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Introduction: The determination of natriuretic peptide levels in patients hospitalized for suspected acute heart failure is important for the confirmation of the diagnosis and for the prognosis. Changes in natriuretic peptide levels in response to therapy have a strong prognostic value. Aim: To decide whether repeated natriuretic peptide measurements for acute heart failure show changes that could influence the diagnosis and/or the prognosis. Method: Prospective data collection was carried out of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission and within 12 hours in patients hospitalized for acute heart failure. Only the data of those patients were analyzed whose symptoms started within 24 hours prior to admission and were due to acute heart failure. Results: The 23 patients whose data we analyzed had an average age of 77.9 ± 8.3 years. Most of them had left ventricular systolic dysfunction with an average ejection fraction of 34.1 ± 3.9%. The time between the start of symptoms and the first measurement was 6.7 ± 2.2 hours, while the time until the repeated determination was 6.5 ± 2.2 hours after the first measurement. The median value of the NT-proBNP levels in the 6 hours control showed an increase from 5064 pg/mL to 8847 pg/mL (p<0.0005), which amounts to a 75 percent increase – mean hs-troponin T showed an increase from 46 ± 25 ng/L to 78 ± 51 ng/L (p<0.002). Conclusions: A significant increase in NT-proBNP levels is to be expected in early repeated measurement after hospital admission. This fact could have diagnostic and prognostic consequences if validated in a larger patient population. Orv Hetil. 2018; 159(25): 1009–1012.

Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

The first cardiac examination of a 15-year-old female patient was due to palpitation. The ECG morphology was typical of Wolff–Parkinson–White syndrome ( Panel A ). Three years later the patient's echocardiography, which was performed after her mother's sudden death during sport activity, suggested hypertrophic cardiomyopathy ( Panel B ), thus a cardiac magnetic resonance (CMR) examination …

Aortopulmonary window is a rare defect caused by failure of fusion of the two opposing conotruncal ridges which are responsible for separating the truncus arteriosus into the aorta and pulmonary tract. A case of long survival with aortopulmonary window causing Eisenmenger syndrome is presented. A 65-year-old female patient was admitted with cardiorespiratory failure. She had had effort dyspnoea for 30 years but had refused investigations. Physical examination revealed generalised cyanosis, marked anasarca and a holosystolic murmur superimposed on an accentuated S2. Oxygen saturation was 95% but the arterial blood gas showed significant hypoxia (pO2 65 mmHg). Blood pressure was 150/80 mmHg. The ECG on admission showed pulmonary P-waves and signs of right ventricular hypertrophy. Echocardiography revealed a grossly dilated right ventricle with severe tricuspid regurgitation and mild pulmonary insufficiency. The estimated pulmonary pressure of 140/70 mmHg was nearly identical with the systemic blood pressure. The dimensions of the left atrium and left ventricle were within normal limits with good left ventricular systolic function.

A súlyos stressz hatására bekövetkező bal kamrai diszfunkció régóta ismert jelenség. Ennek a bal kamra apicalis dilatatiójával járó reverzíbilis formáját Sato és munkatársai 1990-ben történt első leírása nyomán „tako-tsubo”-cardiomyopathiának vagy ampulla-cardiomyopathiának hívják. Az erről szóló publikációkban mind a japán, mind az angolszász irodalomban szinte egyenlőségjelet tesznek a stressz-cardiomyopathia és a tako-tsubo-cardiomyopthia közé. Célkitűzés: A stressz indukálta reverzíbilis balkamra-diszfunkciós betegeink adatainak feldolgozásával tisztázni e kórkép lehetséges klinikai formáit és legjellemzőbb klinikai paramétereiket. Módszer: a 2002 és 2007 közötti, a Budai Irgalmasrendi Kórházban kezelt olyan betegek adatainak retrospektív feldolgozása, akiknél kimutatható volt a reverzíbilis balkamra-diszfunkció, és a koronarográfia negatív eredményt adott, valamint a klinikum és a laborparaméterek nem utaltak myocarditisre. Eredmények: Az elmúlt öt és fél évben összesen 6 olyan esetet találtunk, amelyek megfeleltek a fent leírt kritériumoknak. A betegek 55–80 év közötti nők voltak, akiknél öt esetben volt kimutatható oki tényezője a reverzíbilis balkamra-diszfunkciónak. Következtetések: A stressz indukálta cardiomyopathiának csak egyik formája a bal kamra csúcsi dilatációja, és ennek a csoportnak a fő közös jellemzője nem a tako-tsubo-szerű balkamra-tágulat, amely nincsen mindig jelen, hanem a szinte mindig meglévő QT-megnyúlás és negatív T-hullámok, amelyek a coronariabetegség nélküli akut, reverzíbilis balkamra-diszfunkciót néhány nappal követik megfigyeléseink és az irodalmi adatok alapján.

The authors report the case of an 77-year-old woman with no evidence of previous cardiac disease who developed a non-Q-wave myocardial infarction after beta2-mimetic treatment for the exacerbation of her chronic bronchial asthma. After the five dose of salbutamol spray she developed chest pain. The electrogram showed ST segment elevation in leads I-aVL-V4-6. Urgent coronary angiography showed only non significant left anterior coronary artery stenosis (20%). A subsequent echocardiogram also revealed anterolateral hypokinesia and acute reversible left ventricular dysfunction (LVEF:30%). Both troponin T concentration and creatine kinase rose. Next day in the lateral leads negative T-waves developed with QT-prolongation and without pathologic Q-waves. Although myocardial infarction and acute reversible left ventricular dysfunction is a rare complication following beta2 mimetic treatment one should use high-dose beta2-agonists with caution.