Objectives: This study was conducted to investigate the relationship between heart rate turbulence (HRT) and acute left ventricular systolic dysfunction due to ST-segment elevation acute myocardial infarction (STEMI).
Study design: The study included 50 consecutive patients with acute STEMI. All the patients received thrombolytic therapy on admission and underwent transthoracic echocardiographic (TTE) examination at the 24th hour of hospitalization. The patients were divided into two groups according to whether they had decreased or normal left ventricular ejection fraction (LVEF). There were 25 patients (mean age 48±9 years; LVEF: <55%) in group 1, and 25 patients (mean age 52±9 years; LVEF: ≥55%) in group 2. All the patients underwent 24-hour Holter monitoring after TTE to derive the two HRT parameters, turbulence onset (TO) and turbulence slope (TS), showing early acceleration and late deceleration phases, respectively.
Results: Patients in group 1 exhibited a significantly higher mean TO (0.74±1.82% vs -2.35±1.48%, p<0.05) and a significantly lower LVEF (39.1±6.7% vs 57.2±5.3%, p<0.05). The other Holter and echocardiographic variables did not differ significantly between the two groups (p>0.05). An abnormal TO value (≥0%) was found to have sensitivity and specificity of 88% (p<0.05) in predicting acute left ventricular systolic dysfunction (LVEF<55%) during the peri-infarction period of STEMI.
Conclusion: Impaired TO may be used as a useful predictor of left ventricular systolic dysfunction and poor prognosis in the peri-infarction period of STEMI.

Objectives: We investigated plasma fibrinogen and interleukin-6 (IL-6) levels and the frequency of IL-6 polymorphism in patients with acute coronary syndrome.
Study design: A case-control study was conducted in 115 patients who underwent coronary angiography for suspected ischemic heart disease. The patients were classified into two groups according to angiography findings: 65 patients (49 males, 16 females; mean age 61±10 years) had less extensive coronary artery disease (CAD) (1-vessel stenosis), and 50 patients (36 males, 14 females; mean age 61±9 years) had extensive CAD (≥2-vessel stenosis). Fasting blood samples were taken to determine serum lipids, high sensitivity C-reactive protein, IL-6, and fibrinogen levels. The genotypic distribution and the IL-6 C/G-174 polymorphism were determined by polymerase chain reaction.
Results: Patients with less extensive CAD had a significantly lower prevalence of positive familial CAD and significantly lower plasma IL-6 and fibrinogen levels compared to those with extensive CAD (p<0.05). IL-6 polymorphism was detected in 20 patients (17.4%), its frequency being significantly higher in patients with extensive CAD (32% vs 6.2%; p<0.001).
Conclusion: Our results suggest that the presence of the IL-6 C/G-174 polymorphism and increased IL-6 and fibrinogen levels are strongly associated with the inflammatory system and hemodynamical significance of CAD.

Objectives: We investigated the effect of carvedilol on corrected QT dispersion (QTd) in patients with congestive heart failure (CHF).
Study design: The study included 20 patients (6 females, 14 males; mean age 57±11 years) who had symptomatic CHF with sinus rhythm, resting ejection fraction ≤%40, and no contraindications for beta-blockers. Coronary angiography showed coronary artery disease in nine patients, and dilated cardiomyopathy in 11 patients. Eight patients had myocardial infarction previously. All the patients had been receiving diuretics and angiotensin-converting enzyme inhibitors for one year. Carvedilol was initiated with a minimum dose of 3.125 mg twice daily, to be increased biweekly to reach the maximum tolerable dose (mean daily dose 42.5±13.6 mg). All the patients were assessed by electrocardiography and transthoracic echocardiography before and three months after treatment.
Results: Significant decreases were observed in the following clinical and echocardiographic parameters: heart rate (p=0.001), systolic blood pressure (p=0.002), left atrial diameter (p<0.001), and left ventricular end-systolic (p<0.001) and end-diastolic (p=0.04) diameters. Left ventricular ejection fraction showed a significant increase (p<0.001). There was also a remarkable improvement in NYHA functional capacity in all the patients (p<0.05). Both corrected QTd (p=0.001) and QTd (p<0.001) significantly decreased. Maximum corrected QT and maximum QT did not change significantly (p>0.05), while minimum QT and minimum corrected QT significantly increased (p<0.001). No significant correlation was found between the carvedilol dose and the percent decrease in QTd (p>0.05).
Conclusion: Carvedilol is associated with significant decreases in corrected QTd in patients with CHF.

Objectives: Heart rate recovery (HRR) at 1 minute after peak exercise is a measure of vagal reactivation and is considered a marker of parasympathetic activity. Blood pressure recovery index at 3 minutes (BPRI3) might reflect sympathetic activity. We aimed to assess HRR at 1 minute and BPRI3 in an attempt to determine parasympathetic and sympathetic activity in patients with slow coronary flow (SCF).
Study design: The study included 24 patients (19 males, 5 females; mean age 51±7 years) with angiographically diagnosed SCF using the Thrombolysis in Myocardial Infarction (TIMI) frame-count method. Heart rate recovery was calculated as the difference between the heart rate at peak exercise and heart rate at the relevant minute of recovery. Blood pressure recovery indexes were defined as the ratios of recovery systolic blood pressures at 1, 2, and 3 minutes to the systolic blood pressure at peak exercise. The results were compared with those of 26 age- and sex-matched subjects (19 males, 7 females; mean age 52±8 years) with normal flow.
Results: Patients with SCF had significantly lower HRRs at 1 minute (19±4 vs 25±6 beats/min; p<0.001) and 2 minutes (36±9 vs 44±13 beats/min; p=0.042) compared to controls with normal coronary flow. Blood pressure recovery index at 3 minutes was not significantly different between the two groups (0.81±0.07 vs 0.84±0.12; p=0.440).
Conclusion: Attenuation in HRR at 1 minute suggests the presence of reduced vagal tone in patients with SCF. Decreased vagal activity may contribute to the mechanisms responsible for SCF.

Cardiac hydatid disease is uncommon, occurring in 0.2% to 2% of patients with echinococcal disease. A 67-year-old farmer presented with fatigue, dyspnea, and palpitations. He had no previous history of heart disease. Cardiovascular examination, electrocardiography, chest X-ray, hematologic and biochemical tests were normal. Parasitic serology was negative. Transthoracic echocardiograpy showed a cyst, measuring 3.7x3.5 cm, in the posteroapical region of the left ventricle. Magnetic resonance imaging confirmed the cardiac cyst and showed another cyst in the liver. The patient underwent surgery through median sternotomy and the cyst was removed. Pathologic examination confirmed the diagnosis of echinococcosis. Postoperatively, the patient was treated with albendazole (800 mg/day) for four weeks. At three-month follow-up, the patient was asymptomatic, with improved functional capacity. Two-dimensional transthoracic echocardiography showed no signs of cystic formation.

Coronary ectasia is an infrequent angiographic lesion commonly seen in stenotic coronary arteries. It may result in angina pectoris, even in myocardial infarction due to impaired coronary blood flow. A 70-year-old woman presented with chest pain that occurred after physical activity and lasted nearly 30 minutes. There were no pathologic findings except for a 2/6-degree systolic murmur on the left sternal border. Electrocardiography showed T-wave inversions in leads III, AVF, and V1-V3. Her chest pain did not recur following medical therapy in the coronary intensive care unit. Coronary angiography performed with the diagnosis of acute non-ST elevation myocardial infarction revealed segmental ectasia in both the left anterior descending and right coronary arteries without any obstructive lesion. The patient was discharged with medical therapy. She was followed-up for six months without chest pain.

A 48-year-old woman was admitted to the coronary care unit because of ventricular tachycardia that developed during hospitalization for invasive ductal carcinoma of the breast. Lidocaine infusion suppressed ventricular tachycardia, and ST-segment elevations in inferior and anterior leads were noted on a subsequent electrocardiogram (ECG). She did not have angina, and serum cardiac troponin T levels were in the normal range. Computed tomography of the thorax revealed metastases involving the myocardium and the lungs. Electrocardiographic abnormalities were attributed to myocardial invasion of the malignant tumor rather than to acute coronary syndrome. Ventricular tachycardia did not recur during follow-up under amiodarone treatment. Myocardial infiltration of the tumor should be considered when ECG alterations without typical angina are found in a patient with malignancy and normal cardiac markers.

Cardiac stem cell therapy is considered a promising alternative for the treatment of heart failure resulting from ischemic heart disease. Although short-term results demonstrate the beneficial effects of cardiac stem cell therapy on left ventricular functions and neovascularization, long-term effects have yet to be established. Various methods have been used for cardiac stem cell therapy, yielding varying degrees of success. However, the number of studies that compare the efficacy of these delivery approaches is still inadequate. Further studies are required to increase the efficiency of stem cell therapy, to delineate the pros and cons of different delivery techniques, and to provide more insight into identification, localization, and efficacy of transplanted cells within the target organ.

Corrected transposition of the great arteries (c-TGA) is a complex and unusual abnormality occurring in less than 1 percent of people with congenital heart disease. This condition involves atrioventricular discordance and ventriculoarterial discordance (double discordance). Associated anomalies occur in up to 98% in some series and consist of VSD (75% of cases), pulmonary or subpulmonary stenosis (75% of cases) and systemic (tricuspid) valve anomalies (Ebstein-like in 30% of cases). Only 1-10% of individuals with c-TGA have no associated defects.
We report a case of an asymptomatic 46-year-old man with c-TGA with situs inversus totalis. He was referred by a general practitioner because of abnormal auscultation findings (Heart sounds were noted to be louder over the right precordium with the point of maximal impulse on the right side of the chest and 2/6-degree systolic murmur on the right sternal border). Follow-up was decided because of the patient was being asymptomatic.