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Biomedical subjects

Hoshiar Abdollah

Publications and source records attributed to Hoshiar Abdollah.

7 recordsLinked to original sources
PubMed2006

Aspergillus fumigatus pacemaker lead endocarditis: a case report and review of the literature.

The diagnosis of fungal endocarditis requires a high index of clinical suspicion. Rarely, pacemaker implantation may be a risk factor for the development of fungal endocarditis. A 71-year-old man with a history of multiple transvenous pacemaker manipulations and fever of an uncertain source is described. A diagnosis of culture-negative pacemaker endocarditis was established only after repeat transthoracic echocardiography. Amphotericin B was instituted; however, the patient developed a cerebral infarct and died. Postmortem examination demonstrated Aspergillus fumigatus within a large pacemaker lead thrombus, tricuspid and aortic valve vegetations, and septic pulmonary and renal emboli. The present report describes the clinical and pathological features of a rare case of Aspergillus fumigatus pacemaker lead endocarditis and suggests that serial echocardiograms may be effective in the early detection of pacemaker lead vegetations. The diagnostic features and therapeutic management of pacemaker lead endocarditis are reviewed.

Aged↗
PubMed2005

Defining low risk for coronary heart disease among women with chest pain syndrome: a prospective evaluation.

BACKGROUND: A better understanding of the clinical manifestations of coronary disease in women may lead to earlier recognition and better outcomes. METHODS: One hundred fifty-eight women coming to primary care physicians, emergency rooms, or cardiology clinics with undefined chest pain and at least two risk factors underwent detailed clinical evaluation of risk factor profile and symptom characteristics as well as stress testing. The significance of the presenting symptoms was evaluated on the basis of clinical events during an average 26.2 months of follow-up. Noncardiac pain was diagnosed on the basis of spontaneous resolution of symptoms, establishment of an alternative diagnosis, or negative coronary angiography. Cardiac chest pain was established by the development of cardiac clinical events or angiographic demonstration of coronary disease. RESULTS: Noncardiac chest pain was established in 128 (81%) patients. The remaining 30 (19%) either were found to have had cardiac chest pain or remain symptomatic without definitive diagnosis. Multivariate analysis revealed that noncardiac chest pain was best predicted by a combination of nondiabetic status and negative stress testing. The clinical characteristics of the chest pain syndrome were not significant contributors. CONCLUSIONS: In nondiabetic women with chest pain syndrome and at least two other cardiac risk factors, a negative stress test predicts a benign course in over 2 years of follow-up.

Adult↗
PubMed2005

Stress echocardiography in the evaluation of women presenting with chest pain syndrome: a randomized, prospective comparison with electrocardiographic stress testing.

OBJECTIVE: To evaluate the relative value of three stress testing modalities for establishing the presence of coronary artery disease in women presenting with chest pain. BACKGROUND: Echocardiographic testing modalities have the potential to be more effective than standard electrocardiographic stress testing (EST), but they require prospective evaluation. METHODS: Patients with no cardiac history and at least two cardiac risk factors were randomly assigned to one of three initial diagnostic strategies: treadmill EST (n=54), treadmill echocardiographic stress testing (ExE) (n=57) or dobutamine stress echocardiography (DSE) (n=47). Patients were followed prospectively for 28.1+/-14.2 months. The nature of the presenting chest pain was established clinically. RESULTS: Twelve patients (7.6%) were determined to have had cardiac chest pain, 128 patients (81.0%) received a diagnosis of noncardiac chest pain and 18 patients (11.4%) had indeterminate results. The echocardiographic testing modalities were associated with fewer indeterminate results than was EST (two of 104 [1.9%] versus 13 of 54 [24.1%]). All modalities were highly effective in excluding cardiac chest pain, with negative predictive values of 91.3%, 83.7% and 88.4%, respectively, for EST, DSE and ExE. The proportion of cases for which both definitive and accurate results were provided was 92.9% for DSE, 82.4% for ExE and 67.3% for EST. CONCLUSIONS: The results support the favourable prognosis of women presenting with chest pain syndrome and the reliability of negative results obtained with any of the testing modalities. Echocardiographic testing modalities are more likely than EST to provide both definitive and accurate results and would, therefore, seem to be the superior primary noninvasive testing modality in this patient population.

Adult↗
PubMed2004

Atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained dysrhythmia in adults. It is ironic, then, that although mechanisms and effective treatments for most other supraventricular tachyarrhythmias have been discovered, AF remains incompletely understood and poorly treated. Nonetheless, our understanding of the pathophysiology of AF has improved in the last half-century, including some groundbreaking observations made in the last 10 years. Indeed, for some patients, the potential for cure now appears to be available. Because no unifying mechanism of AF has been proven, the aim of this review is to describe some of the common and important concepts behind current mechanistic theories of AF and how they contribute to our clinical understanding of AF.

Anti-Arrhythmia Agents↗
PubMed2004

Canadian Trial of Physiological Pacing: Effects of physiological pacing during long-term follow-up.

BACKGROUND: The Canadian Trial of Physiological Pacing (CTOPP) reported that the risk of stroke or cardiovascular death was similar between patients receiving ventricular versus physiological pacemakers at the end of the original follow-up period of 3 years. However, the occurrence of atrial fibrillation was significantly less frequent with physiological pacemakers. To assess a potential delayed benefit of physiological pacing, follow-up of patients in this study was extended to 6 years. METHODS AND RESULTS: A total of 1474 patients requiring a pacemaker for symptomatic bradycardia were randomized to receive ventricular and 1094 to physiological pacemakers. The primary outcome was stroke or cardiovascular death. The study was completed in July 1998, and follow-up was extended to July 2001. At a mean follow-up of 6.4 years, there was no difference between treatment groups in the primary outcome of cardiovascular death or stroke. There was no significant difference in total mortality or stroke between groups. There was a significantly lower rate of development of atrial fibrillation in the physiological group, with a relative risk reduction of 20.1% (CI, 5.4 to 32.5; P=0.009). CONCLUSIONS: The CTOPP extended study does not show a difference in cardiovascular death or stroke, or in total mortality, or in stroke between patients implanted with ventricular or physiological pacemakers over a mean follow-up of >6 years. However, there is a persistent significant reduction in the development of atrial fibrillation with physiological pacing.

Atrial Fibrillation↗
PubMed2003

Atrial fibrillation in the pacemaker clinic.

BACKGROUND: Electrocardiographic (ECG) recognition of the underlying rhythm in patients with ventricular pacing can be difficult. Atrial fibrillation (AF) in particular may go unreported. OBJECTIVES: To compare the underlying atrial rhythm determined in the pacemaker clinic with the 12-lead ECG interpretation of the atrial rhythm in those who were continuously paced in the ventricle. It was intended to determine whether long term anticoagulation therapy was related to whether AF was diagnosed before or after pacemaker implantation. METHODS: Pacemaker clinic patients were enrolled if they had a 100% paced ventricular rhythm. The underlying rhythm was determined using pacemaker programming manoeuvres. A 12-lead ECG was recorded on all patients within 10 min of their pacemaker assessment and interpreted by one of the several geographic full-time cardiologists at the centre. All cardiologists were blinded to the results of pacemaker assessment and to the clinical history. RESULTS: Fifty-six patients were enrolled. At the pacemaker clinic, 37 were determined to be in AF and three were in atrial flutter (AFL). Of these 40 patients with AF/AFL, 28 were correctly identified as such on the 12-lead ECG interpretation. Twelve of the 40 were interpreted only as having an 'electronic ventricular pacemaker' (EVP). Sixteen of the 40 patients (40.0%) with AF or AFL were not taking warfarin. Twenty-two of 25 patients with an AF/AFL diagnosis before pacemaker implantation were taking warfarin, compared with two of 15 patients with AF/AFL diagnosis after pacemaker implantation (P<0.0001). CONCLUSION: These results show that the underlying rhythm in patients with ventricular pacing is frequently unrecognized by routine ECG interpretation. This may be of particular importance in the AF/AFL population as a potential contributor to the underuse of warfarin, especially when AF develops after pacemaker implantation. The pacemaker clinic may be in a position to play an important role in the identification of these patients.

Ambulatory Care Facilities↗