High-sensitivity cardiac troponin T (hs-cTnT) is widely used in Oman and other Gulf countries. The availability of newer generation hs-cTnT has increased the sensitivity of diagnosing non-ST-elevation acute coronary syndrome (ACS). They utilize same antibodies as fourth-generation assay but can measure 10-fold lower levels of cTnT. Any detectable level above the 99^th percentile of population suggests myocardial damage. However, the cause could be non-ACS. Therefore, the increase in sensitivity of hs-cTnT assays for ACS comes at the cost of a reduced ACS specificity because more patients with other causes of myocardial injury are detected than with previous cTnT assays. Hence, there is large confusion among emergency physicians regarding optimal cutoff values to definitely confirm non-ST-elevation ACS, especially in patients with low likelihood of ACS. This review summarizes the available clinical and biochemical data to make recommendations about hs-cTnT cutoff values which will guide physicians to take decision in patients presenting with low likelihood ACS.

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A radial artery pseudoaneurysm represents a rare, potentially catastrophic complication of arterial cannulation that has been reported after cardiac catheterization. Treatment options are limited to chemical, mechanical, and combined approaches to obliterate the radial artery pseudoaneurysm and tract. Manual compression protocols using the TR Band have been variableand anecdotal, without objective measurements of adequate compression, making this technique prone to failure (1). In this report, we present an efficient, safe, and noninvasive management for treatment of radial artery pseudoaneurysms that is cost-effective and efficient and ensures correction without occlusion of the radial artery.

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Background: Despite the availability of new potent medical therapies, the rate of progression of angiographic coronary artery disease (CAD) is not well described. The aim of this analysis is to describe the rate and predictors of progression of CAD among patients with recurrent symptoms. Materials and Methods: We reviewed 259 patients (mean age 61 ± 11 years, 70% males) who underwent two coronary angiograms between 2008 and 2013. Progressive CAD was defined as obstructive CAD in a previously disease-free segment or new obstruction in a previously nonobstructive segment. Patients who had coronary artery bypass surgery between these two angiograms were excluded from the analysis. Multivariate logistic regression was used to determine the independent predictors of progression of CAD. Results: The included cohort had a high prevalence of coronary risk factors; hypertension (71%), diabetes (69%), and dyslipidemia (75%). Despite adequate medical therapy, more than half of the patients (61%) had CAD progression. Using multivariate logistic regression, a drop in the left ventricular ejection fraction (LVEF) by more than 5% was the predictor of CAD progression (adjusted odds ratio 5.8, P = 0.042, 95% confidence interval 1.1–31.2). Conclusion: Among high-risk patients with recurrent symptoms, the short-term rate of progression of CAD is high. A drop in LVEF >5% is a predictor of CAD progression. Further studies are needed to determine the prognostic value of CAD progression in the era of potent medical therapy.

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Background: Aspirin (acetylsalicylic acid) is commonly prescribed to patients with a history of myocardial infarction (MI) or occlusive vascular events (e.g., stroke). Due to the complications associated with failure to follow aspirin usage guidelines, determining predictors of aspirin noncompliance in these patient populations is of clinical value and may help prevent poor outcomes. Methods: This cross-sectional study of all patients with a previously diagnosed MI was conducted over a period of 3 months from May 2015 to July 2015 at a government-based hospital in Karachi, Pakistan. Patients were administered a questionnaire that comprised two parts. Part A was designed to measure sociodemographic data including age, gender, and marital status. Part B determined whether the patient was counseled on aspirin significance, and dosage recommendation, and was participating in cardiac rehabilitation therapy. Results: A total of 456 patients included in the study. Of them, 298 (66.7%) were males. The average age was 59 (standard deviation 11) years. The outcome from univariate logistic regression revealed that with 1 year increase of age, the usage of low dose of aspirin was significantly decreased by 2%. Patients with higher education attributed a significantly different effect on the usage of aspirin. Marital status divulged no significant association with the use of different doses of aspirin. The role of rehabilitation had no effect when adjusted for age and level of education. Conclusion: Post-MI patients with higher education level and undergoing rehabilitative therapy are more likely to take low-dose aspirin as compared to those who failed to have these attributes. There is a need for carrying out further work to confirm these findings and expand our recommendations, particularly the sensitive issue regarding adequate doctor counseling among these high-risk patients.

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Iatrogenic acute dissection of ascending aorta following coronary angiography and percutaneous intervention is a rare complication. Most reports involve localized aortic dissections as a complication of cannulation of a coronary artery with propagation into the ascending aorta. It is usually treated by sealing the intima with a stent in the ostium of the coronary artery or conservative management, while extensive dissections may require a surgical intervention. We describe a case of the subclavian dissection extending into the ascending aorta that occurred during diagnostic catheterization using the radial approach. The patient was successfully treated utilizing conservative management.

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We present a 32-year-old woman with no morbidities who was admitted with a dilated cardiomyopathy and cardiac failure due to adrenocortical carcinoma (ACC) which improved completely with surgical resection. Awareness regarding such rare presentations can avoid undue delay in diagnosis and management.

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The combination of Wolff–Parkinson–White (WPW) syndrome and rheumatic mitral stenosis (MS) is rare in clinical practice. The management of this condition primarily depends on the clinical picture. We describe a 26-year-old male patient with no significant previous medical history and who came for a routine medical assessment before entrance to a police academy service. He was found to have rheumatic MS and WPW.

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