Gökmen Gemici

Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography.

ObjectiveTo evaluate the safety and efficacy of heart rate reduction by intravenous esmolol in patients who are assigned for coronary angiography with 64-slice computed tomography (CT). MethodsFive hundred consecutive patients were prospectively analyzed. Patients with an initial heart rate less than 65 beats per minute (bpm) did not receive esmolol. Patients with a heart rate between 65 and 80 bpm received a bolus dose of 1 mg/kg intravenous esmolol. Patients with an initial heart rate between 80 and 90 bpm received a bolus dose of 2 mg/kg intravenous esmolol. An additional 1 mg/kg intravenous esmolol was given to the patients when the target heart rate was not reached with the first bolus dose. Patients with an initial heart rate more than 90 bpm received 50 mg atenolol PO, and were reevaluated after 1 h. ResultsA total of 391 patients with a heart rate ≥65 bpm before multislice computed tomography (MSCT) examination received intravenous esmolol with a mean dose of 158±55 mg. Initial and final mean heart rates were 80±11 bpm and 63±7 bpm, respectively (P<0.0001). Heart rate below 65 bpm was reached in 265 (65%) of these 391 patients. Only four patients (1%) had a final heart rate above 80 bpm before MSCT imaging. Four of the 391 patients (1%) had a final heart rate below 50 bpm. ConclusionIntravenous esmolol is safe and effective to reach the optimum heart rate in patients assigned for MSCT.

Evaluation of myocardial bridges with 64-slice computed tomography coronary angiography.

Objective — The aim of this study is to report the characteristics of myocardial bridging (MB) using 64-slice computed tomography and to demonstrate the association between atherosclerotic coronary artery disease (CAD) and MB. Methods and results — In 990 consecutive patients who underwent multi-slice computed tomography (MSCT) coronary angiography for suspected or known coronary artery disease, myocardial bridge evaluation was performed with axial, curved multiplanar reconstruction and three-dimensional volume-rendered images. 265 bridged segments were identified in 223 (22.5%) patients. Multiple MBs on left coronary arteries were found in 41patients. Most of the MBs were in the LAD (62.6%), followed by the obtuse marginal artery (14.7%) and diagonal artery (14.3%). The average length of MBs was 14±7mm, and the average depth was 1.6±1.1mm. No significant difference was observed between patients with and without MB on the middle LAD in respect of age, gender, prevalence of diabetes, hyperlipidaemia, hypertension, current smoking and prevalence of atherosclerotic plaques at the proximal LAD. On the other hand, prevalence of atherosclerotic plaques at the distal LAD were significantly lower in patients with MB on the middle LAD (3.5% vs. 19.7%, P: 0.0001). Conclusions — The presence and morphological characteristics of MB and its relation with atherosclerotic plaques in the involved coronary artery can be comprehensively analysed with 64-slice computed tomography coronary angiography.Atherosclerosis is a common finding in segments proximal to MB, but the prevalence of plaques in equivalent segments (proximal LAD in our study) is not higher than in patients under similar coronary artery disease risk and without MB. On the other hand, prevalence of atherosclerotic plaques at the distal LAD was significantly lower in our patients with MB on the middle LAD. Finally, we suggest that rather than causing proximal atherosclerosis, MB might have a more important role in the protection of distal segments of the bridged arteries from atherosclerosis.

Diagnostic performance of 64-slice computed tomography coronary angiography to detect significant coronary artery stenosis.

Objective — We aimed to determine the diagnostic accuracy of 64-slice multi-slice computed tomography (MSCT) to detect significant coronary artery stenosis with comparison to conventional coronary angiography (CCA). Methods — In 100 patients (70 men, average age 58 ± 10 years and age range 31-75 years) scheduled to have conventional coronary angiography, MSCT was performed before catheterization (within 2 months).All patients were in sinus rhythm, able to hold breath for 15 seconds, and had serum creatinine levels < 1.5 mg/dl. MSCT scans were analysed by a radiologist and a cardiologist. Sensitivity, specificity, positive and negative predictive values for the detection of significant stenoses by MSCT in comparison with CCA were calculated on patient, vessel, and segmental bases. Results — 64-slice computed tomography is able to detect significant coronary artery stenosis on a segmental basis with a sensitivity of 88% and specificity of 99% when compared with CCA. All patients with significantly stenotic coronary artery disease are correctly diagnosed.The presence of significant stenosis was correctly diagnosed by MSCT in 126 of 144 segments.Twelve non-significant lesions on CCA were overestimated by MSCT. On vessel-based analysis, the sensitivity and specificity of MSCT for detecting significant stenosis were 91% and 97%, respectively. Conclusion — Our results indicate that 64-slice computed coronary angiography is a reliable diagnostic modality for the detection of significant coronary artery stenosis in patients with sinus rhythm and scheduled to have CCA, but still has limitations of diagnostic performance on a per-segment and per-vessel basis.

Acute myocardial infarction in a 24 year-old man possibly associated with sibutramine use

Sibutramine is an anti-obesity drug, which acts by inhibiting neuronal re-uptake of noradrenaline and serotonin. Although the most frequently seen effect of sibutramine on cardiovascular system is an increase in blood pressure and pulse rate, rare but severe side effects such as sibutramine-induced ventricular arrhythmias, heart failure and cardiovascular disease-related death are also reported. We describe a 24 year-old man with low atherosclerotic risk profile who had acute myocardial infarction possibly associated with sibutramine use.

Paclitaxel‐induced ST‐Segment Elevations

A 51‐year‐old woman presented with severe chest pain minutes after starting intravenous paclitaxel as a part of the systemic chemotherapy due to ovarian carcinoma. The electrocardiogram (ECG) revealed sinus rhythm with ST‐segment elevations in inferior and anterior leads. The ST‐segment elevations resolved immediately after sublingual nitroglycerine. Cardiac troponin T and CPK MB levels remained in the normal range at repeat measurements. It was presumed that in spite of standard premedication, paclitaxel had induced acute coronary syndrome with ST‐segment elevations in this patient. Copyright

Giant hydatid cyst of the interventricular septum mimicking acute myocardial infarction on ECG: an unusual cause of ST segment elevation

Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus, which is still endemic in many cattle-raising areas. Cardiac involvement is a rare, but potentially a very serious complication of the hydatid disease. The diagnosis of cardiac cyst hydatid may be difficult due to the nonspecific symptoms and varying clinical presentations. With this report, we describe a case of giant hydatic cyst of the interventricular septum that caused ischemic changes on ECG, mimicking acute myocardial infarction. The final diagnosis was made by combining echocardiography, MRI, and serological tests. Surgical resection of the cyst, followed by albendezol treatment yielded a favorable outcome.

Right coronary artery fistula with significant left-to-right shunt.

We present an image of giant fistula between severely enlarged right coronary artery and coronary sinus, which was evaluated by echocardiography, conventional coronary angiography and multislice computed tomography coronary angiography.

Artifact mimicking non-sustained polymorphic ventricular tachycardia in a patient with recent myocardial infarction

A 78-year-old woman with a history of recent myocardial infarction was admitted to the coronary care unit because of dyspnea. The baseline ECG revealed sinus rhythm of 90 beats/min. Two hours after her admission, her body temperature raised to 38.8 degrees Celcius accompanied by shaking chills. Wide complex tachycardia runs consistent with polymorphic ventricular tachycardia synchronous with shaking chills were noticed on the monitor. Closer observation of the ECG revealed the presence of normal QRS complexes at the cycle length of baseline rhythm. It was presumed that artifact due to shaking chills was responsible for the ECG abnormalities.