Kounis Syndrome: Dexketoprofen-Associated ST-Elevation Myocardial Infarction.

Allergic angina and allergic myocardial infarction are common diseases associated with acute coronary syndromes and encompass a wide spectrum of mast cell activation disorders termed "Kounis Syndrome". We present here a patient with Kounis syndrome presenting with sudden cardiac arrest after intravenous infusion of dexketoprofen in the emergency room. LEARNING POINTS: There are 3 types of Kounis syndrome, of which Type I, allergic coronary vasospasm, is the most common.The most common presentation of Kounis syndrome is ST-elevation myocardial infarction.Although not all cases of Kounis syndrome are reported, they are common in clinical practice and many more causal factors are predicted to play a role in the future.

Plasma Chemerin Levels Are Increased in ST Elevation Myocardial Infarction Patients with High Thrombus Burden.

OBJECTIVE: To investigate plasma chemerin levels in ST elevation myocardial infarction (STEMI) patients and find out possible relationships between plasma chemerin levels and angiographic characteristics. PATIENTS AND METHODS: Ninety-seven consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention (PCI) with coronary stents were enrolled, and 30 age- and sex-matched patients with stable angina pectoris who underwent coronary angiography formed the control group. Angiographic characteristics of the patients including thrombolysis in myocardial infarction (TIMI) thrombus and Gensini scores were noted. Blood samples were taken to detect several biochemical markers including plasma chemerin levels at the admission to hospital. RESULTS: Serum chemerin and C-reactive protein (CRP) levels were significantly increased in patients with STEMI. Among STEMI patients, serum chemerin levels were significantly higher in patients with high thrombus burden (581.5 ± 173.7 versus 451.3 ± 101.2 mg/dL, p < 0.001). CRP levels and peak creatine kinase-MB (CK-MB) levels were higher, and left ventricular ejection fraction and post-PCI TIMI flow were lower in patients with high thrombus burden. After multivariate analysis, serum chemerin levels were also higher in patients with high thrombus grade (odds ratio: 1.009 (1.005-1.014), p < 0.001). Besides, serum chemerin levels were also found to be significantly correlated with CRP (r=0.47, p < 0.001) and peak CK-MB (r=0.376, p < 0.001) levels. CONCLUSIONS: Results from our study have demonstrated for the first time that chemerin levels were higher in STEMI patients with greater thrombus burden and higher level of inflammation.

A giant cardiac hydatid cyst presenting with chest pain and ventricular tachycardia in a pregnant woman undergoing cesarean section.

Cyst hydatid disease is an infectious disease caused by development of the larval form of Echinococcus granulosus in humans. Cardiac involvement of this disease is a rare condition, and if present, it is most commonly located in the left ventricle. Interventricular septal involvement is observed only in 4% of these cases. Herein, we report a case of cyst hydatid located at interventricular septum causing chest pain and ventricular tachycardia during cesarean section.

Atrial Electromechanical Coupling in Patients with Lichen Planus.

BACKGROUND AND OBJECTIVES: A chronic inflammatory disease, lichen planus may cause disturbance of atrial electromechanical coupling and increase the risk of atrial fibrillation. The aim of this study was to evaluate atrial electromechanical delay with both electrocardiography (ECG) and echocardiography in patients with lichen planus (LP). SUBJECTS AND METHODS: Seventy-two LP patients (43 males [59.7%], mean age: 44.0±16.7 years) were enrolled in this cross-sectional case-control study. The control group was selected in a 1:1 ratio from 70 patients in an age and sex matched manner. P wave dispersion was measured by ECG to show atrial electromechanical delay. All of the patients underwent transthoracic echocardiography for measuring inter- and intra-atrial electromechanical delays. RESULTS: The baseline characteristics of the patients and the control group were similar except for the presence of LP. P-wave dispersion measured by ECG was significantly higher in patients with LP (p<0.001). Patients with LP had significantly prolonged intra- and interatrial electromechanical delays when compared to the control group (p<0.001). In addition, all of these variables were significantly correlated with high sensitive C-reactive protein (hsCRP) levels. CONCLUSION: Atrial electromechanical coupling, which is significantly correlated with increased hsCRP levels, is impaired in patients with LP.

Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study.

OBJECTIVE: Myocardial bridge (MB), also known as muscular bridge, is a rare congenital disease with relatively good prognosis. However, it has been associated with unstable angina, myocardial infarction, and sudden cardiac death. Incidence and prognosis of patients diagnosed with isolated MB after having undergone coronary angiography are evaluated in the present retrospective study. METHODS: Coronary angiograms of 18,250 patients, obtained between 2008 and 2011, were reexamined for presence of MB at the cardiology clinic. Of these patients, 241 (0.95%) had MB, and 181 (0.99%) had it as an isolated finding. Patients with isolated MB were divided into 2 groups according to severity of the lesion in the cardiac systole. Group 1 was comprised of patients with non-critical (<70%) stenosis; group 2 was comprised of patients with critical (≥70%) stenosis. Demographic characteristics, symptoms at initial diagnosis, and coronary angiographic findings regarding localization and severity of stenosis were noted. Follow-up was performed by phone, with outpatient clinic visits, and by reviewing hospital records. RESULTS: Twenty-five patients (13%) had critical stenosis (group 2), and 146 (87%) had non-critical stenosis (group 1). Mean follow-up duration was 38±7 months. Recurrent angina and repeated coronary angiography were reported in 15 group 1 patients (10.2%) and in 2 group 2 patients (8.0%) (p=non-significant). No instance of myocardial infarction was reported. CONCLUSION: Isolated MB seems to be a relatively benign disease, a conclusion made in accordance with those of previous studies. Symptoms and prognosis are not determined by degree of stenosis generated by the muscular bridge.

Right Atrial Clot Formation Early after Percutaneous Mitral Balloon Valvuloplasty.

Mitral balloon valvuloplasty which has been used for the treatment of rheumatic mitral stenosis (MS) for several decades can cause serious complications. Herein, we presented right atrial clot formation early after percutaneous mitral balloon valvuloplasty which was treated successfully with unfractioned heparin infusion.

Risk of no-reflow in culprit lesion versus culprit vessel PCI in acute STEMI.

OBJECTIVES: The present report describes patients with acute ST-elevation myocardial infarction who had at least two lesions in the culprit vessel (CV) during primary percutaneous coronary intervention (PCI). Here, we aimed to examine two different strategies, namely, PCI of only culprit lesion (CL) versus PCI of all lesions in the CV in the setting of acute ST-elevation myocardial infarction. PATIENTS AND METHODS: Patients who underwent primary PCI were examined for the presence of an additional lesion in the infarct-related artery and divided into two groups according to the PCI strategy: CV versus CL groups. Coronary angiograms were examined for coronary thrombolysis in myocardial infarction (TIMI) flow and major clinical outcomes were determined. RESULTS: Of 637 patients, 472 (74.1%) underwent primary PCI for the CV (CV group) and 165 (25.9%) underwent primary PCI only for CL (CL group). TIMI flow before primary PCI and after stenting of the CL was similar; however, TIMI flow after completion of the procedure was significantly better in the CL group (P=0.022). The composite of death, nonfatal myocardial infarction and repeat revascularization was significantly better in the CL group (P=0.041) and early stent thrombosis was observed more commonly in the CV group [14 (3.0%) patients vs. 1 (0.6%) patient, P=0.09]. CONCLUSION: In the presence of an additional lesion in the CV during primary PCI, deferring stenting for the non-CL in the culprit artery after stenting the CL may be considered to prevent the development of no-reflow or slow-reflow, and thus major clinical adverse events may be reduced.

Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature.

Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

Serum neutrophil gelatinase-associated lipocalin levels are correlated with the complexity and the severity of atherosclerosis in acute coronary syndrome.

OBJECTIVE: Neutrophil gelatinase-associated lipocalin (NGAL) is a novel inflammatory marker that is released from neutrophils. In this study, we evaluated the correlation between serum NGAL level and clinical and angiographic risk scores in patients diagnosed with non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS: Forty-seven random NSTE-ACS patients and 45 patients with normal coronary arteries (NCA) who underwent coronary angiography were enrolled in the study. GRACE risk score and SYNTAX and Gensini risk scores were used, respectively, for the purpose of clinical risk assessment and angiographic risk scoring. Serum NGAL level was measured via ELISA in peripheral blood samples obtained from the patients at the time of admission. RESULTS: Serum NGAL level was significantly higher in the NSTE-ACS group compared to the control group (112.3±49.6 ng/mL vs. 58.1±24.3 ng/mL, p<0.001). There was a significant positive correlation between serum NGAL levels and the GRACE (r=0.533 and p<0.001), SYNTAX (r=0.395 and p=0.006), and Gensini risk scores (r=0.575 and p<0.001). The intermediate-high SYNTAX (>22) group had statistically significantly higher serum NGAL levels compared to the low SYNTAX (≤22) group (143±29.5 ng/mL vs. 98.7±43.2 ng/mL, p=0.001). CONCLUSION: NGAL level was positively correlated with lesion complexity and severity of coronary artery disease in patients with NSTE-ACS. Serum NGAL levels on admission are associated with increased burden of atherosclerosis in patients with NSTE-ACS.

Spontaneous coronary artery dissection as a cause of myocardial infarction.

Spontaneous coronary artery dissection (SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative's funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending (LAD) artery and left circumflex (LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.

Early effect of left coronary system revascularization on right ventricular mechanics in patients with right coronary artery chronic total occlusion.

OBJECTIVE: No data exist on the functional relevance of collateral vessels in patients undergoing percutaneous coronary intervention (PCI). Also, the subtle effects of improved collateral flow on right ventricular (RV) function are difficult to assess. However, novel echocardiographic approaches like tissue-Doppler imaging (TDI) and two-dimensional speckle-tracking echocardiography (2DSTE) can quantify RV regional myocardial function. We hypothesized that these techniques may help delineate revascularization therapy-induced changes in regional RV contractility that escape clinical routine studies. METHODS: This study was a prospective registry of consecutive patients undergoing PCI for a collateral supplying artery. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before successful PCI and it was repeated after 24 hours and 1 month. RESULTS: There were no significant changes in either the RV systolic myocardial velocities, or the tricuspid annular plane systolic excursion values. However, RV free wall longitudinal strain/systolic strain rate values showed a significant increase 24 hours after PCI when compared to baseline (-25.9 +/- 6.8% vs. -21.5 +/- 6.6%, P < 0.001 and -2.18 +/- 0.40/s vs. -1.64 +/- 0.41/s, P < 0.001, respectively). Also, the improvement of RV function was further suggested by the tendency of RV isovolumic acceleration to be higher when compared with baseline at 1 month of follow-up (2.49 +/- 0.7 m/s2 vs. 2.1 5 +/- 0.6 m/s2, P = 0.056). CONCLUSION: Both TDI-derived isovolumic acceleration and 2DSTE-derived strain/strain rate produced a similar picture with respect to the change in RV contractile function. However, 2DSTE indicated a much more pronounced and earlier improvement of systolic function; therefore, 2DSTE could be included in future studies that involve functional relevance of collateral vessels.