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Currently, it is not clear whether recurrent traumatic events lead to progression of rheumatic heart disease (RHD) after the incident of acute rheumatic fever or a persistent inflammatory state at the site of the valves. The aim of this study was to assess the possible association between plasma high sensitive C Reactive Protein (hs-CRP) level as an indicator of inflammation and RHD.

Objectives:In cirrhotic patients, despite presence of significant metabolic abnormalities and enlarged left atria, we have seldom observed atrial fibrillation (AF) rhythm. The aim of this study was to evaluate the prevalence of AF among cirrhotic patients and comparing it with that reported in the general population. Materials and Methods:Medical documents of 1302 adult cirrhotic patients, booked in the waiting list of liver transplantation, were evaluated retrospectively. Electrocardiograms were reviewed for the presence of AF rhythm, and echocardiographies were reviewed to obtain left atrial (LA) size. Result:Only two patients (0.15%) were detected to have AF rhythm, which was significantly lower than that reported in our general population, even after age and sex adjustment. Six hundred and sixty-eight patients (51%) had enlarged left atria (LAdiameter more than 39mm); both AF patients belonged to this group. Conclusion:The result of this study suggests the protective effect of liver cirrhosis on development of atrial fibrillation. Further studies are needed to verify the possible mechanisms.

Abstract: Atorvastatin is a synthetic inhibitor of 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor. It has a longer half life and longer duration of action than that of all other available HMG-CoA inhibitors. We evaluated the efficacy of alternate-day dosing of atorvastatin in comparison with the standard one-daily dose on total cholesterol, low and High-density lipoprotein (LDL and HDL) and triglycerides. This study is a randomized, blinded, and controlled clinical trial. Sixty-six patients with LDL cholesterol of more than 100 mg/dl were enrolled. Baseline fasting lipid profile (total cholesterol, LDL, HDL and triglyceride), liver function tests and creatine kinase were drawn. Patients were randomized to three atorvastatin dose groups. Group I received 10 mg of atorvastatin every day, group II received 20 mg of atorvastatin every day, and group III received 20 mg every other day. After 6 weeks of treatment with atorvastatin, fasting lipid profiles, liver function tests and creatine kinase concentrations were re-taken. Compliance to treatment was assessed at each visit. Of the sixty-six patients enrolled, sixty completed the study. All three regimens significantly reduced total cholesterol and LDL compared to baseline. No statistically significant difference existed between the three groups in regards to total or a percentage decrease in total cholesterol and LDL cholesterol at 6 weeks compared to baseline. All regimens were well tolerated and none of the patients showed significant elevation of liver enzyme or creatine kinase during the course of the study. In conclusions the alternate-day dosing of atorvastatin is an efficacious and safe alternate to daily dosing and yet inexpensive.

Differentiating coronary artery disease with left ventricular dysfunction from dilated cardiomyopathy is important prognostically and therapeutically. To provide a diagnostic algorithm to distinguish these conditions using a standard 12-lead electrocardiogram, all 105 patients with left ventricular ejection fraction < 50% who underwent angiography between January 2004 and December 2006 were studied prospectively. Coronary artery disease was defined as = 50% stenosis of the left main coronary artery or = 70% stenosis of 1 or more of the 3 major epicardial arteries. Normal coronary angiography findings with left ventricular ejection fraction < 50% was defined as dilated cardiomyopathy. The most specific finding for differentiation of these diseases was pathologic Q waves in lead II, aVF, V3 or V4. The most sensitive parameter was a ratio = 5 of R-wave amplitudes in lead V6 and lead III (94% sensitive). The 12-lead electrocardiogram provides a useful noninvasive method for differentiation of dilated cardiomyopathy from coronary artery disease with left ventricular systolic dysfunction.