Osman Yesildag

The influence of ambulatory blood pressure profile on left ventricular geometry.

Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure, which does not decrease enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24‐hour blood pressure profile on the left ventricular geometry was examined. Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: the patients whose night blood pressure levels decreased by more than 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (nondipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Age, gender, systolic, and diastolic blood pressure were similar within the dipper and nondipper groups. Normal geometry, concentric remodeling, and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the nondipper group compared to the dipper group (42.9% vs 6.3%, P < 0.03). Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy. (ECHOCARDIOGRAPHY, Volume 21, January 2004)

Late pacemaker twiddler syndrome

Dr. Ihsan Dursun, MD ()) · Prof. Osman Yesildag, FESC Korhan Soylu, MD · Prof. Ozcan Yilmaz · Erdogan Yasar, Tech Murat Meric, MD Ondokuz Mayis Universitesi Tip Fakultesi, Kardiyoloji Bolumu 55139 Kurupelit Samsun/Turkey Tel.: 90-5 32 / 4 30 87 62 Fax: 90-3 62 / 4 57 60 41 E-Mail: ihsandursun@mynet.com Sirs: Twiddler syndrome, known as the rolling up of the pacemaker battery within the pacemaker pocket, was first described in 1968 by Bayliss et al. [1]. Frequently, twisting of the pacemaker battery within the pacemaker pocket ends with the dislocation of the electrode, diaphragmatic stimulation and the loss of capture [2]. This situation is not limited to only cardiac pacemaker batteries. It has also been observed in implantable cardioverter defibrillators [3]. Symptoms begin with the twisting of the pacemaker battery within the pacemaker pocket in which it is implanted. The capture problem is a result of the dislocation of the electrode. Hypoperfusion symptoms such as fatigue, tiredness, confusion, presyncope and syncope can be observed if the patient is completely dependent on the cardiac pacemaker [4]. Except the symptoms related with the failure of the cardiac pacemaker, other symptoms are also observed frequently as well due to the damage of the neigbouring organs. Ipsilateral phrenic nerve stimulation concludes the sensation of the diaphragmatic and abdominal pulsations. Additionally, if the electrodes become more twisted around the battery, rhythmic arm movements can occur due to the stimulation of the brachial plexus [5]. However not all cases display clinical symptoms [3]. Capture or pace problems can also be observed in the electrocardiography (ECG). The ECG is also abnormal if the electrode dislocates intermittently. On a chest X-ray, the electrodes can be seen as bent, twisted or dislocated and fractured [4].

Left Circumflex Coronary Artery Arising as a Terminal Extension of Right Coronary Artery A Case Report

Many types of coronary artery anomalies have been detected, and most of them occur in the left circumflex artery. In this report a unique circumflex artery anomaly is presented. The left circumflex artery arose as a terminal extension of the right coronary artery. The main stem and obtuse marginal branches of the circumflex artery were normal and well developed.

192 The influence of ambulatory blood pressure profile on left ventricular geometry

Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure, which does not decrease enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24-hour blood pressure profile on the left ventricular geometry was examined. Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: the patients whose night blood pressure levels decreased by more than 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (nondipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Age, gender, systolic, and diastolic blood pressure were similar within the dipper and nondipper groups. Normal geometry, concentric remodeling, and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the nondipper group compared to the dipper group (42.9% vs 6.3%, P < 0.03). Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy.