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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.

The successes of the diagnosis and the treatment of the grown up congenital heart disease improved the prognosis of these patients by further innovations. Lifelong regular follow up is necessary for these patients. Cardiac magnetic resonance imagination and the computed tomography give us more suffi cient information about the morphology and the function when the fi rst line diagnostic tool echocardiographic information is handicapped., Konjenital kalp hastalıklarının anlaşılmasında, erken teşhisinde ve modern cerrahideki ilerlemeler ve başarılar, konjenital kalp hastalığı olan hastaların prognozlarında belirgin ilerlemelere yol açmıştır. Yaşam boyu düzenli takip, erişkin konjenital kalp hastalığı olan hastaların medikal hayatlarının değişmez bir parçasıdır. Kullanım kolaylığı ve taşınabilirliği nedeniyle hala birinci derecede tanısal olan ekokardiyografi nin yetersiz olabildiği bu hastalarda, kardiyak manyetik rezonans ve bilgisayarlı tomografi ile kardiyak yapılar ve fonksiyonları hakkında daha net bilgiler elde edilebilmektedir

Objectives: There is no data about the incidence, progress and prognosis of Takotsubo Cardiomyopathy (TC) from Turkey. This study aimed to search for the progress and shortterm prognosis of TC patients and to increase the familiarity and awareness for TC in Turkey. Study design: We included 6 patients who were referred to our center with ST elevation myocardial infarction and diagnosed as TC according to the Mayo Clinic diagnostic criteria. Results: Our patients' median age was 46 years (range 17 to 64 years) and 3 of them were males. Triggering factors included emotional stress (3 patients) and physical stress (3 patients). Median troponin I level was 1.65 ng/ml (0.48-2.20), excluding the patients who underwent cardiopulmonary resuscitation. ST elevation in precordial leads was observed on the ECG of 4 patients and in inferior leads on ECG of 2 patients. Five patients' coronary arteries were normal and were diagnosed as typical, but 1 patient had non-critical stenosis on the coronary arteries and was diagnosed with reverse TC. Four patients were discharged without any complications but 2 presented with sudden cardiac death. Conclusion: This study presented the first data about TC in Turkey while attempting to increase awareness about the disease. Emergent ventricle evaluation by ventriculography or echocardiography is recommended for acute coronary syndrome patients with non-critical stenosis for the differential diagnosis.

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.

WOS: 000316646600011, PubMed ID: 24570696, Diagnosis of patent ductus arteriosus is rare in adulthood. Closure of ductus is difficult when diagnosed at an adult age due to the development of pulmonary hypertension and pulmonary arterial disease that generally occurs. Closure of the ductus might be contraindicated, as it may lead to deterioration of the pulmonary arterial perfusion or to a pulmonary hypertensive crisis. In addition, another risk associated with percutaneous closure for these patients is the risk of embolism of the asymmetrically shaped device to the systemic circulation. We present in this manuscript a case with patent ductus arteriosus diagnosed at an adult age that underwent successful closure by the percutaneous method. During closure, an oversized Amplatzer duct occluder device was used to reduce the risk of device embolism.

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.

Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV).Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG analysis. Time domain HRV analysis performed from ambulatory ECG records. Results: 52% of patients at NYHA functional class II, 36% at class III, and 12% at class IV when they have been treated by NIMV. Groups were similar for age and sex (p>0.05 for both). Heart rates of patients were higher significantly than controls’ (p0.05). But, systolic pulmonary pressures were higher of COPD group (p

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.

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., AMAÇ: Kurumumuzda modifiye Duke kriterlerine göre enfektif endokardit tanısı konularak takip ve tedavi edilen 119 enfektif endokardit hastasında embolik olaylar açısından predispozan faktörlerin ve vejetasyon özelliklerinin embolik komplikasyon üzerine olan etkilerinin araştırılmasıdır.YÖNTEMLER: Kurumumuz hastane kayıtları incelenerek, Ocak 1997-Kasım 2004 tarihleri arasında başvuran ve enfektif endokardit tanısı konan 119 hasta klinik, ekokardiyografik ve mikrobiyolojik açıdan değerlendirildi.BULGULAR: Başvuru anında 119 hastanın 28 (%23.5)'inde majör arteriyel emboli gözlemlendi. Bu hastalar emboli grubunu oluşturdu. Kültür pozitifliği (p=0.017, %95 güven aralığı (GA)=1.1-24.6), ejeksiyon fraksiyonu (EF) (p=0.003, %95 GA=1.1-1.4), vejetasyon varlığı (p=0.013, %95 GA=1.1-1.13), vejetasyon büyüklüğü (p=0.002, %95 GA=1.1-2.1), vejetasyon mobilitesi (p=0.01, %95 GA=2.1-24.5), ve korda rüptürü (p=0.041, %95 GA=1.07-7.14) gibi parametrelerin emboli açısından anlamlı prediktörler olduğu tespit edildi.SONUÇ: Endokardit tanılı hastalarda kültür pozitifliği, EF, vejetasyon varlığı mobilitesi ve büyüklüğü ile korda rüptürü varlığı emboli açısından prediktif değere sahip değişkenlerdir. Bu prediktif değişkenlerin ve daha başka değişkenlerin değerinin anlaşılması için daha fazla prospektif kontrollü çalışmaya ihtiyaç vardır.

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: 000338997700001, PubMed ID: 24878253, Non-dipper blood pressure (NDP) as an indicator of autonomic dysfunction could be associated with hypertensive response to exercise (HRE) in diabetic patients. HRE was determined as a predictor of development of unborn hypertension. We aimed to investigate if any correlation among NDP and HRE in normotensive type 2 diabetic patients. A total of 59 consecutive type 2 diabetic patients without history of hypertension and with normal blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) were enrolled to the study. We divided the study population in to two groups depending on their BP on ABPM as dipper (group 1) or non-dipper (group 2). There were 22 patients (mean age 49.5 +/- 7 and 10 male) in group 1 and 37 patients (mean age 53.1 +/- 10 and 14 male) in group 2. Daytime diastolic and mean BP of dippers and night time systolic and mean BP of non-dippers were significantly higher. HRE was not significantly different between groups (59% vs. 62%, p = 0.820). Hemodynamic parameters during the exercise test were similar. At multivariate linear regression analysis, resting office systolic blood pressure (SBP) (r = 0.611, p < 0.001), male sex (r = 0.266, p = 0.002) and age (r = 0.321, p = 0.010) were independently correlated with peak exercises SBP. Logistic regression analyses identified the resting office SBP (OR 1.191, 95% CI 1.080-1.313; p

WOS: 000329360400008, PubMed ID: 24359422, Objective: We aimed to assess the association between resting heart rate (RHR) and severe infection in children with Crimean-Congo hemorrhagic fever (CCHF). Methods: In all, 121 patients under 18 years of age with a laboratory-confirmed diagnosis of CCHF were enrolled in the study. Patients were classified into two groups based on disease severity (severe group and nonsevere group). RHR was measured by electrocardiography (ECG) on admission. Maximum P-wave duration (Pmax), P-wave dispersion (Pd), QRS duration, corrected QT interval, and QT dispersion were also measured. Results: Mean age was 11.43.9 years and 84 patients were male. Twenty-six patients were classified as severe. Patients in this group had a higher RHR (103.6 +/- 10.4vs. 80.5 +/- 8.1, p=0.001) than those with nonsevere disease. There was no difference in Pmax, Pd, QRS duration, QTcmax, or QTc dispersion. The optimal cutoff value of RHR to predict disease severity was>96 beats per minute (bpm), with 70.6% sensitivity and 50.1% specificity. Bleeding, thrombocytopenia (80x10(9)/L), elevated aspartate transaminase (AST) (>208IU/L), elevated alanine transaminase (ALT) (>87IU/L), elevated lactate dehydrogenase (LDH) (>566IU/L), long activated partial thromboplastin time (aPTT) (>42s), and increased hospitalization days were more frequent in patients with RHR >96bpm. Multivariate logistic regression analysis revealed low platelet count (42s), high LDH (>566IU/L), and elevated RHR (>96bpm) as independent risk factors for severe disease. Conclusions: We conclude that elevated RHR was significantly associated with severe disease in children with CCHF, thus offering the potential to identify patients with increased risk.

WOS: 000329838600005, PubMed ID: 23796159, Objective: There is no study about hypertensive response to exercise (HRE), which is a marker of unborn hypertension (HT), and red cell distribution width (RDW) association, in diabetic normotensive patients. So, we aimed to investigate any correlation among RDW and HRE in normotensive type 2 diabetic patients. Methods: Consecutive type 2 diabetic patients without history of HT and with normal blood pressure (BP) on ambulatory BP monitoring were included to the study. We divided the patients into two groups depending on their peak systolic BP on exercise; HRE (Group 1) or normal response to exercise (Group 2). Results: Data of 75 diabetic patients (51.9 +/- 9.7) were analyzed (31 male (48%)). Their mean RDW was 13.11 +/- 0.46. Patients with HRE were significantly older than patients without HRE. Smoking was more frequent in Group 2. Gender distribution and body mass index were similar between the groups. Else hemoglobin, hematocrit, red blood cell count and RDW values were not significantly different. Office systolic BP and diastolic BP, daytime and 24-h systolic BP were significantly higher in Group 1 but heart rate was similar between the groups. Conclusions: This study revealed that RDW do not differ between diabetic normotensive patients with HRE or not.

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.

Congress of the European-Society-of-Cardiology (ESC) -- AUG 25-29, 2012 -- Munchen, GERMANY, WOS: 000308012406383, …, European Soc Cardiol (ESC)

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.

WOS: 000316646600016, PubMed ID: 24570701, Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Spontaneous coronary artery dissection can cause stable angina pectoris, unstable angina pectoris, acute myocardial infarction, cardiogenic shock and sudden cardiac death. It usually occurs in young to middle aged women. Atherosclerosis, peripartum period, and structural and inflammatory diseases affecting the artery wall are predisposing factors. It shows similar clinical presentation to coronary artery disease. Diagnosis and early treatment decrease mortality. Treatment options are medical treatment, percutaneous coronary intervention and surgery. The treatment decision is made according to the clinical presentation of the patient, the affected coronary artery and the length of the dissected segment. Diagnosis of the disease is usually made by coronary angiography. We present a patient who consulted our clinic with atypical chest pain and was diagnosed with spontaneous left anterior descending dissection by coronary computed tomography angiography.

Konjenital kalp hastalıklarının anlaşılmasında, erken teşhisinde ve modern cerrahideki ilerlemeler ve başarılar, konjenital kalp hastalığı olan hastaların prognozlarında belirgin ilerlemelere yol açmıştır. Yaşam boyu düzenli takip, erişkin konjenital kalp hastalığı olan hastaların medikal hayatlarının değişmez bir parçasıdır. Kullanım kolaylığı ve taşınabilirliği nedeniyle hala birinci derecede tanısal olan ekokardiyografi nin yetersiz olabildiği bu hastalarda, kardiyak manyetik rezonans ve bilgisayarlı tomografi ile kardiyak yapılar ve fonksiyonları hakkında daha net bilgiler elde edilebilmektedir, The successes of the diagnosis and the treatment of the grown up congenital heart disease improved the prognosis of these patients by further innovations. Lifelong regular follow up is necessary for these patients. Cardiac magnetic resonance imagination and the computed tomography give us more suffi cient information about the morphology and the function when the fi rst line diagnostic tool echocardiographic information is handicapped

Amaç: Metabolik sendrom ve non -dipper kan basıncı paterni kardiyovasküler hastalıklarla ilişkilidir. Bu klinik durumların ortak patofizyolojik mekanizmalarıyla ilişkili olabilir. Metab olik sendrom ile non -dipper kan basıncı arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: 24 saatlik ambulatuar kan basıncı takibi yapılan yeni tanı almış 118 obez metabolik sendromlu hasta çalışmamıza dahil edildi. Bunlar dipper (n = 46) ve non -dipper (n = 72) olmak üzere iki gruba ayrıldı. Gece non -dipper kan basıncı, gece ortalama sistolik ve/veya diastolic kan basıncı azalması %10 dan daha az azalma oluşu olarak tanımlandı. Bulgular: Ça lışma gurubumuzun ortalama 24 saatlik kan basıncı ortalaması 146/96 mmHg idi. İki grubun temel karakteristik özellikleri benzer olmasına rağmen, non -dipper tansiyon paterni olan grupta metabolik sendrom sıklığı a nlamlı derecede daha fazla idi (p=0.038). Sonuç: Bu çalışmada non -dipper kan basıncı paterni olan hastalarda metabolik sendromun daha fazla bulunduğu saptandı . Bu durum, obez hastalarda metabolik sendrom ile non-dipper kan basıncının ortak bir patofizyolojik mekanizma içerdiğini belirtebilir., Background: Metabolic syndrome and non -dipping blood pressure pattern are related with cardiovascular disease. It is considered that there may be common pathophysiological mechanisms of these clinical entities. We aimed to investigate the association between metabolic syndrome and nondipping blood pressure pattern. Method: 118 consecutive newly diagnosed metabolic syndrome patients with obesity who underwent 24 -hour ambulatory blood pressure monitoring were included in the study. They were divided into dipper (n = 46) and non -dipper (n = 72) groups. Nocturnal non -dipping blood pressure pattern is defined as the lower than 10 % reduction in nocturnal mean systolic and/or diastolic blood pressure. Results: In the whole population, mean 24 -hour ambulatory blood pressure was 146/96 mmHg. Although, the two groups was similar in terms of basic characteristics; the frequency of metabolic syndrome was significantly greater in patients with non -dipping pattern (p=0.038). Conclusion: In this study metabolic syndrome was fou nd to be more prevalent among patients with non -dipping pattern of hypertension. This may indicate a common pathophysi ologic mechanism of metabolic syndrome and non -dipping blood pressure pattern in obese patient.

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.

Plazma fibrinojen yoğunluğu ve kan viskozitesi gibi hemoreolojik faktörler koroner arter hastalığı (KAH) için bağımsız risk faktörleri olarak tanımlanmıştır. Bu çalışmamızda ciddi koroner arter hastalığı ile viskozite ve fibrinojen arasındaki, ilişkiyi araştırmayı amaçladık. 159 KAH hastası (111 erkek, 48 bayan, ortalama yaş 64±9 yıl) ve 88 normal koroner arterli kişinin (48 erkek, 41 bayan, ortalama yaş 58±10 yıl) koroner anjiyografilerini inceledik. Ek olarak bu hastaların demografik parametreleri ve laboratuar sonuçları değerlendirildi. Ve gruplar arası sonuçlar kıyaslandı. Viskozite seviyesi, damar skorlaması ile anlamlı ve paralel bir artış gösterdi. Benzer şekilde fibrinojen seviyesi de, damar skorlaması ile anlamlı ve paralel bir artış gösterdi. Bu farklılıklar gruplar arasında da anlamlı olarak bulundu. Sonuç olarak ciddi koroner arter hastalığı ile viskozite ve fibrinojen seviyesi arasında anlamlı bir ilişki gösterdik. Bu bulgular bize aterosklerotik yayılımın hemoreolojik parametrelerle artış gösterebileceğini ifade etti.

Sol ön inen koroner arter dışındaki arterler üzerine yerleşen anjiyografik olarak tanımlanan myokardiyal köprüleşme olguları çok nadir olarak bildirilmiştir. Ancak çokkesitli bilgisayarlı tomografi ve postmortem otopsi çalışmalarında anjiyografik olarak tanımlanandan çok daha sık olarak ve sol anterior inen arter harici diğer arterler üzerinde de myokardiyal köprüleşme olduğu bildirilmiştir. Bu yazıda koroner anjiyografide sağ koroner arterde boğulmaya yol açan çok nadir bir olguyu bildirdik. Ve bu olgu ışığında değişik görüntüleme yöntemleri ile değişik sıklıklarda myokardiyal köprüleşme izlenmesinin olası sebeplerini tartıştık., Angiographically evident myocardial bridges confined to the other arteries rather than the left anterior descending artery is very rare in the literature. Also cardiac computerized tomography studies and postmortem studies demonstrated that myocardial bridges are not as rare as the angiographic series and may be confined to the other arteries rather than the left anterior descending. We reported a very rare case with myocardial bridge on right coronary artery diagnosed by coronary angiography causing severe obstruction. We want to share this angiographically visible myocardial bridge confined to the right coronary artery and discuss the potential reasons for the frequency dilemma among different diagnostic tools.

WOS: 000311649900016, In invasive cardiology practices, the most commonly used vascular access site is the femoral artery. Atherosclerotic stenoses on the femoral and iliac arteries create difficulties in these practices. Vasospasm rarely occurs on large arteries like these. This paper reports stenosis encountered during coronary angiography on iliac arteries in 2 patients. The stenoses caused difficulties for guidewire and catheter insertion in catheterization. In the revisualization of these arteries at the next session, the stenoses had disappeared, but the arteries were tortuous. The patients did not have peripheral ischemia signs previously, nor did they appear after the procedure. These transient stenoses might have occurred due to vasospasm and the accordion effects caused by the guidewire and/or catheter.

WOS: 000306728300003, Background: Coronary artery calcification (CAC) is a predictor of coronary artery disease (CAD) and closely related to major adverse cardiac events. The Gensini score is a scoring system to determine the severity and extent of coronary atherosclerosis. Aim: We aimed to investigate the relationship between CAC and both the extent and severity of CAD. Material and methods: Coronary artery calcification was identified by visual examination during fluoroscopic examination. The study population was divided into two groups, according to the presence or absence of CAC. The CAC(+) group consisted of 126 patients (45 women, 81 men), the CAC(-) group 156 patients (58 women, 98 men). Gensini scores were calculated from the results of coronary angiography. Results: We identified CAC more frequently in type 2 diabetes mellitus patients, with no gender differences. Other risk factors for CAD - including age, hypertension, smoking, body mass index, waist circumference, and systolic blood pressure were not significantly different between the CAC(+) and CAC(-) groups. Serum levels of triglyceride and very low density lipoprotein (VLDL) cholesterol were significantly lower in the CAC(+) group, and diastolic blood pressure levels and type 2 diabetes mellitus (DM) frequency were higher. By logistic regression, an independent relationship was identified between the Gensini score and CAC. Conclusions: Coronary calcification seems to be more prevalent in type 2 DM patients than in the normal population. The Gensini score, that is, the extent and severity of coronary artery disease, appears to be independently related to CAC, an issue that warrants further investigation to allow for future clinical applications.

WOS: 000302895000008, Three separate coronary arteries originating from the right or left coronary sinus of Valsalva are exceedingly rarely seen coronary anomalies. The clinical course depends on the site of origin and the anatomical trace. We report a case with all coronary arteries arising from the right sinus of Valsalva with different ostia.

Bitkisel ilaçların kontrolsüz kullanımı, ölüm dahil ciddi komplikasyonlara neden olan sorunlara yol açabilir. “Panax”ın içerdiği sponinler aracılığı ile hipokolestromik, antikarsinojenik, antienflamatuvar, antimikrobiyal ve içerdiği “panax ginseng” ile pozitif inotropik etkileri hakkında bilgiler vardır. Ancak, bununla beraber hipokolestromik etkisinin ikincil düşük yoğunluklu lipoprotein (LDL) düzeyini arttırdığı, kronik kullanıcılarda hipertansiyonla giden “ginseng abuse sendromu” tanımlanması ile birlikte hipotansif etkilerinin de olduğu klinik çalışmalarda gösterilmiştir. Bu yazıda, tipik anjina pektoris tanılı ve önerilen koroner anjiyografiyi reddeden erkek hasta sunuldu. Panax kullanan hasta yaygın anterior miyokart enfarktüsü ve kardiyojenik şokla acil servise başvurdu. Hasta uygun tedavi sonrası taburcu edildi., Uncontrolled usage of herbal medications may cause problems that can lead to serious complications, in- cluding 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 hyper- tensive 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.