Myopericarditis in a patient with ulcerative colitis treated with mesalamine-Case report and review of the literature.

Mesalamine has been successfully used as a maintenance treatment in inflammatory bowel diseases such as ulcerative colitis and Crohn's disease for years. Most frequent adverse reactions to this medication are gastrointestinal disorders and headaches while cardiovascular complications are rare and poorly understood. We present a case of a 26-year-old male with ulcerative colitis developing myopericarditis on mesalamine therapy. Although cardiac involvement is reported to be an extraintestinal manifestation of the bowel disease, we describe evidence confirming the diagnosis of mesalamine-induced myopericarditis in our patient and discuss other reports on this topic. Even though myopericarditis is an uncommon adverse reaction to mesalamine, it should be considered in patients with chest pain during mesalamine therapy. In such cases, drug withdrawal may result in rapid clinical improvement. .

Ventricular septal defect complicating acute myocardial infarction-still an unsolved problem in the invasive treatment era.

BACKGROUND: Post-acute myocardial infarction (AMI) ventricular septal defect (VSD) is a rare but catastrophic complication. The aim of study was to delineate the incidence and risk factors of VSD in patients after AMI treated with successful primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: In the years 2004-2006, a total of 1835 patients with AMI underwent successful pPCI in our hospital. Thirteen patients (0.71%) developed VSD after pPCI. Mean time of occurrence of VSD was 24.46 ± 9.32 h. Patients with VSD had longer time from the AMI onset to pPCI vs. patients without VSD (7.77 ± 2.83 vs. 4.49 ± 4.45, P<.001). In the VSD group, most of the patients were nonsmokers, had arterial hypertension, and had no previous history of coronary artery disease (CAD). Neither group differed in administered antiplatelet therapy. According to univariate log-regression analysis, the presence of VSD was strongly associated with age >70 years (OR=4.66; P=.007), female gender (OR=5.73; P=.004), anterior infarction (OR=3.86; P=.04), single-vessel CAD (OR=3.74; P=.03), body mass index (BMI) <25 (OR=2.98; P=.04), and left ventricular wall hypertrophy (OR=3.39; P=.03). CONCLUSIONS: Our study demonstrated that the incidence of VSD after AMI appears to have declined in patients treated with pPCI. The pathomechanism of VSD in the invasive treatment era is the consequence of several processes and needs further investigation. Advanced age, female gender, anterior infarction, single-vessel CAD, left ventricular wall hypertrophy, and low BMI are strong risk factors of this complication after AMI, which remain invariable over the years.

Prinzmetal's variant angina associated with severe heart rhythm disturbances and syncope: a therapeutic dilemma.

Prinzmetal's angina is a distinct syndrome characterized by episodes of chest pain and transient ST-segment elevation caused by coronary vasospasm. This variant form of angina is sometimes associated with complete atrioventricular block and ventricular arrhythmias. We report here a case of variant angina with documented severe heart rhythm disturbances and syncope in a 66 year-old woman. Due to recurrent episodes of high-degree atrioventricular block, a DDD pacemaker was implanted. No further symptoms of angina or cardiac arrhythmias were detected on optimal therapy.

The relationship between early recanalization and serum NT-proBNP levels in patients with a first ST-segment elevation myocardial infarction treated with primary coronary angioplasty.

OBJECTIVE: Primary coronary angioplasty (PCI) performed in the first hours after the onset of chest pain plays an important role in the prevention of death and heart failure after acute myocardial infarction (MI). Levels of circulating natriuretic peptides (BNP and NT-proBNP) reflect the severity of left ventricular (LV) dysfunction. The blood concentration of these peptides is increased in patients with MI. The aim of this study is to evaluate whether early PCI (< or = 3 hours) after onset of chest pain modulates NT-proBNP levels in patients with first ST-elevation acute MI. METHODS AND RESULTS: Serum NT-proBNP levels were measured on hospital admission and 4 to 5 days post MI. Transthoracic echocardiography was performed on the 4th day after MI. We included 111 consecutive patients with first ST-elevation acute MI treated with PCI with stent implantation. In 55 patients (49.5%) PCI was performed within 3 hours after the onset of symptoms (the study group). Multivariate analysis revealed that only the time from the onset of chest pain to PCI and EF/WMI were independently associated with serum NT-proBNP > 105 pg/ml on admission. Only EF/WMI and evolution of non-Q myocardial infarction correlated with an NT-proBNP level > 388.5 pg/ml on discharge. CONCLUSIONS: NT-proBNP concentration measured both on admission and 4 to 5 days after acute MI independently correlates with echocardiographic parameters of LV systolic function (EF and WMSI). One hour delay in PCI raises the risk of NT-proBNP level elevation on admission by 30%.