Development of malignant ventricular arrhythmias in a young male with WPW pattern.

In Wolff-Parkinson-White Syndrome (WPW), presence of accessory pathways causes various tachyarrhythmias that lead to different symptoms and clinical conditions in patients. Atrial fibrillation is observed in about 20-30% of this group of patients. Life threatening malignant ventricular arrhythmias and sudden cardiac deaths are observed in patients having rapid conduction in accessory pathways and short antegrade refractory periods (<250 msn). We present a WPW syndrome case that presented to the emergency service with narrow QRS tachycardia and later developed malignant ventricular arrhythmia.

Relationship between HbA1c and coronary flow rate in patients with type 2 diabetes mellitus and angiographically normal coronary arteries.

OBJECTIVES: We examined the relationship between glycosylated hemoglobin (HbA1c) level and coronary flow rate in patients with type 2 diabetes mellitus (DM) and angiographically normal coronary arteries. STUDY DESIGN: The study included 54 consecutive patients (36 males, 18 females; age range 37 to 72 years) with type 2 DM, whose coronary arteries were found normal on coronary angiography. All patients underwent echocardiography and plasma HbA1c levels were measured before coronary angiography. To determine slow coronary flow (SCF), coronary flow rates of the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries were assessed using the TIMI frame count (TFC) method. RESULTS: None of the patients had echocardiographic abnormalities. The mean HbA1c level was 7.4±2.0%, and the mean TFCs were 34.3±6.5, 22.4±3.5, and 20.4±2.2 for the LAD, Cx, and RCA, respectively. HbA1c levels were <7% in 26 patients, and ≥7% in 28 patients. Thirty-eight patients (70.4%) were found to have SCF in at least one coronary artery. TIMI frame counts of all three coronary arteries were significantly greater in patients in whom HbA1c was ≥7% (p<0.001). TIMI frame counts showed significant correlations with the HbA1c level (LAD: r=0.782; Cx: r=0.707; RCA: r=0.515; p<0.001 for all). The mean HbA1c level was significantly higher in patients with SCF compared to patients without SCF (7.8±1.9% vs. 5.6±0.9%; p<0.001). The incidence of SCF was significantly greater in patients with HbA1c ≥7.0% than those with HbA1c <7.0% (96.4% vs. 61.5%; p=0.004). Increased HbA1c (≥7%) significantly increased the risk for SCF in at least one coronary artery (OR=16.875; 95% CI 1.972-144.38). CONCLUSION: Our findings suggest that there is a strong correlation between the HbA1c level and coronary flow rate.

Acute phase reactants in patients with coronary slow flow phenomenon.

OBJECTIVE: In this study, we sought to investigate the serum levels of high sensitivity C-reactive protein (Hs-CRP), N-terminal pro-brain natriuretic peptide (NT proBNP), erythrocyte sedimentation rate, leukocyte, thyroid hormone and fibrinogen levels in patients with coronary slow flow phenomenon (CSFP). METHODS: A total of 82 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (45 males and 37 females, mean age 59±11 years) and 34 patients with normal coronary arteries and normal coronary flow (19 males and 15 females, mean age 56±10 years) with similar risk profiles were included in this cross-sectional observational study. Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction (TIMI) frame count, serum level of Hs-CRP, NT proBNP, sedimentation, leukocyte, free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) and fibrinogen levels were measured. Statistical analysis was performed using t test for independent samples, Chi-square test and Pearson correlation analysis. RESULTS: Hs-CRP (0.88±0.86 vs 0.36±0.35 mg/L, p=0.001) and NT proBNP (117.83±163.2 vs 47.33±30.6 ng/ml, p=0.01) were found to be significantly higher in patients with coronary slow flow compared with normal control group. There were no significant differences regarding thyroid hormones, fibrinogen, sedimentation rate and leukocyte count between two groups. The mean TIMI frame counts were positively correlated (r=0.454, p=0.001 and r=0.554, p=0.001, respectively) with plasma Hs-CRP levels and NT-proBNP levels. CONCLUSION: Hs-CRP and NT proBNP are significantly higher in patients with coronary slow flow compared with normal control group. Their increased levels are positively correlated with TIMI frame count.