The influenza vaccine reduced major cardiovascular events in patients with ACS. Therefore, it should be encouraged as a secondary prevention in this group of patients.

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Objective: To determine the association between splenectomy and pulmonary hypertension in patients with thalassaemia with anaemia. Design: Prospective cross-sectional study. Methods: 68 patients with thalassaemia, who had a haemoglobin concentration of less than 100 g/l, were recruited into this study. Echocardiography was performed before clinical data were reviewed. Pulmonary artery pressure was estimated by measuring the systolic transtricuspid pressure gradient from tricuspid regurgitation and adding it to the right atrial pressure, which was estimated by the response of the inferior vena cava to inspiration. Pulmonary hypertension was defined as systolic pulmonary artery pressure . 35 mm Hg. History of splenectomy and other clinical data were compared between patients with and without pulmonary hypertension. Results: 29 patients had pulmonary hypertension and 39 did not. Patients with pulmonary hypertension had significantly more nucleated red blood cells and higher platelet counts, and a higher prevalence of splenectomy (75.8% v 25.6%, odds ratio 9.1, 95% confidence interval 3.0 to 27.7). In multivariate analysis, splenectomy was the only factor significantly related to pulmonary hypertension. Conclusion: Splenectomy is a strong risk factor for pulmonary hypertension in patients with thalassaemia.H eart disease is a major cause of mortality and morbidity in patients with thalassaemia after the first decade of life, 1 despite improved prognosis with iron chelation. The common cardiac abnormalities that have been reported in patients with thalassaemia are cardiac hypertrophy, ventricular systolic dysfunction, pericarditis and pulmonary hypertension. Pulmonary hypertension is found in about 59-75% of patients with thalassaemia and can be the leading cause of heart failure in these patients.2 4 5 Factors affecting pulmonary artery pressure include high cardiac output caused by anaemia, left ventricular (LV) systolic dysfunction, chronic pulmonary haemosiderosis, recurrent respiratory tract infections, hypoxaemia and pulmonary fibrosis.5 6 Another proposed cause is the hypercoagulable state with thrombotic obstruction of the pulmonary arteries.7-9 Although most of the reported patients with thalassaemia with pulmonary hypertension were splenectomised, 2 5 6 non-splenectomised patients can also have pulmonary hypertension whereas some of them have normal pulmonary arterial pressure.2 The relationship between splenectomy and pulmonary hypertension in thalassaemia has not been clearly established. The purpose of this study was to explore this relationship. METHODS PatientsWe studied patients with thalassaemia with haemoglobin concentration less than 100 g/l who were being treated at the haematology outpatient clinic from January 2000 to December 2001. They were free from cardiac symptoms and had no evidence of clinical heart failure or signs of chronic liver disease. None were taking cardioactive drugs at the time of examination. We excluded patients with significant valvular heart disease, congenital heart diseas...

Objective: To evaluate the effects of an educational board game on heart failure (HF) patients' knowledge and self-care behavior. Methods: In this randomized controlled study with a follow-up of 3 months, 76 patients with HF with reduced ejection fraction, who had been enrolled in our multidisciplinary HF program, were divided into two groups. During their follow-up appointment at the HF clinic usually 2 weeks after discharge, the interventional group participated in an HF educational board game conducted in Thai language, while the control group received the usual care including standard education. The primary outcome was the change of score achieved in the specialized HF knowledge and self-care behavior assessment. Results: In the intervention group, the knowledge and self-care behavior significantly improved (all P < 0.001), whereas both scores were unchanged in the control group (P = 0.09 and P = 0.21). Mean score change for knowledge and self-care behavior showed greater improvement in the intervention group when compared with the control group (P < 0.002 and P < 0.006). Conclusion: Participation in an interactive educational board game resulted in an increase in the HF patients' knowledge and self-care behavior. Practice Implications: An interactive educational board game may be used as an alternative educational tool in HF patients.

This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively.

A 28-year-old pregnant woman presented at 28 weeks of gestation. She was diagnosed to have a left atrial myxoma 2 years earlier, but was lost to follow-up. During this pregnancy, the transthoracic echocardiography showed a 9 cm mass in the left atrium obstructing mitral valve inflow, interfering with mitral valve closure, causing severe mitral regurgitation and severe pulmonary hypertension. However, there were no clinical signs of pulmonary and systemic congestion or obstruction. Based on the clinical symptoms of the patient, the echocardiographic findings and the term of her pregnancy, the patient decided to schedule for a vaginal delivery with surgical correction after delivery. She gave birth at 32 weeks of gestation. During labour, pulmonary oedema developed but was detected early and it responded to therapy. Two weeks after delivery, a right anterior thoracotomy was performed to facilitate the removal of the left atrial myxoma and repair of the mitral valve.

Purpose: Serum digoxin concentration (SDC) monitoring may be unavailable in some healthcare settings. Predicted SDC comes into play in the efficacy and toxicity monitoring of digoxin. Renal function is the important parameter for predicting SDC. This study was conducted to compare measured and predicted SDC when using creatinine clearance (CrCl) from Cockcroft-Gault (CG) equation and estimated glomerular filtration rate (eGFR) calculated from CKD-Epidemiology Collaboration (CKD-EPI), re-expressed Modification of Diet in Renal Disease (Re-MDRD4), Thai-MDRD4, and Thai-eGFR equations in Sheiner's and Konishi's pharmacokinetic models. Patients and methods: In this retrospective study, patients with cardiovascular disease with a steady-state of SDC within 0.5-2.0 mcg/L were enrolled. CrCl and studied eGFR adjusted for body surface area (BSA) were used in the models to determine the predicted SDC. The discrepancies of the measured and the predicted SDC were analyzed and compared. Results: One hundred and twenty-four patients ranging in age from 22 to 88 years (median 60 years, IQR 50.2, 69.2) were studied. Their serum creatinine ranged from 0.40 to 1.80 mg/dL (median 0.90 mg/dL, IQR 0.79, 1.10). The mean±SD of measured SDC was 1.12±0.34 mcg/L. In the Sheiner's model, the mean predicted SDC was calculated by using the CG and the BSA adjusted CKD-EPI equations and was not different when compared with the measured levels (1.10±0.36 mcg/L (p=0.669) and 1.08±0.42 mcg/L (p=0.374), respectively). The CG, CKD-EPI, and Re-MDRD4 equations were a better fit for patients with creatinine ≥0.9 mg/dL for prediction with minimal errors. In the Konishi's model, the predicted SDC using the CG and the studied eGFR equation was lower than the measured SDC (p<0.05). Conclusion: In Sheiner's model, the CG and the BSA adjusted CKD-EPI equations should be used for predicting SDC, especially in patients with serum creatinine ≥0.9 mg/dL. The other studied eGFRs underestimated SDC in both Sheiner's and Konishi's model.

This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated.