Effects of lying position on p-wave dispersion in patients with heart failure

It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion [PWD] in patients with heart failure [HF]. Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram [ECG] recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration [100.0 +/- 14.5 and 84.7 +/- 16.2 ms; p = 0.001] and a significant decrease in PWD [41.7 +/- 8.0 and 24.1 +/- 7.1 ms; p < 0.0001]. After the left lateral decubitus position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 40.2 +/- 9.7 ms; p = 0.606]. After the supine position, there was no significant change between the baseline PWD values [41.7 +/- 8.0 and 39.7 +/- 9.4 ms; p = 0.427]. Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored

Relationship between renal stone formation, mitral annular calcification and bone resorption markers

Mitral annular calcification [MAC] is associated with osteoporosis and there is evidence of reduced bone mineral density [BMD] in patients with renal stone formation [RSF]. Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. Fifty-nine patients [mean age, 41.5 years] with RSF and 40 healthy subjects [mean age, 44.2 years] underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. MAC was diagnosed in 11 [18%] patients with RSF compared with 1 [2.5%] control [P=.01]. Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower [P<.001, P=.02, P<.001, P<.001 and P<.001, respectively], but serum alkaline phosphatase, calcium and potassium levels were higher [P=.008, P=.007 and P=.001, respectively] in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative [more osteopenic] in patients and subjects with MAC than in those without MAC [P=.01 and P=.004, respectively]. In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC [P=.03 and P=.04, respectively]. Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies

Electrical cardioversion

External electrical cardioversion was first performed in the 1950s. Urgent or elective cardioversions have specific advantages, such as termination of atrial and ventricular tachycardia and recovery of sinus rhythm. Electrical cardioversion is life-saving when applied in urgent circumstances. The succcess rate is increased by accurate tachycardia diagnosis, careful patient selection, adequate electrode [paddles] application, determination of the optimal energy and anesthesia levels, prevention of embolic events and arrythmia recurrence and airway conservation while minimizing possible complications. Potential complications include ventricular fibrillation due to general anesthesia or lack of synchronization between the direct current [DC] shock and the QRS complex, thromboembolus due to insufficient anticoagulant therapy, non-sustained VT, atrial arrhythmia, heart block, bradycardia, transient left bundle branch block,myocardial necrosis, myocardial dysfunction, transient hypotension, pulmonary edema and skin burn.Electrical cardioversion performed in patients with a pacemaker or an incompatible cardioverter defibrillator may lead to dysfunction, namely acute or chronic changes in the pacing or sensitivity threshold.Although this procedure appears fairly simple, serious consequences might occur if inappropriately performed

Effect of coronary collateral vessels in left ventricular segmental motions and myocardial viability using color kinesis dobutamine stress echocardiography

To detect the functional importance of coronary collaterals, which develop after acute myocardial infarctions [AMI]. Forty patients with acute AMI whose coronary angiography demonstrated a total occlusion of the left anterior descendant [LAD] artery were included in the study, between January 2003 and June 2004. All of the study patients underwent coronary angiography and left ventriculography using standard Judkins techniques [Phillips Integris-3000]. Left ventricular [LV] free walls were divided into 5 segments, and all of these segments motions were evaluated then LV free wall motion score index [WMSI] was calculated. The study patients were divided into 2 groups: good [Rentrop 3; group I; n = 14] and poor coronary collateral circulation [Rentrop 0-2; group II; n = 26] according to the Rentrop grading. Then, color kinesis dobutamine stress echocardiography [CK-DSE] was performed to all patients with standard techniques 6 weeks after AMI. There were no significant differences for age, gender, risk factors for the coronary artery disease and use of the fibrinolytic therapy between the groups. There were no significant statistical differences for angiographic WMSI, left ventricular ejection fraction [LVEF], end-diastolic volume, end-systolic volume and end-diastolic pressures between the 2 groups. No difference was detected between Group I and II for initial EF, WMSI and peak dose WMSI in CK-DSE procedure. Viability was determined in all of the 14 patients in group I [100%] and 12 of 26 patients in group II [46%] [p=0.03]. In early periods of an AMI genesis of the coronary collateral circulation does not affect left ventricular global and regional systolic functions, but increase viability quite significantly. According to our findings early revascularization could be carried out in patients with good coronary collateral circulation without doing any test for viability