Arrhythmogenic right ventricular cardiomyopathy/dysplasia: Analysis based on six cases

Background: We sought to investigate the profile of symptoms and results of investigations among six cases of suspected arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Methods: The diagnosis of ARVC/D was made on the basis of standardised diagnostic criteria proposed by the study group on ARVC/D of the European Society of Cardiology. A study was conducted involving six patients with suspected ARVC/D that were diagnosed and treated at our centre in the years 1992-2004. Results: All patients presented with a typical history and with similar complaints and symptoms: limitation of exercise toleration, palpitations, dizziness, presyncope and syncope. In all six cases ECG abnormalities were detected, namely T wave inversion, prolonged QRS complexes in V1-V3 or/and epsilon waves. Echocardiographic abnormalities were also detected in all cases in the form of global or segmental dilation and a reduction in right ventricular ejection fraction, morphological irregularity of the endocardium and tricuspidal valve insufficiency. On the basis of diagnostic criteria we diagnosed ARVC/D in four cases and the borderline variant of ARVC/D in the remaining two. Conclusions: ARVC/D is a heart muscle disease with varied and complex presentation. The profile of symptoms and the results of investigations and diagnostic procedures are varied and can assume various combinations. Accurate diagnosis can be established in most cases as a result of the non-invasive and widely-used techniques of ECG, 24-hour Holter monitoring and echocardiography. (Cardiol J 2007; 14: 396-401

Acute myocardial infarction as the first presentation of thyrotoxicosis in a 31-year old woman - case report

<p>Abstract</p> <p/> <p>A 31-year old woman, previously fit & well was admitted with pressing retrosternal chest pain and palpitations of sudden onset. Her body weight was normal (BMI 20.5 kg/m²) and there was no significant family history of cardiac disease. She smoked, however, about 15 cigarettes a day and she had been taking combined oral contraceptive pill (Cilest^®) for about three years. On admission she appeared sweaty and in pain, blood pressure 130/70 mmHg, heart rate about 110/min, mild lid-lag sign. Heart sounds were normal and chest was clear. ECG revealed 2-3 mm ST segment elevations in II, III, aVF as well as V2 to V5. Troponin I was raised and she was qualified to an emergency coronary angiography. This revealed a massive spasm of left anterior descending (LAD) coronary artery that responded to intracoronary glyceryl trinitrite administration, however, with the presence of critical narrowing of the LAD apical segment with possible superimposed thrombus. Cardiac ultrasound revealed akinesis of 1/2 of apical area consistent with myocardial infarction</p> <p>Treatment and progress</p> <p>She was started on Aspirin, Simvastatin, and Diltiazem, but continued to have persistent tachycardia and tremor. Thyroid function tests were ordered and showed thyrotoxicosis [free T4-46.9 pmol/l (ref. range 9-25), free T3-11.9 pmol/l (2-5), TSH - 0.02 mIU/l (0.27-4.2)]. She was referred for an endocrine opinion and started on Thiamazole. Other investigations revealed elevated anti-TPO and anti-TSH receptor antibodies consistent with Graves' disease. Thrombophilia screen was negative. She had remained euthyroid on a "block & replace" regimen (Thiamazole plus L-Thyroxine) that was discontinued after 18 months. She denies any anginal symptoms, but continues to smoke against medical advice.</p> <p>Conclusions</p> <p>Our case highlights the possibility of development of an acute myocardial infarction in a young subject with thyrotoxicosis. We speculate that patient's smoking habit combined with subtle thyrotoxicosis-induced prothrombotic state and/or coronary-artery spasm had lead to the above-mentioned acute coronary event.</p

Inhibitory reperfuzyjnego uszkodzenia mięśnia sercowego - kolejny milowy krok w leczeniu ostrych zespołów wieńcowych?

Wczesna reperfuzja za pomocą przezskórnej angioplastyki wieńcowej (PCI, percutaneous coronary intervention) czy trombolizy ma decydujące znaczenie w przywracaniu homeostazy, co skutkuje przywróceniem metabolizmu tlenowego, a tym samym - ograniczeniem powierzchni martwicy. Mimo swych niewątpliwych korzyści, leczenie reperfuzyjne, z wyjątkiem czysto teoretycznych sytuacji, w których poprzedza epizod niedokrwienia, także prowadzi do nieodwracalnych zmian w miokardium. Wśród postulowanych hipotez wymienia się przede wszystkim zaburzenia wewnątrzkomórkowej homeostazy jonów wapniowych, wpływ reaktywnych form tlenu, ostrą reaktywną odpowiedź zapalną czy przesunięcia w łańcuchu przemian metabolicznych reperfundowanych kardiomiocytów. Eksperymentalne obserwacje nad wpływem różnych substancji chemicznych w prewencji szkód, które są udziałem leczenia reperfuzyjnego, przyczyniły się do przeprowadzenia wielu dużych prób klinicznych, w których szukano potwierdzenia ich przydatności w codziennej praktyce klinicznej. Optymalizacja kardioprotekcyjnych strategii terapeutycznych z wykorzystaniem nowych substancji (inhibitory czynnika NF kB, peptydowe pochodne fibryny, inhibitory proteaz) jest niezwykle obiecującym kierunkiem we współczesnej kardiologii

Dobowy rytm ciśnienia a niedokrwienie mięśnia sercowego w chorobie wieńcowej z prawidłowym i podwyższonym ciśnieniem tętniczym

Wstęp: Brak nocnego spadku ciśnienia jest czynnikiem ryzyka powikłań narządowych nadciśnienia tętniczego. Znaczenie tego zjawiska u osób normotensyjnych jest nieznane. Celem pracy była ocena wpływu braku nocnego spadku ciśnienia na niedokrwienie mięśnia sercowego w chorobie wieńcowej z prawidłowym i podwyższonym ciśnieniem tętniczym. Materiał i metody: Do badania włączono 98 pacjentów z potwierdzoną koronarograficznie chorobą wieńcową. Na podstawie 24-godzinnego automatycznego monitorowania ciśnienia tętniczego wyodrębniono 55 chorych z nadciśnieniem tętniczym (grupa I) i 43 normotensyjnych (grupa II). W każdej z grup znajdowali się chorzy, u których ciśnienie tętnicze w nocy było niższe o co najmniej 10% w stosunku do wartości rejestrowanych w ciągu dnia. Nazwano ich dippers w odróżnieniu od non-dippers &#8212; pacjentów bez nocnego spadku ciśnienia. Wszystkim chorym wykonano 24-godzinne monitorowanie EKG metodą Holtera oceniając liczbę epizodów obniżenia odcinka ST, ich charakter oraz rytm dobowy. Wyniki: W grupie I zarejestrowano 172, a w grupie II &#8212; 118 przemijających epizodów obniżenia odcinka ST (PEN). W obu grupach około 60% stanowiły epizody nieme. Całkowita liczba PEN w grupach dippers i non-dippers były podobna. Jednak chorzy bez nocnego spadku ciśnienia większość epizodów mieli w nocy, zaś chorzy z zachowanym rytmem dobowym ciśnienia &#8212; w ciągu dnia. U non-dippers istotnie częściej rejestrowano nieme PEN. Zależność ta dotyczyła non-dippers z nadciśnieniem oraz normotensyjnych. Wniosek: W chorobie wieńcowej niezależnie od obecności nadciśnienia tętniczego brak nocnego spadku ciśnienia wiąże się z częstszym występowaniem niemego niedokrwienia i modyfikacją dobowej zmienności niedokrwienia

A coronary fistula diagnosed in the eighth decade of life: The utility of non-invasive methods in the selection of treatment approach

A 77-year-old woman was referred to our Department of Cardiology because of exacerbation of chest pain and decreased exercise intolerance. No acute ischemic electrocardiography changes were seen in an electrocardiogram recorded on admission. An exercise test was terminated at 7 METS because of shortness of breath without evidence of ischemia. The patient was referred for a coronary angiography which showed a coronary artery fistula filling from the left anterior descending (LAD) artery and resulting in a large inflow to the main pulmonary artery, without other significant coronary lesions. Transthoracic echocardiography showed a coronary artery fistula draining to the main pulmonary artery. Coronary steal was suspected and coronary flow reserve was evaluated in LAD, showing normal values for age. Due to the overall clinical picture, with the predominance of heart failure symptoms and the lack of significant abnormalities of flow reserve in LAD, medical therapy was selected. The patient remained free from cardiovascular symptoms at 6-month follow-up.(Cardiol J 2010; 17, 3: 299-302

Myocardial infarction in young people

An estimated 6 to 10% of myocardial infarctions occur in patients under the age of 45. Usually this applies to men, but an increasing prevalence is being observed among women. Atherosclerosis, often one vessel disease, is the main cause. The presence of classic risk factors affects the dynamics of coronary artery disease: the strongest risk factor is smoking, regardless of gender. Environmental influence is also possible. No atherosclerosis is found in 20% of young patients. In such cases, the most frequent mechanisms of ischemia are: coronary artery embolism (5%), thrombosis (5%), anomalies (4%) and inflammation or spasm of the vessel. Age is an independent prognostic factor. Thus the clinical outcome after myocardial infarction is better in younger than in older patients

The influence of physical rehabilitation on arterial compliance in patients after myocardial infarction

Background: The aim of this study was to determine the effect of 6-week physical training on the mechanical properties of the arteries, in patients (pts) after acute myocardial infarction (MI). Methods: The group under investigation consisted 119 pts after their first acute MI qualified for the second stage of post-hospital training. Only 64 pts (Group 1) underwent the training program. The remaining 55 pts (Group 2) could not participate in it. All the pts underwent an initial exercise test, an ultrasound cardiac scan and a pulse wave velocity (PWV) measurement by means of the COMPLIOR system. Group 1 underwent cardiac rehabilitation program according to Model A or B, depending on exercise tolerance at baseline. Then, both groups had another exercise test and another PWV measurement. Additional PWV measurements were taken in both groups after 6 months. Results: Both groups were comparable with respect to demographic data, the site of MI, the method of treatment, left ventricular function, mean exercise time, the workload attained and mean PWV values at baseline (12.8 &#177; 1.6 m/s vs. 12.2 &#177; 2.7 m/s). In group 1 a significant increase in exercise capacity was observed: from 6.46 &#177; 2.7 to 8.95 &#177; 2.16 MET, and the PWV values were significantly lowered from 12.8 &#177; 1.6 to 8.7 &#177; 1.8 m/s. Group 2 showed only a slight lowering of PWV from 12.2 &#177; 2.7 to 10.8 &#177; 2.3 m/s. Conclusions: Controlled physical training after MI significantly improves systemic arterial compliance, probably through improving the endothelial function. (Cardiol J 2007; 14: 366-371