One hundred patients who underwent coronary bypass surgery were studied to investigate the relalionship between Sv02 and CI. After admission of patients to the intensive care unit Sv02, CI, V02 were measured every hour within the first six hours. When the changes of SvO2 were compared with CI and VO2, there was very weak correlation between SvO2 and the other parameters. Correlation coefficient between CI and SvO2 was 0.15 and that between VO2 and CI whereas no significant change was noticed in SvO2. In conclusion SvO2 was not predictive of CI in the postoperative period after open heart surgery.

Fifly (46 male and 4 female) patients, who had ischemic heart disease and left ventricular (LV) aneurysm as demonstrated by coronary angiography and contrast ventriculography (CV), were studied with radionuclide ventriculography (RNV) and two dimensional echocardiography (2DE) to determine the value of RNV and 2DE in disclosing LV aneurysm and thrombus within the aneurysm and to evaluate the global function as compared to CV findings. In patients who underwent operation, we investigated the reliability of CV RNV and 2DE in demonstrating LV ancurysm and thrombus. We found that though none of the techniques, including CV, was absolutely accurate in demonstrating LV ancurysm, RNV and 2DE had almost equal usefulness in this respect. RNV and CV showed strong correlation in the estimation of LV ejection fraction. Furthermore 2DE was more reliable than CV in demonstrating thrombus within the aneurysm.

Isosorbide 5-mononitrate (IS 5-MN), an active metabolite of isosorbide dinitrate, is widely used as an antianginal agent. The acute and subacute effects of IS 5-MN, 20 mg twice daily in 8 patients and three times daily in other 8 patients with stable angina pectoris were evaluated using a placebo controlled, double blind, randomized trial protocol. There were two phases of 10 days each in which patients received placebo or active IS 5-MN. Acute testing was performed 2 hours after the morning dose on day 10. Acute testing showed a significant increase in exercise time after a first dose of IS 5-MN (p<0.05). Time to 1 mm of ST depression increased significantly (p<0.05) and peak exercise ST segment depression decreased significantly (p<0.05). Time to onset of pain, rest and peak exercise heart rate, rest and peak exercise systolic blood pressure, peak double product did not change significantly. After 10 days of therapy the beneficial effects of IS 5-MN on exercise time and exercise time variables were not sustained. These data suggest that there is an attenuation of effect with respect to exercise time and ST segment variables. This may be a result of development of tolerance to IS 5-MN after 10 days of therapy.

Fifty patients (46 male, 4 female) with ischemic heart disease and left ventricular aneurysm demonstrated by coronary angiography and contrast ventriculography (CV) were included in this study. The relation of anatomic localisations of left ventricular ancurysms to coronary artery lesions, electrocardiographic infarct localisation, and sustained ST-segment elevation were studied. It was shown that apical, anterior, and inferior ancurysms were most frequent and were associated with three-vessel or diffuse coronary artery lesions. The most frequently involved arteries were left anterior descending artery in cases of anterior and apical aneurysms and right coronary artery in those of inferior and inferolateral aneurysms. The incidence of sustained ST-segment elevation was found to be 42 %. A significant correlation existed between the anatomic and electrocardiographic localisations of left ventricular aneurysms.

To assess the antianginal, antiischcmic efficacy of nicardipine, a new calcium antagonist, the present placebo-controlled study was performed on 16 normotensive patients with chronic stable angina pectoris. 20 mg nicardipine or placebo was given to patients orally and thrice daily for a week. In the following week, placepo was given to the patients who had received nicardipine or vice versa. During the study, patients were permitted to take sublingual tablets of isosorbide dinitrate (ISDN), only if they exprienced angina. At the end of each period and 3 hours after the last dose of nicardipine or placebo, the patients underwent ergometric bicycle exercise testing. The test was maintained until maximal or tolerable workload and the following parameters were obtained: weekly ISDN consumption, heart rate (HR), systolic blood pressure (SBP), and double product (DP) (=HRxSBP) at rest and HR, SBP and DP at tolerable maximal work during the test, time to occurence of 1 mm ST segment depression, time to occurrence of angina pectoris, maximal exercise time, maximal ST segment depression and tolerable maximal work. Our study revealed that nicardipine at oral dose of 20 mg thrice daily had antianginal, antiischemic efficacy which was related to decrease in myocardial oxygen requirements and probably to increase in coronary blood flow and had no serious adverse reactions.

The aim of this study was to evaluate the use of the new model DDD pacemakers in the treatment of symptomatic sick sinus syndrome (SSS) and their success for solving the commonly encountered problems in this disease. The study material consisted of 67 patients who were implanted with 4. generation DDD pacemakers between 1984-1988 in our instution. 45 of these patients were male and average age was 66±12 years. Clinical and laboratory experiences related to these patients had tachy-brady syndrome and 55 % had ventriculo-atrial retrograde conduction. With the use of these pacemakers; commonly encountered problems like endless loop tachycardia, pacemaker syndrome and thrombo-embolic phnomena were solved. However atrial fibrillation had been a continuing problem. Approximately 87 % of the patients were in DDD mode at the end of an average 27-months follow-up period.

Subarachnoid hemorrhage (SAH) can cause electrocardiographic changes via the sympathoadrenal system. We evaluated 59 patients with subarachnoid hemorrhage which had different etiologies; 90 percent of these patients had ECG abnormalities. We observed QT prolongation (54 %), T wave inversion (49 %) and ST changes (41 %). Frontal interhemispheric bleedings and those close to the hypothalamic region commonly led to ECG almormalities but the difference did not attain significant level. ST changes and QT prolongation seemed roughly to parallel the clinical severity. Endogenous sabstances, sympathetic system and other factors can leed to ECG abnormalities in subarachnoid hemorrhage.

Radionaclide ventriculography (RVg) permits the assessment of Ieft ventricular function during rest and exercise. Although it was initially reported to be a highly specific test for coronary artery disease (CAD), later studies reported a high false positive rate. We studied the exercise responses in ejection fraction (EF) and wall motion in 26 normal male subjects (ages 22-64 years) and the specificity of the method for the diagnosis of CAD. None developed wall motion abnormality and EF increased in all 26 (from 63.0±5.6 to 72.9±6.0. Considering an absoIute 5 % increase as normal, the specificity was found 88.5 %. It is concluded that despite inherent technical difficulties, exercise RVg is a highly specific method for CAD in men and an absolute increase of 5 % in EF may be accepted as normal. However it is essential to determine how much these technical difficulties affect the sensitivity of the method.

A woman with partial hypopituitarism, secondary hypothyroidism and a slightly prolonged QTc interval was monitorized with the expectation of derecting rhythm abnormalities. Torsade de pointes and subsequent ventricalar fibrillation were observed and treated before thyroid hormone replacement therapy was begun. Since adrenal deficiency was excluded and the QTc value did not seem to be afected by the antiarrhythmic agents administered to the patient, hypothyroidism was regarded as the main cause of the ventricular arrhythmias. Disopyramide could have been a contributory factor. The QTc interval returned to normal with the treatment of hypothyroidism.

We report the application in a patient of a nonsurgical technique, for obtaining multiple pericardial biopsies in palients with pericardial effusion. This technique, slightly modified from that proposed by Endrys and coworkers, was performed for the first time in Turkey. An 8 Fr Teflon sheath is introduced by the Seldinger technique under flouroscopy through the subxiphoid approach. The pericardial fluid is aspirated and air is allowed to enter the pericardium. This method outlines the pericardium. Thereafter, a bioptome is inserted through the sheath and multiple samples are taken from different sites of the pericardium for histopathologic and bacteriologic studies.

A total of 20 patients with cardiac tumor operated on at the Hacettepe University Medical Faculty and the Cardiology Institute, Istanbul Universty, during 1973-1989 were reported. Eighteen patients had primary cardiac tumors and two had metastatic tumors. Sixteen of the first group were benign and two were malignant. The most common clinical presentation was congestive heart failure. Indication for operation was established with echocardiography alone in three, cardiac catheterization plus echocardiography in five, and only cardiac catheterization in the rest of the patients. All cases were operated by cardiopulmonary bypass technique. In three, total circulatory arrest was also performed. Four (20 %) of these patients who had total or partial excision of the tumor, succumbed. In cardiac neoplasms which is a rare cardiac disease, echocardiography has an important place both in diagnosis and in postoperative evaluation. Surgical resection is the treatment of choice in primary cardiac tumors and long-term follow up is important in all cases.