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WOS: 000351007900020, PubMed ID: 25764100, Background: Crimean-Congo hemorrhagic fever (CCHF) is a systemic viral disease that also affects the endothelium. Thrombocytopenia and hemorrhage are seen in this disease. But, the cause of thrombocytopenia is not clear. We hypothesized that endothelium dysfunction may be the cause of thrombocytopenia. We evaluated the endothelium functions by flow-mediated dilatation (FMD) in CCHF. Methods: Consecutive children with suspected CCHF who applied to our hospital were evaluated for recruitment into the study. FMD analysis was done in the active and healing period of the disease. Diagnosis was confirmed or ruled out by polymerase chain reaction and/or ELISA test. Basal brachial artery diameter (BBAD) and dilated brachial artery diameter (DBAD) after ischemic period were measured and percent dilatations [(DBAD-BBAD)/BBAD, FMD%] were computed from all subjects. Results: Fifty-four children (40 male, mean age 12.4 +/- 4.4 years) were recruited into the study. CCHF diagnosis was confirmed in 28 children and ruled out in 26 children. Groups were similar for age and gender. FMD% was significantly decreased in CCHF patients when comparing this with the control patients in the active period (2.65 +/- 2.76 vs. 13.76 +/- 7.95, P < 0.001). FMD% was correlated with platelet count in the active period of the disease (r = 0.599, P = 0.004). FMD% was recovered in the healing period (2.65 +/- 2.76 vs. 14.72 +/- 2.66, P < 0.001) and was not significantly different from basal values of control patients (P > 0.05). Conclusions: FMD is significantly decreased in CCHF and recovers in the healing period. So, endothelium functions are disturbed, and disturbance is correlated with thrombocytopenia in CCHF.

OBJECTIVE: We aimed to investigate the predisposing factors of embolic events and the role of vegetation properties on the embolic complications for infective endocarditis (IE).METHODS: The archive records of 119 patients with a definite diagnosis of IE between January 1997 and November 2004 were reviewed for clinical, echocardiographic, microbiologic properties and embolic events.RESULTS: Major arterial embolization was observed in 28 (23.5%) of 119 study patients on admission. These patients were included in the embolization group. Parameters such as culture positivity (p=0.017, 95% confidence interval (CI)=1.1-24.6) ejection fraction (EF) (p=0.003, 95% CI=1.1-1.4), presence of vegetation (p=0.013, 95% CI=1.1-1.13), size of vegetation (p=0.002, 95% CI= 1.1-2.1), vegetation mobility (p=0.01, 95% CI=2.1-24.5), and chordal rupture (p=0.041, 95% CI=1.07-7.14) were identified as significant predictors of embolization. CONCLUSION: In patients with infective endocarditis, culture positivity, EF, presence of vegetation, vegetation mobility, size of vegetation, and the presence of chordal rupture are the variables with predictive value for embolization. Further prospective controlled trials are required in order to identify the predictive value of the presented data and other variables.

WOS: 000324527900001, PubMed ID: 24013617, Aim Diastolic dysfunction (DD) is common in hemodialysis (HD) patients. Because diabetes mellitus (DM) and hypertension (HT) are also common in this patient group, the exact reason for DD in HD patients is not clear. The present study evaluated left ventricular (LV) diastolic function in HD patients without DM and HT. Methods Fifty patients on HD and 34 age-matched and sex-matched healthy control individuals were enrolled. Echocardiography was performed in all participants. LV systolic and diastolic functions were evaluated by B-mode echocardiography, pulsed wave, and tissue Doppler imaging. The HD patients were divided into two groups according to the presence or absence of left ventricular hypertrophy (LVH) in echocardiography. Results LV dimensions and systolic function were within normal limits and similar between groups. However, the HD patients had significantly worse diastolic function (E/A: 0.78 +/- 0.26 vs. 1.19 +/- 0.28, P < 0.001, e '/a ' septal: 0.77 +/- 0.36 vs. 1.04 +/- 0.21, P < 0.001) and increased filling pressure (E/e ': 8.55 +/- 3.2 vs. 5.79 +/- 1.93, P < 0.001). Thirty-one (62%) patients had LVH, whereas 19 (38%) patients did not have LVH. LV systolic and diastolic functions were similar in HD patients with and without LVH. Seventeen (55%) hypertrophies were concentric and 14 (45%) were eccentric. Diastolic functions were similar in patients with either concentric or eccentric hypertrophy. Conclusion Diastolic function is impaired in HD patients even in the absence of diseases that can cause DD such as HT and DM.

WOS: 000321268700008, PubMed ID: 23625275, It is still unknown whether left ventricular ejection fraction (LVEF) might affect the magnitude of improvement after atrial fibrillation (AF) ablation on cardiac function in persistent or longstanding persistent AF (CAF) patients. We performed echocardiography in 35 patients with CAF before and after catheter ablation (CA). Patients were stratified by LVEF into two groups prior to CA-normal LVEF (a parts per thousand yen50 % LVEF, N group, n = 24) and a low LVEF group (< 50 % LVEF, L group, n = 11). Patients were followed at 1 month, 3 months, 6 months, 1 year, and 2 years after ablation. After 15.8 +/- 7.4 months follow-up, the L group showed greater improvement in LVEF and left atrial ejection fraction (LAEF; N group vs L group: LVEF difference (%), 5 +/- 8 vs 20 +/- 13, p < 0.01; LAEF difference (%), 11 +/- 12 vs 21 +/- 10, p < 0.05). LA maximal volume and E/e' showed the same tendency after ablation, although the extent of improvement was not statistically significant. Both groups showed almost the same time course of improvement up to 2 years, although the L group showed earlier recovery in LVEF. The greater improvement in several cardiac functions was seen in patients with greater LV dysfunction, after the CA for CAF.

Background Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function. Methods One hundred and two consecutive patients (68 males, 34 females) requested to perform an exercise stress test were included in our study. Patients were divided into two groups as those having a normal heart rate reserve (Group1, n = 72) and those having an abnormal heart rate reserve (Group2, n = 30). Results In Group1 and Group2, resting heart rate averages were found to be 83.61 ± 18.01/min and 85.10 ± 13.40/min, respectively (P > 0.05), and maximum heart rates during exercise were 141.42 ± 19.70/min and 121.17 ± 19.01/min while those in Group1 had statistically significantly higher heart rates (P < 0.001). A statistically significant positive association was found in the correlation test carried out between the maximum heart rate during the treadmill exercise test and ejection fraction (EF) value (r = 0.201; P < 0.05). Metabolic equivalents of task values obtained during the treadmill exercise test in Group1 and Group2 were 9.48 ± 2.28 and 8.36 ± 2.50, respectively, and the difference between the said values was statistically significant (P < 0.05). Conclusions We believe that the association between low EF and abnormal HRR is worth studying and randomized large-scale studies are needed to determine mortality risk.

WOS:000311771900011 PubMed: 23042315 Background: Metabolic syndrome (MetS), which includes a cluster of risk factors, is being increasingly recognized as a new risk factor for cardiovascular disease. Heart rate turbulence (HRT) is a Holter-based non-invasive method for detecting cardiac autonomic imbalance and is an independent, powoful predictor of cardiac arrhythmias and sudden cardiac death in different patient groups. This study evaluated the effect of MetS on HRT in non-diabetic patients. Methods: This study included 80 non-diabetic MetS subjects and 50 healthy subjects. All 130 subjects underwent a 24-h ambulatory Holter electrocardiogram recording. Two indices of HRT were analyzed: turbulence onset (TO) and turbulence slope (TS). HRT values were classified into 3 categories for risk stratification: 1) Category 0, TO and TS were normal; 2) Category 1, either TO or TS was abnormal; 3) Category 2, both TO and TS were abnormal. Results: When we compared MetS rates in the HRT risk stratification groups, there were significant differences for all groups as compared with the controls (Category 0 = MetS 28.8%, n = 15, Control 71.2%, n = 37, p < 0.001; Category 1 = MetS 80.8%, n = 42, Control 19.2%, n = 10, p

Non-dipping blood pressure pattern was shown to be associated with increased cardiovascular events. In addition, cardiac autonomic dysfunction was found to be associated with non-dipper phenomenon. In this study, we aimed to evaluate the cardiac autonomic functions in dipper and non-dipper pre-hypertensive subjects. A total of 65 pre-hypertensive subjects were enrolled in this study. They were divided into two groups as non-dippers (40 subjects, 52% female) and dippers (25 subjects, 52.5% female). Cardiac autonomic functions of the two groups were compared with the aid of heart rate variability, heart rate turbulence (HRT), atrial premature contractions (APCs), ventricular premature contractions (VPCs), and mean heart rate (MHR). There was no significant difference between non-dippers and dippers in basal characteristics. The two parameters of HRT, turbulence onset and turbulence slope, were found to be significantly abnormal in non-dippers than in dippers (P < .011 and P < .002, respectively). Heart rate variability parameters, including SDNN, SDANN, RMSSD, and pNN50, were found to be similar in dipper and non-dipper pre-hypertensive subjects (P < .998, P < .453, P < .205, and P < .788, respectively). APCs, VPCs, and MHR were compared, and there were statistical differences between the groups (APCs 5.80 ± 4.55, 9.14 ± 7.33, P < .024; VPCs 8.48 ± 8.83, 13.23 ± 9.68, P < .044; and MHR 70.16 ± 11.08, 76.26 ± 11.31, P < .035; respectively). This study demonstrated a possible cardiac autonomic dysfunction in pre-hypertensive subjects with non-dipper pattern. This may be a basis for future studies related to pre-hypertension and non-dipping BP pattern.

WOS: 000311649900004, Background: There are limited data that examine the assessment of subsegmental branches of the pulmonary artery by intravascular ultrasound (IVUS). Aim: To assess the structural characteristics of pulmonary arteries by IVUS in the setting of severe mitral stenosis. Material and methods: Twenty-one consecutive patients (3 men and 18 women; mean age: 38 11 years) who were selected for percutaneous mitral balloon valvuloplasty entered the study. Subsegmental branches of the right lower lobe pulmonary artery were imaged by 40 MHz IVUS when the patients underwent right heart catheterization. Minimal lumen diameter (MLD), external elastic membrane diameter (EEMD), lumen area (LA), and area circumscribed by the external elastic membrane (the total vessel area - TVA) were measured. From these measurements, wall area (WA = TVA - LA), intima-media wall thickness [IMT = (EEMD - MLD)/2], relative wall thickness (RWT = IMT/EEMD), and relative wall area (RWA = WA/TVA) were derived. Results: We were able to perform the IVUS examination in all patients without complications. Several IVUS anatomic indexes correlated with hemodynamic data. Pulmonary artery IMT, RWT, and RWA correlated significantly with pulmonary artery systolic pressure (r = 0.763, p = 0.002; r = 0.698, p = 0.001; r = 0.717, p = 0.006, respectively). However, there was no significant correlation between ultrasound measurements and echocardiographic parameters of the mitral valve. Conclusions: The subsegmental branches of the pulmonary artery can be assessed by IVUS. Patients with pulmonary hypertension in the setting of mitral stenosis have greater pulmonary arterial WT. The severity of WT is correlated with pulmonary artery pressure, but it is not associated with mitral valve area. Intravascular ultrasound may provide useful additional information in the management of patients with mitral stenosis.

OBJECTIVES We evaluated the effectiveness and reliability of percutaneous closure of persistent arterial duct (PAD) with the Amplatzer Duct Occluder II (ADO II), together with short- and mid-term results. STUDY DESIGN The study included 16 patients (10 girls, 6 boys; median age 6 years; range 5 months to 12 years) who underwent percutaneous PAD closure with the ADO II device. The ductus diameter was less than 6 mm in all the cases. According to the Krichenko classification, 10 patients had type A, five patients had type E, and one patient had residual PAD. The patients were assessed by aortography and echocardiography. The mean follow-up was 13.9 months (range 2 to 23 months). RESULTS Closure of PAD was successfully performed via the arterial approach in all the patients. The median ductus waist diameter was 3 mm (range 2 to 5 mm), the median device waist diameter was 4 mm (range 3 to 6 mm), and the waist length was 4 or 6 mm. The mean fluoroscopy time and the mean procedure time were 10.6 min (range 4 to 39 min) and 30 min (range 18 to 80 min), respectively. Immediate aortography following the procedure showed shunt only through the device lumen. No residual shunt or increases in aortic and left pulmonary flow velocities were observed in echocardiographic examinations. No complications occurred during the procedure and follow-up. CONCLUSION In all the cases, the ADO II device was found effective and reliable for closure of PADs of less than 6 mm.

WOS: 000295570200003, Background: Conventional echocardiographic methods have already shown that successful mitral balloon valvuloplasty (MBV) can effectively increase left atrial (LA) functions. Aim: To evaluate LA functions after MBV using colour tissue Doppler imaging. Material and methods: Sixty-eight patients (58 females, mean age: 38 +/- 12 years) were included in the study. Within 24 h before MBV, all the patients underwent colour tissue Doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the LA wall adjacent to the septal and lateral annuli were recorded. All the measurements were repeated 24 h after MBV. The MBV was done using the Inoue technique. Successful MBV patients were included in group A and those who developed severe mitral regurgitation (MR) were included in group B. Results: Sixty-one patients underwent successful MBV while 7 developed MR. Mitral valve areas (MVA) in both groups were significantly increased. Maximum and mean gradients, LA diameter, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly increased in group A. In group B, no significant change in any variable was found except for the increase in MVA Conclusions: After successful MBV, increase in A' velocity was seen in parallel to the recovery of LA functions. Early improvements in left atrial systolic functions after successful MBV can easily be determined by colour tissue Doppler as a quick and reliable method.

Risperidonun aktif metaboliti olan paliperidon piyasadaki yeni atipik antipsikotiklerden birisidir. Kontrollü klinik çalışmalarda paliperidonun şizofreni tedavisinde pozitif ve negatif belirtilerin azaltılmasında etkili olduğu görülmüştür. Bazı çalışmalar ve vaka bildirimlerinde kardiyovasküler ve kardiyometabolik etkileri bildirilmiştir. Bugüne kadar paliperidonun ölümcül bir yan etki olan kardiak tamponada yol açtığı bildirilmemiştir. Bu olguda on sekiz yıldır katatonik şizofreni tanısıyla takip edilen ve son 3 yıldır paliperidon 6 mg/gün kullanan 40 yaşındaki bir kadın hastada perikardiyal tamponad gelişimi sunulmaktadır. Paliperidonun terapötik dozlarda bile kardiyovasküler ve kardiyometabolik yan etkilerinin olabileceği tartışılmaktadır., Paliperidone which is the active metabolite of risperidon is one of the novel antipsychotics. Controlled clinical studies proved its effectiveness on decreasing the positive and negative symptoms of schizophrenia. Some studies and case reports, reported its cardiovascular and cardiometabolic side effects. Cardiac tamponade, that may be mortal, wasn’t reported as a side effect with paliperidone usage before. We present a 40 years old female with catatonic schizophrenia for eighteen years, whom was on 6 mg/day paliperidon for 3 years and presented with pericardial tamponade. We suggest that paliperdione may have cardiovascular and cardiometabolic side effects also in therapeutic doses.

Objective Given the elevated apolipoprotein (apo) A-I level enhancement of type 2 diabetes among Turks, the interrelation among it, apoB, and apoE genotype with respect to the likelihood of diabetes and metabolic syndrome (MetS), and the role of gender need further investigation. Methods A random sample of Turkish adults genotyped for apoE with measured serum apoB and apoA-I concentrations was studied cross-sectionally. Apo ɛ2/ɛ4 genotype was excluded to avoid confounding. MetS was identified by modified criteria of the Adult Treatment Panel III. Results Among 1673 participants, ɛ3 homozygotes prevailed in 74%, apoE2 (ɛ2/ɛ3, ɛ2/ɛ2) in 12%, and apoE4 (ɛ3/ɛ4, ɛ4/ɛ4) in 13%. Low-density lipoprotein cholesterol and apoB levels were significantly lower and apoE concentrations higher in the apoE2 than in the remaining groups. ApoA-I levels in female subjects were significantly higher than in the E4 group. Multivariable analysis for determinants of apoB showed apoE genotype, serum apoE, C-reactive protein, apoA-I, and triacylglycerol levels to be major independent covariates. Logistic regression analyses for MetS, adjusted for potential confounders, revealed that apoB is linked to MetS in men independently of serum triacylglycerols and apoE2 group, whereas that in women in the apoE2 group was associated with MetS by mediation by triacylglycerols or apoB. The independent inverse association of apoA-I with MetS was considered apparent. Multi-adjusted likelihood of diabetes was associated only with triacylglycerol levels and, in women, with apoA-I (odds ratio 1.43, 95% confidence interval 1.10–1.86, per 1 SD increment). Conclusion The confirmed positive association of serum apoA-I with diabetes in Turkish women is independent of apoE genotype and apoB levels.

WOS: 000261016000009 PubMed: 18694616 Background Et aims: Whether serum homocysteine levels are associated with coronary heart disease (CHD) and the metabolic syndrome (MS) needs investigation in different ethnic groups. These associations and the influence of serum folate and vitamin 1312 thereupon were addressed separately in genders. Methods: A random sample of Turkish adults was studied cross-sectionally. Results: Median age of 338 men and 342 women was 55 years. Geometric mean serum homocysteine concentrations were 12.7 +/- 1.5 mu mol/l in men and 9.6 +/- 1.4 mu mol/l in women (p < 0.001). Linear regression analysis among 11 variables revealed mate sex, reduced estimated glomerular filtration rate (eGFR) and vitamin B-12, (in men) reduced folate as significant independent covariates of higher homocysteine levels. Logistic regression analysis disclosed that (sex-specific) top versus bottom homocysteine tertile was borderline significantly and independently associated with CHD in men and both genders combined, after adjustment for gender, age, smoking status, systolic blood pressure, eGFR, folate and vit B-12. Folate revealed significant inverse association with CHD likelihood in men and combined genders (OR 0.73 for doubling [95%CI 0.56; 0.94]), independently of homocysteine levels and even of presence of type-2 diabetes. Serum vit B-12 concentrations were significantly associated with MS likelihood in women atone after adjustment for sex, age, smoking status, folate and antidiabetic medication. Conclusion: High serum homocysteine and tow folate levels are associated in Turkish men independently with CHD, which needs confirmation in a larger sample. In women, vitamin B-12 concentrations are significantly associated with MS likelihood. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. Turkish Society of Cardiology; Pharmaceutical and Nutritional Companies AstraZeneca, Pfizer, SanofiAventis, Novartis and, Danone, Istanbul, TurkeySanofi-AventisPfizer We thank the Turkish Society of Cardiology and the pharmaceutical and nutritional companies AstraZeneca, Pfizer, SanofiAventis, Novartis and, Danone, Istanbul, Turkey, that have supported financially the Turkish Adult Risk Factor survey 2005-07. We appreciate the dedicated works of A.M. Esen, MD; H. Uyarel, MD; A. Karabulut, MD; Z. Kaya and Mr. M. Ozmay, the coworkers in the survey teams.

Uncontrolled usage of herbal medications may cause problems that can lead to serious complications, including death. Panax is thought to have hypocholesterolemic, anticarcinogenic, antiinflammatory, and antimicrobial effects via its saponin ingredient and positive inotropic effects via its panax ginseng effect. However, clinical studies have shown that it can increase the low-density lipoprotein (LDL) levels secondary to its hypocholesterolemic effect, have a hypertensive effect in chronic users via ginseng abuse syndrome, and also have hypotensive effects. Here, we present a case with typical angina pectoris in which coronary angiography was suggested but refused. The male patient initiated panax therapy and presented to our emergency department with diffuse anterior myocardial infarction and cardiogenic shock, and was discharged after appropriate therapy.

Background: The effects of varenicline, an effective drug for smoking cessation, on atrioventricular and ventricular conductance remain unknown. Objective: To evaluate the effects of varenicline on heart rate, PR interval, QT interval and QT dispersion (QTd). Meth ods: A total of 60 smokers were prospectively enrolled in the present study. Twelve-lead electrocardiogram recordings were obtained for all subjects before and on the 15th day of drug administration. Electrocardiograms were recorded at an amplitude of 20 mm/mV and a sweep speed of 50 mm/s. \ Results : The mean (± SD) age of the volunteers was 38±10 years. Thirtyfour (57%) were male. Fourteen (23%) had hypertension, eight (13%) had diabetes and six (10%) had chronic obstructive pulmonary disease. The mean heart rate was 74.7±13.3 beats/min, and mean systolic and diastolic blood pressures on admission were 122.3±14.3 mmHg and 76.5±10.2 mmHg, respectively. Heart rate, and systolic and diastolic blood pressures did not change with varenicline treatment. Varenicline treatment resulted in limited prolongation in PR interval, which appropached significance (163.5±18.3 ms versus 168.2±17.9 ms; P=0.053), while RR interval (796.3±117.4 ms versus 798.3±123.7 ms; P=0.926), QT interval (384.1±17.5 ms versus 383.4±20.9 ms; P=0.852) and QTd (52.6±14.9 ms versus 52.2±14.9 ms; P=0.919) were not significantly changed. Conclusion: Varenicline had a limited effect on atrioventricular conduction, while it had no effect on heart rate, QT interval and QTd. Further studies are needed to prove the effects of varenicline on the conduction system of the heart, especially on PR interval.

Co-existence of coronary and cerebral aneurysms is rare, though coronary and cerebral aneurysms are not infrequent. We present a case with this co-existence of coronary and cerebral aneurysms presented with ST segment elevation myocardial infarction and cerebrovascular event.

We report a case of aorta-right ventricular fistula associated with aortic and mitral valve replacements. We considered it as a para valvular leakage. Aorta-right ventricular fistula is a very rare variant of paravalvular leakage. We discuss the aetiology, diagnosis, and preventive and therapeutic options in the modern era.

Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder occurring in approximately 1 out of every 400 to 1,000 live births. An extremely rare association between ADPKD and coronary aneurysms has been determined. No connection between this association and acute coronary syndromes has been identified; however, a few reports have appeared in the literature. We present and demonstrate the very rare association of ADPKD and coronary aneurysm, and briefly review this unusual relationship.

WOS: 000326838600006, PubMed ID: 24107209, Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. Methods: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. Results: Fifty-two patients (mean age 11.24.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 +/- 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). Conclusion: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.

WOS: 000320505500008, PubMed ID: 23648718, Recovery of the ventricular function in a patient with cardiomyopathy is very rare. Autoimmune polyendocrine syndrome is also very rare. We herein report a case of reversed cardiomyopathy associated with autoimmune polyendocrine syndrome type II (Schmidt's syndrome) composed of Addison's disease, vitiligo and Hashimoto's thyroiditis. The ventricular function and size were reversed following the administration of suitable hormone replacement therapy for polyendocrine syndrome.

A 58-year-old woman with a history of mitral valve replacement (MVR) 17 years ago was admitted to our outpatient clinic with shortness of breath and a nonproductive cough. On physical examination, her blood pressure was 90/ 60 mmHg, and heart rate was 122 beats/min. Distended neck veins were noted, basal crepitations were heard in lungs, and there was grade I peripheral edema. A prosthetic valve sound and a grade III pansystolic murmur were present along the left mid-clavicular line. ECG (Cardioline Delta 60 Plus CP/1 version, Remco Italy Cardioline, Milan, Italy) showed atrial fibrillation with a ventricular rate of 110 beats/min. Laboratory evaluation revealed a creatinine level of 1.36 mg/dL (0.4–1.0), an albumin level of 3.8 mg/dL (3.2– 4.8), and pro-brain natriuteric peptide level of 3050 ng/L (12–133). Chest x-ray revealed marked cardiomegaly (Fig. 1). Echocardiographic examination (Vivid 7 pro, GE, Horten, Norway) showed normal functioning MVR with massive biatrial enlargement (left larger than right), moderate mitral regurgitation, severe tricuspid regurgitation, and mildly depressed left ventricular systolic function. The left atrium, measuring 209 9 96 mm, was so large that it was not possible to fit it to the screen in its entirety (Fig. 2). Giant left atrium is a condition in which the left atrial diameter exceeds 65 mm or one that touches the right lateral thoracic wall. This condition is commonly caused by rheumatic mitral disease and malfunctioning replaced mitral valve. Dilatation is the left atrial compensation mechanism due to the chronic pressure overload in mitral stenosis, to balance pulmonary capillary wedge pressure. It may be misdiagnosed as pleural effusion or a mass, so the clinician must be alert to avoid from further invasive examinations like pleurocentesis or biopsy, which may be associated with dangerous complications. References 1. Hurst JW: Memories of patients with giant left atrium. Circulation 2001;104:2630–2631. 2. Akdemir I, Davutoglu V, Aksoy M: Giant left atrium, giant thrombus, and left atrial prolapse in a patient with mitral valve replacement. Echocardiography 2002;19(8):691– 692. Figure 1. Increased cardiothoracic index and left atrial size in x-ray.

Zakkum (Nerium oleander), her ne kadar Akdeniz bölgesine özgü bir bitki olsa da, bilhassa ılıman bölgelerde olmak üzere tüm dünyada yetiştirilebilir. Biyolojik olarak aktif olan oleander bileşenleri terapötik amaçlarla kullanılabilmektedir. Ancak, bitkisel tedavi amaçlı kişisel kullanımı, ölüm dahil birçok ciddi soruna yol açabilir. Bu yazıda, hemoroit yakınmaları nedeniyle kişisel bitkisel tedavi amacıyla zakkum yapraklarından hazırladığı şurubu içtikten sonra tam atriyoventriküler blok gelişen, 30 yaşında, başka sağlık sorunu olmayan bir erkek hasta sunuldu. Hastaya sodyum sülfat ile birlikte ağızdan kömür tedavisi, elektrolit sıvı desteği ve geçici kalp pili tedavisi uygulandı. Atriyoventriküler blok 30 saat sonra sinüs ritmine döndü ve hasta hemodinamik ve genel durumu düzelmiş şekilde taburcu edildi., Nerium oleander is a plant native only in the Mediterranean region, but it can also be cultivated worldwide, particularly in warm areas. Biologically active oleander compounds may be used for therapeutic purposes. However, when used for self-medication, it may cause serious problems including death. We present a 30-year-old otherwise healthy man who developed complete atrioventricular block after taking a syrup of N. oleander leaves for self-medication to relive hemorrhoidal complaints. The patient was treated by oral administration of charcoal combined with sodium sulfate as well as electrolyte solutions and transient use of an external cardiac pacemaker. The atrioventricular block reverted to sinus rhythm in 30 hours and he was discharged in good hemodynamic status and general condition.

WOS: 000298576700010, PubMed ID: 22088859, Objective: The difference of the conduction velocity (CV) around the tricuspid valve annulus between the counter-clockwise (CCW) atrial flutter and the clockwise (CW) atrial flutter has not been well clarified. This study was undertaken to evaluate the CV and the conducting area (CA) per millisecond around the tricuspid valve annulus using the electroanatomical mapping. Methods: The electroanatomical mapping was performed during the tachycardia for 30 consecutive patients (mean age: 61 16 years) with isthmus-dependent atrial flutter (CCW, 25; CW, 5). We measured the CV and the CA of five divided areas of the right atrium, that is, upper septum (US), lower septum (LS), isthmus (I), upper lateral wall (UL) and lower lateral wall (LL) using the novel measurement method in the isochronal map. Statistical differences of these data between the two groups were assessed by the Student's t-test and one-way analysis of variance methods. Results: In total, the CV of the LS was significantly slower than other areas (m/sec: US, 0.57 +/- 0.18; LS, 0.43 +/- 0.18; UL, 0.60 +/- 0.26; LL, 0.53 +/- 0.20; I, 0.50 +/- 0.17; p

WOS: 000297247000020, PubMed ID: 21941213, Objective: The objective of the study was to evaluate hypoxia-inducible factor 1 (HIF-1), which plays a major role in the stimulation of angiogenesis in placental tissues, by using immunohistochemical staining in preeclampsia model of rats, developed by N-nitro-L-arginine methyl ester (L-NAME) Methods: Thirty pregnant rats were randomized into 2 groups (n = 15 in each group) on day 10 of gestation. L-NAME was given to rats in the study group by gavage. On days 0, 10, and 20 of gestation, rats were weighted, and urine protein values and blood pressures were measured. Hypoxia-inducible factor 1 expressions were assessed with immunohistochemical staining by using avidin-biotin peroxidase via selecting preparation. Results: Systolic and diastolic blood pressures and urine protein value of L-NAME group on day 20 of gestation were found to be significantly higher than those obtained on days 0 and 10 of gestation in the same group and those obtained on day 20 of gestation in the sham group (P < 0.05). Maternal weight, number of fetuses, and mean fetal weight of rats in L-NAME group on day 20 of gestation were found to be significantly lower than those obtained from rats in the sham group (P < 0.05). Regarding HIF-1 expression of placental tissues, mild immunohistochemical staining was found in 2 rats (13.4%) and moderate in 13 rats (86.6%) in the L-NAME group. A significant difference was found in terms of HIF-1 positivity in the maternal placentas of both groups (P < 0.05). Conclusions: L-NAME preeclampsia model of pregnant rats is consistent with human preeclampsia in terms of hypertension, proteinuria, and intrauterine growth retardation; in addition, it also shows evidence of placental hypoxia findings.

Chronic myocardial ischemia often presents with a fairly typical history, but patients can present with atypical chest pain or pain referred to a less-typical location like the jaw, stomach, or back. Sometimes patients describe symptoms usually not attributed to heart disease, like indigestion or feeling cold and clammy, in the presence or absence of chest pain. One important clue to underlying coronary artery disease is the appearance of symptoms that are induced by effort and relieved by rest. This paper describes two unusual presentations of myocardial ischemia in patients whose main symptom was hiccups, the first intractable hiccups over months and the second effort-induced hiccups. Both also described atypical chest pain.

Objectives:To confirm previous findings on excess absolute coronary heart disease (CHD) risk among Turks. Methods: The observed incident CHD risk of a representative population sample was compared with that anticipated by Fra- mingham risk scores (FRS). At 7.4 years of follow-up of 3,027 participants free of CHD at baseline, risk estimation was contrasted in the 398 cases of newly developed fatal and nonfatal CHD. Results:CHD developed at a rate 2.2 times higher than the anticipated risk. In sex-specific quintiles of FRS, the 10-year incidence of CHD events in males in the 2 highest quintiles was 2 times the anticipated levels. In women, the 3 highest quintiles displayed an incidence 2.7 times the anticipated risk. Such individuals typically had abdominal obesity and evidence of dysfunctional apolipoprotein (apo) A-I. Men had high levels of non-high-density lipoprotein (HDL) cholesterol, total apoC-III, apoB and triglycerides. In Cox proportional hazard regression analyses, the 10-year probability of remaining free of CHD was low (81.1% in men, 84.2% in women). Women exhibited C-reactive protein as an independent predictor of CHD, lack of protection by HDL cholesterol and no conferred risk from current smoking. The observed excess CHD risk was primarily attributed to central obesity and related dysfunction of HDL, apoC-III and apoA-I. Conclusion: Dysfunction of protective serum proteins associated with metabolic syndrome impacts on CHD events, in addition to conventional risk factors.

We analyzed the temporal trend and regional distribution of age at all-cause death and the sex-specific and age-bracket defined coronary mortality in the 18-year follow-up of the Turkish Adult Risk Factor Study.The participants of the Turkish Adult Risk Factor Study who have been examined in even years were last surveyed in August 2008. A total of 1,582 individuals were surveyed, which constituted half of the alive participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local heath offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. The cumulative follow-up was 56,700 person-years.Of 1,582 participants, 868 (431 men, 437 women) were examined, in 604 subjects information was gathered, and 47 participants (26 men, 21 women) were ascertained to have died. Twenty-two deaths were classified as of coronary origin. Cumulative assessment of the entire cohort in the age bracket of 45-74 years disclosed coronary mortality to be 7.64 per 1000 person-years in men and 3.84 in women and persisted to be the highest among 30 European countries, whereas overall mortality declined at a greater proportion. Overall mean ages at death were deferred within a 12-year period by 7.4 years in men and 6 years in women, to 71.9 and 74.8 years, respectively. The extension of this mean survival was similar among urban-rural areas and geographic regions.Coronary mortality declined modestly, but life expectancy of Turkish adults rose by a mean of nearly seven years in the 12 years to 2003-08, without showing major differences in sex, urban-rural dwelling, or geographic regions.

The impact of alcohol consumption on various outcomes was prospectively evaluated in the participants of the Turkish Adult Risk Factor Study.A total of 3,443 men and women (mean age 47.6+/-12 years) were included at baseline and followed-up for a mean of 7.4 years (range 5 to 9 years). Alcohol drinking status was assessed as abstention and brackets of moderate and heavy intake. Only 19.5% of adults (35% of men and 4.2% of women) reported consumption of alcohol. In each multivariate analysis, individuals with the examined endpoint at baseline were excluded, and alcohol drinking status was adjusted for age, sex, smoking status, and physical activity.Alcohol intake increased overall mortality (by 2-fold) in men drinking heavily, but not in men drinking moderately, nor in women. Heavy drinking in combined sexes predicted the risk for incident coronary heart disease (CHD) (RR 2.3; 95% CI 1.30; 4.05), while moderate drinking tended to be protective (RR 0.72; 95% CI 0.50; 1.035). Heavy intake predicted incident diabetes risk (RR 2.13) and tended to be so for new metabolic syndrome (MetS) in men (RR 1.71), whereas moderate alcohol intake was not significantly associated with subsequent development of diabetes or MetS and the risk for MetS was reduced in women (p=0.10).Risk of alcohol intake depends on the amount used: heavy intake raising the risk for diabetes and CHD in combined sexes, and overall mortality in men, contrasted to moderate intake reducing (borderline) the CHD risk and marginally reducing all-cause mortality. Risk for MetS tends to be reduced in women alone.

We determined serum adiponectin's role as a biomarker of metabolic syndrome (MetS), type 2 diabetes (DM) and hypertension among Turkish adults who have a high prevalence of MetS. Individuals with measured serum adiponectin concentrations, constituting a random sample of Turkish adults, were studied cross-sectionally. MetS was identified by criteria of the Adult Treatment Panel-III modified for male abdominal obesity. Median age of 547 men and 652 women was 54 years. MetS was identified in 46%. Linear regression analysis among nine variables revealed homeostatic model assessment (HOMA) index in both sexes and C-reactive protein (CRP) only in men as inversely associated covariates of adiponectin, and sex hormone-binding globulin (SHBG) as positive covariate in women. Age-adjusted sex-specifically dichotomized high vs. low adiponectin levels were significantly associated with DM (odds ratio (OR) 0.55, P = 0.01) and hypertension (OR 0.64, P = 0.012) in women, but not in men. Further adjustment for smoking status and presence of high/low BMI did not alter this sex-based relationship. As regards association with MetS, low adiponectin and high BMI interacted significantly in each sex. Yet adiponectin was associated only in men additively to the simultaneously adjusted five MetS components. We conclude that adiponectin concentrations, clearly linked to metabolic disorders, may diverge among sexes regarding protection against cardiometabolic risk through anti-inflammatory or antioxidative function, Turkish men alone revealing significant dysfunction independent of obesity. This dysfunction may underlie also the association of adiponectin levels with MetS in men to be independent of the MetS components.

We analyzed all-cause and coronary mortality as well as incident coronary heart disease (CHD) among the participants of the Turkish Adult Risk Factor Study, who resided essentially in the Marmara and Central Anatolia regions and were surveyed in the summer of 2007.Information on the mode of death was obtained from first-degree relatives and/or health personnel of the local health office. Most of the participants who were alive underwent physical examination and 12-lead electrocardiography. Incident CHD was defined as fatal or nonfatal myocardial infarction that occurred after the previous survey or incident stable angina and/or myocardial ischemia.Of 1,618 participants to be surveyed, 961 were examined, 501 subjects were assessed based on information obtained, 18 men and 12 women were dead, and 52 subjects were lost to follow-up. The number of newly recruited subjects was 138. Addition of 3,010 person-years of follow-up raised the total follow-up of the survey to 48,500 person-years. Eight deaths were attributed to CHD; new coronary events were identified in 16 subjects. Annual mortality was estimated as 10.0 and coronary mortality as 2.7 per 1,000 adults. Overall mortality which was 11.2 per 1,000 person-years in the original cohort declined to 9.1 and 5.9 in more recently recruited 1997/98 and 2002/03 cohorts, respectively. In the age bracket of 45 to 74 years, all-cause mortality which was 15.2 in 2004 decreased to 10.2 per 1,000 person-years in the past three years (p=0.003), with a corresponding decrease in coronary mortality from 6.0 to 5.1 (p0.18), indicating that the decreasing trend in overall mortality and coronary deaths observed in this age group in the previous years did not level off.Our data show that the incidences of overall and coronary mortality continue to decline.

WOS: 000266884600013 PubMed: 18582961 The role of plasma fibrinogen levels in predicting metabolic syndrome (MetS) and assessment of determinants of these levels were investigated. A total of 2234 men and women, aged 49 +/- 12 years, representative of Turkish adults who had plasma fibrinogen determinations, were prospectively evaluated and followed for a mean of 6.6 years. The modified Clauss method was used for assays. MetS was defined by ATPIII criteria modified for male abdominal obesity. MetS cases at baseline were excluded in prospective analyses. Median (interquartile range) fibrinogen values were 2.87 (2.29; 3.56) g/L. Fibrinogen levels predicted significantly newly developing MetS in men (RR 1.40 [95%CI 1.07; 1.83] for a 2-fold increment), after adjustment for age and smoking status, and (RR 1.32 [95%CI 0.95; 1.83] again for doubling), after additional adjustment for all 5 components of MetS. MetS was not significantly predicted by fibrinogen levels in women in either multivariable model. By regression analysis of eight covariates, not waist circumference, but systolic blood pressure, current smoking and C-reactive protein (CRP) in men, and age in women were predictors of elevated (>3.0 g/L) fibrinogen at follow-up (p

To the best of our knowledge this case is the first case of INVM presented with typical angina and ischemic ECG findings without atherosclerotic narrowing but a myocardial bridge in the midportion of the left anterior descending artery documented with coronary angiography.

other A 71 years old female patient presented with shortness of breath, cough, pleuretic chest pain and hemoptysis. Blood pressure was 160/90 mm/Hg and heart rate was irregular with 125 beats per minute.

Carbon monoxide is a nonirritant, odorless, colorless gas, and is lighter than air. It is an end product of the incomplete combustion of hydrocarbons. Its effects are most prominent in organs sensitive to oxygen deprivation, such as the heart, brain, and kidney. Carbon monoxide poisoning becomes more abundant in winter and at cold places. In Turkey, every year we see several deaths due to poisonous gas leaks from coal or wood stoves. Deaths particularly due to hypoxia-related central nervous system damage and ventricular dysrhythmias are observed. On the other hand, an association between thromboembolic accidents and carbon monoxide poisoning has been shown in literature. Thromboembolic accidents in the mesenteric, central nervous system, and extremities are reported. However, no atrial thrombus has been mentioned. In this study, a case of an atrial thrombus associated with carbon monoxide poisoning following a diagnosis of carbon monoxide poisoning and treatment in the emergency room is reported and the literature is revisited.

We report a case of persistent left superior caval vein whom presented with angina pectoris and exertional dyspnea. Echocardiography showed wall motion disturbances with an ejection fraction of 40% and a very large coronary sinus. Our case is a very rare case with a very large coronary sinus presented with angina pectoris.

[No abstract available], Department of Cardiology, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey