Sustained idiopathic ventricular tachycardia originating from the posteroseptal tricuspid annulus.

Tricuspid annular ventricular tachycardia (VT) is a rarely encountered entity. Despite abundant data on idiopathic VTs, the prevalence and clinical characteristics of this infrequent form are not well defined and the efficacy of radiofrequency (RF) catheter ablation treatment remains unknown. We report on a case of a 44-year-old male presenting with symptomatic sustained idiopathic VT originating from the posteroseptal tricuspid annulus.

Woven right coronary artery: a case report and review of the literature.

Woven coronary artery is an extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. A few cases have been reported till now. In this case report, we present a 58-year-old male with a woven right coronary artery.

Increased platelet activation in patients with slow coronary flow.

We tested the hypothesis that increased platelet activation may be present in patients with slow coronary flow (SCF) and may contribute to the pathogenesis of slow coronary flow phenomenon (SCFP). Fifty patients angiographically proven normal coronary flow (control group; mean age = 61.3 +/- 7.0 years, 43 male) and 50 patients with angiographically proven SCF in all coronary arteries (patient group; man age = 62.7 +/- 6.7 years, 38 male) were included in the present study. Coronary flow rates of all subjects were documented by Thrombolysis In Myocardial Infarction frame count (TIMI frame count). Patients with a corrected TIMI frame count greater than two standard deviations from normal published range for the particular vessel were considered as having SCF. Complete blood count and mean platelet volume (MPV) was measured from whole blood sample with Abbott Cell-Dyne 4000 cell counter. Plasma sP-selectin concentrations were analyzed with sP-Selectin ELISA kit. There were no statistically significant differences between the two groups with respect to baseline demographic, clinical and lipid parameters. Not only MPV values but also plasma sP-selectin levels were significantly higher in patients with the patients with SCF compared to those of controls (for MPV; 8.2 +/- 0.7 vs. 7.2 +/- 0.6 fl, P < 0.001, for sP-Selectin; 1.5 +/- 0.3 vs. 1.0 +/- 0.2 ng/ml, P < 0.001). Interestingly, significant positive correlations were detected between mean TIMI frame counts and MPV and sP-selectin levels (for MPV; r = 0.56, P < 0.001, for sP-selectin r = 0.67, P < 0.001). The current study demonstrates that platelet activity is increased in the patients with SCF compared to that of the patients with normal coronary flow.

Takotsubo cardiomyopathy in a patient with Addison disease: is apical ballooning always reversible?

Takotsubo cardiomyopathy is characterized by acute ventricular dysfunction in the absence of coronary obstruction. Complete improvement of ventricular function is seen in the vast majority of the patients. We describe a 40-year-old woman with Addison disease who experienced Takotsubo cardiomyopathy but with persistent apical dysfunction during 5-month-follow up.

Stent fracture: a new villain of the village.

Stent strut fracture (SSF) may be an important complication after drug-eluting stent (DES) implantation particularly in patients undergoing sirolimus-eluting stent (SES) implantation. The occurrence of SSF at 6 to 9 months after the SES implantation, which was relatively common, resulted in a higher rate of focal in-stent restenosis. Although this angiographic unfavorable outcome did not lead to an increased risk of adverse cardiac events in the current study, we believe that large-scale prospective studies are needed to elucidate the exact pathophysiology and clinical sequela of the stent strut fracture, including bare metal stents.

P-wave dispersion and its relationship to aortic elasticity in young prehypertensive patients.

BACKGROUND: Prolonged P-wave duration (P(dur)) and increased P-wave dispersion (PWD) are independent predictors of atrial fibrillation (AF) in patients with hypertension. This study was designed to evaluate the possible relationship between aortic elasticity and PWD in young prehypertensive patients. METHODS: Twenty-five newly diagnosed prehypertensive patients (18 men, mean age = 34 +/- 6 years) and 25 healthy control subjects (16 men, mean age = 33 +/- 6 years) were enrolled in the study. The P(dur) measurements were calculated using a 12-lead surface electrocardiogram (ECG). Aortic elasticity parameters were derived from aortic diameters measured by echocardiography, and simultaneous blood pressure (BP) measurements by sphygmomanometry. RESULTS: The baseline characteristics of patients with prehypertension were homogeneous with those of the controls. PWD and P(maximum) values were found to be higher in patients with prehypertension as compared to those of the controls (PWD; 65 ms vs. 35 ms, P < 0.001; P(maximum); 110 ms vs. 80 ms, P < 0.001). However, P(minimum) values were not significantly different between the two groups (40 ms vs. 45 ms, P = 0.358). Also, a moderate positive correlation was found between stiffness index (SI) and PWD (r = 0.500, P = 0.011), and a moderate negative correlation between aortic elasticity parameters (aortic distensibility and strain indexes) and PWD (for aortic distensibility, r = -0.498, P = 0.011; for strain index, r = -0.578, P = 0.002), in patients with prehypertension. CONCLUSIONS: Young patients with prehypertension have increased PWD and arterial stiffness. These parameters are correlated and may pose additional risk factors for future cardiovascular events.

The effects of perindopril on aortic elasticity and inflammatory markers in hypertensive patients.

BACKGROUND: Inflammation plays an important role in hypertension and in atherosclerosis. Inflammatory changes induced even in prehypertensive subjects can lead to increased arterial stiffness. The effects of perindopril on both inflammatory and aortic elasticity markers were tested in hypertensive patients. MATERIAL/METHODS: One hundred nine hypertensive patients not taking any antihypertensive therapy were included in the study. Aortic strain, aortic distensibility, aortic stiffness index, and inflammatory markers, including CRP, IL-1alpha IL-1beta, and TNF-alpha, were measured in all patients before and after twenty weeks of perindopril therapy. RESULTS: While aortic strain and distensibility showed statistically significant increases with perindopril therapy, the aortic stiffness index and inflammatory markers were found to decrease. CONCLUSIONS: Perindopril therapy resulted in an improvement in aortic elastic properties. There was also an attenuation of inflammatory status of the patients as reflected by lower inflammatory marker levels compared with pretreatment values.

Coronary-subclavian steal syndrome presenting with ventricular tachycardia.

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.