ABSTRACT
To assess exercise heart rate recovery [HRR] indices in patients with systemic sclerosis [SSc] for an assessment of their cardiac autonomic function. Thirty-five patients with diffuse or limited SSc and 35 healthy controls were enrolled. All subjects underwent exercise testing and transthoracic echocardiography. The HRR indices were calculated by subtracting the first- [HRR1], second- [HRR2] and third-minute [HRR3] heart rates from the maximal heart rate. The SSc and control groups were similar in age [45.2 +/- 11.6 vs. 43.9 +/- 10.0 years], had identical gender ratios [31 female/4 male in both groups] and similar left ventricular ejection fraction [66.5 +/- 5.1 vs. 67.7 +/- 5.9%]. The mean HRR1 [21.8 +/- 4.4 vs. 27.7 +/- 4.3 bpm, p = 0.001], HRR2 [43.8 +/- 6.3 vs. 47.6 +/- 4.4 bpm, p = 0.004] and HRR3 [58.8 +/- 10.3 vs. 63.6 +/- 7.3 bpm, p = 0.031] values were significantly lower in the SSc group than in the healthy controls. HRR indices were similar in the limited and diffuse SSc subgroups. The patients with SSc had lower HRR indices than normal subjects. Cardiac autonomic functions might be involved in SSc, even in patients without cardiac symptoms
ABSTRACT
Background Multidetector computed tomography (MDCT) coronary angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. The purpose of this study is to investigate the effect of age and coronary plaque calcification on diagnostic accuracy of MDCT. Methods The patients were examined by using dual-source MDCT and conventional coronary angiography. MDCT results were analyzed with regard to the severity (>50%stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model. Results In total, 181 patients (94 men and 87 women) with 2,687 coronary artery segments were examined with MDCT. Ninety three patients were older than 65 years of age (group A, 42 men) and 88 were younger (group B, 52 men). Two-hundred nine coronary artery segments (7.2%) were ex-cluded because of small distal coronary vessel segments and/or motion artifacts. The overall number of segments with non-diagnostic image quality was similar in both groups of patients. Of the 2,687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value, specificity, and negative pre-dictive value were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8%in group B, respectively. In addition, detailed segment-based analyses in coronary segments with non-calcified, mixed and calcified plaques in both groups were simi-lar diagnostic accuracy. Conclusions Very high diagnostic accuracy observed in this study suggests that MDCT coronary angiography could be a suitable diagnostic tool for not only younger patients but also for older patients.
ABSTRACT
It was the aim of this study to report an aborted cardiac arrest due to ventricular fibrillation and electrocardiographic changes consistent with Brugada syndrome due to liquorice-induced hypokalemia. Clinical Presentation and Intervention: Ventricular fibrillation was witnessed in a 50-year-old woman who was admitted to our emergency department with a history of liquorice ingestion, a herbal product. After stopping liquorice ingestion, the Brugada-like electrocardiographic pattern changed progressively with potassium replacement. A diagnosis of Brugada syndrome was made after the ajmaline challenge test. The patient was discharged with an implantable cardioverter defibrillator and had an uneventfull follow-up. This report illustrates the importance of the investigation for herbal medications in the detailed history of a patient in the cases of electrolyte disturbances and the potential role of hypokalemia in the induction of malignant arrhythmia in Brugada syndrome
ABSTRACT
Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.
Subject(s)
Aged , Humans , Male , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/diagnosis , Postoperative Complications/diagnosis , Subclavian Steal Syndrome/diagnosis , Tachycardia, Ventricular/pathologyABSTRACT
To evaluate the roles of surface electrocardiogram ECG and transthoracic echocardiography ECHO for prediction of atrial fibrillation AF after coronary artery bypass grafting CABG. This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion PWD was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 24% cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively 60 +/- 19 versus 47 +/- 13, p=0.003, postoperative first day 56 +/- 12 versus 44 +/- 11, p<0.002 and fifth day 51 +/- 29 versus 41 +/- 11, p<0.001. Patients with AF were significantly older, the mean age of the AF group was 68 +/- 7 years and of the sinus rhythm SR group was 59 +/- 10 years p<0.001. The AF group had left ventricular systolic dysfunction 56 +/- 13% versus 56 +/- 8%, p=0.042, preoperatively; 49 +/- 8% versus 60 +/- 10%, p=0.001, postoperatively and a larger left atrium 46 +/- 5 versus 39 +/- 5 mm, p<0.001, preoperatively and 44 +/- 7 versus 39 +/- 5 mm, p=0.046, postoperatively than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG