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Brugada syndrome is a rare condition characterized by ST-segment elevation in the right precordial leads. Fever can induce Brugada-like electrocardiographic (ECG) changes. We reported on a 26-year-old male patient with fever and ST-segment elevation in the right precordial leads. Serial cardiac markers were normal and transthoracic echocardiography showed normal wall motion and no evidence for pericardial effusion. Brugada-like ECG changes disappeared after fever resolved. Since the patient had never experienced any arrhythmic symptom, syncope, or spontaneous type 1 ECG, electrophysiological study was not performed and he was not referred for defibrillator implantation. The patient was discharged with strong recommendations to avoid certain medications responsible for Brugada-like ECG changes and to receive urgent treatment for fever. He was asymptomatic during a year follow-up. Emphasis is placed on this particularly rare, but important condition, as it may easily be misdiagnosed and fever may even precipitate ventricular fibrillation.

Objectives: The effect of acute exacerbation of chronic obstructive pulmonary disease (COPD) on brachial artery flow-mediated dilation (FMD) has not been examined. The aim of this study was to assess the endothelial function of COPD patients during acute exacerbations., Study Design: The study included 30 consecutive patients (8 women, 22 men; mean age 64.2+/-10.9 years) who experienced acute exacerbation of COPD, defined according to the Anthonisen criteria (increased dyspnea, sputum, and sputum purulence). All patients received the same antibiotic and bronchodilator treatment. Endothelial function was assessed by brachial artery ultrasonography within the first 48 hours and after complete resolution of exacerbation symptoms. Flow-mediated dilation was defined as both the maximum absolute and maximum percentage changes in the vessel diameter during reactive hyperemia. The results were compared with those of 20 age-and sex-matched controls without COPD., Results: The patient and control groups were similar in terms of age, gender, hypertension, diabetes, hyperlipidemia, coronary artery disease, heart rate, and blood pressure. Parameters of FMD during acute exacerbation were significantly lower than those obtained after recovery (absolute change: 0.23+/-0.12 mm vs. 0.38+/-0.17 mm, p<0.001; percentage change: 6.44+/-3.99% vs. 10.42+/-4.86%, p<0.001) and than those of the control group (absolute change: 0.36+/-0.13 mm, p=0.001; percentage change: 9.77+/-3.83%, p=0.003). Flow-mediated dilation increased significantly after recovery, yielding similar values to those of the controls. Improvements in FMD were significant in both sexes., Conclusion: Acute COPD exacerbation is associated with worsening endothelial function, increasing the risk for cardiovascular morbidity.

There is a great need for the identification of biomarkers for the early diagnosis of atherosclerosis and the agents to prevent its progression. The aim of this study was to explore the effect of 24 week of nebivolol (a third-generation vasodilatory beta-blocker) treatment on serum protein profiles in Apo E(-/-) mice during atherosclerosis progression. Nebivolol treated and non-treated (the control group) groups consisted of 10 genetically modified homozygous Apo E(-/-) mice. Proteomic analyses were performed using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) in the serum samples from the nebivolol treated and non-treated Apo E(-/-) mice. The protein profiles obtained using three different chips, CM10 (weak cation-exchange), H50 (reverse phase), and IMAC30-Cu(2+) (immobilized metal affinity capture) were statistically analyzed using the ProteinChip data manager 3.0 program. At the end of 24 week of nebivolol-treatment period, a total of 662 protein/peptide clustering peaks were detected using 12 different conditions and reading with high and low intensity laser energy. The highest total number of protein/peptide clusters was found on H50 chip array. The peak intensities of 95 of the 662 protein/peptide clusters were significantly different in the nebivolol-treated atherosclerotic group in comparison to the non-treated control mice groups (P < 0.05). Forty-three protein/peptides were up-regulated (high signal intensity) while 52 protein/peptides had lower signal intensity (down-regulated) in the nebivolol-treated atherosclerotic group. The proteomic profiles of nebivolol-treated Apo E(-/-) mice were different than the control group indicating a potential role of nebivolol in atherosclerosis. Our study contributes to understand the efficacy of nebivolol on serum protein/peptide profiles during atherosclerosis development.

Objective: Both diabetes and hemodialysis (HD) are associated with increased oxidative stress. The aim of this study was to clarify the effect of maintenance HD on oxidative stress parameters in diabetic patients and to explore any relation between carotid artery intima-media thickness (CIMT) and oxidative stress markers., Methods: Twenty Type 2 diabetic patients undergoing chronic maintenance HD, 20 type 2 diabetic patients with normal renal function, and 20 age- and sex-matched healthy subjects were included. Serum thiobarbituric acid reactive substances (TBARS), protein carbonyl content (PCO), and nitrite/nitrate levels were determined as oxidative stress markers. Serum vitamin E, plasma sulfhydryl (P-SH), erythrocyte glutathione (GSH) levels, and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were measured as antioxidants. CIMT was assessed by carotid artery ultrasonography., Results: Both diabetic patient groups had enhanced oxidative stress indicated by higher levels of TBARS, PCO, and nitrate/nitrite and lower activities of SOD, CAT, and GPx compared to controls. Diabetic patients undergoing HD had significantly higher CIMT (P=.001) and higher levels of nitrite/nitrate (P=.05), PCO (P=.03), and GSH (P=.04) but significantly lower levels of P-SH (P<.001), serum vitamin E (P=.04), SOD (P=.02), CAT (P=.001), and GPx (P=.006) compared to diabetic patients with normal renal functions. There were significant negative correlations between CIMT and SOD (r=-0.50, P<.001), CAT (r=-0.41, P=.003), and P-SH levels (r=-0.51, P<.001) and significant positive correlation between CIMT and nitrite/nitrate levels (r=0.41, P=.003) and TBARS (r=0.35, P=.02). Linear regression analysis showed TBARS was significantly and positively correlated with CIMT (P=.04), while SOD and P-SH were significantly and negatively correlated with CIMT (P=.05 and P=.02, respectively)., Conclusions: Hemodialysis exacerbates oxidative stress and disturbances in antioxidant enzymes in diabetic patients. Serum nitrite/nitrate and TBARS can be used as positive determinants, while erythrocyte SOD, CAT activities, and P-SH level can be used as negative determinants of atherosclerosis assessed by CIMT in diabetic patients.

The incidence of cardiac masses increased as echocardiography is becoming increasingly popular. Benign tumors of the heart constitute about 72% of all primary cardiac neoplasms and hemangioma accounts for 5-10% of benign cardiac tumors. Cardiac hemangiomas are generally asymptomatic and diagnosed incidentally during echocardiography or magnetic resonance imaging (MRI). We reported a 52-year-old woman presented with atypical chest pain and exertional dyspnea. The echocardiographic examination revealed a hyperechoic round mass in the left ventricle. With an initial diagnosis of left ventricular thrombus, the patient underwent cardiac MRI. The mass was found compatible with cardiac hemangioma. It was removed surgically and histopathologic evaluation identified a cardiac hemangioma. As reports of cardiac hemangioma are extremely rare and cardiac masses are mostly thought to be thrombi or myxomas (being the most common primary cardiac tumor), such hemangioma cases warrant attention as possibility of hemangioma should also be kept in mind.

With the rapid evolution of cardiovascular magnetic resonance imaging (MRI) techniques, cardiovascular MRI has become an important noninvasive diagnostic tool in cardiovascular disease. Cardiac MRI can provide high quality diagnostic information about cardiac and valvular function, coronary anatomy, coronary flow reserve and myocardial perfusion, myocardial viability, contractile reserve and cardiac metabolism. Besides, MRI can also provide prognostic information for certain cardiac diseases. Assessment of the viable myocardium is one of the major issues of the invasive cardiology. Viable myocardium has the potential for contractile recovery after reperfusion. The identification of viable myocardium is useful in predicting which patients will benefit from revascularization and have improved left ventricular ejection fraction and survival. The focus of the present article is on the clinical role of cardiac MRI in the detection of viable myocardium.

Idiopathic hypereosinophilic syndrome is an uncommon leukoproliferative systemic disorder characterized by the overproduction of eosinophils and poor prognosis. A major source of morbidity and mortality of this syndrome is the associated cardiac involvement represented by endocardial thickening and mural thrombi. We report a 64-year-old woman with persistent symptoms of heart failure despite standard medical therapy. Echocardiography revealed reduced left ventricular filling due to a large apical mass; an abnormal diastolic filling pattern was also noticed. Complete blood count revealed remarkable hypereosinophilia. Cardiac magnetic resonance imaging demonstrated an apical thrombus and intense linear enhancement of the endocardium, which were compatible with Löffler endocarditis. Medical therapy, including corticosteroids and anticoagulation, was initiated promptly. The symptoms improved as the peripheral hypereosinophilia resolved in 15 days. The patient was asymptomatic at the 1-year follow-up visit with complete regression of the apical thrombus and no evidence of restrictive cardiomyopathy. We report this case to draw attention to this particularly rare condition with poor prognosis since quick and accurate diagnosis and prompt initiation of therapy may improve symptoms and survival.

It is well known that inflammatory mechanisms play a crucial role in the pathogenesis of atherosclerosis and coronary artery disease. In recent years, allergic episodes have been shown to be associated with acute coronary syndromes. Mast cells release certain inflammatory mediators including histamine and neutral proteases during an allergic episode and these inflammatory mediators are implied to induce coronary artery spasm and/or atheromatous plaque erosion or rupture. As the inflammatory component of acute coronary syndromes is a potential therapeutic target, drugs that stabilize mast cell membrane and monoclonal antibodies that protect mast cell surface may be effective in preventing allergy associated acute coronary syndromes. In this review, we will mention the role of inflammation and allergy and anti-inflammatory therapeutic modalities in acute coronary syndromes.

Venous thromboembolism is a common complication in patients with cancer and an important cause of morbidity and mortality. Idiopathic thrombosis, migratory or recurrent thrombophlebitis may be the first manifestation of an occult malignancy. While deep venous thrombosis and pulmonary embolism are the most common thrombotic conditions in patients with malignant disease, tumor thrombus may be seen in inferior vena cava, mainly in patients with renal cell carcinoma, hepatocellular carcinoma, testicular tumors or adrenal carcinoma. Although pancreatic cancer is one of the cancers that are most strongly associated with thrombotic complications along with cancers of ovary and brain, there has been no report about presence of thrombus in the inferior vena cava in pancreatic cancer. We report a female patient with pancreatic cancer associated with tumor thrombus extending from the inferior vena cava to the right atrium.