Eroin kullanımı ve miyokard infarktüsü

Eroin kullanımı sonrası akut miyokard infarktüsü ile ilişkili bilgiler sınırlıdır ve eroinin tetiklediği akut miyokard infarktüsünün mekanizması tam olarak bilinmemektedir. Eroin kullanımıyla ilişkili akut miyokard infarktüsü gelişen normal koroner arterlere sahip sadece bir olgu şimdiye kadar rapor edilmiştir. Biz de eroin kulanımı sonrası miyokard infarktüsü gelişen normal koroner arterlere sahip bir olgu rapor ettik.Information concerning acute myocardial infarction after heroin usage is limited and the actual mechanism of heroin-induced myocardial infarction is not well known. Only one report has been described noting the association between usage heroin and acute myocardial infarction in a young man with normal coronary arteries. We also reported a patient with normal coronary arteries and acute myocardial infarction after heroin abuse

Sistolik kalp yetmezlikli hastalarda karvedilolün P dalga süresi ve dispersiyonu üzerine etkileri

Amaç: Karvedilol tedavisi, sol ventrikül ejeksiyon fraksiyonunu artırır, ventriküler disfonksiyonun şiddetini, morbidite ve mortaliteyi azaltır. Ancak sistolik kalp yetmezlikli hastalarda karvedilolün P dalga dispersiyonu ve süresi üzerine etkileri bilinmemektedir. Bu çalışmada kalp yetmezliği olan hastalarda karvedilolün P dalga süresi ve dispersiyonu üzerine olan etkilerini araştırdık. Hastalar ve Yöntemler: Sol ventrikül ejeksiyon fraksiyonu %40'ın altında olan kalp yetmezlikli 56 hasta ileriye dönük olarak çalışmaya alındı. Karvedilol kalp yetmezliğinin standart tedavisine ek olarak verildi. Başlangıçta ve karvedilol tedavisinin dördüncü ayında fizik muayene, radyonüklid çalışma ve başlangıç maksimum ve minimum P-dalga süresi ve P-dalga dispersiyonu ölçümleri yapıldı. Bulgular: Karvedilol tedavisi ile maksimum P dalga süresi ve P-dalga dispersiyonu belirgin olarak azaldı. Sol ventrikül ejeksiyon fraksiyonu ve NYHA fonksiyonel sınıfı karvedilol tedavisi sonrası düzeldi. (Maksimum P-dalga süresi; 126±9 ms'den 120±7ms'ye; p=0.001, P- dalga dispersiyonu; 51±7 ms'den 46±5 ms'ye geriledi; p=0.001). Sonuç: Karvedilol tedavisi maksimum P-dalga süresi ve P-dalga dispersiyonunu direkt (doğrudan) ve indirekt (dolaylı) olarak azaltır. Bu kalp yetmezliği olan hastalarda atriyal fibrilasyon görülme sıklığını azaltabilir.Objectives: Carvedilol therapy reduces the severity of the ventricular dysfunction, increases left ventricular ejection fraction and reduces the mortality and morbidity. However, the effect of carvedilol on P-wave dispersion and P-wave duration in patients with systolic heart failure is unknown. In the present study, we aimed to evaluate the effect of carvedilol therapy on P-wave duration and P-wave dispersion in patients with heart failure. Patients and Methods: Fifty-six patients with heart failure and a left ventricular ejection fraction less than 40% were prospectively included in the study. Carvedilol was administered in addition to standard therapy for heart failure. Clinical examination and radionuclide study and baseline maximum and minimum P-wave duration and P-wave dispersion measurements were performed for each patient at the beginning and at the end of the fourth month of carvedilol therapy. Results: Maximum P-wave duration and P-wave dispersion significantly decreased, left ventricular ejection fraction and NYHA functional class improved by carvedilol therapy (Maximum P-wave duration; from 126±9 ms to 120±7ms; p=0.001, P-wave dispersion; from 51±7 ms to 46±5 ms; p=0.001). Conclusion: Carvedilol therapy directly or indirectly reduces maximum P-wave duration and P-wave dispersion. This may lead to a reduction in the occurrence of atrial fibrillation in patients with heart failure

Koroner arter girişimi sırasında ani tıkanma: Bu kabus kontrast maddeyle ilişkili mi?

Kırk altı yaşında, koroner arter hastalığı için risk faktörü olarak hipertansiyon ve aile öyküsü olan erkek hasta akut anterior miyokard infarktüsünün ikinci saati içinde kliniğimize başvurdu. Kurtarıcı perkütan koroner girişim sırasında sol ön inen arterin tam tıkandığı gözlendi. İşlem sırasında kullanılan 150 ml non-iyonik, düşük osmolar kontrast maddenin trombüse yol açarak tam tıkanıklığa neden olabileceği düşünüldü. İntrakoroner bolus tirofiban infüzyonu sonrasında intrakoroner trombozun çözüldüğü görüldü. Lezyon bölgesine stent uygulandı ve TIMI III akımla birlikte çok iyi anjiyografik sonuç elde edildi. Beş ay sonra yapılan kontrol anjiyografide sol ön inen koroner arter tamamen açık idi. Kurtarıcı işlem sırasında gelişen akut koroner tıkanmaların tedavisinde tirofiban infüzyonuyla bareber stentleme tıkanıklığı etkin bir şekilde gidermektedir.A 46-year-old man with hypertension and family history for coronary artery disease presented to our department within the second hour of acute anterior wall myocardial infarction. During rescue percutaneous transluminal coronary angioplasty, total occlusion occured in the left anterior descending (LAD) coronary artery. A total of 150 ml of non-ionic, low-osmolar contrast agent was used and it was thought that non-ionic contrast media could have induced thrombus formation. After bolus intracoronary tirofiban administration, there was satisfactory resolution of the intracoronary thrombosis. Stent implantation at the lesion site resulted in an excellent angiographic result with a TIMI III flow. At five-month control angiography, the LAD was widely patent. Acute total occlusions during rescue coronary angioplasty can be effectively managed by tirofiban infusion and stenting

Percutaneous endovascular therapy for symptomatic chronic total occlusion of the left subclavian artery

CONCLUSION Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results

Badanie służące ocenie występowania choroby wieńcowej w młodym wieku

Introduction. An increasing number of younger patients are being hospitalized with acute coronary syndromes. Earlier risk assessment is essential to prevent or delay coronary artery disease (CAD). This study aimed to assess the rate, risk factor profile, presentation, management and prognosis in young patients with CAD and compared with the same age group without CAD. Material and methods. In this retrospective study, 4325 patients who had undergone coronary angiography from 2011 to 2014 were identified. A total of 627 patients were ≤ 45 years age; 412 of them had CAD, and 215 had normal coronary arteries (control group). Results. The mean age of the patients was 41.7 ± 4.1 years in the CAD group and 41.5 ± 4.5 years in the control group. The prevalences of dyslipidemia, smoking, family history of CAD, hypertension, diabetes, and overweight were higher in the CAD than in the control group. However, the obesity rate was not significantly different between the two groups. Patients with ACS often presented with ST elevation myocardial infarction (STEMI) (49.3%), and single-vessel involvement (55.3%) predominated. Percutaneous coronary intervention (PCI) was the main myocardial reperfusion therapy (68.4%). Conclusıons. Among the young patients studied, CAD had a higher incidence in males. Smoking was the most important modifiable risk factor. Also, patients showed high prevalences of dyslipidemia, overweight, diabetes, and family history of CAD. This study re-emphasizes the relationship between traditional cardiovascular risks and CAD in young.Wstęp. Coraz więcej młodych osób jest hospitalizowanych z powodu ostrych zespołów wieńcowych (ACS). Wczesna ocena ryzyka ma podstawowe znaczenie w zapobieganiu chorobie wieńcowej (CAD) lub opóźnieniu jej wystąpienia. Badanie przeprowadzono w celu oceny częstości występowania CAD, jej czynników ryzyka, objawów, leczenia oraz rokowania u młodych pacjentów z CAD i porównanie tych danych z odpowiednimi danymi dotyczącymi osób niechorujących na CAD. Materiał i metody. Na potrzeby tego retrospektywnego badaniu zidentyfikowano 4325 chorych poddanych koronarografii w latach 2011–2014. W grupie badanych było 627 chorych w wieku nie więcej niż 45 lat; u 412 osób z tej grupy stwierdzono CAD, a u 215 obraz tętnic wieńcowych był prawidłowy (grupa kontrolna). Wyniki. Średni wiek chorych wynosił 41,7 ± 4,1 roku w grupie CAD i 41,5 ± 4,5 roku w grupie kontrolnej. W grupie CAD stwierdzono częstsze występowanie dyslipidemii, palenia tytoniu, dodatniego wywiadu rodzinnego odnośnie do CAD, nadciśnienia tętniczego, cukrzycy i otyłości niż w grupie kontrolnej. Jednak różnica w zakresie częstości występowania otyłości nie była istotna statystycznie. U chorych z ACS często stwierdzano zawał serca z uniesieniem odcinka ST (49,3%), a dominującym typem zmian w koronarografii była choroba jednonaczyniowa (55,3%). Najczęściej stosowanym leczeniem reperfuzyjnym (68,4%) była przezskórna interwencja wieńcowa. Wnioski. W badanej grupie młodych pacjentów stwierdzono większą zapadalność na CAD wśród mężczyzn. Najważniejszym poddającym się modyfikacji czynnikiem ryzyka było palenie tytoniu. U dużej części chorych stwierdzono również dyslipidemię, otyłość, cukrzycę i występowanie CAD w rodzinie. Badanie ponownie zwróciło uwagę na zależność między tradycyjnymi czynnikami ryzyka sercowo-naczyniowego a występowaniem CAD w młodym wieku

Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study)

Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure

Sol ön inen koroner arteri tam tıkalı, anormal elektrokardiyografi bulguları olmayan anstabil anginalı bir hasta

Koroner kollateraller koroner anjiyografide görülebilir ve yeterli kan akımını sağlamak için damar yetersiz kaldığında önemli bir alternatif kaynak olarak görev alırlar. Biz sol ön inen koroner arteri tam tıkanmış, anstabil anginalı ve normal elektrokardiyografi bulgularına sahip bir hasta rapor ediyoruz.Coronary collaterals can be visualized on coronary angiography and they potentially offer an important alternative source of blood supply when the original vessel fails to provide sufficient blood. We report a patient with unstable angina and normal electrocardiography and total occlusion of the left anterior descending coronary artery

Akut pulmoner embolili hastada ters McConnell bulgusu

Pulmoner embolinin tanısı için birçok ekokardiyografik parametre bulunmaktadır. Bu parametreler arasında, sağ ventrikül apikal kasılması normalken sağ ventrikül serbest duvar hareketinde hipokinezi olması “McConnell bulgusu” olarak tanımlanmaktadır. Biz sağ ventrikül apeksi ve serbest duvarının reversibl akinezisine yol açan akut pulmoner embolili bir olgu sunduk ve bu bulguyu “ters McConnell işareti” olarak yorumladık.There are various echocardiographic parameters for diagnosis of pulmonary embolism. Among these paramaters, “McConnell sign” is defined as right ventricular free wall hypokinesis in the presence of normal right ventricular apical contractility. We presented a patient with acute pulmonary embolism which caused reversible akinesia of the apex and right ventricular midfree wall, a finding we would like to term “reverse McConnell sign.&#8221