Browsing by Author "Bilge, M"

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Acute Ecg Changes and Chest Pain Induced by Neck Motion in Patients With Cervical Hernia -: a Case Report
(Westminster Publ inc, 2000) Güler, N; Bilge, M; Eryonucu, B; Cirak, B
We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal EGG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.
Biatrial Thrombosis After Acute Inferior Wall Myocardial Infarction -: a Case Report
(Westminster Publ inc, 2000) Bilge, M; Eryonucu, B; Güler, N
The authors describe a case of biatrial thrombosis after acute inferior wall myocardial infarction (MI) with sinus rhythm. The presence of atrial thrombosis in patients with acute MI has recently been recognized with the aid of echocardiography. However, to the author's knowledge, a case of biatrial thrombosis after acute MI has not been reported previously. In this case, blood stasis, resulting from both left ventricular and right ventricular systolic dysfunction, was the most likely cause of the biatrial thrombi formation. In summary, this case suggests that biatrial thrombosis may occur in acute MI, even in the presence of sinus rhythm.
Brachial Artery Blood Flow Velocity Pattern in Patients With Congestive Heart Failure
(Sage Publications inc, 2000) Güler, N; Bilge, M; Eryonucu, B; Erkoç, R; Ipeksoy, Ü
The purpose of this study was to determine whether there are abnormalities in blood flow velocity pattern of the brachial artery in patients with congestive heart failure (CHF). Brachial artery blood flow velocities were measured with duplex Doppler ultrasonography in 12 normal subjects, 31 patients with congestive heart failure (CHF), and 26 patients with coronary artery disease (CAD). None of the patients had clinical evidence of arterial disorders at upper extremities. In both patient groups, the presence of hypertension was correlated with the peak systolic velocity (r=0.48, p<0.05). Patients with heart failure had significantly larger (p<0.0001) peak reverse velocity (20 +/-6 m/sec) than healthy subjects (5 +/-4 m/sec) and patients with CAD (7 +/-3 m/sec). Peak reverse velocity did not differ significantly between normal subjects and CAD group. These data indicate that the blood flow velocity pattern at brachial artery is abnormal in CHF. The simple measurement of brachial artery flow velocity suggests changes in peripheral vasculature related to CHF.
Cardiac Troponin I Levels in Patients With Left Heart Failure and Cor Pulmonale
(Westminster Publ inc, 2001) Güler, N; Bilge, M; Eryonucu, B; Uzun, K; Avci, ME; Dülger, H
Cardiac troponin levels are regarded as the most specific of currently available biochemical markers of myocardial damage. Elevated levels of troponin have been previously reported in patients with left heart failure, reflecting small areas of undetected myocardial cell death. The aim of this study was to compare the levels of the cardiac troponin I (cTnI) in patients with left- and right-sided heart failure. Cardiac troponin I levels were studied with immunochemical methods in patients with right heart failure (n = 17) resulting from chronic obstructive pulmonary disease, ischemic left heart failure (n = 23), and nonischemic left heart failure (n = 18) who were admitted to departments of cardiology and chest diseases. Also, cTnI levels were measured in 32 healthy subjects as control group. Protein markers of myocardial injury (cTnI and myoglobin) in patients with left and right heart failure were collected approximately 12 to 36 hours after onset of obvious symptoms. Serum creatine kinase MB band was determined on admission and thereafter twice a day during the first 3 days. Elevated levels of serum cTnI were found in patients with nonischemic (0.83 +/-0.6 ng/mL, p < 0.01) and ischemic left heart failure (0.9 +/-0.5 ng/mL, p < 0.01) when compared to healthy subjects, whereas serum cTnI levels in patients with right heart failure due to chronic obstructive pulmonary disease were not significantly different from those of control subjects (0.22 0.1 vs 0.16 +/-0.1 ng/mL, p > 0.05). In addition, creatine kinase MB band and myoglobin levels were not significantly different between patient and healthy groups. The mean of cTnI levels in ischemic and even nonischemic left heart failure were increased compared to the mean of values in healthy individuals but without significant creatine kinase MB band and myoglobin elevations. But cTnI levels were not increased in patients with right heart failure due to chronic obstructive pulmonary disease. These data indicate that the cTnI levels are abnormal in left heart failure but not in cor pulmonale.
A Case of Arrhythmogenic Right Ventricular Cardiomyopathy in Sinus Rhythm Associated With Thrombus in the Right Atrium
(Mosby-year Book inc, 2000) Bilge, M; Eryonucu, B; Güler, N
We describe a patient with arrhythmogenic right ventricular cardiomyopathy (ARCV) in sinus rhythm associated with thrombus in the right atrium. The occurrence of a right heart thrombus in ARCV is extremely rare and, to our knowledge, has been previously reported only in the right ventricle. In our case, ARCV most probably led to right atrial spontaneous echo contrast, and later, right atrial thrombus formation by blood stasis caused by right ventricular systolic dysfunction, In conclusion, our case suggests that right atrial thrombus may occur in ARCV, even in sinus rhythm.
A Case of Left Atrial Appendage Thrombus With Embolic Stroke Association With Aortic Stenosis in Sinus Rhythm
(Mosby, inc, 2000) Bilge, M; Eryonucu, B; Güler, N
Although left atrial appendage (LAA) thrombus formation in the presence of sinus rhythm may potentially be the source for embolic events in various types of heart disease, no cases of IAA thrombus with embolic stroke in association with aortic stenosis in sinus rhythm have been reported. We present a case of valvular aortic stenosis with cerebral embolism in a person who was in sinus rhythm and had an LAA thrombus diagnosed by transesophageal echocardiography.
The Chronic Effect of Rilmenidine on Heart Rate Variability in Patients With Mild Hypertension
(Sage Publications inc, 2002) Eryonucu, B; Ulgen, MS; Bilge, M; Güler, N; Günes, A
The purpose of this study was to evaluate the chronic effect of rilmenidine on time domain indexes of heart rate variability in patients with mild hypertension. Twenty patients (12 males, eight females; mean age, 47 yr; age range, 38-55 yr), with untreated and newly diagnosed mild hypertension were studied. There was no evidence of diseases other than hypertension. All patients received I mg of rilmenidine once daily. If the diastolic blood pressure was still greater than 90 mm Hg after 4 weeks of active treatment, the dose was increased to 2 mg once daily. Twenty-four hour ambulatory electrocardiograms were recorded before, and 4 and 12 weeks after the start of therapy, Time domain parameters of heart rate variability were calculated. Rilmenidine therapy determined a marked decrease in blood pressure. At 4 weeks, rilmenidine induced a significant reduction in systolic and diastolic blood pressure and a further reduction was observed after 12 weeks. At 4 and 12 weeks, time domain parameters of heart rate variability and heart rate were not significantly different in the data obtained before therapy. In conclusion, this study demonstrated that the administration of rilmenidine to patients with mild essential hypertension induced significant reductions in blood pressure, without any significant changes in time domain parameters of heart rate variability.
Comparison of the Acute Effects of Salbutamol and Terbutaline on Heart Rate Variability in Adult Asthmatic Patients
(European Respiratory Soc Journals Ltd, 2001) Eryonucu, B; Uzun, K; Güler, N; Bilge, M
This study investigated the effects of beta (2)-adrenergic agonist therapy on heart rate variability (HRV) in adult asthmatic patients by using frequency domain measures of HRV. A randomized crossover design was used. Twenty adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline forced expiratory volume in one second. Any diseases that might have influenced the autonomic function were excluded. All patients had a complete physical examination and medical history that revealed no cardiovascular disease or medication. The study used 200 mug inhaled salbutamol and 500 mug inhaled terbutaline. HRV analysis was performed for each 5-min segment, 5 min before inhalation of the study drug and 5, 10, 15, 20, 25 and 30 min after inhalation. Total power (TP: < 0.40 Hz), high-frequency power (HF: 0.15-0.40 Hz), low-frequency power (LF: 0.04-0.15 Hz) and LF/HF ratio were calculated. The LF and LF/HF ratio increased and TP decreased at 5, 10, 15 and 20 min after the salbutamol and the terbutaline inhalation, HIT did not change significantly after the salbutamol and terbutaline inhalation. Acute salbutamol and terbutaline inhalation produce similar effects on heart rate variability and increase sympathetic modulation in the cardiac autonomic activity.
Does Acute-Phase Beta Blockade Reduce Left Atrial Appendage Function in Patients With Chronic Nonvalvular Atrial Fibrillation
(Mosby-elsevier, 2001) Bilge, M; Güler, N; Eryonucu, B; Erkoç, R
To investigate whether acute-phase beta-blocker therapy has a harmful effect on left atrial appendage (LAA) function in patients with chronic nonvalvular atrial fibrillation by transesophageal echocardiography (TEE), we evaluated 21 patients with normal left ventricular systolic function and a poorly controlled ventricular rate, despite the use of digoxin. Baseline parameters that were obtained included heart rate, blood pressure, LAA emptying velocities, and left atrial spontaneous echo contrast intensity. Then, each patient was given a bolus dose of 5 mg metoprolol. Ten minutes later, a second set of assessments was performed. After the first TEE studies, each patient began treatment with metoprolol (50 ms orally twice daily for 1 week). A second TEE study was performed after 1 week of continuous oral metoprolol therapy at maintenance dose, and values were again determined. The average resting apical heart rate was 91 +/- 7 bpm. As expected, beta-blocker therapy showed a marked decrease in heart rate at 10 minutes (79 +/- 6 bpm P < .001) and at 1 week (71 +/- 4 bpm, P < .001). Beta-blocker therapy caused a significant reduction in systolic and diastolic blood pressures (144 +/- 16 / 93 +/- 6 mm Hg at baseline, 137 +/- 16 / 87 +/- 9 mm Hg at 10 minutes, and 135 +/- 12 / 86 +/- 8 mm Hg at 1 week, P < .001). With the beta-blocker therapy, the baseline transesophageal Doppler parameter of LAA emptying velocities (at baseline 24 +/- 7 cm/s) fell significantly at 10 minutes (19 +/- 7 cm/s, P < .001) and at 1 week (17 +/- 6 cm/s, P < .001) after initiation of beta-blocker therapy. After a bolus of metoprolol, spontaneous echo contrast intensity did not change in any patients, but 1 week later, it increased in 1 patient. In 2 patients who had not been found to have an LAA thrombus at baseline TEE study, the second TEE examination demonstrated new thrombi in the LAA. In conclusion, our endings suggest that in patients with chronic nonvalvular atrial fibrillation who have normal left ventricular systolic function and a poorly controlled ventricular rate despite the use of digoxin, acute-phase beta blockade may have a harmful effect on LAA function.
The Effect of Autonomic Nervous System Activity on Exaggerated Blood Pressure Response To Exercise
(Taylor & Francis Ltd, 2000) Eryonucu, B; Bilge, M; Güler, N; Uygan, I
Objective - We investigated the effect of autonomic nervous system activity on exaggerated systolic blood pressure (SBP) response to exercise in healthy subjects using heart rate variability (HRV) analysis. Method and results - We studied 53 healthy volunteer subjects with exercise treadmill test according to the Bruce protocol. Time domain and frequency domain of HRV were measured for each 5-minute segment before (rest) and after exercise (recovery) and during the total exercise period. The mean change in SBP (Delta SBP) was 39 +/- 18 mm Hg. The Delta SBP above the value of mean (greater than or equal to 40 mm Hg) was defined as an exaggerated Delta SBP. According to the Delta SBP, subjects were classified into two groups. Group I consisted of 32 patients who showed a normal Delta SBP, group II consisted of 21 patients who showed exaggerated Delta SBP. There were no significant differences in baseline clinical characteristics and exercise duration between the two groups, There were no significant differences in the mean RR intervals, SDNN (standard deviation of all RR intervals), RMSSD (the square root of the mean of the sum of the squares of differences between adjacent RR intervals), and HF (high-frequency power, 0.15 to 0.40 Hz) at rest between the two groups. However, LF (low-frequency power, 0.04 to 0.15 Hz) and LF/HF ratio at rest were significantly higher at rest in group II than in group I. There were no significant differences in the mean RR intervals and HF at exercise between the groups. However, SDNN and RMSSD were significantly lower, LF and the LF/HF ratio were significantly higher at exercise in group II than in group I. No differences in these parameters were observed at recovery between the two groups, Conclusions - The sympathetic activity was higher at rest and during the total exercise period, parasympathetic activity was lower during the total exercise period in healthy subjects with exaggerated SBP response to exercise than in those with normal SBP response.
Effect of Blood Pressure Reduction on Abnormal Left Atrial Appendage Function in Untreated Systemic Hypertensive Patients With Sinus Rhythm
(Sage Publications inc, 2001) Bilge, M; Güler, N; Eryonucu, B; Güntekin, Ü
To investigate whether reduction in blood pressure has a beneficial effect on left atrial appendage (LAA) function, the authors evaluated 24 untreated systemic hypertensive patients with normal left ventricular systolic function in sinus rhythm at baseline and at 3 months after initiation of anti hypertensive therapy. They performed transthoracic and transesophageal echocardiographic examinations in hypertensive patients before and after treatment of hypertension. Three of the 24 patients had blood pressure that failed to respond to the regimen of antihypertensive therapy and were removed from the analysis. Of the remaining 21 patients, mean systolic and diastolic blood pressures at baseline were 170 +/- 18 and 104 +/-6 mm Hg, respectively, and fell significantly at 3 months to 141 +/- 10 and 90 +/-5 mm Hg, respectively, (p <0.001) after initiation of antihypertensive therapy. There was no significant change in heart rate with treatment (baseline 81 +/-8 and at 3 months 84 +/-9 beats/min). There was no significant change in left ventricular end-diastolic diameter, left ventricular ejection fraction, left ventricular wall thickness, or left atrial diameter from baseline (49 +/-4 mm, 58 +/-5%, 12 +/-1 mm, and 41 +/-4 mm, respectively) at 3 months (48 +/-5 mm, 59 +/-4%,12 +/-1 mm, and 40 +/-3 mm). The treatment caused a significant reduction in maximal LAA areas (6.3 +/- 13 cm(2) at baseline, 4.6 +/-0.7 cm(2) at 3 months, p <0.001), with a concomitant increase in LAA emptying velocity (44 +/-7 cm/sec at baseline, 60 +/-9 cm/sec at 3 months, p <0.001). In conclusion, these findings suggest that reduction in blood pressure with antihypertensive therapy could improve LAA function in hypertensive patients with normal left ventricular systolic function in sinus rhythm.
The Effect of Electroconvulsive Therapy on Qt Dispersion
(Acta Cardiologica, 1998) Güler, N; Bilge, M; Eryonucu, B; Kutanis, R; Erkoç, R
Electroconvulsive therapy (ECT) is used frequently in psychiatric practice and various electrocardiographic (ECG) changes have been described during ECT. QT dispersion (defined as maximal QT interval minus minimal QT interval) as assessed on the surface electrocardiogram has been demonstrated to reflect regional inhomogeneity of ventricular repolarization. The aim of this study is to examine the effect of electroconvulsive therapy on QT dispersion. We studied 27 patients (age range 24-42 y, mean age 34 y, II men) without heart disease who were treated with ECT. Structural heart disease was eliminated with routine clinical examination and laboratory tests, echocardiography, and exercise treadmill test, QT interval and corrected QT (QTc) dispersion was measured on a 12- lead ECG before and just after ECT. QTc dispersion increased from 25.9 +/- 7.4 ms at baseline to 81.4 +/- 12.8 ms after the procedure (P < 0.0001). This result demonstrated that QTc dispersion increased significantly during ECT. This finding may explain that increased inhomogeneity of ventricular repolarization is associated with enhanced vulnerability to arrhythmias during ECT.
Effects of Cigarette Smoking on the Circadian Rhythm of Heart Rate Variability
(Taylor & Francis Ltd, 2000) Eryonucu, B; Bilge, M; Güler, N; Uzun, K; Gencer, M
Background - The effects of cigarette smoking on the circadian rhythm of heart rate variability (HRV) are not known. Methods - We studied the effects of cigarette smelting on the circadian rhythm of HRV in 24 smoking and 21 non-smelting healthy subjects. Twenty-four hour ambulatory electrocardiograms were recorded and ti me domain parameters of HRV (SDNN [standard deviation of all R-R intervals], SDANN [standard deviation of the averages of R-R intervals in all 5-minute segments of the entire recording], RMSSD [the square root of the mean of the sum of the squares of differences between adjacent R-R intervals]) were determined for the entire 24-hour period and for each 3-hour period. Results - In total, SDNN and SDANN were significantly lower in smokers than non-smokers (116 +/- 26 vs 136 +/- 27, P < 0.05 for SDNN, 109 +/- 25 vs 121 +/- 24, p < 0.05 for SDANN). However, there were no statistical differences between smokers and non-smokers in heart rate (81+/-9 vs 76 +/- 10, P > 0.05) and RMSSD (32 +/- 12 vs 37 +/- 18, P > 0.05). These HRV parameters showed a circadian variation: they increased at night and decreased during the day in both groups. The parameters were lower in smokers than non-smokers during daytime (especially, between 8-14 hours). However, no differences were detected during night-time. Conclusions - Time domain parameters of HRV (SDNN, SDANN and RMSSD) in both smelting and non-smoking healthy subjects have a circadian rhythm. SDNN and SDANN were lower in smokers than non-smelters during daytime.
The Effects of Halothane and Sevoflurane on Qt Dispersion
(Acta Cardiologica, 1999) Güler, N; Bilge, M; Eryonucu, B; Kati, I; Demirel, CB
QT dispersion is defined as the difference between QT (max) and QT (min) in the 12-lead surface EGG. It has been shown to reflect regional variations in ventricular repolarisation and is significantly greater in patients with arrhythmic events than in those without them. The aim of this study was to examine the effects of halothane and sevoflurane on QT and QTc dispersion during inhalational induction of anaesthesia. The effects on QT and QTc dispersion of halothane and sevoflurane have been investigated during induction of anaesthesia. Forty-six ASA (American Society of Anaesthesiologists) physical status I-II patients, aged 16-50 years, undergoing general anaesthesia were randomly allocated to receive either halothane or sevoflurane. The mean baseline values for QT and QTc dispersion were not significantly different between the two groups (P > 0.05). QT dispersion was increased with halothane compared with baseline values (50 +/- 16 ms vs. 29 +/- 9 ms, P < 0.01) and after sevoflurane compared with baseline (48 +/- 15 vs. 33 +/- 8 ms, P < 0.01). Also, QTc dispersion was increased with halothane compared with baseline values (48 +/- 13 ms vs. 31 +/- 9 ms, P < 0.001) and after sevoflurane compared with baseline (50 +/- 14 vs. 40 +/- 11 ms, P < 0.01). The QTc interval did not change by both sevoflurane (443 +/- 7 vs. 431 +/- 21 ms, P > 0.05) and halothane (419 +/- 33 vs. 431 +/- 19 ms, P > 0.05) compared with baseline. Both halothane and sevoflurane cause myocardial repolarisation abnormalities in man in terms of increased QTc dispersion. This may be relevant in the aetiology of arrhythmias in patients during anaesthesia with halothane or sevoflurane.
The Effects of Volatile Anesthetics on the Q-Tc Interval
(W B Saunders Co, 2001) Güler, N; Kati, I; Demirel, CB; Bilge, M; Eryonucu, B; Topal, C
Objective: To examine the effects of halothane, isoflurane, and sevoflurane on Q-Tc interval (corrected for heart rate) during inhalation induction of anesthesia. Design: Prospective, double-blind, randomized study. Setting: Departments of Cardiology and Anesthesiology in a university hospital. Participants: Patients undergoing noncardiac surgery. Interventions: A total of 65 American Society of Anesthesiologists physical status I-II patients, aged 16 to 50 years, undergoing general anesthesia, were randomly allocated to receive halothane, isoflurane, or sevoflurane. Measurements and Main Results: The time to reach the predetermined end-tidal concentrations of 3 minimum alveolar concentration was 6 to 10 minutes. When compared with preinduction values, heart rate decreased after halothane (p < 0.01) and sevoflurane (p < 0.05) administration; in contrast, heart rate increased after induction of anesthesia with isoflurane (p < 0.05). The mean QRS intervals were not significantly changed after halothane, isoflurane, or sevoflurane. The Q-Tc interval was increased with isoflurane compared with baseline (465 +/- 23 441 +/- 18 msec, p < 0.01), not changed with sevoflurane (441 +/- 17 434 +/- 19 ms, p > 0.05), and shortened with halothane (426 +/- 23 nu 445 +/- 21 msec, p < 0.01). Conclusions: Sevoflurane or halothane may be preferred to isoflurane patients with conditions that are known to induce a prolonged Q-Tc interval. The effects of Q-Tc interval changes resulting from different anesthetic agents on morbidity and the incidence of arrhythmias during anesthesia warrant further investigation. Copyright (C) 2001 by W.B. Saunders Company.
Evaluation of Right Atrial Appendage Blood Flow by Transesophageal Echocardiography in Subjects With a Normal Heart
(Japan Heart Journal, Second dept of internal Med, 1999) Bilge, M; Eryonucu, B; Güler, N; Asker, M
Right atrial appendage (RAA) blood flow pattern was analyzed in 42 normal subjects without cardiovascular disease (aged 30 to 48 years, mean 40 +/- 6) who underwent transesophageal echocardiography. RAA flow pattern was demonstrated to be bi-, tri- or quadriphasic and heart rate dependent (p < 0.01) in this study. In 15 subjects (36%), a biphasic pattern was observed. A triphasic pattern was observed in 12 subjects (28%). Fifteen subjects (36%) had a quadriphasic pattern. In these subjects, we observed a pattern consisting of two diastolic forward flow waves, each followed by a backward flow wave. Mean heart rates among subjects with bi-, tri- and quadriphasic patterns were 110 +/- 6, 91 +/- 4 and 72 +/- 13 beats/min, respectively. In the triphasic pattern, the onset of superior vena cava diastolic forward flow began 18 +/- 4 ms after the onset of tricuspid E wave, whereas the first diastolic forward flow wave in the RAA began 40 +/- 7 ms after onset of the tricuspid E wave. A similar relation was also noted in the quadriphasic pattern. This sequence was constant and independent of heart rate (p < 0.05), suggesting a temporal relation between right ventricular relaxation and the first diastolic forward flow wave in the RAA. In normal subjects, the RAA flow pattern is heart rate dependent and three distinct flow patterns can be differentiated. Right ventricular relaxation appears to induce both the superior vena cava diastolic forward flow wave and the first diastolic forward flow wave of the RAA. These results can be used for comparison with patterns found in disease states.
Frequency of Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Acute Myocardial Infarction
(Excerpta Medica inc-elsevier Science inc, 1999) Bilge, M; Güler, N; Eryonucu, B; Asker, M
Left ventricular systolic dysfunction may precipitate blood stasis as well as thrombus formation in the left atrial appendage of patients with acute myocardial infarction, even in the presence of sinus rhythm. Thus, left atrial thrombi may be an alternative source for systemic embolism in acute myocardial infarction.
Prognostic Value of Heart Rate Variability in Idiopathic Dilated Cardiomyopathy
(Elsevier Science inc, 2000) Eryonucu, B; Bilge, M; Güler, N
Pulmonary Endarteritis and Subsequent Embolization To the Lung as a Complication of a Patent Ductus Arteriosus -: a Case Report
(Westminster Publ inc, 2004) Bilge, M; Üner, A; Özeren, A; Aydin, M; Demirel, F; Ermis, B; Özkökeli, M
The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocardiography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previously reported only in a few cases. In brief, our case not only shows the importance of echocardiography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.
Recurrent Pulmonary Emboli and Thrombus Attached To a Permanently Implanted Pacemaker Wire in Pregnancy
(Acta Cardiologica, 1999) Bilge, M; Güler, N; Eryonucu, B
We present a case of pacer wire thrombus and recurrent pulmonary em boli in pregnancy associated with a permanent pacemaker. Transthoracic echocardiography demonstrated a thrombus attached to the pacer wire at the point where it crossed the tricuspid valve. After the uncomplicated vaginal delivery; thrombolytic therapy was given. This thrombus persisted despite thrombolytic therapy. Consequently, the patient was referred for cardiac surgery. The suspected cause was confirmed during the surgery.