Two cases with suspected permanent pacemaker allergy [Kalici Pacemaker Alerjisi Düşünülen ?ke Olgu]

PubMedID: 15355832[No abstract available

Pericarditis: Review [Perikardit]

Pericarditis is rather frequent disease in the inflammation pathologies of the heart. Firstly, infection agents and other patogens may cause pericarditis by inflammation. There are two clinical titles as acute and chronic pericarditis. Typical chest pain is the most marked clinical findings of acute pericarditis. Enfection pathogens, especially viral agents are the most important etiological reason in acute pericarditis. Right heart failure findings such as pretibial edema, ascites and hepatomegali are seen in chronic pericarditis. Cardiac surgery, malignancy, chronic kidney disease and tuberculosis are the main cause of chronic pericarditis. Nowadays, while classical clinical findings are useful for diagnosis of acute pericarditis, tissue Doppler imaging and magnetic resonans imaging are becoming the important techniques for diagnosis of chronic pericarditis. In this paper, we reviewed clinical features, diagnosis and treatment of the pericarditis. Copyright © 2005 by Türkiye Klinikleri

Cut-off values of BNP and NT-BNP for diagnosis of heart failure in emergency service [5] [BNP ve NT-BNP'nin acil serviste kalp yetersizligi tanisinda uygun eşik degerleri]

PubMedID: 17162299[No abstract available

Aortic atherosclerosis is a marker for significant coronary artery disease

PubMedID: 10737561Atherosclerosis is a generalized process that may involve the entire vasculature as well as the coronary arteries. Aortic atherosclerosis (AA) is associated with an increased risk for recurrent ischemic stroke and cardiovascular death and can be diagnosed by transesophageal echocardiography (TEE). We performed TEE in 60 patients (47 men and 13 women; age range 37-78, mean 53.5 ± 9.9) who underwent coronary angiography, to assess whether atherosclerosis in the thoracic aorta correlates with coronary artery disease (CAD) or may be a marker for it. Significant CAD was defined as either > 50% reduction of internal diameter of the left main coronary artery or > 70% reduction of the internal diameter in the anterior descending, right coronary or circumflex artery. The number of diseased vessels was based on the Coronary Artery Surgery Study criteria. A grading system was used to detect AA.. The thoracic aorta was considered to be normal and classified as grade I when the internal surface was smooth and without lumen irregularities or increased echo-intensity. Grade II changes consisted of increased echodensity of the intima without lumen irregularity or thickening. Grade III changes consisted of increased echodensity of intima with well defined atheroma extending 3 mm and protruding mobile plaques, respectively. Grades III-V were considered as AA. Twenty two of the 29 patients (75.9%) with CAD and 10 of the 31 patients (32.3%) without CAD had AA detected by TEE. There was a significant relationship between CAD and AA (r = 0.44, P < 0.001). The sensitivity and specificity of AA in detecting CAD were 75.9% and 67.7%, respectively. Our data suggest that AA is common in patients with significant CAD. Detection of AA by TEE may be a marker for CAD and early detection of aortic atherosclerosis may contribute to diagnostic and therapeutic interventions and thereby improve the prognosis

Isolated right ventricular myocardial infarction misdiagnosed as anteroseptal myocardial infarction on ECG: A case report [EKG'de anteroseptal miyokart enfarktüsünü düşündüren tek başina sag ventrikül miyokart enfarktüsü: Olgu sunumu]

PubMedID: 23760122In this article, we present a case with isolated right ventricular myocardial infarction (MI) who underwent coronary angiography on suspicion of acute anteroseptal MI detected on ECG; however, occlusion of the proximal right coronary artery (RCA) was detected. A female patient aged 65 years was brought to the emergency room due to loss of consciousness 1 hour before. From the patient's history, it was understood that she had undergone stent placement to her proximal RCA 5 days before. On ECG, a decreasing elevation in ST segment elevation from V1 to V4 was seen, and pathologic Q waves were present at DIII and AVF. A complete AV block was detected on ECG. In the coronary angiography, thrombosis of the stent in the proximal RCA was seen. Stenosis detected in the mid-left anterior descending artery was 50% and at the distal part was 60%. The circumflex coronary artery was found normal. Percutaneous transluminal coronary angioplasty was performed to the 95% thrombotic lesion in the stent of the proximal RCA, and full patency was established. In our case, a decreasing elevation in the ST segment elevation from V1 to V4 was seen. Right ventricular MI usually occurs by an acute stenosis of the non-dominant proximal RCA branch that does not receive collateral flow. In our case, RCA was codominant and an acute stenosis of the stent in the proximal RCA was present. The occlusion of the non-dominant RCA can appear as isolated right ventricular MI without causing a left ventricular infarct, since it does not feed the left ventricle. © 2013 Türk Kardiyoloji Dernegi

Monomorphic ventricular tachycardia during the ajmaline test [Ajmalin testi sirasinda gelişen monomorfik ventrikül taşikardisi]

PubMedID: 24104982A 44-year-old male patient admitted with palpitations was diagnosed with tachycardia with wide QRS, but recovered after being treated with amiodarone. The patient's coronary angiography was normal. As the patient's resting ECG was compatible with Brugada type 2, an ajmaline challenge test was scheduled. The infusion procedure was suspended following an observation of type 1 ECG findings in the 4th minute of infusion. Approximately 10-15 seconds later, a monomorphic ventricular tachycardia with a rate of 150 beats/minute developed. In the follow-up, the patient's heartbeat returned spontaneously to the sinus rhythm within 3-4 minutes. Polymorphic ventricular tachycardia or ventricular fibrillation tachyarrhythmias usually result in syncope or sudden cardiac death in cases of Brugada syndrome, while monomorphic tachycardia, as in our case, is rare. Here, we present a rare case of monomorphic ventricular tachycardia, which was observed during the ajmaline challenge test. © 2013 Türk Kardiyoloji Dernegi

Annular systolic velocity predicts the presence of spontaneous echo contrast in mitral stenosis patients with sinus rhythm

PubMedID: 17803227Ojectives: Thromboembolism is the major cause of morbidity and mortality in mitral stenosis (MS), even in sinus rhythm (SR). Spontaneous echo contrast (SEC) is the strongest predictor of thromboembolism. The aim of the study was to investigate if the annular velocities obtained with tissue Doppler imaging can predict the presence of SEC in MS patients with SR. Methods: One hundred and five MS patients and 100 controls were included. Annular velocities were recorded. All patients underwent transesophageal echocardiography. Subjects were divided into three groups as controls (Group I), the patients without SEC (Group II) and the patients with SEC (Group III). Results: Group III patients had lower ejection fraction, annular systolic velocity, smaller mitral valve area, higher transmitral gradient and larger left atrial size. The annular systolic velocity was the only independent predictor for SEC. The cutoff values of annular systolic velocity for prediction of the presence of any SEC and dense SEC were 13.5 and 11.8 cm/s, respectively. Conclusion: The annular systolic velocity is an independent predictor for SEC in MS patients with SR. © 2007 Wiley Periodicals, Inc

Systolic tissue velocity is a useful echocardiographic parameter in assessment of left atrial appendage function in patients with mitral stenosis

PubMedID: 17767531Background: The incidence of thromboembolism remains high in patients with mitral stenosis (MS). The left atrial appendage (LAA) is a potential site for development of thrombus and LAA dysfunction is an independent predictor of thromboembolism. The LAA dysfunction is represented by reduced LAA late emptying velocity. But the magnitude of LAA flow velocities is dependent on acute changes in loading conditions. Aim: To investigate the value of the LAA tissue velocities obtained by tissue Doppler imaging (TDI) in assessment of LAA function in MS patients with and without thromboembolic events. Methods: The study population consisted of 98 isolated MS patients of 32 age and sex-matched healthy controls. All subjects underwent transesophageal echocardiography (TEE). LAA late peak emptying (LAAEV) and filling (LAAFV) flow velocities were recorded. LAA peak late tissue systolic (LSV) and diastolic (LDV) tissue velocities by TDI were measured. The patients were divided into three groups as Group I (n = 38, sinus rhythm and LAAEV ? 25 cm/s), Group II (n = 26, sinus rhythm and LAAEV < 25 cm/s), and Group III (n = 34, atrial fibrillation). Results: Twenty-one patients had thromboembolic events. LAAEV, LAAFV, LSV, and LDV were significantly reduced in patients with embolic events. Spontaneous echo contrast (SEC) density was strongly negative correlated with LSV, whereas weakly negative correlated with LAAEV. Multivariate regression analysis showed that LSV and the presence of SEC were independently associated with embolic events. Conclusion: LSV seems more reliable and useful parameter in evaluating LAA function. LAA function is more depressed among patients with embolic events. © 2007, the Authors

Mitral annular systolic velocity reflects the left atrial appendage function in mitral stenosis

PubMedID: 16911327Background: Left atrial appendage (LAA) dysfunction is an independent predictor of thromboembolism in mitral stenosis (MS). Objectives: To investigate whether there is a relation between annular velocities obtained by tissue Doppler imaging and LAA function and to determine if the annular velocities can predict the presence of the inactive LAA in MS. Methods: Eighty-five MS patients and 80 healthy controls were evaluated by transthoracic echocardiography and all patients underwent transesophageal echocardiography. The annular systolic (S-wave) and diastolic (E- and A-waves) velocities were recorded. Inactive LAA was defined as LAA emptying velocity <25 cm/sec. Patients were divided into three groups; group I (n = 43): sinus rhythm (SR) and LAA emptying velocity ?25 cm/sec, group II (n = 15): SR and LAA emptying velocity <25cm/sec and group III (n = 27): atrial fibrillation. Results: Thrombus was detected in 12 patients and spontaneous echo contrast (SEC) was detected in 48 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group I to group III. There was a positive correlation between LAA emptying and S-wave velocities (P < 0.001, r = 0.682). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (P = 0.001, odds ratio = 0.143, 95% CI = 0.047-0.434). In patients with SR, the cutoff value of S-wave was 13.5 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 95.3%, specificity: 93.3%). Conclusions: S-wave is an independent predictor of inactive LAA and a useful parameter in estimating inactive LAA in MS with SR. © 2006, the Authors

Coronary venous angioplasty to a ring- like stricture preventing left ventricular lead insertion [Sol ventrikül lead implantasyonunu önleyen striktüre uygulanan koroner venöz anjiyoplasti]

PubMedID: 23618973[No abstract available