International Journal of Cardiovascular Practice

Original Articles

Aerobic Exercise and Eucalyptus Globulus: Cardio-affective effects on recovery and stress

Alfredo Anderson Teixeira-Araujo, Jackson R.G.S. Almeida, Loumaíra Carvalho da Cruz, Xirley P Nunes, Sérgio Rodrigues Moreira

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P1-P6

Introduction: It is necessary to investigate the interrelation between physical exercise and aromatherapy, regarding cardiovascular and affective functions of human. Thus, the aim of this study was to evaluate the effects of aerobic exercise (AE) and eucalyptus essential oil (EO) in cardiovascular and affective responses.

Methods: Twelve adults (19-39 years) performed in a randomized order in different days: 1. AE session; 2. Inhalation of EO session; 3. AE + EO session and; 4. Control session. In each session remained at rest over 15min plus 5min to inhaling EO or blank air in Control session. The AE was 15 min run/walk at 80-85% of maximum heart rate. After recovery (30 min) the Cold Pressor Test (CPT) was applied. At rest, recovery and during CPT were measured cardiovascular and affective variables.

Results: The variation of systolic blood pressure in the CPT was attenuated by AE +EO (12.3 ± 14.9 mmHg) and EO (12.6 ± 6.7 mmHg) compared to Control (17.3 ± 6.5 mmHg; P < 0.05). AE + EO increased pleasure in recovery (1′ = 1.2 ± 1.9 pts and 30′= 0.6 ± 1.1 pts) and reduced displeasure in stress (-3.4 ± 1.7 pts) when compared to Control in recovery (1′= -0.5 ± 1.4 pts and 30′= -0.7 ± 1.5 pts, respectively; P < 0.05) and stress (-4.6 ± 1.8 pts; P < 0.05).

Conclusions: We conclude that aerobic exercise and eucalyptus essential oil attenuated cardiovascular responses and modulated the affect on recovery and stress.

Frequency of HLA-B27 in Patients With Conductive System Disturbance and Implanted Permanent Pacemaker in Iran

Sima Sayah, Morteza Ebrahimi, Poorya Piroozmand

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P7-P9

Introduction: HLA-B27 is considered as one of the causes of heart conductive disorders. We studied the frequency of HLA-B27 among Iranian patients who had undergone permanent pacemaker implantation.

Methods: This descriptive and analytical study was performed among patients who underwent permanent pacemaker implantation. The questionnaire contains demographic data, underling diseases, and history of heart disease or heart surgery. The type of conductive heart disorder was mentioned there, too. We determined the regurgitation of aorta valve and its severity. Finally, HLA-B27 was accessed. All the data was entered in SPSS software and analyzed.

Results: From a total of 103 patients entered in this study, only 6 (5.8%) were HLAB-27 positive. The disturbance of conductive heart disorders based on the HLA-B27 positive or negative patients was not statistically different. Patients with HLA-B27 mostly had regurgitation of the aorta valve.

Conclusions: We concluded that the frequency of positive HLA-B27 genotype in patients with permanent pacemakers did not have any significant difference with the ones with negative HLA-B27 genotype. However; this genotype was associated with regurgitation of the aorta valve.

Evaluation of a Clinical Decision Support System for Dyslipidemia Treatment (HTE-DLPR) by QoE questionnaire

Alberto Zamora, Carme Carrion, Marta Aymerich, Xavier Castells, Lidia Blanco, Anabel Martin-Urda, Guillen Paluzie, Dolors Capellá, Roberto Elosua

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P10-P16

Introduction: Clinical decision support systems (CDSS) are computer systems designed to assist clinicians with patient-related decision making, such as diagnosis and treatment. CDSS have shown to improve both patient outcomes and cost of care.

Methods: A multi-center observational prospective study was conducted. Ten physicians agreed to participate. Seventy-seven patients with high or very high cardiovascular risk were included. After using CDSS for dyslipidemia (HTE-DLPR) for a 3 months period, participants were asked to evaluate their experience with HTE-DLPR using a quality of experience questionnaire (QoE) tool for mHealth applications.

Results: Total score on the QoE was 3.89 out of 5. The highest scores were received for precision, ease of use and content quality. The lowest scores were given to security, appearance and performance. Physicians were in strong agreement with the 1st HTEDLPR recommendation in 86.1% and the system’s use was described as comfortable

in 85% of cases. Users positively evaluated the development of a new version of HTEDLPR in the future receiving a total score of 4.25 out of 5.

Conclusions: A CDSS for dyslipidemia (HTE-DLP) has been positively evaluated by physicians using QoE questionnaire.

The Association between Myocardial Perfusion Scan and Electrocardiographic Findings among Patients with Myocardial Ischemia

Behzad Farahani, Ramin Skandari, Mohammad Amin Abbasi, Sepideh Aghalou, Sepehr Gohari, Amir Hossein Heydari, Mehrdad Farahani

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P17-P20

Introduction: The aim of this study was to determine the consistency of Electrocardiography (ECG) and myocardial perfusion scan findings of patients with myocardial ischemia at Firoozgar and Hazrat-Rasool hospitals.

Methods: Electrocardiogram of 80 patients undergoing myocardial perfusion scans was analyzed. All patients had a stable angina. All patients with bundle branch blocks and history of MI and coronary bypass or angiography were excluded. Overall, 120 patients were evaluated with single photon emission tomography/myocardial perfusion imaging for ischemia and 80 patients had a positive test.

Results: Forty-five percent of patients were female and 55% were male. The average age of patients was 61.48 years. Sixty-one patients (76.25%) had normal ECG and 19 patients (23.75) had pathological changes in their ECG. Eleven patients had ST segment depression and 6 patients had T wave inversion. Furthermore, 21 patients (26.25%) had lateral wall ischemia in their myocardial perfusion scan and 13 (16.25%) patients had septal wall ischemia. The ECG changes in male patients and hypertensive cases were more prominent.

Conclusions: This study showed that ST-T changes (ST depression and T inversion) in the ECG are more suggestive of accuracy of myocardial ischemia and ECG.

Case report

ST–Segment elevation: Not always an acute coronary syndrome

Érico Costa, Elsa Meireles, Catarina Rodrigues, Tiago Godinho Teixeira, Dulce Silva

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P21-P23

Cardiac tumors can be primary or metastatic, the latter being more frequent and usually of pulmonary or hematologic origin. These patients’ clinical signs are non-specific and the electrocardiogram (ECG) can assume many patterns, among which, ST-segment elevation. Nevertheless, associated occlusion of the coronary arteries is rare in these situations.

We present a 79-year-old woman with a history of pulmonary neoplasia who was admitted to the emergency department due to atypical chest pain, cough and worsening dyspnea in the previous 3 days. The ECG revealed an ST-segment elevation in the anterolateral and inferolateral leads, despite normal blood work, namely normal troponin. Due to the disparity between the patient’s symptoms and the ECG findings, a decision was made not to proceed to primary angioplasty, but to further investigate with echocardiography, which revealed a mass localized in the anterolateral and inferolateral left ventricle walls, confirmed by computed tomography. The patient was admitted in the medical ward for symptomatic management. Her clinical condition gradually deteriorated due to the disease’s natural evolution and she died two weeks later.

This case highlights the importance to keep in mind differential diagnoses to acute coronary syndromes, when a ST-segment elevation is encountered on an ECG.

Double Orifice Fissured Subaortic Membrane in the Adult

Giordano Zampi, Marzia Cottini, Amedeo Pergolini, Vincenzo Polizzi, Francesco Musumeci

International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P24-P26

Left ventricle outflow tract obstruction is a relatively common form of congenital heart disease, occurring in 2.8 out of 10,000 live births and accounts for 3-6% of congenital heart diseases. Subvalvular aortic stenosis can be either a fixed stenosis resulting from subaortic membrane or a dynamic stenosis because of hypertrophic cardiomyopathy. We described an original and rare image of double orifice fissured subaortic membrane in the adult.

ECG and EPS for students and associated professionals

Sustained ventricular fusion simulating a biventricular pacing


International Journal of Cardiovascular Practice, Vol. 2 No. 1 (2017), 24 Bahman 2017, Page P27-P29

An electrocardiogram from a patient implanted with a dual-chamber DDD pacemaker showed paced QRS complexes whose morphology and frontal-plane axis were consistent with biventricular stimulation with right ventricular lead located at the apex. However, some electrocardiographic findings were suggestive, rather, of univentricular right apical pacing and sustained ventricular fusion with competing native atrioventricular conduction in the presence of patient’s spontaneous QRS showing right bundle branch block plus left anterior hemiblock. Shortening atrioventricular delay with magnet application advanced right ventricle stimulation and prevented the supraventricular impulse to contribute to ventricular depolarization, thereby making clear the mechanism of right ventricular apical pacing.