A quadricuspid aortic valve causing moderate aortic regurgitation

Quadricuspid aortic valve (QAV) is a rare cause of aortic regurgitation. Most cases are detected incidentally during echocardiography, angiography, autopsy or surgery. It may also be associated with other congenital anomalies of the heart. A 70 year-old man was admitted to our hospital with a five-month history of dyspnea. Echocardiographic examination showed a QAV leading to moderate aortic regurgitation, severe mitral regurgitation, left ventricular dysfunction and aortic root dilatation. Surgical treatment was considered, but the patient refused. We describe a case of QAV leading to aortic regurgitation

Return to Former Activities of Daily Living for Cardiovascular Patients in COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. Despite all the strict precautions, the epidemic probably continues rapidly due to new mutations and negatively affects the whole world. The presence of comorbid diseases has been associated with poor clinical outcomes. We aimed to examine the return of COVID-19 patients with cardiovascular comorbidity to their former Activities of Daily Living (ADL).Methods: The research population was selected from patients who admitted to the outpatient clinic from November 2020 to January 2021. 80 consecutive patients with cardiovascular comorbidity were included in the Study Group (SG). The Control Group (CG) included 100 patients of similar age range and gender, without cardiovascular comorbidities. Nottingham Health Profile (NHP) test was performed in both groups to evaluate changes in ADL. Outpatients were visited until return to their former ADL with telecommunications at appropriate intervals.Results: Symptoms limiting ADL, such as fatigue (weakness), shortness of breath, and myalgia, were significantly higher in SG than CG (p &lt; 0.05). In contrast, anosmia and ageusia were significantly higher in CG than SG (p &lt; 0.001). Pre-COVID-19 NHP scores were similar in both groups. However, at admission, SG’s NHP scores were significantly higher than CG’s (p &lt; 0.001). Related to this, limitations in ADL (p &lt; 0.001) and recovery times (p &lt; 0.05) were higher in SG than CG.Conclusion: In this study, we observed that COVID-19 was more symptomatic in those with cardiovascular comorbidities, such as a higher limitation in ADL and a longer recovery time.</p

Multisystemic Side Effects of an Indispensable Old Drug: A Case Report of Chronic Lithium Use (A Patient with Multiple Side Effects of Lithium)

Presented here is a case of long-term lithium use, with multiple emerging lithium-associated side effects. An 82-year-old woman was brought into the emergency department because of loss of consciousness. According to the physical examination and laboratory analyses, patient was diagnosed with lithium-associated hypercalcemia, hyperparathyroidism, nephrogenic diabetes insipidus (NDI), symptomatic sinus bradycardia, and thyroid dysfunction. In the literature, there is a limited number of case reports with lithium induced multiple clinical conditions. Multiple clinical manifestations due to the side effects of chronic lithium use might be seen. Health care professionals should keep in mind that lithium-related side effects might trigger or exacerbate each other. To avoid toxicity, close follow-up and clinical supervision are important for the early diagnosis and treatment of these side effects, due to the narrow therapeutic index and obscure clinical signs and symptoms of toxicity

Decreased left atrial strain parameters are associated with prolonged total atrial conduction time in lichen planus

duman, hakan/0000-0002-1441-7320WOS: 000446121200006PubMed: 30713754Background: Lichen planus (LP) carries the increased risk of cardiovascular events as it is a chronic inflammatory disease. This study aimed at determining the relationship between total atrial conduction time (TACT), P-wave dispersion, and the left atrium (LA) global strain in the patients with LP. Methods: Forty people as a control group and 40 patients with LP were included in this study. Patient assessed global longitudinal LA strain by two-dimensional speckle-tracking strain echocardiography. Results: the global peak systolic LA myocardium strain during the left ventricular systole (LAGLSRs) and the global peak negative LA myocardial strain rate during the early ventricular diastole (LAGLSRe) values were significantly lower in the patients with LP in proportion to the control group according to the strain measurements (1.7 +/- 0.07 vs. 1.9 +/- 0.1%, p = 0.001; 1.23 +/- 0.04 vs. 1.2 +/- 0.08 s(-1), p = 0.001), respectively. TACT value was found to be significantly longer (102.6 +/- 6.3 ms) in the patients with LP than the control group (96.3 +/- 5.3 ms, p = 0.001), considering the terms of the artial conduction features. Conclusion: This study demonstrated that the subclinical cardiac involvement in LP can determine the prolonged TACT and the impaired left atrial myocardial deformation values

Evaluation of Left Ventricular Function of Patients with Irritable Bowel Syndrome with Tissue Doppler and 2D Speckle Tracking Echocardiography

We aimed to evaluate the systolic and diastolic functions of left ventricule in irritable bowel syndrome (IBS) by conventional echocardiography and two-dimensional (2D) speckle tracking echocardiography (STE) method. Thirty patients with IBS diagnosed with Rome III criteria were referred to our clinic. Standart echocardiographic and 2D-STE evaluation were obtained from all participants. C-reactive protein and erythrocyte sedimentation rate showing inflammation were significantly higher in patients with IBS compared to control group. Comparision of echocardiographic and tissue doppler imaging parameters measured from the septal mitral annulus demonstrated similar values between both groups. There were not any differences between the groups in terms of SRS-3C, SRE-4C, SRE-3C, SRE-2C, GLSRE, SRA-4C, SLA-3C, SLA-2C and GLSRA (p&gt;0.05, for all). GLS (p=0.002), GLSRS (p=0.021), SRS-2C (p=0.030), S-4C (p=0.001), S-3C (p=0.025) and S-2C (p=0.012) values were significantly lower in IBS patients than in the control group. Our results suggest that IBS of which pathogenesis cannot be clearly elucidated is an inflammatory process and the heart may also be affected from this process. 2D-STE can also be useful in determination of subclinical left ventricular dysfunction in IBS patients. [Med-Science 2015; 4(3.000): 2507-15

Thermo-mechanical analysis of double base propellant combustion in a barrel

Accurate determination of burning characteristics of the propellant and thermo-mechanical loads acting on the barrel supports better gun design and its tactical use. As the frequency of successive shots changes, burning rate of the gun propellant also changes and consequently the bullet velocity and internal pressure of the barrel changes as well. In this work, combustion characteristics of double base propellants with various grain sizes and initial temperatures were determined by performing a series of shooting tests and employing a thermo-mechanical model with ABAQUS (R) finite element code. Effects of various grain sizes (300-425, 425-500, 500-600, 600-710, 710-850 mu m) and initial temperatures (-60, 20, 0, 20, and 60 degrees C) of double base propellants on internal pressure, bullet velocity and barrel heat transfer were investigated experimentally and computationally. Samples of propellants were tested in a shooting range by using a NATO standard small caliber barrel of 7.62 mm in diameter, and barrel internal pressure, bullet velocity and barrel surface temperatures were measured experimentally. The barrel experienced high thermal stresses during the shootings. Based on the comparisons between the simulations and the experiments, the finite element model was in agreement with the data within 90% accuracy. (C) 2016 Elsevier Ltd. All rights reserved

Myringosclerosis as a predictor of the requirement for a permanent pacemaker in patients with drug-related atrioventricular block

Aims. Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative conduction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guidelines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation. Methods. This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients' demographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed. Results. There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4-7] days vs. 2 [1-5] days; P&lt;0.001). The incidence of myringosclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194-3.058; P=0.01). Conclusion. Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB

Total Bilirubin Levels Predict Subclinical Atherosclerosis in Patients With Prediabetes

Vuruskan, Ertan/0000-0001-6820-3582; Durakoglugil, Emre/0000-0001-5268-4262; duman, hakan/0000-0002-1441-7320WOS: 000386036600005PubMed: 26921264Bilirubin may have important antiatherosclerotic effects. Prediabetes (PD), the intermediate stage before diabetes mellitus, is associated with increased cardiovascular morbidity and mortality. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with PD. We enrolled 170 consecutive patients with PD. the patients underwent ultrasonography to evaluate cIMT. the patients were divided into groups according to cIMT values (<0.9 vs 0.9 mm). the patients with cIMT 0.9 mm had significantly higher diastolic blood pressure, neutrophil-lymphocyte ratio (NLR), and glycated hemoglobin values compared with patients having cIMT < 0.9 mm, whereas total and direct bilirubin values were significantly lower in this group. Multivariate regression analyses revealed NLR and total bilirubin as the independent predictors of subclinical atherosclerosis. the present study demonstrated that NLR and lower total bilirubin levels were independent predictors of subclinical atherosclerosis in patients with PD. Simple measures such as NRL and total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with PD

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus