Plasma fibrinogen level may predict critical coronary artery stenosis in young adults with myocardial infarction

Background: This study aims to determine the role of hematological variables in determining critical coronary artery stenosis in young adults with myocardial infarction. Methods: This study includes 76 of 1,804 patients who applied to our hospital between January 2001 and December 2005. All were under 35 years old, diagnosed as acute myocardial infarction with clinical and laboratory findings, and had coronary angiography. Study patients were divided into two groups: those having critical coronary artery lesions (group I) and those having normal coronary arteries (group II). Then we compared these groups for age, sex, body mass index, risk factors, plasma protein C, protein S, antithrombine III and fibrinogen. Student t test, the c2 test, Fisher’s exact test and Mann Whitney U test were used. Results: There were no differences between the two groups in terms of hypertension (p = 0.70), smoking (p = 0.50), hyperlipidemia (p = 0.09), body mass index (p = 0.14), family history (p = 0.10), plasma protein C (p = 0.08), protein S (p = 0.35) or antithrombine III (p = 0.60). Plasma fibrinogen levels were significantly higher in group I than in group II (p = 0.001). Conclusions: Our study shows that high plasma fibrinogen levels may be used as a predictor of critical coronary artery lesions in young patients with acute myocardial infarction

Bidirectional tachycardia in a patient with pulmonary embolism

We report a 55 year-old man with sudden cardiac arrest. Electrocardiography revealed runs of bidirectional ventricular tachycardia, and transthoracic echocardiography showed indirect findings of pulmonary embolism. (Cardiol J 2010; 17, 2: 194-195

The relationship between coronary artery disease and uric acid levels in young patients with acute myocardial infarction

Background: Serum uric acid concentrations are higher in patients with established coronary artery disease than in healthy controls. This study aimed to determine the role of uric acid in predetermining coronary artery disease in young patients with acute myocardial infarction (AMI). Methods: This study included 80 of 1612 patients who applied our hospital between January 2000 and December 2005. All of the patients were under 35 years old, diagnosed with AMI by clinical and laboratory findings, and had coronary angiography. The study population was divided into two groups, the first having critical coronary artery disease (group I) and the second having normal coronary arteries (group II). Then we compared these groups with age, body mass index, risk factors, serum protein C, protein S, antithrombin III, creatinine and uric acid levels. Results: Myocardial infarction was located in 65% anterior, 15% inferior, 15% inferiolateral and 5% high lateral, respectively. Forty five % of patients had critical coronary artery disease (group I, n = 36) and 55% had normal coronary arteries (group II, n = 44). There were no differences in the two groups with regard to body mass index, family history, hypertension, smoking, cholesterol level, triglyceride level and creatinine level, lack of protein C, lack of protein S or lack of antithrombin III. Serum uric acid levels were found to be higher in group I (7.0 &plusmn; &plusmn; 1.4 mg/dL) than in group II (4.9 &plusmn; 1.1 mg/dL; p = 0.003). Conclusions: This study showed that high serum uric acid levels were associated with critical coronary artery disease in young patients (< 35 years) with AMI (Cardiol J 2008; 15: 21-25

The Effect of Pulmonary Sarcoidosis on Cardiac Autonomic Dysfunction

Aim:The assessment of heart rate variability (HRV) has been considered as an important non-invasive method to evaluate cardiac autonomic function. Concerning recent evidence on the relationship between impaired autonomic dysfunction and sarcoidosis, we aimed to investigate the effect of pulmonary sarcoidosis on cardiac autonomic dysfunction.Materials and Methods:This prospective study comprised of 36 participants, including 18 patients diagnosed with pulmonary sarcoidosis and 18 age-matched healthy volunteers. All participants underwent echocardiographic examination, 12-channel electrocardiography and 24-h Holter monitoring. HRV parameters were determined and compared between the groups.Results:In time domain analyses, RMSDD values significantly decreased in the patient group compared to the control group (p=0.043). The low-frequency power in frequency domain analyses between sarcoidosis patients and controls demonstrated a statistically significant difference (p=0.045). In the correlation analysis, PR duration was negatively correlated with all-time domain and frequency domain parameters as SDNN, SDANN and high-frequency values, which had a statistically significant difference (p=0.009, p=0.003, p=0.047 respectively). Corrected QT (QTc) duration was negatively correlated with all-time domain and frequency domain parameters as well. The low-frequency/high-frequency ratio was positively correlated with QTc duration.Conclusion:The patients with pulmonary sarcoidosis displayed a decrease in all HRV values reflecting diminished parasympathetic tone or blunted cardiac response to vagal modulation. This may cause cardiac outcomes such as atrioventricular conduction abnormalities, proarrhythmic tendency, ventricular arrhythmias and sudden death

Koroner arter girişimi sırasında ani tıkanma: Bu kabus kontrast maddeyle ilişkili mi?

Kırk altı yaşında, koroner arter hastalığı için risk faktörü olarak hipertansiyon ve aile öyküsü olan erkek hasta akut anterior miyokard infarktüsünün ikinci saati içinde kliniğimize başvurdu. Kurtarıcı perkütan koroner girişim sırasında sol ön inen arterin tam tıkandığı gözlendi. İşlem sırasında kullanılan 150 ml non-iyonik, düşük osmolar kontrast maddenin trombüse yol açarak tam tıkanıklığa neden olabileceği düşünüldü. İntrakoroner bolus tirofiban infüzyonu sonrasında intrakoroner trombozun çözüldüğü görüldü. Lezyon bölgesine stent uygulandı ve TIMI III akımla birlikte çok iyi anjiyografik sonuç elde edildi. Beş ay sonra yapılan kontrol anjiyografide sol ön inen koroner arter tamamen açık idi. Kurtarıcı işlem sırasında gelişen akut koroner tıkanmaların tedavisinde tirofiban infüzyonuyla bareber stentleme tıkanıklığı etkin bir şekilde gidermektedir.A 46-year-old man with hypertension and family history for coronary artery disease presented to our department within the second hour of acute anterior wall myocardial infarction. During rescue percutaneous transluminal coronary angioplasty, total occlusion occured in the left anterior descending (LAD) coronary artery. A total of 150 ml of non-ionic, low-osmolar contrast agent was used and it was thought that non-ionic contrast media could have induced thrombus formation. After bolus intracoronary tirofiban administration, there was satisfactory resolution of the intracoronary thrombosis. Stent implantation at the lesion site resulted in an excellent angiographic result with a TIMI III flow. At five-month control angiography, the LAD was widely patent. Acute total occlusions during rescue coronary angioplasty can be effectively managed by tirofiban infusion and stenting

Assessment of ventricular and left atrial mechanical functions, atrial electromechanical delay and P wave dispersion in patients with scleroderma

Background: The aim of this study was to investigate ventricular functions and left atrial (LA) mechanical functions, atrial electromechanical coupling, and P wave dispersion in scleroderma patients. Methods: Twenty-six patients with scleroderma and twenty-four controls were included. Left and right ventricular (LV and RV) functions were evaluated using conventional echocardiography and tissue Doppler imaging (TDI). LA volumes were measured using the biplane area- -length method and LA mechanical function parameters were calculated. Inter-intraatrial electromechanical delays were measured by TDI. P wave dispersion was calculated by 12-lead electrocardiograms. Results: LV myocardial performance indices (MPI) and RV MPI were higher in patients with scleroderma (p = 0.000, p = 0.000, respectively) while LA passive emptying fraction was decreased and LA active emptying fraction was increased (p = 0.051, p = 0.000, respectively). P wave dispersion and inter-intraatrial electromechanical delay were significantly higher in patients with scleroderma (25 [10&#8211;60] vs 20 [0&#8211;30], p = 0.000, 16.50 [7.28&#8211;26.38] vs 9.44 [3.79&#8211;15.78] and 11.33 [4.88&#8211;16.06] vs 4.00 [0&#8211;12.90], p < 0.05, respectively). Interatrial electromechanical delay was negatively correlated with LV E wave, (p = 0.018). LV E wave was demonstrated to be a factor independent of the interatrial electromechanical delay (R2 = = 0.270, b = &#8211;0.52, p = 0.013). Conclusions: This study showed that in scleroderma patients, global functions of LV, RV and mechanical functions of LA were impaired, intra-interatrial electromechanical delays were prolonged and P wave dispersion was higher. LV E wave was demonstrated to be a factor that is independent of the interatrial electromechanical delay. Reduced LV E wave may also give additional information on the process of risk stratification of atrial fibrillation. (Cardiol J 2011; 18, 3: 261&#8211;269

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

Wellens&#8217; syndrome: The electrocardiographic finding that is seen as unimportant

Wellens&#8217; syndrome is a pattern of electrocardiography T-wave changes associated with critical proximal left anterior descending artery lesion. Patients with Wellens&#8217; syndrome are at high risk of the development of extensive myocardial infarction of the anterior wall and death. Thus, it is vital that this finding is recognized promptly. We present a patient with Wellens&#8217; syndrome in this article