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Background: Cardiac syndrome X (CSX) is characterised by angina-like chest pain, a positive stress test, and normal coronary arteries. Increased red cell distribution width (RDW) level may be indicative of an underlying inflammatory state. Aim: To investigate RDW level in patients with CSX and compare patients having coronary artery disease (CAD) and normal subjects. Methods: 245 subjects (79 patients with CSX, 81 patients with CAD, and 85 controls) were enrolled in the study. The CSX group consisted of patients with anginal chest pain, ischaemia on noninvasive stress test and a normal coronary angiogram. CAD was defined as ≥ 50% stenosis in at least one coronary artery. The control group was selected from the patients with anginal symptoms but a normal stress test and a normal coronary angiogram. RDW measurements among the three groups were compared. Results: Baseline clinical and biochemical characteristics were not different among the three groups. There were no statistically significant differences in RDW levels between the CSX and CAD groups (p = 0.17). RDW measurements in both the CSX and CAD groups were found to be significantly higher than the control group (p < 0.01). Conclusions: We discovered that patients with CSX and CAD have significantly higher RDW measurements compared to controls. The relationship between CSX and higher RDW level suggests that endothelial dysfunction may also contribute to the etiopathogenesis of the CSX phenomenon as it does with CAD.

Systemic lupus erythematosus (SLE) is an inflammatory disease characterized by deposition of autoantibodies and pathogenic immune complexes in the cells and tissues of an organism, causing lesions. The heart is one of the most frequently involved organ. The involvement of heart has great clinical importance and associated with the presence of a specific autoantibody, the antiphospholipid antibody (aPL). In these circumstances, major complications may occur such as arterial or venous thrombosis, thrombocytopenia. A 42 year old woman with history of sle admitted our hospital with complaints of dyspne and palpitation for three months. Physical examination revealed a blood pressure of 110/70mmHg, heart rate of 80 bpm and sinus rhythm was detected in ECG. Heart sounds were regular and 3\6 systolic murrmur was noted on mitral area. There were bibasillary ralls on lungs. Two-dimensional transthoracic echocardiography revealed a normal left ventricular dimensions and there were no wall motion abnormalities. Moderate mitral, tricuspid regurgitation was detected and estimated peak systolic pulmonary artery pressure of 42mmHg. A large, polypoid mass (3.0×1.2 cm) was seen attached to the outflow tract of the left ventricle causing obstruction which suggested a primary cardiac tumor (Figures 1, 2).

A 73-year-old woman was referred to our outpatient clinic with complaints of nausea and vomiting. Transthoracic echocardiography apical four-chamber view showed a mass (M) compressing the left atrium (LA) (Fig. 1A). Full-volume three-dimensional transthoracic echocardiography after cropping the left and right ventricle walls revealed a mass compressing the LA (Fig. 1B). Subcostal view of the stomach (STO) and oesophagus (ESO) showed the reflux of stomach contents in real-time viewing (Fig. 1C). Oblique sagittal (Fig. 1D) and coronal (Fig. 1E) computed tomography (CT) angiography images revealed a hiatal hernia (HH) compressing the LA. Oblique sagittal view of coloured three-dimensional volume rendered CT angiography images also demonstrated a relationship between the HH and the LA (Figs. 1F, G). A close relationship between the LA and HH may result in extrinsic LA compression. For this reason, the full spectrum of non-invasive cardiac imaging modalities should be performed in the diagnosis of HH.

plasma adiponectin levels on myocardial contractile function has not been fully examined. The aim of this study was to investigate the relationship between three-directional systolic function and plasma adiponectin levels in asymptomatic hypertensive patients using two-dimensional speckle-tracking echocardiography (2DSTE). Methods: The study population consisted of 78 hypertensive patients and 40 healthy controls. The patients were divided into two groups according to the presence or absence of LV hypertrophy. LV systolic function was calculated by global strains assessed by 2DSTE. Plasma adiponectin levels were measured by enzyme-linked immunosorbent assay. Results: Longitudinal strain was significantly reduced in all patients, including those without LV hypertrophy (P = 0.009), whereas no significant change was observed in the radial or circumferential strain. Concurrently, plasma levels of adiponectin were lower in hypertensive patients; also, decreases in adiponectin levels were more prominent in patients with LV hypertrophy (LVH (+), 0.83+0.2mg/ml; LVH (−), 0.98+0.2mg/ml; control, 1.10+0.2m/ml; P < 0.05). In multiple regression analysis, plasma adiponectin levels (b = −0.273, P = 0.008) and LV mass index (b =0.458, P < 0.001) independently correlated with the LV longitudinal strain. Conclusions: In asymptomatic hypertensive patients, low plasma adiponectin concentrations were associated with the progression of LV hypertrophy with impaired LV longitudinal systolic function. These findings may provide novel insights into early hypertension induced LV systolic dysfunction, and may enable the physicians identifying patients at higher risk for heart failure.

A-20-year-old man was admitted to our outpatient clinic with a complaint of presyncope and cold hands. On physical examination, right arm blood pressure was higher than the left. Pulsations of the left brachial and radial artery were weak. Transthoracic echocardiography four-chamber view showed the descending aorta …

We read the article by Munz et al. with interest [1]. They aimed to investigate the benefits of cardiac venous arterialization in reducing acute myocardial infarct size and its effects on cardiac performance. This study revealed that selective cardiac venous arterialization can nourish the myocardium and is able to reduce the infarct size by more than 50%, while protecting cardiac performance. The study is successfully planned and the results are presented well — thanks to the authors for their contribution. In the absence of collateral circulation, coronary occlusion causes myocyte necrosis, the extent of which correlates directly with the speed and duration of the occlusion. Early reperfusion of an ischaemia related artery (IRA) would decrease myocardial necrosis, improve left ventricular (LV) function, and reduce mortality rates. Opening an occluded IRA, whether early or late, produces survival rates disproportionate to the amount of myocardium salvaged. A current trial clearly showed that in patients diagnosed with acute coronary syndrome, an early invasive approach is superior to a conservative approach [3]. Early reintervention may limit the extent of myocardial cellular damage compared with conservative medical strategy in patients with myocardial ischaemia due to early graft failure as well as in patients with acute myocardial infarction [4]. Myocardial reperfusion has been shown to improve both short- and long-term survival in patients who have experienced an AMI. The open artery hypothesis suggests that survival after AMI depends on improved LV remodeling and healing, electrical stability, and myocardial perfusion rather than on the reduction of the infarct size (i.e., myocardial salvage) [5]. Studies showed that late patency of an IRA, as opposed to persistent occlusion, was independently associated with better 1-year survival. In a long-term follow-up study of 505 patients who underwent percutaneous transluminal coronary angioplasty for post-MI ischaemia, 22 patients with an open IRA had a lower 5-year mortality rate than patients with a closed IRA. This held true even for patients with LVEFs

They concluded that the newly synthesized tricyclic benzothieno 1,2,3-triazine derivatives possess significant anti-hyperlipidemic activity against dexamethasone and Triton WR-1339-induced hyper-lipidemia in rats. Thanks to the authors for their contribution of such a study that was successfully designed and well presented. We believe that the findings will enlighten further studies specifically towards the study of antihyperlipidemics and atherosclerosis.We are aware that hyperlipidemia is strongly associated with the development of coronary artery disease, cerebrovascular accident and peripheral vascular disease. The success in decreasing serum lipid levels would thereby succeed in decreasing the morbidity and mortality of patients. In addition to lifestyle changes and exercise

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Objectives Following ischemia/reperfusion injury, antioxidant defense mechanisms may remain insufficient depending on the duration of ischemia which is caused by any reason (MI, after percutaneous coronary intervention, during cardiac surgery). After that, free oxygen radicals increasing within the cell cause structural deterioration. Cytokines which activate a series of reactions that cause tissue damage and inflammatory response are released during reperfusion of ischemic tissues. In this study, we aimed to compare the effects of dexmedetomidine and ketamine in cardiac ischemia/reperfusion injury. Material and methods The study included 18 rats randomly divided into three groups. Group I/R (n = 6): control, Group I/R-K (n = 6): ketamine, and Group I/R-D (n = 6): dexmedetomidine. Before the 10 min surgery, after the 20 min ischemia and 20 min reperfusion period, hemodynamic parameters were compared among the three groups. After the 45 min ischemia and 120 min reperfusion period, tissue samples were obtained from the rat hearts, and MDA, SOD, GSH-Px, IL-1β and TNF-α levels were compared. Results MDA and GSH-Px levels were significantly higher in the control group compared to the ketamine and dexmedetomidine groups. However, both levels were similar in the ketamine and dexmedetomidine groups. SOD levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group, but they were similar in the ketamine and dexmedetomidine groups. IL-1β levels were similar in all groups. TNF-α levels were significantly lower in the ketamine and dexmedetomidine groups compared to the control group. They were similar in the ketamine and dexmedetomidine groups. Conclusions According to our study, it can be concluded that dexmedetomidine and ketamine have similar effects on reducing myocardial ischemia reperfusion injury. Dexmedetomidine provides better heart rate control but causes hypotension, so, because of cardiac depression, we think that its clinical use may necessitate further investigation.