A Case of Triple Valve Endocarditis in a Patient on Haemodialysis

A 22 year-old male patient referred to cardiology clinic with complaints of fever, chills and malaise. He had been on haemodialysis for 12 months due to immunoglobulin A nephropathy. On admission his body temperature, pulse rate and blood pressure was 38.6°C, 115 beats/min and 110/70 mmHg, respectively. In the laboratory examination there were leukocyte, C-reactive protein and erythrocyte sedimentation rate elevation. There were vegetations on the mitral, aortic and tricuspid valves. Blood cultures were positive for Enterococcus faecalis which was susceptible to vancomycin. Since the patient did not accept the surgical operation, he died because of multi-organ dysfunction

Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation

Objectives: In this study, we aimed to compare the effectsof infarct localization in patients with ST ElevatedMyocardial Infarction (STEMI) on the right ventricular(RV) functions by using advanced echocardiographicmethods.Materials and methods: A total of 89 patients withSTEMI were included into the study and patients weredivided to three groups as anterior, isolated-inferior andinferior+RV MI groups. In addition to standard echocardiographicmesurements, RV tissue doppler, RV EjectionFraction (RVEF), Myocardial performance index (MPI)and TAPSE measurements of all patients were performedbetween 24-72 hours after the event.Results: Compared to groups, RV functions in inferior MIwith RV involvement group were deteriorated. Tricuspidannular plane systolic excursion (TAPSE) value for theinferior MI with RV involvement (19±1mm) group werelower than those for Inferior MI group without RV involvement(23±1mm) and anterior MI (23±1mm) (p<0.05). TheRV MPI value for inferior MI group with RV involvement(0.76±0.14) were found to be higher than those for anterior(0.64±0.1) and inferior MI (0.56±0.1) group withoutRV involvement (p<0.05). Peak Sm (r = -0.35, p =0.01), TAPSE (r = -0.47, p<0.001) and RV EF (r = -0.46,p<0.001) showed a negative correlation with RV MPI value.Furthermore, RV tricuspid E/A rate (r = -0.19, p = 0.7)and RV free wall tissue doppler Em/Am rate (r = -0.26, p =0.01) displayed a negative correlation with RV MPI value.Conclusions: Use of advanced methods addition to theconventional echocardiographic methods in STEMI patients,could produce more valuable information to evaluateRV functions and provide a positive impact on treatmentstrategies.Key words: Acute myocardial infarction, right ventricle,echocardiography, TAPSE, MP

The Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

Background: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) is a prospective,multicenter study designed with the aim of describing the prevalence and epidemiology ofAF practice in Turkey. This study aims to evaluate stroke risk in non-valvular atrial fi brillation(AF) and anticoagulant drug utilization within conformity to AF guidelines.Methods: Patients were recruited in 17 referral hospitals refl ecting all the population of7 geographical regions of Turkey. 2242 consecutive patients who had been admitted with AFon ECG were included in the study. 1745 of these patients, who had non-valvular AF, wereincluded in the statistical evaluation. Stroke risk was evaluated with the CHA2DS2-VASc score.Results: The average age of participants was determined to be 69.2 ± 11.5 years (56%female). Persistent-permanent AF was found to be the most common type of non-valvularAF (78%). The most common comorbid disorder was hypertension (73%). It was found thatoral anticoagulant therapy was used by 40% of all patients, 37% of whom had effective INR(2.0–3.0). Upon multivariate analysis, age was found to be the only independent predictorof stroke among the variables’ effects on thromboembolic events that created CHA2DS2-VAScabbreviations (OR 1.026, p &lt; 0.001).Conclusions: These results suggest that stroke risk scores should be thoroughly heededbased on guidelines, and that anticoagulation must be applied according to their guidance

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study.Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treatedat 13 major hospitals in Turkey from 2005 to 2012.Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14–6.13), poor functional status (OR 24.5; 95% CI 3.1–196.5) and high CRP (OR 1.02; 95% CI1.00–1.03) measured on admission were independent risk associates for in-hospital mortality.Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class ofIII/IV and high CRP reflected independent risk for stroke/mortality end point

Unusual Cause of Inappropriate Implantable Cardioverter Defibrillators’ Shock: Tremor

Implantable cardioverter defibrillators are widely used for primary and secondary prevention from sudden death. These devices terminate attacks of ventricular tachycardia and ventricular fibrillation by applying direct current shock, if it necessary. Despite these benefical effects, inappropriate shocks are important side effects of implantable cardioverter defibrillators. Inappropriate implantable cardioverter defibrillator shocks impair life quality by causing pain and psychological side-effects, and even induce new arrhytmias. In this paper we present a case of inappropriate implantable cardioverter defibrillator shock due to tremor

Evaluation of Endothelial Functions of Psoriasis Patients by Flow Mediated Dilatation Method

Aim: Flow mediated dilatation (FMD) is a good sonographic indicator of early atherosclerotic changes which reflects endothelial functions by measuring dilatation of peripheral arteries in response to physical stressors. In this study, we aimed to measure FMD on brachial artery of patients with psoriasis which reflects endothelial dysfunction and compare to that of healthy volunteers. Methods: 30 patients with psoriasis and 31 control subjects matched in terms of age, gender, and demographic characteristics were included to this observational, case-control study. FMD was measured on the nondominant arm of the subjects by using sonographic techniques. Results: The patients and controls were similar in terms of sex, gender, smoking, arterial blood pressure, and body mass index. FMD values, reflecting endothelial functions, were tended to be lower in psoriasis group than healthy controls; however this difference was not statistically significant (7.7 ± 3.1 vs. 8.6 ± 2.8, respectively; p = 0.247). Conclusion: These results support that presence of psoriasis is not a risk factor for future cardiovascular disease development. Prospective, multi-center, large scale studies including control group are needed in order to clarify this issue