Myocardial infarction due to coronary thrombosis in a patient with Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is characterized by vasculitic involvement of small-sized vessels and results in multisystem manifestations. Cardiac involvement is extremely rare and myocardial infarction with coronary thrombus formation in those patients has also rarely been reported. Herein, we report a 33-year-old man with acute myocardial infarction due to coronary thrombus formation and HSP.

Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome

OBJECTIVE

To assess cardiac flow parameters in patients with polycystic ovary syndrome (PCOS).

DESIGN

A prospective case-control study.

SETTING

University-based hospital.

PATIENT(S)

Thirty consecutive patients with PCOS were enrolled. Thirty women with regular menstrual cycles served as the controls.

INTERVENTION(S)

Systolic and diastolic function parameters were assessed by standard two-dimensional and M-mode echocardiography. Insulin sensitivity was evaluated by a standard 75-g oral glucose tolerance test and area-under-curve insulin analysis. Serum hormones, lipid profile, homocysteine, vitamin B(12), folate, fibrinogen, uric acid, and plasminogen activator inhibitor-I concentrations were measured.

MAIN OUTCOME MEASURE(S)

Systolic and diastolic function parameters, insulin sensitivity and serum homocysteine levels.

RESULT(S)

The mean serum homocysteine and uric acid concentrations were significantly higher in the PCOS group. Patients with PCOS had significant hyperinsulinemia. All systolic function parameters were comparable between the two groups. However, patients with PCOS had significantly lower peak mitral flow velocity in early diastole and significantly lower ratio between the early and late peak mitral flow velocities and also had significantly longer isovolumic relaxation time, reflecting a trend for nonrestrictive-type diastolic dysfunction. The area-under-curve insulin correlated positively with peak mitral flow velocity in late diastole (r = 0.375). The mean cholesterol/high-density lipoprotein ratio correlated negatively with mean mitral flow velocity in early diastole (E) peak (r = -0.474). The mean fasting insulin level correlated negatively with mean E/A ratio (r = -0.387).

CONCLUSION(S)

Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular disease risk in patients with PCOS.

Exercise-induced left bundle branch block during thallium 201 myocardial perfusion scintigraphy--a case report

Exercise-induced left bundle branch block (Ex-LBBB) is a rare entity encountered during exercise testing. The authors present a 53-year-old woman who developed intermittent Ex-LBBB asymptomatically during Tl 201 myocardial perfusion scintigraphy. Scintigraphic findings revealed septal-anteroseptal ischemia while the coronary arteriogram appeared normal. False-positive septal-anteroseptal scintigraphic findings suggesting ischemia in patients with persistent left bundle branch block (LBBB) is well known, but since the LBBB in this case was induced by exercise testing and was spontaneously terminated at rest, scintigraphic findings may be attributed to microcirculatory ischemia, which cannot be detected angiographically, as the cause of Ex-LBBB.

Left atrial appendage function in patients with cardioembolic stroke in sinus rhythm and atrial fibrillation

The purpose of this study was to determine the left atrial appendage (LAA) function in patients with stroke. The study group consisted of 61 patients with stroke and 37 control subjects. Patients with stroke were divided into 2 groups on the basis of the presence of atrial fibrillation (group 1) or sinus rhythm (group 2). Group 1 showed a significant reduction of LAA flow velocities (13.2 +/- 6.4 cm/s versus 27.5 +/- 8 cm/s, P <.05) and significant increase in LAA areas (minimum area: 360.5 +/- 204 mm(2) versus 217.7 +/- 113.9 mm(2), P =.004). Group 2 showed a decrease in LAA flow velocities (17.7 +/- 8.2 cm/s versus 27.5 +/- 8 cm/s, P <.05), but no significant change was found in LAA areas. No significant difference was found in other parameters related to LAA. These findings show that a decreased LAA flow velocity is a risk factor for stroke in patients in sinus rhythm without LAA enlargement. Left atrial appendage area was increased in size only in patients with atrial fibrillation.

Percutaneous balloon valvuloplasty for severe mitral stenosis in pregnancy. Four case reports

Four pregnant women with mitral stenosis who did not respond to medical therapy underwent successful percutaneous balloon valvuloplasty with complete resolution of their symptoms. Their clinical features and echocardial and hemodynamic data are presented. The procedures and the remainder of their pregnancy were uncomplicated. Percutaneous balloon valvuloplasty of the mitral valve is a safe and effective alternative to surgical therapy if medical management is unsuccessful.

Angiotensin converting enzyme gene polymorphism and the risk and extent of ischemic heart disease among Turkish patients

OBJECTIVE

To evaluate the effects of the angiotensin converting enzyme gene polymorphism on the presence and extent of coronary artery disease and myocardial infarction among Turkish patients.

METHODS

In total 393 consecutive patients undergoing coronary angiography were evaluated for cardiac risk factors including the lipoprotein profile, lipoprotein (a), apoprotein B, and apoprotein A1 levels. The angiotensin converting enzyme genotype was determined by polymerase chain reaction. The extent of coronary atherosclerosis was determined from the angiograms using the Gensini and Leaman scores.

RESULTS

The angiotensin converting enzyme genotype was found not to be associated either with coronary artery disease (odds ratio 0.81, P > 0.05) or with myocardial infarction (odds ratio 1.16, P > 0.05). Exclusion of high-risk individuals failed to reveal any association for these subgroups. Furthermore, there was no association between aneurysm formation and the genotype (P > 0.05). The lipid parameters were also not affected by the genotype (P > 0.05). However, the extent of coronary atherosclerosis determined by the Gensini score was related significantly to the genotype by multivariate analysis (P = 0.007).

CONCLUSION

The DD genotype is not associated with coronary artery disease and myocardial infarction among these angiographically assessed Turkish patients, even when low-risk subgroups are analysed. Nonetheless, the extent of coronary atherosclerosis in patients with coronary artery disease is affected by their genotype.

Measurement of right ventricular ejection fraction by contrast echocardiography

We evaluated 20 healthy subjects with no cardiac disease (8 males, 12 females, age 49+/-12) to determine the accuracy of right ventricular ejection fraction measurement with contrast echocardiography performed with D-galactose (Echovist 300). All patients underwent two dimensional echocardiography where the right ventricular ejection fraction was calculated by the Simpson's rule first without contrast, then after the injection of 5 ml D-galactose in the same position and compared to the right ventricular ejection fraction measured by the first pass radionuclide angiography on the same day. Subjects had a normal left ventricular ejection fraction of 66+/-5 and a body mass index of 28.9+/-1.2. The correlation between echocardiographic and radionuclide derived right ventricular ejection fraction significantly increased when contrast was used (r=0.81 vs. r=0.6). The r value for interobserver variability also increased significantly with contrast use (r=0.98 vs. r=0.7). We conclude that D-galactose contrast injection significantly enhances border detection and improves the accuracy of right ventricular ejection fraction calculations with echocardiography making it a simple and reliable method.

Silent myocardial ischemia in Behçet's disease

OBJECTIVE

Behçet's disease (BD) is a multisystemic disorder usually described as a triple symptom complex consisting of aphthous stomatitis, genital ulcerations, and uveitis. Vasculitis is a key feature of the disease, which may lead to functional disturbances in highly vascularized organs. However, cardiac involvement is seldom recognized. We investigated the prevalence of silent myocardial ischemia (SMI) in BD as the clinical presentation of microvascular disease.

METHODS

Ambulatory cardiac monitoring (Holter) was used in 36 patients with BD to detect silent myocardial ischemia. 201Thallium myocardial perfusion scintigraphy and radionuclide ventriculography were also performed. All patients fulfilled International Study Group for Behçet's Disease criteria and 11 of them had major vascular involvement. The same method was also performed on 38 control subjects for comparison of SMI positivity in patients with BD.

RESULTS

Ambulatory cardiac monitoring was performed for 9.2 +/- 0.9 h, mean heart rate was 82 +/- 9 bpm, and no serious rhythm disturbance was recorded. SMI was described in 9 of 36 patients (25%) (median age 38 years, range 30-46) as ST segment depression of 3.00 +/- 0.42 mm with a duration of 4.01 +/- 0.9 min. One SMI positivity only was recorded in the control group in a 52-year-old man with a stenotic lesion in the left anterior descending coronary artery (p < 0.001). Eight of 9 patients with SMI showed a partially reversible myocardial perfusion defect after exertion, and 7 demonstrated some degree of left ventricular wall motion abnormality by radionuclide ventriculography. Coronary angiography was normal in 7 of 9 patients with SMI. Additionally, 7 of 9 patients with SMI had major vascular involvement, while only 4 of 27 without SMI had major vascular disease (p = 0.0022).

CONCLUSION

SMI incidence is significantly higher in BD compared to the control group. Impaired endothelial cell function may be the underlying cause in the pathogenesis of BD or of its vascular complications such as SMI.