Persistent ductus arteriosus in a 72-year-old woman with paroxysmal atrial fibrillation and depression syndrome: a therapeutic and diagnostic problem

Effects of Dabigatran on Dementia Pathogenesis and Neuropsychological Function: A Review

BACKGROUND

Patients with atrial fibrillation (AF) carry higher risks of cognitive consequences and psychological burden. An optimal anticoagulant therapy would be expected to better preserve neuropsychological function in addition to effective prevention of stroke and systemic thromboembolism.

OBJECTIVE

The aim of this review is to explore the effects of the non-vitamin K antagonist oral anticoagulant (NOAC) dabigatran, a direct thrombin inhibitor, on cognitive and psychological function as well as dementia pathogenesis.

METHODS

We performed a comprehensive search of PubMed/Medline for all types of relevant articles using a combination of dabigatran and associated keywords updated to August 31, 2021. All titles and abstracts were screened for eligibility, and potentially relevant papers were collected for inclusion.

RESULTS

The pooled results demonstrated neutral to positive impacts of dabigatran on cognitive and psychological outcomes, including laboratory results in animal models of Alzheimer's disease, and reduced incidences of anxiety/depression and dementia for AF patients. Dabigatran also exhibited better therapeutic profiles than warfarin in preclinical and observational research.

CONCLUSION

Given limited strength of evidence from heterogeneous studies, our review proposed modest beneficial effects of dabigatran on neuropsychological function. Further clinical trials are warranted to affirm the pleiotropic protective effects of NOACs on dementia treatment.

Quality of life, anxiety and depressive disorders in patients with extrasystolic arrhythmia

INTRODUCTION

The aim of this study was to perform a comparative and economic analysis of the degree of development of anxiety-depressive disorder in patients with different types of extrasystolic arrhythmia using different assessment scales.

MATERIAL AND METHODS

The study was conducted in 2018-2019 at the premises of clinic No. 4, involving 450 patients (Moscow, Russia). Patients were divided into three groups: with coronary heart disease (CHD) (147 patients), with myocardiodystrophy (MCD) (113) and with cardiopsychoneurosis (CPN) (190). Everyone underwent round-the-clock electrocardiography (ECG) and echocardiography. If symptoms of depressive disorder are detected in a timely manner, the risk of adverse cardiovascular diseases may be reduced.

RESULTS

Depression and anxiety indicators on all three scales differed significantly (p ≤ 0.05) in patients with supraventricular extrasystole (more than 40 points on the Zung scale, 14 points on the Montgomery-Asberg depression scale, more than 38 points on Zung and 3 points on Covi anxiety scales). For patients with ventricular extrasystole, a significant difference was established between groups 1 and 2 only in terms of the level of depression on the Zung scale. Factors of psychogenic origin determine the development of cardiac rhythm disturbances.

CONCLUSIONS

The study showed that for supraventricular extrasystoles, these factors determine the overall health of the patient. The differences between the three groups are significant on all scales of depression and anxiety (p ≤ 0.05). The most susceptible to depression and anxiety are patients with extrasystolic arrhythmias diagnosed with CHD, as well as MCD.

A rare case of patent ductus arteriosus diagnosed during coronary artery bypass grafting operation in a 73-year-old man

BACKGROUND

Although patent ductus arteriosus (PDA) is more prevalent among infants and children, it might be seen among adults as well. It is not usually seen among adults, since it is often diagnosed and treated in childhood.

CASE REPORT

In the present case, a 73-year-old man referred to the hospital with symptoms including dyspnea, cold sweating, and chest pain with a burning nature which was lasting for 30 minutes. Angiography revealed coronary artery obstruction, so he became a coronary artery bypass grafting (CABG) candidate. Except for dilatation of the left atrium, no specific findings were reported in the patient's echocardiography report. When the pump was turned off by the surgeon, the patient's heart filled up and he was not able to get off the pump. Simultaneously, the patient started to have bloody respiratory secretions. With all that in mind, the surgeon suspected that he might suffer from a PDA, then he found an 8-mm PDA and closed it. Then, the patient was taken off the cardiorespiratory pump.

CONCLUSION

Although PDA is more common among children and infants, it can be found among adults according to previous cases and our case as well. Since patients with PDA refer to physicians for other clinical issues, it is recommended to apply more precision in diagnostic methods such as taking a good history, echocardiography, and electrocardiogram (ECG). Moreover, it is recommended that if a patient has conditions similar to our patient, the surgeon must be sure of a possible PDA.