Spontaneous Coronary Artery Dissection and Woven Coronary Artery: Three Cases and a Review of the Literature

Spontaneous coronary artery dissection (SCAD) and woven coronary artery anomaly (WCAA) are relatively rare. A few of the previously reported woven coronary artery cases have involved in a single coronary artery. We present an unusual woven case involving all coronary arteries and two patient with SCAD. We have also reviewed the literature related to these disease, as they resemble one another

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction.Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated.Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p < 0.001; respectively. MPV and RDW levels were different in all four groups (p < 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p < 0.001).Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups

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

Atipik semptomlarla seyreden sol ana koroner arter total tıkanıklığı

Sol ana koroner arter tıkanıklıkları genellikle ölümle sonuçlandığı için koroner anjiyografilerde nadir saptanır. Kliniğimize efor anjinası ve çarpıntı ile başvuran ve 6 ay önce sol ana koroneri tam tıkanıklığına bağlı terleme, baş dönmesi ve bayılma hissi hikayesi olan 55 yaşında erkek bir olguyu sunduk.Left main coronary artery total occlusion is rarely determined by coronary angiography because; it almost always results in death. Here, we report a case of a 55 year old man who was admitted to our clinic with exertional angina and palpitations. He also had a history of dizziness, sweating and faintness six months previously due to total occlusion of the left main coronary artery

Heart rate recovery may predict the presence of coronary artery disease

Objective: We investigated whether post-exercise first minute abnormal heart rate recovery (HRR1) helps to predict the presence and severity of CAD, because of some confounding data. Methods: A cross-sectional, retrospective study was performed. Two hundred individuals were included. Gensini scores and the number of coronary artery involvements were used to evaluate the severity of CAD. Student's t-test, Mann-Whitney U test and chi-square test were used for the analysis continuous and categorical data. Spearman's correlation analysis was used to determine whether there is correlation between Gensini scoring and HRR1. Univariate and multivariate logistic regression were used to determine predictors for abnormal HRR1. ROC curve analysis was performed to detect the best sensitivity and specificity value of HRR1 in predicting CAD presence. Results: Seventy subjects (35%) did not have CAD, and CAD was present in 130 patients (65%). HRR1 0.05), there was relationship CAD presence and abnormal HRR1 (OR=2.1, 95% CI: 1.1-3.9, p=0.02), but not between CAD severity and HRR1 (r=-0.13, p=0.112). The sensitivity, specificity, and the positive and negative predictive values of abnormal HRR1 <= 21 beats at first minute for predicting CAD presence were 76.1%, 41.3% (AUC=0.588, CI 95%: 0.517-0,657, p=0.039), 70.7% and 48.3%, respectively. Conclusion: In the study abnormal HRR1 predicted the presence of CAD, but not the severity of it

Anomalous origin of left internal mammary artery from distal subclavian artery

The internal mammary artery arises from the first part of the subclavian artery. The left internal mammary artery (LIMA) is an excellent graft for myocardial revascularization of the left anterior descending artery. In this article, we describe a quite important variation of an anomalous origin of LIMA, which is rarely seen. In our case, LIMA was arising from the distal of the third part of the subclavian artery. Therefore, it is of utmost importance to perform LIMA angiography before coronary artery bypass grafting surgery

Usefulness of Maximal Exercise- Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY[No Abstract Available]Turkish Soc Cardio

Severe occlusion of the left main coronary artery with preserved left ventricular systolic function

[No Abstract Available

Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: Comparison of Simpler Heart Rate Corrections

Background and Objectives: The relationship between QT prolongation and myocardial ischemia is widely known. Due to the limited value of ST depression, we aimed to evaluate, by using four simpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the value of maximal exercise-QTc prolongation in the diagnosis of coronary artery disease (CAD) presence and severity. Subjects and Methods: We enrolled 234 subjects (mean age 57.3 +/- 9 years, 143 men) who had undergone exercise testing and coronary angiography due to a suspicion of CAD in the study. Evaluating CAD severity with Gensini scoring, the CAD group (n=122) and controls with non-CAD were compared in terms of corrected QT duration at maximal exercise. Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, resting, and peak heart rate were similar between the two groups (all p>0.05). The CAD group had higher raw QT values than the controls {268 (169-438) vs. 240 (168-348), p= 350 ms and Fridericia QTc of >= 340 ms were seen to be useful for the diagnosis of CAD, there was no additive diagnostic value of exercise QTc in addition to ST depression. Maximal exercise-QTc Bazett (r=0.163, p=0.01), Framingham (r=0.239, p=0.001), and Fridericia (r=0.206, p=0.001) equations were weakly positively correlated with Gensini scoring. Conclusion: The patients with CAD have longer QTc intervals at peak heart rates during exercise. This finding provides insufficient evidence to support routine incorporation of QTc at peak heart rates into exercise test interpretation

Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.Scientific Research Projects Fund of Namik Kemal University [NKUBAP.02.YL.16.046]This research was supported by the Scientific Research Projects Fund of Namik Kemal University (NKUBAP.02.YL.16.046)