Simultaneous thrombosis of multiple coronary arteries in a patient with rheumatoid arthritis.

We present a case of simultaneous coronary thrombosis of the left main, the left anterior descending artery and the right coronary artery in a patient, recently diagnosed with rheumatoid arthritis.

Does autonomic dysfunction exist in postmenopausal osteoporosis?

OBJECTIVE: The aim of this study was to investigate the presence of autonomic dysfunction in patients with osteoporosis. DESIGN: This is a prospective controlled trial. Sixteen postmenopausal female patients with osteoporosis and 10 age-matched postmenopausal nonosteoporotic controls were included in the study. Participants were divided into the postmenopausal osteoporosis group and the nonosteoporotic control group according to bone mineral densities. Heart rate variability parameters and sympathetic skin responses were studied to evaluate autonomic functions. RESULTS: The latencies of sympathetic skin responses obtained from both hands were significantly increased in the patient group when compared with the control group. The sympathetic skin response amplitude of the right hands and both feet of the patient group were found to be decreased significantly when compared with that of the control group. A 24-hr high-frequency value was significantly decreased in the patient group than in control group. A 24-hr low-/high-frequency value was significantly higher in the patient group than in the control group. CONCLUSIONS: Autonomic dysfunction characterized with increased sympathetic and decreased parasympathetic activity may be present in osteoporosis, and cardiac functions in patients with osteoporosis may also be affected by accompanying autonomic dysfunction.

Correlations between autonomic dysfunction and circadian changes and arrhythmia prevalence in women with fibromyalgia syndrome.

OBJECTIVE: It is known that increased sympathetic activity and decreased parasympathetic activity are present in patients with fibromyalgia syndrome (FMS). This study aims to investigate the correlations of autonomic dysfunction and differences in autonomic circadian activity with arrhythmia prevalence in women with FMS. METHODS: Fifty female patients with FMS and 30 healthy female controls were included in this cross-sectional, case-controlled study. A 12-lead electrocardiogram and 24-hour Holter monitoring were performed in all patients to evaluate arrhythmias and autonomic function tests. Heart rate variability (HRV) parameters were utilized to detect autonomic dysfunction in patients with FMS. HRV measurements were performed in total 24-hour, day time (06:00-22:59), night time (23:00-05:59) periods and during autonomic tests (stand - supine, inspiration-expiration and Valsalva tests) using 24-hour Holter monitoring recordings. Student t-test , Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The correlation of data was tested by using Spearman correlation analysis. RESULTS: The mean ages of the patient and control groups were 38+/- 7.4 and 36+/- 8.1 years, respectively. In HRV measurements, high frequency (HF) power, was significantly decreased in the patient group as compared with control group (167.4 msec2 (107.0- 312.0) vs.314.5 msec2 (124.0- 905.0), p=0.017). The low frequency/HF ratio (LF/HF) values for total 24 hours (2.22+/- 0.18 vs. 1.22+/- 0.12, <0.001) and in the night time period (2.78+/- 1.97 vs.1.15+/- 0.77, <0.001) were found to be significantly higher in the patient group than in control one. The ratio of LF/HFDay / LF/HFNight was markedly higher in the control group (2.67 (1.22- 5.65) vs. 1.45 (0.83- 2.05), p=0.004). The prevalence (p=0.028) and total number (127.1+/- 21.4 vs. 187.3+/- 62.3, p=0.019) of supraventricular extrasystoles in 24-hour period was higher in the patient group. CONCLUSION: The sympathetic activity was significantly increased and parasympathetic activity significantly decreased in FMS patients. Additionally, significant autonomic circadian activity changes were also detected in these patients. These autonomic changes might be linked to increased arrhythmia prevalence.

QT interval and dispersion differences between normal and prehypertensive patients: effects of autonomic and left ventricular functional and structural changes.

OBJECTIVE: We aimed to investigate the effects of autonomic and left ventricular functional and structural changes on QT interval and dispersion differences between normal and prehypertensive patients. METHODS: A total of 291 normotensive patients (<140/90 mmHg) (135 males, age range: 16-75 years, mean age: 45+/- 11 years; 156 females, age range: 17-71 years, mean age 38+/- 10 years) were enrolled into this cross-sectional case-controlled study. Patients were categorized into two groups according to their blood pressure (BP) levels as Group 1 - patients with normal BP (<120/80 mmHg) or Group 2 - patients with prehypertensive BP (120-139/80-89 mmHg). We evaluated autonomic states by using heart rate variability measurements. Left ventricular structure and functions were evaluated by using Doppler echocardiography in both normal and prehypertensive BP groups regarding their effect on QT intervals and QT dispersion. Statistical analyses (Student's t and Mann-Whitney U tests) were used to evaluate the differences in QT intervals and QT dispersion between the BP groups. RESULTS: There were statistically significant differences between the two BP groups with respect to QT intervals and QT dispersion (for QT min, p<0.001, QTc min, p<0.001 and QT dispersion, p<0.001). We also detected that prehypertensive patients had increased sympathetic activity and slightly impaired left ventricular systolic and diastolic function (for low frequency power / high frequency power ratio -p=0.029, left ventricular ejection fraction - p=0.054, and transmitral peak A wave velocity - p<0.001). CONCLUSION: QT interval and dispersion differences are present in prehypertension. Moreover, these differences are independent of left ventricular mass. Autonomic changes can be effective on these differences between the patient groups.

Differences in left ventricular structure, functions and elastance in the patients with normotensive blood pressure.

OBJECTIVE: We aimed in this study to investigate the differences in left ventricular (LV) structure, function and elastance parameters in the patients with normotensive blood pressure (BP) levels. METHODS: A total of 294 normotensive patients (<140/90 mmHg) (135 males, mean age: 45+/-11 years; 159 females, mean age 38+/-10 years) were enrolled into the present cross-sectional study. Patients were categorized into three groups according to their BP levels as optimal BP (<120/80 mmHg), normal BP (120-129 / 80-84 mmHg) and high normal BP (129-139 / 84-89 mmHg) groups. We evaluated LV structure and functions by using Doppler echocardiography in all participants. Afterwards we compared the measurements for revealing the echocardiographic differences among the BP groups. In this study, one-way ANOVA Kruskal-Wallis, one-way ANCOVA and partial correlation analysis tests were used for the statistically evaluation of the data. In addition, relative risk ratios (RR) were also calculated for determination of the effects of BP levels to echocardiographic parameters. RESULTS: There were significant statistical differences in left atrial diameter (LA) (p=0.002), transmitral A wave velocity (A) (p=0.002), meridional wall stress (MWS) (p<0.001), pulmonary capillary wedge pressure (PCW) (p=0.029) among BP groups. After the correction of the data for anthropometric measurements, multiple comparisons have shown that only end-systolic (Es) and end-diastolic elastance (Ed) were different between the normal and high-normal BP groups (for Es, p=0.013; for Ed, p=0.007). But it was found that optimal BP group had significant differences in LV structure and function parameters when compared to high normal BP group (for LA, p=0.028; for A, p=0.035; for MWS, p=0.002; for Es, p<0.001; for Ed, p<0.001). Besides, increased RR were detected for increased left atrial diameter index and pulmonary capillary wedge pressure values in high-normal BP group (RR: 1.537, 95% CI (1.197-1.974), p=0.005 and RR: 1.272, 95% CI (1.089-1.485), p=0.032, respectively). CONCLUSION: Pathologic changes in LV due to increasing BP begin at below-hypertensive BP levels. It could be possible that normal BP stage is the beginning level of these changes.

Effects of statin treatment on serum sex steroids levels and autonomic and erectile function.

OBJECTIVES: To investigate the effect of statin treatment on serum sex steroid levels, heart rate variability, erectile function, and libido in patients with hyperlipidemia. METHODS: A total of 74 patients (mean age 44.7 +/- 7.1 years) with hyperlipidemia were enrolled into this study. After a cardiac examination, the serum lipid levels were measured, and the 24-hour Holter monitoring, heart rate variability, and autonomic test results were also evaluated. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire. Later, atorvastatin 40 mg/day was initiated in all patients and used for the subsequent 12 months. All diagnostic tests (cardiac, biochemical, and autonomic and the IIEF questionnaire) were performed again at 6 and 12 months of follow-up. RESULTS: A statistically significant decrease was found in the serum lipid levels at 6 months (P <0.05). In contrast, the average IIEF scores (24.7 +/- 6.4 at baseline) had increased to 25.0 +/- 4.9 and 26.1 +/- 5.9 at 6 and 12 months of follow-up, respectively. Although the parasympathetic activities increased and sympathetic activities decreased with atorvastatin treatment, these changes were not statistically significant (P >0.05). In paired comparison, significant differences were found among the IIEF scores of the three periods (P = 0.013). The difference was more evident after 6 months of treatment (IIEF(1vs2) = 0.475; IIEF(1vs3) = 0.027; IIEF(2vs3) = 0.012). CONCLUSIONS: Although improvement in the lipid profile occurred early during the statin treatment, restoration of erectile function appeared later, which could be attributed to the restoration of endothelial functions by lowered serum lipid levels.