Pulmonary artery hypertension as an initial manifestation of Takayasu's arteritis: A case report

AbstractTakayasu's arteritis is a rare chronic vasculitis of unknown etiology. Symptomatic pulmonary artery disease may be the first sign of Takayasu's arteritis. We describe a 51-year-old woman who presented with severe dyspnea. The initial evaluation and routine exams suggested the presence of pulmonary hypertension of unknown etiology. Absence of bilateral radial and brachial pulses in the physical examination led to an angiographic study, which confirmed the diagnosis of Takayasu's arteritis with severe pulmonary hypertension. During bosentan therapy, the patient's clinical symptoms and exercise capacity improved and her 6-min walking distance increased. We emphasize the importance of considering Takayasu's arteritis in the early diagnosis and therapy of pulmonary artery hypertension

The prognostic value of N- terminal pro-brain natriuretic peptide in patients with ST segment elevation myocardial infarction

AMAÇ: B tipi Natriütetik peptid düzeyi akut koroner sendromlu hastalarda prognozu belirlemede kullandığımız belirteçlerdendir. Bu çalışmada natriüretik peptid ailesinden N Terminal (NT) proBNP' nin ST segment yükselmeli miyokard enfarktüslü olgulardaki prognostik değerini araştırmayı amaçladık. GEREÇ ve YÖNTEM: Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Kliniği yoğun bakım ünitesinde akut ST segment yükselmeli miyokard enfarktüsü tanısı ile izlenen 57 hasta incelendi. Olgulardan 6 ve 36. saatte plazmada NT-proBNP bakılmak üzere venöz kan örnekleri alındı. Eş zamanlı EKG'leri çekildi ve kardiyak enzimleri çalışıldı. Üçüncü ayda hastalar, istenmeyen major kardiyak olaylar (ölüm, revaskülarizasyon, tekrarlayan miyokard enfarktüsü ve angina) açısından değerlendirilirken NT-proBNP değerleri ölçüldü. Her üç NT-proBNP değeri ile istenmeyen major kardiyak olaylar arasındaki ilişki araştırıldı. BULGULAR: Hastalar ST segment yükselmesine göre anterior MI geçiren (Grup A) ve inferior MI geçiren (Grup B) hastalar olarak iki gruba ayrıldı. Grup A' da sol ventrikül ejeksiyon fraksiyonunun daha düşük, duvar hareket skor indeksinin daha yüksek olduğu saptandı. Üçüncü ay sonunda en az bir istenmeyen major kardiyak olay geçirenlerle hiç geçirmeyenler arasında NT-proBNP seviyeleri açısından anlamlı istatistiksel fark elde edilemedi (p>0,05). 36. saatte saptanan ortalama NT-proBNP düzeyi 6. saat ortalama NT-proBNP düzeyi ile kıyaslandığında grup A olgularında 10,6±26,2 kat artış gösterdiği, grup B olgularında 3,6±4,7 kat artış gösterdiği saptandı ve bu değer her iki grup arasında istatiksel olarak anlamlı farklılık saptandı (p=0,016). Sol ventrikül ejeksiyon fraksiyonu ve NT-proBNP düzeyleri arasında ilişki saptanmadı. 36. saat NT-proBNP düzeylerinin 300 pg/ml'nin üzerinde olması kötü prognozun öngörücüsüydü. SONUÇ: NT-proBNPdüzeyleri istenmeyen major kardiyak olayları öngörmede önemli katkı sağlayabilir. Özellikle 36. saat NT-proBNP değerlerinin 300 pg/ml'nin üzerinde olması istenmeyen major kardiyak olayların önceden tespitinde ve önlem alınmasında yararlı olabilir.OBJECTIVE: B-type natriuretic peptide levels has been used as a biological marker for prognosis in patients with acute coronary syndrome (ACS). We sought to determine the prognostic value of N-Terminal (NT) proBNP in patients with ST segment elevation myocardial infarction. MATERIALS and METHODS: 57 patients from Uludağ University Cardiology Department Intensive Care Unit with ST segment elevation myocardial infarction if they matched the inclusion criteria after the standart treatment was began to patients were enrolled. We measured the NT-proBNP in plasma specimens in the 6th and 36th hours after hospitalization. The cardiac markers were measured and taken ECG records at the same times. After follow up of third month the major advers cardiovascular events (MACE) were evaluated and NTproBNPwas measured again. The relation between MACE and each of NT-proBNP levels were analysed. RESULTS: The patients which were included to the study were divided in two groups in terms of ST segment elevation. These groups are anterior MI (Group A) and inferior MI (Group B) patients. In Group A the left ventricle ejection fraction was found lower and wall motion score index was found higher but they were not statistically significant (p>0,05). After the third month there was no statistically difference in NT-proBNPlevels between the group which had minimally one MACE and the other group which had no MACE (p>0,05). The 36th hours mean NT-proBNP levels compared with sixth hours mean NT-proBNP levels was statistically different in two groups. In Group A, NT-proBNPlevelsincreased 10,6±26,2 timesand in Group B NT-proBNPlevels increased 3,6±4,7 times (p=0,016). There was no correlation between left ventricle ejection fraction and NTproBNP levels. Especially we found that the patients which had 36th hours NT-proBNP level sover 300 pg/ml showed worse prognosis depending on major cardiovascular advers events. CONCLUSION: Circulating NT-proBNP levels appear elevated in patients with ST Elevation ACS. 36th hours NT-proBNP value sover 300 pg/ml, are associated with worse prognosis depending on major cardiovascular events

Working at Night in Hospital Environment is a Risk Factor for Arterial Stiffness

Aim: Arterial stiffness is an independent risk factor for cardiovascular disease. In previous studies, emotional stress has been reported to be a risk factor for cardiovascular disease. In this study, we aimed to investigate the effects of anxiety, stress and fatigue associated with working at night in hospital environment on arterial stiffness in physicians. Methods: The study was carried out with 30 physicians employed in Medical Faculty of Uludağ University between October 2011 and March 2012. Measurements were made using Pulse Wave Sensor HDI system (Hypertension Diagnostics Inc, Eagan, MN)(Set No: CR000344) by radial artery pulse wave at the onset and end of night shift. Results: The mean age of night doctors included in the study was 26 years (range: 22-38) and the female/male ratio was 2/1. It was determined that mean values of arterial stiffness were significantly higher after night shift (1330±360 dyne/sn/cm-5) compared to mean values before night shift (1093±250 dyn/s/cm-5) (p=0.01). In the evaluation of other parameters before and after night shift, no statistically significant difference was detected (p>0.05). Conclusion: The increasing arterial stiffness in hospital employees after night shift could be attributed to the effects of stress and fatigue experienced during night shift. (The Me di cal Bul le tin of Ha se ki 2012; 50: 93-5

Investigation of Retinal Microvascular Findings in patients with Coronary Artery Disease

Objectives: Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease. Material and Method: Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated. Results: This study enrolled 100 patients (male: 72 (72%), mean age: 58.25±7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p<0.001). Conclusions: Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions

The Relationship of Acute Exacerbation Severity with Uric Acid and Uric Acid to Creatinine Ratio in Patients with Chronic Obstructive Pulmonary Disease

Aim: Acute exacerbation in chronic obstructive pulmonary disease (COPD) may result in a lot of systemic consequences due to hypoxemia and systemic inflammation. We investigated uric acid levels and uric acid to creatinine ratio in COPD patients developing acute exacerbation. Methods: We included 25 patients who had been admitted with acute exacerbation of COPD according to the GOLD diagnosis and treatment guidelines between May and December 2011. Uric acid and creatinine levels were recorded from blood samples of the patients. Results: Average uric acid and uric acid to creatinine ratio values were 5.7±2.09 mg/dl and 7.32±3.0 in patients with mild hypoxemia, 6.4±2.1 mg/dl and 7.01±2.9 in those with moderate hypoxemia, and 6.7±2.0 mg/dl and 9.1±1.8 in those with severe hypoxemia, respectively. While no statistically significant correlation was found between uric acid levels and uric acid to creatinine ratio in the three groups (p=0.97, p=0.76, respectively), these values were found to increase along with increasing severity of hypoxemia. Conclusion: Uric acid levels and the ratio of uric acid to creatinine remained unchanged while severity of hypoxemia increased during acute exacerbations of COPD, however, these values were found to increase with increasing severity of hypoxemia. (The Medical Bulletin of Haseki 2013; 51: 147-50

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

Background: Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. Aims: To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Study Design: Cross sectional study. Methods: Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early- (E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardial peak systolic (Sm) and peak early (Em) and late (Am) diastolic mitral annular velocities were also assessed for changes. Results: Transmitral E and A velocities and the E/A ratio decreased significantly after HD (p<0.001). Pulmonary vein S (p<0.001) and D (p<0.001) velocities decreased, and S/D ratios increased significantly (p=0.027). HD led to a reduction in septal Em (p<0.001), lateral Em (p=0.006), and Am (p<0.001) velocities. Contrary to the decreases in Em and Am, the Em/Am ratio remained unchanged. Conclusion: A single HD session was associated with an acute deterioration in the diastolic parameters. Since the Em/Am ratio remained unchanged, we conclude that this index is a relatively load-independent measure of diastolic function in HD patients