DOBUTAMİN STRES EKOKARDİYOGRAFİDE İSKEMİ VARLIĞI İLE STRES SONRASI SERUM KALP YAĞ ASİDİ BAĞLAYICI PROTEİN DÜZEYİ DEĞİŞİMİ ARASINDAKİ İLİŞKİSİ

Amaç: Kalp yağ asidi bağlayıcı protein (KYABP) molekül ağırlığı düşük olan ve kardiyomiyositler ile iskelet adelesinde intrasitoplazmik alanda yoğun olarak bulunan bir proteindir. Stres sırasında oluşan geçici miyokard iskemisinde plazma KYABP seviyelerinde artma beklenebilir. Çalışmanın amacı Dobutamin Stres Ekokardiyografi (DSE) ile gösterilen miyokard iskemisinin serum KYABP düzeylerine etkisini değerlendirmektir. Yöntemler: Kararlı koroner arter hastalığı kliniği olan ve miyokard iskemisi açısından değerlendirilmek üzere DSE istenen ardışık 30 olgu (yaş ortalaması 54.9 ± 9.6 yıl , %53 erkek) çalışmaya alındı. Testten hemen önce ve testin sonlanmasının 1. saatinde alınan venöz kan örneklerinde KYABP düzeyleri ölçüldü. ve hastalar DSE pozitif (iskemik) ve DSE negatif (iskemik değil) olarak iki gruba ayrılarak değerlendirildi. İki grubun karşılık gelen bazal ve 1. saat HFABP değerleri karşılaştırıldı. İskeminin HFABP seviyeleri etkisini değerlendirmek için, her grubun bazal ve 1. saat değerleri kendi içinde karşılaştırıldı. Bulgular: DSE olguların 8’inde (% 27) pozitif, 22’sinde (% 73) negatif idi. DSE pozitif olan grup daha yaşlı idi ve geçirilmiş MI ve KABG operasyonu sıklığı daha yüksekti. Diğer demografik özellikler ve laboratuvar bulgularında iki grup arasında farklılık saptanmadı. Her iki grubun başlangıç KYABP düzeyleri benzerdi (1.66 ± 1.18’e karşılık 1.61 ± 0.77, p = 0.884 ). DSE den bir saat sonra alınan örneklerde KYABP düzeyleri DSE pozitif grupta anlamlı olarak yüksek saptandı (2.65 ± 1.34’e karşılık 1.85 ± 0.76, p = 0.048). Grupların başlangıç ve birinci saat KYABP düzeyleri kendi içlerinde değerlendirildiğinde DSE pozitif grupta 1. saatte anlamlı bir artış saptanırken (1.66 ± 1.18’e karşılık 2.65 ± 1.34, p = 0.004), DSE negatif grupta anlamlı bir artış saptanmadı (1.61 ± 0.77’e karşılık 1.85 ± 0.76, p = 0.066). Sonuç: Kararlı koroner arter hastalığı kliniği olan olgularda, DSE’de gösterilen iskemi varlığında 1 saat içerisinde serum KYABP düzeylerinde anlamlı artma saptanırken, benzer bulguya iskemi olmayan grupta rastlanmadı.Background: Heart fatty acid binding protein (HFABP) is a low-molecular weight protein which is abundant in the intracytoplasmic space of myocytes and skeletal muscle. Its serum levels may be expected to increase in myocardial ischemia. The aim of this study was to evaluate the effect of myocardial ischemia induced by dobutamine stres echocardiography (DSE) on serum HFABP levels. Methods: Thirty consecutive patients (mean age 54.9 ± 9.6 years , 53 % male) with stable clinical coronary syndromes, who were ordered a DSE examination for the evaluation of myocardial ischemia made up the study population. Levels of HFABP were measured on venous blood samples obtained immediately before and 1 hour after completion of DSE. The patients were grouped into two as DSE positive (ischemia positive) and DSE negative (ischemia negative). The corresponing basal and 1-hour levels of HFABP were compared between the two groups. The effect of ischemia on HFABP levels were evaluated by comparing the basal and 1-hour levels of HFABP in each group by using within-group statistics. Results: DSE was positive in 8 (27 %) and, negative in 22 (73 %) patients. The clinical characteristics and laboratory findings of the two groups were similar except for a significantly higher age and a significantly more frequent history of myocardial infarction and coronary artery by-pass surgery in the DSE positive group. The basal HFABP levels were similar in the two groups (1.66 ± 1.18 vs. 1.61 ± 0.77, p = 0.884 ). The 1-hour HFABP level was significantly higher in the DSE positive group as compared to the DSE negative group (2.65 ± 1.34 vs.1.85 ± 0.76, p = 0.048). When the basal and 1-hour levels of HFABP were grouped within each group, the 1-hour HFABP rose significantly in the DSE positive group (1.66 ± 1.18 vs. 2.65 ± 1.34, p = 0.004), where it remained unchanged in the DSE negative group (1.61 ± 0.77 vs.1.85 ± 0.76, p = 0.066). Conclusion: Serum HFABP levels rose significantly at 1 hour in the presence of ischemia brought out by DSE in patients with stable clinical coronary syndromes. No such increase was evident in the absence of ischemia

Association Between Mitral Valve Prolapse, Migraine, and White Matter Hyperintensities on Magnetic Resonance Imaging

Objective: Migraine is linked with an elevation in vascular risk factors, ischemic stroke, and a variety of constitutional brain lesions. However, the pathogenesis of this relationship is still inexplicit. The link between cardiac diseases and comorbid migraine-ischemic stroke might be a vascular disease involving both heart and brain. In this study, an association between mitral valve prolapse (MVP), migraine, and the presence of brain white matter hyperintensities (WMHs) were evaluated among adult subjects with migraine headache devoid of any traditional vascular risk factors. Materials and Methods: Four hundred subjects (200 subjects with migraine headache, 200 healthy controls; age range 18-50 years) were incorporated in the retrospective study. Existence of a headache compatible with migraine was diagnosed according to the International Headache Society-2 criteria. The participants were devoid of any known comorbid diseases, vascular risk factors or inflammatory diseases. All patients, both those with migraine and controls were screened with echocardiography to assess for MVP and with brain magnetic resonance imaging co evaluate the presence of any WMHs. Results: The prevalence of MVP was found to be higher in the migraine group (p<0.011). The odds ratio (OR) for the presence of MVP in patients with migraine compared with controls was 2.44 [95% confidence interval (CI): 1.25-4.74; p=0.0086]. The OR for the presence of WMHs in patients with migraine compared with controls was 5.88 (95% CI: 3.42-10.10; p<0.0001). After modifying for confounding factors, multiple linear regression analyses revealed that migraine was independently and positively associated with MVP (p=0.044), tricuspid regurgitation (p=0.003), and WMHs (p<0.001), and mitral regurgitation and migraine was independently and positively connected with WMHs (p<0.005 and p<0.001, respectively). Conclusion: MVP is found CO be independently associated with migraine when compared with controls. Therefore, we suggest that MVP might have an association with migraine. Nevertheless, we could not demonstrate any correlation between MVP and WMHs. Hence, we suggest that MVP might nor be involved in the evolution of WMHs in migrain

Successful treatment of massive pulmonary embolism with reteplase

Unexpected and unexplained out-of-hospital cardiac arrests have a poor prognosis. Difficulties encountered during the differential diagnosis phase may delay the administration of specific treatment for treatable and reversible causes of cardiac arrest. Massive pulmonary embolism is a reversible cause of cardiac arrest, but without proper management it has a high mortality rate. Presently described is the case of a 53-year-old female patient with a massive pulmonary embolism

Fatal Postpartum Hemorrhage In A Patient With Niemann-Pick Disease Type B

Background Niemann-Pick Disease Type B (NPD B) is a rare lysosomal storage disorder resulting from an inherited deficiency of acid sphingomyelinase activity. Here, we report the case of a splenectomized patient with NPD B who died because of severe postpartum hemorrhage (PPH). Case Presentation A 23-year-old nulliparous woman was admitted to intensive care unit (ICU) after cardiopulmonary arrest during urgent hysterectomy because of severe postpartum bleeding. The patient concealed her disease from her family and obstetricians during her pregnancy, and her NPD B diagnosis was revealed during her stay in ICU while searching for the cause of the splenectomy and severe bleeding. Unfortunately, she had a detrimental course with hypoxic brain injury leading to brain death. Conclusions In conclusion, physicians should keep in mind that patients with a history of splenectomy and/or uncontrollable hemorrhage must be carefully evaluated for rare diseases like lysosomal storage diseases and that NPD B can cause mortality because of postpartum bleeding. Adult intensivists should be familiar with adult presentations of rare metabolic or genetic diseases as more and more children with metabolic or genetic diseases will survive to adulthood and will be admitted to and unfortunately will even die in the adult ICU.PubMe

Mid-term clinical outcomes of new generation drug-eluting stents for treatment of diffuse coronary artery disease

Objective: Diffuse coronary artery disease (CAD) is a challenging issue in clinical cardiology practice. There are limited data about percutaneous revascularization in these patients. Methods: This study was an observational clinical evaluation. The records of patients with diffuse CAD revascularized with new-generation drug-eluting stents (DES) were researched retrospectively. Patients treated with multiple, overlapping new-generation DES (at least 60mm in length per vessel) were included. The incidence of major adverse cardiac events (MACE), defined as cardiac death, stent thrombosis, non-fatal myocardial infarction, and target lesion revascularization (TLR), at the end of the first year following the index procedure was recorded. Results: A total of 71 patients (with 75 coronary vessels) treated with new-generation DES for diffuse CAD were enrolled in the study. Zotarolimus-eluting stents were used in 48 vessels and biolimus A9-eluting stents were used in 27 vessels. The median total stent length per vessel was 75.0 mm (60.0-106.0) and the median number of stents implanted was 3 (2-4) for each vessel. The cumulative incidence of MACE at the end of the first year was 11.2% (8 patients). The presence of diabetes mellitus (DM) and ST-segment elevated myocardial infarction (STEMI) were defined as independent clinical risk factors related to MACE development. Conclusion: Coronary artery revascularization with new-generation drug-eluting stents can be a good choice in the treatment of selected patients with diffuse CAD. DM and STEMI were found to be related to poorer clinical outcomes with this treatment option in our study

Pulmonary Nocardiosis Presenting with Pericarditis

Nocardiosis is usually seen in the immunsupressive persons and occurs in the lungs. In this case report, pulmonary nocardiosis with pericarditis in a pregnant woman who hasn’t got any underlying immunsupressive disease is presented