Mehmet Bilge

P-Wave Duration and Dispersion in Patients with Metabolic Syndrome

Background: Metabolic syndrome (MS) has been reported to be associated with an increased risk of atrial fibrillation (AF). The aim of this study was to investigate P‐wave dispersion (PWD) in patients with MS.

Effects of cigarette smoking on the circadian rhythm of heart rate variability.

BACKGROUND The effects of cigarette smoking on the circadian rhythm of heart rate variability (HRV) are not known. METHODS We studied the effects of cigarette smoking on the circadian rhythm of HRV in 24 smoking and 21 non-smoking healthy subjects. Twenty-four hour ambulatory electrocardiograms were recorded and time domain parameters of HRV (SDNN [standard deviation of all R-R intervals], SDANN [standard deviation of the averages of R-R intervals in all 5-minute segments of the entire recording], RMSSD [the square root of the mean of the sum of the squares of differences between adjacent R-R intervals]) were determined for the entire 24-hour period and for each 3-hour period. RESULTS In total, SDNN and SDANN were significantly lower in smokers than non-smokers (116 +/- 26 vs 136 +/- 27, p < 0.05 for SDNN, 109 +/- 25 vs 121 +/- 24, p < 0.05 for SDANN). However, there were no statistical differences between smokers and non-smokers in heart rate (81 +/- 9 vs 76 +/- 10, p > 0.05) and RMSSD (32 +/- 12 vs 37 +/- 18, p > 0.05). These HRV parameters showed a circadian variation: they increased at night and decreased during the day in both groups. The parameters were lower in smokers than non-smokers during daytime (especially, between 8-14 hours). However, no differences were detected during night-time. CONCLUSIONS Time domain parameters of HRV (SDNN, SDANN and RMSSD) in both smoking and non-smoking healthy subjects have a circadian rhythm. SDNN and SDANN were lower in smokers than non-smokers during daytime.

Frequency of Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Acute Myocardial Infarction

Left ventricular systolic dysfunction may precipitate blood stasis as well as thrombus formation in the left atrial appendage of patients with acute myocardial infarction, even in the presence of sinus rhythm. Thus, left atrial thrombi may be an alternative source for systemic embolism in acute myocardial infarction.

Pulmonary endarteritis and subsequent embolization to the lung as a complication of a patent ductus arteriosus--a case report.

The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocar diography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previ ously reported only in a few cases. In brief, our case not only shows the importance of echocar diography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.

Acute coronary syndrome due to complete bare metal stent fracture in the right coronary artery

Stent fracture (SF) was suggested to be an unusual cause of restenosis after drug eluting-stent implantation. However, angiographically visible complete SF after bare metal stent (BMS) implantation is extremely rare. Here we report a case of SF of a BMS representing with acute coronary syndrome (ACS). To our knowledge, this is the first report of early fracture of a BMS in the right coronary artery, resulting in ACS.

The effect of autonomic nervous system activity on exaggerated blood pressure response to exercise : evaluation by heart rate variability

OBJECTIVE We investigated the effect of autonomic nervous system activity on exaggerated systolic blood pressure (SBP) response to exercise in healthy subjects using heart rate variability (HRV) analysis. METHOD AND RESULTS We studied 53 healthy volunteer subjects with exercise treadmill test according to the Bruce protocol. Time domain and frequency domain of HRV were measured for each 5-minute segment before (rest) and after exercise (recovery) and during the total exercise period. The mean change in SBP (delta SBP) was 39 +/- 18 mm Hg. The delta SBP above the value of mean (> or = 40 mm Hg) was defined as an exaggerated delta SBP. According to the delta SBP, subjects were classified into two groups. Group I consisted of 32 patients who showed a normal delta SBP, group II consisted of 21 patients who showed exaggerated delta SBP. There were no significant differences in baseline clinical characteristics and exercise duration between the two groups. There were no significant differences in the mean RR intervals, SDNN (standard deviation of all RR intervals), RMSSD (the square root of the mean of the sum of the squares of differences between adjacent RR intervals), and HF (high-frequency power, 0.15 to 0.40 Hz) at rest between the two groups. However, LF (low-frequency power, 0.04 to 0.15 Hz) and LF/HF ratio at rest were significantly higher at rest in group II than in group I. There were no significant differences in the mean RR intervals and HF at exercise between the groups. However, SDNN and RMSSD were significantly lower, LF and the LF/HF ratio were significantly higher at exercise in group II than in group I. No differences in these parameters were observed at recovery between the two groups. CONCLUSIONS The sympathetic activity was higher at rest and during the total exercise period, parasympathetic activity was lower during the total exercise period in healthy subjects with exaggerated SBP response to exercise than in those with normal SBP response.

Cardiac Troponin I Levels in Patients with Left Heart Failure and Cor Pulmonale

Cardiac troponin levels are regarded as the most specific of currently available biochemical markers of myocardial damage. Elevated levels of troponin have been previously reported in patients with left heart failure, reflecting small areas of undetected myocardial cell death. The aim of this study was to compare the levels of the cardiac troponin I (cTnl) in patients with left- and right-sided heart failure. Cardiac troponin I levels were studied with immunochemical methods in patients with right heart failure (n = 17) resulting from chronic obstructive pulmonary disease, ischemic left heart failure (n = 23), and nonischemic left heart failure (n = 18) who were admitted to departments of cardiology and chest diseases. Also, cTnl levels were measured in 32 healthy subjects as control group. Protein markers of myocardial injury (cTnl and myoglobin) in patients with left and right heart failure were collected approximately 12 to 36 hours after onset of obvious symptoms. Serum creatine kinase MB band was determined on admission and thereafter twice a day during the first 3 days. Elevated levels of serum cTnl were found in patients with nonischemic (0.83 ±0.6 ng/mL, p<0.01) and ischemic left heart failure (0.9 ±0.5 ng/mL, p<0.01) when compared to healthy subjects, whereas serum cTnl levels in patients with right heart failure due to chronic obstruc tive pulmonary disease were not significantly different from those of control subjects (0.22 ±0.1 vs 0.16 ±0.1 ng/mL, p> 0.05). In addition, creatine kinase MB band and myoglobin levels were not significantly different between patient and healthy groups. The mean of cTnl levels in ischemic and even nonischemic left heart failure were increased compared to the mean of values in healthy individuals but without significant creatine kinase MB band and myoglobin elevations. But cTnl levels were not increased in patients with right heart failure due to chronic obstructive pulmonary disease. These data indicate that the cTnl levels are abnormal in left heart failure but not in cor pulmonale.

Wolff-Parkinson-White Syndrome Mimicking Acute Anterior Myocardial Infarction in a Young Male Patient A Case Report

A young male with Wolff-Parkinson-White syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V1-V6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed Wolff-Parkinson-White syndrome with two accessory pathways.

A Case of Arrhythmogenic Right Ventricular Cardiomyopathy in Sinus Rhythm Associated with Thrombus in the Right Atrium

We describe a patient with arrhythmogenic right ventricular cardiomyopathy (ARCV) in sinus rhythm associated with thrombus in the right atrium. The occurrence of a right heart thrombus in ARCV is extremely rare and, to our knowledge, has been previously reported only in the right ventricle. In our case, ARCV most probably led to right atrial spontaneous echo contrast, and later, right atrial thrombus formation by blood stasis caused by right ventricular systolic dysfunction. In conclusion, our case suggests that right atrial thrombus may occur in ARCV, even in sinus rhythm.

Impact of metabolic syndrome on coronary patency after thrombolytic therapy for acute myocardial infarction.

ObjectivesThe metabolic syndrome (MS) is highly prevalent in patients with acute myocardial infarction. It has been shown that MS is associated with poor in-hospital outcome and long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of MS on the infarct-related artery patency in patients treated with thrombolytic therapy for acute myocardial infarction. MethodsWe retrospectively analyzed 116 patients who were admitted to our clinics with acute ST elevation myocardial infarction and received thrombolytic therapy within 12 h of chest pain. MS was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. The flow in the infarct-related artery was analyzed according to the thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count. ResultsMS was present in 55.2% of patients. The proportion of patients with MS who achieved TIMI grade 3 flow after thrombolysis was significantly lower than that of patients without MS (41.5 vs. 58.5%, P<0.001). Moreover, corrected TIMI frame counts were significantly higher in patients with MS (58.3±34.8 vs. 44.7±28.1, P = 0.02). On multivariate logistic regression analysis MS was the only independent predictor of TIMI flow less than 3 (P = 0.03, odds ratio = 3.545, 95% confidence interval: 1.064–11.808). ConclusionWe have shown for the first time that patients with MS have lower rates of TIMI grade 3 flow and higher corrected TIMI frame counts after thrombolytic therapy for acute myocardial infarction.