Takotsubo Syndrome: Still Graveyard of Case Reports?

Takotsubo syndrome, or previously named as Takotsubo cardiomyopathy, is an increa-singly recognized acute reversible form of heart failure, which is typically seen in post-menopausal women following emotional or physical stress. Although several mechanisms regarding pathophysiology had been proposed, the most common ones include catecholamine toxicity, diffuse epicardial coronary artery spasm and microvascular dysfunction. A vast majority of patients with TTS (>90%) have good prognosis as they regain normal left ventricular systolic function in 3–6 months after the acute phase. Increased awareness among physicians led to the recognition of a great number and variety of conditions associated with TTS and played a key role for the development of new diagnostic criteria. However, there are still big gaps in the management and treatment of this syndrome to be supported with further well-designed randomized controlled trials

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To the Editor, We would like to thank the authors for their interest in our paper and their comments regarding our study entitled “A review of the fixed dose use of new oral anticoagulants in obese patients: Is it really enough?” published in Anatol J Cardiol 2015; 15: 1020-9 (1). Under-representation of obese patients in the subgroups of relevant studies raises concerns about the efficacy and safety of new oral anticoagulants (NOACs). The number of patients with high body weights is quite low in studies investigating the pharmacodynamics and pharmacokinetics of NOACs. In the context of data obtained from these studies, a fixed dose use of NOACs is recommended for obese or morbidly obese patients with no distinction from other patients

Changes in electrocardiographic p wave parameters after cryoballoon ablation and their association with atrial fibrillation recurrence

Background: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence. Methods: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence. Results: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P 0.05). Conclusion: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA

Should we use a staged or ad hoc approach in percutaneous coronary interventions through the radial artery to avoid radial artery spasm?

Objective: Transradial approach has recently been adopted as the default strategy for percutaneous coronary interventions due to benefits which include reduced all-cause mortality, major access-site complications, and hospital stay, as well as increased patient comfort and early ambulation. However, radial artery spasm (RAS) is still a major drawback. The impact on RAS of an ad hoc compared with a staged intervention strategy has not previously been investigated. In this study, we sought to investigate the effect of ad hoc and staged percutaneous coronary intervention (PCI) on RAS in patients undergoing elective transradial coronary interventions. Materials and Methods: In this retrospective study, patients with symptoms suggestive of ischemia who were scheduled for coronary angiography and candidates for elective PCI were enrolled and divided into two equal groups: ad hoc group and staged group. RAS was clinically identified and established based on the existence of two or more of predefined clinical features. Results: A total of 60 patients was enrolled in the study: 30 in the ad hoc group and 30 in the staged group. The mean time between coronary angiography and intervention in the staged group was 2.5 [1–30] days. RAS rates were similar between the ad hoc and staged PCI groups (16.7% [n=5] vs. 31% [n=9], p=0.233), but post-procedural pain was more frequent in patients in the ad hoc group (64.5% [n=20] vs. 33.3% [n=10], p=0.021). Radial artery occlusion did not differ between the ad hoc and staged PCI groups (10.7 % [n=3] vs. 11.1 [n=3], p=1

Serbest dalış öncesi ve sonrası elektrokardiyografik değişikliklerin incelenmesi

Aim: To evaluate the electrocardiographic (ECG) parameters and hemodynamic parameters in predicting the development of arrhythmias after free diving static apnea performance and maximum breath hold. Material and Methods: Twenty-four volunteer athletes participating in the free diving competition in 2015 (19 males (79.2%) and 5 females (20.8%)) were included in the study. Peripheral O2 saturation (SpO2), heart rate (HR), ECG parameters (PR interval, QRS time, T wave amplitude, corrected QT time, presence of bandle branch block and new bandle branch block development, atrial premature beats, ventricular premature beats) were analyzed. Results: There was no statistically significant difference between before static apnea measurements (systolic blood pressure (SBP) 124.7 ± 10.8 mmHg, diastolic blood pressure (DBP) 76.5 ± 6.7 mmHg, heart rate (HR) 80.2 ± 13.4 beats / min, SpO2 97.1 ± 0.9%) and after performance (SBP 128.8 ± 13.6 mmHg DBP 78.0 ± 5.9 mmHg, HR 85.8, ± 16.5 beats / min and SpO2 96.7 ± 2.3%)(p = 0.175; p = 0.334; p = 0.104; p = 0.336, respectively). Conclusion: No significant changes were observed in ECG parameters, heart rate, saturation and blood pressure values evaluated after static apnea performance. These findings can be used to support that the risk of arrhythmia during static apnea does not persist after apnea has ended.Amaç: Serbest dalış statik apne performansı ile maksimum nefes tutma sonrası aritmi gelişimini öngörmede elektrokardiyografik (EKG) parametreleri ve hemodinamik göstergeleri değerlendirmek. Gereç ve Yöntemler: Çalışmaya 2015 yılında düzenlenen serbest dalış yarışmasına katılan 24 gönüllü sporcu dahil edilmiştir (19 erkek (%79,2) and 5 kadın (%20,8)). Performans öncesi ve sonrası ( 5. dakikada) periferik O2 satürasyonu ( pO2), kalp hızı (KH), EKG parametreleri ( PR aralığı, QRS süresi, T dalga amplitüdü, düzeltilmiş QT süresi, dal bloğu varlığı ve yeni dal bloğu gelişimi, atriyal erken atım, ventriküler erken atım varlığı) analiz edildi. Bulgular: Sporcuların statik apne öncesi sistolik kan basınçları (SKB) 124,7±10,8 mmHg, diyastolik kan basınçları (DKB) 76,5±6,7 mmHg, kalp hızı 80,2 ±13,4 atım/dk, pO2 %97,1±0,9 ve performans sonrası SKB 128,8±13,6 mmHg, DKB 78,0 ±5,9 mmHg, KH 85,8±16,5 atım/dk, pO2 %96,7±2,3 arasında istatistiksel olarak anlamlı fark saptanmadı ( sırasıyla p=0,175; p=0,334; p=0,104; p=0,336). Sonuç: Statik apne performansı sonrası değerlendirilen EKG parametrelerinde, kalp hızında, satürasyon ve tansiyon değerlerinde herhangi bir anlamlı değişiklik izlenmedi. Bu bulgular statik apne esnasında gelişebilecek aritmi riskinin apne sonlandıktan sonra devam etmediğini desteklemede kullanılabilir

Health care services in shopping centers: A routine mass-gathering event

Background:Shopping centers (SCs) are social areas with a group of commercial establishments which attract customers of numerous people every day. However, analysis of urgent health conditions and provided health care in SCs has not been performed so far.Objective:The aim of the study was to perform a comparative analysis of clients visiting SCs and demographics, complaints, and health care of patients admitted to Emergency Medical Intervention Units (EMIU) located in grand SCs in Ankara, Turkey.Methods:Customer and health care records of nine grand SCs in Ankara from January 1, 2018 through December 31, 2018 were evaluated retrospectively. Health care services in EMIUs of SCs were provided by employed medical staff. Data including demographic characteristics, complaints, treatment protocols, discharge, and referral to hospital of the patients were retrospectively analyzed from medical registration forms.Results:Medical records of nine grand SCs were analyzed. Number of customers could not be obtained in three SCs due to privacy issues and were not included in patient presentation rate (PPR) and transport-to-hospital rate (TTHR) calculation. Total number of customers in the remaining six SCs were 53,277,239. The total number of patients seeking medical care was 6,749. The number of patients seeking health care in six SCs with known number of customers was 4,498 and PPR ranged from 0.018 to 0.381 patients per 1,000 attendants. The median age of the recorded 4,065 patients (60.2%) was 28 (interquartile range [IQR]: 38-21), and 3,611 (53.5%) of the patients admitted to EMIUs were female. The number of patients treated in the SC was 4,634 (68.6%) and 189 patients (2.8%) were transferred-to-hospital by ambulance for further evaluation and treatment. Transportation to hospital was required in 125 patients who sought medical care in six SCs which provided total number of customers, and TTHR ranged from 0.000 to 0.005 patients per 1,000 attendants. No sudden cardiac death was seen. Medical conditions were the primary reasons for seeking health care. The most frequent causes of presentation were laceration and abrasions (639 patients, 9.4%).Conclusion:The PPR and TTHR in SCs are low. The most common causes of presentation are minor conditions and injuries. Majority of urgent medical conditions in SCs can be managed by health care providers in EMIUs

Practical considerations on non-vitamin K oral anticoagulants in patients with high body weight

We have read with great interest the manuscript by Housseinsabet (1) entitled “Assessment of atrial conduction times in patients with mild diastolic dysfunction and normal atrial size,” published in the Anatolian Journal of Cardiology 2015; 15: 925-31. In this study, Hosseinsabet (1) clearly demonstrated that there were no differences in atrial conduction times (ACTs) and atrial electromechanical delays (EMDs) in patients with mild diastolic dysfunction and normal left atrial volume compared with normal subjects

Serbest daliş öncesi ve sonrasi elektrokardiyografik değişikliklerin incelenmesi

Aim: To evaluate the electrocardiographic (ECG) parameters and hemodynamic parameters in predicting the development of arrhythmias after free diving static apnea performance and maximum breath hold. Material and Methods: Twenty-four volunteer athletes participating in the free diving competition in 2015 (19 males (79.2%) and 5 females (20.8%)) were included in the study. Peripheral O2 saturation (SpO2), heart rate (HR), ECG parameters (PR interval, QRS time, T wave amplitude, corrected QT time, presence of bandle branch block and new bandle branch block development, atrial premature beats, ventricular premature beats) were analyzed. Results: There was no statistically significant difference between before static apnea measurements (systolic blood pressure (SBP) 124.7 ± 10.8 mmHg, diastolic blood pressure (DBP) 76.5 ± 6.7 mmHg, heart rate (HR) 80.2 ± 13.4 beats / min, SpO2 97.1 ± 0.9%) and after performance (SBP 128.8 ± 13.6 mmHg DBP 78.0 ± 5.9 mmHg, HR 85.8, ± 16.5 beats / min and SpO2 96.7 ± 2.3%)(p = 0.175; p = 0.334; p = 0.104; p = 0.336, respectively). Conclusion: No significant changes were observed in ECG parameters, heart rate, saturation and blood pressure values evaluated after static apnea performance. These findings can be used to support that the risk of arrhythmia during static apnea does not persist after apnea has ended.Amaç: Serbest dalış statik apne performansı ile maksimum nefes tutma sonrası aritmi gelişimini öngörmede elektrokardiyografik (EKG) parametreleri ve hemodinamik göstergeleri değerlendirmek. Gereç ve Yöntemler: Çalışmaya 2015 yılında düzenlenen serbest dalış yarışmasına katılan 24 gönüllü sporcu dahil edilmiştir (19 erkek (%79,2) and 5 kadın (%20,8)). Performans öncesi ve sonrası ( 5. dakikada) periferik O2 satürasyonu ( pO2), kalp hızı (KH), EKG parametreleri ( PR aralığı, QRS süresi, T dalga amplitüdü, düzeltilmiş QT süresi, dal bloğu varlığı ve yeni dal bloğu gelişimi, atriyal erken atım, ventriküler erken atım varlığı) analiz edildi. Bulgular: Sporcuların statik apne öncesi sistolik kan basınçları (SKB) 124,7±10,8 mmHg, diyastolik kan basınçları (DKB) 76,5±6,7 mmHg, kalp hızı 80,2 ±13,4 atım/dk, pO2 %97,1±0,9 ve performans sonrası SKB 128,8±13,6 mmHg, DKB 78,0 ±5,9 mmHg, KH 85,8±16,5 atım/dk, pO2 %96,7±2,3 arasında istatistiksel olarak anlamlı fark saptanmadı ( sırasıyla p=0,175; p=0,334; p=0,104; p=0,336). Sonuç: Statik apne performansı sonrası değerlendirilen EKG parametrelerinde, kalp hızında, satürasyon ve tansiyon değerlerinde herhangi bir anlamlı değişiklik izlenmedi. Bu bulgular statik apne esnasında gelişebilecek aritmi riskinin apne sonlandıktan sonra devam etmediğini desteklemede kullanılabilir

Başarılı perikardiyosentez sonrası nadir ve tehlikeli bir komplikasyon: Perikardiyal dekompresyon sendromu

Pericardial decompression syndrome (PDS) is an infrequent but mostly fatal complication after successful pericardiocentesis. We present a case of a 27-year-old female patient with suspected malignancy and cardiac tamponade treated with pericardiocentesis, followed by acute pulmonary edema and cardiac arrest 2 hours later. We also reviewed possible mechanisms involved in PDS pathophysiology in the context of literature data.Perikardiyal dekompresyon sendromu (PDS), başarılı perikardiyosentez sonrası görülebilecek nadir ancak ölümcül bir tablodur. Yirmi yedi yaşında malignite sebebiyle takip edilen, kardiyak tamponad sebebiyle perikardiyosentez yapılan ve sonraki ikinci saatte dispne, akut pulmoner ödem ve kardiyak arrest gelişen olguyu sunduk. PDS patofizyolojisinde etkili mekanizmalar ve olası tedavi literatür bağlamında gözden geçirildi

Kalıcı kalp pili implantı olan atriyal fibrilasyonlu hastada başarılı kateter kriyoablasyon

In daily practice, several methods including electrocardiography, 24-hour Holter ECG monitoring, or event recorders are frequently used for diagnosis and follow-up of patients with atrial fibrillation (AF). Although these tests provide crucial information, they may be insufficient in selected cases. In this case, we utilized intracardiac electrocardiogram recordings for both diagnosis of AF and detection of its recurrence in a patient with a permanent pace-maker who underwent AF ablation because of symptomatic and asymptomatic paroxysmal AF episodes. Because patients with permanent pacemakers are continuously monitored via intracardiac recordings, we believe that it is the most definite method for both diagnosis and monitoring of treatment success.Günlük pratikte hastalarda atriyal fibrilasyon ataklarının tanı ve takibinde sıklıkla elektrokardiyografi, ritim holter ve olay kaydedici kullanılmaktadır. Bu testler önemli bilgi sağlasa da yetersiz kaldıkları olgular olabilmektedir. Biz olgumuzda daha önce kalıcı kalp pili implante edilmiş, semptomatik ve asemptomatik atriyal fibrilasyon atakları olan hastanın tanısının koyulmasında ve atriyal fibrilasyon ablasyonu sonrası rekürrensin takibinde kalp içi kayıtlardan faydalandık. Kalıcı kalp pili olan hastalarda, intrakardiyak kayıtlarla devamlı takip sağladığından, hem tanı koymada hem de tedavi başarısını belirlemede kullanılabilecek en kesin yöntem olduğunu düşünüyoruz