23 research outputs found
Hypertension in the elderly [Yaşlılarda hipertansiyon]
No full textHypertension (HT) is a common problem in elderly persons (age >65 years), reaching a prevalence as high as 60 to 80%. Isolated systolic HT mostly occurs in older patients. Treatment of HT in all patients, independent of age, consists of lifestyle modifications and antihypertensive therapy. Randomized trials have provided clear evidence of benefit from treating HT in elderly patients, including those over the age of 80 years. Drug therapy should be started in elderly hypertensive patients if lifestyle changes are insufficient and in the absence of a hypertensive emergency or urgency, blood pressure reduction should always be gradual. A long-acting dihydropyridine or a thiazide diuretic is generally preferred because of increased blood pressure-lowering efficacy in this population. Goal blood pressure recommendation for most hypertensive elderly is to attain a systolic pressure below 140 mmHg
Eosinophilic myocarditis presenting as acute coronary syndrome
No full textEosinophilic myocarditis (EM) is a rare condition that may result from several heterogeneous eosinophilic diseases, including parasite infection, hypersensitivity reaction, vasculitis, and hypereosinophilic syndrome. Regardless of etiology, the disease may present with various cardiac conditions, such as acute coronary syndrome, heart failure, or arrhythmia. Irreversible endomyocardial fibrosis, which causes restrictive cardiomyopathy, occurs in the late phase of the disease. Early diagnosis and treatment is crucial to prevent disease progression. Presently described is a case of EM presenting as acute coronary syndrome that was treated with steroids
Changes in cardiovascular physiology in the elderly
No full textThe ageing process is associated with important changes in the responses of the cardiovascular system. They are not limited to the arterial system, involved in the modulation of cardiac afterload and vascular resistance, but they also involve the low-resistance capacitance venous system and the heart. This review focuses on the effects of ageing on the cardiovascular morphological, functional, electrological system and vascular functions
Primary cardiac amyloidosis mimicking interstitial lung disease and bleeding diathesis: A case report
No full textPrimary amyloidosis is a rare systemic disease due to various organ involvements that can lead to atypical clinical findings. In this article, we discuss a case of primary cardiac amyloidosis in a patient presenting with bleeding eyelids and interstitial lung disease
An observational study to evaluate factors responsible and actions taken for hypertensive patients who are not at blood pressure goal: i-target Goal Study
No full textWOS: 000305001900010PubMed ID: 22318207To evaluate the percentage of hypertensive patients who could achieve target blood pressure (TBP) according to the guidelines in the context of recommended measures and the factors responsible for failure. A total of 589 hypertensive patients (59.0% female; mean age: 57.7+/-10.4 years) were assessed twice for TBP achievement based on 2007 ESH/ESC guidelines and the investigators' view, in addition to the recommended measures and possible causes of failure in hypertension management in this national multi-center (n = 99), non-interventional observational study. Only 29.5% of the patients at the first visit and 46.8% at the second visit achieved the TBP levels specified by the guidelines. However, the investigators' evaluation indicated a higher achievement rate at the first (43.5%) as well as the second (69.1%) visit when compared with the guideline-based assessments (P<0.001). The primary reasons identified by the investigators for the failure to reach TBP were non-compliance with dietary recommendations (61.6%) at the first visit and non-compliance with treatment (63.92%) at the second visit. Recommendations for lifestyle were the most commonly identified treatment plan by the investigators at both visits (62.9% and 66.1%, respectively). Although more patients achieved the TBP levels specified by the guidelines for the second visit compared with the first, effective blood pressure control was achieved only in 29.5% of our patients. Interestingly, the investigators had a more optimistic view about their patients' control of hypertension, which may have contributed to a poor achievement of TBP. Hypertension Research (2012) 35, 624-632; doi:10.1038/hr.2012.12; published online 9 February 2012Sanofi-Aventis TurkeyThe study was funded by Sanofi-Aventis Turkey. We thank Cagla Isman, M. D. and Professor Sule Oktay, M. D., Ph.D. from KAPPA Consultancy Traning Research Ltd., Istanbul, who provided editorial support; and Oguz Akbas, M. D., Ph.D., Esra Koruyucu and Arzu Calisgan M. Sc. from Monitor CRO, Istanbul, for their support of the statistical analysis, funded by Sanofi-Aventis Turkey
Myocardial bridge: a bridge to atherosclerosis
No full textObjective: Myocardial bridge (MB) is a congenital anomaly characterized by narrowing during systole of some of the epicardial coronary arterial segments running in the myocardium. Although, it is considered as a benign anomaly, it may lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. In this study, we aimed to investigate demographic, clinical and angiographic characteristics of the patients with MB found on coronary angiography. Methods: The present study included 71 patients with MB found on coronary angiographies performed in our institution between January 1999 and September 2003. Based on the findings on angiography, the patients were subdivided into group A (n=41) and group B (n=30). The patients in the group A had no atherosclerotic lesion and the patients in the group B had coronary artery disease in addition to MB. Angiographic, demographic and clinical characteristics of both groups were compared. Results: There were no differences between two groups in distribution of gender and risk factors of coronary artery diseases whereas mean age of the patients in the group A was lower (47 +/- 5 years vs 55 +/- 11 years, p = 0.01). Frequency of two or more risk factors for coronary artery disease in a particular patient was significantly higher in the group B (55% vs 30%, p = 0.03). Myocardial bridge was located at proximal or mid segments of left anterior descending artery (LAD) in 40 patients whereas its presence in both LAD and right coronary artery was found only in one patient in group A. Mean bridging percent was 43 +/- 27% in group A. Localization of MB was LAD in 29 patients of group B, which was significantly higher than in group A (p<0.05). Atherosclerotic narrowing developed in only LAD in 14 patients, LAD and other vessels in 7 patients and in the vessels without MB in 9 patients. In patients with MB in LAD atherosclerotic narrowing of vessel developed proximally to the MB. Clinically, stable angina pactoris was seen more frequently in group A than group B (70% vs 35%, p = 0.01), whereas the frequency of acute coronary syndrome was higher in group B (65% vs 30%, p=0.04). In regard to therapeutic approach, more patients in the group A received medical management (80% vs 50%, p=0.01), while more patients in the group B underwent surgical and percutaneous interventions (50% vs 18%, p=0.04). Conclusion: Myocardial bridge probability should be considered in young patients presenting with angina or if the same symptoms are persistent in the patients without more than one risk factor for coronary artery disease. Myocardial bridge may initiate the development of atherosclerotic lesion or may facilitate progression of atherosclerosis in the proximal segment of the vessel. The risk of acute coronary syndrome rises when atherosclerosis is superimposed on MB. Myocardial bridge should be considered in the young patients, presenting with angina or its equivalents without atherosclerotic lesions on coronary angiography
The left atrial phasic functions and the relationship with plasma n-terminal pro-b-type natriuretic peptide in patients with hypertrophic cardiomyopathy
No full textEffect of levosimendan on E/E' ratio in patients with ischemic heart failure
No full textBackground: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E' ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. Methods: Patients with an LVEF 0.05). There was no difference for pre-treatment baseline E/E' ratios between levosimendan and dobutamine groups (15.7 +/- 4.0 vs 15.2 +/- 7.5 respectively, p=0.1). There were significant reductions in post-treatment E/E' ratios in levosimendan ( 15.7 +/- 4.0 vs 9.3 +/- 2.8, p=0.01) and dobutamine groups ( 15.2 +/- 7.5 vs 12.9 +/- 5.6, p=0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p=0.01). Conclusions: Levosimendan causes a greater reduction of E/E' ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure. (c) 2007 Elsevier Ireland Ltd. All rights reserved
Speckle tracking echocardiography and left ventricular twist mechanics: predictive capabilities for noncompaction cardiomyopathy in the first degree relatives
No full textIn non-compaction cardiomyopathy (NCCM), there are several echocardiographic and cardiac magnetic resonance (CMR)-based quantitative diagnostic indices, current criteria mainly placed on morphological features, and none of the diagnostic indices includes left ventricular (LV) function. LV function and hemodynamics could be normal in NCCM patients. Evaluation of left ventricular function at the subclinical stage, strain echocardiographic parameters could be used alternative to standard echocardiographic examinations. the aim of this study to evaluate; NCCM patients, their first-degree relatives, ventricular motion patterns, strain characteristics, and the predictive capabilities of these features for early diagnosis of cardiomyopathy. This cross-sectional, case-control study included 32 NCCM patients, 30 first-degree relatives (father, mother, siblings and children) and 31 healthy volunteers. All patients evaluated with baseline echocardiography, strain measurements, and ventricular wall motion pattern. There were no differences between the groups in terms of age, weight, and body surface area. We observed a statistically significant decrease in ejection fraction (EF), fractional shortening (FS), E/E ' and global strain values in patients' relatives compared to healthy volunteers(Patients' relatives: LVEF:60.9 +/- 7.2%, FS:0.34 +/- 0.07, E/E ':7.51 +/- 1.83, GLS: - 18.6 +/- 3.6, GLSr: - 1.1 +/- 0.1, GCS: - 17.1 +/- 3.1, GCSr: - 1.2 +/- 0.1, GRS:37.1 +/- 6.2, GRSr:1.7 +/- 0.1; all p values< 0.05). 'Rigid Body Rotation (RBR)' movement pattern was also observed in some of the patient's relative's like in the patients. RBR movement pattern determined patients; EF, longitudinal strain-strain rate, and basal layer rotation values were significantly lower, but radial strain values were higher with the RBR movement pattern(for all values p < 0.05). RBR movement pattern, deterioration of strain parameters, and accompanying echocardiographic features like LVEF, fractional shortening (FS), E/E ' in patients' relative groups may contribute to reveal the subclinical status of disease and could be predictive for early diagnosis of cardiomyopathy
