Sinus Node Dysfunction as the First Manifestation of Left Ventricular Noncompaction with Multiple Cardiac Abnormalities

AbstractLeft ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease

Electromechanical delay detected by tissue Doppler echocardiography is associated with the frequency of attacks in patients with lone atrial fibrillation

Background: Our main purpose in this study is to compare atrial (inter-atrial, intra-leftatrial, intra-right atrial) electromechanical delays of patients with lone atrial fibrillation (LAF) with healthy individuals and examine the relationship of annual LAF attack frequency.Methods: 32 entirely healthy individuals and 32 patients who have presented with tachycardia and complying with LAF criteria have been included in the study. The time passing from the beginning of the P wave on electrocardiography to the A’ wave on tissue Doppler trace was accepted as the atrial conduction time (PA’). The PA’ time difference between the mitral annulus of left ventricle (ML) and the tricuspid annulus of right ventricle (TL) was defined as inter-atrial electromechanical delay (IA-EMD), the PA’ time difference between the ML and septal mitral annulus (MS) as intra-left electromechanical delay (ILeft-EMD), the PA’ time difference between MS and the TL as intra-right electromechanical delay (IRight-EMD).Results: ILeft-EMD (21.8 ± 9.1 vs. 14.1 ± 4.9, p < 0.001), IRight-EMD (9.3 ± 6.8 vs. 5.9 ± 4.9, p = 0.03) and IA-EMD times (24.7 ± 11.2 vs. 11.9 ± 7.1, p < 0.001) were significantly longer in LAF patients. In multivariate regression analysis, using a model including age, gender and left atrium (LA) volumes, ILeft-EMD times (OR 1.14, 95% CI 1.03–1.27,p = 0.012), IA-EMD times (OR 1.12, 95% CI 1.03–1.23, p = 0.007) and LA volumes (OR 1.18, 95% CI 1.05–1.32, p = 0.005) were independent predictors of LAF. In LAF group, the frequency of AF episodes was significantly correlated with ILeft-EMD (r = 0.90, p < 0.001) and IA-EMD times (r = 0.36, p < 0.004), whereas, IRight-EMD times and LA volumes were not correlated with recurrence rates.Conclusions: ILeft-EMD and IA-EMD may increase in the early stages of atrial fibrillation even without the left atrial dilation and may be more valuable than left atrial area and volume in predicting atrial fibrillation

A case of anomalous origin of circumflex artery from right sinus of valsalva recognized by three-dimensional transesophageal echocardiography and coronary computed tomography angiography

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly. It is thought to be of no clinical relevance unless cardiac surgery is performed. We report a 53-year-old patient with aberrant circumflex coronary artery origin from the right aortic sinus of Valsalva which was first suspected from transthoracic 2D and transesophageal 3D echocardiographic views and confirmed by coronary CT angiography. The patient did not receive further diagnostic or therapeutic options. Therefore, we recommended medical therapy with optimal treatment of his cardiovascular risk factors together with regular clinical follow up

Investigation of Retinal Microvascular Findings in patients with Coronary Artery Disease

Objectives: Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease. Material and Method: Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated. Results: This study enrolled 100 patients (male: 72 (72%), mean age: 58.25±7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p<0.001). Conclusions: Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions

Case Reports 399 Incremental utility of Live/Real time

three-dimensional transesophageal echocardiography in diagnosis of a unique type of subaortic membrane: a case repor

Fragmentacja zespołu QRS w 12-odprowadzeniowym EKG u chorych ze zwolnionym przepływem wieńcowym

Background: Coronary slow flow (CSF) is characterised by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. It has been reported that CSF may cause angina, myocardial ischaemia, and infarction. Fragmentation of QRS complex (fQRS) is an easily evaluated non-invasive electrocardiographic parameter. It has been associated with alternation of myocardial activation due to myocardial scar and/or ischaemia. Whether CSF is associated with fQRS is unknown. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with CSF.Aim: To investigate the presence of fQRS in patients with CSF.Methods: Sixty patients (mean age 55.5 ± 10.5 years) with CSF and 44 patients with normal coronary arteries without associated CSF (mean age 53 ± 8.4 years) were included in this study. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory.Results: The presence of fQRS was higher in the CSF group than in the controls (p = 0.005). Hypertension was significantly more common in the CSF group (p < 0.001). There was no significant association between the presence of fQRS and an increasing number of vessel involvements. Logistic regression analysis demonstrated that the presence of CSF was the independent determinant of fQRS (OR = 10.848; 95% CI 2.385–49.347; p = 0.002).Conclusions: Fragmented QRS, indicating increased risk for arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with CSF. We have not found an association between the presence of fragmented QRS and the degreeof CSF. Further prospective studies are needed to establish the significance as a possible new risk factor in patients with CSF.Wstęp: Zwolniony przepływ wieńcowy (CSF) cechuje się opóźnieniem opacyfikacji tętnic wieńcowych przy braku zwężeń w tętnicach nasierdziowych. Istnieją doniesienia, że CSF może powodować dławicę, niedokrwienie mięśnia sercowego i zawał serca. Fragmentacja zespołu QRS (fQRS) jest nieinwazyjnym, łatwym do oceny parametrem elektrokardiograficznym. Uważa się, że fQRS stanowi następstwo zmian aktywności mięśnia sercowego spowodowanych przez blizny i/lub niedokrwienie. Nie wiadomo, czy CSF wiąże się z obecnością fQRS. Stwierdzenie fQRS w badaniu EKG może być wskaźnikiem uszkodzenia miokardium u chorych z CSF.Cel: Celem niniejszego badania była ocena występowania fQRS u chorych z CSF.Metody: Do badania włączono 66 pacjentów (średnia wieku 55,5 ± 10,5 roku) z CSF i 44 osób z prawidłowymi tętnicami wieńcowymi, u których nie występowało zwolnienie przepływu wieńcowego (średnia wieku 53 ± 8,4 roku). Defragmentację zespołu QRS definiowano jako obecność dodatkowego załamka R, zawęźlenie załamka R lub S bądź obecność fragmentacji w dwóch sąsiadujących odprowadzeniach odpowiadających obszarowi unaczynienia tętnicy wieńcowej.Wyniki: Obecność fQRS stwierdzano częściej w grupie chorych z CSF niż w grupie kontrolnej (p = 0,005). Nadciśnienie tętnicze występowało istotnie częściej u osób z CSF (p < 0,001). Nie wykazano istotnych zależności między obecnością fQRS a zwiększoną liczbą zajętych naczyń. Na podstawie analizy regresji logistycznej stwierdzono, że CSF była niezależnym czynnikiem determinującym występowanie fQRS (OR = 10,848; 95% CI 2,385–49,347; p = 0,002).Wnioski: Wykazano, ze fQRS, świadcząca o zwiększonym ryzyku zaburzeń rytmu i zgonu z przyczyn sercowo-naczyniowych, występowała istotnie częściej u chorych z CSF. Autorzy nie stwierdzili zależności między występowaniem fQRS a zaawansowaniem CSF. Należy przeprowadzić dalsze prospektywne badania w celu określenia znaczenia fQRS jako potencjalnego nowego czynnika ryzyka u chorych z CSF

Case Reports

Incremental utility of Live/Real time threedimensional transesophageal echocardiography in a case with ventricular septal aneurysm and hypertrophic obstructive cardiomyopathy: a case repor

Aktywność paraoksonazy 1 w surowicy kobiet z zespołem metabolicznym

Background: Metabolic syndrome (MetS) is a leading risk factor for coronary artery disease (CAD) in women. Reduced paraoxonase 1 (PON1) activity may play a role in the pathogenesis of atherosclerosis through increased susceptibility to lipid peroxidation in patients with MetS. Aim: To examine whether there is a relationship between serum PON1 activity and MetS in women. Method: The study group consisted of 54 women with MetS. The NCEP ATP III guidelines were used to define MetS. The control group consisted of 65 women without MetS and CAD. All patients from the MetS group underwent coronary angiography. Results: The PON1 activity and salt-stimulated PON1 activity were not significantly altered in women with MetS when compared to controls (p = 0.902, p = 0.877, respectively). There was no significant difference in PON1 activity (p = 0.159), and salt-stimulated PON1 activity (p = 0.139) between diabetics and non-diabetics. In the MetS group, patients with CAD (n = 16) had significantly reduced PON1 activity and salt-stimulated PON1 activity compared to MetS patients without CAD (p = 0.008 and p = 0.004, respectively). Conclusions: Serum PON1 activity is significantly reduced in women with CAD and MetS. MetS per se does not alter serum PON1 activities. Kardiol Pol 2010; 68, 11: 1219-1224Wstęp: Zespół metaboliczny (MetS) jest najważniejszym czynnikiem ryzyka choroby wieńcowej (CAD) u kobiet. Zmniejszenie aktywności paraoksonazy 1 (PON1) może wpływać na rozwój miażdżycy u osób z MetS poprzez zwiększenie podatności na peroksydację lipidów. Cel: Celem badania było ustalenie, czy istnieje zależność między aktywnością PON1 w surowicy a występowaniem MetS u kobiet. Metody: Badana grupa składała się z 54 kobiet z MetS. Zespół metaboliczny rozpoznawano zgodnie z kryteriami NCEP ATP III. Grupę kontrolną stanowiło 65 kobiet, u których nie stwierdzono ani MetS, ani CAD. U wszystkich pacjentek z grupy MetS wykonano angiografię wieńcową. Wyniki: Aktywności PON1, zarówno podstawowa, jak i po stymulacji solą, nie różniły się istotnie między grupą kobiet z MetS i grupą kontrolną (odpowiednio p = 0,902; p = 0,877). Nie stwierdzono również istotnych różnic w podstawowej aktywności PON1 (p = 0,159) oraz aktywności PON1 po stymulacji solą (p = 0,139) między chorymi na cukrzycę i kobietami bez tego schorzenia. Wśród kobiet z MetS oraz z CAD (n = 16) stwierdzono istotnie zmniejszoną aktywność PON1 (podstawową i po stymulacji solą) w porównaniu z osobami bez CAD (odpowiednio p = 0,008; p = 0,004). Wnioski: U kobiet z CAD i MetS aktywność PON1 w surowicy jest istotnie zmniejszona. Zespół metaboliczny per se nie powoduje zmiany aktywności PON1. Kardiol Pol 2010; 68, 11: 1219-122

Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow

Abstract Background: The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF). Methods: In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient. Results: The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis. Conclusion: Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies