Management of obstructive coronary artery disease in patients with aortic stenosis and severe left ventricular dysfunction is challenging. Mechanical circulatory support at the time of percutaneous coronary interventions may be necessary in these extreme-risk patients. We present a case in which the TandemHeart was used to support a patient with severe aortic stenosis, severe protected left main and circumflex disease, and severe cardiomyopathy and review the literature on this subject.

Objective: To determine the clinical outcome of patients admitted with acute anterior versus acute inferior wall myocardial infarction. Study Design: Comparative cross-sectional study. Place and Duration of Study: The study was conducted in emergency departments and adult cardiology wards of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Aug 2019 to Nov 2019. Methodology: This study was conducted on 340 patients (208 patients with Anterior wall myocardial infarction and 132 patients with inferior wall MI who presented with Acute ST-Elevation MI) to emergency department of Armed Forces Institute of Cardiology/National Institute of Heart Disease during specified period. Outcome was calculated using Electrocardiogram, Two-dimensional transthoracic echocardiogram, Troponin-I, baseline investigations and coro angiography Data was entered and analyzed with SPSS-23. Results: Mean age was 59.38 ± 12.91 years in each group. In clinical symptoms chest pain was highest n=255 (71.4%) followed by diaphoresis 55 (15.4%) and breathlessness 51 (14.3%). The most common complications in patients with inferior wall MI were brady arrhythmia 8 (2.3%) whereas left ventricular failure 41 (12.1%) was more prevalent in patients with anterior wall MI after TVCAD. The results of cardiogenic shock 5 (1.5%),ventricular tachycardia 3 (0.8%) in inferior wall myocardial infarction were comparative to the results of cardiogenic shock 18 (5.3%) ventricular tachycardia 2 (0.5%) in anterior wall myocardial infarction. The number of stable patients was 91 (43.7%) in Anterior wall myocardial infarction and 51 (38.6%) in inferior wall MI. Conclusion: The study shows the comparative clinical outcome of anterior wall myocardial infarction versus inferior wall myocardial infarction.

Objective: To identify the risk factor profile of Atrial Fibrillation applying CHA2DS2-VASC scoring system Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in outdoor patient and emergency departments of Armed Forces Institute of Cardiology/National Institute of Heart Diseases in 4 months duration after approval of synopsis, from Sep 2019 to Dec 2019. Methodology: All patients with symptoms of palpitation and dyspnea were evaluated with detailed history, physical examination, electrocardiogram and 2-D echocardiography for collection of data. Patients who were found with Atrial Fibrillation on electrocardiogram and non-valvular on 2-D echocardiography were enrolled. Detailed History regarding CHA2DS2-VASC scoring system was taken. Patients with age <18 years, those with moderate rheumatic stenos is, hypertrophic cardiomyopathy and Atrial Fibrillation with prosthetic valves were excluded. Data was entered and analyzed with SPSS-23. Results: Out of 100 patients enrolled, frequencies of male and female patients were 60 (60%) and 40 (40%) respectively. The age varied from 25 years to 89 years with a mean age of 64.27 ± 12 years. Maximum number of patients was between 65-74 years (31%). Hypertension (57%) was the most common risk factor after gender followed by age. Frequencies of other risk factors were congestive heart failure (33%), diabetes mellitus (18%), vascular disease (14%) and stroke/TIA/thrombo-embolism (13%). Paroxysmal atrial fibrillation was the most common type of atrial fibrillation observed (67%) followed by persistent atrial fibrillation (31%). The number of patients having CHA2DS2-VASC score 2 and greater than 2 were 76 (76%) and less than 2 were 24%. Conclusion: Our findings highlighted the prevalence of non-modifiable as well as modifiable predictors of thromboembolic phenomena in atrial fibrillation using CHA2DS2-VASC scoring system in our population.

Crataegus aronia is widely known for its antioxidant, anti-inflammatory, and hypolipidemic properties, and it has traditionally been used to treat cardiovascular disorders. This study aimed to evaluate the impact of Crataegus aronia extract on the liver enzyme markers, blood glucose levels, lipid profiles, and kidney function biomarkers as well as hematological parameters in induced diabetic rats. Male Wistar rats were divided into seven groups: normal Control; Diabetic; and Diabetic animals treated with two doses of Crataegus aronia extract (5 and 10mg/kg) (DM + extract), Control treated with the extract ( 5 and 10mg/ kg) and induced diabetic treated with insulin. Streptozotocin (STZ)-induced diabetic rats (50 mg/kg, ip)and normal were orally administrated with Crataegus aronia extract once a day for 4 weeks. At the end of the experiment, the biochemical and hematological parameters were measured in all groups. Also, the phytochemicals and antioxidant activity of the Crataegus aronia extract were evaluated. According to findings, the total phenols, total flavonoid, and flavonol contents were 538.3 mg Galic acid equivalent /g extract, 149.3 mg Rutin equivalent / g extract, and 79.3 mg Rutin equivalent / g extract), respectively. The antioxidant activity according to 2,2-diphenyl-2-picrylhydrazyl (DPPH) IC 50 and ferric reducing antioxidant power (FRAP) assays were 28.02 µg/ml and in the range of 0.273 -0.960 µmol Fe +2 /g dw, respectively. Crataegus aronia extract significantly (p <0.05) affects red blood cells, hemoglobin, hematocrit, white blood cells, lymphocytes, and platelets values. Also, Crataegus aronia had a significant (P < 0.05) effect on serum biochemical parameters, including glucose, total proteins, albumins, triglycerides, creatinine, bilirubin, and serum aspartate aminotransferase (AST). However, Crataegus aronia treatment had no significant effects (p < 0.05) on serum alanine aminotransferase, alkaline phosphatase, and cholesterol levels. Crataegus aronia exerts antioxidant activity and significantly improves the biochemical and hematological biomarkers in induced diabetic rats.

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