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Amac: Kemik iliginde bulunan kok hucreler, doku onarimini artirmak icin miyokardiyal hasar sonrasi dolasima salinmaktadir. Basta atriyal fibrilasyon olmak uzere; kardiyak aritmilerin radyofrekans ile ablasyonu sonrasi dolasimda bulunan kok hucrelerin inflamatuar aracilar vasitasiyla saliniminin tetiklendigi gosterilmistir. Bizim calismamizda, yavas yol veya aksesuar yol gibi genis olmayan ablasyon islemlerinden sonra dolasimdaki kok hucre sayisinin artip artmadigi arastirilmistir. Method: 26 hastaya [13 kadin, yas 54 (18-74)] radyofrekans ablasyon islemi uygulandi. Bu hastalardan 18’ine atriyoventrikuler nodal reentran tasikardi nedeniyle yavas yol ablasyonu; 8’ine ise atriyoventrikuler reentran tasikardi nedeniyle aksesuar yol ablasyonu yapildi. Hastalarda periferikdolasimdan alinan kan orneklerinde islem oncesi ve islem sonrasi 7. ve 30. gunlerde CD34+ hucre sayilari ve cesitli serolojik belirteclerin [Troponin-I (Tn-I), interlokin-6 (IL-6), Stromal deriveted faktor 1-α (SDF 1-α) ve C-reaktif protein (CRP)] duzeyleri incelendi. Bulgular: CD34+ hucrelerin, islem sonrasi 7. gunde bazal olcume gore anlamli artis gosterdigi [33 (15-133) vs. 22,5 (5-79) hucre/mikrolitre sirasiyla, P

To evaluate the accuracy of cardiac computed tomography (CT) parameters and pulmonary artery (PA) obstruction (OS) scores in determining the echocardiographic right ventricular dysfunction (RVD) in hemodynamically stable patients with acute pulmonary embolism (PE). A total of 120 patients with acute PE were included in the study. Right ventricle/left ventricle ratio (RV/LV); PA axial diameter; superior vena cava (SVC) axial diameter; and Ghanima, Miller, Qanadli, and Mastora obstruction scores were obtained using CT. RVD was assessed by echocardiography. The patients were divided into two groups based on the presence or absence of RVD. RV/LV ratio, SVC axial diameter, PA axial diameter, and Miller, Qanadli, and Mastora scores were significantly increased in the RVD group. Multivariate logistic regression analysis showed that RV/LV ratio [OR 6.36 (2.02–279.46 95 % CI), p = 0.01] and PA axial diameter [OR 5.02 (1.02–1.26 95 % CI), p = 0.03] were independent predictors of echocardiographic RVD. Predictive values of these parameters were improved when combined with other intragroup cutoff values. A cutoff value for the RV/LV ratio of >1.08 had 81.43 % sensitivity, 52.08 % specificity, 71.3 PPV, and 65.8 NPV for prediction of RVD. Tomographic axial diameters enable more accurate predictions of RVD than OS scores do.

Recent studies have reported that a novel cardiac biomarker, heart-type fatty acid-binding protein (h-FABP), significantly predicts mortality inpatients with pulmonary embolism (PE) at intermediate risk. The aim of this study was to evaluate the effect of thrombolytic therapy on prognosis of the intermediate risk acute PE patients with elevated levels of h-FABP. This is non-interventional, prospective, and single-center cohort study where 80 patients (mean age 62 ± 17 years, 32 men) with confirmed acute PE were included. Only patients with PE at intermediate risk (echocardiographic signs of right ventricular overload but without evidence for hypotension or shock) were included in the study. h-FABP and other biomarkers were measured upon admission to the emergency department. Thrombolytic (Thrl) therapy was administered at the physician’s discretion. Of the included 80 patients, 24 were h-FABP positive (30 %). 14 patients (58 %) with positive h-FABP had clinical deterioration during the hospital course and required inotropic support and 12 of these patients died. However, of 56 patients with negative test, only 7 patients worsened or needed inotropic support and five patients died during the hospital stay. Mortality of patients with PE at intermediate risk was 21 %. The 30-day mortality rate was significantly higher in h-FABP(+) patients compared to h-FABP(−) patients (9 vs. 50 %, p < 0.001). Multivariate analysis revealed h-FABP as the only 30 day mortality predictor (HR 7.81, CI 1.59–38.34, p = 0.01). However, thrl therapy did dot affect the survival of these high-risk patients. Despite, h-FABP was successful to predict 30-days mortality in patients with PE at intermediate risk; it is suggested to be failed in determining the patients who will benefit from thrl therapy.

The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper.From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively. Of the 312 acute PE cases confirmed with computed tomography, total 35 patients who were diagnosed with concomitant RHT (prevalence of 11%) by echocardiography were recruited. After excluding of six patients with metastatic malignancy a total 29 patients were accepted eligible for the analysis. In addition, catheter -induced thrombus (type B) were not included to the study. The difference between categorical variables was analyzed with Chi-square test and continuous variables were analyzed with Mann-Whitney U test. A p value of0.05 was considered statistically significant.Overall mortality was high (34%) in study population: among undergoing surgery-100%, therapy with thrombolytics -18%, and heparin -27%. Troponin levels were found significantly higher in died patients than that in survived patients (p=0.03). There was no significant difference regarding to clinical and echocardiographic characteristics of patients received heparin versus thrombolytic except for shock index (p=0.02). In addition, patients treated with heparin had increased duration of hospitalization compared to subjects treated with thrombolytic (median: 8 vs 3 days p0.01).Despite of the low incidence of RHT, a mortal course is still an important problem during PE. The decision on treatment modality should be performed based on the hemodynamic parameters, laboratory findings, and bleeding risk of the patients.AMAÇ: Pulmoner emboli (PE) ile ilişkili sağ kalp trombüslerinin mortalitesi 3-4 kat artmaktadır. En korkulan senaryo ise sağ kalp trombüslerinin parçalanması sonucunda rekürren pulmoner emboli gelişmesidir. Pulmoner embolilere eşlik eden sağ kalp trombüsü vakalarının tedavisi zordur ve bu konu ile ilgili literatürde yeterli veri bulunmamaktadır. YÖNTEMLER: Ocak 2006 ila Aralık 2011 tarihleri arasında akut pulmoner emboli tanısı almış 312 hastanın verileri retrospektif olarak incelendi. Bilgisayarlı tomografi ile tanı almış 312 akut PE hastalarından ekokardiyografide sağ kalp trombüsü bulunan 35 hasta çalışmaya alındı. Metastatik malignansi bulunan 6 hasta çalışmadan dışlandı. Yirmi dokuz hasta değerlendirilme için uygun bulundu. Hastaların ekokardiyografik raporları da incelendi. Ayrıca katetere bağlı gelişen trombüs (tip B) vakaları da çalışmaya dahil edilmedi. Kategorik değişkenlerin karşılaştırılmasında Ki-kare ve non-parametrik sürekli değişkenlerin karşılaştırılmasında ise Mann-Whitney U testleri kullanıldı. P değerinin 0,05’in altında olması istatistiksel olarak anlamlı kabul edildi.Hastaların mortalite oranı yüksek bulundu (%34): cerrahi mortalite %100, trombolitik alanlardaki mortalite %18 ve heparin alanlarda mortalite %27 bulundu. Ölen hastalardaki troponin düzeyleri hayatta kalan hastalara göre anlamlı olarak yüksek bulundu (p=0,03). Heparin alanlarla trombolitik tedavi uygulanan gruplar arasında klinik ve ekokardiyografik olarak anlamlı fark saptanmadı. Fark sadece şok indeksinde saptandı (p=0,02). Ek olarak heparin alan hastaların yatış süresi trombolitik alanlara göre anlamlı olarak uzun bulundu (ortanca olarak 8 güne karşın 3 gün, p0,01). SONUÇ: Akut pulmoner emboliye eşlik eden sağ kalp trombüsü vakalarının insidansının düşük olmasına rağmen mortalitelerinin yüksek seyretmesi halen önemli bir problem olarak kalmaktadır. Tedavi modalite seçiminde hastanın hemodinamik değerleri, laboratuvar parametreleri ve kanama riskleri esas alınarak karar verilmelidir.

Background Acute pulmonary embolism (PE) is a serious clinical condition characterised by a high mortality rate. Previous studies showed that leukocytosis was associated with recurrences of venous thromboemboli, major bleeding and increased mortality. The aim of the present study was to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) in patients with acute PE during short term follow-up. Method A total of 640 patients were screened by I26 code of ICD-9 and 359 patients were included as cases of confirmed acute PE. Admission blood counts and clinical data were obtained from medical charts. The predictors of 30-day mortality were examined. Results Fifty-one out of 359 patients (14.2%) included in the study died during 30 days follow-up. In multivariate Cox regression analysis systolic blood pressure (HR:0.97 (0.94–0.99 CI95%), p = 0.019), diabetes mellitus (HR:3.3 (1.30–8.39 CI95%), p = 0.012), CK-MB(HR:1.03 (1.01–1.06 CI95%), p = 0.024) and NLR (HR:1.03 (1.01–1.06 CI95%), p = 0.008) were predictors of 30-day mortality. An optimal cut-off value of NLR was determined as 9.2 by using ROC curve. Hazards ratio of NLR > 9.2 was found to be 3.60 (1.44–9.18 CI95%, p = 0.006). NLR > 9.2 had a sensitivity, specificity, negative predictive value, and positive predictive value of 68.6%, 80.5%, 93.9% and 36.5%, respectively. Conclusion NLR on hospital admission may be a predictor of 30-day mortality in acute PE. Since complete blood count is a part of the routine laboratory investigation in the most hospitalised patients use and preliminary promising results of this study, NLR should be investigated in future prospective randomised trials regarding prognostic value in acute PE.

Objective: Mobile right heart thrombi (MRHT) are uncommon but the true prevalence is still unknown. Previous studies reported thay MRHT occur in 7% to 18% of patients with pulmonary embolism. Chartier et al. have reported in-hospital mortality of MRHT as 44.7%. The main manifestations of venous thromboembolism (VTE) are deep venous thrombosis (DVT) and pulmonary embolism (PE). In addition, genetic factors play an important role in pathogenesis of VTE. The relationship between common genetic mutations such as factor V Leiden, prothrombin factor II G 20210A, methylenetetrahydrofolate reductase (MTHFR), deficiencies of protein C, protein S, and antithrombin III, and VTE have been reported. Nevertheless, hyperhomocysteinemia was documented in the pathogenesis of VTE. Methods: A 34-year-old man was presented to the emergency department because of sudden onset of dyspnea. He describes loss of consciousness occurred two days before. He had no previous history of both venous thromboembolism and acute coronary syndrome. He denied any trauma, history of malignancy, recent surgery, and any drug usage. Admission physical examination was unremarkable. Examination of lower extremities was also normal. Baseline 12-lead electrocardiogram (ECG) revealed sinus rhythm and S1Q3T3 sign. Because of suspicion of PE, bedside transthoracic echocardioghraphy (TTE) was performed and revealed mobile right atrial mass. Left ventricular systolic functions were normal. Right ventricle was not enlarged and estimated systolic pulmonary arterial pressure was 28mmHg. Because of poor imaging quality with TTE, transesophageal echocardiography (TEE) was performed and two hypermobile and snake-like thrombi in the right atrium were demonstrated (Figure 1A). Duplex scan of the lower extremities was normal. Laboratory parameters were within normal limits. Homocysteine was slightly elevated: 19.6mmol/L (5.5–14mmol/L). Upon genetic testing, there were no mutations in the factor V Leiden (G1691A), factor II (G20210A), and MHFR (C677T). Only homozygous mutation of MTHFR (A1298C) was detected. Pulmonary computed tomography revealed bilateral lower lobe PE. Because of hemodynamic stability and no evidence of RV strain, anticoagulation with heparin was administered. After 10 days of hospitalization, control TEE was performed and right atrial thrombi were markedly decreased (Figure 1B). The patient was discharged with warfarin treatment for indefinite time. Results: In the present case, we postulated that the possible cause of right atrial thrombi is MTHFR A1298C homozygous mutation because no other predisposing factors were present in our patient. For the best of our knowledge, right heart thrombus as a manifestation of homozygous MTHFR mutation have not been reported previously. Figure 1. (A) Pretreatment transesophageal echocardiography showing two mobile thrombi in the right atrium. (B) Aftertreatment transesophageal echocardiography showing markedly reduced thrombi in the right atrium. RA, right atrium; RV, right ventricle; PA; pulmonary artery; Th; thrombus.

Electrical storm is a challenging diagnosis for the clinician and requires detailed evaluation of the patient. Amiodarone is frequently used for the cessation of ventricular tachycardia attacks. Within antiarrhythmic effects of amiodarone, there are some harmful effects of the recent drug. Thyroid gland toxicity is one of the most important adverse effects of amiodarone and is called amiodarone-induced thyrotoxicosis. Thyrotoxicosis may alter arrhythmia and lead to frequent ventricular tachycardia attacks. Herein, we report a case of electrical storm caused by amiodarone-induced thyrotoxicosis.

PP-022 Number of studies have been performed on the hypertensive patients, related to the level of circulating aldosteron which leads to the cardiac fibrosis, and which is associated to the atrial fibrillation. The aim of our research is to see if there is a relation beetwen atrial

OP-116 Presence and degree of right ventricular dysfunction (RVD) are important factors that determine the poor outcomes in patients with acute PE. Echocardiography is considered as the best tool for diagnosing of RVD. There are numerous publications pointing to the relationship between RVD and

Electrolyte disorders can alter cardiac ionic currents and depending on the changes can promote proarrhythmic effects. Potassium (K(+)) is the most common intracellular cation related to arrhythmic disorders. Hyperkalemia is mainly seen in the setting of impaired renal function. Severe hyperkalemia may lead to rhythm disorders. Herein, we report a patient with accelerated idioventricular rhythm (AIVR) due to hyperkalemia, which was successfully treated with glucose-insulin (GI) infusion.

Acute pulmonary embolism (PE) is a frequent life-threatening condition in emergency departments. Careful diagnosis is important, and different diagnostic tests such as electrocardiogram (ECG), biochemical markers, echocardiogram, and computed tomography are required. Although ECG is a cheap and rapid diagnostic test for pulmonary embolism, it has some limitations in the differential diagnosis of acute coronary syndrome and acute PE. Herein, we report ECG results of a patient diagnosed with acute PE mimicking acute coronary syndrome.

Purpose: A lot of studies conducted before have shown that there is a corelation between nondipper pattern with the left ventricular hypertrophy and diastolic dysfunction based on circadian rhythm of the blood preasure (BP). The main aim of the study is to investigate the relationship between the amount of the 24-hour urinary aldosterone and the nondipper pattern of the BP. Method: The study included both an office and ambulatory BP which were monitored in normotensive people (office BP

Amaç: Bu çalışmada sol ventrikül ejeksiyon fraksiyonunun korunduğu hastalarda (ejeksiyon fraksiyonu >%50), mitral A dalga yükselme zamanının, sol ventrikül diyastol sonu basıncını öngörmedeki yerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Mayıs 2012 ile Ekim 2013 tarihleri arasında koroner anjiyografi yapılmasına karar verilen 121 hasta çalışmaya dahil edildi. Ekokardiyografi kayıtları alındıktan sonra, ölçümlerden habersiz başka bir araştırmacı tarafından sol kalp kateterizasyonu ile sol ventrikül diyastol sonu basıncı ölçüldü. Basınç değerlerine göre hastalar üç gruba ayrıldı. Sol ventrikül diyastol sonu basıncı 0 ile 10 mmHg arası olanlar grup 1, 11 ile 15 mmHg arasında olanlar grup 2, 16 mmHg ve üzeri olanlar ise grup 3'e dahil edildi. Demografi k özellikler, vital bulgular ve ekokardiyografi k parametreler gruplar arasında karşılaştırıldı. Bulgular: Çalışmamıza dahil edilen 121 hastadan 60 (%49,5) tanesi grup 1'e, 30 (%24,7) tanesi grup 2 ye, 31 (%25,6) tanesi grup 3 içerisine alındı. Gruplar arası yapılan analizde yaş, cinsiyet, vücut kitle indeksi, komorbit durumlar ve vital bulgular arasında anlamlı bir fark izlenmedi. Gruplar arasında mitral A dalga yükselme zamanında anlamlı bir fark izlenmedi. (Sırasıyla, 79,3±19,6 cm/sn, 83,9±12,5 cm/sn, 80,2±20,1 cm/sn p=0,51). Sonuç: Tüm bu bulgulara rağmen net veriler için daha fazla hasta katılımının olduğu çalışmalara ihtiyaç olduğu açıktır., Objective: Our aim in this study was to evaluate the value of the acceleration time of the mitral A wave in predicting left ventricle end diastolic pressure of patients with preserved left ventricle ejection fraction (ejection fraction

Duschenne müsküler distrofisi (DMD) müsküler distrofiler içerisinde en sık görülen ve en ciddi seyreden formudur. Distrofin proteinindeki mutasyon sonucu iskelet ve kalp kasında dejenerasyon ve bunun yerini alan yağ dokusu ve fibrosiz ile karakterize kalıtsal bir hastalıktır. Kardiyak tutulumun 90 olduğu bu hastalıkta kalp yetersizliğine ek olarak ritim problemleri de olabilmektedir. Bu olguda DMD ile takip edilen ve senkop şikayeti olan bir hastaya elektrokardiyogramda (EKG) sinüs duraklamaları olması nedeniyle kalıcı pacemaker implantasyonu yapıldı. DMD’nin aritmik komplikasyonlarını bu vaka takdiminde kısaca tartışmaya çalıştık., Duschenne muscular dystrophy (DMD) is the most frequent and severe form of the muscular dystrophies. The syndrome is hereditary disease which is characterized with degeneration in the sceletal and cardiac muscle cells as a cause of mutation in the dystrophin protein. Cardiac involvement is about 90 and in addition to heart failure, rhythm disorders may also develop. In this case report, patient with a diagnosis of DMD presented with syncope and sinus pause in the electrocardiogram was referred to the cardiology and pacemaker implantation was performed. We briefly discuss arrhythmic ccomplications of DMD in this case presentation

Aort diseksiyonu; tanısı konulmadığında veya tanı konulmasında geç kalındığında yüksek mortaliteyle seyreden acil klinik bir durumdur. Tedavi edilmediği takdirde her saat mortalitesi %1-2 oranında artmaktadı r. Hastalar yırtıcı vasıfta, sırta yayılan, çok şiddetli göğüs ağrısından senkop, hemiparezi, hemipleji gibi nörolojik bozukluklar, akut miyokard enfarktüsü ve akut böbrek yetmezliği gibi çok geniş klinik yelpazeyle karşımıza çıkabilmektedir. Sunacağımız vakada tipik şikayetleri olmadığı halde baş ağrısı ile başvuran hastada fizik muayene, elektrokardiyogram ve akciğer grafisinden şüphelenilerek ciddi bir akut aort diseksiyonu vakasının yakalanabileceğini sunmaya çalıştık., Aortic dissection is a life-threatening emergency clinical condition when diagnosis was failed or delayed. The mortality rate of patients with aortic dissection is 1-2% per hour in untreated patients. The patients may present with following symptoms and clinical conditions: severe and tearing chest or upper back pain, syncope, paralysis of one side of body, myocardial infarction, and acute renal failure. In this case report, we present a patient with headache where detailed physical examination, electrocardiogram, and chest radiograph supported a diagnosis of aortic dissection with atypic presentation.