Background: Brugada syndrome (BrS) is a genetic cardiac disorder characterized by specific electrocardiogram (ECG) abnormalities and a heightened risk of sudden cardiac death. The role of antiarrhythmic drugs, particularly flecainide, in modifying ECG parameters in BrS patients’ remains underexplored. Objectives: This study aims to evaluate the effects of flecainide on the QT interval and QT dispersion in patients diagnosed with or suspected of having BrS. Methods: A retrospective analysis was conducted involving 20 patients, divided into two groups: Ten diagnosed with BrS and 10 without. Each participant received a 300 mg oral dose of flecainide, followed by continuous ECG monitoring for 24 hours. Key ECG parameters, including the QT interval, QTc interval, and QT dispersion, were analyzed pre-and-post-administration. Results: Post-flecainide administration, a significant increase in the right QT interval was observed in the overall cohort (P = 0.04). Notably, while BrS patients exhibited changes, none were statistically significant. In contrast, non-BrS patients showed significant increases in left QTD, right QT, and right QTc intervals (P = 0.02, P = 0.03, P = 0.02, respectively). Conclusions: Flecainide significantly alters ECG parameters, particularly in non-Brugada patients, emphasizing its diagnostic utility in confirming BrS. These findings highlight the need for refined diagnostic strategies and tailored management approaches for patients at risk of arrhythmogenic events.

Background: Left ventricular thrombus (LVT) is a significant cardiovascular complication in patients with coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives: This study aimed to investigate the risk factors and outcomes of COVID-19 patients with LVT. Methods: Twenty-two COVID-19 patients with normal myocardial signals on echocardiography, normal coronary findings, and normal cardiac biochemical tests but with LVT were included. Patients were aged between 18 and 65 years. Data on risk factors and outcomes were collected from electronic records, including patient demographics, clinical characteristics, comorbidities, laboratory values, and in-hospital outcomes. Results: Of the 22 patients surveyed, 9 (40.8%) were admitted to the ICU, and 4 (18.1%) died during follow-up. Mechanical ventilation was required for 6 (27.2%) patients. Acute respiratory distress syndrome (ARDS) and acute kidney injury were reported in 6 and 5 patients, respectively. Shock was experienced by 27% of patients (6 individuals), and ventricular arrhythmias were reported in only one patient. Conclusions: In summary, COVID-19 patients who developed LVT during hospitalization had a higher mortality rate. Screening echocardiography at admission may benefit such patients.

Background: Resolution of ST-segment (STR) and thrombolysis in myocardial infarction (TIMI) and frame count (TFC) are useful parameters to evaluate the reperfusion status following primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) patients. Objectives: Here, the association of ejection fraction (EF), as a parameter of systolic function, with TFC and STR was assessed in patients with STEMI who underwent PPCI. Methods: Ejection fraction was evaluated by transthoracic echocardiography using Simpson’s biplane method before PPCI in the first 24 hours after the admission of STEMI patients. Also, STR and TFC were assessed in all patients after PPCI. Then, the association of EF with STR and TFC was examined before and after the operation. Results: STEMI patients with STR less or greater than 50% were comparable in terms of clinical and demographic characteristics and laboratory indices. Our results showed a weak inverse correlation between EF before PPCI and TFC (r = -0.2336, P = 0.0002). However, there was a strong inverse correlation between EF after PPCI and TFC (P < 0.0001, r = -0.3137). The results of correlation analysis showed that the mean EF (pre- and post-PPCI) was significantly higher in patients with STR of ≥50% compared to those with STR < 50%. Conclusions: The results of this study showed that EF after PPCI, as an echocardiographic indicator, could reflect the status of cardiac and microvascular perfusion. We also found that cardiac status on ECG could better reflect EF.

Double aortic arch is a congenital vascular abnormality in which the connected segments and their branches course between and compress the trachea and esophagus, often resulting in invariable airway compression and gastrointestinal presentations. A 2-month girl with a history of double aortic arch diagnosis in fetal echocardiography was admitted to our hospital with recurrent pneumonia. The double aortic arch was confirmed by computed tomography angiogram. After surgery, the patient was followed for one year of age and had no problem. Our study showed early diagnosis and treatment of a double aortic arch might prevent chronic, irreversible complications.

Fabry disease is an X-linked disorder due to deficiency of the lysosomal hydrolasea-galactosidase A and the resultant accumulation of glycosphingolipids throughout the body, such as in the heart. Cardiac manifestations in Fabry disease are due to glycosphingolipid deposition in the myocardium, valves, and conduction system. Fabry cardiomyopathy, characterized by progressive severe concentric left ventricular hypertrophy. We, as a result of this, have reported a case of Fabry disease with left ventricular hypertrophy. He was admitted with dyspnea and also dizziness, general weakness, and acroparesthesias. Physical examination showed Angiokeratoma on the skin. The electrocardiography revealed ST-segment depression in leads V3–V6, and changes related to left ventricular hypertrophy. Echocardiography showed concentric left ventricular hypertrophy.

Many patients present with myocardial ischemic symptoms, but fail to be diagnosed of obstructed coronary artery disease, since the normal coronary arteries or no any atherosclerosis stenosis ≥ 50% at coronary angiography. Myocardial ischemia can be caused by either abnormalities of epicardial coronary arteries or coronary microvascular dysfunction (CMD). Patient with microvascular angina in the absence of coronary artery disease and myocardial diseases, CMD is suggested to be the unique cause of symptoms. The previous clinical and pathogenetic classification of CMD is based on presence or absence of coronary artery disease, myocardial diseases, or other traditional risk factors, which would obscure the importance of the disease primarily provoked by CMD. The role of atherosclerotic plaque rupture in epicardial coronary arteries and the abnormality of hemorheology (especially in perimenopausal women) should be more stressed in the pathogenetic mechanism of CMD. The pathogenetic mechanism of CMD will be classified according to microvascular structure (embolization and stenosis), microvascular function and blood risk factors in this paper. The CMD related diseases including cardiac X syndrome and coronary slow flow would be better uniformly named as microvascular angina. While little data supported therapies for CMD related diseases so far, the blood healthy therapy as a novel method is recommended to treat microvascular angina, especially in the patients with high hematocrit, increased blood viscosity and coronary slow flow.

Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation.Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test.Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04).Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications.

Coronary artery disease (CAD) is a disease of major concern worldwide. It is the main cause of mortality in many societies and improving the understanding about the CAD mechanism, progression and treatment, is necessary. Recent discovery of genetic factors underlying CAD has improved our knowledge of the disease in support of well-known traditional risk factors. Genotype-environment interaction is known as the main risk factor. Loci on many different chromosomes have been identified as a risk factors that increase CAD susceptibility. Here we performed a comprehensive literature review pinpointing hotspot loci involved in CAD pathogenicity. The 9p21.3 locus is the most common region associated with CAD and its specific structure and function have been remarkable in many studies. Moreover, the variations in the 9p21.3 locus have been implicated in CAD patients in different populations around the world. According to conclusions from this the 9p21.3 locus can be the first point of focus in etiology investigations of CAD patients.

Introduction: Recognition of risk factors in different high-risk groups such as smokers in comparison with non-high risk groups would help to develop good preventive strategies for pulmonary thromboemboli (PTE). The purpose of this study was to investigate and compare clinical findings and risk factors in smoker and nonsmoker patients with pulmonary thromboembolism and assessing anatomical variant in pulmonary computerized tomography angiographies.Methods: In this descriptive study 260 consecutive patients suspected to have PTE underwent pulmonary computerized tomography angiographies in a training hospital since 2015 to 2018. Patient with documented PTE were enrolled. Clinical finding and risk factors were determined and compared between them.Results: From 260 patients 172 subjects (66.15%) had PTE and enrolled in the study. Fifty-six (32%) were smoker and 116 (68%) non-smoker. The smoker group was younger and male gender was more predominant. Oxygen saturation and inspired oxygen partial pressure differed between smokers and non-smokers (P < 0.05). The predisposing factors of thromboembolism and anatomic distribution of emboli were the same in smokers and non-smokers.Conclusion: Regarding different factors responsible for PTE in smokers and non-smokers, clinical presentation and anatomic distribution of PTE are comparable.

Introduction: Some pacemaker implanted patients have an atherosclerotic disease which promotes conduction system ischemia and conduction disturbances. The aim of this study was to determine prevalence of coronary artery disease (CAD) and its risk factors in patients undergoing permanent pacemaker implantation (PPI).\nMethods: This prospective, single-center hospital based study examined patients older than 40 years who required PPI. Presence of atherosclerotic risk factors and CAD was examined.\nResults: Of 258 patients undergoing PPI, CAD was present in 50 (19.37 %) patients. CAD was more common among middle age and elderly patients (P = 0.03). Patients older than or equal 76.5 years had specificity of 78.8% for an association with CAD. Multivariate analysis showed that age (odds ratio: 1.042; 95% confidence interval: 1.009–1.075; P = 0.01) and diabetes (odds ratio: 3.437; 95% confidence interval: 1.618–7.303; P = 0.001) had a statistically significant association with CAD. Of 169 patients with involvement of the atrioventricular (AV) node, 28 (16.6 %) had associated left anterior descending artery (LAD) involvement with P = 0.01, suggesting an association between LAD disease and chronic degenerative changes in the AV node.\nConclusion: CAD was present in 19.4% of patients undergoing PPI. Age and diabetes had a strong association with CAD. LAD stenosis was significantly more prevalent in AV nodal/ infra-hisian disease compared with sinus nodal disease.