Hyperhomocysteinemia in a young woman presenting with acute myocardial infarction: Case report.

Homocysteine (Hcy), a sulfur-containing amino acid that is formed by demethylation of dietary methionine to cystein. Elevated homocysteine level is known to be associated with coronary artery disease. We present a case of acute myocardial infarction in a 25-year-old woman, associated with hyperhomocysteinaemia. Her other risk factors for coronary artery disease were smoking, a moderately high LDL level, and a family history of sudden cardiac death. This case illustrates the need to include plasma homocysteine measurement in the setting of acute coronary syndromes in women with premature atherosclerosis, even in the presence of traditional risk factors for coronary artery disease.

Hyperacute anterior myocardial infarction in a patient with dextrocardia and situs inversus.

Dextrocardia with situs inversus is an uncommon congenital condition in which the major visceral organs are reversed. The clinical diagnosis and electrocardiographic localization of myocardial infarctions in these patients remain a great challenge unless dextrocardia is recognized. A 50-year-old male with known dextrocardia and situs inversus presented with acute chest pain radiating to the right arm. The reversed normalized electrocardiogram showed acute anterior myocardial infarction and cardiac catheterization showed a proximal occlusion of the left anterior descending artery. He underwent coronary angioplasty with stenting, resulting in relief of chest pain and improvement in his clinical condition.

Acute myocardial infarction and subacute stent thrombosis associated with cabazitaxel: a case report.

CASE: Although newer cancer treatments and supportive care treatments have led to vast improvements in the management of complications associated with cancer treatment, sometimes they might cause serious side effects such as coronary artery disease, myocardial infarction and heart failure. These complications may occur any time during or after chemotherapeutics. In this report we present a patient with prostate cancer who experienced myocardial infarction and stent thrombosis probably caused by cabazitaxel -a new chemotherapeutic agent- administration. CONCLUSION: Cardiologists and oncologists should take into consideration the cardiac side effects of new chemotherapeutic agents with the aim of maximizing both quality of life and survival.

[Saphenous vein graft disease: causes, prevention, and contemporary treatment strategies]. / Safen ven grefti hastaligi; nedenleri, önlenmesi ve tedavisinde güncel yaklasimlar.

Coronary bypass graft surgery provides symptomatic relief and a long life expectancy for most patients with coronary artery disease who have suitable vessels. Although arterial conduits are becoming more popular, saphenous vein grafts (SVG) are still frequently used in coronary artery bypass surgery since they are readily available, especially in emergency situations. However, SVG tend to degenerate over time, as nearly half of them develop significant stenosis and nearly 40% of them become completely occluded within a decade. Treatment options for SVG failure include redo-surgery, percutaneous intervention, and/or medical therapy. However, challenges in maintaining graft patency (as a predictor of long-term survival) and interventional complications (e.g., distal embolization, ''no-reflow,'' and higher rates of periprocedural myocardial infarction) are still ongoing problems for cardiologists and cardiovascular surgeons. This review discusses the possible causes of graft failure and the contemporary approaches for improving outcomes in patients undergoing coronary artery bypass graft surgery with at least one SVG.

Sirolimus-Versus Zotarolimus-Eluting Stents in Acute Coronary Syndromes With C Type Left Anterior Descending Artery Lesions: A Three-Year Clinical Follow-Up.

BACKGROUND: Drug-eluting stents have improved the efficacy of percutaneous coronary intervention and made it the preferred therapy in the treatment of ischemic heart diseases including acute coronary syndromes. The objective of the study was to compare the clinical efficacy and safety of sirolimus-eluting stent with that of zotarolimus-eluting stent following percutaneous coronary intervention for acute coronary syndrome patients with C-type left anterior descending stenosis. METHODS: A total of 154 acute coronary syndrome patients with C-type lesions in the left anterior descending artery, requiring a stent > 28 mm in length, were randomized into two groups to receive either sirolimus- (n = 74) or zotarolimus-eluting stent (n = 80). The follow-up period after stent implantation was approximately 36 months. The primary endpoint was a major cardiac event (a composite of cardiac death, myocardial infarction, or ischemia-related target vessel revascularization), and the secondary endpoint included these individual end points plus stent thrombosis. RESULTS: After 3 years follow-up, the rate of the primary end point (major cardiac event: cardiac death, myocardial infarction, ischemia-related target vessel revascularization) was 16% in the sirolimus group (n = 12) versus 11.2% in the zotarolimus group (n = 9) (P = 0.2). Although there were four cases of stent thrombosis with sirolimus-eluting stent and one with zotarolimus-eluting stent (4.0% sirolimus vs. 1.25% zotarolimus; P = 0.2), neither non-Q myocardial infarction (4.0%sirolimus vs. 1.25% zotarolimus; P = 0.2) nor stent thrombosis, differed significantly. CONCLUSIONS: Although zotarolimus-eluting stent implantation showed more favorable results with respect to stent thrombosis and major adverse cardiac event rates compared to sirolimus-eluting stent implantation, statistically, both stent groups have nearly similar clinical safety and efficacy in the treatment of acute coronary syndromes with C-type lesions in the left anterior descending artery disease.

Effect of obstructive sleep apnea on heart rate, heart rate recovery and QTc and P-wave dispersion in newly diagnosed untreated patients.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is associated with autonomic dysfunction, whereas increased heart rate (HR), HR recovery time (HRR-1), QT-corrected interval (QTc) and P-wave dispersion (Pd) are associated with cardiovascular events. The aim of the current investigation was to clarify the influence of OSAS severity on these cardiac parameters. METHODS: Ninety newly diagnosed and untreated patients with OSAS underwent overnight polysomnography and cardiopulmonary exercise testing, including HRR-1, echocardiography, 24-hour Holter electrocardiography, surface electrocardiogram (ECG) and measurement of several metabolic parameters. The patients were divided into the following 4 groups: 26 with apnea-hypopnea index (AHI) <5, 20 with 5 ≤ AHI <15, 20 with 15 ≤ AHI <30 and 24 with AHI ≥30. QTc and Pd were calculated in all leads of the surface ECG. Mean HR was measured using 24-hour Holter ECG, and HRR-1 was measured using cardiopulmonary exercise testing. RESULTS: QTc was increased in patients with moderate-to-severe OSAS. Pd was significantly increased in patients with OSAS compared with those without OSAS. In addition, Pd was correlated with AHI and associated with the severity of disease. Mean HRs over a period of 24 hours during wakefulness and sleep correlated significantly with AHI and the lowest SpO2 in patients with OSAS, whereas HRR-1 was inversely correlated with the severity of OSAS, as expressed by AHI. CONCLUSION: We showed that HR, Pd, HRR-1 and QT-corrected time are correlated with OSAS severity. Further studies are required in order to investigate the prognostic effect of HRR-1, Pd, HR and QTc in OSAS.

Significant stenoses of twin circumflex arteries accompanied by heart failure: a rare coronary artery anomaly.

Although coronary artery anomalies may cause some clinical symptoms, most are incidentally discovered as benign findings on coronary angiograms. A circumflex coronary artery anomalously originating from the right sinus of Valsalva is the most common coronary anomaly. However, a double circumflex coronary artery, both stenotic in their mid portions, resulting in symptomatic heart failure is a rare clinical and angiographic condition. In this case, we present a 71-year-old male patient admitted to our clinic with the diagnosis of acute heart failure. Angiography revealed stenotic double circumflex arteries, arising from the left and right sinus of Valsalva, and the patient was treated by percutaneous coronary intervention.

Interventricular septal rupture after myocardial infarction despite early percutaneous coronary intervention.

Ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) is a serious clinical problem with high mortality rate due to cardiogenic shock or prolonged hemodynamic compromise. Despite multiple improvements in medical, interventional and surgical techniques, early and long-term prognosis after AMI related VSR still remain unpromising. We report a patient in whom an acute VSR was diagnosed 7 days after an anterior myocardial infarction treated with early primary percutaneous coronary intervention (pPCI).