Tolga Sinan Güvenç

Coronary artery fistula: Review of 54 cases from single center experience*

BACKGROUNDnDemographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail.nnnMETHODSnWe have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study.nnnRESULTSnA total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%.nnnCONCLUSIONSnOur findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed.

Kounis Syndrome secondary to cefuroxime axetil use in an asthmatic patient

A sixty-one year old female with a past history of asthma was admitted to the emergency department because of vertigo, nausea, vomiting, chest pain and generalized erythema after taking an oral dose of cefuroxime axetil. Electrocardiography showed ST segment elevation in inferior leads. After coronary angiography, type 2 variant of Kounis Syndrome is diagnosed. We present first drug induced Kounis Syndrome in an asthmatic patient with severe anaphylactic shock. The present report also shows that atopic people expressing an amplified mast cell degranulation may have more serious hemodynamic decompensation during hypersensitivity reactions.

Glue (Toluene) Abuse: Increased QT Dispersion and Relation with Unexplained Syncope

Exposure to toluene, one of the major components of glue, can lead to cardiac arrhythmias and sudden sniffing death syndrome. QT dispersion is a useful risk marker for cardiac arrhythmias and sudden cardiac death. The aim of this study was to investigate the effects of glue abuse on QT interval and QT dispersion. The study included 44 patients with inhalant abuse and 34 healthy controls. Patients were divided into three groups: glue abusers with history of unexplained syncope (n = 20), asymptomatic glue abusers (n = 24), and healthy control subjects (n = 34). QT intervals, QT dispersion, and corrected QT dispersion values were measured. QT and corrected QT duration were greater in the symptomatic group than in athe symptomatic group and greater in the asymptomatic group than in controls. QT and corrected QT dispersion in both symptomatic and asymptomatic group were significantly greater than controls (p= .001), and also QT and corrected QT dispersion in symptomatic group was greater in asymptomatic group (p = .001). These findings demonstrate that QT interval and corrected QT dispersion increase in symptomatic or asymptomatic toluene abusers. The QT and QTc dispersion were also found to be longer in the symptomatic group than those in the asymtomatic group.

Low serum copeptin levels in patients with obstructive sleep apnea

PurposeCopeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group.MethodsA total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method.ResultsPatients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48u2009±u20090.24. vs. 0.64u2009±u20090.28xa0ng/ml, pu2009=u20090.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (nu2009=u200913) and severe (nu2009=u200947) obstructive sleep apnea patients (0.42u2009±u20090.18 vs. 0.49u2009±u20090.26xa0ng/ml, pu2009=u20090.409).ConclusionsRather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.

Diagnostic Value of Strain Echocardiography, Galectin-3, and Tenascin-C Levels for the Identification of Patients with Pulmonary and Cardiac Sarcoidosis

BackgroundCardiac involvement in sarcoidosis has been associated with poor prognosis. We evaluated myocardial contractility quantitatively in a cohort of pulmonary sarcoidosis (PS) patients with and without cardiac involvement. We also studied markers of fibrosis (tenascin-C [Tn-C] and galectin-3 [Gl-3]) as diagnostic tools for PS and cardiac sarcoidosis (CS).MethodsForty ambulatory patients with PS of grades 1–2 and 26 healthy subjects were prospectively enrolled. All patients with PS underwent cardiac magnetic resonance (CMR) to explore the presence of CS. The study population was divided into three groups: controls (nxa0=xa026), non-CS patients (nxa0=xa034), and CS patients (nxa0=xa06). Speckle-tracking strain echocardiography (STE) was performed on all patients, and Gl-3 and Tn-C values were measured in all patients and controls.ResultsPS patients had higher levels of Gl-3 and Tn-C than did controls, and the STE parameters of PS patients, including global longitudinal strain (GLS) and global circumferential strain (GCS), were lower than those of controls (pxa0<xa00.001 for all comparisons). GLS values were lower in CS patients than in the other groups (pxa0=xa00.05).ConclusionsPS patients demonstrate reduced cardiac contractility, independent of CMR-proven structural cardiac lesions, while patients with structural lesions have a more pronounced drop in strain parameters. Tn-C and Gl-3 are promising markers for the diagnosis of PS, but they are not specific for cardiac involvement.

Comparison of Effects of Low- versus High-Dose Heparin on Access-Site Complications during Transradial Coronary Angiography: A Double-Blind Randomized Study

Objectives: Although heparin is highly effective in reducing the rate of radial artery occlusion after transradial catheterization, the optimal heparin dose is still controversial. The aim of this study was to evaluate the efficacy and safety of two different heparin doses during transradial coronary angiography. Methods: 490 consecutive patients undergoing transradial coronary angiography were prospectively enrolled into this double-blind randomized trial. A total of 202 patients enrolled in the low-dose (LD; 2,500 U of heparin) group and 202 patients enrolled in the high-dose (HD; 5,000 U of heparin) group were included in the final analysis. The primary endpoint of the study was radial artery occlusion. Bleeding and hematomas were the secondary outcome measures. Results: At day 7, radial artery occlusion occurred in 5.9% of the patients in the LD group and in 5.4% of the patients in the HD group (p = 0.83). Bleeding during deflation of the transradial band occurred in 6.4% of the patients in the LD group and in 18.3% of the patients in the HD group; the difference was statistically significant (p < 0.001). Higher-dose heparin was found to be an independent predictor of bleeding (p = 0.007). Conclusion: A lower dose of heparin (i.e. 2,500 U) decreases bleeding during transradial band deflation without an increase in radial artery occlusion.

Effects of high altitude and sea level on mean platelet volume and platelet count in patients with acute coronary syndrome.

A relationship exists between exposure to high altitude and increased coagulability. Mean platelet volume is a parameter of platelet functions and may be a marker for increased platelet aggregability. The aim of this study was to compare the mean platelet volumes and platelet counts in patients who experienced an acute coronary event at moderately high altitude and at sea altitude. Four hundred and one patients who experienced an acute coronary event were enrolled, of them 211 were born and had been living at the sea level, while 190 were born and had been living at high altitude (at least 2,000xa0m above the sea level). Patients were compared regarding the mean platelet volumes and platelet counts. The mean platelet volumes were significantly higher in patients living in high altitude (Pxa0=xa00,001). No statistically significant differences were found among the groups regarding the platelet counts. As a result, this increased MPV values in highlanders who experienced an acute coronary event may reflect increased platelet aggregability.

Severe Tricuspid Regurgitation and Atrioventicular Block Caused by Blunt Thoracic Trauma in an Elderly Woman

BACKGROUNDnSymptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury.nnnOBJECTIVESnUnlike with the mitral valve, post-traumatic tricuspid heart valve insufficiency is usually well tolerated. Indeed, severe tricuspid regurgitation can resolve spontaneously.nnnCASE REPORTnA 68-year-old woman with no previous cardiac or medical history was brought to our Emergency Department after an automobile accident. She had chest pain and shortness of breath upon admission. Transthoracic echocardiographic examination revealed severe tricuspid regurgitation with rupture of the chordae tendineae and prolapse of the valve cusps into the right atriumxa0during systole. An electrocardiogram was consistent withxa0second-degree Mobitz II atrioventricular block on admission, which subsequently progressed to complete atrioventricular block on day 3. During follow-up with close hemodynamic monitoring, her symptoms disappeared and repeat echocardiography revealed a regression in the severity of tricuspid regurgitation. Operative repair of the tricuspid valve was deemed unnecessary and the patient was discharged with medical therapy on the eighth day after admission.nnnCONCLUSIONSnIt is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.

Acute Aortic Regurgitation with Myocardial Infarction: An Important Clue for Aortic Dissection

BACKGROUNDnAortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Echocardiography is an important tool for the differential diagnosis.nnnOBJECTIVESnTo stress the importance of recognizing aortic regurgitation for the differentiation of myocardial infarction and aortic dissection.nnnCASE REPORTnAn 80-year-old woman was admitted to our hospital with chest pain that was diagnosed as inferior and lateral wall myocardial infarction based on electrocardiographic findings. The diagnosis was reevaluated when aortic regurgitation was detected on echocardiography. Closer inspection of the ascending aorta revealed a dissection flap as the cause of aortic regurgitation.nnnCONCLUSIONnDetection of aortic regurgitation in a patient with myocardial infarction and normal valves should prompt the search for a possible aortic dissection, whether or not the dissection flap can be visualized.

Predictive value of red cell distribution width in intrahospital mortality and postintervention thrombolysis in myocardial infarction flow in patients with acute anterior myocardial infarction.

ObjectivesRecent studies have reported a strong independent association between increased red cell distribution width (RDW) and the risk of adverse outcomes in patients with heart failure, stable coronary disease, and acute coronary syndromes. However, in this study we aimed to determine the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow and intrahospital mortality in patients with acute anterior myocardial infarction (AMI). MethodsA total of 763 patients with acute AMI undergoing a primary percutaneous coronary intervention were evaluated retrospectively. Upon admission, the RDW level was measured by an automated complete blood count. Postinterventional TIMI flow and intrahospital mortality was documented for all patients from hospital registries. The patients were classified according to the RDW level. RDW more than 14.8% was defined as elevated RDW. All groups were compared statistically according to the preinterventional characteristics. ResultsElevated RDW was found to be an independent predictor of increased intrahospital mortality in multivariate regression analysis (hazard ratio: 3.677, 95% confidence interval: 1.228–11.008, P=0.02). Other independent predictors for intrahospital mortality were diabetes mellitus (hazard ratio: 6.743, 95% confidence interval: 1.941–23.420, P=0.003), smoking (hazard ratio: 6.779, 95% confidence interval: 1.505–30.534, P=0.013), and creatinine more than 0.8 mg/dl (hazard ratio: 7.982, 95% confidence interval: 1.759–36.211, P=0.007). However, there were no independent predictors for TIMI including elevated RDW. ConclusionA high admission RDW level in patients with acute AMI undergoing a primary percutaneous coronary intervention was associated with an increased risk for intrahospital cardiovascular mortality, but was not associated with worse postinterventional TIMI flow.