ST elevation in inferior derivation, coronary ectasia, and slow coronary flow following ceftriaxone use.

A 24-year-old male patient presented with acute coronary syndrome with ST elevation following an allergic reaction to ceftriaxone. A coronary angiogram revealed ectasia and slow coronary flow in the right coronary artery, whereas the left coronary system was found to be normal. The patient was transferred to the coronary intensive care unit and given steroids, antihistamines, acetylsalicylic acid, clopidogrel, low­molecular weight heparin, and diltiazem. In this case study, we presented acute coronary events following an allergic reaction to ceftriaxone.

Acute effect of methylphenidate on QT interval duration and dispersion in children with attention deficit hyperactivity disorder.

Among childhood psychiatric disorders, attention deficit hyperactivity disorder (ADHD) is of greatest interest to practitioners. Methylphenidate (MPH) is a drug that is widely used in the treatment of children in whom ADHD has been diagnosed. Although this treatment has been used for years, its effects on the heart remain the subject of debate. The QT interval comprises the ventricular activation and recovery periods as seen on electrocardiogram (ECG). The acute effect of MPH on QT interval dispersion is unknown. Researchers in the present study sought to investigate the acute effects of MPH on QT interval as seen on ECG. A total of 25 patients with ADHD (mean age, 9.4+/-2.1 y) who were treated with MPH were enrolled in the study. Twelve-lead derivation ECGs were taken before and 2 h after administration of 10 mg of MPH. Maximum QT interval, minimum QT interval, and interval durations were measured, and QT dispersion was calculated, for each ECG. QT dispersion measured after medication administration decreased significantly from 59.6+/-16.3 ms to 50.8+/-10.9 ms (P=.016); corrected QT dispersion decreased significantly from 70.9+/-17.6 ms to 61.3+/-13.3 ms (P=.011). Maximum QT interval duration decreased from 73.7+/-21.8 ms to 361.8+/-29.0 ms (P=.006); minimum QT interval duration rose from 317.0+/-23.3 ms to 322.3+/-21.6 ms (P=.312). In conclusion, the findings of this study show that MPH reduces QT dispersion during the acute period shortly after its administration.

Acute effects of smoking on right ventricular function. A tissue Doppler imaging study on healthy subjects.

BACKGROUND: Smoking is a risk factor for cardiovascular mortality and morbidity. Besides chronic effects, it has unfavourable effects in the acute period. Although there are plenty of data regarding its effect on left ventricle functions, the effect of cigarette smoking on right ventricular function in the acute period is unknown. The objective of this study was to investigate the effect of cigarette smoking on the right ventricular function. METHODS: Twenty healthy young male were evaluated by echocardiography before and after smoking one cigarette. Heart rate, blood pressure, mitral and tricuspid inflow parameters as well as annulus velocity parameters were obtained. Pulmonary artery acceleration time was measured as a surrogate marker for pulmonary artery pressure. Results at baseline and at minutes 5, 15, 30, 60; consecutively after smoking were compared. RESULTS: There was not any significant change at left ventricular diastolic function with pulsed wave Doppler echocardiography, however right ventricular diastolic function was significantly impaired. Both right and left ventricle diastolic functions were impaired significantly with tissue Doppler echocardiography though there was no change at systolic functions. Pulmonary artery pressure increased significantly concomitant with impairment of right ventricular diastolic dysfunction. All the changes seen after smoking a cigarette almost returned to baseline levels after 30 minutes. CONCLUSIONS: Cigarette smoking does not change right ventricular systolic function however impairs right ventricular diastolic function in the acute period. Its effect on diastolic function may be related to increased afterload due to increase in pulmonary artery pressure.

Bisoprolol improves echocardiographic parameters of left ventricular diastolic function in patients with systemic hypertension.

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol's effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.

Live three-dimensional transthoracic echocardiographic assessment of anomalous origin of left coronary artery from the pulmonary artery.

We describe live three-dimensional transthoracic echocardiographic (3DTTE) findings in a 52-year-old female who had previously undergone an aortopulmonary tunnel operation for anomalous origin of the left coronary artery (ACA) from the pulmonary artery. Three-dimensional transthoracic echocardiography clearly delineated the origin of the ACA from the posterolateral aspect of the main pulmonary artery just above the pulmonary valve, the surgically created tunnel, as well as a small defect in the tunnel near the aortic end communicating with the pulmonary artery.

Transesophageal and transpharyngeal ultrasound demonstration of reversed diastolic flow in aortic arch branches and neck vessels in severe aortic regurgitation.

In the current study, we describe an adult patient with torrential aortic regurgitation due to an aortic dissection flap interfering with aortic cusp motion, in whom a transesophageal echocardiogram with the probe positioned in the upper esophagus and transpharyngeal ultrasound examination demonstrated prominent reversed flow throughout diastole in the left subclavian, left vertebral, left common carotid, and left internal carotid arteries. Another unique finding was the demonstration of aortic valve leaflets held in the fully opened position in diastole by the dissection flap as it prolapsed into the left ventricular outflow tract, dramatically documenting the mechanism of torrential aortic regurgitation in this patient.