Influence of recurrent electroconvulsive therapy on cardiac function

To investigate the effects of recurrent electroconvulsive therapy [ECT] on cardiac function as assessed by echocardiography. Twenty-three patients [11 males and 12 females] with different psychiatric disorders who were apparently free of any cardiovascular disorders and underwent ECT were enrolled in the study. Echocardiographic findings including diastolic mitral inflow and tissue Doppler features were recorded at baseline and at the end of the 7th and last ECT in all patients. The mean age of the patients was 37.95 +/- 13.28 years [range 19- 71]. There was no significant difference in mitral E wave velocities and tissue Doppler E' velocities between the baseline and after the 1st ECT [p = 0.161 and p = 0.083, respectively]. The results were similar after the last ECT session [p = 0.463 and p = 0.310, respectively]. However, there was a significant increase in transmitral A wave velocity after the 1st and 7th ECT session compared to the values at baseline [p = 0.008 and p = 0.017, respectively]. The mitral diastolic inflow A wave velocity increased 20 min after ECT, and this increase persisted after recurrent ECT sessions. This finding could be considered as an indicator of acutely increased sympathetic tone

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

An Iatrogenically Unmasked Life Threatening Disease: Brugada Syndrome

Brugada syndrome is a life threatening disease that is usually overlooked during emergency service admissions. It is characterized by typical electrocardiography resembling right bundle branch block, static or dynamic ST-segment elevation in leads V 1-3. There is familial tendency in some cases. A majority of patients have a structurally normal heart and are likely to remain asymptomatic, however they may present to emergency departments with syncope and various serious arrhythmias. Therefore it is crucially important for emergency medicine physicians not to omit this potential diagnosis. Herein we report a case with Brugada syndrome which was iatrogenically unmasked after propafenone administration for atrial fibrillation.

Recurrent Prosthetic Mitral Valve Dehiscence due to Infective Endocarditis: Discussion of Possible Causes

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.

Coronary sinus dilatation a simple additional echocardiographic indicator of severe rheumatic mitral and tricuspid valve disease

To evaluate the usefulness of examining the coronary sinus [CS] anatomic diameter as an additional surrogate marker of severity in chronic rheumatic valve disease [RVD]. In this cross-sectional observational study, we echocardiographically analyzed 88 patients with RVD, and 104 normal subjects in the Department of Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey between February 2007 and April 2007. Echocardiographically all valve regurgitation, stenosis, left ventricular function, left/right atrial volume, and pulmonary artery pressure were obtained. Coronary sinus was assessed as a sonolucency in the posterior atrioventricular groove. Strong positive correlation was present between CS measurements and mitral mean gradient, mitral and tricuspid regurgitation grade, tricuspid stenosis gradient, pulmonary artery systolic pressure, left and right atrial volume, and New York Heart Association class. A statistically negative correlation was present between CS measurements and mitral valve area and ejection fraction. Only the mitral valve area, tricuspid regurgitation grade, and the right atrial volume were predictors of body surface area adjusted mean CS dilatation. In this preliminary study, we showed that echocardiographic assessment of dilated CS may provide useful additional information in predicting the severity of mitral/tricuspid RVD. Findings of this study needs to be confirmed in further studies