Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

A 71-year-old woman with chest pain occurring on physicalexercise was admitted to cardiology department.Myocardial perfusion scintigraphy revealed inferior andanteroapical segment hypoperfusion. Selective coronaryangiography revealed multiple coronary-cameral fistulasoriginating from the left anterior descending artery andthe right coronary artery and emptying into the left ventriclewithout any significant coronary artery stenosis. Coronaryartery fistulas are defined as abnormal communicationsbetween a coronary artery and a cardiac chamber ormajor vessel. Coronary-cameral fistulas terminating in theleft ventricle are uncommon. Small fistulas usually do notcause any hemodynamic compromise. However, the largerand multiple fistulas may cause myocardial ischemiaascribed to a coronary steal phenomenon. The best wayto manage cameral fistulae is uncertain largely due to therarity of the condition. In the present case, anti-ischemicmedications with metoprolol 50 mg/day provided an uneventfulfollow-up of six months without any intervention

Acute alcohol consumption is associated with increased interatrial electromechanical delay in healthy men

Background: Acute alcohol consumption can cause atrial fibrillation in patients with, and without, heart disease. Increased atrial electromechanical delay (EMD) has been associated with atrial fibrillation. We evaluated the atrial conduction properties by tissue Doppler imaging (TDI) echocardiography in healthy men following acute alcohol intake. Methods: Thirty healthy male volunteers were included in this study. Baseline ECG, heart rate, blood pressure, and TDI echocardiographic findings were compared to readings taken one hour after drinking six 12-oz cans of beer (76.8 g of ethanol). Results: Although the blood pressure and heart rate remained similar before and one hour after alcohol intake, Pmax and Pd values were significantly prolonged (114.2 &#177; 10.4 vs 100.8 &#177; 10.6, p = 0.002; 50.6 &#177; 9.6 vs 34.5 &#177; 8.8, p < 0.0001). Interatrial EMD was significantly increased after drinking alcohol compared to the baseline (19.8 &#177; 9.2 vs 14.0 &#177; 5.5 ms, p < 0.0002). Conclusions: Acute moderate alcohol intake was associated with an increased interatrial EMD obtained by TDI echocardiography. This finding may help explain how these patients express increased susceptibility to atrial fibrillation. (Cardiol J 2011; 18, 6: 682&#8211;686

Theophylline toxicity and hyperadreoergic syndrome

Bu makalede, yüksek miktarda teofilin alımına bağlı olarak ortaya çıkan teofilin toksisitesi ve hiperglisemili bir olgu sunulmaktadır. Hastadaki hiperglisemi, hipokalemi ve hipotansiyonun, teofilin toksisitesi ile ilgili olduğuna karar verilmiştir. Hastanın klinik ve laboratuvar bulguları rapor edilmiş; beta-adrenerjik sistem ile teofilin toksisitesinin ilişkisi tartışılmış ve literatür gözden geçirilmiştir.In this article, a case with toxicity and hyperglycemia due to ingestion of high amounts of theophylline is presented. It has been decided that hyperglycemia, hypokalemia and hypotension of the patient have been related to theophylline toxicity. Clinical and laboratory manifestations of the patient have been reported; the relation between beta-adrenergic system and theophylline toxicity has been discussed and the literature has been reviewed

Metabolic syndrome in childhood obesity

Objectives: We determined the frequency of metabolic risk factors and the prevalence of Metabolic Syndrome in childhood obesity. Subjects: 186 obese children (97 females and 89 males), aged 11.2 ± 2.8 (6-16) years and 98 healthy children (46 females and 52 males), aged 10.9 ± 3.2 (6-16) years were recruited for the study, as study and control groups, respectively. Methods: Subjects were evaluated for anthropometry, blood pressure (BP) and biochemical cardiovascular risk factors. Metabolic syndrome was defined in presence of ≥ 3 of the following: (i) fasting triglyceride ≥ 100 mg/dL; (ii) high density lipoprotein - cholesterol 75th percentile for age and gender and (v) systolic BP > 90th percentile. Results: We found that 144 (77.4%) children in the obese group had one, two or more cardiovascular risk factors. Using a pediatric definition, the prevalence of metabolic syndrome was 2.1%. In the control group, the clustering of one, two and three risk factors was very rare. Conclusion: Childhood obesity is associated with increased frequency of cardiovascular risk factors and metabolic syndrome

Ischemic preconditioning

It has been shown that repeated brief coronary occlusions increase myocardial resistance towards prolonged episodes of ischemia. This phenomenon, which renders the heart more tolerant to ischemia with subsequent limitation of infarct size, has been termed ischemic preconditioning. Ischemic preconditioning also protects the heart against postinfarction left ventricular dysfunction and ventricular arrhythmias. Ischemia induced activation of adenosine receptors, and opening of ATP-sensitive potassium channels and stress protein synthesis are thought to be the potential mechanisms of this phenomenon. The exploration of the exact mechanisms of ischemic preconditioning might improve the treatment strategies for acute myocardial infarction in the future

Angiographic detection of the left anterior descending and the right coronary artery after fistulas into the pulmonary artery in a patient with rheumatic mitral stenosis

Coronary artery fistula is a rare heart defect found in approximately 0.2% of the adult population undergoing coronary angiography. The diagnosis is usually made by aortography and selective coronary angiography. We report here an adult patient with rheumatic mitral stenosis and left anterior descending coronary artery and pulmonary conus branch of right coronary artery-pulmonary artery fistulas detected by coronary angiography. © 2005 Elsevier Ireland Ltd. All rights reserved

Mitral valve prolapse syndrome: Orthostatic hypotension and physiopathology of its clinical symptomatholgies

Although several investigations on mitral valve prolapse syndrome (MVPS) have been performed, clinical symptoms of this syndrome are not yet clarified. Atypical chest pain, palpitations, fatigue, dyspnea and anxiety are the most frequent symptoms associated with this syndrome. However, dizziness and syncope may be serious symptoms in MVPS. Dizziness and syncope are related to cardiac arrhythmias and are proposed to distinguish types, frequency of arrhythmias and relation to the symptomes. Orthostathic hypotension and tachcardia rarely occur in MVPS. The physiopathological mechanisms of these symptoms are not known clearly, but multifactorial causes are thought to be responsible including autonomic dysfunction, hyperadrenergic state, abnormalities in regulation of baroreceptors, parasympathetic derangements, decrease of intravascular volume, abnormal renin-aldosterone response to depletion of intravascular volume and abnormal release of atrial natriuretic factor

Right coronary artery arising as a terminal extension of the left circumflex artery (a rare coronary artery anomaly)

A single coronary artery is a very rare type of coronary artery anomaly that may present in various forms. A patient is presented in whom the right coronary artery coursed as the terminal branch of the left circumflex artery. This is the second case of this anomaly in the literature

Anomalous origin of the left circumflex coronary artery: A case report

The anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva is a relatively common anatomical variation. Difficulties may occur in the diagnostic procedure, but recognition and adequate visualization of the anomaly is essential for proper patient management, especially in patients undergoing evaluation for percutaneous coronary intervention, coronary artery surgery or prosthetic valve replacement. In the present report, a patient who had undergone percutaneous coronary intervention for a right coronary artery lesion after inferior myocardial infarction is described. The anomalous origin of the left circumflex coronary artery arising independently from the right sinus of Valsalva was previously undetected