Sudden cardiac arrest in takotsubo cardiomyopathy - a case study.

We present a 59-year-old woman who was admitted to hospital after sudden cardiac arrest due to ventricular fibrillation. Finally takotsubo syndrome was diagnosed. In the acute phase of takotsubo syndrome life-threatening ventricular arrhythmias and significant hemodynamic disorders may occur due to strong adrenergic stimulation and myocardial ischemia. It has been proved that the occurrence of torsade de pointes tachycardia in the acute phase of takotsubo cardiomyopathy is associated with QT prolongation. There are no clear guidelines on pharmacological treatment and implantable cardioverter defibrillator implantation after a past takotsubo episode. Takotsubo cardiomyopathy has not been entirely explained as an etiological disease.

Atrial paralysis due to progression of cardiac disease in a patient with Emery-Dreifuss muscular dystrophy.

We present the progressive nature of the disease in a 26 year-old woman who had suffered from Emery-Dreifuss muscular dystrophy detected at the age of three. In 2002, at the age of 20, due to recurring presyncopal states accompanied by sinus bradycardia and atrioventricular block, she was implanted with a dual chamber pacing system. During testing of the pacing in 2008, permanent electrical atrial stand-still without atria stimulation were detected and the mode of heart stimulation was changed to VVIR.

[Syncope in male--let us think about Brugada syndrome! Presentation of 3 cases]. / Omdlenia u mezczyzn­pamietajmy o zespole Brugadów! Prezentacja 3 przypadków klinicznych.

Brugada syndrome is a genetic disease characterised by ST segment elevation in right precordial leads and the occurrence of episodes of polymorphic ventricular tachycardia. It is also associated with a high risk of sudden death. We describe three males in whom Brugada syndrome was finally diagnosed after several hospitalisations due to syncope and ventricular tachycardia.

Myocarditis - clinical course and 2-year outcome in 32 patients.

BACKGROUND: Acute myocarditis is one of the most challenging diagnoses in cardiology. It is a disease with variable clinical presentation, progression and outcome. AIM: To assess clinical characteristics and outcome of patients hospitalised with diagnosis of acute myocarditis from year 2006 to 2008. METHODS: We analysed hospital files of consecutive 32 patients admitted to our hospital due to myocarditis. All demographic, clinical and laboratory data were analysed and compared between patients with acute or subacute myocarditis. After discharge the patients were followed for 8-24 months. RESULTS: The majority of patients were males (84%) in a mean age of 33 years. Clinical and echocardiographic parameters improved in 25 (78%) of patients during hospital stay. During follow-up decreased left ventricular ejection fraction (LVEF) was observed more often in patients with subacute than acute myocarditis (mean LVEF values of 49 vs. 61%, respectively). Patients with a subacute form of the disease more frequently required chronic pharmacological therapy and more often retired from occupational activities. CONCLUSIONS: Diagnosis of myocarditis is still challenging. Careful history taking, serial laboratory, ECG and echocardiographic examinations are helpful in therapeutic decisions making and assessing prognosis. Patient with subacute myocarditis are more symptomatic than patients with acute myocarditis.

[Undetermined type of acute coronary syndrome in a patient with a pacemaker]. / Obraz ostrego zespolu wiencowego typu nieokreslonego u chorej ze wszczepionym rozrusznikiem serca.

Venticular paced rhythm makes diagnosis of acute myocardial infarction difficult. We present a case of a 77-year-old woman with cardiac DDD pacemaker, suffering from diabetes, arterial hypertension and renal insufficiency. She was admitted to hospital due to heavy chest pain, radiated to neck and jaw and shortness of breath. The electrocardiogram recorded on admission showed ventricular paced rhythm and ST segment elevation > 0.5 mV, which fulfilled Sgarbossa's criteria for indetermined acute coronary syndrome in a patient with pacemaker. Troponin levels were not increased. Severe stenosis of left anterior descendent coronary artery was revealed in coronarography and percutaneus coronary angioplasty with stent implantation was performed immediately.

The effects of left ventricular diastolic function on natriuretic peptide levels after cardioversion of atrial fibrillation.

BACKGROUND: Diastolic heart failure often coexists with atrial fibrillation (AF). Elevated plasma levels of natriuretic peptides are the left ventricular (LV) marker of diastolic dysfunction. AIM: To evaluate the influence of sinus rhythm restoration on ANP and BNP levels in patients with normal and impaired LV diastolic function. METHODS: The study included 42 patients (19 men, 23 women), aged 58.6 +/- 8.2 years with non-valvular persistent AF with preserved LV systolic function who were successfully converted to sinus rhythm by DC cardioversion (CV) and maintained sinus rhythm for at least 30 days. On day 30 following CV in patients with sinus rhythm, Doppler echocardiography was performed to assess LV diastolic function. ECG, echocardiography, ANP and BNP plasma level measurements were made at baseline 24 h before CV and 24 h as well as 30 days after CV. RESULTS: The average ANP level in the whole study group during AF was 254.9 +/- 79.9 pg/ml and the average BNP level was 113.6 +/- 49.1 pg/ml. There was an evident decrease in ANP/BNP serum concentration in all the patients after successful DC cardioversion. Measured on the 30th day after CV, ANP and BNP levels were 153.2 +/- 67.9 pg/ml and 61.9 +/- 25.1 pg/ml respectively (p < 0.001). Thirty days after CV normal LV diastolic function was diagnosed in 15 patients and in 27 patients impaired diastolic function: 20 with impaired LV relaxation and 7 with impaired LV compliance. The extent of natriuretic peptides drop was dependent on the LV diastolic function, being more substantial in the subgroup with impaired LV diastolic function. In the subgroup with LV diastolic dysfunction the average ANP serum concentration measured 30 days after conversion was reduced by 111.2 +/- 93.9 pg/ml (37%) (p < 0.001) and BNP level was reduced by 67.5 +/- 36.0 pg/ml (46%) (p < 0.001). In patients with normal diastolic function sinus rhythm restoration significantly influenced ANP level, while having no relevant effect on BNP plasma concentration. The average ANP reduction in this subgroup was 64.4 +/- 71.8 pg/ml (by 38%) and BNP reduction was 11.4 +/- 16.7 pg/ml (by 23%) (NS). CONCLUSIONS: The drop in ANP and BNP plasma concentrations after conversion to sinus rhythm in patients with AF depends on the LV diastolic function. Restoration of sinus rhythm is associated with improvement of the heart's haemodynamics, especially in patients with impaired LV diastolic function, which may be inferred from the more pronounced decrease of BNP level after DC cardioversion in this subgroup, as compared to that with normal LV function.

The influence of left ventricle diastolic function on natriuretic peptides levels in patients with atrial fibrillation.

BACKGROUND: The diagnosis of the impaired left ventricle (LV) diastolic function during atrial fibrillation (AF) using traditional methods is very difficult. Natriuretic peptides seem to be useful for assessment of diastolic function in patients with AF. AIM: To evaluate the influence of LV diastolic dysfunction on natriuretic peptides concentrations and to assess the diagnostic value of atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in patients with AF and impaired LV diastolic function. METHODS: The study included 42 patients (23 males, 19 females), aged 58.6 +/- 8.2 years with nonvalvular persistent AF with preserved LV systolic function who were converted into sinus rhythm by DC cardioversion (CV) and maintained sinus rhythm for at least 30 days. Echocardiography (ECG), ANP, and BNP level measurements were taken at baseline 24 hours before CV and 24 hours and 30 days after CV. On the 30th day following CV in patients with sinus rhythm, Doppler ECG was performed to assess LV diastolic function. RESULTS: Thirty days after CV, normal LV diastolic function in 15 patients and impaired diastolic function in 27 patients was diagnosed: 20 with impaired LV relaxation and seven with impaired LV compliance. During AF and 24 hours, and 30 days after sinus rhythm restoration, significantly higher ANP and BNP levels were observed in patients with LV diastolic dysfunction as compared to the subgroup with normal LV diastolic function. The average values of ANP during AF in patients with normal and impaired diastolic function were 167.3 +/- 70.1 pg/mL and 298.7 +/- 83.6 pg/mL, respectively (P < 0.001), and the average values of BNP in the above mentioned subgroups were 49.5 +/- 14.7 pg/mL and 145.6 +/- 49.6 pg/mL respectively (P < 0.001). While comparing the diagnostic value of both natriuretic peptides it was noted that BNP was a more specific and sensitive marker of impaired LV diastolic function. ANP value >220.7 pg/mL measured during AF identified patients with impaired LV diastolic function with 85% sensitivity and 90% specificity. BNP value >74.7 pg/mL proved 95% sensitive and 100% specific in the diagnosing of such a group. CONCLUSIONS: The increase of ANP/BNP concentration in patients with AF results not only from the presence of AF, but also reflects the impaired LV diastolic function. Natriuretic peptides, especially BNP, may be useful in diagnosing LV diastolic dysfunction in patients with AF.

[Inoperable sinus venosus atrial septal defect in a young woman with severe pulmonary hypertension--a case report]. / Nieoperacyjny ubytek przegrody miedzyprzedsionkowej typu sinus venosus u mlodej kobiety z utrwalonym nadcisnieniem plucnym--opis przypadku.

Atrioventricular septal defect accounts for approximately 3% of all congenital cardiovascular malformations. We describe a case of a 34-year-old woman with inoperable sinus venosus atrial septal defect with severe pulmonary hypertension and symptoms of the Eisenmenger syndrome. Electrocardiography, chest radiography, transthoracic and transoesophageal echocardiography with and without contrast were performed and provided valuable information about haemodynamic consequences of this malformation.

[Acute pulmonary embolism--four case reports]. / Ostry zator tetnicy plucnej potwierdzony bezposrednim uwidocznieniem materialu zatorowego.

Four patients with acute pulmonary embolism are presented. The diagnostic role of transesophageal echocardiography and spiral computerised tomography is underlined.

Efficacy of biphasic shock for transthoracic cardioversion of persistent atrial fibrillation: can we predict energy requirements?

Although electrical cardioversion of atrial fibrillation (AF) is frequently performed, initial energy requirements for cardioversion of persistent AF is still a matter of debate. The aim of the study was to determine the efficacy of biphasic shocks for transthoracic cardioversion of persistent AF and to predict adequate initial energy. A prospective study enrolled 94 consecutive patients with persistent AF, who were referred for elective cardioversion with a biphasic waveform. The paddles were placed in the anterolateral position. A step-up protocol was used to estimate the cardioversion threshold. The initial shock energy was 50 J, with subsequent increments to 100, 200, and 300 J in the event of cardioversion failure. The mean age of the study group was of about 65 years (6 +/- 11 years) and a median duration of AF was 65 days (3-324). Sixty-two out of 94 patients were men, 55% of the study population was classified as having well-controlled hypertension. The overall success rate of cardioversion was 89%, with a mean 2.2 +/- 1.4 shocks, and effective J 217.8 +/- 113 delivered during repeated cardioversions. The success rate of low energy shocks: 50 and 50 +100 J was 51%. By logistic regression analysis the only independent predictor of success at low energy shock was shorter duration of AF (r =-0.51; P = 0.02). Patients with shorter duration of AF have a higher probability for successful cardioversion with low energy. In patients with longer AF duration, a 200 J shock should be considered for cardioversion as the initial energy.

[Intramural haematoma as a complication of myocardial infarction in a patient with apical hypertrophic cardiomyopathy--a case report]. / Kardiomiopatia przerostowa. Krwiak sródscienny lewej komory jako powiklanie zawalu serca. Opis przypadku.

A patient with apical hypertrophic cardiomyopathy and myocardial infarction complicated by intramural haematoma of the left ventricle is presented. The angiographic examination confirmed atherosclerotic etiology of myocardial infarction. The other reasons of myocardial ischaemia in a hypertrophic cardiomyopathy are discussed, pointing at multi-factorial pathogenesis of myocardial infarction in this disease. Probable mechanisms of this rare complication and its prognostic value are also analysed.