Holter ECG assessment of the effects of three different local anesthetic solutions on cardiovascular system in the sedated dental patients with coronary artery disease.

OBJECTIVE: The purpose of the study is to compare the effects of lidocaine alone, epinephrine-combined lidocaine and prilocaine with octapressin on the cardiovascular system during minor oral surgery of sedated cardiac dental patients under local anesthesia. METHODS: Connected to a Holter electrocardiogram (ECG) monitor for a total of 5 hours starting 1 hour before the procedure, twenty patients with high risk of coronary artery disease were included in the prospective cohort study. All the patients had three operations at 3 different appointments with at least one-week intervals and each operation was performed under local anesthesia achieved by 3.6 mL of 3% prilocaine with octapressin, 3.6 mL of 2% lidocaine with 1:80.000 epinephrine and 3.6 mL of 2% lidocaine without a vasoconstrictor. Data of the Holter ECG device assessed at the end of every hour and evaluated statistically. Repeated measures ANOVA, Friedman test, and Wilcoxon signed ranks test were used to perform statistical analysis. RESULTS: Heart-rate showed significant differences between lidocaine with epinephrine and pure lidocaine in an hour following the injection (p<0.05 for all). Cardiac rhythm showed significant differences between prilocaine with octapressin and pure lidocaine at the second hour after its administration (p<0.05 for all). There were no significant differences between 3 local anesthetics in terms of ST segment deviation. CONCLUSION: In minor oral operation on the sedated patients with cardiac disease, the use of 3.6 mL or a less amount of local anesthetic injection containing epinephrine appears to be a predictable and safe method.

[Evaluation of hospitalization period and five-year follow-up of patients admitted with acute coronary syndrome following coronary artery bypass graft surgery]. / Koroner arter baypas ameliyatindan sonra akut koroner sendromla basvuran hastalarda hastaneiçi dönem ve bes yillik izlem.

OBJECTIVES: We evaluated patients admitted with the diagnosis of acute coronary syndrome (ACS) after coronary artery bypass graft (CABG) surgery. STUDY DESIGN: This retrospective study included 72 consecutive CABG patients (10 women, 62 men; mean age 63±9 years; range 45 to 83 years). Acute coronary syndrome was defined as the presence of unstable angina or myocardial infarction (MI) with or without ST elevation. Time from CABG surgery to admission with ACS was defined as bypass age. Following discharge, information was derived by phone calls from the patients or relatives on cardiovascular events within a five-year period. RESULTS: On admission, 14 patients (19.4%) had non-ST elevation MI, nine patients (12.5%) had ST elevation MI, and 49 patients (68.1%) had unstable angina. The mean bypass age was 5.6±3.5 years. Of the study group, 38.9% were obese, 25% were diabetic, 54.2% were hypertensive, 44.4% were hyperlipidemic, and 26.4% were current smokers. Medications before admission included aspirin (81.9%), statin (25%), beta-blocker (27.8%), ACE inhibitor or angiotensin receptor blocker (27.8%), and calcium channel antagonist (36.1%). Increased LDL cholesterol (≥100 mg/dl) and decreased HDL cholesterol (≤50 mg/dl) levels were present in 55.6% and 80.6%, respectively. Mortality occurred in 15 patients, four during hospitalization, and 11 after discharge. The overall mortality rate was 21.4%. In correlation analysis, mortality was positively correlated with age (r=0.34, p=0.005), bypass age (r=0.37, p=0.001), CRP level (r=0.31, p=0.033) and negatively correlated with beta-blocker use (r=-0.25, p=0.041) and ejection fraction (r=-0.37, p=0.016). CONCLUSION: Our results show that, following CABG surgery, special consideration should be given to risk factor management and use of agents with proven effects against cardiovascular mortality such as statins, beta-blockers, and ACE inhibitors.

[Egg consumption and cardiovascular health]. / Yumurta tüketimi ve kardiyovasküler saglik.

Egg has been accepted as a symbol of high cholesterol diet for years and its consumption has been a matter of debate for cardiovascular health. Clinical studies have yielded conflicting results, increasing the amplitude of arguments. This article reviews the current literature related to egg consumption and summarizes the merits and demerits of egg consumption on a scientific basis. Current guidelines recommend to restrict dietary cholesterol consumption to 200 mg daily for cardiovascular health. Therefore, when making dietary suggestions especially for patients with cardiovascular disease, diabetes, severe risk factors and hypercholesterolemia, or a family history of premature atherosclerosis, we should keep in mind that an average egg yolk contains >200 mg cholesterol even though its negative effect on serum lipid levels is less than that of other sources of dietary cholesterol.

Pseudonormalization: clinical, electrocardiographic, echocardiographic, and angiographic characteristics.

OBJECTIVE: Spontaneous pseudonormalization (PN) is a unique 12-lead electrocardiography (ECG) finding which has been reported to be associated with severe, transmural myocardial ischemia. To date, a paucity of data exists about the incidence and clinical characteristics of patients with PN. Therefore the aim of this study was to investigate the incidence and the electrocardiographic, echocardiographic, and angiographic characteristics of patients with PN. METHODS: Clinical, laboratory, electrocardiographic, echocardiographic, and angiographic characteristics of 12 consecutive patients with PN on 12-lead ECG (Group 1) were compared with patients (Group 2, n=28) presenting with acute coronary syndrome (ACS) associated with ST-T wave changes without PN. RESULTS: All patients presented with chest pain. The incidence of PN among patients presenting with ACS was 1%. Pseudonormalization was present in precordial leads in 11 and in inferior leads in 1 patient. Nine out of 12 (75%) patients in Group 1, 16 out of 28 (57%) patients in Group 2 had elevation of cardiac enzymes compatible with acute myocardial infarction. Severely narrowed or totally occluded ischemia and/or infarction-related coronary arteries were present in all patients in Group 1, in 20 (71%) patients in Group 2. Three patients in Group I and one patient in Group 2 had coronary artery thrombus formation. Group 1 patients had worse coronary collateral grading in comparison to Group 2 patients. CONCLUSION: Pseudonormalization is a rare entity and it is typically associated with severely narrowed or totally occluded coronary arteries along with thrombus formation, and poor coronary collateral development.

Benefits of statin treatment in cardiac syndrome-X1.

AIMS: The pathophysiological mechanism in cardiac syndrome-X (anginal chest pain, positive exercise test, and angiographically normal coronary arteries) has been suggested as an impairment in normal endothelial function of the coronary microvasculature, resulting in inadequate flow reserve. The aim of this study was to determine whether statins with proven beneficial effects on endothelium, have any effect on endothelial functions and exercise induced ischaemia in cardiac syndrome-X. METHODS AND RESULTS: Study population consisted of prospectively enrolled 40 patients with cardiac syndrome-X. Patients with left ventricular hypertrophy, hypertension, diabetes mellitus, and LDL levels >/=160 mg/dl were excluded. Half of the patients received pravastatin (40 mg/day) for 3 months irrespective of their lipid values, according to a single-blind, randomized, placebo-controlled design. Endothelial functions were assessed with high-resolution vascular ultrasound, which measured the brachial artery flow mediated dilatation (FMD). Lipid measurements, symptom limited exercise tests and vascular ultrasound images were obtained before and at the end of 3 months. After the treatment, FMD improved significantly in pravastatin group. Exercise duration, and time to 1mm-ST depression were significantly prolonged after statin therapy. Ischaemic symptoms and ECG findings during exercise test disappeared completely in 5 (26%) patients in the statin group. However, there were no significant changes in FMD and exercise parameters in placebo group. CONCLUSIONS: Statin therapy resulted in beneficial effects on both exercise induced ischaemia and FMD in cardiac syndrome-X. The mechanism of this beneficial effect is probably the result of improvement in endothelial functions.

Guideline implementation in a multicenter study with an estimated 44% relative cardiovascular event risk reduction.

BACKGROUND: The extent of cardiovascular risk reduction by implementing coronary prevention guidelines needs to be documented in various population samples. HYPOTHESIS: This is a multicenter study to assess the impact of risk reduction in cardiovascular events upon implementation of coronary prevention guidelines in patients with or at high risk for coronary heart disease (CHD) in the setting of clinical practice. METHODS: Enrolled volunteers numbered 2,021. Inclusion criteria postulated a minimum of 20-40% cardiovascular event risk in the subsequent 10 years as estimated from the risk table of the European Society of Cardiology (ESC) Guidelines. The estimated CHD risk reduction was assessed in terms of the Framingham risk scores at baseline and at 12 months, computed from the data of each individual. Data of the compliant group (making up half of the initial participants) at the end of the study, along with absolute and relative risk reductions in the compliant group, were analyzed. RESULTS: Mean global risk burden was 25.9% at baseline, reduced through multilateral preventive measures in absolute terms by 9.4% at 6 months and by 11.7% at 12 months; the latter represents a relative risk reduction of 44%. Independent variables determining the (enhanced) reduction in risk level at the end of 12 months included (high) level of baseline risk, (high) degree of compliance with treatment, younger age, female gender, smoking, and (high) baseline triglyceride/high-density lipoprotein cholesterol (TC/HDL-C) ratio. While the relative reduction in patients with CHD amounted to 43%, a reduction of 46% (p<0.001) was obtained in the setting of primary prevention. Diabetes emerged as a factor modestly limiting the extent of risk reduction. While subjects without hypertension revealed a decline of coronary risk by merely 8.7%, those with hypertension showed a decline by 12.7% (p<0.001). Risk reductions were accompanied by a decrease of mean low-density lipoprotein cholesterol (LDL-C) level of 25.4%, a rise in mean HDL-C level of 5 mg/dl, a decrease in mean systolic blood pressure of 26 mmHg. Forty-five percent of smokers succeeded in discontinuing the habit. CONCLUSION: By implementing standard prevention guidelines in the Turkish population among 1,000 compliant high-risk men and women and among 1,000 patients with CHD, prevention of cardiovascular events could be expected in 117 persons in the subsequent 10 years.

[Evaluation of early alterations in transmitral diastolic flow and tissue Doppler findings of the Basal segments of both ventricles in early period after coronary angioplasty]. / Koroner anjiyoplasti sonrasi erken dönemde mitral diyastolik akim ve her iki ventrikül bazal bölge doku Doppler bulgularindaki degisikliklerin degerlendirilmesi.

OBJECTIVE: Diastolic dysfunction of the left ventricle (LV) appears to be the earliest manifestation of myocardial ischemia. Experimental and clinical studies have shown that both early and late improvements of diastolic function occur after percutaneous transluminal coronary angioplasty (PTCA). Because of the limited utility of transmitral flow profile in the evaluation of the LV diastolic function, recently, assessment of myocardial velocities by Doppler tissue imaging is gaining importance. The aim of this study was to determine the utility of pulsed wave tissue Doppler (PWTD) pattern from the mitral and tricuspid annulus motion in the evaluation of early alterations of the LV diastolic function after revascularization with PTCA in patients with coronary artery disease. METHODS: Pulsed wave tissue Doppler in combination with conventional pulsed-Doppler indices were used to evaluate LV diastolic function before and 24 hours after PTCA. Examinations were performed on 31 patients with chronic ischemic heart disease underwent elective first PTCA. As conventional Doppler indices, early diastolic mitral velocity (e), and its deceleration time (Edt), isovolumic relaxation time (IVRT), late diastolic mitral velocity (a) were measured. Using 2-dimensional echocardiography four chamber apical window, mitral annulus septal and lateral site and tricuspid annulus lateral site were viewed, and PWTD velocity profile were used to calculate; early diastolic maximum velocity and time, late diastolic maximum velocity and time, systolic maximum velocity and time, IVRT and isovolumic contraction time (IVCT) from each site. RESULTS: After PTCA only 2 transmitral conventional pulsed-Doppler indices were changed significantly (IVRT; from 139.7+/-22.2 msec to 120.0+/-15.9 msec, p=0.0001; Edt; from 279+/-11 msec to 248+/-36 msec, p=0.005). However, PWTD (mitral annulus lateral site) analyses showed significant improvement in most of the diastolic parameters: e/a ratio - from 0.80+/-0.26 to 0.89+/-0.22, p=0.012; s wave - from 11.6+/-3.1 cm/sec to 13.2+/-3.6 cm/sec, p=0.03; IVRT - from 130+/-37 msec to 108+/-29 msec, p=0,0001; IVCT - from 84.1+/-19.2 msec to 75.6+/-12.2 msec, p=0.02. Similar significant changes were also observed in the PWTD diastolic parameters of both the mitral annulus septal and tricuspid annulus sites. Peak systolic velocities that reflect the LV systolic functions, of three annular sites significantly improved early after PTCA, however ejection fraction was not changed as much as tissue Doppler parameters (s maximum velocity before PTCA: 11.7+/-3.1 cm/sec versus 13.2+/-3.6 cm/sec after PTCA, p=0.03). CONCLUSION: Tissue Doppler indices of the mitral annulus reflecting both the diastolic and systolic functions, improve early after successful PTCA in patients with coronary artery disease.