Sule Korkmaz

Mean platelet volume and exercise stress test.

AbstractBackground: Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production. Design and Methods: We evaluated Treadmill exercise test (TMET) and compared MPV values (fl) before and after TMET in 63 consecutive patients who, then, underwent coronary angiography and found to have significant coronary artery disease in more than one coronary artery (>70% diameter stenosis in left anterior descending, right coronary or circumflex artery and >50% diameter stenosis in left main coronary artery). Sixty-three male patients were enrolled as a patient group with a mean age of 52.43 ± 4.08 years and with strongly positive exercise test (≥2 mm ST segment depression, horizontal or down-sloping). Thirty-five patients without significant coronary artery disease were selected as a control group with a mean age of 52.66 ± 4.39 years having undergone TMET. Results and Discussion: In the patient and control groups, mean MPV values before TMET were the same, 8.52 ± 0.63 and 8.45 ± 0.58 respectively. Following TMET within 30 minutes, mean MPV were 10.03 ± 0.96 and 8.50 ± 0.45 respectively (p < 0.001). When pre and post-TMET MPV values were evaluated together, the patient group had a significant increase in the MPV (p < 0.001), whereas, the control group had no significant increase in the MPV (p = 0.379). It was concluded that exercise possibly makes patients with significant coronary artery disease, more susceptible to a thrombotic event through various routes, one of that is platelet activation that could be measured indirectly via MPV. Healthy subjects react this thrombotic process by increasing their fibrinolytic capacity acutely. Patients with ischemic heart disease, particularly those with significantly narrowed coronary arteries, known to lack fibrinolytic capacity and have high shear stress, on the other hand, might face ischemic events, including sudden death following acute exercise.

Late recurrence of left atrial myxoma with multiple intracranial aneurysms

Atrial myxomas are rare tumors. They occur in less clinical history. In her neurological examination, no than 0.05% of the population, but they constitute persisting deficit was noticed. She was, then, conapproximately 50% of primary cardiac neoplasms [1]. sulted to the neurology department for differential They are true neoplasms thought to be derived from diagnosis of severe headache. At her contrast-enpluripotential subendocardial mesenchymal cells [2]. hanced computerized tomographic examination of the These tumors present with systemic embolization in cranium, she was noticed to have many commaup to 45% of cases [3,4], with the cerebral circulation shaped enhancing lesions one of which was a giant being involved in one-half of these instances [5]. aneurysm on the left side. She was, then, referred to Cerebral ischemia resulting from direct tumor emthe neurosurgery department on an urgent basis. bolization is the most common neurological preFollowing her hospitalisation in the neurosurgery sentation [6]. Other rare neurological manifestations department, she underwent cerebral angiography in include parenchymal brain metastasis [7], intracerebrwhich there were multiple fusiform aneurysms on al hemorrhage [5] and oncotic aneurysm formation both carotid artery territories, one of which was a [1,8]. With rare exceptions, neurological symptoms giant aneurysm on the left middle cerebral artery related to atrial myxomas occur before or at the time artery locus (Fig. 1) of primary tumor diagnosis. We describe a patient Treatment with coil embolization of the aneurysm who presented with transient neurological symptoms was decided due to localisation of the giant 25 years after complete resection of left atrial myxaneurysm. Before the procedure, since she was oma as initial finding of late recurrence. known to have resection of myxoma, an echocardiogA 38-year-old woman was admitted to our raphy was performed and a mass lesion originating emergency department with chief complaints of from the posterior wall of the left atrium with severe headache and episodes of right sided weakmultiple, mobile, papillary extensions towards mitral ness. She was normotensive having 115/75 mmHg valve was noted (Fig. 2). Following coil embolization systolic /diastolic blood pressures and known to have of the giant aneurysm, she was referred to our left atrial myxoma resection 25 years ago in her department and operated successfully for the mass lesion. Pathology confirmed our diagnosis and the diagnosis for the late recurrence of the myxoma at the first site was established. She has been followed up *Corresponding author. SSK Bloklari 70 /7 06170, Yenimahalle /Anby our clinic uneventfully for both recurrence and kara, Turkey. Tel.: 190-312-346-9401. E-mail address: cardioceptor@ttnet.net.tr (M.B. Yilmaz). progression or regression of cerebral aneurysms.

Maximum P Wave Duration and P Wave Dispersion in Adult Patients with Secundum Atrial Septal Defect: The Impact of Surgical Repair

Background: Patients with atrial septal defect (ASD) have an increased risk for atrial fibrillation (AF). Previously it was shown that maximum P wave duration and P wave dispersion in 12‐lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. We studied P maximum and P dispersion in adult patients with ASD during normal sinus rhythm. In addition, the impact of surgical closure of ASD on these variables within 1 year after surgery was evaluated.

Outcome of Significant Functional Tricuspid Regurgitation Late After Mitral Valve Replacement for Predominant Rheumatic Mitral Stenosis

Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 ±10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 ±2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.

Metabolic syndrome negatively impacts early patency of saphenous vein grafts

BackgroundCoronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (≤5 years). MethodsCoronary angiograms of 314 consecutive patients (mean age 62.6±8.5 years), having at least one saphenous vein bypass graft within the last 5 years, were evaluated. ResultsOne hundred and twenty-one patients (group 1) had either an occluded saphenous vein graft or a saphenous vein graft with a significant lesion, and 193 patients (group 2) had patent saphenous vein grafts. Metabolic syndrome was present in 46.2% of all patients (n=145), in 57% of patients in group 1 and in 39.4% of patients in group 2 (P=0.002). Having metabolic syndrome increased the risk of saphenous vein graft occlusion or having a significant lesion on saphenous vein grafts by 2.04-folds. In multivariable logistic regression, smoking (P=0.015, odds ratio=1.88), metabolic syndrome (P=0.019, odds ratio=1.81) and diabetes mellitus (P=0.048, odds ratio=1.36) were found to be associated with poor venous graft fate in the relatively short-term period after bypass. ConclusionMetabolic syndrome seems to impact saphenous vein graft patency negatively in the relatively short term.

Mean platelet volume in the patients with cardiac syndrome x

Background:Angina with normal coronary arteries, cardiac syndrome X, is a diagnosis of exclusion. The exact mechanism of this clinical syndrome remains unclear. Although the prognosis is as good as equal to that of normal population, symptoms related with the syndrome impair largely quality of life. Mean platelet volume showing the platelet size is an indicator of platelet function. Larger platelets are more active than smaller ones.Methods and results: We designed a study, evaluated mean platelet volume of the patients with cardiac syndrome X (group A) and stable angina (group B) and investigated the relation between groups. Eighty patients with cardiac syndrome X with a mean age of 51.08 ± 9.79 years and 67 patients with stable angina with a mean age of 55.16 ± 11.96 years were studied. At the end of the study, mean platelet volume of group A was significantly higher than that of group B, 10.55 ± 1.08 fl vs. 9.39 ± 0.58 fl, respectively (P < 0.001).Conclusion: Raised platelet size has been shown to be associated with adverse cardiac events. Mean platelet volume has increased in acute coronary syndromes and also in cardiac syndrome X in our study. Life style modification may optimize platelet size and improve symptoms in these patients.

Level of Awareness of on-Treatment Patients About Prescribed Statins

AbstractBackground: Statins are frequently prescribed drugs for patients with coronary heart disease according to evidence-based medicine. However, compliance with these agents has still been far from ideal, since they require long term, probably life long therapy. We conducted a survey on patients who were already on statin treatment and evaluated their level of awareness of prescribed statins. Methods: 236 participants (117 male, 119 female), who had been on treatment with statins for at least three months, were enrolled in our study after giving informed consent. Patients were asked close-ended survey questions. Results: Only 5.5% of participants were on statin treatment for primary prevention, and 16.1% of them had a CHD equivalent, defined as those with clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease) and diabetes mellitus. Most participants (70%) stated that they had been using statins to decrease cholesterol, whereas 16.5% stated that they had no idea. More than half of the participants (58%) stated that they did not know how long they would have to keep using their statins, whereas 21% replied that they would use them continuously. One fifth of participants had some idea about side effects. Participants in whom statin therapy was started during hospitalisation for coronary angiography and/or PCI more frequently answered that statins should be used continuously (49% vs. 12% not hospitalised, p < 0.01). Also, therapy adjustment by the physician led to a better understanding of the need for continuous use (55% vs. 31% without medication change, p < 0.001), as was the case for patients with < 2 comedications (36% vs. 17% with > 2 comedications, p 0.002). Presence of other risk factors did not have any impact on level of awareness. Conclusion: Comprehensive information at initial prescription, initiation of statins during hospitalization, dose adjustment during follow up, and as little co-medication as possible seem to increase the level of awareness of the benefits of long-term statin treatment. This might result in better compliance rates.

Uncomplicated heart and lung perforation by a displaced ventricular pacemaker lead: a case report.

Lead perforation is a rare complication of pacemaker implantation and associated with the risk of disastrous results like cardiac tamponade or pneumo‐hemothorax. We report a patient in whom a ventricular lead perforated the right ventricle and left lung parenchyma without the development of cardiac tamponade, pneumothorax, or hemothorax. No objective evidence for perforation was found on echocardiographic evaluation and thorax computed tomography has made the definite diagnosis. In the literature available to us, it is the first reported case of an uncomplicated right ventricular and lung parenchymal perforation associated with pacemaker implantation.

Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment elevation acute coronary syndromes.

BackgroundMetabolic syndrome (MS) comprises a group of factors that are associated with increased risk for cardiovascular events. Acute coronary syndromes account for the most important part of cardiovascular events with considerable morbidity and mortality. We aimed to investigate the association of MS with extension of coronary artery disease in patients presenting with non-ST segment elevation (NSTE) acute coronary syndromes (ACS). MethodsThree hundred and six consecutive patients (220 men, 86 women patients) with the diagnosis of NSTE ACS, who were hospitalized within the first 24 h of their chest pain in the coronary care unit, were prospectively enrolled into our study. Patients with elevation of troponins (T or I) were classified as NSTE myocardial infarction (MI) and otherwise as unstable angina pectoris (USAP). Components of MS were noted as previously identified. Coronary angiograms were evaluated by two authors, who were blinded to the study plan and each other, via Sullivans method. ResultsMS was noted in 49% of all patients, and was significantly more common in women than in men (62.8 versus 43.6%, P=0.003). The mean total stenosis score of patients with MS was significantly higher than for those without MS (16±6 versus 12±5, P<0.001), and the mean extension score of patients with MS was significantly higher than for those without MS (63±29 versus 44±26, P<0.001). The presence of MS together with some clinical factors and poor total cholesterol/high-density lipoprotein cholesterol ratio, hypertension and diabetes mellitus, was found to be independently predictive of extension of coronary artery disease (CAD) in a group of patients presenting with NSTE ACS. ConclusionsMS is independently associated with CAD extension, and hence, might account for poor cardiovascular outcomes through CAD extension in patients with NSTE ACS.

Porcelain heart: a case of massive myocardial calcification

Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.