The role of coronary CT angiography in diagnosis of patent foramen ovale

PURPOSE:We aimed to examine the incidence of patent foramen ovale (PFO) and atrial septal aneurysms (ASA) in the Turkish population using coronary computed tomography angiography (CTA); assess the feasibility of coronary CTA for PFO diagnosis by conducting a comparison with transthoracic echocardiography (TTE); and determine the diagnostic role and characteristics of the interatrial tunnel, free flap valve (FFV), and shunts.METHODS:The present study was conducted retrospectively and included a sample of 782 patients. Coronary CTA results for all patients were evaluated for the following parameters: the presence of PFO, the degree of contrast jet (if present due to PFO), ASA existence, free flap valve (FFV) length, and PFO tunnel diameters (1 and 2). Coronary CTA and TTE results for PFO detection were also compared for 19 patients who underwent both procedures.RESULTS:PFO was present in 118 patients (15%). In 19 patients who underwent both CTA and TTE, the shunt was present in 15 patients on TTE compared with nine patients on CTA. The sensitivity and specificity of CTA for shunt existence were 53% (8/15) and 75% (3/4), respectively. FFV was observed on CTA in 118 patients (15%). No significant relationship was observed between shunt existence and FFV length (P = 0.148), or between shunt existence and tunnel diameter-1 (P = 0.638) or diameter-2 (P = 0.058). ASAs were present in 16 patients (2%), while accompanying PFO was present in three patients (2.4%) .CONCLUSION:Coronary CTA constitutes a more practical and efficient alternative to TTE for PFO diagnosis. Further, it allows the clear visualization of anatomical details of the interatrial tunnel, shunts, and associated abnormalities and detects ASAs

Giant J (Osborn) Wave due to Bonsai Abuse: Comments on Clinical Practice

Background: Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse. Case Report: In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse. Conclusion: Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsa

Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload

WOS: 000317946500523Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring and were compared with 20 matched patients with PS. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Results: Among the ECG changes studied, premature atrial contraction (p = 0.008), right axis deviation (p < 0.001), indeterminate axis (p = 0.001), incomplete right bundle branch block (p = 0.02), late R in aVR (p = 0.001), qR in V1 (p = 0.02), and P pulmonale (p = 0.03) were significantly more common in patients with PS than in those with acute PE. Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload