Comparison of the acute hemodynamic effect of right ventricular apex, outflow tract, and dual-site right ventricular pacing.

BACKGROUND: We studied the acute effect of pacing at the right ventricular outflow tract (RVOT), right ventricular apex (RVA) and simultaneous RVA and RVOT-dual-site right ventricular pacing (DuRV) in random order on systolic function using impedance cardiography. METHODS: Seventy-three patients (46 males), aged 52-89 years (mean 71.4 years) subjected to routine dual chamber pacemaker implantation with symptomatic chronic II or atrioventricular block, were included to the study. RESULTS: DuRV pacing resulted in significantly higher cardiac index (CI) in comparison to RVOT and RVA and CI at RVOT was higher than at RVA pacing (2.46 vs 2.35 vs 2.28; P < 0.001). In patients with ejection fraction >50% significantly higher CI was observed during DuRV pacing when compared to RVOT and RVA pacing and there was no difference of CI between RVOT and RVA pacing (2.53 vs 2.41 vs 2.37; P < 0.001). In patients with ejection fraction <50%, DuRV and RVOT pacing resulted in significantly higher CI in comparison to RVA pacing while no difference in CI was observed between RVOT and DuRV pacing (2.28 vs 2.21 vs 2.09; P < 0.001). CONCLUSION: Dual-site right ventricular pacing in comparison to RVA pacing improved cardiac systolic function. RVOT appeared to be more advantageous than RVA pacing in patients with impaired, but not in those with preserved left ventricular function. No clear hemodynamic benefit of DuRV in comparison to RVOT pacing in patients with impaired systolic function was observed.

Dyspnea as a dominant clinical manifestation in a patient with takotsubo cardiomyopathy treated for chronic obstructive pulmonary disease and hyperthyroidism.

This paper discusses the case of a female patient treated for chronic obstructive pulmonary disease and hyperthyroidism, who also had takotsubo cardiomyopathy with dyspnea at rest as a dominant clinical manifestation.

[Haemobilia in the course of acenocoumarol overdosage in patient with cholelithiasis--case report]. / Hemobilia w przebiegu przedawkowania acenokumarolu u pacjentki z kamica zólciowa--opis przypadku.

Haemobilia is a rare cause of acute upper gastrointestinal bleeding and is often associated with a history of hepatic or biliary tract injury, tumor growth, hepatic artery aneurysm, cholecystitis, or hepatic abscess. We report a case of a 79-year-old women with haemobilia due to acenocoumarol overdosage. She has been, taking 12 mg acenocoumarol by mistake for 5 days before admission because of atrial fibrillation. INR was 20 during an admission. Ultrasonographic evaluation demonstrated hepatomegaly, cholelithiasis, thick sludge in gallbladder represented blood clots and also dilated biliary tract. Cholecystectomy was carried out. The cut section of gall bladder showed stone, haemolysed blood and blood clots. Choledochotomy showed only blood clots within the duct. The treatment lasted long period and patient died because of multiorgan insufficiency in the course of sepsis.

Circadian rhythm of spectral indices of heart rate variability in healthy subjects.

Circadian pattern of heart rate variability spectral indices, including hourly, 24-hour, night, day, morning, and sex-adjusted measures of low frequency (LF), high frequency (HF), and LF/HF, was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. HF showed circadian pattern with the greatest night values and LF/HF with the smallest night values. Peaks of hourly LF were found between 5 and 9 am and between 4 and 6 pm. The smallest LF was between 11 pm and 3 am. Hourly HF peaked between 11 pm and 5 am. The smallest HF was observed between midday and 2 pm. LF/HF peaked between 6 and 9 am as well as between 4 and 6 pm with the smallest values between midnight and 5 am. Sex adjustment was of no significance. In healthy subjects, HF and LF/HF have circadian pattern. Evaluation of all 5-minute intervals of 24-hour period seems to be a precise method of heart rate variability analysis.

Circadian rhythm of the QT interval dispersion in healthy subjects. Correlation with heart rate variability circadian pattern.

Circadian variation of QT interval dispersion (QTd) and heart rate variability spectral indices was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. Mean values, SD, and SD/mean were evaluated for 24 hours, each hour separately and in night, day, and morning periods. Table Curve 2D and multiple regression were applied to find correlations between parameters. In 50% of subjects, a significant negative correlation was revealed between QTd and HF. Also, in 50% of persons, a significant positive correlation was found between QTd and low frequency/high frequency. After adjustment for periods, correlations were only observed during morning hours. With Table Curve 2D, 2 models of correlations between QTd and HF were found. Multiple regression analysis revealed relations between mean QTd and R-R as well as mean QTd and HF. It is possible that it is sympathovagal balance, as reflected in heart rate variability, and not the tone of both autonomic components that affects QTd variability.

[Splenic abscess in the course of infective endocarditis--report of a case]. / Ropien sledziony w przebiegu infekcyjnego zapalenia wsierdzia--opis przypadku.

Infective endocarditis is the most common condition predisposing a patient to splenic abscess. We report the case of man aged 65 who was admitted to the Internal Medicine Department to diagnose the fever of unknown origin. The fever lasted longer than one year. Clinical status and executed diagnostics, among others: echocardiography, blood cultures, abdominal ultrasonography, abdominal computed tomography allowed to give the diagnosis splenic abscess caused by Acinetobacter Baumanii in the course of infective endocarditis. Patient was treated by splenectomy and antibiotics. As a result of the treatment normalization of temperature and recovery was obtained.

G-protein beta3 subunit gene C825T polymorphism is associated with arterial hypertension in Polish patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes mellitus type 2 results from a complex of hereditary and environmental factors. Genes encoding elements of the G-protein system are candidate genes in hypertension and obesity. Since insulin uses G-sensitive mechanisms to enhance tissue glucose uptake and vasodilatation, the GNB3 gene may be a candidate gene in type 2 diabetes. The goal of our research was to determine if the C825T polymorphism at the G-protein b3 subunit gene locus is associated with type 2 diabetes. MATERIAL/METHODS: The study population consisted of 172 Polish patients with type 2 diabetes and 172 healthy, age- and sex-matched controls. The C825T polymorphism was detected by PCR and RFLP. RESULTS: A higher frequency of genotypes containing the mutation (CT+TT) was observed among the diabetics than in the controls. The T825 variant occurred more often among hypertensive diabetics (71%) than among diabetics with normal blood pressure (42.5%). The OR for hypertension in diabetic subjects bearing CT+TT genotypes was higher than in patients with the CC genotype. Overweight and obesity were not associated with the T825 variant in either the experimental subjects or the controls. CONCLUSIONS: In this population, the T825 variant of the GNB3 gene was not associated with type 2 diabetes itself, nor with overweight and obesity, but was associated with diabetic hypertension. Upon confirmation of our results this variant may be useful as a genetic marker of susceptibility to hypertension and vascular complications in type 2 diabetes.

Prognostic value of the atrial pulsed Doppler recordings of transmitral flow in the assessment of left ventricular diastolic dysfunction.

Volume sample location is the most important factor influencing pulsed Doppler recordings of left ventricular (LV) diastolic filling. Transmitral diastolic flow velocities measured at the tips of mitral valve leaflets are usually higher than those obtained from atrial location. Nevertheless, independently of volume sample location, differences between early to late velocities ratio (E/A) are nonsignificant, so E/A became the most useful index of ventricular diastolic performance. In some patients, however, with E/A > 1 measured between the tips of mitral leaflets, the pattern of delayed LV relaxation, with diminished E and predominant A wave (E/A < 1), is often obtained from left atrial volume sample location. The aim of our study was to compare LV dimensions and wall thickness between patients with E/A > 1 recorded both at the tips of mitral valve leaflets and in the left atrium and patients with E/A > 1 at the tips of mitral valve leaflets and E/A < 1 in the left atrium. The study population consisted of 51 patients with E/A > 1 recorded between the tips of mitral valve (E/Avent) and excluded pseudonormalized filling pattern. The study population was divided into two groups based on Doppler profile recorded in the left atrium: group A--26 patients with E/A < 1 (E/Aatr) and group B--25 patients with E/Aatr > 1. Patients from group A were significantly older (55.6 +/- 12.8 vs 43.5 +/- 10.5 yrs, p < 0.001) and had increased body mass index (28.8 +/- 4.4 vs 25 +/- 4.1 kg/m2, p < 0.01) compared to subjects from group B. The average thickness of intraventricular septum was 13.5 +/- 2.8 mm in group A and 9.7 +/- 1.6 mm in group B, the average thickness of LV posterior wall was 11.6 +/- 1.7 and 9.2 +/- 1.8 mm, respectively. The results of this study suggest that abnormal atrial recordings of diastolic flows may reflect the earliest stage of left ventricular diastolic dysfunction in asymptomatic patients with echocardiographic signs of mild cardiac damage.