Clinical investigation: thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome

INTRODUCTION: It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. METHOD: Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction (AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (<5 min, 5–10 min and >10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), tri-iodothyronine (T(3)), free T(3), thyroxine (T(4)), free T(4), troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. RESULTS: The T(3 )and free T(3 )levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups (P < 0.0001). On the other hand, there were no significant differences between T(4), free T(4 )and TSH levels between the three groups (P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T(3 )and free T(3 )levels in the cardiac arrest group (P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T(3), free T(3), T(4 )and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min (P < 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). CONCLUSION: TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state

Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation

Objectives: In this study, we aimed to compare the effectsof infarct localization in patients with ST ElevatedMyocardial Infarction (STEMI) on the right ventricular(RV) functions by using advanced echocardiographicmethods.Materials and methods: A total of 89 patients withSTEMI were included into the study and patients weredivided to three groups as anterior, isolated-inferior andinferior+RV MI groups. In addition to standard echocardiographicmesurements, RV tissue doppler, RV EjectionFraction (RVEF), Myocardial performance index (MPI)and TAPSE measurements of all patients were performedbetween 24-72 hours after the event.Results: Compared to groups, RV functions in inferior MIwith RV involvement group were deteriorated. Tricuspidannular plane systolic excursion (TAPSE) value for theinferior MI with RV involvement (19±1mm) group werelower than those for Inferior MI group without RV involvement(23±1mm) and anterior MI (23±1mm) (p<0.05). TheRV MPI value for inferior MI group with RV involvement(0.76±0.14) were found to be higher than those for anterior(0.64±0.1) and inferior MI (0.56±0.1) group withoutRV involvement (p<0.05). Peak Sm (r = -0.35, p =0.01), TAPSE (r = -0.47, p<0.001) and RV EF (r = -0.46,p<0.001) showed a negative correlation with RV MPI value.Furthermore, RV tricuspid E/A rate (r = -0.19, p = 0.7)and RV free wall tissue doppler Em/Am rate (r = -0.26, p =0.01) displayed a negative correlation with RV MPI value.Conclusions: Use of advanced methods addition to theconventional echocardiographic methods in STEMI patients,could produce more valuable information to evaluateRV functions and provide a positive impact on treatmentstrategies.Key words: Acute myocardial infarction, right ventricle,echocardiography, TAPSE, MP

Simultaneous Occurrence of a Large Asymptomatic Prolapsing Left Atrial Myxoma with a Cutaneous Squamous Cell Carcinoma

Synchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area

Turkish registry for diagnosis and treatment of acute heart failure: TAKTIK study

WOS: 000392634300003PubMed ID: 28045409Objective: The goal of this study was to develop a national database of patients hospitalized in Turkey with acute heart failure (AHF) using evaluations of diagnostic and therapeutic approaches. Methods: Patient data were collected using an Internet-based survey. A total of 588 patients were enrolled from 36 participating medical centers across the country. Results: Mean age was 62 +/- 13 years and 38% of the patients were female. Ratio of de novo AHF to study cohort was 24%. Coronary heart disease and hypertension were found in 61% and 53% of the patients, respectively. Valvular heart disease was the underlying cause in 46% of heart failure patients. The most frequent factor associated with decompensation was noncompliance with treatment, observed in 34% of patients. Systolic blood pressure was 125 +/- 28 mmHg and heart rate was 93 +/- 22 beats/minute in the cohort. The most common findings on physical examination were inspiratory fine crackles (84%), peripheral edema (64%), and cold extremities in 34%. Mean ejection fraction (EF) measured at admission was 33 +/- 13%. Preserved EF (>=%40) was present in 20% of patients. On admission, 60%, 46%, and 40% of patients were using angiotens-in-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, or aldosterone antagonist, respectively. In-hospital events were reported as 3.4% death, 1.6% stroke and 2% myocardial infarction. Conclusion: Compared to previous data collected around the world, AHF patients in Turkey were younger, had more frequently valvular heart disease as the underlying cause, and were more noncompliant with medical treatment, but overall mortality was lower. Drugs shown to reduce mortality, and which also form the basis of guideline-directed medical therapy, are still used inadequately.Turkish Society of CardiologyTurkish Society of Cardiolog