MOTS-c as a predictor of coronary lesions and complexity in patients with stable coronary artery disease

OBJECTIVE

Atherosclerosis plays a major role in the development of coronary artery disease (CAD). It has been shown that mitochondrial open-reading-frame of the twelve S rRNA-c (MOTS-c), a mitochondrial-derived peptide, has preventive effects on atherosclerosis. The aim of this study was to determine the relationship between MOTS-c levels and CAD presence and severity using SYNTAX score (SS) in patients with stable angina pectoris.

PATIENTS AND METHODS

Ninety-two consecutive patients with stable coronary artery disease (CAD+) and ninety-two consecutive patients with normal coronary artery (CAD-) were included. Presence and severity of coronary artery disease were determined using the SS.

RESULTS

We observed that the MOTS-c levels was lower in the CAD group (111±13 vs. 161±23, p<0.001). The MOTS-c levels were also found to be significant independent predictors for CAD in multiple regression analysis (p<0.001). A MOTS-c levels ≥130.9 had 80.3% sensitivity and 73.2% specificity (area under the curve [AUC]: 0.858, 95% CI: 0.895-0.999, p<0.001) for predicting CAD.

CONCLUSIONS

The authors revealed that there is a strong correlation between MOTS-c levels and CAD. Therefore, MOTS-c may help identify patients with CAD, thus allowing for early preventive treatment.

Geant4-based electromagnetic background model for the CRESST dark matter experiment

The CRESST (Cryogenic Rare Event Search with Superconducting Thermometers) dark matter search experiment aims for the detection of dark matter particles via elastic scattering off nuclei in CaWO 4 crystals. To understand the CRESST electromagnetic background due to the bulk contamination in the employed materials, a model based on Monte Carlo simulations was developed using the Geant4 simulation toolkit. The results of the simulation are applied to the TUM40 detector module of CRESST-II phase 2. We are able to explain up to ( 68 ± 16 ) % of the electromagnetic background in the energy range between 1 and 40 keV .

Observation of Complex Time Structures in the Cosmic-Ray Electron and Positron Fluxes with the Alpha Magnetic Spectrometer on the International Space Station

We present high-statistics, precision measurements of the detailed time and energy dependence of the primary cosmic-ray electron flux and positron flux over 79 Bartels rotations from May 2011 to May 2017 in the energy range from 1 to 50 GeV. For the first time, the charge-sign dependent modulation during solar maximum has been investigated in detail by leptons alone. Based on 23.5×10^{6} events, we report the observation of short-term structures on the timescale of months coincident in both the electron flux and the positron flux. These structures are not visible in the e^{+}/e^{-} flux ratio. The precision measurements across the solar polarity reversal show that the ratio exhibits a smooth transition over 830±30 days from one value to another. The midpoint of the transition shows an energy dependent delay relative to the reversal and changes by 260±30 days from 1 to 6 GeV.

Observation of Fine Time Structures in the Cosmic Proton and Helium Fluxes with the Alpha Magnetic Spectrometer on the International Space Station

We present the precision measurement from May 2011 to May 2017 (79 Bartels rotations) of the proton fluxes at rigidities from 1 to 60 GV and the helium fluxes from 1.9 to 60 GV based on a total of 1×10^{9} events collected with the Alpha Magnetic Spectrometer aboard the International Space Station. This measurement is in solar cycle 24, which has the solar maximum in April 2014. We observed that, below 40 GV, the proton flux and the helium flux show nearly identical fine structures in both time and relative amplitude. The amplitudes of the flux structures decrease with increasing rigidity and vanish above 40 GV. The amplitudes of the structures are reduced during the time period, which started one year after solar maximum, when the proton and helium fluxes steadily increase. Above ∼3  GV the p/He flux ratio is time independent. We observed that below ∼3  GV the ratio has a long-term decrease coinciding with the period during which the fluxes start to rise.

Observation of New Properties of Secondary Cosmic Rays Lithium, Beryllium, and Boron by the Alpha Magnetic Spectrometer on the International Space Station

We report on the observation of new properties of secondary cosmic rays Li, Be, and B measured in the rigidity (momentum per unit charge) range 1.9 GV to 3.3 TV with a total of 5.4×10^{6} nuclei collected by AMS during the first five years of operation aboard the International Space Station. The Li and B fluxes have an identical rigidity dependence above 7 GV and all three fluxes have an identical rigidity dependence above 30 GV with the Li/Be flux ratio of 2.0±0.1. The three fluxes deviate from a single power law above 200 GV in an identical way. This behavior of secondary cosmic rays has also been observed in the AMS measurement of primary cosmic rays He, C, and O but the rigidity dependences of primary cosmic rays and of secondary cosmic rays are distinctly different. In particular, above 200 GV, the secondary cosmic rays harden more than the primary cosmic rays.

Observation of the Identical Rigidity Dependence of He, C, and O Cosmic Rays at High Rigidities by the Alpha Magnetic Spectrometer on the International Space Station

We report the observation of new properties of primary cosmic rays He, C, and O measured in the rigidity (momentum/charge) range 2 GV to 3 TV with 90×10^{6} helium, 8.4×10^{6} carbon, and 7.0×10^{6} oxygen nuclei collected by the Alpha Magnetic Spectrometer (AMS) during the first five years of operation. Above 60 GV, these three spectra have identical rigidity dependence. They all deviate from a single power law above 200 GV and harden in an identical way.

Precision Measurement of the Boron to Carbon Flux Ratio in Cosmic Rays from 1.9 GV to 2.6 TV with the Alpha Magnetic Spectrometer on the International Space Station

Knowledge of the rigidity dependence of the boron to carbon flux ratio (B/C) is important in understanding the propagation of cosmic rays. The precise measurement of the B/C ratio from 1.9 GV to 2.6 TV, based on 2.3 million boron and 8.3 million carbon nuclei collected by AMS during the first 5 years of operation, is presented. The detailed variation with rigidity of the B/C spectral index is reported for the first time. The B/C ratio does not show any significant structures in contrast to many cosmic ray models that require such structures at high rigidities. Remarkably, above 65 GV, the B/C ratio is well described by a single power law R^{Δ} with index Δ=-0.333±0.014(fit)±0.005(syst), in good agreement with the Kolmogorov theory of turbulence which predicts Δ=-1/3 asymptotically.

Antiproton Flux, Antiproton-to-Proton Flux Ratio, and Properties of Elementary Particle Fluxes in Primary Cosmic Rays Measured with the Alpha Magnetic Spectrometer on the International Space Station

A precision measurement by AMS of the antiproton flux and the antiproton-to-proton flux ratio in primary cosmic rays in the absolute rigidity range from 1 to 450 GV is presented based on 3.49×10^{5} antiproton events and 2.42×10^{9} proton events. The fluxes and flux ratios of charged elementary particles in cosmic rays are also presented. In the absolute rigidity range ∼60 to ∼500  GV, the antiproton p[over ¯], proton p, and positron e^{+} fluxes are found to have nearly identical rigidity dependence and the electron e^{-} flux exhibits a different rigidity dependence. Below 60 GV, the (p[over ¯]/p), (p[over ¯]/e^{+}), and (p/e^{+}) flux ratios each reaches a maximum. From ∼60 to ∼500  GV, the (p[over ¯]/p), (p[over ¯]/e^{+}), and (p/e^{+}) flux ratios show no rigidity dependence. These are new observations of the properties of elementary particles in the cosmos.

Limits on Momentum-Dependent Asymmetric Dark Matter with CRESST-II

The usual assumption in direct dark matter searches is to consider only the spin-dependent or spin-independent scattering of dark matter particles. However, especially in models with light dark matter particles O(GeV/c^{2}), operators which carry additional powers of the momentum transfer q^{2} can become dominant. One such model based on asymmetric dark matter has been invoked to overcome discrepancies in helioseismology and an indication was found for a particle with a preferred mass of 3  GeV/c^{2} and a cross section of 10^{-37}  cm^{2}. Recent data from the CRESST-II experiment, which uses cryogenic detectors based on CaWO_{4} to search for nuclear recoils induced by dark matter particles, are used to constrain these momentum-dependent models. The low energy threshold of 307 eV for nuclear recoils of the detector used, allows us to rule out the proposed best fit value above.

Precision Measurement of the Helium Flux in Primary Cosmic Rays of Rigidities 1.9 GV to 3 TV with the Alpha Magnetic Spectrometer on the International Space Station

Knowledge of the precise rigidity dependence of the helium flux is important in understanding the origin, acceleration, and propagation of cosmic rays. A precise measurement of the helium flux in primary cosmic rays with rigidity (momentum/charge) from 1.9 GV to 3 TV based on 50 million events is presented and compared to the proton flux. The detailed variation with rigidity of the helium flux spectral index is presented for the first time. The spectral index progressively hardens at rigidities larger than 100 GV. The rigidity dependence of the helium flux spectral index is similar to that of the proton spectral index though the magnitudes are different. Remarkably, the spectral index of the proton to helium flux ratio increases with rigidity up to 45 GV and then becomes constant; the flux ratio above 45 GV is well described by a single power law.

Precision Measurement of the Proton Flux in Primary Cosmic Rays from Rigidity 1 GV to 1.8 TV with the Alpha Magnetic Spectrometer on the International Space Station

A precise measurement of the proton flux in primary cosmic rays with rigidity (momentum/charge) from 1 GV to 1.8 TV is presented based on 300 million events. Knowledge of the rigidity dependence of the proton flux is important in understanding the origin, acceleration, and propagation of cosmic rays. We present the detailed variation with rigidity of the flux spectral index for the first time. The spectral index progressively hardens at high rigidities.

Precision Measurement of the (e^{+}+e^{-}) Flux in Primary Cosmic Rays from 0.5 GeV to 1 TeV with the Alpha Magnetic Spectrometer on the International Space Station

We present a measurement of the cosmic ray (e^{+}+e^{-}) flux in the range 0.5 GeV to 1 TeV based on the analysis of 10.6 million (e^{+}+e^{-}) events collected by AMS. The statistics and the resolution of AMS provide a precision measurement of the flux. The flux is smooth and reveals new and distinct information. Above 30.2 GeV, the flux can be described by a single power law with a spectral index γ=-3.170±0.008(stat+syst)±0.008(energy scale).

Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score

BACKGROUND

Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality.

OBJECTIVES

The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers.

METHODS

We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients.

RESULTS

The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (p<0.05 for both). Compared to the well-developed CCC group, the SYNTAX score, Hs-cTnT, hs-CRP, NT-proBNP, uric acid, neutrophil count and mean platelet volume (MPV) values were higher in patients with poorly developed CCC (p<0.05 for all). On multivariate logistic regression analysis, hs-cTnT (β=0.658, 95% CI=0.589-0.735, p<0.001) and NT-proBNP (β=0.991, 95% CI=0.987-0.995, p<0.001) as well as hs-CRP and diabetes were independent predictors of CCC.

CONCLUSION

Cardiac risk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion.

Electron and positron fluxes in primary cosmic rays measured with the alpha magnetic spectrometer on the international space station

Precision measurements by the Alpha Magnetic Spectrometer on the International Space Station of the primary cosmic-ray electron flux in the range 0.5 to 700 GeV and the positron flux in the range 0.5 to 500 GeV are presented. The electron flux and the positron flux each require a description beyond a single power-law spectrum. Both the electron flux and the positron flux change their behavior at ∼30  GeV but the fluxes are significantly different in their magnitude and energy dependence. Between 20 and 200 GeV the positron spectral index is significantly harder than the electron spectral index. The determination of the differing behavior of the spectral indices versus energy is a new observation and provides important information on the origins of cosmic-ray electrons and positrons.

High statistics measurement of the positron fraction in primary cosmic rays of 0.5-500 GeV with the alpha magnetic spectrometer on the international space station

A precision measurement by AMS of the positron fraction in primary cosmic rays in the energy range from 0.5 to 500 GeV based on 10.9 million positron and electron events is presented. This measurement extends the energy range of our previous observation and increases its precision. The new results show, for the first time, that above ∼200  GeV the positron fraction no longer exhibits an increase with energy.

Gamma glutamyl transferase activity: relationship with thoracic aortic intima media thickness and inflammation

OBJECTIVE

Increased serum gamma-glutamyl transferase (GGT) activity is known to be associated with atherosclerotic diseases. Thoracic aortic intima-media thickness (IMT) was reported as a marker of preclinical atherosclerosis. However, there is a lack of research directly examining the relationship between serum GGT activity and thoracic aortic IMT. Therefore, we aimed to investigate the association between serum GGT activity and thoracic aortic IMT.

PATIENTS AND METHODS

The study population consisted of 329 patients without coronary artery disease, who underwent transesophageal echocardiography (TEE) examination for various indications from January 2011 to April 2013. GGT, high-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all patients. The patients were classified into tertiles according to their GGT activities (GGTlow < 19 U/l, GGTmid ≥ 19 U/l < 29 U/l, and GGThigh ≥ 29).

RESULTS

The highest aortic IMT values were observed in the GGThigh group compared with the GGTmid and GGTlow groups (p < 0.05, for all). Also, aortic IMT values in the GGTmid group were higher than in the GGTlow group (p < 0.05). Multivariate regression analysis showed that GGT activity was independently associated with aortic IMT (β = 0.487, p < 0.001) hs-CRP (β = 0.282, p < 0.001), and triglyceride level (β = 0.161, p = 0.007).

CONCLUSION

The higher serum GGT concentrations within the "normal" range were associated with a greater IMT of the thoracic aorta. GGT activity may be a predictor of the extent of subclinical aortic atherosclerosis assessed with thoracic aortic IMT.

NT-proBNP is associated with SYNTAX score and aortic distensibility in patients with stable CAD

OBJECTIVE

A high N-terminal pro-brain natriuretic peptide (NT-proBNP) level provides significant prognostic information on patients with coronary artery disease (CAD). It is unclear whether aortic distensibility (AD), which reflects the aortic stiffness, and the extent and complexity of CAD, assessed with the SYNTAX score (SS), affect the secretion of NT-proBNP in stable CAD. We aimed to investigate the relationship between NT-proBNP levels and AD as well as with the extent and complexity of CAD in stable CAD patients.

METHODS

The study included 411 patients with stable CAD (mean age = 61.7 ± 9.9 years, male/female = 247/164). The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group < 114 pg/ml and NT-proBNPhigh group ≥ 114 pg/ml). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements. Coronary angiography was performed and SS was determined in all patients. NT-proBNP and other biochemical markers were measured in all subjects.

RESULTS

The AD and ejection fraction values of the NT-proBNPhigh group were lower and their SS levels were higher compared with those from the NT-proBNPlow group (p < 0.05, for all). The NT-proBNP level was independently associated with AD (β = -0.378, p < 0.001), SS (β = 0.262, p < 0.001), and ejection fraction (β = - 0.295, p < 0.001) on multiple linear regression analysis.

CONCLUSION

NT-proBNP was independently associated with an impaired elastic property of the aorta and with the extent and complexity of CAD as well as with left ventricular systolic dysfunction.

Permanent atrial standstill with irregular junctional ectopic rhythm mimicking atrial fibrillation

We present an interesting case of 'pseudo' atrial fibrillation which was further diagnosed as atrial standstill with irregular junctional ectopic rhythm during electrophysiologic study. A 56-year-old woman presented to a health facility with symptoms of palpitation, lightheadedness, and shortness of breath. Upon detection of irregular rhythm with narrow QRS complexes and no visible P waves on the electrocardiogram, newly developed atrial fibrillation was considered and a direct current cardioversion was performed, during which cardiac asystole developed necessitating cardiopulmonary resuscitation. The patient was then transferred to our institution. Echocardiographic examination showed biatrial dilatation, normal left ventricular systolic function, marked left ventricular hypertrophy, severe aortic stenosis, moderate mitral regurgitation, and severe tricuspid regurgitation. The electrocardiogram showed an irregular rhythm with narrow QRS complexes without any fibrillatory f waves and 24-hour Holter monitoring revealed three episodes of ventricular asystole lasting for more than 3.5 seconds. During the electrophysiologic study, no electrical activity was observed at the high and low levels of the right atrial lateral free wall and septal wall. The final diagnosis was established as atrial standstill and irregular junctional ectopic rhythm. The patient refused aortic valve replacement and died due to progression of the underlying disease one year following permanent pacemaker implantation..

Perforations of right heart chambers associated with electrophysiology catheters and temporary transvenous pacing leads

OBJECTIVES

Perforation of heart chambers is one of the rare complications observed during electrophysiological studies and placement of pacemaker leads. In this study, we performed a retrospective evaluation of patients with catheter-related right heart perforation, aiming to determine its incidence and clinical course.

STUDY DESIGN

We reviewed cases with catheter-related cardiac perforations observed at our institution from June 2002 to November 2007.

RESULTS

During the study period, a total of 2,385 procedures were performed (1,287 electrophysiologic studies, 1,098 temporary nonballoon-floating pacing lead placements). Eight cardiac perforations were diagnosed, with the overall procedure-based and catheter-based incidences of 0.34% (8/2,385) and 0.14% (8/5,603), respectively. Three of these perforations were related to diagnostic electrophysiology catheters, and five were related to temporary (1 permanent) transvenous pacemaker leads. Seven perforations involved the right ventricle and one involved the right atrium. Three patients in whom right ventricular perforation was detected at a late stage died suddenly after pacemaker lead implantation. One patient underwent surgical exploration because of right atrial perforation. Two patients underwent coronary bypass operation and, in one of these patients, perforation was detected during surgery. Two patients were managed conservatively.

CONCLUSION

Although right ventricular perforations detected early have a relatively benign course, those detected late and right atrial perforations require emergent surgical exploration and may have catastrophic consequences.

Slow heart-slow brain: consequence of short-term occupational exposure to toluene in a young woman: what is the real mechanism?

Herein we describe a case of acute occupational exposure to toluene in a 27-year-old female patient, presented to the emergency department of our institute. On admission she had electrocardiographic signs of profound sinus bradycardia with sinus arrhythmia and low amplitude slow wave activity recorded on her electroencephalogram (EEG). The mechanisms underlying the cerebral and cardiac effects of toluene are also discussed.

Electromagnetic interference with electrocardiogram recording of exercise test equipment

Herein, we report a case of pseudosinus tachycardia resulting from an electromagnetic interference between a mobile phone and treadmill device. Electromagnetic interference from a charging mobile phone connected to the same socket with the exercise device turned the recording of a patient to that of pseudosinus tachycardia at approximately twice the rate of actual basal heart rate. Removal of the mobile phone from the socket resulted in normalization of the electrocardiogram.

Successful use of ivabradine in a case of exaggerated autonomic dysfunction

We present a 30-year-old male with complex and predominantly cardiovascular autonomic dysfunction. He had frequent syncopal attacks and paroxysmal atrial fibrillation (PAF). Physical, electrocardiographic, and echocardiographic findings were unremarkable. Syncopal attacks were precipitated by emotional stress, upright position, and micturition. Electrocardiograms obtained immediately after syncopal events revealed PAF with a low ventricular rate, which spontaneously returned to sinus rhythm without any medication. Syncopal events were suggestive of postural orthostatic tachycardia syndrome (POTS), were induced during upright position, and were associated with a sudden increase in heart rate to approximately 140 beats per minute and a sudden drop in blood pressure. Syncope was also induced during carotid sinus massage (CSM) in the upright position. It was thought that cardiac autonomic dysfunction, with POTS as the main component, was responsible for this clinical condition. Syncopal episodes increased in frequency during treatment with metoprolol. Treatment with ivabradine (5 mg twice a day) resulted in disappearance of syncopal episodes both during upright position and CSM. During six months of follow-up, the patient remained asymptomatic without syncope or atrial fibrillation.

Optimization of repolarization during biventricular pacing: a new target in patients with biventricular devices?

BACKGROUND

Evaluation of repolarization during sequentional biventricular pacing.

METHODS

Patients with biventricular devices, and left ventricular leads placed to the basal part of lateral left ventricular wall were enrolled. QRS, QTc, JTc, and corrected Tpeak-Tend intervals were compared during sequentional biventricular, left ventricular, and right ventricular pacing.

RESULTS

Five patients with nonischemic and five with ischemic cardiomyopathy due to anterior myocardial infarction were enrolled. No correlation was observed between values of repolarization among patients. The optimal values of repolarization were significantly different from values of echocardiographically guided hemodynamic optimization. Two patients with biventricular pacing-induced ventricular fibrillation were successfully treated by reprogramming of V-V delay according to interventricular delay resulting in shorter Tpeak-Tend interval, although delayed effect of amiodarone in one of these patients cannot be ruled out.

CONCLUSIONS

Patients with biventricular devices may be prone to development of ventricular arrhythmias depending on programmed V-V interval. We suggest that optimization of repolarization may be performed in patients with biventricular pacemakers in the absence of backup ICD and those with frequent episodes of ventricular tachyarrhythmias, although this finding deserves further study.

[Arrhythmogenic cardiomyopathy with predominant left ventricular involvement]

Arrhythmogenic right ventricular cardiomyopathy is a relatively well-defined clinical entity. This disease is characterized with right ventricular involvement and is an important cause of sudden cardiac death in young patients. However, arrhythmogenic cardiomyopathy with left-dominant involvement has recently been better described in the literature. This new presentation may be confused with other diseases such as idiopathic dilated cardiomyopathy. This review outlines left-dominant arrhythmogenic cardiomyopathy in the light of the most recent information.

Electrophysiologic characteristics of wide QRS complexes during pharmacologic termination of sustained supraventricular tachycardias with verapamil and adenosine: observations from electrophysiologic study

BACKGROUND

In this study we evaluate wide QRS complexes observed during pharmacologic termination of supraventricular tachycardias.

METHODS

Patients with supraventricular tachycardia, undergoing electrophysiologic study were enrolled. 12 mg of adenosine or 10 mg of verapamil were administered during tachycardia, under continuous monitoring of intaracardiac and surface electrocardiograms. Electrocardiographic features of ventricular ectopy were noted.

RESULTS

Seventy-four patients were enrolled. 48 patients were randomized to adenosine and 26 to verapamil. Five different appearance patterns of ventricular ectopy were observed during termination of tachycardias. All wide QRS complexes were of ventricular origin and all of them were observed during the termination of tachycardia. Adenosine more frequently resulted in appearance of ventricular beats (15.4% vs 41.7%, P = 0.003), and this was more frequently observed in patients with atrioventricular nodal reentrant tachycardia. Patients with ventricular beats were younger than those without, in both, verapamil (47.5 +/- 15.6 vs 65.0 +/- 8.8 years, P = 0.04) and adenosine (40.9 +/- 13.8 vs 49.7 +/- 16.8, P = 0.03) groups. Left bundle branch block (LBBB)/superior axis morphology was most frequent morphology in adenosine group (55%). Two of 4 patients in verapamil group displayed LBBB/inferior axis QRS morphology and another 2 patients displayed LBBB/superior axis morphology.

CONCLUSIONS

Noncatheter induced, five different appearance patterns and four distinct morphologies of ventricular origin were observed. Most of them do not directly terminate tachycardia, but are associated with its termination and are not observed in ongoing tachycardia.

Chronic total occlusion of left circumflex artery after radiofrequency ablation of left ventricular outflow tract tachycardia

In this report, we present a 22-year-old female patient referred to our institution for evaluation of anginal chest pain. Her medical history revealed two ablation procedures of the left ventricular outflow tract tachycardia performed 1 month a part, 2 years ago. Coronary angiography revealed chronic total occlusion of the proximal left circumflex artery. To our knowledge, this is the first report of ablation-related chronic total occlusion of a coronary artery.

Early development of pacemaker Reel syndrome in an elderly patient with cognitive impairment

Reel syndrome is a rare form of Twiddler's syndrome and is characterized by rotation of permanent pacemaker on its transverse axis and rolling of the electrode around the generator. An 83-year-old man with severely impaired mental status, agitation, and uncontrolled movement of extremities underwent pacemaker implantation for symptomatic atrial fibrillation. The pacemaker generator was fixed to the pectoral fascia with nonabsorbable ligatures. On the next day, failure to capture the ventricle was noted. Fluoroscopic examination showed coiling of the electrode around the generator. During urgent intervention, the ligature of the generator was observed to be released from the pectoral fascia. The pacemaker lead was not damaged; therefore, the same lead was re-implanted, connected to the generator, and carefully fixed to the pectoral fascia. The patient showed rapid clinical improvement together with his mental status. No abnormality was detected during three months of follow-up. Patients with impaired consciousness, children, and older persons require a close follow-up because of their propensity to this serious and life-threatening complication.

An unusual cause of OptiVol alarm: increased intra-abdominal pressure associated with irritable bowel syndrome

Monitoring intrathoracic impedance has become an integral part of follow-up of patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy/defibrillator due to heart failure. However, several noncardiac factors may influence intrathoracic impedance. We report on an unusual cause of decrease in intrathoracic impedance in a 54-year-old male patient following successful implantation of biventricular ICD for heart failure symptoms due to nonischemic dilated cardiomyopathy and severely impaired left ventricular systolic function. During the follow-up period, the patient presented several times with the OptiVol alarm due to an increase in the OptiVol fluid index, in the absence of symptoms or signs of heart failure. Further inquiry into the possible causes of decreased intrathoracic impedance revealed that the patient had frequent episodes of irritable bowel syndrome, which increased intra-abdominal pressure, leading to elevation of diaphragm and subsequent compression of intrathoracic organs, and thus to a decrease in intrathoracic impedance.

[Successful percutaneous cryoablation of recurrent atrioventricular nodal re-entrant tachycardia after radiofrequency ablation]

A 21-year-old male patient underwent radiofrequency catheter ablation for refractory attacks of supraventricular tachycardia. One month after the procedure, he developed recurrent atrioventricular nodal re-entrant tachycardia, for which percutaneous cryoablation was performed. Programmed atrial stimulation at the end of cryoablation did not induce an atrio-His (AH) jump or tachycardia. During a four-month follow-up without any medications, the patient was free of any signs of tachycardia.

Unusual electrocardiographic presentation of pacemaker battery depletion with lead failure: pacing spike, artefact or native QRS? A short communication

Herein we report an unusual electrocardiographic presentation of a patient with pacemaker battery depletion and lead insulation failure.

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.

Large inferoposterior wall pseudoaneurysm of the left ventricle with a thrombus after myocardial infarction

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Spontaneous dissection of the left main coronary artery: a case report and review of the literature

Primary spontaneous coronary artery dissection is an unusual occurrence. There have been less than 150 cases reported in world literature. This process frequently occurs in relatively young women, particularly in the peripartum or early postpartum period. This article reports the clinical course of one patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting. To our knowledge, it is the second case to be treated with the use of left internal mammary artery.

Takayasu arteritis in Turkey

Takayasu arteritis is a non-specific inflammatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

A rare indication for stenting: persistent coronary artery spasm

A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.

Combination therapy with verapamil and nitrendipine in patients with hypertension

Forty patients with mild to moderate hypertension were divided into two groups, 20 patients (group A) received 240 mg verapamil and 20 patients (group B) received 20 mg nitrendipine daily during the first six weeks. During the second six weeks, all 40 patients were given 10 mg nitrendipine plus 120 mg verapamil. After the combination therapy, group B received verapamil, 240 mg and group A nitrendipine 20 mg for a further period of six weeks. When verapamil and nitrendipine were used alone, BP decreased significantly in each group. However, BP decreased more when the combination therapy was used and increased when the treatment was changed to single drug therapy from the two-drug combination. In addition, side-effects were three to four times fewer during the combination therapy. It is concluded that the combination of two different calcium antagonists in the treatment of hypertension provides a new dimension to therapy.

Low prevalence of mitral valve prolapse in bipolar affective disorder

The authors report the prevalence of mitral valve prolapse in bipolar affective disorder. 22 bipolar patients (13 men and 9 women; age 17-75 years, mean 42.3) were selected at random from 41 bipolar patients for echocardiographic examination. Diagnosis of mitral valve prolapse was made if prolapsus of the anterior or posterior valve to the left atrium was seen in the two-dimensional echocardiography and if mid-to late-systolic posterior motion of the mitral valve was greater than 2 mm in M-mode echocardiography. Of the 22 bipolar patients, only two had mitral valve prolapse. This rate does not differ significantly from the 5% rate found in the general population.