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Transesophageal echocardiography (TEE) revealed a free-floating left atrial ball thrombus in a 56-year-old male patient who was taking warfarin for mechanical prosthetic mitral valve and had recently short-term warfarin interruption for noncardiac surgery and bridging with enoxaparin was admitted to an external center for left abdominal pain and after the detection of spleen and renal infarct, the patient was referred to us for further examination. The patient, who was considered to be at high risk for surgical intervention by the cardiac surgeons, was treated with a warfarin regimen and on the 14th day of the treatment, computed tomography (CT) scan showed that the thrombus disappeared. According to this case report, if patients who have a free-floating left atrial ball thrombus are at high risk for surgical intervention, warfarin therapy can be considered as an alternative to surgery.

Objectives: Early recognition and appropriate therapy of diastolic dysfunction (DD) is advisable to prevent further progression to diastolic or systolic heart failure and death. The mitral aUioventricalar plane displacement (AVPD) method has been shown to be a ...

Aim: The presence of coronary collaterals (CC) may exert a protective effect on outcome. Impaired collateral formation could be one of the reasons for increased risks of cardiovascular events. We aimed to determine the influence of clinical characteristics on the presence of CCs in patients with occlusive coronary artery disease. Materials and methods: This retrospective study enrolled one hundred and fourteen patients who had at least one total occlusion of a coronary artery on angiograms performed between July 2002 and December 2003 at the Department of Cardiology, Pamukkale University. CC flow was graded with Rentrop’s classification. Patients were divided in two groups: group 1 with well-developed collaterals and group 2 with less well-developed collaterals. Results: Demographic, clinical, and laboratory characteristics except the presence of q waves on ECG were similar between the two groups. The presence of q waves in leads V3-4 was associated with poor collateral development ...

Kardiyojenik şok ve mu/tip / pulmoner mikroemboliye neden olan bir sağ atriya/ tromboemboli olgusu, nadir olması sebebiyle bildirilmiştir. Sağ atriyumda serbestçe dolaşan, diyasro/ sırasında trikiispit kapaktan sağ ventrikiile prolabe olan ve sağ ventrikül giriş (inj7ow) ve çıkışmda ( outflow) tıkamklığa yol açan dii:ensiz geniş bir kitle iki boyutlu ekokardiyografi ile tespit edilmiştir. Acil operasyona alınarak kardiyopulmoner baypasa girilmeden, tromboembolik materyal sağ atriyumdan başarıyla çıkarılmıştır. Bu örnek vaka, antikoagülasyon ve trombolizis gibi daha konservati.f yöntemlerden ziyade cerrahi miidalıalenin ne kadar etkin o/duğımu vurgulamaktadır.

Objectives In this study, we evaluated the association between morning blood pressure surge (MBPS) levels and diastolic function parameters in patients with masked hypertension (MH). Methods A total of 92 patients with diagnosis of MH were enrolled in the study. Patients were divided into three groups according to their MBPS levels. Cardiac dimensions, left atrial volume and ejection fraction were determined by transthoracic echocardiography. A two-dimensional Doppler echocardiogram was performed to evaluate diastolic function parameters including transmitral E-wave and A-wave velocity, mitral annular E′ and A′ velocity, E wave deceleration time and isovolumic relaxation time. Results Mean MBPS value of the total study population was 25.1 ± 6.4 mmHg. When going from the lowest MBPS group to the higher MBPS groups; E velocity [0.75 (0.74–0.77) vs. 0.71 (0.69–0.73) vs. 0.68 (0.66–0.69) cm/s, respectively] E/A ratio [1.44 (1.40–1.48) vs. 1.35 (1.32–1.39) vs. 1.26 (1.23–1.29), respectively] and E′ velocity [0.114 (0.111–0.117) vs. 0.102 (0.100–0.105) vs. 0.093 (0.089–0.096) cm/s, respectively] were significantly decreased. E/E’ ratio [7.3 (6.9–7.7) vs. 6.6 (6.4–7.9), P = 0.002] and left atrial volume index [27.24 (25.5–28.9) vs. 21.90 (21.0–22.7) ml/m2, P < 0.001] were significantly higher in the highest MBPS tertile than the lowest tertile. There was a positive correlation between E/E’ ratio and MBPS values (r = 0.306, P = 0.003). Conclusion Increased MBPS levels were found to be related with deterioration of diastolic function parameters in patients with MH.

Kardiyak yakınması olmayan 60 tip-2 diabetik hastada, sessiz miyokard iskemisi ve onun otonom disfonksiyonla iliş­ kisi araştırıldı. Tüm hastalara otonom fonksiyon testlerinden sonra, egzersiz testi ve talyum miyokardperfüzyon sintigrafısi yapıldı. Sessiz iskemi grubu olarak, egzersiz testinde ST segnıentiııde > İmm depresyonu olan ve talyum miyokard per­ füzyon sintigrafısinde bunun reversible defektlerle destek­ lendiği olgular kabul edildi. Kardiyak otonomik disfonksiyon olarak, aşağıdaki testlerden iki ya da daha fazlasının anormal bulunması kabul edildi. Bu testler şunlardı;l)istirahat kalp hızının (15 dakikalık dinlenme sonrası) 100 atım/dakika, ya da üzerinde olması, 2) elektrokardiyografık olarak, derin soluk alıp vermekle atımlar arası hız farkının olmaması , ya da 10 alım/dakikadan az olması, 3) valsalva manevrası sırasındaki en uzun RR süresinin, en kısaya oranının 1,1 ya da allında ol­ ması, 4) hemen ayağa kalktıktan sonra 30. atım sıralarındaki RR süresinin, 15. atımdaki RR süresine oranının 1 ya da al­ tında olması, 5) bir dakikalık ayakta durmayı takiben alınan sistolik kan basıncında, 30mmHgya da üzerinde düşüş olması. Diabetik 60 hastanın 21'inde (%35) kardiyak otonom dis­ fonksiyon bulundu. Sessiz miyokard iskemisi 10 hastada ("•i)16,7) tesbit edildi ve sessiz miyokard iskemisi otonom disfonksiyonu olan hastalarda olmayanlara göre daha sıktı (%36'ya karşılık %5, p=0,0003). Sonuç olarak, sessiz miyokard iskemisinin, kardiyak otonom disfonksiyonu olmayan diabetiklerde o kadar da sık olmadığı, kardiyak otonom dis­ fonksiyon varlığında sıklığının arttığı söylenebilir.

Background: Physiologic adaptations in an athlete’s heart include increased left and right ventricular chamber size, left ventricular wall thickness and mass. Angiotensin-converting enzyme (ACE) is a key enzyme in angiotensin II production causing cardiac hypertrophy. The cloning of the ACE gene has made it possible to identifya deletion (D)-insertion (I) polymorphism that appears to affect the level of serum ACE activity. Therefore, the ACE genes, which have been shown to be polymorphic, could be candidate genes for large-artery stiffness. Methods: 56 endurance athletes and 46 sedentary subjects were included in this study, and they underwent both complete echocardiographic examination, and analysis of ACE insertion (I) and deletion (D) allele frequencies in peripheral blood. The aortic diameter was recorded by M-mode echocardiography at a level 3 cm above the aortic valve. Aortic systolic diameter was measured at the time of full opening of the aortic valve, and diastolic diameter...

Background — Hypertensive patients have both impaired endothelium-dependent vasodilation and increased activity of the endothelin (ET-1) system, which participate in their increased vascular tone and may predispose them to atherosclerosis. This study investigated the contribution of increased ET-1 activity to the impaired endothelium-dependent vasodilator function of hypertensive patients. Methods and Results — Forearm blood flow (FBF) responses to intraarterial infusion of acetylcholine (ACh; 7.5, 15, and 30 μg/min) and sodium nitroprusside (SNP; 0.8,1.6, and 3.2 μg/min) were assessed by strain-gauge plethysmography before and after nonselective blockade of ET A and ET B receptors by combined infusion of BQ-123 (ET A blocker; 100 nmol/min) and BQ-788 (ET B blocker; 50 nmol/min). During saline administration, the vasodilator response to ACh was significantly blunted in hypertensive patients compared with controls ( P <0.001), whereas the vasodilator effect of SNP was not differen...

Giriş: Ani kardiyak ölümlerde, otopsi kesin ölüm nedenini belirlemede ilk ve tek seçenektir. Avrupa Kardiyovasküler Patoloji Birliği tarafından, ani ölüm/ ani kardiyak ölüm tanımlamaları, otopsi prosedürü ve yapılması gereken laboratuvar tetkiklerinin açıklandığı, ani kardiyak ölümlerin otopsisi için güncellenmiş kılavuz yayınlanmıştır. Çalışmamızda bu kılavuzdan hareket edilerek, konu hakkında standart oluşturma çabasına yönelik temel multidisipliner teorik bilgi aktarımı ve kalp diseksiyonu beceri eğitimini de içeren, iki günlük bir eğitim şeklinde planlanan ve “Postmortem Kalp Okulu” adı altında uygulamaya konulan bir kurs programının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kurs, teorik ve uygulama eğitiminin yapıldığı iki kısım olarak planlamıştır. Katılan adli tıp uzmanlık öğrencilerinin bilgi düzeyinde, öğrenme hedeflerine ulaşıp ulaşamadıklarını saptamak amacıyla, kursun başlangıcı ve bitişinde kullanılmak üzere öğrenme hedeflerine uygun olarak 10 soruluk bir test o...

Both left ventricular hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth-promoting effect on cardiomyocytes. The purpose of this study was to examine the relationship between left ventricular structure, function and IR in patients with EH. We enrolled 73 patients (21 men, mean age 51.7 +/- 9.2 years) with untreated hypertension (BP > 140 and/or 90 mm Hg, fasting glycaemia < 110 mg/dl) and 64 healthy subjects without diabetes mellitus and hypertension (21 men, mean age 48.9 +/- 10.6 years) constituted the control group. In all subjects, transthoracic echocardiography was performed and blood samples were taken. Homeostasis model assessment (HOMA) was calculated by the formula: HOMA-index = fasting blood glucose (mg/dl) * immunoreactive insulin (microU/ml)/405 for the assessment of IR. Hypertensive patients were divided in two groups by mean HOMA index values. Each subject was examined for LV end-diastolic diameter, septal and posterior wall thickness, LV mass index (LVMI), fractional shortening (FS), mitral inflow velocity pattern, atrial filling fraction (AFF), left ventricular outflow velocity pattern and the total ejection isovolume index (TEI index). The HOMA index (p < 0.001), LVMI (p < 0.001), AFF (p < 0.0001), peak A velocity (p < 0.028), septal (p < 0.0001) and posterior (p < 0.0001) wall thickness were significantly higher and FS (p < 0.001), E/A ratio (p < 0.0001) were significantly lower in hypertensive patients than healthy controls. LVMI (p < 0.01) and septal wall thickness (p < 0.001) were significantly higher in those hypertensive patients with a higher HOMA index. The HOMA-index was univariately related to the TEI index (r = 0.27, p = 0.01) and septal wall thickness (IVS) (r = 0.29, p = 0.01) by Pearson correlation analysis in hypertensive patients. LVMI, FS and mitral inflow velocity pattern were not related to the HOMA index. The TEI index (R2 = 0.20, p = 0.0001) and IVS (R2 = 0.12, p = 0.002) were significantly related to the HOMA-index as an independent variable by stepwise regression analysis. These results demonstrated that hypertensive patients had both abnormal cardiac structure and function and higher IR index. In our study group, the effect of hypertension on cardiac structure and function was correlated with IR. Our results suggested that IR might be an important factor causing left ventricular dysfunction and wall thickness in non-diabetic patients with EH.

Preinfarction angina (PA) and early reperfusion of infarct-related arteries have been shown to reduce infarct size in patients with acute myocardial infarction (AMI). The beneficial effects of PA on infarct size have been attributed to the development of ischemic preconditioning and faster coronary recanalization in patients treated with thrombolytic therapy (TT). To evaluate the effect of PA on clinical coronary reperfusion time in patients with AMI receiving successful TT. Seventy-five patients presenting with AMI (within 6 h after the initial onset of symptoms) were studied. All patients received TT and were evaluated with coronary angiography (CA) at predischarge. The patients were divided into two groups: group 1 (PA-positive) comprised those who experienced a new onset of prodromal angina within 72 h before the onset of AMI. Group 2 (PA-negative) comprised those who had a sudden onset of AMI without the preceding angina. The successful myocardial reperfusion criteria after TT ...

Metabolic syndrome (MS) is a condition, which is recognized as raising the risk of cardiovascular disease. The aim of our study is to estimate the left ventricular functions by atrioventricular plane displacement (AVPD), myocardial performance index (MPI) and conventional methods in patients with MS who were diagnosed according to NCEP (ATP III) criteria. Fifty-three female patients with MS (mean age 53.1+/-6.9 years) and 30 healthy female subjects (mean age 52.8+/-6.3 years, p>0.05) underwent complete echocardiographic assessment. All of the subjects had no heart and pulmonary diseases. The systolic mitral AVPD was recorded at 4 sites (septal, lateral, anterior, and posterior) by M-mode echocardiography and left ventricle ejection fraction (LVEF) was calculated from the AVPD-mean (EF-AVPD). The LVEF was also established by biplane Simpson's (EF-2D) and Teichholz's methods (EF-T). Left ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation ...

Myocardial injury may complicate allergic reactions caused by several medications. We evaluated a case of a myocardial injury with transient ST segment elevation in a 72 year-old man presenting with collapse caused by sulbactam-ampicilllin assumption. The purpose of this report is to present this interesting case and revise the classification of Kounis syndrome.

The purpose of this study was to investigate the possible cardiovascular side effects of 4% cocaine solution in the presence of adrenaline during septal surgery. Sixty adult patients undergoing elective septal surgery with local anaesthesia were included in the study. Noses were packed with 5-mL 4% cocaine (200-mg) solution on cotton pledgets, which were left in the nose for 15 minutes. Then, 10 mL of local anaesthetic (lidocaine 2% and adrenaline 1:100,000) were infiltrated in septal mucosa, and 15 minutes later, the surgical procedure was initiated. At the beginning of the operation, intervals from 12-lead surface electrocardiograms and vital signs including blood pressures and heart rate were recorded as a baseline. All measurements were repeated just before local anaesthetic infiltration, just before the beginning of the surgical procedure, and, finally, at the end of the operation. All four measurements and electrocardiographic tracings were examined. Systolic and diastolic blood pressures and QT parameters, RR intervals, and heart rates obtained from electrocardiogram were compared statistically with repeated-measures analysis of variance. No statistically significant difference was found among all four staged measurements. None of the patients developed tachycardia, hypertension, hypotension, or any chest pain. In electrocardiogram tracings, no sinus tachycardia depression, elevation, or bundle branch block was noted. This study shows that concomitant use of cocaine and adrenaline in the proper concentration and volume and in a carefully screened patient group was safe for the cardiovascular system.

Changes in lipid profiles, Lp(a) lipoprotein, and acute phase reactants are associated with early atherosclerosis in rheumatoid arthritis (RA). The associations of Lp(a) levels with atherosclerotic disorders, diabetes, RA, and renal diseases suggest that Lp(a) might be involved in autoimmune reactions. Eighty-seven women with RA diagnosed according to American Rheumatism Association criteria (mean age 45.4+/-9.4 years) were recruited and 50 healthy women (mean age 44+/-10.7 years) included as a control group. Serum Lp(a), total cholesterol (TC), triglyceride (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and C-reactive protein levels were analyzed. In the RA and C groups, serum Lp(a) levels were 39.2+/-20.6 mg/dl and 14.8+/-9.7 mg/dl, respectively (P<0.001). The TC levels were 188.4+/-41.8 mg/dl and 185.3+/-19.3 mg/dl (P>0.05), TG levels were 124.5+/-50.1 mg/dl and 94.6+/-24.9 mg/dl (P<0.01), HDL-C levels were 40.0+/-7.4 mg/dl and 52.8+/-4.8 mg/dl (P<0.01), and LDL-C levels were 123.4+/-24.6 mg/dl and 113.3+/-21.1 mg/dl (P>0.05). While serum CRP levels showed a positive correlation with Lp(a), they correlated negatively with HDL-C levels (r=0.83 and P<0.0001, r=-0.49 and P<0.0001, respectively). It was meaningful that Lp(a) correlated negatively with serum HDL-C level (r=-0.36, P<0.001). It is suggested that higher serum Lp(a), lower HDL-C, higher TG level, and a high ratio of TC/HDL-C might show high risk of atherosclerosis. Inflammation in RA may cause changes in HDL-C and Lp(a) metabolisms.

Obstructive sleep apnea (OSA) has a critical association with cardiovascular mortality and morbidity. Carotid intima-media thickness (IMT), flow-mediated dilatation (FMD) and aortic stiffness are early signs of atherosclerosis. The presence of subclinical atherosclerosis was assessed in OSA patients using these parameters. 40 patients with OSA showing an apnea-hypopnea index (AHI) > or =5 (mean age 51.3 +/- 9 years, 32 males) and 24 controls (AHI < 5, mean age 51.9 +/- 5.2 years, 19 males) were enrolled in the study. In all subjects, polysomnographic examination and recordings were performed during sleep. IMT of the carotid artery, endothelium-dependent/-independent vasodilation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. The demographic data of the patients with OSA and controls were not significantly different. Subjects with OSA demonstrated higher values of aortic stiffness (7.1 +/- 1.88 vs. 6.42 +/- 1.56, respectively) and IMT (0.85 +/- 0.13 vs. 0.63 +/- 0.11 mm, p = 0.0001, respectively) but lower distensibility (9.47 +/- 1.33 vs. 11.8 +/- 3.36 cm(2)/dyn/10(6)) and FMD (4.57 +/- 1.3 vs. 6.34 +/- 0.83%, p = 0.0001, respectively) than the controls. The respiratory disturbance index correlated positively with aortic stiffness and IMT and negatively with distensibility and FMD. We observed blunted endothelium-dependent dilatation, increased carotid IMT and aortic stiffness in patients with OSA compared with matched control subjects. This is evident in the absence of other diseases, suggesting that OSA is an independent cause of atherosclerosis. These simple and non-invasive methods help to detect subclinical atherosclerosis in OSA.

Both left ventricular (LV) hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth promoting effect on cardiomyocytes rather than affecting the LV internal diameter. The purpose of this study was to examine the effect of IR on LV geometry. We enrolled 105 patients (71 females, mean age, 49.2 +/- 13.6 years) with recently diagnosed and untreated hypertension (blood pressure > 140 and/or 90 mmHg, fasting glucose < 110 mg/dL), and grouped them as normal (N) (39 patients, 26 females, mean age, 48.5 +/- 14.7 years) if all M-mode echocardiographic measurements were within normal limits, concentric remodeling (CR) (22 patients, 15 females, mean age, 50.5 +/- 14.8 years) if relative wall thickness was increased but left ventricular mass index (LVMI) was normal, concentric hypertrophy (CH) (13 patients, 9 females, mean age, 50.3 +/- 10.8 years) if both ventricular thicknesses and the LVMI were increased, and eccentric hypertrophy (EH) (31 patients, 21 females, mean age, 48.6 +/- 12.9 years) if ventricular thicknesses were normal, but LVMI was increased. Transthoracic echocardiography was performed in all subjects, and interventricular septal thickness (IVS), posterior wall thickness (PWT), sum of wall thickness (SWT), left ventricular end-diastolic internal diameter (LVED), relative wall thickness (RWT), and LVMI were recorded. Blood samples for routine biochemical examination and fasting insulin levels were obtained and then the homeostasis model assessment (HOMA) index was calculated by the formula: HOMA Index = Fasting Blood Glucose (mg/dL) x Immunoreactive Insulin (microU/mL)/405, for the assessment of IR. There were no significant differences among the groups with respect to age, blood pressure (BP) levels, fasting blood glucose (FBG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), total cholesterol (TC), or triglyceride (TG) levels. Insulin levels were significantly higher in the CR and CH groups in comparison with the N group (P = 0.004), and the HOMA index was higher in the CH group compared to the N group (P = 0.024). In Pearson's correlation analysis, insulin was found to be directly correlated with IVS (r = 0.29, P = 0.002), SWT (r = 0.25, P = 0.009), and RWT (r = 0.33, P = 0.0001). The HOMA index was also directly correlated with IVS (r = 0.33, P = 0.001), SWT (r = 0.29, P = 0.002), and RWT (r = 0.29, P = 0.003). Cardiac changes in hypertensive patients include increased LVMI and altered LV geometry. The concentric LV geometry seen in hypertensive patients might be mediated, at least in part, by increased insulin levels and the HOMA index.

SUMMARY Late potentials (LP) detected on the signal-averaged electrocardiogram (SAECG) pre-dict arrhythmic events after acute myocardial infarction (AMI). It is also well established that successful thrombolytic therapy reduces the incidence of LP. Our aim was to evaluate ...

Elevation of plasma homocysteine (Hcy) level has been implicated in the pathogenesis of slow coronary flow (SCF) as it can severely disturb vascular endothelial function. Helicobacter pylori chronically infect the human stomach and causes malabsorption of vitamin B(12) and folate in food, leading ultimately to an increase in circulating Hcy levels. Forty-three patients with angiographically proven SCF (group I) were enrolled in this study; 43 cases with normal coronary flow pattern (group II) served as controls. Fasting plasma levels of Hcy, vitamin B(12), and folate were measured in all subjects. Presence of H. pylori infection was defined as positive 14 C urea breath test. Coronary flow patterns for each major epicardial coronary artery were determined with the Thrombolysis in Myocardial Infarction (TIMI) frame count method. Mean TIMI frame count was 46.3 +/- 8.7 in group I and 24.3 +/- 2.9 in Group II (p = .0001). Vitamin B(12) levels were similar, whereas folate levels were dramatically reduced in group I compared to group II (13.2 +/- 4.3 vs. 17.1 +/- 5.2, p = .0001). Plasma Hcy levels were significantly higher in group I compared to group II (13.4 +/- 5.6 vs. 7.9 +/- 2.5, p = .0001) as was the prevalence of H. pylori infection (90.7% in group I vs. 58.1% in group II, p = .001). Hcy levels were elevated (11.7 +/- 5.3 vs. 7.5 +/- 2.7, p = .0001) and folate levels were reduced (13.9 +/- 4.7 vs. 18.6 +/- 4.9, p = .0001) in patients with H. pylori infection, while vitamin B(12) levels were similar in patients with and without H. pylori infection. Correlation analysis revealed a significant negative correlation between plasma folate and Hcy levels and also between folate levels and mean TIMI frame counts (r = -.33, p = .002 vs. r = -.33, p = .003). Moreover, there was a significant positive correlation between plasma Hcy levels and mean TIMI frame counts (r = .66, p = .0001). In addition, the folate level was the only significant determinant of the variance of Hcy in multiple regression analysis (r = -.21, p = .03). Our data showed that plasma folate levels were decreased and plasma Hcy levels were increased in patients with SCF compared to controls. Also, the prevalence of H. pylori infection was increased in patients with SCF. These findings suggest that elevated levels of plasma Hcy, possibly caused by H. pylori infection, and/or a possible disturbance in its metabolism may play a role in the pathogenesis of SCF.