Open Access Case Report

Surgical Treatment of a Coronary Artery Fistula that has Opened into the Pulmonary Artery

Gokce Sirin

Asian Journal of Research in Cardiovascular Diseases, Page 57-63

Introduction: Coronary artery fistula (CAF) is a rare cardiac malformation of congenital, traumatic or iatrogenic origin, and is an abnormal connection between the coronary arteries and the cardiac chambers or the great vessels. The incidence in the general population is estimated to be approximately 0.002%. CAF may be asymptomatic or complicated by congestive heart failure, myocardial ischemia, infective endocarditis, fistula rupture or thrombosis.

Objective: Coronary artery fistulas are very rare malformations, and they need to be kept in mind as a possible cause of myocardial ischemia in patients who present with fatigue, dyspnea, and chest pain.

Case Presentation: A symptomatic patient with CAF and fistulous aneurysm between the left anterior descending artery and the pulmonary artery, treated successfully with cardiopulmonary bypass on arrested heart is presented.

Discussion: Small fistulas can close spontaneously, but larger and symptomatic fistulas may require closure by surgical or transcatheter methods. Surgical treatment should be considered in patients who are symptomatic, have significant aneurysmal enlargement, and in whom transcatheter occlusion methods have failed.

Conclusion: In patients with CAF, early surgery is a good option to avoid potential complications, and surgical closure can be performed with very low morbidity and mortality rates.

Open Access Case Report

Scorpion Envenomation, A Sting to the Heart: A Rare Case Report

Yassine Ettagmouti, Lamiaa Afendi, Abdessamad Couissi, Rachida Habbal

Asian Journal of Research in Cardiovascular Diseases, Page 71-76

Scorpion envenomation (SE) remains a public health problem in Morocco, with a severity of lesions and a mortality rate correlated with a young age.

These bites are harmless in most cases, but sometimes have serious clinical sequelae that can go as far as death.

Severity is greater in children under 15 years old and morality is particularly important in children under 6 years old.

Such bites can have serious clinical sequelae including cardiovascular damage: myocardial infarction, acute pulmonary edema, cardiogenic shock and even death.

We report the case of a SE causing a fatal cardiac complication in a 50 year old patient.

Open Access Case Report

Venous Involvement in Takayasu Disease: A Case Report

Meriem El Mousaid, Essadqi Fadwa, Asmaa Elamraoui, Keltoum Boumlik, Rachida Habbal

Asian Journal of Research in Cardiovascular Diseases, Page 104-110

Takayasu's disease (TD) is an inflammatory arteritis of the large vessels that affects with predilection the aorta and its main branches, the thickening of the vascular wall is the most characteristic early sign of the disease leading progressively to stenoses, thromboses and occasionally the development of aneurysms. It is a vasculitis that generally spares the veins, few cases of deep vein thrombosis (DVT) have been reported during this pathology. It is in this order that we report the case of a 48-year-old patient followed for a month in the internal medicine department for Takayasu's disease, a diagnosis established because of her young age, female gender, abolition of pulses in the lower limbs and the radiological aspect. The patient underwent treatment with high-dose corticosteroid therapy (prednisone 1 mg/kg per day). For DVT, she was put on DOAC. The evolution under treatment was marked by the regression of the inflammatory signs and the negativation of the infectious assessment. Addressing this issue is important as the risk of restenosis or occlusion is still high with vascular interventions.

Open Access Original Research Article

Hypoglycemic and Hypolipidemic Effect of Dialum guineense (ICHEKU) Fresh Leaves on Alloxan-induced Diabetes in Male Albino Rats

Alaebo, Prince Ogochukwu, Njoku, George Chigozie, Udensi Great Chukwuma, Ugwu Cynthia Onyinye

Asian Journal of Research in Cardiovascular Diseases, Page 1-7

Background: According to current Globe Health Organization predictions, the number of diabetes patients globally will reach 370 million by 2030. It is expected to become one of the most frequent human degenerative diseases, necessitating immediate attention. Plants have long been used as a primary source of medicine.

Purpose: This study evaluated the effects of Dialium guineense (Dg) ethanol extract on hypoglycemic and hypolipidemic properties of alloxan-induced albino rats

Methods: Thirty-six (36) healthy male adult albino rats weighing 125-150g were divided into six groups with six rats each. Group 1 was the normal control (received feed and water only), and group 2 received only alloxan and served as untreated diabetic rats. Group 3 received 5 mg/kg bw of glibenclamide (standard drug), while groups 4, 5, and 6 received 200 mg/kg bw, 500 mg/kg bw, and 1000 mg/kg bw of Dg extract, respectively, for 28 days. The rats were induced intraperitoneally using alloxan monohydrate (100 mg/kg bodyweight). At the end of the experiment, the rats were sacrificed under mild anesthesia with chloroform. Blood was collected for biochemical evaluation using standard techniques (Randox kits). Fasting blood glucose level was checked weekly.

Result: Blood sugar levels in the diabetic control group experienced severe hyperglycemia compared to normal animals. The blood glucose level in the negative control group was 359.5 ± 1.6 mg/dl on Day 0 and 389.0 ± 1.5 mg/dl on Day 28. Administration of Dialum guineense extract at 200 mg/kg, 500 mg/kg, and 1000 mg/kg significantly (P < 0.05) decreased the fasting blood glucose level in the diabetic rats on days 7,14,21, and 28 as compared to the negative control group. Increased total cholesterol (TC), triglyceride, and low-density lipoprotein cholesterol (LDL-C) activities reduced significantly (p<0.05) in both groups treated with ethanol extract of Dialum guineense when compared with untreated diabetic rats. In contrast, HDL-C was not statistically significant compared to untreated diabetic rats.

Conclusion: These findings suggest that ethanolic extract of Dialum guineense leaves may have hypoglycemic and hyperlipidemic properties and may be used in managing diabetes, whose pathogenesis and progression are known to be influenced by oxidant species.

Open Access Original Research Article

The Impact of Therapeutic Education in the Practice of Blood Pressure Self-measurement at the Institute of Cardiology of Abidjan

Koffi Djinguin, Gnaba loa, Niamkey Thierry, Kouamé Stephan, Djoman Hugues, Horo Kigninlman

Asian Journal of Research in Cardiovascular Diseases, Page 8-19

Introduction: Self-measurement of blood pressure is a recent technique, already studied and validated, but it is still underused in the management of hypertension. Therapeutic education of the patient aims at helping patients acquire or maintain the skills they need to best manage their lives with a chronic disease.

Aim: The objective of the study was to evaluate the value of therapeutic education in the practice of blood pressure self-measurement in patients followed at the Institute of Cardiology of Abidjan in order to integrate this technique into the management of hypertensive patients in Côte d'Ivoire.

Materials and Methods: This study was conducted for 15 months at the Institute of Cardiology of Abidjan. The study included patients aged at least 18 years old who were diagnosed with hypertension for at least 6 months and followed up in outpatient clinics. The data were collected on an individual survey form with several items based on information from the medical records and questioning of the patients. The analyzed parameters were: socio-demographic features, other cardiovascular risk factors, clinical and paraclinical data, antihypertensive treatment, and information on self-measurement.

Qualitative variables were presented as numbers and percentages and compared by Pearson's Chi-Square Test. Quantitative variables were described as means ± standard deviation and compared by the Reduced Error Test for large samples and by the Student's t-test for small samples (n<30). The results were statistically significant when p<0.05.

Results: The study population consisted of 300 patients with a male predominance (sex ratio of 1.46). The mean age of the patients was 59.5±12.7 years old. 65.3% of patients were uninsured. Other cardiovascular risk factors were dyslipidemia (35%) and overweight (30.3%). Patients with hypertension had complications in 39.3% of cases. Heart failure was the most common complication (14.7%).

Patients presented 38.3% and 26.3% left ventricular hypertrophy on the electrocardiogram and rhythm disorders, respectively. Echocardiographic data revealed 56.3% of left atrial dilatation. The geometry of the left ventricle was abnormal in 50.7% of cases. Among the patients, 68.3% said that they knew about the self-measurement of blood pressure. 36.3% of the subjects, who were interviewed, had already performed a blood pressure self-measurement. 40.3% were trained in blood pressure self-monitoring.

71.9% of physicians provided blood pressure self-measurement training to patients. Medical staff talked to the patient about self-monitoring in 52.1% and encouraged the patient to perform it in 37.2% of cases. Among those who had received training in blood pressure self-measurement, 31.4% said they were familiar with the 3-step rule and in whom 39.5% gave a correct explanation. Only 25.7% of patients had self-measurement devices at the time of the survey, and the majority of blood pressure monitors or devices were upper arm ones (65.5%).

The patients acquired blood pressure monitors by medical prescription in 41.6% of cases. Patients holding electronic blood pressure monitors or tensiometers used them regularly in 55.8% of cases.

Among them, 71.4% performed self-measurement at least once during their follow-up and 63.6% had insurance. 74.6% of complications occurred in patients who did not perform self-measurement. Therapeutic education improved considerably the practice of self-monitoring of blood pressure.

Conclusion: The various results show that few patients had self-measurement tensiometers. The insured patients own these devices. The practice of self-measurement of blood pressure was low. However, when properly practiced, it reduced the occurrence of cardiovascular complications. The practice of therapeutic education has positive effects on patients' self-measurement of blood pressure.

Open Access Original Research Article

Correlation between Electrocardiogram and Coronary Angiography in ACS with Persistent ST Segment Elevation: Institutional Cross-sectional Study

Abakar Bachar, Fatima Azzahra Benmessaoud, Abdoul Wahab Karimou, Diatta Abdoulaye, Abbas Ermilo Haroun, Latifa Oukerraj, Mohammed Cherti

Asian Journal of Research in Cardiovascular Diseases, Page 20-26

Background: The electrocardiogram provides more information on the exact location of the lesion, prediction of the final infarct size, and estimation of the prognosis. Nevertheless, coronary angiography remains the gold standard for identifying the culprit artery. The aim of our work is to study the correlation between electrical and coronary data and to determine the reproducibility of the electrocardiogram in the identification of the culprit lesion. 

Methods: This is a retrospective study of 91 cases of ST+ ACS, collected in the cardiology department B of the Souissi maternity hospital over a 6-month period.

Results: The mean age of the general population was 59.5 ± 9.2 years with 78% men and 22% women, 80% of whom were menopausal. The percentage of patients with typical infarct chest pain was 95%.

Electrically, the electrocardiogram showed ST-segment elevation in all patients. The anterior territory was affected in 64.8% of cases, nearly half of which were extensive anterior. The inferior territory was affected in 25 patients (27.5%).

Angiographic analysis of the lesions showed monotruncal coronary involvement in almost half of the cases. The majority of cases (65.6%) involved the anterior interventricular artery.

Conclusions: The ECG remains an essential tool in the early identification of the artery responsible for the infarction to guide the revascularisation procedure.

The combination of ECG and coronary angiography is essential for better assessment of acute myocardial infarction in order to optimize its management.

Open Access Original Research Article

Effects of Valproic Acid Administration on Cardiovascular Risk Factors in Male Albino Rats

Abiodun Olusoji Owoade, Adewale Adetutu, Temitope Deborah Olaniyi, Akinade William Owoade

Asian Journal of Research in Cardiovascular Diseases, Page 27-38

Background: Valproic acid (VPA) is an antiepileptic drug with a well-documented hepatotoxic effect among other several side effects. However, the effect of valproic acid administration on lipid profile and cardiovascular risk factors remains inconclusive and highly controversial.

Method: In order to investigate the effects of valproic acid on lipid profile, male albino rats were treated with valproic acid at a dose of 7.14 mg/kg body weight intraperitoneally for two and four weeks while a group was allowed to recover for seven days after four weeks of valproic acid administration.

Results: Administration of valproic acid induced dyslipidemia in different compartments of the animals under investigation. Hypocholesterolemia characterized the effect of valproic acid administration in the LDL+VLDL while hypertriglyceridemia was the hallmark of its effect in all blood compartments although hypertriglyceridemia effect drops significantly when rats were allowed to recover for 7 days. In the tissues, valproic acid administration did not significantly affect cholesterol and triglyceride levels but phospholipid levels in the heart and kidney were significantly decreased by 46.03% and 38.57% after 2 weeks of administration while phospholipid levels in other tissues compartment were not affected.

Conclusion: The results presented in this study are in support of the argument that valproic acid administration does not significantly affect lipid profile because the perturbations of lipid content observed are non-lipotoxic and may not pose a cardiovascular disease risk.

Open Access Original Research Article

Effect of Integrated Approach of Yoga Therapy on Noninvasive Cardiovascular Responses: Study on Young and Older Healthy Males

Snehasis Bhunia, Sohan Raj Tater

Asian Journal of Research in Cardiovascular Diseases, Page 39-47

Background and Aims: Arterial stiffness index (ASI) is significantly reduced after physical exercise or after Yoga activities.  However, the effect of integrated yoga therapy (IAYT) for longer duration, using PC based cardiovascular analyzer & PPG analysis system on non-invasive cardiovascular responses such as arterial stiffness index or ankle brachial index (ABI) are not yet reported. The aim of the study was to investigate the effect of IAYT for a longer duration on noninvasive cardiovascular responses including arterial stiffness index in both young and older healthy males living in rural areas.

Methodology: A total of 20 healthy subjects were included in the study. All healthy participants were divided into two groups (A&B) based on their age. There were 10 participants in group A considered as young healthy aged below 40 years, 10 old healthy adults aged above 50 years were included in group B. All participants in group A & B were accepted and recorded all non- invasive cardiovascular parameters as experimental control (group C). A 6-weeks integrated approach of yoga therapy (IAYT) was given as an intervention to the participants come under group A & B. The PC based cardiovascular analyzer and PC based PPG analysis system were used to record almost all cardiovascular parameters signifying the status of arterial stiffness index and ankle brachial index at the beginning and end of the yoga program. The arterial stiffness index (ASI) and reflection index (RI) were computed from the pulse data. The data were analyzed using the paired-samples t test.

Results: There was a significant reduction in Pulse Wave Velocity (PWV), ASI (P < 0.05) and no significant alterations (P>0.05) on ABI after IAYT for 6-weeks of IAYT in young and old participants. There was non-significant reduction in BMI after IAYT in healthy young and older adults, but the ASI was more significantly low (P<0.01) in young adults. There were no significant changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Pulse Pressure (PP) after IAYT for 6 weeks.

Conclusion:  Our findings suggest that IAYT offered was more effective than Yoga or brisk-walk separately in reducing ASI. This could be due to reduce sympathetic activity and improved   endothelial function with enhancement in bioavailability of NO, which would be less effective in aged individuals. The age-related endothelial dysfunction associated with decreased bioavailability of nitric oxide (NO), a potent vasodilator, contributes to vascular stiffness would not be ruled out. The life-style modalities in IAYT must be considered as a prime candidate to reduce cardiovascular diseases (CVD).

Open Access Original Research Article

Study on the Effect of Salvia miltiorrhiza on Lowering Blood Lipid Based on Zebrafish Hyperlipidemia Model

Xinyu Wen, Tao Yuan, Yan Deng, Yue Chen, Hongzhi Li, Yi Huang

Asian Journal of Research in Cardiovascular Diseases, Page 48-56

Objective: This study investigated the lipid-lowering effects of Salvia miltiorrhiza by constructing the high blood lipid zebrafish model.

Methods: The hyperlipidemia model was constructed using egg yolk to feed the zebrafish larval. On this basis, Zebrafish larval with hyperlipidemia were treated with different concentrations of Salvia miltiorrhiza extract. Then the light density, length, cholesterol, and triglyceride content were determined. By comparing the above data between the drug treatment group and the blank group, the hypolipidemic efficacy of Salvia miltiorrhiza was analyzed.

Results: The triglyceride (TG) and total cholesterol (TC) contents of the model groups were significantly increased comparing control group, showing that the hyperlipidemia model had been effectively established. After treatment with 0.516 μg/ml, 1.135 μg/ml, and 2.325 μg/ml of Salvia miltiorrhiza extract, the lipid reduction in the hyperlipidemia model was 27.11%, 41.58%, and 62.83%, respectively. Furthermore, the TG content was reduced by 32.07%, 53.12%, and 51.46%. The TC content was reduced by 20.29%, 29.55%, and 38.80%, respectively.The data of each group were statistically significant (P<0.01).

Conclusion: Salvia miltiorrhiza has a good hypolipidemic effect in the zebrafish hyperlipidemia model. The above data provide a basis for the further development of Salvia miltiorrhiza in the field of hypolipidemic.

Open Access Original Research Article

Medication Poor Adherence and Associated Factors among Patients in Hypertensive Management at a Health Facility in Eastern Part of Ghana

Maxwell Owusu Peprah, Hopeson Nimo Yeboah, Mark Danquah, Eunice Fordjour, Nicholas Quansah, David Saanaa, Wisdom Djange Ogbordjor

Asian Journal of Research in Cardiovascular Diseases, Page 77-91

Background: Globally, hypertension is spreading like a pandemic and is now a problem for every community. It is well established that it has negative impact on population, acting as a significant risk factor for cardiovascular disease with consequent multi-organ dysfunction. In this study, patients evaluating their healthcare at a hypertensive clinic at Volta River Authority Hospital, Akosombo, were assessed the determinants that were associated with poor adherence to anti-hypertensive medication.

Methodology: In order to gather primary data for this descriptive cross-sectional health facility based study, structured questions were used to recruit 235 participants using a convenience sampling technique. With the agreement of the participants data was collected in person and one on one with participants. After the data were coded and entered into Stata version 16, data was analysed descriptively and inferentially and results were presented visually and in tables. A p-value less than 0.05 was regarded as statistically significant at a 95% confidence interval between the dependent and independent variables.

Results: The study found 47.5% of poor adherence to anti-hypertensive medication among patients. Factors such as non–formal education [P=0.014], Alcoholic intake [P=0.038], inability to afford the cost of care [P=0.001] and verbal communication between provider and patient [P=0.010] had an increased odds of contributing to poor adherence of anti-hypertensive medication among patients.

Conclusion: Poor adherence to anti-hypertensive medication was high contributing to significant complications such as stroke and related organ damage. Factors such as non-formal education, alcohol intake, non-affordability of cost of services and verbal communication on medication prescription contributed to the poor adherence.

Open Access Original Research Article

Antihypertensive Efficacy and Safety of the Fixed-dose Combination of Efonidipine and Chlorthalidone in Indian Patient

Bhupesh Dewan, Siddheshwar Shinde, Shweta Kondekar

Asian Journal of Research in Cardiovascular Diseases, Page 92-103

Aim: This study aimed at evaluating the efficacy and safety of a fixed-dose combination (FDC) of Efonidipine and Chlorthalidone in a randomized, Phase III trial setting.

Study Design: Multicentric, randomized, double-blind, parallel, comparative, active-controlled Phase III.

Place and Duration of Study: Six geographically distributed sites across India were involved in this trial.

Methodology: Present study enrolled patients of Indian origin who were diagnosed with Stage I or Stage II hypertension as per JNC VII guideline. A total of 240 hypertensive patients were randomized (1:1) to receive either FDC of Efonidipine 40 mg + Chlorthalidone 12.5 mg tablet (E+C group) or FDC of Cilnidipine 10 mg + Chlorthalidone 12.5 mg tablet (C+C group) once daily for 90 days. The study site staff, investigator and patients were blinded to the treatment allocation. Patients were evaluated for changes in their blood pressure (BP) from baseline to Day 30, 60 and 90. BP was recorded as the mean of 3 consecutive measurements taken in a sitting position. the number of patients achieving target BP as per JNC VIII guideline was also evaluated. The safety and tolerability were assessed based on the incidences of adverse events (AEs) and serious adverse events (SAEs) reported.

Results: The mean (±SD) Systolic BP (SBP) and Diastolic BP (DBP) at baseline was 159.10±11.43/101.19±10.03 mmHg in the E+C group. After 30 days of treatment with the E+C group, the mean (±SD) reduction in SBP/DBP of 25.13±16.23/16.11±10.35 mmHg was observed whereas at Day 60 reduction of 32.51±19.73/17.91±11.06 mmHg was seen from baseline. The primary endpoint focused on evaluating the mean BP reduction from baseline at Day 90. As compared to baseline, BP decreased from 159.10±11.43/101.19±10.03 mmHg to 118.95±15.31/ 81.59±3.78 mmHg with a mean reduction of 40.15/19.60 mmHg at day 90 in the E+C group. The secondary endpoint of target BP <140/90 mmHg attainment as per JNC VIII guideline, was also achieved in 90.99% of the patients given the E+C group regimen. Furthermore, it was observed that 94% of Stage I and 88% of Stage II hypertensive patients achieved the target BP goal. Overall, 2.54% of patients from the E+C group reported adverse events (AEs) which were mild in severity and resolved without any sequelae at the end of the study. No unexpected AEs were reported, and the E+C group regimen was well tolerated.

Conclusion: It was concluded that the FDC of Efonidipine 40 mg and Chlorthalidone 12.5 mg was efficacious in the management of hypertension in both Stage I and Stage II hypertensive patients. It was evident from the study results that clinically meaningful reductions in blood pressure were observed over a period of 90 days. The test drug was safe and well tolerated by the patients after being administered as a single tablet daily.

Open Access Review Article

An Overview on Coronary Artery Disease and Cardiovascular Stents

T. G. Bhuvana

Asian Journal of Research in Cardiovascular Diseases, Page 64-70

Coronary artery disease (CAD) is commonly called coronary heart disease, a condition with inadequate supply of blood and micronutrient to heart due to narrowing of arteries. Generally, symptoms are not seen in early stages but as disease progress common signs such as discomfort in chest, shortness of breath, tiredness and irregular heartbeats are detected.  Primarily, CAD was one of the uncommon causes of death in the start of 20th century. But this scenario was changed from mid 1960s as peaks were observed in CAD deaths. At present, CAD is leading cause of death worldwide, though there is significant decline. However, there are treatments available for this medical condition such as angioplasty and stent placement. In this review, we present a detail study on diagnosis, risk factors, potential treatment options using different stents and their availability as well as relevant benefits. Furthermore, the future prospects of stent technology are also discussed.