Aortic propagation velocity in the prediction of coronary artery disease severity

Aims. To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). ethods. The study population comprised 214 SAP subjects who received a coronary angiography. The APV and ca-rotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). Results. High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 +/- 0.24 vs. 0.74 +/- 0.21 mm, respectively; P<0.001). APV demonstrated a negative cor-relation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P <0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. Conclusion. APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients

Recurrent Takotsubo Cardiomyopathy

Stress-induced cardiomyopathy or takotsubo syndrome is a transient cardiac dysfunction which is precipitated by intense emotional or physical stress. It mimics acute coronary syndrome clinically (chest pain and dyspnea) and has specific echocardiographic findings in the absence of significant coronary stenosis. The underlying pathophysiologic mechanism is mostly due to stress-induced catecholamine release. This syndrome is more commonly seen in females especially in the postmenopausal period. The prognosis of stress-induced cardiomyopathy is usually favorable with a prevalence of in-hospital mortality of less than 2%. Reports of a single episode of stress-induced cardiomyopathy are common in the literature, but recurrence of stress-induced cardiomyopathy is rare. Herein, we present an uncommon case of recurrent stress-induced cardiomyopathy in order to provide an explanation of the pathophysiology of this unique syndrome

Cardiac manifestations in Behcet's disease

Behcet's disease (BD) is a chronic inflammatory disorder, with vasculitis underlying the pathophysiology of its multisystemic effects. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognised that cardiac involvement and arterial complications are also important aspects of the course of the disease. Cardiac lesions include pericarditis, endocarditis, intracardiac thrombosis, myocardial infarction, endomyocardial fibrosis, and myocardial aneurysm. Treatment of cardiovascular involvement in BD is largely empirical, and is aimed towards suppressing the vasculitis. The most challenging aspect seems to be the treatment of arterial aneurysms and thromboses due to the associated risk of bleeding. When the prognosis of cardiac involvement in BD is not good, recovery can be achieved through oral anticoagulation, immunosuppressive therapy, and colchicine use. In this review, we summarise the cardiovascular involvement, different manifestations, and treatment of BD

Giant myocardial bridge

Koroner arterin bir bölümünün miyokard içinde seyretmesi miyokardiyal köprü (MK) olarak adlandırılmaktadır. Diğer arterlerde de görülebilmesine rağmen MK en sık sol ön inen koroner arterde görülmektedir. MK 10-30mm uzunluğundaki kas lifleridir. Kalp kası bandı nedeniyle oluşan asıl hemodinamik bozukluk sistol sırasında oluşan darlığın, erken ve middiyastolik faza kadar devam etmesidir. Kalp kası bandı olup, hasta üçüncü grupta semptomatikse ve bu semptomlar etkin tıbbi tedaviye rağmen devam ediyor ve efor testi veya eforlu talyum sintigrafisinde iskemi tespit edilmişse suprakoroner miyotomi tercih edilmesi gereken bir yöntemdir.When a portion of the coronary arteries in the myocardium it is called myocardial bridge (MB). Although MB occurs in other arteries; it most frequently occurs over anterior descending coronary artery. MB is muscle fibers 10-30mm long. Actual hemodynamic disorder caused by myocardial band is the continuation of the narrowing that occurs during systole phase until early and middiastolic phase. If patients have myocardial band and are in the third group and symptomatic and if these symptoms continue in spite of effective medical treatment and there is ischemia in the exercise test or thallium scintigraphy with exercise test; supracoronary myotomy is a preferable method

Melhora da Pressão Arterial após Jejum Intermitente na Hipertensão: O Sistema Renina-Angiotensina e o Sistema Nervoso Autônomo Podem Funcionar?

Resumo Fundamento Embora tenha sido relatado que a dieta de jejum intermitente (JI) tem efeitos positivos na saúde do coração e na melhora da pressão arterial, ainda não foi suficientemente esclarecido como poderia ter esses efeitos positivos.Objetivo: Nosso objetivo foi avaliar os efeitos do JI no sistema nervoso autônomo (SNA) e no sistema renina-angiotensina (SRA), que estão intimamente relacionados à pressão arterial. Métodos Setenta e dois pacientes hipertensos foram incluídos no estudo, e os dados de 58 pacientes foram usados. Todos os participantes jejuaram por cerca de 15-16 horas por 30 dias. Os participantes foram avaliados com monitorização ambulatorial da pressão arterial de 24 horas e eletrocardiograma Holter antes e após o JI; também, amostras de sangue venoso de 5 ml foram coletadas para avaliação dos níveis séricos de angiotensina I (Ang-I) e angiotensina II (Ang-II) e da atividade da enzima conversora de angiotensina (ECA). Para análise dos dados, o valor de p < 0,05 foi aceito como significativo. Resultados Comparado ao pré-JI, observou-se queda significativa nas pressões arteriais dos pacientes no pós-JI. Um aumento na potência de alta frequência (AF) e na raiz quadrada média da soma dos quadrados das diferenças entre intervalos NN adjacentes (RMSSD) foram observados após o protocolo JI (p=0,039, p=0,043). A Ang-II e a atividade da ECA foram menores em pacientes após JI (p=0,034, p=0,004), e níveis decrescentes de Ang-II foram determinados como fatores preditivos para melhora da pressão arterial, como o aumento da potência de AF e RMSSD. Conclusão Os presentes achados de nosso estudo demonstraram uma melhora na pressão arterial e a relação da pressão arterial com resultados positivos, incluindo VFC, atividade da ECA e níveis de Ang-II após o protocolo JI

Traumatic Coronary Artery Dissection in a Young Woman after a Kick to Her Back

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died

The relationship between left atrium global longitudinal strain and epicardial fat thickness in patients with paroxysmal atrial fibrillation

Amaç: Çalışmamızın amacı paroksismal atriyal fibrilasyonlu (AF) hastalarda epikardiyal yağ kalınlığı (EYK) ve sol atriyum global longi- tudinal strain (SA-GLS) arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem: Hastaların tanımlayıcı demografik ve klinik özellikleri kaydedildi. EYK konvansiyonel ekokardiyografiyle değerlendiril- di. SA-GLS iki boyutlu speckle tracking ekokardiyografi ile değerlendirildi. Atriyal doku doppler görüntülemeyle total atriyal ileti zamanı (TAİZ) değerlendirildi. Bulgular: Grup 1’de yaş grup 2’den anlamlı olarak yüksekti. EYK değeri grup 1’de grup 2’den anlamlı olarak yüksekti (sırasıyla grup 1; 7,5±0,5; grup 2; 4,5±0,5, p<0,05). SA-GLS değeri grup 1’de grup 2’ye göre anlamlı olarak düşüktü (sırasıyla grup 1; 18,3±0,5; grup 2; 22,5, p<0,05). TAİZ değeri grup 1’de grup 2’ye göre anlamlı olarak yüksekti (sırasıyla grup 1; 109,1±5,1 ms; grup 2; 81,0±3,0 ms, p<0,05). Sonuç: Paroksismal AF’li hastalarda EYK artmış, SA-GLS değeri azalmış ve TAİZ uzamıştır. Bu parametreler AF’nin öngörülmesinde kulla- nılabilir.Objective: The aim of our study was to evaluate the relationship between left atrium global longitudinal strain (LA-GLS) and epicardial fat thickness (EFT) in patients with paroxysmal atrial fibrillation (AF). Material and Method: Descriptive demographic and clinical characteristics of patients were recorded. EFT was assessed by conventional echocardiography. LA-GLS was evaluated by two-dimensional speckle tracking echocardiography. The total atrial conduction time (TACT) was evaluated by atrial tissue doppler imaging. Results: The age was significantly higher in group 1 than in group 2 (control group). EFT was significantly higher in group 1 than in group 2 (respectively, group 1; 7.5±0.5; group 2; 4.5±0.5, p<0.05) . The study found that LA-GLS was significantly lower in group 1 than in group 2 (respectively, group 1; 18.3±0.5; group 2; 22.5, p<0.05). TACT was also significantly longer in group 1 than in group 2 (respectively, group 1; 109.1±5.1 ms; group 2; 81.0±3.0 ms, p<0.05). Conclusion: EFT increased, LA-GLS values decreased and TACT has been extended in patients with paroxysmal AF. These parameters can be used for predicting AF

Investigation of Arrhythmia Markers and KCNJ8-S422L Gene Mutation in a Population with Early Repolarization Pattern on ECG

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400150…Turkish Soc Cardio

Evaluation of red cell distribution width (RDW) in patients with acute coronary syndromes

Amaç: Günümüzde yeni bir risk belirteci olarak tanımlanmış olan eritrosit dağılım aralığı (RDW), birçok kardiyovasküler hastalıkta mortalite ve morbiditenin prediktif bir değeri olarak gösterilmektedir ve tam kan sayımında rutin olarak çalışılmaktadır. Biz, RDW’nin, akut koroner sendromlu (ACS) hastalarda yükselebileceğini düşündük ve çalışmamızda ACS’nin klinik ve anjiyografik sınıflaması üzerine etkisini araştırdık. Gereç ve Yöntem: Çalışmaya ACS’li 236 hasta, kalp yetmezlikli 46 hasta ve 136 kontrol grubu hastası dahil edildi. ACS grubundaki hastalar klinik olarak 4 alt gruba (stabil AP, unstabil AP, akut MI ve non-kardiyak AP) ve anjiyografik olarak 3 alt gruba (kritik damar darlığı, non-kritik damar ve normal) ayrıldı. Gruplar ve grupların alt tipleri çalışılan laboratuvar parametreleri açısından karşılaştırıldı. Bulgular: Kalp yetmezliği grubuyla diğer gruplar arasında total kolesterol, trigliserid, kalsiyum ve lökosit (WBC) seviyelerine göre anlamlı bir fark mevcuttu (p<0,05). Tüm gruplar arasında üre, kreatinin, albümin, nötrofil yüzdesi, RDW ve troponin seviyelerine göre anlamlı bir fark mevcuttu (p<0,05). Klinik sınıflamada, troponin seviyelerine göre akut MI grubu ile diğer gruplar arasında anlamlı bir fark mevcut iken (p<0,05), RDW seviyelerine göre anlamlı bir fark bulunamadı. Anjiyografik değerlendirmede RDW seviyelerine göre anjiyografisi normal olanlar ile diğer gruplar arasında belirgin bir fark mevcuttu (p<0,05). Sonuç: Biz akut koroner sendromlu ve kalp yetmezlikli hastalarda RDW seviyelerini yüksek tespit ettik, fakat ACS’ nin alt tipleri arasında anlamlı bir fark bulamadık. Sonuç olarak biz RDW’nin acil servise başvuran ACS’li hastaların değerlendirilmesi için diğer kardiyak belirteçlerle birlikte göz önünde bulundurulması gerektiğini düşünmekteyiz.Objective: The RDW a recently described novel risk marker has been shown to be predictive of morbidity and mortality in variety of cardiovascular settings, and routinely reported as part of the complete blood count. We thought that RDW can increase in patient with ACS and investigated the effect of RDW on the clinical and angiographic classification of ACS. Material and Methods: 236 patients with ACS, 46 patients with heart failure and 136 control patients were included to the study. ACS group divided into four subgroups clinically (stabil AP, unstabil AP, acute MI, non-cardiac AP) and angiographically divided into three subgroups (critical vascular occlusion, non-critical vascular occlusion, normal). The groups were compared according to laboratory parameters. Results: There was difference between heart failure group and the other groups according to levels of total cholesterol, triglyceride, calcium and WBC. There was difference in all groups according to levels urea, creatinine, albumin, neutrophil count, RDW and troponin (p<0.05). In clinical classification, There was no difference in levels of RDW while there was a difference between acute MI group and the others in troponin level (p<0.05). In angiographic evaluation, there was difference between normal group and the others according to levels RDW (p<0.05). Conclusion: We detected that RDW were increased in patients presenting with ACS and heart failure, but we saw no difference between the subtypes of ACS. In conclusion, we think that RDW might be considered with other cardiac markers for the evaluation of ACS patients admitted to emergency departments