Association of male pattern baldness with angiographic coronary artery disease severity and collateral development.

OBJECTIVE: We aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously. METHODS: Coronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores. RESULTS: Although subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development. CONCLUSIONS: There was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.

A rare cause of syncope: cough.

BACKGROUND: Syncope is a transient loss of consciousness, associated with loss of postural tone, with spontaneous return to baseline neurologic function. Syncope is a common complaint in the emergency department. OBJECTIVES: Cough syncope occurs immediately after coughing. Cough syncope rapidly recovers in 1-2 second. Although cough syncope has been classified in vasovagal syncope, it may differ from pathogenetic mechanism. Physicians should be aware of this easily recognizable cough induced syncope. CASE REPORT: We present a 59-year-old obese man was referred for clinical evaluation because of recurrent syncope without seizures following coughing who developed cough syncope. CONCLUSIONS: Physicians should be aware of this easily recognizable cough induced syncope in all subjects admitted with syncope and should screen possible underlying sources of cough.

Spontaneous healing of occlusive type F coronary artery dissection.

In the presence of resistance to circumferential expansion of atherosclerotic plaques due to mechanical dilation high shear stresses between stiff plaques and normal vessel segments may occur and thus may result in coronary dissection. Limited data are available on the clinical and angiographic outcome of severe (type E, type F) coronary dissections. Herein, we report a case of type F dissection (causing total occlusion) of proximal right coronary artery during balon angioplasty which healed spontaneously. In conclusion, although the type F dissection has worse prognosis due to complete cessation of distal vessel perfusion, the possibility of spontaneous healing should be kept in mind after unsuccessful intervention.

Giant coronary sinus and absent right superior vena cava.

Although persistent left superior vena cava (PLSVC) is rare, it is the most common thoracic venous anomaly. The prevalence of PLSVC is 0.3 % in a general population and 10 % in patients with congenital heart disease. Diagnosis of PLSVC is usually incidental during cardiovascular imaging or surgery. Although PLSVC is usually not associated with any negative hemodynamic effect, it is important to be aware of its existence, since it may cause problems in central venous catheterization, pacemaker implantation and cardiopulmonary bypass. The overall proportion of absent right superior vena cava in patients with PLSVC is approximately 20 %. If PLSVC is associated with absence of the right superior vena cava, the coronary sinus may become gigantic due to excessive inflow. Herein, we report a case of PLSVC complicated by the absence of a right superior vena cava resulting in a giant coronary sinus.

Analysis of circadian variation of acute myocardial infarction: afternoon predominance in Turkish population.

BACKGROUND: Although data about circadian variation of myocardial infarction (MI) in western populations reveal morning peak between 06:00 and 12:00 hours, differences have been reported in different regions of the world and ethnic groups. We aimed to evaluate circadian variation of MI in a Turkish cohort. METHODS: A total of 476 patients (mean age 56.7 +/- 11.7; 80% men) with acute st elevation MI were included into the study. Patients were categorised into four 6-h increments (00:01-06:00; 06:01-12:00; 12:01-18:00 and 18:01-24:00 hours). RESULTS: Onset of MI exhibited significant circadian variation among four time periods (p < 0.001), demonstrating afternoon peak (between 12:01 and 18:00 hours) and trough between 00:01 and 06:00 hours. Incidence of MI between 12:01 and 18:00 hours was significantly higher when compared with other three 6-h periods (p = 0.001). Incidence of MI between 00:01 and 06:00 hours was significantly lower when compared with other three 6-h periods (p = 0.001). Incidence of MI between 12:01 and 18:00 hours was 1.64 times that of average frequency of the remaining 18:00 hours of the day and 2.3 times that of frequency between 00:01 and 06:00 hours. When analysed for the subgroups of the study sample, only smoking blunted the afternoon peak. CONCLUSIONS: Instead of early morning peak in western countries, there is afternoon predominance in circadian variation of MI in a Turkish cohort. It may be related with genetic and/or demographic characteristics of Turkish population. Further studies are required to determine underlying pathophysiological mechanisms causing these differences in chronobiology of MI among populations.

A dreadful sign of aortic dissection: aortic intimo-intimal intussusception with prominent intimal flap prolapsing into the left ventricular apex.

Intimo-intimal intussusception is an unusual clinical form of aortic dissection resulting from circumferential detachment of the intima. Clinical presentation varies according to the level of detached intima in the aorta. We present a case of acute type A dissection with prominent prolapse of the circumferential detachment intimal flap into the left ventricular cavity extended to the apex.

Diagnostic value of homocysteine, C-reactive protein and bilirubin for coronary artery disease.

We evaluated 3 new markers for coronary artery disease (CAD) [bilirubin, total homocysteine (t-Hcy) and high-sensitivity C-reactive protein (hs-CRP)] in 319 patients with chest pains divided into 2 groups based on coronary angiography: CAD group (n = 262) and non-CAD group (n = 57). A control group consisted of 50 healthy subjects. t-Hcy had the highest diagnostic value for diagnosis of angiographically documented patients; bilirubin had the lowest. The sensitivities and specificities (based on ROC curves) of bilirubin, hs-CRP and t-Hcy were 70.9%, 50% and 76.8% respectively, and 40.4%, 80.7% and 70.2% respectively. We conclude that serum bilirubin levels cannot identify people at risk of CAD and t-Hcy and hs-CRP may be stronger markers.

Renal infarction mimicking renal colic in patient with a prosthetic aortic valve.

A 31 year old man with prosthetic aortic valve replacement presented with sudden onset of colic right flank pain. Analysis of the urine revealed haematuria, and the international normalised ratio was suboptimal. The patient was misdiagnosed as having ureteral colic. On the second day, an ultrasound showed no signs of obstructive uropathy, and there was no evidence of absent function on intravenous pyelogram. Computed tomography with contrast agent was performed and revealed a right renal infarction. Renal angiography demonstrated total occlusion of the right renal artery. Fibrinolytic therapy and angioplasty were unsuccessful. To our knowledge, aortic prosthetic valve thrombus as a source of renal artery embolism mimicking renal colic has not been reported previously. This case underlines the importance of renal colic as a manifestation of renal infarction in patients with prosthetic valves and the need for a high index of suspicion of renal embolism.

Giant hiatal hernia presenting with stable angina pectoris and syncope--a case report.

A 70-year-old woman with giant hiatal hernia presented with stable angina pectoris and three syncope attacks in the previous 3 months. Chest radiography showed marked cardiomegaly and an air-fluid level at the basal region of the heart. A mixed type large hiatal hernia that distorted the heart was detected in contrast-enhanced computed tomography and esophagogastroduodenography. Postprandial nonsustained ventricular tachycardia was present on 24-hour Holter ECG monitoring. The patient's symptoms were attributed to giant hiatal hernia and improved following surgery.

Relationship between coronary in-stent restenosis and plasma urotensin II level.

AIM: In-stent restonosis is an important limitation for coronary stenting. The cause of in-stent restenosis is neointimal hyperplasia developed from smooth muscle and matrix. We aimed to investigate the association between urotensin II (U-II) and in-stent restenosis after coronary stenting, which causes endothelial and muscle proliferation and accumulation of collagen. METHODS: Total 153 patient was enrolled to the study who meet criteria for angiographic indication underwent coronary artery angiography. All patients have history undergone for coronary stent implantation 3 to 9 months ago. In-stent restenosis is identified as ≥50% narrowing inside the stent. In-stent restenosis was observed in 73 and remaining of 80 patients revealed no critical lesion in stent on angiographic evaluation. Plasma level measurement of U-II was performed in all subjects. RESULTS: Urotensin II levels were found to be significantly higher in Group I compared to Group II (1.44±0.74 ng/mL and 1.21±0.59 ng/mL, respectively, P=0.03). In a subgroup analysis, U-II levels were significantly higher in group I than group II in patients treated with bare metal stent (BMS) (1.50±0.76 ng/mL and 1.18±0.56 ng/mL, P=0.016); however, there was not significant change in patients treated with drug-eluted stent (1.26±0.64 ng/mL and 1.27±0.63 ng/mL, P=0.9). Multivariate statistical significance: negative correlation was found between in-stent restenosis and renin-angiotensin-system (RAS) blocker usage (P=0.040) and right coronary artery (RCA) lesion interventions (P=0.018). CONCLUSION: This study revealed high plasma U-II level might be accepted as a risk factors for in-stent restenosis with BMS. In-stent restenosis is less developed after RCA interventions and taking drug of RAS blockages. Our study findings need to be confirmed in further studies.

Increased epicardial fat thickness is related with body mass index in women with polycystic ovary syndrome.

AIM: We aimed to investigate the relationship between PCOS and epicardial fat thickness with transthoracic echocardiography. PATIENTS AND METHODS: PCOS patients were divided into two groups according to the lean or obesity status: PCOS patients with lean 34 subjects (BMI: 23.3±2.8; mean age: 25.5±4), PCOS patients with obese16 subjects (BMI: 32.3±7.6; mean age: 27.2±3.7) were compared with control healthy lean subjects (BMI: 23.5±1.7; mean age: 25.9±2.2). RESULTS: There was increased epicardial thickness in obese PCOS subjects compared to lean PCOS subjects (6.3±0.9 mm, 4.7±0.5, respectively, p < 0.001). However, epicardial fat thickness between lean PCOS subjects and lean healthy control groups were not significantly varied (4.7±0.5 mm, 4.5±0.5, respectively, p = 0.6). There was increased epicardial thickness in obese PCOS subjects compared to lean healthy control subjects (6.3±0.9 mm, 4.5±0.5, respectively, p < 0.001). This sudy showed for the first time that increased epicardial fat thickness measured using transthoracic echocardiography is associated with increased BMI in PCOS subjects. CONCLUSIONS: Epicardial fat thickness between lean PCOS subjects and lean healty control group were similar which indicate the importance of obesity in PCOS subjects.

Rare mechanical complication of myocardial infarction: isolated right ventricle free wall rupture.

Rupture of the left ventricular free wall is a dramatic complication of acute myocardial infarction (MI) and occurs in about ten percent of patients with fatal acute MI. However, there are limited reports about right ventricular free wall rupture due to MI. In this case report, a patient with isolated right ventricular rupture following MI that was visualised with real-time transthoracic echocardiography is discussed for the first time in the literature.

The microbial colonisation of mobile phone used by healthcare staffs.

Mobile phones are dispensable accessories in social life and normally they are not cleaned properly. Therefore, they serve as a reservoir of bacteria and may cause nosocomial infections in hospitals. The purpose of this study was to investigate microbiological colonization of mobile phones used by healthcare staffs. The study was carried out collecting swab samples with Cary-Blair transport medium from mobile phones of attending healthcare staffs from different departments of three hospitals in March, 2008. All collected samples were inoculated in 5% sheep blood agar, eosin-methylene blue agar and Sabouraud Dextrose agar. Isolated bacteria were identified using by classic technique and Vitec2 (Biomerieux, France) full automated bacteria identification system. Growth was observed in 65 of collected 106 samples, corresponding to 61.3%. The most frequent bacteria were Staphylococcus epidermidis followed by Staphylococcus aureus, Bacillus sp., Corynebacterium sp. and Escherichia coli, respectively. In conclusion, bacteria were colonized on mobile phones frequently and mobile phones may become reservoir of microorganism for nosocomial infections.

Initial clinical experience with a novel biodegradable ring in patients with functional tricuspid insufficiency: Kalangos Biodegradable Tricuspid Ring.

BACKGROUND: Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. METHODS: Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. RESULTS: Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P < 0.0001). The right atrial diameter and tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. CONCLUSIONS: Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.

Phaeochromocytoma-induced myocarditis mimicking acute myocardial infarction.

A 44-year-old woman presented with sudden onset of chest pain, headache and nausea. Physical examination was remarkable for mild hypotension and tachycardia. ECG demonstrated sinus tachycardia with poor R wave progression in precordial leads and T wave inversion in leads V1-3. Cardiac enzymes were raised. Echocardiographic examination revealed normal cavity diameters with basal and mid left ventricular hypokinesia and an ejection fraction of 45%. A diagnosis of non-ST elevation myocardial infarction was made. A few orthostatic hypotensive attacks occurred at follow-up. A coronary angiogram showed normal coronary arteries. Within a few days, the echocardiographic findings, ECG and all cardiac markers had returned to normal. Two months later she presented with headache, palpitation, fever, neck swelling, flushing and hypertensive attacks. Phaeochromocytoma was diagnosed on the basis of increased metanephrine on urinalysis and a left suprarenal mass on CT scan.

Incessant monomorphic ventricular tachycardia during febrile illness in a patient with Brugada syndrome: fatal electrical storm.

A 55-year-old male with structurally normal heart presented with sustained monomorphic ventricular tachycardia (VT) and was cardioverted into sinus rhythm revealing a right bundle branch block pattern at baseline electrocardiography. Sustained monomorphic and nonsustained polymorphic VT were reproducibly inducible during electrophysiological study. During the diagnostic workup, the patient experienced fever due to hospital based pneumonia, which unmasked typical ST segment changes of Brugada syndrome. In the intensive care unit, fever became intractable leading to incessant monomorphic VT, which was resistant to all medical manoeuvers resulting in the patient's death.

Carotid and brachial intima-media thickness, arterial diameter and resistivity indices in aortic regurgitation.

PURPOSE: To evaluate signs of atherosclerosis in carotid and brachial arteries in patients with aortic regurgitation (AR). MATERIAL AND METHODS: The sonograms of 33 patients (24 M and 9 F, 16-67 years old) with pure AR and 20 control subjects (15 M and 5 F, 19-49 years old) were evaluated. Patients with AR and control subjects completed a questionnaire with SMART risk score based on pre-existing vascular disease and risk factors. AR patients and control subjects were assessed for intima-media thickness (IMT) of common carotid artery (CCA), IMT of brachial artery (BA), CCA diameter, and resistivity index (RI) of CCA and RI of internal carotid artery (ICA). RESULTS: There was no significant difference in the cardiovascular risk score between the patients with AR and control subjects. All measured parameters were statistically significantly greater in AR patients than in control subjects with P values 0.0233 for CCA IMT, 0.0034 for BA IMT, 0.0429 for CCA diameter, <0.0001 for CCA RI, and 0.0002 for ICA RI. CONCLUSION: AR is associated with signs generally considered to represent atherosclerosis, such as increased CCA and BA IMT, CCA diameter, and CCA and ICA RI.

Duplex sonography of the carotid arteries in patients with pure aortic regurgitation: pulse waveform and hemodynamic changes and a new indicator of the severity of aortic regurgitation.

PURPOSE: To determine the changes of multiple hemodynamic parameters and pulse wave contour in pure aortic regurgitation (AR) and to present a new indicator of the severity of AR (shrink ratio of proximal common carotid artery). MATERIAL AND METHODS: The sonograms of 42 patients (31 M, 11 F; 16-68 years) with pure AR and 18 control subjects (15 M, 3 F; 20-47 years) were assessed for velocities and indices, and change of pulse wave contour (bisferious pattern, zero level and retrograde diastolic flow) in each carotid artery. Shrink ratio (maximum diameter-minimum diameter/maximum diameter) of each proximal common carotid artery was calculated. RESULTS: Bisferious waveforms seen in patients with AR grade 1, grade 2, and grade 3-4 were 66%, 83%, and 88%, respectively. Diastolic reversed flow was determined in 7 (39%) of 18 patients with AR grade 3-4. Three patients (25%) with AR grade 2 and 4 patients (22%) with AR grade 3-4 had zero level diastolic flow in the common carotid artery. Statistically significant changes of decreased end-diastolic velocity, increased peak systolic velocity/end-diastolic velocity, resistivity index, and pulsatility index were revealed, especially in AR grade 3-4 compared to controls. Significantly increased shrink ratio was seen only in AR grade 3-4. CONCLUSION: Increased shrink ratio or changes in hemodynamics or pulse waveform can be used in recognition of AR.