Acute myocardial infarction in a patient with post-splenectomy thrombocytosis: A case report and review of literature

Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis (RT) is usually considered a benign process without thrombotic complications. We describe a case of acute myocardial infarction in a young heavy smoker with RT following splenectomy. Coronary angiography showed a linear filling defect at mid-part of left anterior descending artery. We performed balloon angioplasty and stenting for this lesion. Aspirin and clopidogrel were administered. His in-hospital course was uneventful and platelet count returned to the normal range at four month follow-up. We concluded that RT may not be an entirely benign process, especially in patients with a history of smoking. Regular monitoring of platelet count, and possibly antithrombotic agents like aspirin prescription for high risk patients with moderate thrombocytosis, may be useful. (Cardiol J 2010; 17, 1: 79-82

Aneurysmal coronary arteriovenous fistula closing with covered stent deployment: A case report and review of literature

Coronary arteriovenous fistula (CAVF) is a rarely encountered congenital coronary anomaly, in which coronary artery blood flow bypasses the myocardial capillary network and usually drains to a heart chamber or great vessel. It is usually asymptomatic. However, the risk of symptoms and complications increases with age. High output heart failure, pulmonary hypertension, myocardial ischemia and infective endocarditis may complicate the course of this anomaly. The appearance, and even rupture, of a saccular aneurysm is one of the even rarer complications of CAVF. Here we describe a 57 year-old patient with incidental finding of an aneurysmal CAVF which was treated successfully using covered stent. (Cardiol J 2011; 18, 5: 556–559

Izolowana bąblowica serca - opis przypadku

Cardiac hydatidosis is rarely encountered. A case of isolated cardiac hydatid cyst of the left ventricle in a young woman is described. The diagnosis was suggested by echocardiography and was confirmed later by pathological evaluation. Serological tests were negative. The patient underwent a successful operation for cyst resection

Zamknięcie tętniakowato poszerzonej przetoki tętniczo-żylnej naczyń wieńcowych z użyciem stentu powlekanego: opis przypadku i przegląd piśmiennictwa

Przetoka tętniczo-żylna naczyń wieńcowych (CAVF) jest rzadko spotykaną wrodzoną wadą naczyń wieńcowych, w której krew omija układ włośniczek miokardium i wpływa bezpośrednio do komór serca lub dużych naczyń. Najczęściej nie powoduje żadnych objawów, ale ryzyko ich pojawienia się oraz wystąpienia powikłań wzrasta wraz z wiekiem. Do głównych powikłań zalicza się niewydolność serca, nadciśnienie płucne, chorobę niedokrwienną serca oraz infekcyjne zapalenie wsierdzia. Powstanie, a nawet pęknięcie, tętniaka workowatego stanowi jedno z najrzadszych powikłań CAVF. W niniejszej pracy opisano 57-letniego pacjenta z przypadkowo wykrytym tętniakiem CAVF skutecznie leczonym wszczepieniem stentu powlekanego (Folia Cardiologica Excerpta 2012; 7, 2: 115-119

Association of Vitamin D Deficiency and Thyroid Function in Postmenopausal Women

Pupose: Although there are reports of vitamin D (VitD) insufficiency in immune-mediated hypothyroidism, an association between VitD and thyroid-stimulating hormone (TSH) levels has yet to be shown. We aim to examine VitD and TSH levels among postmenopausal women, as both conditions are more prevalent in elderly women. Methods: The clinic records of postmenopausal women during their routine maintenance visits were reviewed. All patients were examined for the symptoms related to thyroid function and osteoporosis. Participants were divided into three subgroups according to their TSH levels (below 4.0 mIU/L). Patient characteristics and VitD levels were compared between these subgroups. Multivariate linear regression model was constructed using serum VitD and serum TSH as the dependent variables to identify factors independently associated with these laboratory values. Results: Two-hundred and nighty nine postmenopausal women were included. Average age was 62.2±7.5 years old. VitD was insufficient (10-30 ng/mL) in 12.0% and deficient (<10 ng/mL) in 60.9% of the participants. In 11.3%, TSH was low and in 7.6% of women, TSH was high, while the remaining 80.1%, had normal TSH levels. Subjects with low TSH had significantly higher VitD concentrations (34.2±29.1 ng/mL) compared to the other two groups (P-value: 0.039). In multivariate regression analysis, TSH was not a contributing factor, as age was the only significant predictor of VitD levels. Meanwhile, no predictor (including age and VitD) was identified for TSH levels in linear regression analysis. Conclusion: Age was the only independent predictor of serum VitD in this study population. Though suppressed TSH was associated with higher VitD levels, the association was not linear between TSH and VitD in postmenopausal women

Sevoflurane-mediated modulation of oxidative myocardial injury

Introduction: Volatile anesthetics offer protection when administered throughout an ischemic injury. We examined how volatile anesthetics modulate the cardiac myocytic injury associated with hydrogen peroxide. Methods: Forty-eight Long-Evans rats were divided into four groups depending on the treatment: none (CONT), Glibenclamide (GLB); Sevoflurane (SEV); or GLB+SEV. Each group was further divided into two, one of which was exposed to hydrogen peroxide (H2 O2 ). Oral GLB was administered 48 hours before myocardial isolation. All rats were anesthetized by intraperitoneal injection of Ketamine, and the hearts were harvested after heparinization. Cardiomyocytes were isolated using a combination of mechanical mincing and enzymatic digestion. After isolation, the aliquots of cells were exposed to H2 O2 and FeSO4 for 30 minutes. The cell suspensions were then bubbled for 10 minutes with 100% oxygen and 1.5% SEV if appropriate. Apoptosis was detected by fluorescein-bound annexin-V (ANX-V), necrosis by propidium iodide, and ELISA assessed caspase-3 activity in all groups. Results: There was an increase in apoptosis, necrosis, and caspase-3 activity in the cells following exposure to hydrogen peroxide. SEV reduced the rate of cell necrosis and apoptosis. Pretreatment with GLB did not alter the effects of SEV. Similarly, caspase-3 activity did not change with GLB, although SEV administration reduced this enzymatic activity in response to hydrogen peroxide. Conclusion: In this oxidant injury model, we demonstrated that incubating isolated cardiomyocytes with SEV profoundly diminished H2 O2 -induced apoptotic and necrotic cells compared to their CONTs. These results support the hypothesis that KATP channels are not the sole mediators associated with anesthetic preconditioning

Zatorowość płucna u pacjentki z rzadką anomalią tętnic wieńcowych - wskazówka dotycząca znaczenia proksymalnych gałęzi prawej tętnicy wieńcowej

A 65 year-old female was admitted with acute pulmonary embolism and hypotension. Intravenous streptokinase was administered but severe hypotension persisted. Pulmonary angiography was performed and partial recanalisation of the culprit branch was noted. Echocardiography showed severe right ventricular (RV) dysfunction and free wall akinesia. Due to exaggerated RV dysfunction and severe haemodynamic compromise a coronary angiography was done and showed abnormal origin of right coronary artery (RCA) from left circumflex artery (LCx) with rudimentary RV branches and absent conus artery and right atrial (RA) branch. Inotropic agents were necessary to stabilize the patient&#8217;s haemodynamic condition for the next four days. We concluded that this coronary anomaly was an important contributory factor in our patient&#8217;s prolonged unstable condition. This emphasizes the critical role of normal RCA flow under acute haemodynamic stress. Evaluation of the condition of RV perfusion and RCA patency might be justified in any prolonged and disproportionate RV dysfunction following acute pulmonary embolism. Kardiol Pol 2010; 68, 7: 844-84

Left ventricular non-compaction in a patient with ankylosing spondylitis

A 58 years old male with a long-standing history of HLA-B27 positive ankylosing spondylitis presented with increasing fatigue and dyspnea on exertion. He had left ventricular dysfunction and enlargement, flail right coronary leaflet of aortic valve with severe eccentric aortic insufficiency along with left ventricular non-compaction in echocardiography. The most common cardiac manifestations of ankylosing spondylitis are aortic insufficiency and conduction disturbances. Involvement of myocardium, in the form of dilated cardiomyopathy and restrictive cardiomyopathy, has also been reported. This case presents a very rare association of ankylosing spondylitis with non-compaction cardiomyopathy