Browsing by Author "Eryonucu, B"

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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.
Aneurysm of Sinus of Valsalva Dissecting Into Interventricular Septum
(Blackwell Futura Publishing, inc, 2004) Güler, N; Eryonucu, B; Tuncer, M; Asker, M
A 43-year-old man who had a Carbomedics prosthetic aortic valve replacement in 1997 was admitted to our hospital with complaints of shortness of breath and dyspnea on exertion in 2000. The patient was hospitalized due to atrioventricular (AV) complete block and a permanent pacemaker was implanted. At that time echocardiography indicated an aneurysm at the left sinus of Valsalva. In 2003, the patient was re-admitted to our clinic with complaints of shortness of breath and fatigue. Echocardiography showed a sinus of Valsalva aneurysm dissecting into interventricular septum. Operation confirmed dissection of the interventricular septum and communication between this cavity and the aneurysm of the left sinus of Valsalva. The postoperative course was uneventful and the patient was discharged in a satisfactory condition. This is the first reported case of aneurysm of the sinus of Valsalva dissecting into interventricular septum late and complicating aortic valve replacement.
The Assessment of Obsessive-Compulsive Symptoms
(Turkiye Sinir ve Ruh Sagligi dernegi, 2005) Besiroglu, L; Agargün, MY; Boysan, M; Eryonucu, B; Gülec, M; Selvi, Y
Objective: We examined the reliability and validity of the 60-and 41-item versions of the Padua Inventory (PI and PI-R) which were developed to assess the frequency and severity of obsessive-compulsive symptoms, in a Turkish population. Method: The sample consisted of 43 OCD patients, 30 non-OCD patients with other anxiety disorders, 30 nonobsessional depressed patients, 76 healthy adults, and 181 undergraduate students. We investigated internal consistency, test-retest reliability, and factor structure, concurrent and discriminant validity. Results: Psychometric analyses showed that both the original PI and PI-R had a high internal consistency and test-retest reliability. While principal factor analysis of the 41 items revealed six factors that are consistent with the PI-R, the factor structure of the original scale was not confirmed. All the subcales and total scores for both instruments were significantly correlated with the Yale-Brown scores except for the impulses subscale. There were significant differences between OCD patients and nonclinical samples in all total and subscale scores for both instruments. OCD patients scored significantly higher on the total, contamination/washing and checking subscales for both instruments than nonobsessional anxious, and depressed patients. While OCD patients scored significantly higher on the PI-R rumination scale than nonobsessional anxious patients, their PI impaired control subscale score was not different from that of the other clinical groups. Conclusions: The Turkish version of the PI has appropriate reliability and validity for assessing the frequency and severity of obsessive-compulsive symptoms.
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.
A Case of Successful Six Consecutive Deliveries in a 41-Year Woman With Uhl's Anomaly
(Elsevier Ireland Ltd, 2003) Güler, N; Demirbag, R; Eryonucu, B; Gül, A
Uhl's anomaly, or parchment right ventricle is a myocardial disorder of unknown cause that mainly involves the right ventricle. Uhl's anomaly may represent a cause of right heart dilatation, failure, and premature sudden death due to ventricular arrhythmias. Although most of the cases of Uhl's anomaly end fatally in infancy or childhood, a limited number of cases have been reported in advanced ages. Also, in pregnant women, this situation increases the risk to both mother and baby and requires special management. This is the first report of six successful consecutive gestations and vaginal deliveries without special managements in a patient with Uhl's anomaly. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
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.
Clinical and Echocardiographic Predictors of Left Atrial Appendage Dysfunction in Patients With Mitral Stenosis in Sinus Rhythm
(Mosby, inc, 2004) Güler, N; Demirbag, R; Özkara, C; Eryonucu, B; Günes, A; Tuncer, M; Agirbash, M
Background: Mitral stenosis (MS) causes left atrial (LA) appendage (LAA) dysfunction resulting in reduced LAA flow velocities. Low LAA peak emptying velocity (PEV), determined by transesophageal echocardiography, is a risk for thrombus formation and systemic embolism. Objective: We sought to investigate various clinical and echocardiographic predictors of low LAA blood flow velocities. Methods: A total of 44 patients with newly diagnosed MS were classified into two groups on the basis of the presence of high (PEV greater than or equal to 46 cm/s) or low (PEV < 46 cm/s) LAA flow profile on Doppler transesophageal echocardiography. LAA flow velocities were measured to be 27.38 +/- 8.17 cm/s in patients with LAA dysfunction and 70.75 +/- 16.71 cm/s in high-flow profile (P < .0001). Simultaneous 12-lead electrocardiogram was used to measure P waves. Results: P maximum, P dispersion, and LA diameter were significantly higher in patients with low LAA PEV (n = 32) than in those with high LAA PEV (111.87 +/- 16.93 vs 96.66 +/- 14.97, P = .0084; 73.12 +/- 20.7 vs 49.16 +/- 9.96, P < .0001; 46.06 +/- 4.384 vs 38.08 +/- 7.42 mm, P = .004; respectively). Patients with MS and low LAA blood flow had smaller mitral valve area compared with those with high LAA blood flow velocity (1.48 +/- 0.431 vs 1.85 +/- 0.442 cm(2), P = .02). Male sex, spontaneous echocontrast, and thrombus were more frequent in patients with low LAA PEV (7 [21.87%] vs 5 [41.66%], P = .026; 21 [65.62%] vs 4 [33.3%], P = .088; 4 [12.5%] vs none; respectively). Mild MS was more frequent in patients with high blood flow velocity {6 [27.2%] vs 14 [63.6%], P = .03}. Conclusion: At linear regression analysis, only P-wave dispersion and LA diameter predicted the LAA mechanical dysfunction reflected as low LAA PEVs.
A Comparison of Heart Rate Variability in Patients With Multiple Sclerosis Undergoing Immunomodulating Therapy or No Such Treatment
(Elsevier, 2005) Tombul, T; Tuncer, M; Eryonucu, B; Anlar, O
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.
Comparison of the Effects of Nitroglycerin and Nitroprusside on Transmitral Doppler Flow Parameters in Patients With Hypertensive Urgency
(Sage Publications inc, 2005) Eryonucu, B; Güler, N; Güntekin, O; Tuncer, M
Background: Sodium nitroprusside (NIP) and nitroglycerin (NIT) are frequently selected agents for acutely reducing blood pressure. However, it is not clear which agent is more efficacious in improving left ventricular filling pressure in hypertensive crises. OBJECTIVE: To compare the acute effects of nitroglycerin (NIT) and nitroprusside (NIP) on transmitral Doppler filling parameters in patients with hypertensive urgency. METHODS: We identified 37 patients from our emergency department with hypertensive urgency and left ventricular filling abnormalities. Hypertensive urgency was defined as a severe blood pressure elevation without evidence of progressive end-organ injury. Patients were randomized to receive an infusion of NIT or NIP. NIT was infused at a starting dose of 10 mu g/min; NIP was infused at a starting dose of 0.25 mu g/kg/min. The infusion rates were adjusted to decrease mean arterial pressure by 25%, and this reduction was obtained within 2 hours in all patients. Diastolic filling parameters were measured by using echocardiography before and after treatment. Pulsed-wave Doppler transmitral flow velocities were used. Early diastolic flow, atrial contraction signal, early diastolic flow/atrial contraction signal, deceleration time, and isovolumetric relaxation time (IVRT) were measured. RESULTS: There were no differences between groups in baseline demographic and echocardiographic parameters. Blood pressure decreased significantly in both treatment groups. In posttreatment echocardiographic examinations, atrial contraction signal, deceleration time, and IVRT were significantly decreased in both treatment groups. Early diastolic flow was significantly decreased in the NIT group. There were no significant differences between the groups in terms of posttreatment early diastolic flow, atrial contraction signal, deceleration time, and IVRT values. CONCLUSIONS: In hypertensive urgency with left ventricular filling abnormalities, reduction of blood pressure associated with NIT or NIP treatment may improve transmitral Doppler filling parameters. There were no differences demonstrated between the 2 agents.
Comparison of the First Dose Response of Fosinopril and Captopril in Congestive Heart Failure - a Randomized, Double-Blind, Placebo Controlled Study
(int Heart Journal Assoc, 2001) Eryonucu, B; Koldas, L; Ayan, F; Keser, N; Sirmaci, N
The purpose of this study was to compare the safety and tolerability of recommended initial doses of fosinopril (FOS) with those of captopril (CAP), in diuretic-treated, salt depleted "high risk" patients with congestive heart failure. Thirty patients were randomized in a double blind fashion to receive a single dose of either FOS 10 mg, CAP 6.25 mg or placebo. CAP produced a significant early and brief fall in BP, while the first-dose hypotensive response with FOS did not differ significantly from placebo. Baseline plasma angiotensin converting enzyme (ACE) activity was similar in all groups. Only CAP showed atl acute and significant fail in plasma ACE activity, whereas FOS and placebo did not change ACE activity. There was no correlation between mean arterial pressure or percentile change in mean arterial pressure and plasma ACE activity. Also no correlation was found between high or low ACE activity level and first dose hypotension. The practical importance of the results are: For patients with congestive heart failure, FOS and CAP have different effects on BP after the first dose, and this effect may be dependent on the plasma ACE activity level. FOS produces ACE inhibition and BP changes similar to placebo so it is the safer choice for the treatment of congestive heart failure.
Comparison of the Short-Term Effects of Salmeterol and Formoterol on Heart Rate Variability in Adult Asthmatic Patients
(Elsevier, 2005) Eryonucu, B; Uzun, K; Güler, N; Tuncer, A; Sezgi, C
Study objectives: We investigated the effects of beta(2)-adrenergic agonists salmeterol and formoterol on heart rate variability (HRV) in adult asthmatic patients using time-domain measures of URV. Patients: Thirty-nine adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline FEV1. Any diseases that might have influenced the autonomic function were excluded. All patients underwent a complete physical examination and medical history that revealed no cardiovascular disease or medication. Methods: The beta(2)-adrenergic inhaled agonists salmeterol, 50 mu g, and formoterol, 12 fig, were used in the study, HRV analysis was performed for each 5-min segment: 5 min and 10 min before inhalation of the study drug, and 5, 10, 15, 20, 25, and 30 min after inhalation. Time-domain parameters of HRV were calculated: (1) the SD all normal-to-nornial intervals, (2) the SD of the mean of all normal-to-normal intervals in all 5-min segments of the entire recording; (3) the root mean square of differences between adjacent normal-to-normal intervals, (4) the mean of the SD of all normal-to-normal intervals in all the 5-min intervals; and (5) the SD of the SD of all normal-to-normal intervals in all the 5-min intervals. Results: Baseline HRV parameters were not significantly different between formoterol and salmeterol groups. There were no significant differences in HRV parameters after formoterol and salmeterol inhalation. The HRV parameters in each 5-min segment in the formoterol group were not statistically significant different when compared to the same segment in the salmeterol group. Conclusion: Salmeterol and formoterol have no short-term adverse effects on HRV.
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.