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Inferior paraseptal accessory pathways (APs) have a wide distribution and prediction of AP location before radiofrequency ablation is very important in such pathways. We aimed to estimate successful ablation site based on electrocardiogram in 137 patients (mean age: 25.8±9.0; 126 males) with single manifest inferior paraseptal AP. Right endocardial inferior paraseptal APs were discriminated from left endocardial APs with an R/S ratio <1 (p<0.001) and negative delta wave in lead V1 (p<0.001). Epicardial inferior paraseptal APs were differentiated from endocardial APs by a negative delta wave in lead II (p=0.001), positive delta waves in AVR (p<0.001) and V1 (p=0.012), R/S ratio <1 in lead II (p=0.03), and R/S ratio ≥1 in V1 (p=0.04). Delta wave polarity and R/S ratio in lead V1 differentiate right endocardial inferior paraseptal APs from left endocardial APs. Delta wave polarities in leads II, AVR and V1, and R/S ratios in leads II and V1 estimate epicardial inferior paraseptal APs. [ABSTRACT FROM AUTHOR]

Abstract: Isolated right ventricular myocardial infarction (RVMI) rarely occurs and accounts for only 3% of all myocardial infarction cases. In the literature, there are several reported isolated RVMI cases with precordial ST-segment elevation. We describe a 45-year-old man with marked ST-segment elevations in leads V1 through V4 accompanied by slight ST-segment elevations in the inferior leads (III, aVF) caused by acute occlusion of a nondominant small right coronary artery proximal to the conus branch causing isolated RVMI. [Copyright &y& Elsevier]

Background: Recent evidence has demonstrated that inflammation plays a major role in the initiation and progression of atheroma plaques. C-reactive protein (CRP) is shown to have prognostic significance in acute coronary syndromes. We investigated the influence of CRP levels before thrombolytic therapy on infarct-related artery (IRA) patency and the degree of residual stenosis. Methods: 45 consecutive patients with a first attack of acute myocardial infarction (MI) who underwent streptokinase therapy and subsequently coronary angiography were enrolled into the study. Patients were divided into 2 groups according to the level of CRP on admission. Results: Serum CRP levels were ≥0.5 mg/dL in 26 patients (Group-I) and <0.5 mg/dL in 19 patients (Group-II). The patency of IRA (TIMI-2 and 3) evaluated at 90th minute after the initiation of thrombolytic therapy was similar between the two groups (62% vs. 68%, p>0.05). However, the presence of TIMI-3 flow was significantly lower and TIMI-2 flow was higher in Group-I as compared to Group-II (12% vs. 53%, p=0.003 and 50% vs. 16%, p=0.018 respectively). Additionally, among patients with patent IRA, the degree of residual stenosis was significantly higher in Group-I (80±14% vs. 68±15%, p=0.032). Conclusion: High serum CRP levels on admission in patients within 6 hours after the start of acute ST-segment elevation MI are associated with lower TIMI flow grades and higher residual stenosis of IRA after intravenous streptokinase. Our observations imply that patients with higher CRP levels on admission require closer follow-up during and after acute MI. [Copyright &y& Elsevier]

Abstract: Monocyte chemoattractant protein-1 (MCP-1) plays a crucial role both in the initiation and progression of atherosclerosis. MCP-1 is a unique cytokine produced by macrophages, smooth muscle cells and endothelial cells within atherosclerotic plaques and seems to be a reliable indicator of atherosclerotic plaque burden. Higher levels of MCP-1 have been associated with a poor prognosis and increased risk for death independent of other risk factors in patients with acute coronary syndromes. In this paper, we discussed the role of MCP-1 in the pathogenesis of acute coronary syndromes. [Copyright &y& Elsevier]

Abstract: Recent researches have shown that active inflammation is considered a crucial step in the pathogenesis of acute coronary syndromes. C-reactive protein has long been utilized as a nonspecific clinical marker of inflammation, with the advent of high-sensitivity assays, has emerged as one of the most powerful independent predictors of cardiovascular disease. However, it is not clear whether C-reactive protein is only an excellent indicator or a perfect trigger in acute coronary syndromes. In this paper, we discussed the role of C-reactive protein in the pathogenesis of acute coronary syndromes. [Copyright &y& Elsevier]

Abstract: Leptin, a recently discovered obesity gene product, is primarily involved in the regulation of food intake and energy expenditure. Recent observations suggest that leptin has a much broader biological role other than regulation of body weight and energy metabolism. It has been shown that leptin increases sympathetic nerve activity, stimulates generation of reactive oxygen species, induces platelet aggregation and promotes arterial thrombosis, and is an independent risk factor for coronary heart disease. In this paper, we discussed the role of leptin in the pathogenesis of acute coronary syndromes and its usefulness as a biomarker for risk stratification in acute coronary syndromes. [Copyright &y& Elsevier]

Abstract: Myocardial bridges may cause angina pectoris, myocardial infarction, life threatening arrhythmias and even sudden cardiac death but most of them are harmless. Although the exact management is not well known, beta blockers seem to be the first choice. Stenting is controversial and one must think “twice" before stenting the bridged coronary artery. [Copyright &y& Elsevier]

Abstract: The association between metabolic syndrome and coronary artery disease, either clinical or subclinical, has been well established. There is also a consensus regarding the higher prevalence of metabolic syndrome in females compared with males with coronary artery disease. However, the impact of gender on the coronary artery disease severity has not been investigated in patients with metabolic syndrome. The available data have suggested no significant association between gender and the extent and severity of coronary artery disease. [Copyright &y& Elsevier]

Abstract: Takotsubo cardiomyopathy is characterized by acute ventricular dysfunction in the absence of coronary obstruction. Complete improvement of ventricular function is seen in the vast majority of the patients. We describe a 40-year-old woman with Addison disease who experienced Takotsubo cardiomyopathy but with persistent apical dysfunction during 5-month-follow up. [Copyright &y& Elsevier]

Abstract: Background: Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Therefore, it is important to assess non-invasively the risk of developing paroxysmal atrial fibrillation (PAF) in hypertensive patients during sinus rhythm. This study was undertaken to determine if hypertensive patients with history of PAF could be identified while in sinus rhythm by measurement of signal-averaged ECG P-wave duration. Methods: Signal-averaged electrocardiography (SAECG) P-wave recording was performed in 44 hypertensive patients (30 men and 14 women; mean age 60±11 years, group A) who had a history of paroxysmal AF and in 50 hypertensive patients without history of AF (33 men and 17 women; mean age 57±12, group B). All patients were also evaluated by using echocardiography to measure left ventricular ejection fraction (LVEF) and left atrial diameter (LAD). Results: SAECG P-wave duration was found to be significantly higher in group A than in group B (146±14 ms vs. 128±11 ms, p&#60;0.001). Left atrial diameter was not significantly different (40.1±3.4 mm vs. 39.3±3.0 mm, p>0.05), whereas LVEF was significantly lower in group A than group B (63±5% vs. 67±4%, p=0.03). There was a correlation between SAECG P-wave duration and age (r=0.32, p&#60;0.05). In univariate analysis, SAECG P-wave duration and LVEF were significant predictors of PAF, but only SAECG P-wave duration remained a significant independent predictor of PAF in multivariate analysis. Conclusion: The results of this study indicate that hypertensive patients with history of PAF can be detected while in sinus rhythm by signal-averaged ECG P-wave duration. [Copyright &y& Elsevier]

Abstract: Variant angina is generally a benign disease with self limiting symptoms. But in some cases serious ventricular arrhythmias which can lead to death can be seen. In this paper we present a case of variant angina who subsequently developed polymorphic ventricular tachycardia and was treated successfully with long acting nitrate and calcium channel blockade therapy. [Copyright &y& Elsevier]

Abstract: Cardiac hydatid cyst is a rare complication of parasitic infection caused by Echinococcus granulosus. Cardiac involvement occurs in only 0.2–2% of hydatidosis cases. Rupture of hydatid cysts into cardiac chambers is very rare. In this report, we present a case of intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction. [Copyright &y& Elsevier]