Cardiol J
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Negative T wave and lack of ST segment elevation in predischarge ECG in ST-segment elevation myocardial infraction (STEMI) patients are given as markers of good prognosis. Repolarization duration, especially its late part (TpeakTend - TpTe), likewise ST-T patterns, is related to local post-myocardial infarction myocardial attributes. We analyzed the differences in QT parameters in STEMI patients with negative or not-negative T wave pattern in predischarge ECG. ⋯ STEMI patients who underwent successful percutaneous coronary intervention of infarct-related coronary arteries and demonstrated persistent ST elevation, without negative T wave at hospital discharge, had a longer repolarization duration, especially the late phase of it. Further studies are necessary to assess the prognostic value of this finding.
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Case Reports
T wave oversensing and low percentage of biventricular pacing in cardiac resynchronization therapy.
The success of cardiac resynchronization therapy (CRT) depends on a high percentage of ventricular pacing. We present the electrocardiography and electrograms of a patient who underwent an implantable cardioverter-defibrillator (ICD) with CRT implantation showing a low percentage of ventricular pacing as a result of T wave oversensing of paced QRS. The patient showed no clinical improvement. We suggest finding a good sensitivity of F waves in induced ventricular fibrillation during ICD implantation in order to overcome the harm of possible oversensing.
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Inappropriate shocks from implantable cardioverter-defibrillators (ICDs) may occur for many reasons. Inappropriate shocks are not simply painful inconveniences for patients; they also may result in the need for further operative procedures, and sometimes even death. Herein, we report the case of a patient who after upgrade of an ICD to a cardiac resynchronization therapy-defibrillator device (CRT-D), returned with multiple shocks due to altered sensing and defibrillation polarities that resulted from actual physical reversal of the distal (-) and proximal (+) lead terminals in the header of the device.
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Bicuspid aortic valve is one of the most common congenital cardiac anomalies and it may be accompanied by other cardiovascular anomalies. Sinus of Valsalva aneurysm is a rare anomaly in adult population, but it coexists with bicuspid aortic valve quite often. This report describes a 57 years-old patient who had a bicuspid aortic valve accompanied by unruptured Valsalva sinus aneurysm with significant left anterior narrowing and who underwent successful surgery with ascending aorta and aortic valve replacement as well as coronary by-pass grafting.
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Adult patients with congenital heart disease (CHD) usually find their exercise capacity satisfactory. However, objective evaluation is important for diagnostic and prognostic purposes. The aim of this study was to evaluate exercise capacity using cardiopulmonary exercise tests and measurement of serum B-type natriuretic peptide (BNP) levels in adult patients with CHDs, both in the entire study cohort and in subjects with individual types of cardiac lesions, as well as to verify the relation between BNP level and cardiac performance. ⋯ The exercise capacity of patients with CHD is, in general, compromised, most strikingly in patients suffering from pulmonary hypertension and cyanosis. Serum BNP levels in these subjects are increased and correlate well with exercise capacity. BNP level is higher in patients with cyanotic CHDs.