Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus

The prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The clinical presentation of myocarditis varies and often mimics myocardial infarction. Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection. (Cardiol J 2011; 18, 5: 552–555

Cor triatriatum sinister with significant pressure gradient in an adult patient

WOS: 000314377200027Cor triatriatum sinistrum is rare congenital cardiac malformation. It accounts for approximately 0.1-0.4% of all patients with congenital heart disease. Most cases are diagnosed in childhood, while adult cases are very rare. The condition is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers a superior posterior chamber and an inferior anterior chamber. A 30-year-old male presenting with progressive exertional dyspnea for the past two years was admitted to our clinic. Color Doppler ultrasonography revealed an eccentric, mosaic pattern of continuous turbulent flow near the interatrial septum across the membrane. The peak velocity of the flow across the membrane was 2.70 m/s, indicating that the pressure gradient between two chamber was 11.5 mmHg. Surgical correction of the membrane was recommended. The membrane was excised and all symptoms resolved in the scheduled visit at one month following surgery. In this article, we report an adult case of incomplete cor triatriatum sinister with a significant pressure drop

Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation

Introduction and objectives: We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. Methods: Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. Results: Mean LV-GLS before ablation was 17.3 ± 3.7 and 20.5 ± 2.6 after ablation; the difference was statistically significant (p−16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. Conclusion: In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS. Resumo: Introdução e objetivos: O nosso objetivo foi avaliar os efeitos de ablação eficaz na deformação longitudinal global do ventrículo esquerdo (LV-GLS) em doentes com extrassístoles ventriculares (PVCs). Também avaliamos os potenciais fatores de risco de LVGLS anormal. Métodos: Trinta e seis doentes consecutivos sem doença cardíaca estrutural tratados com ablação por radiofrequência (RF) devido a PVCs frequentes foram incluídos no estudo. Todos os doentes foram avaliados com ecocardiografia transtorácica com speckle tracking bidimensional (2D-STE). Resultados: Os valores médios de LVGLS antes da ablação foram de 17,3 ± 3,7. Esse valor foi observado como 20,5 ± 2,6 após a ablação e a diferença foi estatisticamente significativa (p−16% e ≤16%. Baixo valor de PVC E flow/post-PVC E flow e PVC SV/post-PVC SV associaram-se com LV-GLS anormal. Conclusão: Em doentes sintomáticos com PVCs frequentes e fração de ejeção do ventrículo esquerdo (FEVE) normal, observamos melhoria significativa no valor LV-GLS após ablação por RF bem-sucedida. Doentes com LV-GLS anormal apresentam frequentemente nonejecting PVCs e potencialização pós-extrassistólica (PEP) em comparação com doentes com LV-GLS normal

Thrombus formation on angioplasty equipment during primary Percutaneous coronary intervention for acute st elevation myocardial infarction despite intravenous Enoxaparin use: Case report

ABS TRACT Unfractionated heparin (UFH) has been traditionally used as the choice of antithrombin treatment during percutaneous coronary intervention. Increasing evidence suggests that treatment with the low molecular weight heparin enoxaparin during percutaneous coronary intervention (PCI) is safe and effective. Insufficient anticoagulation increases the risk of catheter thrombus formation during PCI. We report here a case with acute ST elevation myocardial infarction that periprocedural macroscopic thrombus formation on PCI equipment following antithrombin therapy with 0.75 mg/kg intravenously enoxaparin. All PCI equipments were removed and a bolus of intravenous UFH 100 U/kg was administered. New PCI equipments were inserted and the procedure was completed with stent implantation. Low molecular- weight heparin enoxaparin in the absence of a glycoprotein IIb/IIIa receptor blocker may be insufficient during percutaneous coronary intervention. Copyright © 2013 by Türkiye Klinik leri

Incremental effects of restless legs syndrome (RLS) on nocturnal blood pressure in relatively young untreated hypertensive patients and normotensive individuals

Congress of the European-Society-of-Cardiology (ESC) -- AUG 25-29, 2012 -- Munchen, GERMANYWOS: 000308012406399…European Soc Cardiol (ESC

Effect of dipping status on QRS morphology in patients with hypertension

WOS: 000281909800003PubMed: 20559141Background Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. Methods A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. Results There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P = 0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r = -0.482, P < 0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. Conclusion QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension. Blood Press Monit 15:247-250 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals

WOS: 000311106200002PubMed: 23111555Background Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. Patients and methods After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. Results In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P = 0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio = 0.43, 95% confidence interval = 0.21-0.83; P = 0.013) and the nondipping BP patterns (odds ratio = 1.96, 95% confidence interval = 1.05-3.67; P = 0.035). Conclusion We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk. Blood Press Monit 17:231-234 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. Blood Pressure Monitoring 2012, 17:231-23

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study

WOS: 000299865000007PubMed: 22214740Objective: In patients with ST-elevation myocardial infarction (STEN) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography was associated with better angiographic results and improved prognosis compared with patients without spontaneous reflow. The role of systematic emergency PCI in patients with spontaneous reperfusion during myocardial infarction is debated. We compared the amount of ST wave resolution (STR) in patients with and without spontaneous coronary reperfusion (SCR) in the infarct related artery. Methods: This study was designed as an observational cohort study. One hundred sixty-one consecutive patients (121 males, 40 females, with a mean age of 56 10 years) who had STEMI and treated with primary PCI without previous thrombolytic therapy were included in the study. All patients were treated with primary PCI within 12 hours from the onset of the symptoms and had stent implantation in the culprit lesion. ST wave resolution was measured as percent resolution of ST segment elevation from electrocardiogram (ECG), before and after PCI, classified as complete (>70%), partial (30% to 70%), or absent (<30%). SCR was defined as a TIMI grade III flow in the IRA on baseline coronary angiogram. The amount of ST wave resolution (STR) in patients with and without SCR in the IRA was compared. We used Chi-square test, Student's t-test and the Mann-Whitney U test for statistical analysis. Results: At the baseline coronary angiography 40(25%) patients had SCR and 121 patients (75%) had TIMI flow grade 0, 1 or 2 (non-SCR group). ST segment resolution amount was significantly higher in patients without SCR (53 +/- 17 versus 13 +/- 23 mm; p<0.001). In fact; in five patients whom had patent infarct related artery in initial angiography, ST segment elevation increased according to pre-PCI ECG. Conclusion: Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography. (Anadolu Kardiyol Derg 2012; 12:30-4

Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia

Karabulut, Ahmet/0000-0002-2001-9142WOS: 000279760800009PubMed: 20395236Data related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 3 I patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P = .006)

St elevasyonlu miyokard i?nfarktüslü hastalarda primer perkütan girişim sonrasi no-reflow fenomeni gelişimi ile serum ürik asit düzeyleri arasindaki i?lişki

No-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. Uric acid (UA) release during ischemia and washout from the ischemic zone during reperfusion is adenine nucleotide breakdown product. Therefore uric acid may play reperfusion injury and no-reflow. İn this study, we aimed to compare serum uric acid value of ST segment elevated Mİ patients groups whith no-reflow phenomenon and normal miyocardial perfusion after primary coronary intervention. 47 patients was enrolled consecutively to this study. During hospital admission, patients blood samples were taken for serum uric acid value. Patients was grouped as no reflow and normal perfusion groups according to myocardial blush grades (MBG). Patient with myocardial blush grades 0-1 were accepted as no-reflow group, patients with MBG 2-3 normal perfusion group. When the serum uric acid value of no-reflow and normal perfusion groups was compared, there was statistificaly significant difference (respectively 6,680±1,11 mg/dl versus 5,066±0,68 mg/dl. p<0,05). A significant correlation was found between the serum uric acid level and the presence of no-reflow phenomenon (r=0.598; p<0.025). Multivariate logistic regression analysis showed an independent relationship between no-reflow phenomenon and serum uric acid level (OR 1.815; 95% CI 1.098-1.493; p<0.031). In ST segment elevated Mİ patients with higher serum uric acid value before primary coronary intervention, no-reflow phenomenon is developed more frequently. Uric acid may play important role in mechanism of no-reflow phenomenon. © 2010 Düzce Medical Journal