[Atypical complaint in myocardial ischaemia: belching]. / Atípusos panasz myocardialis ischaemiában: böfögés.

While educating non-medical personnel on acute coronary syndrome we often emphasize the importance of early recognition and urgent transfer to acute cardiac center of patients with acute myocardial infarction. Aside from typical symptoms of chest tightness and pain radiating to shoulder, arm and jaw, angina often presents with atypical, non-cardiac complaints. These symptoms, often suggesting gastrointestinal problems, can sometimes mislead even the most experienced physicians. We would like to present the case of an 83-year-old woman with several decades long history of ischaemic heart disease, who recently developed a new anginal symptom: lound, uncontrollable belching. Within the past eight months she was admitted four times with complaints of belching followed by chest pain. Even though initially it was thought as an incidental finding, in all four cases she had proven coronary occlusion requiring cardiac intervention. Orv. Hetil., 2017, 158(5), 183-186.

[Takotsubo cardiomyopathy: a novel beta-adrenergic blocker withdrawal syndrome]. / Béta-blokkoló-megvonás okozta takotsubo cardiomyopathia.

The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.

Isolated spontaneous septal myocardial infarction.

Isolated occlusion of the septal perforating branch of the left anterior descending coronary artery is extremely rare. As a result, little is known about its electrocardiographic manifestations compared with those of an anteroseptal myocardial infarction. We present the case of an isolated septal myocardial infarction with ST-segment elevation.

[A new ECG marker of anterior acute myocardial infarction]. / Az akut anterior myocardialis infarctus új EKG-jele.

ST-segment elevation is the hallmark of acute transmural myocardial ischemia caused by acute occlusion of a coronary artery. ST-segment elevation is the major criterion for the patients with chest pain to immediate reperfusion therapy. Despite its clinical importance, the mechanism of ST-elevation remains unclear. Two patients are reported with proximal left anterior descending coronary occlusion but without ST-segment elevation. The distinct ECG patterns were tall, with symmetrical T-waves and upsloping and digoxin-like ST-segment depression. Patients with these ECG patterns need immediate coronary intervention.

Dangerous single lead ST elevation.

Discriminating among the various coronary obstruction patterns influences early management decisions. One of the most important tasks is the identification of ST-elevation myocardial infarction caused by left main occlusion. We present a case of single-lead ST-segment elevation in aVR caused by acute left main coronary artery occlusion.

[Reverse Takotsubo syndrome pattern induced by local anaesthesia]. / Reverz Takotsubo-szindróma lokális anesztézia után.

We report a new entity of the Takotsubo syndrome. While the classic form of Takotsubo syndrome presents as transient apical ballooning, in reverse Takotsubo syndrome we see just the opposite, i.e. transient dilatation of the basal segments and a hyperkinetic apex. The reverse Takotsubo phenomenon was seen in a 36-year-old female patient who had an injection of lidocaine with adrenaline for plastic surgery of the ear. Coronary artery disease was excluded as the cause of this patient's prolonged chest pain and troponin positivity. Echocardiography revealed akinesis of the basal segments and a hyperkinetic apex. The wall motion abnormalities resolved in three days.

[Transient left ventricular dysfunction: special form of stress cardiomyopathy]. / Reverzibilis, stressz indukálta cardiomyopathiak.

INTRODUCTION: The phenomenon of stress induced left ventricular dysfunction has been long recognised. A special reversible form of it, characterized by left ventricular apical dilatation, is the so-called "tako-tsubo" or ampoule cardiomyopathy, based on its first description by Sato et al. in 1990. The tako-tsubo cardiomyopathy and stress cardiomyopathy are considered almost equivalent in the referring publications. METHODS: Retrospective analysis of patient data between 2002 and 2007: these patients suffered from transient left ventricular dysfunction and coronary artery disease and myocarditis were disclosed. RESULTS: 6 female patients between 55 and 80 years. In 5 of 6 cases the different forms of stress could be found before the patients were admitted to our department. CONCLUSIONS: The presented cases shed light to the fact that the apical dilatation of the left ventricle is only one of the possible presentations of stress induced cardiomyopathy. The main feature of this entity is not the tako-tsubo-like left ventricular dilatation, which is not always present, but the almost universal QT prolongation and negative T waves. These ECG features come a few days after the appearance of the reversible left ventricular dysfunction.

Tako-tsubo syndrome associated with sexual intercourse.

We present a case of Tako-tsubo syndrome induced by sexual activity. This is the first reported case of reversible left ventricular dysfunction associated with sexual intercourse, which necessitated mechanical ventilation in this female patient with acute heart failure.

[Acute myocardial infarction triggered by salbutamol in asthma bronchiale]. / Salbutamollal kapcsolatos akut myocardialis infarctus asthma bronchialeban.

The authors report the case of an 77-year-old woman with no evidence of previous cardiac disease who developed a non-Q-wave myocardial infarction after beta2-mimetic treatment for the exacerbation of her chronic bronchial asthma. After the five dose of salbutamol spray she developed chest pain. The electrogram showed ST segment elevation in leads I-aVL-V4-6. Urgent coronary angiography showed only non significant left anterior coronary artery stenosis (20%). A subsequent echocardiogram also revealed anterolateral hypokinesia and acute reversible left ventricular dysfunction (LVEF:30%). Both troponin T concentration and creatine kinase rose. Next day in the lateral leads negative T-waves developed with QT-prolongation and without pathologic Q-waves. Although myocardial infarction and acute reversible left ventricular dysfunction is a rare complication following beta2 mimetic treatment one should use high-dose beta2-agonists with caution.

N-terminal pro-brain natriuretic peptide and tombstoning ST-segment elevation in patients with anterior wall acute myocardial infarction.

Tombstoning ST-segment elevation myocardial infarction (STEMI) has been associated with a poor prognosis ever since Wimalaratna's first description of this clinical entity, and the reasons for this are not fully understood. We studied 87 consecutive patients who had anterior STEMI (January 2004 to September 2004) to compare the form of STEMI, coronary anatomy, and initial N-terminus pro-brain natriuretic peptide (NT-pro-BNP) level. Patients who had tombstoning STEMI had higher levels of NT-pro-BNP despite significant differences in cardiac enzyme levels or extent of coronary disease. This finding suggests that, in addition to changing the shape of repolarization, decreased microcirculation plays a role in the development of increased wall tension. Increased wall tension in turn is the probable cause of higher NT-pro-BNP levels and increased mortality.

[Percutaneous coronary intervention without on-site cardiac surgery: the first one thousand patients]. / Percutan coronaria-intervenció kórházon belüli szívsebészet nélkül: az elso ezer beteg.

At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (700 male and 331 female, average age 59.8 +/- 15.1 years) between July 2000 and June 2002. The indications were: stable effort angina 679 (65.8%), unstable angina and non-ST elevation myocardial infarction 267 (26.0%), ST elevation myocardial infarction 85 (8.2%). Single vessel dilatation was performed on 906 (87.9%), double and triple vessel on 125 (12.1%) pts in 1170 vessels (1145 native, 24 saphenous vein and 1 mammary artery graft) and in 1372 stenoses. During the interventions, 1043 stents were implanted in 797 pts, average 1.3/pt. The intervention was clinically successful in 950 (92.1%) and unsuccessful in 81 (7.9%) pts. In most of cases, the lack of success was a result of ineffective recanalisation. 65 major adverse cardiac events occurred in 35 (3.4%) pts (acute redilatation 20 (1.9%), acute surgery 4 (0.4%), acute myocardial infarction 34 (3.3%) and fatal outcome 7 (0.7%). Fatal outcome occurred in the group of stable angina 1 (0.1%), in the group of unstable angina and non-ST elevation myocardial infarction 4 (1.5%), in the group of ST elevation myocardial infarction 2 (2.4%). Within one year, 228 (22.1%) repeated dilatations were performed because of chronic restenosis. The results suggest that the moderate risk interventions can be performed with satisfactory result and average risk even without in-hospital cardiac surgery. High-risk interventions are still to be performed in institutes without on-site surgery.

[Acute ST segment elevation during noncardiogenic shock]. / Nem cardiogen shock által indukált tranziens ST-eleváció.

Transient elevation of the ST segment was observed in a patient during noncardiogenic shock. The coronarography was negative. The patient received dopamine infusion. The 48 yr-old man had Crohn disease with septicaemia and ARDS. The exact pathomechanism is not known, but the negative coronarography ruled out the epicardial coronary disease. The suggested mechanisms are dopamine induced coronary vasoconstriction or complement activation.