Coronary artery-left ventricular microfistulae associated with apical hypertrophic cardiomyopathy

A 58 year-old Caucasian man was admitted to the coronary care unit with angina pectoris. There were deep inverted T waves and ST segment depression at anterior precordial derivations. Coronary angiography revealed widespread coronary artery to left ventricular microfistulae arising from distal portions of both left and right coronary systems. Left ventriculography and transthoracic echocardiography revealed typical features of apical hypertrophic cardiomyopathy. Angina pectoris was alleviated by beta-blocker therapy. Both multiple coronary artery to left ventricular microfistulae and apical hypertrophic cardiomyopathy are rare conditions and little is known about pathophysiological and clinical aspects of this combination. Accumulating evidence will provide us this information so that the management of the patients will be enhanced. (Cardiol J 2011; 18, 3: 307–309

Zolmitriptan-induced acute myocardial infarction

Triptans are an established treatment for acute migraine attacks. By activating 5HT1B/1D receptors they lead to vasoconstriction of the cerebral blood vessels which are dilated during migraine attacks. Moreover, they reduce secretion of vasoactive peptides and conduction of pain stimuli over the cerebral cortex. In up to 7% of cases of treatment with triptans, thoracic pain occurs, although this is mostly transient, mild and without lasting ischemia. We present the case of a 45 year-old woman with a history of migraine with visual aura since the age of 20. She had no history of diabetes mellitus, hypertension, smoking or any other risk factors for cardiovascular events before she was admitted to our emergency room with typical chest pain. An electrocardiogram revealed anterior myocardial infarction following her monthly dose of oral zolmitriptan. Catherization revealed a normal coronary arterial system. The laboratory indices for cardiac risk were within normal ranges. The patient was advised to avoid triptans permanently on being discharged. (Cardiol J 2012; 19, 1: 76–78

Monocyte-to-HDL-cholesterol ratio is associated with Ascending Aorta Dilatation in Patients with Bicuspid Aortic Valve

Background: The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve. Methods: The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter 65 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups. Results: The mean age of the participants was 44.7 \ub1 15.4 years and average ascending aorta diameter was 3.2 \ub1 0.3 cm in dilatation negative group and 4.4 \ub1 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve. Conclusion: We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve

Artykuł oryginalnyBrucella endocarditis – a registry study

Background: A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world, like in our country. One of the most devastating conditions related to this infection is endocarditis, although it is rare. Unfortunately, adequate studies on the characteristics of Brucella endocarditis have not been performed. In addition, there was no consensus on optimal type and duration of medical and interventional therapies. Aim: To answer the following questions: what are the clinical characteristics of Brucella endocarditis, which type of therapy should be performed, and can an alternative antibiotic regimen be applied? Methods: Patients with the diagnosis of Brucella endocarditis were included in the study during a 6-year period. A total of 10 patients were interrogated for their signs, symptoms, drug use, and clinical conditions. In addition, baseline clinical and laboratory characteristics of the patients were evaluated. Results: All patients in the study were male with a mean age of 55.9 ± 12.7 years. Hospitalisation and total follow-up periods were 52.6 ± 11.2 and 80.6 ± 29.0 days, respectively. The most frequently presenting symptom was fever (60%). Dyspnoea and fatigue were the other frequent symptoms in descending order. Valve pathology was present in 70% of the study population. The aortic valve was affected more than the mitral valve. Affected mitral valves had rheumatic disease whereas only 57% of the aortic valves had underlying pathology. Isolation of Brucella spp. was possible in 20% of the patients. Mortality rate was 30% in our study; 20% of the patients were on medical follow-up without disease progression and with clinical stability, 60% of patients were on a combination therapy with a tetracycline group, a rifampicin, and a third-generation cephalosporin. Patients who took this combination and underwent aortic valve replacement had good clinical results with a mortality rate of 20%. The 30% of patients were on a combination therapy with a tetracycline group, rifampicin, and an aminoglycoside group. Mortality rate with this combination was 33%, although the success rate was 67%. Conclusion: Brucella endocarditis should be considered in the differential diagnosis in patients with vegetations on the cardiac valves, especially in endemic areas. Optimal therapy seems to be a combination of antibiotics and surgery, although medical therapy can be an alternative, especially in stable patients. Addition of a third-generation cephalosporin instead of aminoglycoside to the combination therapy is an alternative.Wstęp: Bruceloza występuje w różnych endemicznych rejonach świata, w tym w Turcji. Jednym z najcięższych, ale sporadycznie spotykanych powikłań brucelozy jest infekcyjne zapalenie wsierdzia (IZW). W piśmiennictwie nie ma badań opisujących w pełni to powikłanie brucelozy. Cel: Przedstawienie klinicznego obrazu IZW wywołanego brucelozą, ocena skuteczności leczenia, w tym możliwości zastosowania niestandardowej antybiotykoterapii. Metody: W ciągu 6 lat chorzy z IZW wywołanym brucelozą włączani byli do specjalnego rejestru. W sumie grupa badana składała się z 10 chorych, u których poddano analizie wszystkie dostępne dane kliniczne i laboratoryjne. Wyniki: Wszyscy chorzy byli płci męskiej, a ich średni wiek wynosił 55,9 ± 12,7 roku. Czas hospitalizacji i obserwacji ambulatoryjnej wynosił odpowiednio 52,6 ± 11,2 i 80,6 ± 29,0 dni. Najczęściej spotykanym objawem przy przyjęciu była gorączka – 60% chorych, a następnie duszność i męczliwość. Wady zastawkowe wykryto u 70% chorych. Zastawka aortalna zajęta była procesem chorobowym częściej niż zastawka mitralna. Proces reumatyczny dotyczył wszystkich zajętych zastawek mitralnych i 57% zastawek aortalnych. Izolacja drobnoustroju Brucella spp. możliwa była u 20% chorych. Śmiertelność wyniosła 30%. U 20% chorych stosowano leczenie farmakologiczne, uzyskując stabilizację choroby. U 60% chorych stosowano złożoną antybiotykoterapię, w skład której wchodziły tetracykliny, ryfampicyna i cefalosporyna trzeciej generacji. Chorzy leczeni takim zestawem antybiotyków, u których następnie wymieniono zastawkę aortalną, rokowali względnie dobrze, a śmiertelność wynosiła 20%. U 30% chorych stosowano tertracykliny, ryfampicynę i aminoglikozyd – w tej grupie śmiertelność wyniosła 33%. Wnioski: Infekcyjne zapalenie wsierdzia spowodowane brucelozą powinno być zawsze brane pod uwagę, jeśli stwierdza się wegetacje na zastawkach serca, szczególnie u osób pochodzących z rejonów endemicznych. Optymalnym postępowaniem wydaje się połączenie antybiotykoterapii i wymiany zastawki, aczkolwiek samo leczenie farmakologiczne może być skuteczne, szczególnie u chorych w stanie stabilnym. Ponadto wydaje się, że korzystne może być zastosowanie cefalosporyn trzeciej generacji zamiast aminoglikozydów

Nieadekwatna tachykardia zatokowa - skuteczna terapia iwabradyną

Inappropriate sinus tachycardia (IST) is characterised by an exaggerated increase of heart rate in response to normal physiologic demands. Therapeutic options including medical and radiofrequency ablation interventions are still under debate. Ivabradine inhibits spontaneous pacemaker activity of the sinus node by selectively blocking If channels of pacemaker cells. Here we present a case of a patient with IST, who was successfully treated with ivabradine after various ineffective therapeutic approaches. Kardiol Pol 2010; 68, 8: 935-93