Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A 'Historic' Dilemma

Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different

Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A 'Historic' Dilemma

Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different

Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A 'Historic' Dilemma

Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different

The comparative effects of esmolol and amiodarone on isolated coronary artery bypass grafts

Background/aim: Esmolol and amiodarone are two most commonly used antiarrhythmic drugs in coronary artery bypass grafting (CABG) surgery. Nevertheless, blockade of beta-2 receptors by increasing doses raise concerns about possible vasospasms. We studied the vasoactive effects of amiodarone and esmolol on left internal mammary artery (LIMA), radial artery (RA), and saphenous vein (SV) grafts. Materials and methods: After determining the presence of functional smooth muscle and endothelial layers, the responses of submaximally preconstricted graft samples were recorded in a tissue bath system. A total of 96 graft samples from 40 patients were used: 16 LIMA, 16 RA, and 16 SV grafts for each drug. Esmolol and amiodarone were added to reservoirs separately, starting from a concentration of 10-8 M until a concentration of 10-4 M. Results: Although both drugs caused vasodilatation, amiodarone exhibited a more potent vasodilatory effect than esmolol (P < 0.0001 for LIMA, P = 0.0128 for RA, and P < 0.0001 for SV). The vasodilatation rates with esmolol were 48.99 +/- 1. 2.28% in LIMA, 49.77 +/- 3.03% in RA, and 41.90 +/- 4.05% in SV grafts and with amiodarone they were 71.65 +/- 5.18% in LIMA, 58.61 +/- 5.87% in RA, and 65.07 +/- 4.09% in SV grafts. Conclusion: This in vitro study revealed that even increasing doses of both drugs induce vasodilatation of CABG grafts, with amiodarone having a more potent vasodilatory effect than esmolol

Symptomatic huge pericardial cyst: a case report

Mediastinal kistler nadir gözlenen, konjenital, neoplastik ve inflamatuar kaynaklı patolojilerdir. Basit perikardiyal kistler tüm yaş gruplarında görülmekle beraber sıklıkla yetişkin yaş grubunda gözlenmektedir. Perikardiyal kistler tüm mediastinal kistler arasında %7 gibi bir oranda gözlenmektedir. Hastaların kliniği sıklıkla asemptomatik seyretmektedir. Semptomlar nadir gözlenmekle beraber %20-30 olguda semptomatik olup ağrı, nefes darlığı, taşipne ve öksürük en sık gözlenen semptomlardır. Kistin kardiyak basısına bağlı olarak hipotansiyon, aritmi, atrial fibrilasyon ya da ani kardiyak ölüm semptomlarda gözlenebilmektedir. X-ray, bilgisayarlı tomografi, ekokardiografi gibi tetkikler ile saptanmaktadır. Yazımızda 35 yaşında, medikal tedaviye dirençli hipotansiyon, aritmi ve nefes darlığı olan, sağ atriuma bası yapan perikardiyal kist olgusunu sunduk.Mediastinal cysts are uncommon and results from congenital, neoblastic or inflamatuar abnormalities. Pericardial cyst may occur in patients of all ages, but commonly present in adults. The overall incidence of pericardial cyst is 7% in mediastinal cysts. The clinical presentation is commonly asymtomatic. Pain, tachpnea, dsypne and cough is the most common symptoms. Tachycardie, hypotansion, arytmi and sudden death are usually because of cardiac compression by the cystic mass.They are commonly found incidentally upon chest radiography, computed tomography or echocardiograph. We present, herein, the case of a 35-year-old female with a symptoms of dsypne, hypotansion and atrial arrhythmia resistant to medical therapies with finding of a pericardial cyst compression to the lateral wall of the right atrium

Relationship between plasma osmolality and neutrophil/lymphocyte ratio in heart failure with reduced ejection fraction

Aim: Heart failure (HF), a progressive disease, is accompanied by chronic inflammation and changes in osmolality. The neutrophil-to-lymphocyte ratio (NLR) demonstrates a sys- temic inflammatory response in most diseases; however, the relationship between plasma osmolality and the systemic inflammatory response in HF patients is not yet clear. There- fore, we aimed to investigate the possible associations of NLR with plasma osmolality levels in patients with HF. Materials and Methods: The present study included 189 consecutive patients with chronic HF with an ejection fraction (EF) of <40%. They were classified into four groups based on admission plasma osmolality quartiles: hypo-osmolar (first quartile), normo- hypo-osmolar (second quartile), normo-hyperosmolar (third quartile), and hyperosmolar (fourth quartile). We evaluated the relationship between NLR, plasma osmolality, type-B natriuretic peptide (BNP), and the New York Heart Association (NYHA) functional class. Results: The hyperosmolar group had an increased NLR (p = 0.007). The presence of NYHA class 3–4 functional capacity, high-sensitivity C-reactive protein, and high osmo- lality were independent predictors of increased NLR. In correlation analysis, osmolality was significantly positively correlated with NLR (r = 0.201, p = 0.011). Conclusion: Higher NLR values may be associated with increased plasma osmolality, which may indicate an increased inflammatory status in the HF phenomenon

Patient satisfaction with hemodialysis catheter in patients with chronic renal failure

Amaç: Kronik böbrek yetmezliği bulunan, renal transplant yapılamayan hastalar hemodiyaliz bağımlı olarak yaşamaktadır. Hemodiyalize giriş yolu olarak arteriovenöz şant (AV) altın standart yöntemlerdir. AV şant açılamayan ya da AV şant mevcut olup henüz olgunlaşmamış hastalarda hemodiyaliz'e girebilmek için hemodiyaliz kateterleri kullanılmaktadır. Hemodiyaliz kateterleri sıklıkla femoral, subklaviyan ve juguler venlere uygulanmakla beraber nadir olarak torakolomber yaklaşımla inferior vena kavaya da takılmaktadır. Çalışmamızda hemodiyaliz amacıyla kullanılan kateterlerin hasta memnuniyeti ve yaşam kalitesine etkilerini incelemeyi amaçladık. Yöntem: Kliniğimizde ocak 2011- mayıs 2012 yılları arasında hemodiyaliz amacıyla arteriyovenöz şant açılan ve katater takılan topla 139 hasta çalışmaya alındı. Hastalardan 91 erkek 48 kadın, yaş ortalaması 60,85 ±14,6 (min: 54, max:83) idi. Hastalar arasında demografik olarak anlamlı fark yoktu. Bu hastalar ile tek tek görülerek takılan kateter ve bölgelere göre menuniyet durumları araştırıldı. Bulgular: Takılan kataterlere bağlı olarak olguların %69.06'da herhangi bir şikayet gözlenmedi. En sık gözlenen şikayet ağrı olup olguların %17.9'da bu şikayet mevcut idi. Diğer şikayetler sırası ile %9.3 olguda görünümünden rahatsız olma ve %3.5 olguda yaşam kalitesinin olumsuz etkilenme olarak belirlendi. Komplikasyon olarak %10.7 oranında katater yeri enfeksiyonu ve %9.3 oranında katater oklüzyonu tespit edildi. Femoral bölgeye takılan kataterlerin enfeksiyon oranı %85 oranında tespit edildi. Sonuç: Kronik böbrek yetmezliği bulunan olgularda hemodiyaliz amacıyla katater takılacağı durumlarda öncelikli olarak juguler bölgenin tercih edilmesi gerektiği, juguler bölgenin uygun olmadığı durumlarda yüksek enfeksiyon oranları sebebiyle subklaviyan bölgenin ve en son seçenek olarak femoral bölgenin tercih edilmesi gerektiğini düşünüyoruz. Katater takılacak bölge ve oluşabilecek şikayetler hakkında hastaların bilgilendirilmesinin hasta memnuniyetini arttıracağı kanaatindeyizPurpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85&plusmn;14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter.There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction

The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe

Introduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency

Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes

Background: Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. Objectives: Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. Methods: The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. Results: The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile (tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (B: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (B: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (B: 0.168 [0.0 to 0.001]; p=0.003). Conclusions: This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients

Evaluation of the Coronary Angiography Results Performed at the Namık Kemal University Medical Faculty

Aim:In this study, we have tried to elucidate the influence of major cardiovascular risk factors such as age and gender on the prevalence of occlusive coronary artery disease (CAD) and define the prevalence of patients presenting with acute myocardial infarction(MI) or post-procedural MI in patients undergoing coronary angiography(CAG) at our center.Material and Methods:Five hundred consecutive CAG procedures carried out between may 2015 and july 2015 were retrospectively analysed in terms of demographic data (age, gender, prior sten tor coronary bypass procedure), angiographic characteristics (extense of CAD,number of occluded vessels, treatment and stent number),occurence of MI before or after the procedure.Results:In our study population (mean age 62.06±11.18 and 63% male) the rate of normal coronary arteries (NCA) was 14,6%, of nonocclusive CAD was 21,8%, of slow flow phenomenon was 3,8% and occlusive CAD was 59,8%. The mean age of patients with NCA was 56,1±10,5 years which was significantly lower than that of the patients with occlusive CAD (mean age 64±11,3) and nonocclusive CAD (mean age61±10) (p=0,000 and p=0,006 respectively). The patients with occlusive CAD were significantly older when patients with CAD were analysed.(p=0,026). Patients with NCA were more likely to be female (%74) while male gender was more common in patients with occlusive (71,2%) and nonocclusive(64,8%) CAD. Age did not effect the prevalence of presentation with MI. (p=0,11). There was no statisticaly significant difference in presentation with MI in terms of gender (p=0,287) but older women more commonly presented with MI when compared to men(p=0,015) and men experienced more thromboembolic complications after procedure when compared to women (p=0,011).Conclusion:The analysis of the KAG results showed that the prevalence of occlusive CAD is high among our patients. In the light of these data, more emphasis should be given to the primary prevention of cardiovascular diseases in our region