Propafenone Induced Takotsubo Cardiomyopathy: A Mere Coincidence or A New Causal Relationship?

Propafenone is a class 1C antiarrhythmic drug that blocks sodium channels and is used in the treatment of arrhythmia. Because of its rapid effect on terminating paroxysmal episodes of atrial fibrillation, it can be used as a pill-in-the-pocket. In patients with structural heart disease, it is less preferred due to cardiotoxic effects in long-term use. Although propafenone use is known to cause several cardiovascular side effects, the development of Takotsubo cardiomyopathy is unknown. Propafenone toxicity at standard doses is a rare condition. Propafenone plasma concentrations may increase through inhibition of cytochrome P450 2D6 and complete inhibition of 2D6 metabolism can increase propafenone levels by up to 3 to 10 times. In this case report, we aimed to present a 37-year-old female patient who developed Takotsubo cardiomyopathy and cardiogenic shock after the first dose of propafenone use and recovered with medical treatment

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1–19, p = 0.014) and CAVI (95% CI 15–29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research

Extensive, Idiopathic, Recurrent, Spontaneous Coronary Artery Dissection Healed With Medical Treatment

Spontaneous coronary artery dissection is a rare cause of sudden cardiac death and acute coronary syndrome, and mainly affects young female. Treatment of this condition depends on the clinical features, hemodynamic and angiographic findings of the patient, but due to the rarity of the disease, guideline support was insufficient until the last period. Depending on the condition of the patient and the coronary blood flow, medical observation, percutaneous coronary intervention or coronary artery bypass graft surgery are used in the treatment. We present a young female patient who underwent emergency coronary artery bypass graft surgery after spontaneous left main coronary artery dissection four years ago and was recently diagnosed with extensive spontaneous coronary artery dissection in her right coronary artery. After the diagnosis, the patient was given medical treatment and recovered completely

Suttonella indologenes peritonitis in a patient receiving continuous ambulatory peritoneal dialysis

Suttonella indologenes is a Gram-negative, aerobic coccobacillus of Cardiobacteriaceae family and its natural habitat is the mucous membranes of the upper respiratory system. The literature includes limited number of case reports concerning fatal endocarditis due to infection in the prosthetic heart valves caused by the aforementioned microorganism. However, there is no information on extracardiac involvement due to this microorganism. Here, we present a peritonitis case caused by Suttonella indologenes in a patient receiving continuous ambulatory peritoneal dialysis

Assessment of cardiac autonomic functions by heart rate recovery indices in patients with myocardial bridge

Background: Heart rate (HR) recovery (HRR) reflects autonomic activity and predicts cardiovascular events. The aim of this study was to assess HRR in patients with myocardial bridge (MB). Methods: Medical recordings of 93 patients with MB and appropriate age, compared to 78 sex-matched healthy subjects were analyzed. MB was diagnosed via coronary computed tomography angiography after a positive exercise stress test (EST). HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2) and 3rd (HRR3) minute HR from the maximal HR during EST. Results: HRR1 (30.2 ± 13.3 bpm vs. 35.8 ± 10.4 bpm, p = 0.001) and HRR2 (52.3 ± 13.3 bpm vs. 57.1 ± 11.6 bpm, p = 0.013) were lower in patients with MB. In addition, HRR1 was lower in patients with left anterior descending (LAD) MB than non-LAD MB (28.5 ± 13.2 vs. 37.1 ± 11.4, p = 0.013). Presence of MB, deep MB, LAD MB and multi-vessel MB were predictors of HRR1 (p < 0.01 for all). In a multivariate analysis, LAD MB was the only significant independent predictor of HRR1 (b = –8.524, p = 0.009). Conclusions: Patients with MB have impairment in HRR indices which is more pronounced among patients with LAD MB. Cardiac autonomic dysfunction in MB might be due to recurrent myocardial ischemia.

Obstrüktif Uyku Apneli Hastalarda Metabolik Sendrom İçin Göğüs Radyografisi Üzerinde Güçlü Bir İpucu: Aortik Ark Kalsifikasyonu

Amaç: Obstrüktif uyku apnesi (OSA), ateroskleroz ve metabolik sendrom (MetS) gelişimi için önemli bir risk faktörüdür. Vasküler kalsifikasyon ateroskleroz gelişiminde önemli bir rol oynamaktadır. Buna rağmen, literatürde MetS ile vasküler kalsifikasyon arasındaki ilişkiyi gösteren veriler yetersizdir. Bu çalışmanın amacı, OSA'lı hastalarda MetS ile aortik ark kalsifikasyonu arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Bir gece polisomnografi laboratuvarında yatan ve OSA tanısı koyulan hastalar çalışmaya dahil edildi. Hastalar MetS varlığına göre iki gruba ayrıldı. Polisomnografik değerlendirme sonuçlarından habersiz olan iki araştırmacı akciğer grafilerini inceledi.Bulgular: Çalışmaya OSA tanısı alan toplam 314 hasta dahil edildi. Hastaların %33,1 kadın ve ortalama yaş 51,2±10,9 idi. Çalışmaya alınan hastaların %43,6'sında hafif OSA, %30,9'unda orta derecede OSA ve %25,5'inde ağır OSA varlığı saptandı. Hastaların %56,4'ünde (n=177) aortik ark kalsifikasyonu, %58,6'sında (n=184) ise MetS saptandı. Aortik ark kalsifikasyonu prevalansının MetS saptanan hastalarda MetS saptanamayan hastalara göre daha yüksek olduğu bulundu (p<0,001). Çoklu lojistik regresyon analizinde, vücut kitle indeksinin (1,148; %95 GA 1,089-1,210), apne hipopne indeksinin (1,039; %95 GA, 1,016-1,062) ve aortik ark kalsifikasyonunun (4,986; 95% GA 2,887-8,610) MetS varlığı için bağımsız prediktörler olduğu bulundu.Sonuç: OSA'lı hastalarda akciğer grafisinde görülebilen aortik ark kalsifikasyonu ile MetS arasında güçlü bir ilişki olduğu bulundu. Aortik ark kalsifikasyonu, OSA'lı hastalarda MetS gelişimi ile ilgili klinisyenler için uyarıcı bir bulgu olabilir