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

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

Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris

Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study

akil, mehmet ata/0000-0001-6004-1822; KAYA, HASAN/0000-0003-3923-4026WOS: 000319517900003PubMed: 23661513OBJECTIVE: This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study. PATIENTS AND METHODS: 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed. RESULTS: The mean age of the patients was determined as 80.3 +/- 4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range. CONCLUSIONS: The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment