Paget-von Schrötter syndrome: upper extremity deep vein thrombosis after heavy exercise

We present a 52-year-old man with swelling, tightness, heaviness, and redness in the right half of his neck, face, upper arm, and right precordial area after repetitive exercises. No etiological factors such as trauma, venous catheter, malignancy, hematologic disorder history, or any chronic disease were noted. A Doppler ultrasound of the upper extremities was performed, which showed a complete thrombotic occlusion in the right internal jugular vein, partial occlusion in the right brachiocephalic and subclavian veins with thrombosis, and chronic thrombosis occluding the left brachial vein. Complete blood cell count, coagulation profiles, and rheumatologic and tumor markers were normal. The patient reported that he had taken spinning classes for the last 18 months, and for the past 4 days he reported that he had done his spinning exercises harder and more frequently. The swelling and redness regressed partially on the 3rd day of therapy with enoxaparin sodium. In the first month follow-up visit we performed a control Doppler ultrasound and it showed partially thrombosed areas in the right brachiocephalic and internal jugular veins. Also, chronic thrombosis persisted in the left brachial and basilic veins. Computed tomography images showed no evidence for malignancy and some sections showed filling defects in the vena cava superior, which was attributed to thrombotic materials. The patient was successfully treated with anticoagulants for 6 months.

Unusual association of multiple congenital left ventricular diverticulum and cerebrovascular events in an adult

Congenital ventricular diverticulum is a rare and usually asymptomatic cardiac malformation which can cause major complications such as systemic thromboembolism, infective endocarditis, cardiac rupture, heart failure, arrhythmia and sudden death. We present a case with multiple congenital left ventricular diverticulum admitted to hospital with sudden onset right-sided hemiplegia and dysarthria.

The relationship between C-reactive protein and the lapse of time since the onset of the symptoms after acute myocardial infarction: an prospective-observational study

OBJECTIVE

It is important to know the elapsed symptom-to-door (StD) time between the emergence of ST-elevation myocardial infarction (STEMI) symptoms and admission to the hospital in terms of the selection of appropriate treatment and prognosis. In this study, we aimed to assess the relationship between serum C-reactive protein (CRP) and StD time after STEMI.

METHODS

436 of the patients admitted to our center with STEMI between August 2012-February 2013 (338 male, mean age, 63.9±12.8) were included in this prospective-observational cohort study. Blood samples were obtained from laboratory results of the first reference period. Patients were divided into four groups according to the duration of StD time [0-1. hour; group 1 (G1), 1-3. hour; group 2 (G2), 3-6. hour; group 3 (G3), 6-12. hour; group 4 (G4)]. Statistical analysis was performed via chi-squre test, ANOVA test, Pearson's correlation analysis and receiver operator charecteristic (ROC) analysis.

RESULTS

As the time progressed, an increase in CRP levels was observed. The difference among the means of the G1-G3 (p=0.002), G1-G4 (p<0.001), G2-G4 (p<0.001) and G3-G4 (p<0.001) groups was found to be statistically significant. There was a good correlation between the StD time and CRP levels (r=0.676). ROC analysis of the predictive value of CRP for the third hour was determined as 0.78 mg/dL, respectively (AUC was 0.824; 95% C.I. was 0.785-0.859; 73.9% sensitivity, 78.1% specificity).

CONCLUSION

According to serum CRP levels after STEMI at hospital admission, StD time can be estimated.

[Prevalence and clinical features of microfistulas between the coronary artery and left ventricle: single-center experience]

OBJECTIVES

Coronary artery fistula is an infrequent malformation, and the prevalence was reported as approximately 0.1-0.4% in previous studies. However, the number of studies about microfistulas from coronary arteries to the left ventricle is inadequate, especially in the Turkish population. The purpose of this study was to evaluate the prevalence and clinical features of microfistulas in subjects undergoing coronary angiography for the assessment of coronary artery disease.

STUDY DESIGN

In this retrospective study, we researched the cardiac catheterization laboratory database between January 2008 and July 2013. The presence of microfistulas was established according to the following criteria: 1) direct filling of the heart cavity during selective coronary injection without interposing "capillary" phase or venous filling, and 2) visualization of small vessels interposed between the epicardial coronary vessels and the heart cavity and emptying into the heart.

RESULTS

Microfistulas were found in 12 (0.11%) of the 11403 coronary angiographies. There were 7 (58.3%) female patients (mean age, 70.2±10.8 years), and contemporary severe coronary artery stenosis was noted in 2 (16.7%) patients. Chest pain was the most frequently encountered complaint, followed by dyspnea. Microfistulas originated from the left anterior descending artery (100%), circumflex artery (66.7%), and right coronary artery (58.3%). In addition, multiple microfistulas were seen in 6 (50%) patients, bilateral microfistulas in 3 (25%) patients and unilateral microfistula in 3 (25%) patients, and all of them terminated in the left ventricle.

CONCLUSION

Our study found an overall incidence of microfistulas of 0.11%. Microfistula is a rare cardiac anomaly that sometimes causes cardiac symptoms; otherwise, it is detected during routine coronary angiography.

Relationships between P wave dispersion, atrial electromechanical delay, left atrial remodeling, and NT-proBNP levels, in patients with hypertrophic cardiomyopathy

BACKGROUND

We evaluated the associations among the well-known atrial fibrillation (AF) predictors including P-wave dispersion (PWD), intra- and inter-atrial electromechanical dyssynchrony (EMD), left atrial (LA) phasic functions, and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels, in patients with hypertrophic cardiomyopathy (HCM).

METHODS

Seventy patients with HCM and age and sex matched 70 subjects were enrolled. PWD, LA total emptying fraction (LATEFr), active emptying fraction (LAAEFr), passive emptying fraction (LAPEFr), expansion index (LAEI) intra- and inter-atrial EMD were calculated. Levels of NT-proBNP of all subjects were determined.

RESULTS

Higher PWD (p = 0.006), significantly decreased LAEI (p < 0.001), LATEFr, and LAPEFr (both p values < 0.001) values and significantly increased inter-atrial (p < 0.001), LA (p = 0.001), and right atrial dyssynchrony (p < 0.001) were observed in the HCM group compared to controls. PWD was negatively correlated with LAEI (r = -0.236, p = 0.005) and LATEFr (r = -0.242, p = 0.04), however not with LAPEFr (p = 0.7), or LAAEFr (p = 0.3). Except for the LA lateral wall PA' (r = 0.283, p = 0.02), PWD was not correlated with any atrial EMD parameter. Inter-atrial dyssynchrony was related to LAEI (r = -0.272, p = 0.001), LATEFr (r = -0.256, p = 0.03), and LAPEFr (r = -0.332, p = 0.006), but not, however, to LAAEFr (p = 0.4). The plasma NT-proBNP levels of patients were not correlated with either PWD (p = 0.927) or inter-atrial dyssynchrony (p = 0.102).

CONCLUSIONS

PWD and inter-atrial dysynchrony seem to independently promote AF, although both are associated with LA reservoir function in HCM populations. The NT-proBNP level is not associated with these two AF predictors in patients with HCM. NT-proBNP seems to be a poor marker of atrial electrical remodeling in HCM patients.

Effect of bauhinia bauhinioides kallikrein inhibitor on endothelial proliferation and intracellular calcium concentration

OBJECTIVES

Proteinase inhibitors act as a defensive system against predators e.g. insects, in plants. Bauhinia bauhinioides kallikrein inhibitor (BbKI) is a serine proteinase inhibitor, isolated from seeds of Bauhinia bauhinioides and is structurally similar to plant Kunitz-type inhibitors but lacks disulfide bridges. In this study we evaluated the antiproliferative effect of BbKI on endothelial cells and its impact on changes in membrane potential and intracellular calcium.

MATERIALS AND METHODS

HUVEC proliferation was significantly reduced by incubation with BbKI 50 and 100 µM 12% and 13%. Furthermore, BbKI (100 µM) exposure caused a significant increase in intracellular Ca2+ concentration by 35% as compared to untreated control.

RESULTS

The intracellular rise in calcium was not affected by the absence of extracellular calcium. BBKI also caused a significant change in the cell membrane potential but the antiproliferative effect was independent of changes in membrane potential.

CONCLUSIONS

BBKI has an antiproliferative effect on HUVEC, which is independent of the changes in membrane potential, and it causes an increase in intracellular Ca2+.

Increased epicardial adipose tissue thickness is linked to aortic stiffness in patients with primary hypertension

AIMS

In patients with hypertension (HT), increased aortic stiffness is related to higher cardiovascular morbidity and mortality. Recent investigations have shown that epicardial adipose tissue (EAT) is a new potential cardiometabolic risk factor. The aim of our study was to examine the relation between echocardiographically measured EAT thickness and aortic stiffness in patients with primary HT.

METHODS

The study included 144 newly diagnosed and untreated essential hypertensive outpatients. Transthoracic echocardiographic EAT thickness and aortic stiffness measurements were performed for all study participants. Afterwards patients were divided in two groups according to their median EAT thickness values. The patients with EAT thickness of < 7 mm were included in group 1 and patients with EAT thickness of ≥ 7 mm were included in group 2.

RESULTS

Aortic strain and distensibility parameters of group 2 were lower than in group 1. The aortic stiffness index of group 2 was found to be higher than group 1. Multivariate regression analysis revealed that EAT thickness was the only independent variable for all three parameters of aortic stiffness index, aortic strain and aortic distensibility.

CONCLUSION

In patients with newly diagnosed primary HT, increased EAT thickness was significantly linked to impaired aortic elastic properties independently of other conventional adiposity measurements.

Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction

Objectives:

In this study, we aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI).

Methods:

A total of 349 patients with STEMI were recruited to this retrospective study. Baseline characteristics were reviewed. Patency of IRA was evaluated by thrombolysis in myocardial infarction flow grade.

Results:

Of all patients, 293 patients formed the occluded IRA group and 56 patients formed the patent IRA group. The NLR was significantly higher in occluded IRA group (4.4 ± 4.1 vs 1.9 ± 1.1, P < .001). Glucose levels were also higher in occluded IRA group (171.3 ± 78.0 vs 144.7 ± 49.7, P = .022). Regression analysis demonstrated admission NLR and plasma glucose levels as independent predictors of IRA patency.

Conclusion:

In this study, we found that admission NLR and glucose levels were higher in patients with occluded IRA than in patients with STEMI. We also found that NLR and glucose levels were independent predictors of IRA patency. Because hemogram is a cheap, fast, and widely available test, it can be used in daily practice as a predictor of IRA patency.

A case of multiple coronary microfistulas to the left ventricle and apical myocardial hypertrophy coexisting with stable angina

A coronary artery fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common congenital anomaly that can affect coronary perfusion. However, coronary fistulas to one of the cardiac chambers and coexisting apical myocardial hypertophy are infrequent anomalies, and usually are found unexpectedly. Herein, we report a case in which all three major coronary arteries emptied into the left ventricle with apical hypertrophy, through multiple microfistulas.

Relationship Between Neutrophil to Lymphocyte Ratio and Slow Coronary Flow

Objectives:

We evaluated the relationship between neutrophil to lymphocyte ratio (NLR) and slow coronary flow (SCF).

Methods:

A total of 180 participants were recruited to the present study. Of all the participants, 82 patients were with SCF and 98 participants were with normal coronary arteries. Basal characteristics were recorded. Coronary flow was quantified by thrombolysis in myocardial infarction frame count.

Results:

Basal characteristics were similar between the 2 groups. The NLR was significantly higher in the SCF group when compared to the control group (2.3 ± 0.8 and 1.5 ± 0.4 respectively, P < .001). In multiple logistic regression analysis, NLR remained as the independent predictor of SCF ( P < 0.001).

Conclusions:

Our findings showed that NLR was significantly higher in the SCF group when compared to the control group with normal coronary arteries. We also showed that NLR was related to the presence of SCF rather than the extent of SCF. Besides these findings, we also showed the NLR as an independent predictor of SCF.