Maladies cardiovasculaires et diagnostic

Background: Conventionally, the Framingham Risk Score (FRS) was used as a tool to risk stratify individuals for cardiovascular (CV) events and death. More recently, the coronary artery calcium score (CACS) has been used as a complimentary method for the assessment of CV risk. This study’s objective is to quantify the magnitude of marked discordance (MD) between FRS and CACS. The subjects were from two different ethnic groups, namely, a Middle Eastern population and a veteran American population.

Methods: This is a retrospective observational cohort study of 499 consecutive patients who underwent multidetector cardiac computerized tomography (MDCT) at King Fahd Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia and Veterans Affairs Loma Linda Health Care System (VALLHCS). CACS was measured using the Agatston method. FRS was calculated by chart review. MD was defined as a CACS of <100 with a high risk FRS or a CACS of >400 with low risk FRS. Patients had CACS between 100 and 400 were excluded from the analysis.

Results: A total of 499 patient CT studies were reviewed with 450 meeting study criteria,130 patients from the VALLHCS (63 ± 12, 95% males) and 320 from KFAFH (27% males). MD was found in 308 (68%) of the total number enrolled. In the American population, of the 62 patients with a CACS <100, 3% (2 patients) only had discordantly high FRS and of the 69 patients with a CACS >400, 20 patients (29%) had a discordantly low FRS. In the Middle Eastern population, of the 290 patients with a CACS <100, 281 patients (96.9%) had discordantly high FRS and of the 30 patients with a CACS >400, only 5 patients (16.7%) had a discordantly low FRS.

Conclusion: The majority of MD in the Middle Eastern population had a high FRS with a low CACS. In contradistinction, the American veterans with MD had a high CACS and a low FRS.

Radial artery access has rare but significant vascular complications that can occur even in high volume centers. We present a case of a 60-year-old man with perforation of a high takeoff radial artery due to catheter manipulation. A combination of manual external pressure of the axillary artery combined with internal tamponade effect from a 45 cm hydrophilic sheath was used with no immediate or late neurovascular complications. As radial technique becomes more popular, operators should be aware of potential management options. The present case illustrates one such complication and management strategy.

Aortic pseudoaneurysm is extremely rare and a catastrophic sequelae of aortic surgery and blunt chest trauma involving the aorta. They can be asymptomatic or present with non-specific cardiac symptoms. In some instances, they present with life threatening complications such as rupture or even sudden death. Symptoms are usually due to the anatomical location, size and pressure on the neighboring anatomical structures. Here we report on a 37-yearold male with history of multiple cardiac surgeries including aortic root and aortic valve surgeries who developed a pseudoaneurysm two weeks after an aortic root patching. The pseudoaneurysm was found to be externally compressing the left anterior descending artery, leading to a myocardial infarction.

Type II endoleaks occur commonly following endovascular aneurysm repair (EVAR). Although they remain enigmatic, multiples studies have evaluated preoperative risk factors and strategies for prevention of type II endoleaks. Prophylactic treatment of type II endoleaks can include embolization of accessory arteries, as well as complete aneurysmal sac occlusion. Regular post-operative surveillance and screening for type II endoleaks with triple-phase CTA is the standard of care. Aneurysm size and growth rate are factors that predict whether a persistence type II endoleak is hemodynamically significant, and whether it requires treatment with percutaneous trans-lumbar or trans-arterial embolization techniques. Less commonly, type II endoleaks can be repaired using laparoscopic or open surgical ligation of feeder arterial branches. Emerging methods using endovascular aneurysm sac sealing technology may continue to alter the incidence and long-term management strategies of type II endoleaks. Here we review the latest strategies in the treatment of Type II endoleaks following EVAR.

We report the case of young man with acute aortic dissection type A treated by Bentall operation. Postoperatively the patient was febrile and echocardiography revealed fluid collection around the aortic graft. Indicated surgery revealed sterile perigraft seroma which recurred after reoperation, Corticosteroids were therefore administered. Ten months after the Bentall operation the patient was treated for pneumonia with sepsis and incidentally an asymptomatic aortic pseudoaneurysm was revealed. Successful re-Bentall operation was performed and the patient finally discharged. We presume the postoperative perigraft seroma appearance and subsequent corticosteroid administration predisposed this patient to pseudoaneurysm development, tissue glue usage was also considered.

Objective: To determine the association between serum uric acid (UA) levels and different risk factors ofacute myocardial infarction (AMI).

Methodology: Cross sectional study was containing on 120 patients with newly diagnosis of acute myocardial infarction and carried out in Department of Cardiologyof Liaquat university of Hospital Hyderabad with the duration of time from 15th June 2015 to 14th October 2015. All with age between 30 to 50 years either both gender were incorporated in the study. Serum uric acid was assessed through blood sample from Research and Diagnostic laboratory of Liaquat University of medical and health science. All the data was entered in the proforma.

Results: Mean age of the cases was 43.36 ± 6.11 years, male were found in the majority 66.67%. UA concentration was significantly higher in the male as compare to female P=value 0.02. According to the risk factors of the myocardial infarction high concentration of UA concentration was found in hypertensive 7.1 ± 1.5 mg/dland those who were noted with multiple risk factors 7.7 ± 1.8 mg/dl, following by Diabetes, obesity, dyslipidemia, smoking and Alcohol as: 6.1 ± 1.0 mg/dl, 6.9 ± 1.2 mg/dl, 6.7 ± 1.3 mg/dl and 7.0 ± 1.6 mg/dl respectively. While in the diabetes and family history cases uric acid was found with normal levels.

Conclusion: Elevated UA is highly associated with different risk factor of acute MI. From this inference uric acid level should be monitored in all risk factors especially in hypertensionand multiple risk factors.