Predictors of femoral hematoma in patients undergoing elective coronary procedure: a trigonometric evaluation.

Vascular complications in the femoral artery puncture site are the most common complications of the coronary angiography. Femoral hematoma is the leading participant of the vascular complications. We investigated the femoral hematoma predictive value of angle of sheath to trochanter major in patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. Patients were divided into two as femoral hematoma (n = 23) and control (n = 223) groups according to post-procedure femoral hematoma status. Other independent predictors of femoral hematoma were also evaluated. In-hospital multivariable analysis revealed higher rates of femoral hematoma for patients with chronic renal failure (OR 24.97, 95% CI 3.04-78.88, p = 0.003), with higher diastolic blood pressure after the procedure (OR 1.08 95% CI 1.00-1.16, p = 0.037), with femoral vein puncture during procedure (OR 17.74, 95% CI 2.67-54.74, p = 0.003) and with higher angle of sheath to trochanter major (OR 1.52, 95% CI 1.13-2.05, p = 0.005). The best cut-off value of the angle of sheath to trochanter major to predict femoral hematoma was 15.6° with 74% sensitivity and 70% specificity (AUC: 0.75; 95% CI 0.63-0.86; p < 0.001). The angle of sheath to trochanter major provides an independent predictor of femoral hematoma in patients undergoing elective coronary procedures. Our data suggests the importance of fluoroscopic guidance during femoral artery access with the predictive role of the angle of sheath to trochanter major.

Does endoscopic thoracic sympathectomy through clipping procedure have early effects on electrocardiographic parameters?

BACKGROUND & OBJECTIVES: Hyperhidrosis is a pathologic condition of excessive sweating in amounts greater than physiologic needs. Endoscopic thoracic sympathectomy (ETS) is a globally accepted treatment modality for primary palmar and axillary hyperhidrosis. ETS also has distinctive effects on the heart, circulatory and respiratory systems. In this study early effects of ETS on electrocardiographic (ECG) parameters of hyperhidrosis patients were evaluated. METHODS: Twelve-lead ECGs were performed on 72 patients who were free from cardiovascular, metabolic, neurological and pulmonary diseases and underwent planned ETS because of hyperhidrosis, before and after the procedure within the first 24 h. Heart rate (HR), PR, QT, corrected QT (QTc), QTc/Tpeak-Tend (TpTe) intervals, P-wave and QTc/TpTe dispersions were compared by ECG. RESULTS: A total of 72 patients (24.1±6.0 yr, 17 female) were included in the study. The pre-operative HR of patients was significantly higher than post-operative HR of patients (73.8±12.8 vs. 68.1±12.6 beats/ min; P<0.001). The QTc dispersion (QTcd) durations of pre-operative patients were significantly longer than those of post-operative patients (51.5±6.3 vs. 44.9±5.6 msec; P<0.01). The TpTe dispersion value of pre-operative patients was significantly (P<0.001) higher than that of post-operative patients. INTERPRETATION & CONCLUSIONS: Our study showed that ETS through clipping procedure had positive effects on the mechanisms of arrhythmia by reducing HR, QTcd, TpTe and TpTe dispersion parameters of ECG in early periods in hyperhidrosis patients.

Giant J (Osborn) Wave due to Bonsai Abuse: Comments on Clinical Practice.

BACKGROUND: Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse. CASE REPORT: In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse. CONCLUSION: Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsai.

A Very Rare Case of Co-Existence of Cor Triatriatum Sinister and Left Pulmonary Vein Atresia.

Cor triatriatum sinister (CTS) is a rare congenital abnormality. Clinical presentation of patients with CTS mainly depends on the anatomic features of membrane and may vary from mild or moderate symptoms mimicking mitral stenosis to more severe and complicated cardioembolic stroke or a new onset heart failure. We herein have reported on a young male who presented with the signs and symptoms of mitral stenosis and was diagnosed as CTS with gradient on the orifice of the membrane after transthrocacic echocardiography. Computerized tomographic angiography revealed that the patient had unilateral, left sided pulmonary arterial hypoplasia and pulmonary vein atresia, with only the right pulmonary veins draining into the left atrial chamber. Further cardiac imaging by either computed tomography or magnetic resonance imaging is necessary in order to seek accompanying cardiac and vascular abnormalities. Patients with CTS have improved short and long term survival rates if CTS and accompanying abnormalities are surgically treated before the disease is complicated with heart failure, pulmonary hypertension, stroke and etc.

Assessment of cardiac autonomic functions by heart rate recovery indices in patients with myocardial bridge.

BACKGROUND: Heart rate (HR) recovery (HRR) reflects autonomic activity and predicts cardiovascular events. The aim of this study was to assess HRR in patients with myocardial bridge (MB). METHODS: Medical recordings of 93 patients with MB and appropriate age, compared to 78 sex-matched healthy subjects were analyzed. MB was diagnosed via coronary computed tomography angiography after a positive exercise stress test (EST). HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2) and 3rd (HRR3) minute HR from the maximal HR during EST. RESULTS: HRR1 (30.2 ± 13.3 bpm vs. 35.8 ± 10.4 bpm, p = 0.001) and HRR2 (52.3 ± 13.3 bpm vs. 57.1 ± 11.6 bpm, p = 0.013) were lower in patients with MB. In addition, HRR1 was lower in patients with left anterior descending (LAD) MB than non-LAD MB (28.5 ± 13.2 vs. 37.1 ± 11.4, p = 0.013). Presence of MB, deep MB, LAD MB and multi-vessel MB were predictors of HRR1 (p < 0.01 for all). In a multivariate analysis, LAD MB was the only significant independent predictor of HRR1 (b = -8.524, p = 0.009). CONCLUSIONS: Patients with MB have impairment in HRR indices which is more pronounced among patients with LAD MB. Cardiac autonomic dysfunction in MB might be due to recurrent myocardial ischemia.

The role of coronary CT angiography in diagnosis of patent foramen ovale.

PURPOSE: We aimed to examine the incidence of patent foramen ovale (PFO) and atrial septal aneurysms (ASA) in the Turkish population using coronary computed tomography angiography (CTA); assess the feasibility of coronary CTA for PFO diagnosis by conducting a comparison with transthoracic echocardiography (TTE); and determine the diagnostic role and characteristics of the interatrial tunnel, free flap valve (FFV), and shunts. METHODS: The present study was conducted retrospectively and included a sample of 782 patients. Coronary CTA results for all patients were evaluated for the following parameters: the presence of PFO, the degree of contrast jet (if present due to PFO), ASA existence, free flap valve (FFV) length, and PFO tunnel diameters (1 and 2). Coronary CTA and TTE results for PFO detection were also compared for 19 patients who underwent both procedures. RESULTS: PFO was present in 118 patients (15%). In 19 patients who underwent both CTA and TTE, the shunt was present in 15 patients on TTE compared with nine patients on CTA. The sensitivity and specificity of CTA for shunt existence were 53% (8/15) and 75% (3/4), respectively. FFV was observed on CTA in 118 patients (15%). No significant relationship was observed between shunt existence and FFV length (P = 0.148), or between shunt existence and tunnel diameter-1 (P = 0.638) or diameter-2 (P = 0.058). ASAs were present in 16 patients (2%), while accompanying PFO was present in three patients (2.4%). CONCLUSION: Coronary CTA constitutes a more practical and efficient alternative to TTE for PFO diagnosis. Further, it allows the clear visualization of anatomical details of the interatrial tunnel, shunts, and associated abnormalities and detects ASAs.

The Effects of Female Sex Hormones on Ventricular Premature Beats and Repolarization Parameters in Physiological Menstrual Cycle.

BACKGROUND: The effects of gender difference on cardiac electrophysiology have been well studied. In this study, we aimed to evaluate the effects of estradiol and progesteron changes occuring in physiological menstrual cycle on ventricular premature beats (VPBs) and cardiac repolarization parameters. METHODS: Women of reproductive age with VPBs were included into the study group and healthy women were recruited as the control group. During the menstruation period, a 12-lead electrocardiography, blood samples, and 24-hour rhythm Holter were applied to the study group. Similarly, all tests were repeated in the estimated ovulation period (12-14 days before menstruation) by all cases. RESULTS: The study group consisted of 20 women patients with VPB, and the control group of 18 healthy women. While the number of VPB in the menstruation period was 210 beats/day (interquartile range [IQR]: 1,144), it decreased to 86 beats/day (IQR: 251) in the ovulation period with statistical significance (P < 0.05). Average heart rate in the menstruation period was 81.4 ± 10 beats/min and it significantly increased to 84.6 ± 8 beats/min in the ovulation period (P < 0.05). There were no differences in cardiac repolarization parameters in both menstruation and ovulation periods between the study and control groups. Comparing the menstruation and the ovulation periods, J-Tpeak interval, which reflects early repolarization, was shorter in the ovulation period (193 ± 27.7 ms and 201.1 ± 28.6 ms, respectively; P < 0.05). Other repolarization parameters did not show any significant difference. CONCLUSION: VPB frequency decreases with estradiol peak in the ovulation period. This suggests that estrogen may have protective effects against ventricular arrhythmias.

Can a novel scoring system derived from hemodynamic and anthropometric variables predict sympathetic drive in young patients?

AIM: Sympathetic overdrive is generally the main pathophysiological abnormality in cardiovascular disease. However, its grading is not easy in clinical practice because of its complex interactions and differences in phenotypical expression. We proposed an easy, feasible, and global scaling system for sympathetic activity level. 'Sympathetic activity index' (SAI) is based on scores of heart rate, BMI, and blood pressure categories, which are the major representatives of sympathetic activity. MATERIALS AND METHODS: Respectively, 1, 2, and 3 points were determined for heart rate below 69, 70-89, and above 90 bpm; -1, 1, and 2 points for BMI less than 20, 20-24.9, and at least 25 kg/m; and 1, 2, and 3 points for normal, prehypertension, and hypertension categories. Demographic and echocardiographic parameters, and left ventricular (LV) mass and mass indexes (LVMIBSA and LVMIHeight) of 545 young males were compared among groups with SAI 1-8. RESULTS: We observed that LVM, LVMIBSA, and LVMIHeight, left atrial diameter were significantly increased in association with SAI (P<0.001). SAI was correlated with LVM (R=0.314, P<0.001), LVMIBSA (R=193, P<0.001), and LVMIHeight (R=0.316, P<0.001). SAI of at least 5.5 could determine the left ventricular hypertrophy with a sensitivity and a specificity of 57 and 70%, respectively (AUC=682, 95% confidence interval 0.610-0.753, P<0.001). CONCLUSION: Integration of clinical, anthropometric, and hemodynamic variables in a novel index such as SAI may provide an objective and noninvasive means of grading actual sympathetic drive. SAI may be used to follow-up sympathetic activity and to predict clinical events in the management of young patients with cardiovascular and metabolic abnormalities.

Hypercholesterolemia is Accounted for Atherosclerosis at the Proximal Arterial Segments of Myocardial Bridging: A Pilot Study.

Arterial shear stress was generally implicated in the development of atherosclerotic plaque (AP). Atherosclerotic plaque may be associated with myocardial bridging (MB). We evaluated the metabolic abnormalities which could determine the localization of AP at the proximal coronary segment of MB. We analyzed the patients with MB, AP&MB, and AP on left anterior descending (LAD) artery who were diagnosed by multislice computed tomography coronary angiography. Serum levels of metabolic parameters were compared among study groups. Patients with MB&AP and AP were significantly older than those in the MB group. Patients with MB&AP had AP and MB at the proximal and middle segments of LAD artery, respectively. Total cholesterol, low-density lipoprotein (LDL) cholesterol and very LDL, and triglyceride levels were significantly higher in patients with MB&AP and AP compared to only MB. Low-density lipoprotein cholesterol was significantly correlated with the type of coronary artery disease in multiple regression analysis. Myocardial bridging may be an anatomical determinant for the localization of AP proximal to itself in the presence of hypercholesterolemia.