[Cardiac failure secondary to idiopathic hypoparathyroidism: a case report]. / Idiyopatik hipoparatiroidiye bagli gelisen kalp yetersizligi: olgu sunumu.

Hypocalcemic cardiomyopathy due to hypoparathyroidism is a very rare condition. Ensuing heart failure due to hypocalcemia is refractory to conventional treatment. We reported a 41-year-old man who developed cardiac failure due to hypocalcemia secondary to idiopathic hypoparathyroidism. Echocardiography showed biventricular low ejection fraction, dilated heart chambers, pulmonary hypertension, and valvular regurgitations. Serum calcium and parathyroid hormone levels were low. After treatment of heart failure and calcium-vitamin D supplementation, signs and symptoms of heart failure improved rapidly. At 6 months, biventricular systolic and diastolic functions returned to normal. Serum calcium level should be monitored in every patient with cardiac failure and hypocalcemia should be considered in patients with refractory heart failure.

The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study.

BACKGROUND: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self-training in preventing syncope in patients with recurrent VVS. METHODS: Eighty-two consecutive patients (mean age 41 +/- 4 years, 37 males) with recurrent VVS episodes and positive head-up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end-points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence. RESULTS: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 +/- 2/year syncopal episodes prior to the HUT. The mean follow-up after randomization was 12 +/- 2 months. Spontaneous syncope recurrence during follow-up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 +/- 20 days vs 50 +/- 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow-up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 +/- 1 vs 2 +/- 1, P = 0.4). CONCLUSIONS: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.

The effect of combination therapy on regression of left ventricular hypertrophy in cases with hypertension.

OBJECTIVE: Up to this date, it is well shown that several antihypertensive drugs have different regressive effect on left ventricular hypertrophy (LVH). However, there are different studies regarding the effect of antihypertensive combination therapies on regression of LVH. In this study, 2 different combinations ACE-I plus calcium channel blocker and ACE-I plus diuretic were compared in cases with hypertension whose BPs were not controlled by ACE-I alone. METHODS: Forty patients with mild to moderate hypertension were included in this study. The treatment was continued for 6 months in the Faculty of Medicine at Ege University, Turkey, between January and December 2003. Adequate response with lisinopril 20 mg/daily failed to be achieved in all patients. Patients divided into 2 groups. There were no differences between the groups in patients' age, blood pressure (BP) and other clinical and laboratory range. First group patients received lisinopril 20 mg + nifedipine GITS 30 mg and second group patients received lisinopril 20 mg + hydrochlorothiazide 25 mg. The treatment was continued for 6 months. Blood pressure were measured every 2 weeks, echocardiographic findings, and blood and urinary analysis were performed before and at the end of treatment. RESULTS: Systolic and diastolic BP decreased significantly in both groups and no significant difference regarding BP was found between the 2 groups. Left ventricular mass index also decreased significantly in both groups. However, in the first group left ventricular mass index decreased more compared to the second group. CONCLUSION: The effect of combination therapies with angiotensin converting enzyme inhibitor (ACE-I) plus diuretic and ACE-I plus calcium channel blocker on systolic and diastolic BP are similar. However, when LVH is present, regressive effect of the combination of ACE-I plus calcium channel blocker is superior to the combination of ACE-I plus diuretic.