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Gastroduodenal artery (GDA) aneurysms are rare but a potentially fatal condition if rupture occurs. They represent about 1.5% of all visceral artery (VAA) aneurysms and are divided into true and pseudoaneurysms depending on the etiologic factors underlying their development. Atherosclerosis and pancreatitis are the two most common risk factors. Making the diagnosis can be complex and often requires the use of Computed Tomography and angiography. The later adds the advantage of being a therapeutic option to prevent or stop bleeding. If this fails, surgery is still regarded as the standard for accomplishing a definite treatment.

Previous studies reported an association between elevated mean platelet volume (MPV) and post-myocardial infarction mortality. This study explores the association between long-term mortality after non-ST-segment elevation myocardial infarction (NSTEMI) and the peripheral blood platelet indices (i.e., the mean platelet volume (MPV), platelet count, and the MPV/platelet (MPV/P) ratio). Two physicians independently reviewed the data of 619 NSTEMI patients. The blood samples were drawn and analyzed within 1 h of admission, the second, and the last hospital days. Patients were stratified into equal tertiles according to the platelet count, MPV, and MPV/platelet ratio. The primary outcome, 4-year all-cause mortality, was compared among the platelet indices tertile models. According to MPV, platelet count, and MPV/platelet ratio tertile models, there was a trend of higher 4-year mortality for the lower and upper tertiles in comparison to the middle tertiles. However, only the admission MPV/platelet ratio tercile model was statistically significant for predicting the 4-year mortality. The mortality rate of the highest MPV/platelet (48/207 (23%)) and the lowest (41/206 (20%)) tertiles were significantly higher than the middle tertile (19/206 (9%)), p = 0.0004 by the chi-squared test. After adjusting for Global Registry of Acute Coronary Events, the patients in the combined first and third MPV/P tertiles had higher mortality in reference to those in the middle MPV/P tercile (hazard ratio 1.951, confidence interval 1.032-3.687, and p < 0.0396). Our novel finding is that the MPV/platelet ratio is superior to the MPV alone in predicting long-term mortality after NSTEMI. We suggest that using this ratio will magnify any existing relationship between platelet indices and mortality post-NSTMI. Further studies are needed to confirm our finding.

Background: Red blood cell distribution width (RDW) is a strong predictor of adverse outcomes in patients with heart failure, stable coronary artery disease, stroke and acute myocardial infarction. The aim of our study was to explore the predictive value of RDW on all-cause mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Method: This observational study includes 619 NSTEMI patients, discharged from Staten Island University Hospital between September 2004 and December 2006. Patients were divided into equal RDW tertiles and survival was evaluated in each tertile. Result: Patients in the highest RDW tertile (RDW >14) had higher in-patient (7 vs. 1%) and 4-year (30 vs. 7%) mortality rates compared to those in the lowest tertile (RDW <13) (Wilcoxon χ² = 34.64, p < 0.0001). After controlling for Global Registry of Acute Coronary Events risk profile scores and other confounding variables, the RDW adjusted hazard ratio for 4-year all-cause mortality increased by 1.10 for each one unit increase in RDW (confidence interval 1.004–1.213, p = 0.042). Conclusion: RDW is an independent predictor of all-cause long-term mortality in NSTEMI patients. Further studies are needed to clarify the mechanisms of this association between RDW and adverse outcomes in patients with coronary artery disease.

We report two cases of immune thrombocytopenic purpura (ITP) associated with acute coronary artery syndrome highlighting the interventions done in every case along with the medications used during intervention and as outpatient. The first case is that of a woman with ITP exacerbation while on dual antiplatelet therapy and the second case is that of a male presenting with non-ST elevation myocardial infarction (NSTEMI) while in a thrombocytopenic crisis. In both cases antiplatelet therapy was held and thrombopoietic therapy was initiated before resuming full anticoagulation and coronary intervention. Given the paucity of data on ITP and antiplatelets treatment in the setting of acute coronary syndrome, no strict recommendations can be proposed, but antiplatelets appear to be safe acutely and in the long term in this category of patients as long as few measures are undertaken to minimize the risks of bleeding and thrombosis.

Hypertension has a major impact on cardiovascular and renal mortality and morbidity, with a 90% lifetime risk of developing hypertension. 1 Optimal blood pressure control reduces the risk of stroke by 38% and of myocardial infarction by 16%. 2 Compared to peripheral arterial pressure measurements, aortic pressures were shown to better predict coronary artery disease (CAD) 3,4 and cardiovascular risk. 5 Brachial arterial pressure does not correctly reflect aortic pressure, especially its systolic component, due to pulse pressure amplification. 6,7 It is also important to mention that central (aortic) pressures are the pressures directly affecting coronary and cerebral circulations, as well as the left ventricle, much more than pressures measured in the arm, and the latter is of paramount importance in end-organ damage related to hypertension. 8 Several ascending aortic blood pressure indices were studied, among which aortic pulse pressure (APP) correlated with increased cardiovascular complications. 9 Moreover, a higher APP was associated with more extensive CAD at time of coronary angiography. 10 A recent large prospective study has shown the superiority of central (aortic) over peripheral (brachial) pressures, as well as the superiority of APP and pulsatility over mean pressure in predicting adverse cardiovascular events. 11 Higher APP is related to arterial stiffness, a feature of aging and multiple cardiovascular conditions. 7 Although arterial stiffening is thought to represent by itself a form of cardiovascular end-organ damage, 7 and although APP is only an indirect indicator of arterial stiffness, higher APP may link arteriosclerosis (arterial stiffening) to other forms of end-organ damage such as atherosclerosis. The role of cyclical stretch due to pulsatile pressure in atherosclerosis is recognized. 12 BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (cAD). Besides, the left coronary artery (LcA) has a predominantly diastolic flow while the right coronary artery (RcA) receives systolic and diastolic flow. thus, we hypothesized that increased systolicdiastolic pressure difference had a greater atherogenic effect on the RcA than on the LcA.

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Cardiac papillary fibroelastomas are the most common primary valvular tumors. Generally benign, they account only for about 10% of all primary cardiac neoplasms, can occur in normal or diseased hearts, and are associated strongly with open heart surgery and radiotherapy. They are, in most cases, incidental findings, but can be discovered after syncope. We report the case of an elderly female, who was referred for syncope and was found to have a large fibroelastoma at the mitral valve annulus, intermittently obstructing the left ventricular inflow tract, and mimicking the presentation of left atrial myxoma. This case illustrates another potential mechanism of syncope in patients with fibroelastomas.