hearts. In this report, a patient, with compensated ischemic cardiomyopathy, complaining of disabling stable angina was indicated for diagnostic coronary angiography that showed a chronic total occlusion (CTO) at the mid-segment of the left anterior descending coronary artery (LAD) and otherwise no significant stenoses in the epicardial coronary tree. After the failure of maximized anti-ischemic medical therapy, the patient underwent elective percutaneous intervention (PCI) to the left anterior descending coronary artery (LAD) chronic total occlusion (CTO) with 2 overlapping drug-eluting stents that yielded a favorable outcome on patient follow-up even though a myocardial perfusion imaging failed to show considerable reversible ischemia at the left anterior descending coronary artery (LAD) territory. The report points out that elective chronic total occlusion (CTO) revascularization may alleviate anginal pain, despite the absence of a considerable macroscopic ischemia, after failure of a maximized anti-ischemic medical regimen.
Abstract: Refractory anginal pain affects nearly 5-10% of stable coronary artery disease patients, and maximizing the anti-ischemic medical therapy is the standard first-line treatment. The presence of a scarred myocardial territory of the epicardial coronary chronic total occlusion (CTO) limits the implementation of other modalities, such as angioplasty and...
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Research Article
Prevalence of Anemia in Heart Failure Patients Hospitalized in a Cardiology Department in Dakar, Senegal
Issue:
Volume 8, Issue 4, December 2024
Pages:
96-103
Received:
14 October 2024
Accepted:
25 November 2024
Published:
12 December 2024
Abstract: The objectives of this study were to assess the prevalence of anemia in patients with heart failure, analyze the characteristics of anemia in this population, and identify prognostic factors related to anemia and heart failure. We conducted a descriptive and analytical retrospective study over a period of nine months, from April 1, 2018, to December 31, 2018. The study included patients aged over 18 years who were hospitalized in a cardiology department for heart failure of all causes, with hemoglobin levels strictly below 12 g/dl for women and 13 g/dl for men. Heart failure diagnosis was based on ESC 2016 criteria. The study was approved by the ethics committee of Cheikh Anta Diop University, Dakar. Data analysis was performed using SPSS 18 (Statistical Package for Social Sciences version 18), with a p-value of ≤ 0.05 considered statistically significant. We identified 182 patients with anemia, representing a hospital prevalence of 11.61%. The average age was 58.9 ± 15.93 years, with a female predominance in those under 50 years and a male predominance in those over 50. Most patients (77.1%) had a low socioeconomic status. Major cardiovascular risk factors included physical inactivity (56%) and hypertension (47%). Clinically, 78% of patients had dyspnea, 31.9% had chest pain, 40.7% had cutaneous-mucosal pallor, and 72.2% had global heart failure. Ischemic heart disease was the main cause of heart failure (49.2%). Diagnostic investigations revealed elevated ferritin in 50% of cases, elevated CRP in 88.1%, and elevated creatinine in 37.4%. The mean hemoglobin level was 11.6 ± 7.15 g/dl, with 71.4% of patients having hemoglobin between 10 and 13 g/dl. Normocytic normochromic anemia predominated. The study showed that anemia was more common in patients with an ejection fraction > 50% (48.1%) and those with global heart failure (72.2%). Statistically significant associations with severe and mild anemia were observed in the age groups 20-29 years (p=0.003) and 50-59 years (p=0.014) and with endocarditis (p=0.03). Only women showed severe and very severe anemia (p=0.21). The hospital mortality rate was 15.38%. In conclusion, this study reveals a significant prevalence of anemia among hospitalized patients, with important correlations between anemia and various clinical and socioeconomic factors.
Abstract: The objectives of this study were to assess the prevalence of anemia in patients with heart failure, analyze the characteristics of anemia in this population, and identify prognostic factors related to anemia and heart failure. We conducted a descriptive and analytical retrospective study over a period of nine months, from April 1, 2018, to Decembe...
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Research Article
Transcatheter Aortic Valve Replacement Improves the Quality of Life for Patients with Chronic Obstructive Pulmonary Disease
Issue:
Volume 8, Issue 4, December 2024
Pages:
104-112
Received:
11 November 2024
Accepted:
25 November 2024
Published:
13 December 2024
DOI:
10.11648/j.ccr.20240804.13
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Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a common comorbidity in patients with aortic stenosis and when severe is a surgical aortic valve replacement contraindication. However, the impact of COPD in patients undergoing TAVR is unclear. This study defines TAVR risks/benefits including quality of life, morbidities, and mortality in COPD patients. All patients undergoing TAVR from August 2012 to June 2023 at a single institution were retrospectively reviewed (n = 1565). 1273 patients with preoperative pulmonary function testing were studied. FEV1/FVC and FEV1% predicted were used to separate patients into groups of COPD severity based on the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria. Preoperative and postoperative quality of life (QoL) were measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Adverse outcomes and mortality at 30-days and 1-year were measured. Severe and very severe COPD patients had significantly higher rates of new onset atrial fibrillation and myocardial infarction compared to patients with no COPD or mild to moderate COPD. There were no statistically significant differences in rates of stroke, permanent pacemaker implantation, 30-day mortality, or 1-year mortality. TAVR improved QoL in all patients regardless of COPD severity or use of home oxygen. Severe COPD patients had the greatest improvement in KCCQ QoL at 30-days and 1-year post-TAVR, while very severe COPD patients had the smallest improvement in KCCQ QoL. Patients with COPD experienced an improvement in quality of life regardless of severity of COPD. Additionally, one year mortality was not significantly different between COPD severity groups. Therefore, TAVR benefits should not be withheld for COPD patients regardless of their severity.
Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a common comorbidity in patients with aortic stenosis and when severe is a surgical aortic valve replacement contraindication. However, the impact of COPD in patients undergoing TAVR is unclear. This study defines TAVR risks/benefits including quality of life, morbidities, and mortality in COPD patien...
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,
Aliou Alassane Ngaide*
