Rasim Enar

The Prognostic Significance of Narrow Fragmented QRS on Admission Electrocardiogram in Patients Hospitalized for Decompensated Systolic Heart Failure

Narrow fragmented QRS (fQRS) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases.

Effects of aldosterone blockade on left ventricular function and clinical status during acute myocardial infarction

Abstract Objective: Heart failure is frequently a serious complication of acute myocardial infarction (AMI). ACE inhibitors, Angiotensin II receptor blockers, β-blockers and aldosterone receptor blockers have been shown to improve outcomes in this setting. This study aimed to determine the effect of spironolactone on the frequency of clinical heart failure, mortality, rehospitalization and left ventricular functions determined by echocardiography. Material and methods: A total of 82 patients with STEMI hospitalized within 6–12 h of debut of symptoms were included in the study. The patients were randomly assigned into spironolactone (group A) or placebo (group B) groups after informed consent had been obtained. Results: All patients were followed for 6 months. There were no statistically significant differences between the two groups when demographic criteria were compared. The incidence of post-MI angina pectoris, rhythm and conduction disturbance during hospitalization was significantly higher in Group B than in Group A. Although not statistically significant, the incidence of clinical heart failure was slightly lower in Group A than in Group B (5% versus 11%). Left ventricular end-diastolic volumes were slightly lower in Group A than in Group B, although statistically this was not significant. Conclusions: In concordance with these findings, the ejection fraction was slightly higher in Group A than in Group B, although this was not statistically significant (47% versus 44%). This trend continued during a 6-month follow-up after randomization. Our findings suggest that early administration of aldosterone blockers provides additional benefits after AMI, reducing the incidence of post-MI angina pectoris and rhythm and conduction disturbances.

The Relation Between Early Ventricular Tachycardia and QT Dispersion in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy.

In this study, we investigated the influence of increased QT dispersion (defined as maximal QT interval minus minimal QT interval) on the occurrence of early non-sustained ventricular tachycardia (NSVT) in patients with acute myocardial infarction (AMI) who received thrombolytic therapy. In the retrospective analysis of 96 patients with clinical reperfusion criteria, 36 had NSVT within the first 12 hours after the onset of thrombolytic therapy (group A), and 60 patients did not have NSVT during the same period (group B). On admission ECG, QT and QTc dispersion and the amount of jeopardized myocardial area (Aldrich score) were calculated. In group A, Aldrich score was significantly higher (21.4 ± 7.2% vs 14.2 ± 4.9%;p<0.005). There were significantly higher QT dispersion values on admission (83.3 ± 23.4 vs 67.5 ± 23.7 msec;p<0.005), at 24th hour (87.1 ± 12.6 vs 72.1 ± 27.4 msec;p<0.005) and on the 10th day (63.5 ± 31.2 vs 49.5 ± 14.3 msec;p<0.005) in group A. In subgroup analysis of group A, patients with NSVT between 6–12 hours (group A2) had significantly higher Aldrich score and QT dispersion values at all above time points compared to patients with NSVT between 0–6 hours (group A1) after AMI. In conclusion, in this study we found a strong relation between the occurrence of NSVT within 12 hours and increased QT dispersion on admission ECG in patients with AMI who received thrombolytic therapy. This relation was even stronger for the subgroup of patients with NSVT within 6–12 hours. Thus, these results may indicate that NSVT is related to increased QT dispersion which is secondary to larger jeopardized myocardial area in patients with AMI.

Acute myocardial infarction due to antiphospholipid antibody syndrome in a young pregnant woman

Myocardial infarction (MI) in pregnant patients confer additional risks and unique problems related to necessity of concomitant obstetric interventions and coexistence of disorders as hypercoagulability. Therefore, patients usually have a more complicated course which demands prompt diagnosis and appropriate treatment. Here we report a 22 year old pregnant woman with an acute anterior myocardial infarction and the complicated course of the management. Although the patient underwent a successful percutaneous coronary intervention at the first presentation with MI, one week later she suffered a stent thrombosis presumably due to cessation of clopidogrel in order to prevent bleeding before the termination of pregnancy. Later, a detailed examination of the patient has led to diagnosis of antiphospholipid antibody syndrome.

Spontaneous splenic rupture complicating thrombolytic therapy in acute myocardial infarction

A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinase, i.v. heparin, and aspirin. After 20 hours of hospitalization she developed hypotension and a fall in hematocrit level with acute onset of severe abdominal pain. After genitourinary and gastrointestinal bleeding, pulmonary embolism and reinfarction had been ruled out, however, abdominal ultrasonography revealed intraabdominal hemorrhage and the patient was given three units of blood transfusion. Abdominal laparotomy and laparoscopy were not performed as the patients clinical status stabilized on the 3rd day and hemodynamics did not deteriorate thereafter. Abdominal computerized tomography in the second week revealed a splenic rupture.

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

Inferior myocardial infarction (MI) is considered to have a more favorable prognosis than anterior wall MI but includes high risk groups with increased mortality and morbidity. It is well known that congestive heart failure (CHF) complicating acute MI has poor prognosis. In this study we assessed the clinical and prognostic significance of CHF and the predictive value of the baseline demographic and clinical variables for CHF in patients with acute inferior MI. A total of 350 patients with acute inferior MI were included. In group A there were 26 patients (7.4%) with CHF, and in group B there were 324 patients (92.6%) without this complication. Baseline clinical and demographic characteristics and in-hospital complications of the groups were assessed. In group A patients were older (67.6±9.5 vs 53.7±10.9 years, p<0.0001) and there were more female patients (50% vs 15%, p<0.00001) compared to group B. The prevalence of diabetes mellitus (58% vs 16%) and precordial ST segment depression on admission ECG (81% vs 50%) were significantly higher in group A compared to group B (p<0.00001 and p=0.002 consecutively). In group A there was a higher rate of righ ventricular (25% vs 23%), posterior (26% vs 24%) and posterolateral myocardial infarction (19% vs 14%), but the differences were not statistically different. In group A patients had significantly higher rate of second- or third-degree AV block (46% vs 8%, p<0.00001), cardiogenic shock (35% vs 1%, p<0.00001) and mortality (46% vs 3%, p<0.00001) compared to group B. In a multivariate regression analysis diabetes mellitus (p=0.0003) and precordial ST segment depression on admission ECG (p=0.002) were found as the independent predictors of in-hospital CHF in patients with acute inferior MI. CHF and ST segment depression on admission ECG were found as the independent predictors of in-hospital mortality (p<0.00001, p=0.04 consecutively). Patients with CHF complicating acute inferior MI have more unfavorable demographic and clinical characteristics on admission, higher rate of in-hospital complications and mortality. History of diabetes mellitus and precordial ST segment depression on admission ECG have an independent predictive value for CHF in this particular group of patients.