P Wave Dispersion is Increased in Pulmonary Stenosis

Aim: The right atrium pressure load is increased in pulmonary stenosis (PS) that is a congenital anomaly and this changes the electrophysiological characteristics of the atria. However, there is not enough data on the issue of P wave dispersion (PWD) in PS. Methods: Forty- two patients diagnosed as having valvular PS with echocardiography and 33 completely healthy individuals as the control group were included in the study. P wave duration, p wave maximum (p max) and p minimum (p min) were calculated from resting electrocariography (ECG) obtained at the rate of 50 mm/sec. P wave dispersion was derived by subtracting p min from p max. The mean pressure gradient (MPG) at the pulmonary valve, structure of the valve and diameters of the right and left atria were measured with echocardiography. The data from two groups were compared with the Mann-Whitney U test and correlation analysis was performed with the Pearson correlation technique. Results: There wasn’t any statistically significance in the comparison of age, left atrial diameter and p min between two groups. While the MPG at the pulmonary valve was 43.11 ± 18.8 mmHg in PS patients, it was 8.4 ± 4.5 mmHg in the control group. While p max was 107.1 ± 11.5 in PS group, it was 98.2 ± 5.1 in control group (p=0.01), PWD was 40.4 ± 1.2 in PS group, and 27.2 ± 9.3 in the control group (p=0.01)Moreover, while the diameter of the right atrium in PS group was greater than that of the control group, (38.7 ± 3.9 vs 30.2 ± 2.5, p=0.02). We detected a correlation between PWD and pressure gradient in regression analysis. Conclusion: P wave dispersion and p max are increased in PS. While PWD was correlated with the pressure gradient that is the degree of narrowing, it was not correlated with the diameters of the right and left atria

Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study

Background: Secondary prevention plays an important role after acute coronary event due to high risk of adverse events in elderly. In present study we aimed to evaluate the lifestyle, management of risk factors and medical treatment for secondary protection in elderly patients with known coronary heart disease (CHD). Methods: ELDERTURK is a non-interventional, multi-centered, observational study, which included total of 5694 elderly patients ( > 65 years) from 50 centers in Turkey. In this study elderly patients from the ELDERTURK population with known CHD were evaluated for cardiovascular risk factors, comor- bidities and medication usage. Results: A total of 2976 (52.3% of study) out of 5694 patients included in the ELDERTURK study were evaluated. All had known CHD with a mean age of 73.4 ± 6.2 years and 60.3% were male. 13.0% of patients were smokers, 42.4% were overweight and 21.1% were obese. Only 23.6% of patients reported to do regular exercise, 73.4% had history of hypertension, 47.4% had dyslipidemia and 33.9% had diabetes mellitus. The rate of patients with systolic blood pressure > 140 mmHg were 31.1% and only 13.9% of patients had a recommended ≤ 70 mg/dL level of low-density lipoprotein cholesterol. Anti- platelet, statin, beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage was limited to 27.3%. Conclusions: The ELDERTURK study shows that many patients with CHD have a high prevalence of modifiable risk factors and unhealthy lifestyle. Apart from this, many patients are not receiving thera- peutic intervention and as a consequence most were not achieving the recommended goals.   

Leptospirosis in Istanbul, Turkey: A wide spectrum in clinical course and complications

Patients with high fever and multiorgan involvement were investigated for the determination of frequency, clinical course and complications of leptospirosis in Istanbul. Leptospirosis was determined in 22 cases among the 35 hospitalized patients that were prediagnosed as leptospirosis according to 'Probable Leptospirosis Diagnosis and Follow-up' form. Among the leptospirosis cases 19 were male and 16 were military staff. Mean age was 35.6 y. Dark field examination (DFE), latex agglutination test (LAG), ELISA IgM, leptospirosis culture (LC) and microscopic agglutination test (MAT) were performed to confirm the diagnoses. The most frequent initial symptoms and findings were fever, fatigue, headache, nausea-vomiting and increased muscle sensitivity. Jaundice was noted only in 2 cases. A 74-y-old female patient died after the recurrence of the disease with severe rhabdomyolysis and pulmonary failure. Sagittal sinus thrombosis, perimyocarditis and chronic renal failure were major complications in another 3 patients. ELISA IgM, LC, DFE, LAG and MAT tests were positive in 68, 72, 82, 100 and 100% of the patients, respectively. As a conclusion, diagnosis of leptospirosis is usually overlooked. Clinical awareness, use of probable leptospirosis diagnosis forms and the application of different laboratory methods in the diagnosis of suspected cases may offer the chance to diagnose the leptospirosis accurately

A magnetic resonance imaging finding in children with cerebral palsy: Symmetrical central tegmental tract hyperintensity

Background: Central tegmental tract is an extrapyramidal tract between red nucleus and inferior olivary nucleus which is located in the tegmentum pontis bilaterally and symmetrically. The etiology of the presence of central tegmental tract hyperintensity on MRI is unclear

Uniesienie odcinka ST w odprowadzeniu aVR podczas próby wysiłkowej może wskazywać na zwężenie pnia lewej tętnicy wieńcowej

Background: Exercise treadmill testing (ETT) is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery (LMCA) disease before invasive procedures is very important in risk assessment because of its severe clinical outcome. Aim: To examine whether ST elevation in lead aVR during ETT may suggest LMCA disease since the lead aVR is the reciprocal lead of LMCA. Methods: In this study, 61 patients with positive ETT were included. The study group consisted of 21 patients with ST elevation in lead aVR. Forty patients, also having positive ETT, but without ST elevation in lead aVR comprised the control group. All patients underwent coronary angiography. Results: Coronary angiography in the study group revealed significant LMCA stenosis in 16 (76%) patients, whereas LMCA disease was present in only 3 (8%) patients from the control group. There was no significant coronary artery stenosis in 5 patients in the study group and 12 patients in the control group. Of the 16 patients who had LMCA stenosis, 9 had isolated LMCA disease and 7 had additional stenotic lesions in LAD or circumflex coronary arteries. The sensitivity and specificity of ST segment elevation in lead aVR during ETT was 84% and 88%, respectively. The values of positive and negative predictive value of this finding in diagnosing the presence of LMCA were 76% and 93%, respectively. Conclusions: ST segment elevation in lead aVR during ETT may point to a high probability of the presence of LMCA disease. Kardiol Pol 2010; 68, 10: 1107-1111Wstęp: Test wysiłkowy (TW) na ruchomej bieżni jest najpowszechniej stosowaną metodą rozpoznawania choroby wieńcowej. Możliwość przewidywania zwężenia pnia lewej tętnicy wieńcowej (LTW) przed zabiegami inwazyjnymi jest bardzo ważna w ocenie ryzyka ze względu na poważne następstwa kliniczne tego stanu. Cel: Celem pracy było zbadanie, czy uniesienie odcinka ST w odprowadzeniu aVR podczas TW może wskazywać na zwężenie pnia LTW, ponieważ w tym odprowadzeniu uwidaczniają się "lustrzane" zmiany wynikające ze zwężenia pnia LTW. Metody: Do badania włączono 61 pacjentów z dodatnim wynikiem TW. Grupa badana składała się z 21 chorych z uniesieniem odcinka ST w odprowadzeniu aVR, a grupę kontrolną stanowiło 40 osób z dodatnim wynikiem TW, ale bez uniesienia odcinka ST w odprowadzeniu aVR. U wszystkich pacjentów wykonano koronarografię. Wyniki: Koronarografia wykazała istotne zwężenie pnia LTW u 16 (76%) pacjentów w grupie badanej, natomiast tylko u 3 (8%) osób w grupie kontrolnej. Istotnych zwężeń tętnic wieńcowych nie stwierdzono u 5 chorych w grupie badanej i u 12 pacjentów w grupie kontrolnej. U 9 spośród 16 pacjentów ze zwężeniem pnia LTW w grupie badanej było to izolowane zwężenie, natomiast u 7 osób występowało dodatkowo zwężenie gałęzi przedniej zstępującej lub gałęzi okalającej. Czułość i swoistość uniesienia odcinka ST w odprowadzeniu aVR podczas TW wyniosły odpowiednio 84% i 88%, a dodatnia i ujemna wartość prognostyczna tego objawu w rozpoznawaniu zwężenia pnia LTW wyniosł,y odpowiednio 76% i 93%. Wnioski: Uniesienie odcinka ST w odprowadzeniu aVR podczas TW może wskazywać z dużym prawdopodobieństwem na obecność zwężenia pnia LTW. Kardiol Pol 2010; 68, 10: 1107-111