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Background The ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI). Objective Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI. Methods Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined. Results Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95 ± 7.93% vs. 40.32 ± 7.28%; p = 0.011); it worsened in smokers at follow-up (mean decrease in LVEF: −2.70 ± 5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97 ± 8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF. Conclusion True or persistent ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing p-PCI. The ‘smoker's paradox’ is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.

We investigated the relationship between resting heart rate (HR) and The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score in patients with stable coronary artery disease (SCAD). A total of 420 patients who were admitted to our outpatient clinic for stable angina pectoris with sinus rhythm and had at least 50% narrowing in at least 1 coronary artery after coronary angiography were included in the study. Patients were divided into 3 tertiles based on the resting HR: HR of tertile 1 was ≤65 (n = 138), tertile 2 was between 66 and 76 (n = 139), and tertile 3 was ≥77 beats/min (n = 143). The SYNTAX score (7.6 ± 4.6, 12.4 ± 5.6, 20.3 ± 8.1; P < .001) was significantly higher for those in tertile 3 than for those in tertiles 1 and 2. Leukocyte count (7.8 ± 2.2, 7.9 ± 2.2, 8.4 ± 2.3 × 109/L; P = .035) and C-reactive protein (CRP) levels (2.4 ± 0.5, 3.2 ± 0.7, 4.5 ± 1.2 mg/L, P < .001) were increasing from the lowest to the highest tertile. Using multiple logistic regression analysis, CRP (odds ratio [OR] 1.54 [1.17-2.11], P = .001) and resting HR (OR 1.67 [1.25-2.19], P < .001) emerged as independent predictors of SYNTAX score. Resting HR is related to SYNTAX score in patients with SCAD.

Background: Coronary Slow Flow (CSF) is described as delayed opacification of the distal vasculature and angiographically Normal Coronary Arteries (NCA). Numerous studies have suggested that the interval from the peak to the end of electrocardiographic T wave (Tp-e) may correspond to transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. Objectives: The present study aimed to evaluate ventricular repolarization in patients with CSFby using Tp-e interval and Tp--e/QT ratio. Patients and Methods: This study was conducted on electrocardiographic parameters of 100 patients with angiographically proven NCA with CSF in all three coronary arteries and 100 patients with NCA without CSF. The patients were followed up for arrhythmias and clinical events. Results: Tp–e tail interval (120 ± 5.5 msn, 101 ± 3.9 msn; P < 0.001), Tp–e tangent interval (99 ± 4.0 msn, 78 ± 3.0 msn, P < 0.001), Tp-e tail/QT ratio (0.31 ± 0.004, 0.26 ± 0.003, P < 0.001), and Tp-e tangent/QT ratio (0.25 ± 0.003, 0.19 ± 0.003, P < 0.001) were significantly higher in the CSF patients compared to the NCA group. Rhythm holter analyses also showed that ventricular extrasystoles were higher (157 ± 22.5, 87 ± 11.9, P = 0.002) in the CSF group compared to the NCA group. Conclusions: Tp-e interval and Tp-e/QT ratio were significantly higher in the patients with CSF compared to the NCA group

Objective Although the role of platelet activation has been debated in patients with mitral stenosis (MS) and spontaneous echocardiographic contrast (SEC), data on differences in mean platelet volume (MPV) according to the presence of SEC/left atrial thrombus and the rhythm status are lacking. In this study, MPV was analyzed in patients with MS according to the presence of SEC/left atrial thrombus. Methods Between January 2005 and March 2014, 188 symptomatic patients having moderate or severe MS (mean age, 45.0±11.7 years; female, 81.4%) with favorable valve morphology for percutaneous mitral balloon valvuloplasty (PMBV) and underwent a transesophageal echocardiogram to assess the eligibility for PMBV were retrospectively enrolled in the study. The relation between MPV and echocardiographic thromboembolic risk factors were evaluated. Independent predictors of SEC/left atrial thrombus presence were determined by multiple logistic regression analyses. Results Among all patients, MPV did not differ according to the rhythm status or the presence of SEC/left atrial thrombus (p>0.05). Also, MPV did not vary according to the gender and presence of prior stroke in both atrial fibrillation and sinus rhythm groups (p>0.05). In correlation analysis, MPV did not show any significant correlation with the echocardiographic thrombus predictors (p>0.05). Conclusion Using MPV with echocardiographic and clinical thrombus risk determinants for predicting individual thromboembolism risk in MS is debatable according to our results.

In many cardiovascular diseases (CVD), white blood cell counts with differentials are used to predict adverse events. Both platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are studied in various CVDs.The role of inflammatory condition assessed using routine laboratory tests in cardiac resynchronisation therapy (CRT) response has not been investigated thoroughly. Therefore, we aimed to assess the association of NLR, PLR, and relative lymphocyte count (L%) with response to CRT.A total of 157 patients (76.4% male; mean age 58.7 ± 11.8 years) who underwent CRT implantation at our tertiary referral hospital were retrospectively analysed.Among included patients, a total of 50 (31.8%) patients were defined as "non-responders". Median NLR and PLR were significantly higher in the non-responder group (p0.001), and median L% was significantly lower in the non-responder group (p0.001). Also, median NLR was significantly higher in patients with New York heart Association (NYHA) class II-III when compared to patients with NYHA class I after six months of CRT implantation (p0.001, p = 0.004, respectively). Correlation analysis demonstrated a positive correlation between paced QRS duration and NLR (p = 0.031) and a negative correlation between paced QRS duration and L% (p = 0.002). In addition, both NLR and L% showed significant correlations with post-procedural NYHA functional classes (p0.001; p = 0.008, respectively). Patients with PLR173.09 had a 2.9‑fold and NLR3.45 had a 12.2-fold increased risk of CRT nonresponse, respectively.In the current study non-responders to CRT had higher NLR and PLR and lower L%, which may support the deleterious effects of baseline inflammatory condition in advanced heart failure.

Endothelial dysfunction plays a major role in erectile dysfunction (ED). Atrial fibrillation (AF), regardless of subtype, is associated with a prothrombotic state, which is related to endothelial dysfunction. In this study, we aimed to determine whether AF is an independent risk factor for ED. A total of 50 patients diagnosed with paroxysmal lone AF and 80 age-, gender-, and body mass index-matched controls without AF who admitted to outpatient clinics at a tertiary center were enrolled. Diagnosis of ED was performed by using Sexual Health Inventory for Men (SHIM) questionnaire. Patients with a SHIM score ≤21 were defined as having ED. Mean age of patients were 51.8 ± 7.7 and all of the study population were male. Twenty-nine of 50 patients in lone AF group and 25 of 80 patients in control group were diagnosed with ED (58 vs 31.2 %, p = 0.002). Mean SHIM score was significantly lower in lone AF group compared with controls (20.74 ± 2.67 vs 22.39 ± 2.21, p

Infarct-related artery (IRA) patency yields a better outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Red cell distribution width (RDW) emerges as a marker of adverse cardiovascular events and mortality in STEMI. Therefore, we aimed to assess the relationship between IRA patency and RDW value on admission in patients with STEMI undergoing primary PCI.A total of 564 patients with STEMI undergoing primary PCI were recruited in this study. According to thrombolysis in myocardial infarction (TIMI) flow grade in the IRA before PCI, the study population was divided into two groups as TIMI 0 or 1 group (occluded IRA, n = 398) and TIMI 2 or 3 group (patent IRA, n = 166).RDW was significantly higher in the occluded IRA group (15.1 ± 1.7 versus 13.4 ± 1.3, p 0.001) as compared to the patent IRA group. White blood cell (WBC) count, platelet count, creatine kinase-myocardial band (CK-MB) and troponin-I levels were also significantly higher in the occluded IRA group (p 0.05). Moreover, RDW showed positive correlations with troponin-I (r = 0.397, p 0.001), CK-MB (r = 0.344, p 0.001) and WBC (r = 0.219, p 0.001). In multivariate regression analysis, RDW (OR: 0.483, 95% CI: 0.412-0.567, p 0.001) and WBC count were significantly and independently associated with IRA patency.Our findings suggested that RDW value and WBC count on admission were independent predictors of IRA patency in patients with STEMI. As RDW is an easily available, simple and cheap biomarker, it can be used in daily practice as a novel predictor for IRA patency.

OBJECTIVE Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Vitamin D deficiency is associated with cardiovascular diseases such as coronary artery disease, heart failure and hypertension. We aimed to evaluate the effect of vitamin D on nondipper hypertension. DESIGN This study included total 200 essential hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring was performed for each patient. In addition to routine tests, vitamin D levels were analysed. RESULTS The study population was divided into two groups: 100 dipper patients (mean age; 50.6±9.9 years, 54 women and 46 men) and 100 nondipper patients (mean age; 49.2±8.2 years, 53 women and 47 men). Clinical blood pressures were significantly higher in nondipper hypertensives than dipper hypertensives (systolic blood pressures 141.2±5.6 vs. 139.1±6.6 mmHg, diastolic blood pressures 88.4±2.6 mmHg vs. 87.4±3.4, P

Introduction Patients with heart failure (HF) and implantable cardioverter defibrillators (ICDs) may misunderstand the indication of ICDs due to unsatisfactory information. The goal of this study is to evaluate the patient perspective of ICD indication and its relation to quality of life, as well as to identify probable communication gaps between doctors and ICD receivers. Methods A total of 119 patients with HF who were implanted with a single-chamber ICD were evaluated in outpatient clinics. Patients with cardiac resynchronization therapy-defibrillators were not included in the study. In a questionnaire, patients were asked about the indication of the ICD procedure and classified according to the perceived benefits. Results This study showed that most of the patients (n = 92, 77.3%) believed that ICD was implanted for improvement of heart dysfunction or for symptom relief. According to the perceived benefit groups, physical function, general health, vitality, and role physical scores were significantly lower in the symptom relief group (p

Epicardial adipose tissue (EAT) is the ectopic fat surrounding the heart, and it may contribute to coronary collateral vessel (CCV) formation. We aimed to evaluate the association of EAT with the presence of CCV in patients with acute coronary syndrome (ACS).A total of 230 patients with ACS were included. The CCVs were graded according to the Rentrop scoring system, and a Rentrop grade 0-1 was accepted as low-grade CCV group, Rentrop grade 2-3 was accepted as high-grade CCV group.According to angiography, 70 (30%) patients constituted the high-grade CCV group and 160 (70%) constituted the low-grade CCV group. The high-grade CCV group had thicker EAT than the low-grade CCV group (6.1 ± 1.4 vs. 5.3 ± 1.4 mm; p = 0.001). Multivariate logistic regression analysis showed that presence of CCV was independently associated with EAT thickness, ejection fraction, presenting with ST-segment elevation myocardial infarction, and presence of angina on admission. EAT thickness of5.7 mm can independently predict high-grade CCV with 73% sensitivity and 69% specificity (area under the curve or AUC: 0.65; 95% confidence interval or CI: 0.57-0.72).EAT thickness on admission was associated with the presence of CCVs in patients with ACS.

Objectives. Platelet-to-lymphocyte ratio (PLR) provides a simple method for assessment of infl ammatory status. The aim of the present study was to investigate the predictive value of preprocedural PLR on development of in-stent restenosis in patients undergoing bare-metal stent (BMS) implantation. Design . Six hundred and seventy-fi ve consecutive patients (mean age: 60.6 8.3, 66% men) who had undergone successful BMS implantation and additional coronary angiography for stable or unstable angina pectoris were analyzed. Mean period between 2 coronary angiographies was 14.3 3.4 months. Results. Patients were divided into tertiles based on preprocedural PLR. Restenosis occurred in 58 patients (26%) in the lowest tertile, in 82 (36%) in the middle tertile, and in 115 (51%) in the highest tertile ( p 0.001). Serum C-reactive protein levels were also signifi cantly higher in patients in tertile 3 than in those in tertiles 1 and 2 ( p 0.001). Smoking, diabetes mellitus, high-density lipoprotein, stent length, preprocedural PLR, and C-reactive protein levels emerged as independent predictors of in-stent restenosis. In receiver-operating characteristics curve analysis, PLR 122 had 81% sensitivity and 72% specifi city in predicting in-stent restenosis. Conclusions. High preprocedural PLR is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.

Objective: Despite recent advances in medical support and interventions, only 5% to 10% of patients with out-of-hospital cardiac arrest (OHCA) survive to discharge. In this study, factors related to neurologically favorable survival in patients with OHCA were analyzed. Methods: A total of 129 patients who were admitted to hospital with OHCA were retrospectively enrolled. Results: Sustained return of spontaneous circulation (ROSC) (ROSC lasting >20 min) was achieved in 29 (22.4%) patients. Percentage of cardiac arrests with ischemic etiology was significantly higher in successful ROSC group (p

The polymorphic ventricular tachycardia (PVT) is uncommon arrhythmia with multiple causes and has been classified according to whether they are associated with long QT interval or normal QT. Whereas “Torsade de pointes (TdP)” is an uncommon and distinctive form of PVT occurring in a setting of prolonged QT interval, which may be congenital or acquired (congenital or acquired), “PVT with normal QT” is associated with myocardial ischemia, electrolyte abnormalities (hypokalemia), mutations of the cardiac sodium channel (Brugada syndrome), and the ryanodine receptor (catecholaminergic PVT). This distinction is crucial because of the differing etiologies and management of these arrhythmias. Moreover, the PVT in the setting of acute MI generally occurs during the hyperacute phase, is related to ischemia (“ischemic PVT”) and is not associated with QT prolongation. It is triggered by ventricular extrasystoles with very short coupling interval (the “R-on-T” phenomenon) and is not pause-dependent. However, recently there has been described a new PVT during the “healing phase” of MI in patients with no evidence of ongoing ischemia and following excessive QT prolongation, the electrophysiologic abnormality being a “pause-dependent infarct-related TdP” due to a LQTS in healing MI patients. Therefore, “ischemic PVT” differs from “infarct-related TdP” in terms of pathophysiology and ECG manifestations.

Background T-wave peak to T-wave end interval (Tp-e) correlates with dispersion of ventricular repolarization. The purpose of this study was to assess the ability of Tp-e to predict appropriate implantable cardioverter defibrillator (ICD) shocks and all-cause mortality in patients who underwent ICD implantation for primary prophylaxis. Methods Two hundred twenty-eight patients with left ventricular ejection fraction ≤35% and an ICD implanted were followed-up prospectively. Patients divided into two subgroups according to presence of appropriate ICD shocks (Group 1: 112 patients with ICD shocks, Group 2: 116 patients without shocks). End points were appropriate ICD therapy due to ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined end point of VT/VF or death. Results During a mean follow-up of 22.3 ± 7.7 months, appropriate ICD shocks were observed in 112 of 228 patients (49.1%). The mean duration of the Tp-e Group 1 was significantly longer than Group 2 (115.3 ± 22.2 vs 104.7 ± 20.2 ms, P < 0.001). Ischemic etiology and Tp-e duration were found to be independent predictors of ICD therapy. When the patients were divided into two groups based on Tp-e interval, there was no significant difference regarding the mortality between groups (21.2% vs 21.8%, P: 0.186). However, appropriate ICD shocks due to VT/VF (37.5% vs 58.8%, P < 0.001) and combined end point (39.4% vs 64.5%, P: 0.002) were significantly higher in patients with longer Tp-e group. Conclusions Tp-e interval independently predicts appropriate ICD shocks in patients with systolic dysfunction and ICDs implanted for primary prevention.

Background: Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry. Objective: The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients. Method: We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed. Results: The RVOT-FS was less in HF patients than healthy controls (18.8 ± 15.7 vs 55.8 ± 6.7, p

Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4–6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography.

Objective: The aim of this study was to compare health-related quality of life (HRQoL) measures between novel oral anticoagulants (NOACs) and warfarin-treated Turkish patients who had been started on oral anticoagulants (OACs) due to non-valvular atrial fibrillation (AF) and to determine the effects of OACs on patient’s emotional status, anxiety and depression. Methods: A total of 182 patients older than 18 years with non-valvular AF and being treated with OACs for at least 6 months according to current AF guidelines who were admitted to outpatient clinics between July 2014 and January 2015 were included in this cross-sectional study. The exclusion criteria were receiving OACs for conditions other than non-valvular AF and being unable to answer the questionnaire. A questionnaire was administered to all participants to evaluate HRQoL, depression and anxiety. The mean differences between the groups were compared using Student’s t-test; the Mann–Whitney U test was applied for comparisons of the medians. Results: The annual number of hospital admissions was significantly higher in the warfarin group (p

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil–lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI.

Previous studies showed that both inflammation and platelets have a role in development of slow coronary flow (SCF). Platelet to lymphocyte ratio (PLR) as an emerging inflammatory indicator was significantly associated with adverse cardiovascular events. Therefore, we aimed to assess the relationship between PLR and SCF. Patients who had angiographically normal coronary arteries were enrolled in this retrospective study (n = 221 as SCF group and n = 293 as control group). Patients who had thrombolysis in myocardial infarction frame counts (TFC) above the normal cutoffs were considered to have SCF. Both PLR and C-reactive protein (CRP) were significantly higher in the SCF group. In correlation analysis, PLR has a significantly positive correlation with the left anterior descending artery TFC ( P = .001), circumflex artery TFC ( P < .001), right coronary artery TFC ( P < .001), and serum CRP level ( P < .001). In multiple logistic regression analysis, PLR was independently associated with presence of SCF (odds ratio: 1.014, P < .001). In conclusion, higher PLR levels were significantly and independently related to the presence of SCF. Besides, PLR was positively correlated with serum CRP level as a conventional marker for systemic inflammation.

OBJECTIVE A growing body of evidence supports an association between vitamin D and cardiovascular diseases. Coronary artery bypass grafting surgery is a treatment modality for suitable patients with coronary artery disease; however, patency rates of saphenous vein grafts (SVGs) are low. In this study we aimed to determine the association between vitamin D levels and the SVG disease. METHODS The study population included 180 patients who had undergone a primary coronary artery bypass grafting surgery with at least one SVG and later had a control angiography because of clinical indications. Patients were divided into two groups: 100 patients with SVG disease and 80 of them with patent SVG. RESULTS The mean age of 180 patients was 57.4±8.8 years, and 64.4% of the study population were men. The total number of SVGs was 364, and the mean number of SVGs to each patient was 2.02±0.61. Vitamin D levels were higher in the patent SVG group than in the SVG disease group (36.2±10.7 and 21.1±10.4, respectively; P

Coronary artery vasospasm is an important cause of chest pain syndromes that can lead to myocardial infarction, ventricular arrhythmias, and sudden death. In 1959, Prinzmetal et al described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography. Persistent angina is challenging, and repeated coronary angioplasty may be required in this syndrome. Calcium antagonists are extremely effective in treating and preventing coronary spasm, and may provide long-lasting relief for the patient. Whereas the Wellens' syndrome is characterized by symmetrically inverted T-waves with preserved R waves in the precordial leads suggestive of impending myocardial infarction due to a critical proximal left anterior descending stenosis, the pseudo-Wellens' syndrome caused by coronary artery spasm has also rarely been reported in literature. We present a pseudo-Wellens syndrome as a cause of vasospastic angina, and a diffuse ST segment elavation on electrocardiogram resembling the Greek letter lambda, called also 'action potential-like' ECG in a patient with vasospastic-type Printzmetal angina.

A 32 year-old previously healthy man presented theemergency de-partment with a 6-hour history of retrosternal chest pain, palpitationsandemesis.Hissymptomsstarted5or6hafterdrinking5bottlesofen-ergy drink. He denied cigarettes, alcohol, cocaine or other drug uses.There was no family history of premature coronary artery disease.At admission his vital signs were blood pressure 178/92 mm Hg,pulse 85, temperature 37 °C, 98% oxygen saturation, and breathingwasrate22respirationsperminute.Physicalexaminationwasunremark-able.TheECGshowedmarkedSTelevationV2throughV6( Fig.1).Abed-side echocardiogram demonstrated anterior, apical and interventricularseptum hypokineses, and normal aorta and left ventricular EF was 35%.An emergent coronary angiogram performed demonstrated a largethrombus occupying nearly 90% of the diameter of the left main coro-nary artery and a second thrombus that occluded the proximal leftanterior descending artery (Fig. 2a,b,c). No atherosclerotic lesions orcoronary malformations were identified.After coronary angiogram we performed balloon angioplasty to a100% thrombotic LAD lesion.Before angioplasty intracoronary tirofibanbolus was administrated. After balloon angioplasty LADflow wasachieved at proximal segment but TIMI 0 flow at distal segment. Al-though repeated balloon angioplasty distal LADflow could not beachieved. After angioplasty procedure the patient was admitted to coro-narycareunit.After24-hourtiro fibanandheparininfusioncontrolangi-ography was planned but the patient refused control angiography.Further laboratory tests, including a lipid pro file and coagulation panel,were within normal limits. Anticardiolipin antibodies, homocysteinelevel, andprotein C and protein S activities were negative or within nor-mal ranges. The patient was discharged home with dual antiplatelettherapy.Energy drinkconsumptionisincreasingandhasbecomevery popu-lar,especiallyamongyoungpeople.Previouscasereportshadlinkeden-ergy drinks with sudden cardiac death, coronary vasospasm, reversibleposturaltachycardiasyndrome,andseriousarrhythmias,includingven-tricular fibrillation. Most of the cases were related to overuse or con-comitant alcohol intake [1–4].Almost all such commercially available drinks have the same basicstimulants, caffeine, glucoronolactone, taurine, and vitamins, and it isdifficulttoknowwhichcomponentisresponsiblefortheeffectinplate-let aggregation and endothelial function. Energy drink consumptionacutely increases platelet aggregation and decreases endothelial func-tion in healthy young adults [4]. Endothelial function acutely becomesworse after drinking energy beverage [5]. These drinks contain, amongother ingredients, large amounts of caffeine. Though these drinks con-tain many other ingredients in addition to caffeine, there is little evi-dence they bare any hazards. Caffeine in high doses is well related tovarious adverse effects, and though it has a wide therapeutic index,there are many reports of serious toxicities, even death [6].Theeffectsofenergydrinksshouldbebetterinvestigatedbecauseoftheir increasing consumption by the public and their potentially lethaleffects.References

Coronary artery anomalies are detected on approximately 1.3% of coronary angiograms. Single coronary artery anomaly (SCA) is defined as the coronary artery arising from a single coronary ostium, nourishing the entire heart. SCA anomalies are usually benign; however, serious complications such as sudden cardiac death and myocardial infarction resulting from these anomalies are also reported in the literature. We report the anomalous origin of the right coronary artery (RCA) as a continuum of the septal branch from the left anterior descending (LAD) artery, which is a very rare variation of a single coronary artery.

Background and Objectives: Coronary artery ectasia (CAE) is an angiographic finding characterized by dilation of an arterial segment with a diameter at least 1.5 times that of its adjacent normal coronary artery. Fragmented QRS (fQRS) complexes are electrocardiographic signals which reflect altered ventricular conduction around regions of a myocardial scar and/or ischaemia. In the present study, we aimed to evaluate the presence of fQRS in patients with CAE. Subjects and Methods: The study population included 100 patients with isolated CAE without coronary artery disease (CAD) and 80 angiographically normal controls. fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of frag mentation in two contiguous leads corresponding to a major coronary artery territory. Results: The two groups were similar in terms of age, sex, hypertension, dyslipidemia, and family history of CAD. The presence of fQRS was significantly (p