Wolff-Parkinson-White Syndrome and Rheumatic Mitral Stenosis: an Uncommon Coincidence that can Cause Severe Hemodynamic Disturbance

The combination of rheumatic mitral stenosis and Wolff-Parkinson-White syndrome is a rare situation. In this case, we are reporting an 72-year-old man presenting with multi-organ failure due to the this combination and successfully treated with radiofrequency ablation during preexcitated atrial fibrillation

Acute effects of cardiac resynchronization therapy on arterial distensibility and serum norepinephrine levels in advanced heart failure

Background: Cardiac resynchronization therapy (CRT) has become an accepted method fortreating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffnessand a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drugrefractory HF.Methods: Fourteen cardiac HF patients (53.6 ± 9.1; 39–67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III–IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) < 35% and QRS duration ≥ 120 ms. Blood samples for norepinephrine and B-type natriuretic peptidewere collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition.Results: Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p < 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman.Conclusions: The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves

Evaluation of pulse wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet's disease

Objectives: Connective tissue diseases involve characteristic inflammatory lesions in the cardiovascular system, in addition to other systems. The involvement of the cardiovascular system in the course of connective tissue diseases may result in serious morbidity and mortality. Pulse wave velocity which is an indicator of arterial dilatation capacity may predict cardiovascular risk of patients. Pulse wave velocity is inversely proportional to arterial dilatation capacity. Decreased dilatation capacity leads to a reduction in arterial blood pressure and flow dynamics and impairment in coronary perfusion

Evaluation of pulse wave velocity in systemic lupus erythematosus, rheumatoid arthritis and Behcet's disease

Objectives: Connective tissue diseases involve characteristic inflammatory lesions in the cardiovascular system, in addition to other systems. The involvement of the cardiovascular system in the course of connective tissue diseases may result in serious morbidity and mortality. Pulse wave velocity which is an indicator of arterial dilatation capacity may predict cardiovascular risk of patients. Pulse wave velocity is inversely proportional to arterial dilatation capacity. Decreased dilatation capacity leads to a reduction in arterial blood pressure and flow dynamics and impairment in coronary perfusion

Assessment of Arterial Stiffness with Pulse Wave Velocity or Augmentation Index: Which Method is the Best?: Scientific Letter

Assesment of large arterial stiffness is increasingly used in clinal settings. Although there are several invasive and non-invasive methods such as carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), researchers and clinicians still face problems in selecting the best methodology for their specific use. PWV, which is defined as the velocity of the arterial pulse for moving along the vessel wall, plays an important clinical role in defining patients under high cardiovascular risk and it is inversely correlated with arterial elasticity and relative arterial compliance. PWV along the aorta can be measured by using two ultrasound or pressure sensitive transducers fixed transcutaneously over the course of a pair of arteries separated by a known distance: the femoral and right common carotid arteries. PWV is calculated from measurements of pulse transit time and the distance, according to the following formula: PWV (m/s)= distance (m)/transit time (s). AI is defined as Dp/pp (where Dp is the difference between the late systolic peak and the mid-systolic peak and pp is the amplitude of the pulse pressure wave). Central blood pressure and pulse pressure, the AI and PWV, which are often used incorrectly as interchangeable indexes of arterial stiffness, increase with age, hypertension, diabetes mellitus and hyperlipidemia, and are associated with target organ damage such as left ventricular hypertrophy, microalbuminuria, carotid intima-media thickness and endothelial dysfunction. Althouhg the carotid-femoral (aortic) PWV is the gold standard test for assessing central arterial stiffness, the AI reflects stiffness of the systemic arterial tree. This paper summaries the advantages and disadvantages of PWV and AI in the assessment of arterial stiffness

Koroner arter hastalığında güncel tedavi yaklaşımlarını ne düzeyde gerçekleştirebiliyoruz?

In this study, we aimed to investigate the level and efficacy of treatment approaches to coronary artery disease(CAD) in a tertiary center. The study population consisted of 100 consecutive patients who were hospitalised in the previous month due to angina pectoris and CAD was verified by elective coronary angiography. The patients' demographic and clinical data, coronary risk factors, medicines prescribed before hospitalisation and on discharge, lipid levels, biochemical tests, blood pressures, coronary angiographic data, suggested treatment plan and information about the attending assistant doctor were obtained from the hospital's archive. The patients' mean age was 58;plusmn;10 year, and 21% of them were female. Sixty-six percent of all patients were hyperlipidemic, 59% were hypertensive, and 18% diabetic. Five percent and twenty percent of all cases were not aware that they were hypertensive and hyperlipidemic, respectively. On admission, 46% and on discharge 66% of the patients were on beta blockers. Of the 34 patients, who were not prescribed beta blockers on disharge, 13 patients had absolute or relative beta-blocker contraindications and 7 were taking cardioselective calcium antagonists. No contraindications for beta blocker therapy were noted in the remaining 14 cases. On admission 31%, and on discharge 65% of patients were receiving statins. Of the 35 patients who were not on statins, 11 patients had indications for statin use. None of the patients had contraindications for statins. Thirty-two percent of patients were receiving angiotensin converting enzyme (ACE) inhibitors before admission and 66% were prescribed ACE inhibitors before discharge. Of the 34 patients who were not prescribed ACE inhibitors, only one patient had contraindication for ACE inhibitors. According to the guidelines, ACE inhibitors were indicated for 11 of these patients. Hence, use of beta blockers, ACE inhibitors and statins that have proved to be favourable on morbidity and mortality in CAD, has approached the levels reported in series abroad but it is still not satisfactory. In-hospital prescription of medicines, very important in increasing the patient's compliance, should be enhanced, and patients and physicians should be knowledged and encouraged about these agents.Kardiyovasküler alanda tedavinin başarısını artırmak için ilgili tedavi kılavuzlarını etkin bir şekilde uygulayıp, bu kılavuzlardaki hedeflere ulaşılması gerekmektedir. Bu çalışmada koroner arter hastalığında (KAH) bir tersiyer merkezdeki tedavi yaklaşımlarının düzeyi ve etkinliğinin araştırılması amaçlanmıştır. Hasta popülasyonu, bir üniversite hastanesi kardiyoloji kliniğine angina pektoris yakınması ile başvuran ve elektif koroner anjiyografi amacı ile son 1 ay içinde yatırılarak KAH saptanan ardışık 100 olgudan oluşmuştur. Bu olguların hastane dosya kayıtlarından demografik ve klinik özellikleri, koroner risk faktörleri, yatmadan önce ve hastaneden çıkarılırken verilen tedavi, lipid düzeyleri, biyokimyasal tetkikleri, kan basınçları, anjiyografik bulguları, önerilen tedavi planı ve izlemi yapan asistan doktorlara ait faktörler elde edildi. Olguların yaş ortalaması 58±10 olup %21'i kadındı. Tüm olguların %66'sı hiperlipidemik, %59'u hipertansif ve %18'i diyabetikti. Tüm olguların %5'i hipertansif, %20'si hiperlipidemik olduğunu bilmiyordu. Olguların yatışta %46, taburcu olurken %66'sı beta bloker kullanmaktaydı. Taburcu olurken beta bloker verilmeyen 34 hastadan sadece 13'ünde gerçek veya nisbi beta-bloker kontrendikasyonu varken, 7'si kardiyoselektif kalsiyum kanal blokeri kullanıyordu. Onbir hastada ise kullanımı engelleyecek bir durum söz konusu değildi. Olguların yatışta %31'i taburcu olurken %65'i statin kullanmaktaydı. Statin kullanmayan 35 hastadan 11'inde kesin olarak statin endikasyonu vardı ve hiçbir hastada statin kullanımı açısından kontrendikasyon yoktu. Yatışta %32 ve taburcu olurken %66 hasta anjiyotensin dönüştürücü enzim (ACE) inhibitörü kullanmaktaydı. ACE inhibitörü verilmeyen 34 hastanın sadece 1 tanesinde ACE inhibitörü kontrendikasyonu varken 11 olguda tedavi kılavuzlarına göre ACE inhibitörü endikasyonu mevcuttu. Sonuç olarak, koroner arter hastalığında mortalite üzerine olumlu etkileri kanıtlanmış olan beta bloker, ACE inhibitörü ve statin grubu ilaçların kullanımları yabancı serilerde bildirilenlere yaklaşmakla birlikte hala yeterli düzeylere ulaşabilmiş değildir. Tedaviye hastanın uyumunu artırmada çok önemli olan hastane içi dönemde ilaç uygulamasının artırılması, hasta ve doktorların bu ajanlar konusunda bilinçlendirilmesi ve cesaretlendirilmesi gereklidir