Objectives: We investigated the effect of acute myocardial infarction (AMI) on right ventricular functions.
Study design: The study consisted of 39 patients with ST-segment elevation AMI. The patients were divided into two groups according to the localization. Inferior and anterior AMI groups included 21 patients (1 female, 20 males; mean age 56 years) and 18 patients (2 females, 16 males; mean age 56 years), respectively. Nine patients with inferior AMI were assessed as a subgroup with right ventricular AMI. The control group included 22 subjects who were found to have normal coronary angiography, electrocardiography, and echocardiography findings.
Results: Compared to controls, myocardial performance indices (MPI) of the left and right ventricles were significantly higher in both inferior and anterior AMI groups (p<0.001). Similarly, the right ventricle MPI differed significantly between patients with or without right ventricle involvement (p=0.023). In multivariate regression analysis, the left ventricle MPI (b=0.450, p=0.001) and right ventricular isovolumetric relaxation time (b=0.507, p<0.001) showed independent relationship with the right ventricle MPI. There were significant differences between patients with (n=13) or without (n=13) successful thrombolytic therapy with regard to the right ventricle MPI (p=0.001) and right ventricular isovolumetric relaxation time (p=0.040).
Conclusion: Regardless of the localization of AMI, impairment in left ventricle functions is accompanied by deterioration in right ventricle functions, which is apparent in diastolic function of the right ventricle with no adverse effect on systolic function. Moreover, impairment in diastolic function is more prominent with right ventricle involvement. Successful thrombolytic therapy not only improves left ventricle functions but also diastolic function of the right ventricle.

Objectives: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary artery syndromes and sudden death. We evaluated characteristics of patients who were found to have SCAD at coronary angiography.
Study design: We reviewed 32,000 coronary angiographies performed in a five-year duration and detected SCAD in 24 patients (0.07%; 22 males, 2 females; mean age 54 years; range 35 to 72 years). Clinical and angiographic findings of these patients were evaluated.
Results: Of 24 patients with SCAD, eight patients (33.3%) had no coronary artery disease (CAD), whereas 16 patients (66.7%) had CAD of varying severity. Two or more risk factors were detected in 66.7% and 33.3% of patients with or without CAD, respectively. Dissections were found in the left coronary artery in 17 cases (70.8%), left anterior descending artery in four cases (16.7%), and circumflex artery in three cases (12.5%). Fourteen patients had no restriction in flow, so they received medications including aspirin, nitroglycerin, beta-blocker, ACE inhibitor, and a statin. Five patients underwent emergency coronary bypass surgery, four patients underwent primary stenting, and one patient received thrombolytic treatment. No complications were encountered during hospitalization.
Conclusion: Detection of CAD of varying severity or multiple cardiovascular risk factors in most of the patients may imply the need for considering coronary atherosclerosis among classical risk factors for SCAD.

Objectives: We evaluated gamma-glutamyltransferase (GGT) activity in patients with calcific aortic stenosis (AS) and investigated the association between GGT levels and the maximum and mean aortic gradients.
Study design: The study included 34 patients (5 women, 29 men; mean age 63±13 years) with calcific AS. Thirty-eight subjects (8 women, 30 men; mean age 57±10 years) with echocardiographically normal aortic valves constituted the control group. Echocardiographic evaluation was performed in all the subjects and venous blood samples were obtained to determine plasma glucose, fibrinogen, total cholesterol, LDL and HDL cholesterol, triglyceride, and GGT levels. The activity of GGT was determined by the kinetic method. Associations were sought between GGT levels and the maximum and mean aortic gradients.
Results: In the AS group, the mean maximum and mean gradients of the aortic valve were 74±15 mmHg and 39±9 mmHg, respectively. Fibrinogen concentrations differed significantly between the patient and control groups (3.9±1.7 mg/dl and 2.9±0.9 mg/dl, respectively; p<0.02). Activity of GGT was not influenced by gender in both groups (p>0.05). Compared to controls (21±14 U/l), the mean GGT level was significantly higher in the AS group (39±13 U/l; p=0.005). In linear regression analysis, weak but significant sex- and age-adjusted correlations were found between the GGT level and the maximum (r=0.20, p<0.001) and mean (r=0.17, p<0.001) aortic gradients.
Conclusion: Patients with calcific AS have higher GGT levels compared to controls, suggesting the presence of a common etiologic mechanism for both calcific AS and coronary artery disease.

Objectives: It has been suggested that erectile dysfunction (ED) may be the first clinical reflection of vascular disease. We investigated the stiffness and elastic properties of the aorta by conventional and color tissue Doppler echocardiography (TDE) in patients with ED of vascular origin.
Study design: Thirty male patients with ED (mean age 52±8 years; range 41 to 73 years) were studied. Systolic and diastolic aortic diameters were measured by M-mode echocardiography to asses elastic properties of the aorta. Tissue Doppler velocities (S, E, and A cm/sec) of the upper and inferior aortic wall were measured by color TDE. Aortic strain and elasticity, and aortic stiffness index (ASI) were calculated. The results were compared with those of 30 healthy male controls (mean age 49 years).
Results: Systolic and diastolic pressures and aortic systolic and diastolic diameters differed significantly between the two groups (p=0.001, p=0.034, p=0.045, p=0.004, respectively). Compared to controls, ASI was significantly higher (p=0.007), and aortic strain (p=0.002) and S wave velocity of the upper wall (p=0.001) were significantly lower in patients with ED. Significant correlations were found between S wave velocity of the upper wall with ASI (r=-0.389, p=0.004), aortic strain (r=0.444, p=0.001) and elasticity (r=0.504, p<0.001), and between S wave velocity of the mitral lateral annulus and ASI (r=-0. 472, p<0.001) and aortic elasticity (r=0.533, p<0.001).
Conclusion: Erectile dysfunction of vascular origin is associated with increased aortic stiffness and decreased aortic elasticity, this may foreshadow other vascular system diseases having a silent course.

Objectives: It is sometimes observed that informing patients about cardiovascular procedures is not taken into appropriate consideration. In this study, we assessed the patients’ level of knowledge obtained through informing regarding the procedures performed in cardiology.
Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation.
Results: Of the participants, 33% had hypertension, 7.5% had diabetes mellitus, and 23% had coronary artery disease. Although the majority of the patients (n=159, 79.5%) had a prior electrocardiogram, only 7% (n=14) responded that it gave information about coronary artery disease. Eighty-six percent (n=172) of the participants did not know what Holter was. According to 44%, CAG was performed for visualization, and to 37%, for patency of the coronary arteries. Concerning the PCI procedure, 42% stated that they did not know how it was carried out, and 35% stated that the balloon was blown up during the procedure.
Conclusion: Furnishing patients with necessary information about cardiovascular procedures is important for improved health of individuals and the society at large, and there seems to be a considerable gap in this respect.

Coronary vasospasm is a cause of acute coronary syndrome. Many factors, in particular smoking may induce vasospasm. Xylometazoline is a commonly used sympathomimetic to provide decongestive action with topical effect. A 50-year-old male patient was admitted with typical angina pectoris that developed after heavy smoking. Coronary angiography showed normal coronary anatomy. One month later, he presented with myocardial infarction of ST elevation following high dose of xylometazoline application. There was no other cause to provoke coronary vasospasm. This case underlines the need for a thorough investigation into drug use in young and relatively low-risk patients presenting with chest pain.

A 54-year-old man was referred to our hospital for investigation into a possible cardiac source of an embolic cerebrovascular event. Physical examination of the cardiovascular system and transthoracic echocardiographic findings were normal. Transesophageal echocardiography enabled detection of an atheromatous ulcerative plaque with mobile thrombus in the thoracic aorta. When the embolic source of stroke cannot be determined by standart diagnostic modalities, transesophageal echocardiography of the aorta may be helpful in this respect.

Coronary-subclavian steel syndrome is a rare disease characterized by symptoms of myocardial ischemia, upper extremity claudication, and cerebrovascular insufficiency. A 57-year-old man who had undergone coronary artery bypass surgery with the use of a left internal mammary artery graft a year before developed angina pectoris of three-month history. He had complaints of increased chest pain induced by left arm movements and left arm incompetency. Physical examination showed a significant blood pressure difference between the right and left arms. Electrocardiography showed no recent ischemic changes. Cardiac enzymes were normal. On coronary angiography, vein grafts were patent. An aortogram showed proximal stenosis in the left subclavian artery and a selective subclavian angiogram showed diminished blood flow through the left internal mammary artery graft. Left subclavian artery angioplasty and stent implantation were performed, which resulted in complete patency of the left subclavian artery and sufficient re-flow through the graft. Subclavian steal syndrome disappeared.

Intravenous positive inotropic agents play an important role in the short-term management of acute decompensated heart failure. The most commonly used positive inotropic agents are beta-adrenergic agonists and phosphodiesterase inhibitors. Positive inotropic effect of these drugs is primarily through increasing cAMP and calcium concentration in cardiac myocytes, in which circumstance increased intracellular calcium consentrations may lead to serious adverse events. Calcium-sensitizing agents, in contrast, exert positive inotropic action by increasing the sensitivity of the contractile apparatus to calcium. Theoretically, these agents do not present major limitations of cAMP-dependent agents because they increase myocardial contractility without increasing intracellular cAMP or calcium. Levosimendan is a new calcium-sensitizing agent used in the treatment of decompensated heart failure. In this paper, we reviewed the use of intravenous positive inotropic agents and levosimendan in the treatment of acute decompensated heart failure.

A 39-year-old female patient wihout any previous cardiac symptoms was admitted for coronary angiography after acute anterior myocardial infarction and angiography revealed a huge dissection flap in left anterior descending artery.