The Journal of Tehran University Heart Center
Volume:3 Issue: 1, Jan 2008

Garlic has been used since time immemorial as a culinary spice and medicinal herb. Garlic has been cultivated in the Middle East for more than 5,000 years and has been an important part of traditional Chinese medicine. The region with the largest commercial garlic production is central California. China is also a supplier of commercial garlic. The bulb is used medicinally. Garlic has been touted as an herb with numerous health benefits, from treating the common cold to serving as an anticancer agent. Research has proven that garlic is beneficial for those with hypertension. By thinning the blood garlic can lower blood pressure by 5 to 10 percent. It can also lower cholesterol and discourage clot formation. The sulfur compound allicin, produced by crushing or chewing fresh garlic or by taking powdered garlic products with allicin potential, in turn produces other sulfur compounds: ajoene, allyl sulfides, and vinyldithiins. Aged garlic products lack allicin, but may have activity due to the presence of S-allylcysteine. In this review, we focused on the cardiovascular effects of garlic.

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR) in patients who received percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2) after PCI (n=62) or CABG (n=178) at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus) was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019). The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG) after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.

A relatively common disease, congestive heart failure has a significant effect on the quality of life. Given that hospital admission is an important problem in patients afflicted with congestive heart failure, we sought to evaluate the effect of discharge education on the quality of life and hospital readmission in this group of patients. Eighty patients admitted with decompensated heart failure were selected and divided into 2 matched groups. The quality of life scores were measured for each patient. Upon discharge and during the first week after that, the intervention group received 3 sessions of education. Both groups were followed for 6 months. Data on the readmission rate and quality of life scores were collected. The baseline quality of life scores in the control and education subjects were similar (p-value: NS). The quality of life scores showed a significant improvement at 3 and 6 months’ follow-up in the education group. The hospital readmission rate, however, was higher in the control group at 3 and 6 months’ follow-up. The present study showed that discharge education could enhance the quality of life and reduce the rate of hospital readmission in those suffering from congestive heart failure. It is, therefore, advisable that self-care training and discharge education be incorporated in the heart failure management strategy

Latest research shows that about 0.5% of percutaneous coronary intervention (PCI) patients will need urgent coronary artery bypass grafting (CABG) because of coronary accidents. The ACC/AHA guidelines regard on-site cardiac surgery back-up obligatory for PCI centers. It seems the need for urgent CABG in some Iranian PCI centers is less than 0.5%, which may affect decision-making for performing PCI without on-site surgical back-up in the same condition in Iran. This retrospective study reviewed all elective PCI documents in two large educational centers with on-site cardiac surgery back-up in Tehran from April 2005 to April 2006. CABG immediately after PCI or until 24 hours after PCI was considered urgent. There were 1533 PCI patients (71% male) and 1936 PCI vessels in our study. The patients’ mean age was 56 (95% CI 46-66) years. The prevalence of hypertensives, smokers, and diabetics was 42%, 44%, and 24%, respectively. The mean stenotic lesion length was 20.5 mm (95% CI 19.5-21), and the mean lesion diameter was 3.02 mm (95% CI 2.58–3.52). There were 98 (5.8%) unsuccessful PCI procedures. The relative frequency of PCI on different vessels was 1070 (55%) on the left anterior descending artery (LAD), 591(30.5%) on the proximal part of LAD, 286 (14.5%) on left circumflex artery (LCX), 438 (22%) on the right coronary artery (RCA), and 142 (7.2%) on other arteries such as the obtuse marginal (OM) or diagonal arteries. There was only one case of urgent CABG in these patients. The recent widespread use of coronary stenting, new antiplatelet drugs, and increased skills of operators has ushered in a considerable reduction in urgent CABG after PCI.

Obesity is a common risk factor for morbidity and mortality after cardiac surgery. However, the relationship between obesity and postoperative risk has not been fully defined. A prospective study of 1015 consecutive patients undergoing isolated coronary artery bypass grafting (CABG) was carried out. Body mass index (BMI) was used as the measure of obesity and was categorized as normal weight (BMI=20-25) and obese (BMI>25 and<35). The preoperative, operative, and postoperative risk factors as well as the complication and in-hospital death rates were compared between the two groups. Of the 1015 patients, 40% had a normal weight and 49% were obese. Compared with the normal-weight group, the obese group had a significantly higher incidence of diabetes mellitus (P=0.007) and lower arterial partial pressure of oxygen (PaO2) (P=0.03). The normal-weight patients had a higher New York Heart Association (NYHA) Functional Class (P=0.03) and were at a higher risk for emergent surgery (P=0.003) or reoperation (P=0.002). Among the postoperative complications, respiratory complications (P=0.027) were more frequent in the obese patients. The duration of mechanical ventilation (P=0.001), the incidence of arrhythmia (P=0.011), low cardiac output syndrome (P=0.001), reintubation (P=0.001), and neurological complications (P=0.003) were significantly higher in the normal-weight patients. Obesity was associated with a lower risk of reoperation for bleeding (P=0.032). There were no significant differences in infective complications, length of intensive care unit (ICU) stay, total length of stay in hospital, and operative mortality between the groups. In the patients undergoing isolated CABG procedures, obesity did not increase the risk of operative mortality and morbidity with the exception of respiratory complications. The normal body weight patients were at a higher risk for complications than were the obese patients. Therefore, obese patients may safely undergo CABG without previous weight reduction if due attention is paid to minimize respiratory complications.

Electrocardiography (ECG) is a valuable device in the assessment of cardiovascular diseases. Recent medical software developments such as the invention of modern automated ECG interpreters have greatly facilitated the work of electrocardiographers and cardiologists. We present our experience in the use of one such device in the routine reporting of 200 successive ECGs recorded in our Cardiac Care Unit and Cardiac Emergency Ward. The interpretations of 200 ECGs provided by the GE-digital ECG device were chosen and compared with those supplied by four cardiologists in a single blind manner. All statistical analyses were performed by using SPSS version 11.5 for windows. A p value of less than 0.05 was considered statistically significant. There was a diagnostic match between the interpretations by the device and those by the cardiologists in 107 (53.5%) cases as opposed to a diagnostic mismatch in 93 cases (46.5%). The matching rate in the interpretations of myocardial ischemic disorders was high, which means practically all the ischemic cases diagnosed by the device were confirmed by the cardiologists. Only in 12 cases myocardial infarction or ischemic changes were reported by the cardiologists, while they were missed by the device. As regards rhythm disorders, the sensitivity and specificity of the device were 67.7% and 75.7%, respectively. With respect to conductive disorders, the respective sensitivity and specificity of the device were 70% and 96.6%, respectively. Finally, in the case of structural disorders, the interpretations of the device were 92.8% sensitive and 83.3% specific. According to the results of our study and similar researches, it seems that the interpretations of an automated ECG device in diagnosing the ischemic and structural disorders of the heart are reliable. The device, however, should not be relied upon when assessing conduction disorders and dysrhythmias. We, therefore, recommend that the users of digital ECG devices recheck the digital interpretations in those cases.

Atherosclerosis of the peripheral arteries occurs in 12% of individuals at 65 years of age or older. At least 28% of these patients suffer from coronary heart diseases and 10% of them are afflicted with cerebrovascular diseases. To calculate the agreement between two diagnostic tests for peripheral arterial disease (PAD), namely ankle brachial index (ABI) and ultrasound duplex scanning (USD). Forty symptomatic PAD patients were enrolled in this study, and their demographic characteristics, risk factors, and symptoms as well as their ABI and USD measurements were recorded. On the basis of the symptoms and ABI and USD findings, the patients were divided into four groups and comparisons were made between them so that the associations between the findings could be analyzed. The study population included 32 (80%) men at a mean age of 62.9+12.8 years (26-90). Smoking (75%) and hypertension (100%) were the most common risk factors in the men and women, respectively, followed by diabetes in both genders. Whereas the agreement between ABI and USD findings in the men was significant (Kappa=0.28, P=0.02), it was not significant (Kappa=-0.91, P=0.68) in the women. Additionally, there was a significant correlation between symptoms and ABI findings (Kappa=0.21, P=0.04), while that between symptoms and USD measurements was not significant (Kappa=0.09, P=0.3) The correlation between ABI findings and symptoms, especially in the men, was better than that between ABI findings and USD measurements. ABI could, therefore, be considered an appropriate tool for the initial screening of arterial stenosis and lower extremity circulation.

Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Fenestration closure was performed at a mean age of 8 yr (6-12 yr) and average of 15 months after the Fontan operation. Aortic O2 saturation increased by an average of 17.6% (9-26%). During more than a two-year period of follow-up (mean: 27 months), two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O2 saturation and well-being and confers acceptable growth and development in children.

In this paper, we describe a case of an aneurysmal circumflex artery connected to the coronary sinus through a fistula in a 40-year-old man with a two-year history of palpitation and chest pain. We discussed surgical management for patients with coronary artery fistula (CAF), particularly for asymptomatic patients with a small left-to-right shunt.