Cardiac emergencies caused by honey ingestion: a single centre experience.

An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study is a retrospective case series of 19 patients admitted to an emergency department in 2002, poisoned by "mad" honey. All of the patients had the complaints of nausea, vomiting, sweating, dizziness, and weakness, several hours after ingesting "mad" honey. Physical examination showed hypotension in 15 patients, sinus bradycardia in 15, and complete atrioventricular block (AVB) in four patients on admission. Two patients with bradycardia and two with AVB fell and injured their heads. Three of them presented with local haematoma. One patient had a 6 cm cut on his head without any neurological deficit and his cranial computed tomography imaging was normal. Hypotension and conduction disorders resolved with atropine treatment, resulting in complete recovery within 24 hours.

Atrial fibrillation after electrical shock: a case report and review.

A 52 year old man was admitted to an emergency department with a fast ventricular rate atrial fibrillation after an electrical shock. Electrical cardioversion was attempted after echocardiographic examination. This failed, but the heart rate slowed. Successful pharmacological cardioversion was achieved after 16 hours of amiodarone infusion. Pre-excitation syndrome was detected on baseline echocardiograph. Serum cardiac specific markers were all within normal limits. No abnormal findings were detected by chest radiography, echocardiographic, or coronary angiographic investigations. Acute onset atrial fibrillation after electrical injury is discussed.

Paradoxical embolism in Ebstein's anomaly.

A 26-year-old man with Ebstein's anomaly had cerebellar infarction due to paradoxical embolism. Ebstein's anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects. Paradoxical embolism is a potential complication whenever a right to left shunt exists (for example, atrial septal defect). Ebstein's anomaly diagnosed in adult life is a benign and stable disease, particularly if the patient is asymptomatic; surgical correction must be performed if the patient becomes symptomatic because of either paradoxical embolism or worsening of the tricuspid regurgitation.

Prediction of viability by pulsed-wave Doppler tissue sampling of asynergic myocardium during low-dose dobutamine challenge.

Dobutamine stress echocardiography is widely used to predict reversible left ventricular dysfunction, but evaluation with this method is subjective. Pulsed-wave tissue Doppler imaging is a new technique that allows to obtain quantitative data on wall motion velocities of different myocardial segments through sample-volume placement. Therefore, this tool in combination with DSE may be suitable for identifying viability in asynergic myocardium. To evaluate this, in 40 patients (mean age 57+/-9) with resting dyssynergy (akinesis in 52, hypokinesis in 30) baseline wall motion scores and tissue Doppler variables were collected before and after 5 min infusion of 10 microg/kg per min dobutamine. Forty-six of 82 segments were classified as viable (a reduction in segmental score of at least one grade) according to follow-up echocardiography that was performed 4 weeks after revascularization. While myocardial S velocity percent increase in viable segments was 45+/-10, the increase was 25+/-12 in necrotic segments (n=36) during 10 microg dobutamine infusion (P=0.0001). Assuming 35% as a cut-off for viability the increase in S velocities by DSE yielded an 89% sensitivity and 86% specificity for predicting post-revascularization functional recovery. In conclusion, pulsed-wave tissue Doppler imaging of asynergic myocardium during dobutamine stress echocardiography can identify the viability quantitatively.

PTCA in chronic total occlusions: clinical results with a wire system.

The authors discuss the use of a wire system in chronic total occlusion, noting the factors that affect primary success and the clinical results. Percutaneous transluminal coronary angioplasty was performed on 29 patients with single-vessel disease. The mean age of the patients was fifty-three +/- three years. The authors used routine angioplastic techniques with the wire system. Fifteen of the lesions were functional and the others were in total anatomic occlusion. The primary success rate was 69%. Primary success was 88%, 48%, and 75%, in the left anterior descending, left circumflex, and right coronary artery, respectively. In 4 cases the wire did not cross the occlusion. One patient required direct-current cardioversion for ventricular fibrillation during the procedure, and 1 patient sustained a non-Q wave myocardial infarction following the procedure. There were no deaths.

Dobutamine stress radionuclide ventriculography for the detection of coronary artery disease.

Thirty patients were prospectively studied to assess the value of radionuclide ventriculography (RNV) during step-wise dobutamine infusion for the detection of coronary artery disease (CAD). Radionuclide ventriculography was performed under basal conditions and during dobutamine infusion at each 10 micrograms kg-1 min-1 dose increment from 10 to a maximum of 40 micrograms kg-1 min-1. The test response was considered positive if the ejection fraction (EF) decreased by more than 5% or if segmental contraction abnormalities developed. Dobutamine stress testing was well tolerated, no complications and no significant arrhythmia were observed. In nine of 11 patients without CAD, EF increased more than 5% of the rest value and the left ventricular wall motion was normal in 10 of them during dobutamine infusion (specificity 91%). In 18 of 19 patients with CAD, new wall motion abnormalities (WMA) were identified in segments corresponding to the arterial lesions diagnosed by angiography (sensitivity 94%). Ejection fraction response was significantly different in normal subjects and in patients with CAD: 11 +/- 5.9% versus 1.9 +/- 9.5% (P < 0.01). However, abnormal EF response was found in seven of 19 CAD patients and development of new WMA was found to be a more sensitive and specific parameter than EF response for dobutamine RNV. It is concluded that dobutamine RNV is an accurate, widely available and cost-effective test for detecting CAD, especially in patients unable to exercise.

Value of dobutamine technetium-99m-sestamibi SPECT and echocardiography in the detection of coronary artery disease compared with coronary angiography.

The value of dobutamine echocardiography and 99mTc-sestamibi SPECT imaging was evaluated as a noninvasive diagnostic method for assessing coronary artery disease (CAD). Twenty-seven patients who underwent coronary angiography were submitted to two separate injections of 99mTc-sestamibi, one under control conditions and the other after reaching a peak dobutamine infusion rate. Simultaneous ECG and echocardiographic monitoring was also performed during stepwise dobutamine infusion. Whereas the overall sensitivity and specificity of dobutamine sestamibi SPECT imaging were 94% and 88%, these values for dobutamine ECG and echocardiography were 61%, 55% and 84%, 88%, respectively. When dobutamine echocardiography and 99mTc-sestamibi SPECT imaging were evaluated together, the diagnostic accuracy reaches almost 100%. Dobutamine echocardiography is of value in determining ischemic threshold earlier than clinical symptoms and allows simultaneous evaluation of ventricular performance and contractile function associated with perfusion abnormalities on 99,Tc-sestamibi SPECT imaging. Our experience shows that 99mTc-sestamibi SPECT imaging, when combined with dobutamine echocardiography, is a safe, practical, well tolerated method with high diagnostic accuracy for the evaluation of CAD.

Late hemodynamic changes in percutaneous mitral valvuloplasty.

Percutaneous mitral valvuloplasty (PMV) was performed in 57 patients with mitral stenosis. Twenty-three women and 34 men (mean age 28 +/- 10 mean +/- SD) were included in the study. A single-balloon (trefoil or bifoil) technique was used in 49 patients and a double-balloon (trefoil + monofoil) technique in eight. After a 3-month follow-up period, right- and left-sided cardiac catheterization was repeated. In the single-balloon group there was improvement in the mitral valve gradient (16.10 +/- 5.99 to 4.41 +/- 2.03 mm Hg), mean left atrial pressure (22.65 +/- 6.13 to 9.76 +/- 3.01 mm Hg), and mitral valve area (0.89 +/- 0.22 to 1.95 +/- 0.46 cm2/m2). Mean pulmonary artery pressure and mean pulmonary wedge pressure decreased to 19.33 +/- 4.19 mm Hg and 10.73 +/- 2.60 mm Hg from 32.94 +/- 7.90 mm Hg and 21.49 +/- 5.98 mm Hg. Cardiac output increased to 6.86 +/- 0.56 L/min from 5.57 +/- 0.66. All improvements were statistically significant (p less than 0.001). In the double-balloon study group, mitral valve gradient (23.75 +/- 2.77 to 4.50 +/- 1.94 mm Hg), mean left atrial pressure (31.63 +/- 3.57 to 9.50 +/- 1.94 mm Hg), mean pulmonary artery pressure (44.00 +/- 6.36 to 18.88 +/- 7.10), and mean pulmonary wedge pressure (29.25 +/- 3.73 to 10.25 +/- 1.85 mm Hg) all improved significantly (p less than 0.001). Mitral valve area and cardiac output increased from 0.89 +/- 0.15 to 2.44 +/- 0.44 cm2/m2 (p less than 0.001) and from 5.46 +/- 0.76 to 7.15 +/- 0.52 L/min (p less than 0.002), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)