The treatment of spontaneous coronary dissection extending to the Valsalva sinus during percutaneous coronary intervention with primary stenting

Aortocoronary dissections are among the rare complications of percutaneous coronary interventions. Occasionally, coronary dissections can be the triggering factor for aortocoronary dissection. In this case, the dissection in the coronary artery may extend to the Valsalva sinus and ascending aorta progressively. In this article, we present and discuss a 54-year-old male who underwent percutaneous coronary intervention for acute inferior myocardial infarction. The aetiology for right coronary artery occlusion appeared to be spontaneous coronary dissection which extended to the Valsalva sinus. After treatment with primary stenting, the 6-month follow up results are presented here.Aortocoronary dissections are among the rare complications of percutaneous coronary interventions. Occasionally, coronary dissections can be the triggering factor for aortocoronary dissection. In this case, the dissection in the coronary artery may extend to the Valsalva sinus and ascending aorta progressively. In this article, we present and discuss a 54-year-old male who underwent percutaneous coronary intervention for acute inferior myocardial infarction. The aetiology for right coronary artery occlusion appeared to be spontaneous coronary dissection which extended to the Valsalva sinus. After treatment with primary stenting, the 6-month follow up results are presented here

Body composition indices and electromechanical durations in metabolic syndrome

Aim: To examine electromechanical delay (EMD) a predictive of atrial fibrillation (AF) risk, in obese and non-obese metabolic syndrome (MS) patients and to research the relationship between EMD and the new body composition indices. Method: 118 overweight (body mass index (BMI)>26 kg/m2) individuals with MS meeting the criteria for IDF and ATP III were included in the study. The subjects were divided into two groups: Group 1; 54 obese persons with MS (33 females; mean age 46.2±14.1) while Group 2 included 64 non-obese persons with MS (33 females; mean age 41.4±13.2). In addition to laboratory findings, body composition indices, conventional and tissue Doppler imaging were obtained. Atrial EMD was defined as the time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the late diastolic A wave. Inter, intra and left atrial EMD’s were measured from the data obtained. Results: Inter, intra and left atrial EMDs were significantly greater in the obese group compared to the non-obese group. There was a significant correlation between interatrial EMD and left atrial EMD and all body composition indices except body surface index. The strongest correlation was between body roundness index (BRI) and interatrial and left atrial EMD (r=0.46; p<0.001, r=0.39; p<0.001, respectively). Conclusions: EMD intervals were more prolonged in obese subjects with MS than in non-obese subjects with MS. The parameter most relevant to EMD was BRI. BRI is the body composition index most correlated with increased risk for AF in persons with MS. &nbsp

Pacemaker lead endocarditis with hiccups (Kalayci)

Background: Lead-related infections that might develop after pacemaker implantation associated with high mortality and morbidity rates are challenging to manage and pose high-cost. Patients with lead-related infections usually present with fever, chills and fatigue and the treatment can be challenging unless the implant system is extracted. Case presentation: A 66-year old male patient who underwent dual chamber pacemaker and implantable cardioverter defibrillator was admitted to the emergency service with a six-week history of complaints of hiccups and fever. After a detailed investigation, lead-related infective endocarditis was the diagnosis. The patient was initiated on antibiotic therapy and lead extraction was performed. Conclusions: Patients with signs of infection who underwent pacemaker implantation may present with atypical symptoms such as hiccup. In these cases, imaging, particularly echocardiography, should be performed as soon as possible and the localization of the pacemaker leads and signs of infective endocarditis should be investigated

Atypical type of dual left anterior descending coronary artery

AbstractDual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature.<Learning objective: In our cases a novel dual LAD variant is presented with two main branches of equal length and reaches the cardiac apex. Cardiologists and cardiovascular surgeons should be aware of these variants to avoid misinterpretation of coronary angiography and intraoperative complications.

Evaluation of the anatomical and electrical axis of the heart after pneumonectomy

Aim: To investigate the position of the heart after pneumonectomy and, also to find out how the changes in the electrical axis of the heart contribute for the possible electrocardiographic and echocardiographic changes. Methods: Ninety-eight patients with pneumonectomy were included to this observational study. To calculate the rotation of the heart and angle measurement two perpendicular lines, one septal and another atrioventricular, were drawn on the images acquired from thoracic computed tomography. Thoracic CT were taken at every 3 months for the first two years. On electrocardiograms net QRS vectors, amplitudes of p waves, findings of right and left ventricular hypertrophy, and other possible changes were recorded. Results: The mean age of all patients was 55.51 ± 8.9. Right pneumectomy was performed in 40 (57%) and left pneumonectomy in 30 cases (43%) cases. There was no significant change regarding both the angle of rotation and the amount of pleural effusion between the findings of the second and first year after the operation. The QRS shift was significantly more pronounced in patients with left pneumonectomies than right pneumonectomies. On echocardiography these cases showed right ventricular hypertrophy and increased pulmonary artery pressures in the second year when compared to the preoperative period. Conclusions: The current study showed that many significant changes occurred in the electrocardiographic and echocardiographic parameters of the heart after pneumonectomy

Noncompaction and scleroderma reply

WOS: 000375094600024PubMed: 2711132

Pacemaker lead endocarditis with hiccups (Kalayci)

Background: Lead-related infections that might develop after pacemaker implantation associated with high mortality and morbidity rates are challenging to manage and pose high-cost. Patients with lead-related infections usually present with fever, chills and fatigue and the treatment can be challenging unless the implant system is extracted. Case presentation: A 66-year old male patient who underwent dual chamber pacemaker and implantable cardioverter defibrillator was admitted to the emergency service with a six-week history of complaints of hiccups and fever. After a detailed investigation, lead-related infective endocarditis was the diagnosis. The patient was initiated on antibiotic therapy and lead extraction was performed. Conclusions: Patients with signs of infection who underwent pacemaker implantation may present with atypical symptoms such as hiccup. In these cases, imaging, particularly echocardiography, should be performed as soon as possible and the localization of the pacemaker leads and signs of infective endocarditis should be investigated. &nbsp

The relationship of age-adjusted Charlson comorbidity index and diurnal variation of blood pressure

WOS: 000454914000002PubMed: 29504835Backgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients. Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed. Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = -0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012-1.165) Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality

Transient ST segment elevation and left bundle branch block caused by mad-honey poisoning

We herein present a case of a 76-year-old male patient presented with transient ST segment elevation and left bundle branch block caused by mad-honey poisoning