Objectives: We evaluated the contractile function of the left atrial appendage, an important anatomical structure in the pathogenesis of systemic embolism, by transesophageal echocardiography in patients with hyperthyroidism.
Study design: Transthoracic and transesophageal echocardiography were performed in four patient groups having the following features: hyperthyroid patients with atrial fibrillation (group I, n=23), hyperthyroid patients with sinus rhythm (group II, n=22), control patients with atrial fibrillation (group III, n=12), and control patients with sinus rhythm (group IV, n=12). Transthoracic and transesophageal echocardiography findings were compared between groups I and III, and groups II and IV.
Results: No significant differences were found between the groups with respect to standard transthoracic echocardiography parameters. In transesophageal echocardiography, the emptying (0.5 m/s vs 0.3 m/s, p=0.028) and filling (0.5 m/s vs 0.4 m/s, p=0.015) velocities of the left atrial appendage were found to be significantly higher in group I than in group III. Similarly, compared to group IV, group II had significantly higher emptying (0.7 m/s vs 0.4 m/s) and filling (0.7 m/s vs 0.4 m/s) velocities (p=0.0001).
Conclusion: Our results show that the contractile functions of the left atrial appendage are preserved in patients with hyperthyroidism, suggesting a lower risk for hemostasis and thrombus formation.

Objectives: Levosimendan, a calcium sensitizer, improves myocardial contractility without increasing myocardial oxygen demand. We investigated the effect of levosimendan on QT dispersion in patients with decompensated heart failure.
Study design: The study included 20 male patients (mean age 59±10 years; range 48 to 70 years) who were admitted with decompensated heart failure (New York Heart Association functional class III-IV). Intravenous levosimendan was administered with an initial bolus dose of 12 µg/kg for 10 min, followed by a continuous infusion of 0.1 µg/kg/min for 24 hours. Transthoracic echocardiograpy was performed and electrocardiograms were obtained before and after drug infusion. QT dispersion (QTd) was defined as the difference between the maximum (QTmax) and the minimum (QTmin) QT duration, and the value was corrected for heart rate (QTc).
Results: Left ventricular ejection fraction was 35% or less in all the patients before and after the infusion. No significant differences were found before and after treatment with respect to QTmax and QTmin durations. Levosimendan administration was associated with decreased QTd (52±20 msec vs 61±24 msec, p=0.09) and QTc (63±25 msec vs 72±29 msec, p=0.11) values, without exerting a significant effect.
Conclusion: Our results suggest that therapeutic doses of levosimendan do not exert a negative effect on ventricular homogeneity.

Objectives: Although clinical and pathophysiologic features of slow coronary artery flow (SCAF) have been previously described, the underlying pathophysiology has not been fully elucidated. The aim of this study was to investigate the association between DNA damage and SCAF.
Study design: The study was comprised of 23 patients with SCAF and 23 healthy volunteers. DNA damage was assessed by the alkaline comet assay in peripheral lymphocytes and plasma total antioxidant capacity (TAC) was determined by a novel, automated method.
Results: Although DNA damage was higher in the SCAF group than in controls, this did not reach significance (106.6±38.2 AU vs 80.5±51.7 AU; p=0.055). Similarly, TAC levels did not differ significantly between the two groups (1.32±0.32 mmol Trolox equiv./L vs 1.35±0.26 mmol Trolox equiv./L, p=0.667). In the patient group, DNA damage showed a positive correlation with age (r=0.775, p<0.001) and a negative correlation with TAC (r=-0.791, p<0.001) and HDL cholesterol levels (r=-0.456, p= 0.029). In multiple linear regression analysis, TAC and age were found to be independent predictors of DNA damage in patients with SCAF.
Conclusion: These findings indicate that SCAF is not associated with increased DNA damage and decreased TAC, suggesting that DNA damage may not be useful in the differential diagnosis of SCAF.

Objectives: Selection of a sphygmomanometer with the right bladder size is essential for accurate measurement of blood pressure. We investigated whether the size of the bladders commonly used in clinical practice was appropriate for accurate blood pressure measurements.
Study design: We measured the bladder sizes of sphygmomanometers used in 52 outpatient clinics of university and state training hospitals in Ankara. The size of the bladders was approximated with the closest corresponding size recommended in the guidelines of the American Heart Association for blood pressure measurements. In the second phase, we measured arm circumferences of 100 consecutive hypertensive patients (49 women, 51 men; mean age 34.6±13.9 years; range 19 to 80 years) in our clinic to determine the use of appropriate bladder size according to the guidelines of the American Heart Association.
Results: Of 52 outpatient clinics, only five kept a second sphygmomanometer available. The bladder size was 12x22 cm in 96.5% of the sphygmomanometers and this was the appropriate size for only 39% of the patients. Only 3.5% of the sphygmomanometers had a bladder size of 16x30 cm, which was the proper size for 58% of the patients. Sphygmomanometers with bladder sizes of 16x36 cm and 16x42 cm were not available.
Conclusion: As to the bladder size, a significant percentage of sphygmomanometers currently used in clinical practice were not found appropriate for accurate blood pressure measurements. These results suggest that a spare sphygmomanometer with a bladder size of 16x30 cm should be available in outpatient clinics.

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. A 46-year-old male patient presented with manifestations of acute coronary syndrome. He underwent coronary angiography because of angina unresponsive to medical therapy. A spontaneous right coronary artery dissection was detected during coronary angiography. Distal flow was assessed as TIMI-0-I. A coronary stent, 4.0x15 mm in size was implanted, after which the dissection disappeared and the distal flow became normal.

Double left anterior descending (LAD) coronary artery arising from both the left and right coronary arteries is a very rare congenital abnormality. A 40-year-old male patient presented with dyspnea. Coronary angiography showed no signs of atherosclerosis. The left anterior descending artery terminated before reaching the apex. Another coronary artery that arose from the proximal of the right coronary artery reached the apex. Multislice computed tomographic angiography showed double LAD originating from the left and right coronary arteries. The patient was informed about the abnormality and was discharged to be monitored without medications.

Interventional cardiac catheterization procedures in low-birth-weight neonates are associated with specific problems including hypothermia during the procedure, difficulty in vascular access, and problems related to the small size of cardiac structures. Physical examination of a premature neonate, delivered by cesarean section at the 34th week of gestation with birth weight of 1790 g revealed a systolic murmur of 3/6 intensity. The murmur continued on the following day and cardiomegaly was observed on a chest radiogram. Echocardiographic examination revealed a patent foramen ovale with right-to-left shunt, patent ductus arteriosus, right ventricular hypertrophy, and valvular pulmonary stenosis. Balloon pulmonary valvuloplasty was performed upon detection of increased right ventricular pressure and pulmonary artery pressure gradient and development of marked tachypnea and dyspnea. Following the procedure, right ventricular pressure and pulmonary gradient decreased and the infant was discharged eight days after the procedure. Pulmonary artery pressure gradient was 56 mmHg after a month.

Implantable cardioverter defibrillators (ICD) have a high success rate in terminating ventricular tachycardia and ventricular fibrillation. During the follow-up of ICD patients, 10-30% receive multiple shocks within a short period of time, presenting as one of the most demanding clinical problems, known as arrhythmic or electrical storm. This condition is defined as attacks of ventricular tachycardia or fibrillation occurring three or more times in a 24-hour period, usually requiring electrical cardioversion or defibrillation. This article reviews the clinical importance and therapeutic methods of electrical storm in ICD patients.

Recent guidelines for the evaluation and management of heart failure have come up with important changes in the approaches to the diagnosis and treatment of this disorder. This review summarizes those changes.

A 61-yeard-old woman who had been complaints of chest pain, squeezing and dyspnea for three months admitted to our hospital. She had any history of known heart disease. Echocardiography revealed left ventricular regional wall motion abnormality. Multi-slice computed tomography(MSBT) was performed to detect coronary artery disease. MSBT showed coroner artery aneurysm on proximal segment of left anterior descending artery and significant stenosis on distal segment. Coronary angiography confirmed these findings.