[Thrombus or tumour of the mitral valve--a case of 75-year-old woman with acute coronary syndrome and aortic insufficiency]. / Skrzeplina czy guz zastawki mitralnej--przypadek 75-letniej chorej z ostrym zespolem wiencowym i niedomykalnoscia aortalna.

Papillary fibroelastomas are rare, primary, benign cardiac tumors most frequently located in the heart valves. They are a potential cause of systemic embolization and may be associated with myocardial ischaemia, transient ischaemic attacks, strokes, or sudden death. We describe the case of 75-year-old woman with diagnosed aortic insufficiency who was admitted to hospital with acute coronary syndrome. The fibroelastoma of the anterior mitral leaflet was diagnosed using transthoracic and transoesophageal echocardiography. We provide a differential diagnosis and review of the literature concerning the pathologic intracardiac masses affecting cardiac valves.

[Cardiovascular diseases risk factors knowledge among soldiers of the Polish army]. / Znajomosc czynników ryzyka chorób ukladu sercowo-naczyniowego wsród zolnierzy polskiej armii.

UNLABELLED: Cardiovascular diseases (CVDs) are the main cause of death and disability in Poland. There are many risk factors of CVD which are modifiable due to preventive strategies. Knowledge about these factors among population at risk of CVD is the most important condition for success of them. THE AIM OF THE STUDY: To evaluate the knowledge of CVD risk factors among soldiers of the Polish Army and try to identify a demographic factors influenced on them. MATERIAL AND METHODS: Authors investigated the level of knowledge about CVD risk factors among 644 soldiers (aged between 18 to 62 years) using the special questionnaire. Whole group was analyzed according to a place of origin: city, town and village and according to a function: professionals and conscripts. RESULTS: Soldiers achieved a total score of 58.4% correct answers. Commonly known risk factors of CVD (average 82% of correct answers) in studied group were: obesity, tobacco smoking, high level of cholesterol and hypertension. Knowledge about above risk factors was significantly higher (p < 0.01) than about other. Lesser known risk factors (average 54% of correct answers) were: male gender, abnormal diet, sedentary lifestyle, family history of CVDs, diabetes, family history of heart infarction below 55 yrs and peripheral atherosclerosis. residents achieved 64.5% correct answers, town--61.5%, and village--58%. Professionals achieved 65.1% vs. 58.8% for conscripts. The level of knowledge about CVD risk factors are significantly higher among professionals than in urban population. CONCLUSIONS: Our data confirm the need of continuation and developing new CVDs preventive strategies in Poland, especially among poor educated and village populations. There is a need to emphasize the role of lesser known, modifiable CVD risk factors (e.g., obesity, sedentary lifestyle) in existing and future health programs.

[Inappropriate therapy of an implantable cardioverter-defibrillator--is it always an undesired event? A case report]. / Nieuzasadnione wyladowanie wszczepialnego kardiowertera-defibrylatora--dzialanie niepozadane czy pozadane?

Inappropriate implantable cardioverter defibrillator (ICD) therapy is the commonest adverse event in patients with ICD. We present a case of sinus rhythm restoration after an inappropriate shock in a man with permanent atrial fibrillation and dilated cardiomyopathy. During follow-up, clinical improvement has been observed.

The association between SCN5A, KCNQ1 and KCNE1 gene polymorphisms and complex ventricular arrhythmias in survivors of myocardial infarction.

BACKGROUND: Post-MI patients are highly susceptible to sudden cardiac arrest (SCA) and sudden cardiac death (SCD) resulting from ventricular arrhythmia (VA). The search for new clinical predictors to identify those patients who are at the highest risk of these events is therefore essential. Numerous data indicate that the presence of polymorphisms and mutations in the cardiac ion channel genes SCN5A, KCNQ1 and KCNE1 might serve as such a predictor. Since genetic alterations in these genes underlie congenital long QT syndrome (LQTS), which is associated with an increased occurrence of arrhythmic complications and SCD, we decided to verify how alterations in these genes contribute to QT interval abnormalities and consequently to VA, SCA and SCD in post-MI patients. AIM: To detect single nucleotide polymorphisms (SNP) in SCN5A, KCNQ1 and KCNE1 of post-MI patients, and to assess whether they are related to electrophysiological markers of cardiac arrhythmia (QT interval) and the clinical course. METHOD: The study group consisted of 100 patients (27 females, mean age 69 years) with documented MI 3 months before enrolment. All patients underwent baseline and (after 12 months) control examinations encompassing history, physical examination, basic laboratory analysis, resting 12-lead ECG, 24-hour 12-lead Holter ECG monitoring and echocardiography. Genetic tests were performed during baseline examination. RESULTS: In post-MI patients two exonic polymorphisms, H558R in SCN5A and S38G in KCNE1, and two intronic ones, in KCNQ1, were detected. H558R was associated with an increase in QT dispersion (QTd) at minimum and maximum heart rate and QT interval prolongation before premature ventricular beats (PVB), whereas S38G and intronic polymorphisms were related to an increase in QTd before PVB. None of the above polymorphisms was related to complex VA, SCA or SCD. CONCLUSION: The above polymorphisms were associated with abnormal repolarisation phase patterns in post-MI patients, which manifested in QT interval prolongation and QTd increase. There was no relationship between these polymorphisms and complex VA, SCA or SCD. The results show that not only exonic alterations but also intronic ones may affect the phenotype.

Novel KCNQ1 mutations in patients after myocardial infarction.

BACKGROUND: Patients after myocardial infarction (MI) are at greater risk of sudden cardiac death (SCD) than people in the overall population. The aim of this study was to detect mutations, including intronic ones, in the KCNQ1 gene coding for proteins of cardiac potassium channels and evaluate their possible effects on the clinical course in patients after MI. METHODS: The study group was composed of 100 Polish patients after MI, which included 27 women (mean age 69 years) and 73 men (mean age 67 years). All patients underwent clinical examinations and genetic tests. The genetic test results have been correlated with the clinical data. The following parameters have been chosen as endpoints for this survey: sudden cardiac arrest (SCA) or SCD, complex ventricular arrhythmia, QT interval and QT dispersion values assessed during 24-hour Holter ECG monitoring in relation to ventricular arrhythmias as well as the minimum and maximum heart rate (HR) observed during the examination. RESULTS: Six new mutations in the KCNQ1 gene: C2505734T, A2753831C in exons and C2505846A, G2753881A, T2755854C, T2755875G in introns. Detected intronic mutations in patients after MI were related to a worse clinical course and frequent occurrence of SCA. CONCLUSIONS: The novel intronic mutations may have a significant influence on the clinical course of the disease.

[Cardiac arrest with subsequent permanent anoxaemic brain damage in a patient with the Brugada syndrome]. / Nagle zatrzymanie krazenia z nastepczym anoksemicznym uszkodzeniem mózgu u pacjenta z zespolem Brugadów.

The paper presents a case of a 20-year-old student with a history of cardiac arrest due to ventricular fibrillation. The episode of cardiac arrest occurred when the patient did not complain of any health problems, and there was no visible structural heart disease. Consequently, permanent anoxaemic brain damage was observed. Based on ECG examination, the Brugada syndrome was diagnosed as the cause of cardiac arrest. The ajmaline challenge test was performed in the members of the patient's family.

[Clinical significance of muscle bridge narrowing coronary artery lumen--description of three cases]. / Mostek miesniowy zwezajacy swiatlo tetnicy wiencowej--znaczenie kliniczne--opis trzech przypadków.

The muscle bridge is an anomaly which is found in 0.5-2.5% of coronary angiography examinations and may lead to impairment of coronary blood flow. The clinical course of the disease may be heterogeneous--from completely asymptomatic to the development of myocardial infarction or severe ventricular arrhythmia. We present three patients with muscle bridge in the left anterior descending artery. The clinical course of the disease was different in each patient--from mild symptoms to cardiac arrest during exercise test.

Sinoatrial Wenckebach periodicity as an independent marker for the development of high-degree sinoatrial exit block.

BACKGROUND: The present study of patients with Wenckebach-type second-degree sinoatrial block (W-block) evaluated the probability of the development of a more advanced grade of sinoatrial block. Data on the clinical significance of W--block are limited. It is unknown whether W-block predicts a more advanced grade of sinoatrial block. METHODS: Standard ECGs of 412 patients with symptoms that might have been related to cardiac arrhythmias were reviewed for the presence of W-block. In the initial ECG W-block occurred in 29. During the follow-up period of 62 +/- 35 months the main end-point was the first episode of type II second-degree sinoatrial block. An additional end-point was the occurrence of a sinus pause greater than 3 s or the development of type II second-degree sinoatrial block. RESULTS: Of the 29 patients with W-block initially, 6 (20.7%) developed higher grade sinoatrial block, and sinoatrial arrhythmic events occurred in 9 (31%). In the 383 patients without W-block subsequent episodes of higher grade sinoatrial block occurred in 14 (3.7%) and sinoatrial arrhythmic events in 28 (7.3%). A multivariate Cox analysis identified W-block as an independent marker for developing type II second-degree sinoatrial block (HR = 3.72, 95% CI 1.39-9.99) and for the occurrence of sinoatrial arrhythmic events (HR 3.01, 95% CI 1.37-6.58). CONCLUSIONS: In patients with symptoms that might be caused by cardiac arrhythmias the presence of W-block in a standard ECG indicates a high probability of developing a more advanced grade of sinoatrial block. (Cardiol J 2007; 14: 391-395).

[Left ventricular function in gated single photon emission computed tomography (GSPET) in patients with myocardial infarction subjected to thrombolysis or primary PTCA]. / Ocena czynnosci lewej komory serca za pomoca bramkowanej tomografii emisyjnej pojedynczego fotonu (GSPET) u chorych z zawalem leczonych fibrynolitycznie lub pierwotna angioplastyka naczyn wienicowych.

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) is increasingly common method of treatment patients with acute myocardial infarction. The aim of the study was to assess the left ventricular function in patients with myocardial infarction subjected to thrombolysis or primary PTCA. Gated Single Photon Emission Computed Tomography was performed in 40 patients 6 months after myocardial infarction treated either with thrombolysis or primary PTCA. Left ventricular ejection fraction (LVEF), left ventricular enddiastolic (LVED) and systolic (LVES) volumes were analysed both at rest and after stress. Six months after myocardial infarction LVEF was significantly greater and LVED, LVES volumes smaller in patients treated with primary PTCA in comparison to patients treated with thrombolysis. The above observation suggests that patients subjected to primary PTCA might have better functional outcome in comparison to matched patients treated with thrombolysis after 6 months post myocardial infarction.

[The metabolic syndrome--epidemic of XXI century]. / Zespól metaboliczny--epidemia XXI wieku.

There has been an increase in the incidence of obesity, which is a substantial component of metabolic syndrome. It is visceral obesity, which especially favours the occurrence of insulin resistance endothelial dysfunction and acceleration of atherogenesis. The influence of inflammation, neuro-humoral balance, genetic background and sleep apnoea on the metabolic syndrome development are discussed. Current opinions on the treatment of metabolic syndrome are shown.

[Remote repeatability of tilt test]. / Powtarzalnosc odlegla testu pionizacyjnego.

The aim of this study was the assessment of long-term repeatability of tilt-table test and parameters of heart rate variability analysis. Westminster protocol tilt-table test extended with nitroglycerin test was combined with analysis of heart rate variability. Five-minute intervals of ECG record were evaluated before and after the upright tilting, before syncope and 24-hour record was analysed. The test was performed in duplicate in 27 persons including 14 men (mean age 33 +/- 13.5) at interval of 29 +/- 13 months. The patients were then observed for 14 +/- 11.4 months. The study subjects were divided into groups with and without the recurrence of syncope. Repeatability was observed in 76.5% in positive test result and in 70% in negative test result. A low repeatability of positive test was observed. Blood pressure, heart rate and heart rate variability analysis parameters demonstrated a high repeatability during both tests. The recurrence of syncope was observed in 10 (37%) persons. The patients with both tilt tests positive, demonstrated recurrence of syncope two times more frequently what makes that the identification of the patients at risk for syncope return is easier.

[Diagnostic and prognostic significance of homocysteine determined in acute phase of myocardial infarction]. / Znaczenie rozpoznawczo-prognostyczne homocysteiny oznaczanej w ostrej fazie zawalu.

THE AIM: Of this study was to assess the serum homocysteine concentration in subjects with acute myocardial infarction and its correlation with the course of infarction and further prognosis considering particularly left ventricle dysfunction, heart rate and conduction disorders as well as to assess the usefulness of metionin load test as a prognostic test in patients with myocardial infarction. MATERIAL AND METHODS: 66 patients were studied: 36 with recent myocardial infarction and 30 healthy individuals as a control group. Fasting serum homocysteine and its concentration two hours after metionin load were determined in all patients. They all underwent echocardiographic examination, stress test and 24-hour Holter monitoring. The study revealed a significant positive correlation between increased serum homocysteine concentration in patients with myocardial infarction and worsening of contractility parameters, extent of infarction area, and negative correlation between homocysteine concentration and ejection fraction. CONCLUSIONS: On the basis of the study outcome we can make a statement that increased homocysteine concentration in patients with acute phase of myocardial infarction indicates its more severe course, more extensive disorders of myocardium kinetics, more significant left ventricle diastolic and systolic dysfunction. Increased serum homocysteine in metionin load test indicates higher death risk in patients with myocardial infarction.

[Selected inflammatory markers in patients with acute coronary syndrome]. / Wybrane wskazniki zapalenia u chorych z ostrymi zespolami wiencowymi.

The aim of the study was the assessment of selected inflammatory markers in patients with stable and unstable angina pectoris, in comparison to patients with dyslipidemia without coronary artery disease. The study group included 61 patients (37-79 years old), divided into three subgroups: group I. 26 (43%) with unstable angina, group 2. 19 (26%) with stable angina, group III. 16 (26%) dyslipidemia without coronary artery disease. We measured serum levels of cytokines (IL-1B, IL-1Ra, IL-2, IL-6, TNF-alpha), immunoglobulins (IgG, IgE, IgM), fibrinogen. C-reactive protein and subclass of lymphocytes T CD4 and T CD8. In stable and unstable angina pectoris group we found lower percentage of T CD4, T CD8 and higher level of TNF-alpha. In unstable angina group the level of IL-1 beta was lower and the concentration of C-reactive protein, IgE was higher in comparison to group without coronary artery disease. Observed immunoregulatory disorders confirm immune mechanism in the origin of unstable angina pectoris.