Akut miyokard infarktüsünde yeni genetik risk faktörleri

TEZ5156Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2004.Kaynakça (s. 36-44) var.vi, 44 s. ; 30 cm.

Why was not every patient with acute myocardial infarction given fibrinolytic therapy?

Akut miyokart infarktüsünde fibrinolitik tedavi aspirinle beraber verildiğinde mortaliteyi %42 oranında azaltmaktadır. Bu çalışmanın amacı akut miyokart İnfarktüslü hastalarda fibrinolitik tedavi verilme oranı ile fibrinolitik verilmeme nedenlerinin değerlendirilmesidir. Hastanemize son bir yıl içinde akut miyokart infarktüsü (AMİ) nedeni ile başvuran 190 (K-38, E-152) hastanın verileri geriye dönük olarak değerlendirildi. Bu hastalardan 20'sinin (%10.5) akut non Q Mİ nedeniyle fibrinolitik tedaviye aday olmadığı saptandı. Geriye kalan 170 hastanın ise ancak 97'sinin (%57.0) fibrinolitik tedavi aldığı tespit edildi. Fibrinolitik tedavinin ilk 6 saatte uygulandığı hasta sayısı ise 83(%48.8) olarak saptandı. Hastanemizdeki fibrinolitik tedavi almayan 73 hastanın gecikmesindeki nedenler incelendiğinde en sık olarak 28'inin (%38.3) hastaneye geç başvurduğu, 16'sının (%21.9) buna ek olarak ulaşım nedeniyle geciktiği ve 18'ine (%24.6) ise tanı konulamadığından fibrinolitik tedavi verilemediği saptandı. Fibrinolitik tedavi almayan grupta ileri yaş, kadın cinsiyet ve önceden AMİ geçirme hikayesi daha yüksek oranda tespit edildi (p<0.05). Sonuç olarak, hastanemize başvuran hastaların yaklaşık olarak yarısına fibrinolitik tedavi verildiği ve bu oranın artması için hasta ve sağlık personelinin daha dikkatli davranmaları gerektiği düşünüldü.Fibrinolytic therapy concomitant with aspirin in acute myocardial infarction (AMI) has been shown to reduce mortality in a rate of 42%. The aim of this study is to evaluate what percentage of patients treated with fibrinolytic treatment and to determine the reasons why this therapy was not given. The records of 190 patients (158 male and 38 female) have been evaluated retrospectively. Twenty patients (10.5%) did not receive fibrinolytic therapy because of Non-Q AMI. Ninety-seven patients (57.0%) received fibrinolytic therapy. it was administered to 83 (48.8%) of those only patients in the first 6 hours of AMI. Fibrinolytic treatment was not given to 73 patients. The reasons of that; late arrival in 28 (38.3%), inadequate transportation in 16 patients (21.9%), and inappropriate diagnosis in 18 (24.6%) patients. Late arrival was due to older age, female sex and previous MI history. in conclusion, fibrinolytic treatment was administered in about half of the patients with AMI. To increase the fibrinolytic treatment rate in patients with AMI, every worker at every steps must be alert such as patients, medical doctor who consult the patient first and in ambulance, at emergency room

Leimyoma extending to the right ventricle:Case report

İntravenöz leiomiyomlar, uterus miyomlarından köken alırlar ve venlerin lümenlerine yaydım gösterirler. Leiomiyomlar nadir de olsa, sağ kalp boşluklarına ulaşabilmekte, çeşitli kardiyovasküler semptomlara neden olabilmektedir. Leiomiyomlar trombus ile karıştırılabilir ve trombus tedavisine bağlı komplikasyonlar görülebilmektedir. Leiomiyomun triküspit kapağa ulaşması halinde, ani ölüm riski oluşmaktadır. Bu yazıda, iliyak venden sağ ventriküle kadar uzanan ve endokardit gelişimine zemin hazırlayan dev bir leiomiyom olgusu sunulmaktadır.Intravenous leiomyomas originate from the uterine myomas and may spread intravenously. Leiomyomas rarely can reach the right heart cavities and may cause various cardiovascular symptoms. They may be misdiagnosed as thrombus and some complications due to anti thrombotic treatment may occur. Sudden death risk arises if the leiomyoma reaches to the tricuspid valve. We report a giant leiomyoma case that originated from the iliac veins, reached the right ventricle and predisposed to the development of endocarditis

A giant right atrial myxoma: Case report

Miksoma nadir görülen kalp tümörlerinin yarısını oluşturmaktadır. Miksoma çoğunlukla sol atriyum seyrek olarak da sağ atriyumda görülmektedir. Bu yazıda sağ atriyal boşluğun tamamına yakın kısmını kaplayan dev bir miksoma olgusu sunulmaktadır.Half of the cardiac tumors are myxomas. Most of them are located in the left atrium; however they may also be rarely seen in the right atrium, lathis report we present a giant myxoma case covering most of the right atrial cavity

Paroksismal atriyal fibrilasyonlu hastalarda kriyobalon ablasyon parametrelerinin nüks üzerine etkisi

Objective: The aim of this research was to investigate the relationship between atrial fibrillation (AF) recurrence and second generation cryoballoon ablation (CBA) procedural parameters in patients with non-valvular paroxysmal AF (PAF). Methods: A total of 131 patients with a PAF diagnosis who underwent second-generation CBA (59 male; mean age: 55.2±10.6 years) were enrolled. Recurrence was defined as the detection of AF on a 12-lead electrocardiography (ECG) recording, or an attack lasting at least 30 seconds observed on Holter ECG records. CBA procedural data and echocardiographic findings were recorded and compared. Results: After 1 year of follow-up, AF recurrence was detected in 27 patients. Patients with recurrence were older and had higher rates of hypertension and diabetes (p<0.05 for both). Left atrial diameter, left atrial volume (LaV), left atrial volume index, and the averaged warming angle (calculated by combining lowest temperature point and balloon temperature at 20°C point) were significantly higher in the recurrence group. Balloon warming time was significantly longer in the non-recurrence group (p<0.001). In binary logistic regression analysis, the averaged warming angle (odds ratio [OR]: 1.559, 95% confidence interval [CI]: 1.342– 1.811; p<0.001) and LaV (OR: 1.063, 95% CI: 1.028–1.100; p<0.001) were found to be independent parameters for predicting recurrence. The cutoff value of the warming angle obtained with ROC curve analysis was 50° for the prediction of recurrence (sensitivity: 94.3%, specificity: 88.5%, area under the curve: 0.909; p<0.001). The cutoff value of LaV obtained by ROC curve analysis was 53.5 for prediction of recurrence (sensitivity: 77.8%, specificity: 74.5%; p<0.001). Conclusion: Measurement of balloon warming angle during CBA and increased LaV may predict the AF recurrence.Amaç: Bu çalışmada, valvüler olmayan paroksismal atriyal fibrilasyonu (PAF) olan hastalarda AF nüksü ile ikinci jenerasyon kriyobalon ablasyon (KBA) prosedürü parametreleri arasındaki ilişkiyi araştırmayı planladık. Yöntemler: İkinci jenerasyon KBA (59 erkek; ort. yaş 55.2±10.6 yıl) yapılan PAF tanısı alan 131 hasta dahil edildi. Nüks, 12 derivasyonlu elektrokardiyografide (EKG) AF görülmesiyle ya da ritim Holter kayıtlarında en az 30 saniye süren AF ataklarının saptanması olarak tanımlandı. Bazı KBA prosedür verileri ve ekokardiyografik bulgular kaydedildi ve karşılaştırıldı. Bulgular: Bir yıl sonra izlemde 27 hastada AF nüks tespit edildi. Nüksü olan hastalar daha yaşlıydı ve daha yüksek hipertansiyon ve diyabet oranları vardı (hepsi için, p<0.05). Sol atriyum çapı (SaD), sol atriyum volümü (SaV), sol atriyum volümü indeksi (SaVI) ve ortalama ısınma açısı (en düşük sıcaklık noktasını ve balon sıcaklığını 20°C noktasının birleştirilmesi ile elde edilen) nüks grubunda anlamlı olarak artmıştı. Nüks olmayan grupta balon ısınma süresi önemli ölçüde uzamıştı (p<0.001). İkili lojistik regresyon analizinde, ortalama ısınma açısı (OO=1.559, %95 GA: 1.342–1.811, p<0.001) ve sol atriyum volümü (SaV, OO: 1.063, %95 GA: 1.028–1.100, p<0.001) nüks tahmini için bağımsız parametreler bulundu. ROC eğrisi analizi ile elde edilen ısınma açısının kestirim değeri, nüks tahmini için 50° idi (duyarlılık: %94.3, özgüllük: %88.5, EAA: 0.909, p<0.001). ROC eğrisi analizi ile elde edilen SaV’nin kesme değeri, nüks tahmini için 53.5 idi (duyarlılık: %77.8, özgüllük: %74.5, p <0.001). Sonuç: Kriyobalon ablasyon sırasında balon ısınma açısının ölçülmesi ve artan SaV, AF nüksetmesini öngörebilir

İdiyopatik dilate kardiyomiyopatili hastalarda lenfosit alt grupları

Objective: Although chronic myocardial inflammatory process mediated by viral and autoimmune factors has been postulated in the pathogenesis of idiopathic dilated cardiomyopathy (IDC), the role of autoimmune mechanisms still remains unclear. The aim of the present study was to investigate the rates of various T cell subsets and natural killer (NK) cells in peripheral blood in order to see whether they had a role in the immunoregulation of IDC. Methods: The surface markers of peripheral T and B lymphocytes were detected and percentages of pan T and B cells as well as helper (CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio (CD4+/CD8+) were determined in 27 patients with IDC and in 20 healthy controls. NK cell percentage was also studied. Results: There were no significant differences between IDC and control groups with respect to T and B cell percentages. The percentages of CD4+ T cell subsets were similar in both groups (48.7±8.7 % vs. 43.5±9.7 % respectively; p=0.107). CD8+ T cell percentage was significantly decreased in patients with IDC than in controls (22.6±7.7 % vs. 28.2±8.2 %, respectively; p=0.044). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls (2.6±1.8 vs. 1.6±0.6, respectively; p=0.006). There was no significant difference in the NK cell percentage between groups. Conclusion: Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC.Objective: Although chronic myocardial inflammatory process mediated by viral and autoimmune factors has been postulated in the pathogenesis of idiopathic dilated cardiomyopathy (IDC), the role of autoimmune mechanisms still remains unclear. The aim of the present study was to investigate the rates of various T cell subsets and natural killer (NK) cells in peripheral blood in order to see whether they had a role in the immunoregulation of IDC. Methods: The surface markers of peripheral T and B lymphocytes were detected and percentages of pan T and B cells as well as helper (CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio (CD4+/CD8+) were determined in 27 patients with IDC and in 20 healthy controls. NK cell percentage was also studied. Results: There were no significant differences between IDC and control groups with respect to T and B cell percentages. The percentages of CD4+ T cell subsets were similar in both groups (48.7±8.7 % vs. 43.5±9.7 % respectively; p=0.107). CD8+ T cell percentage was significantly decreased in patients with IDC than in controls (22.6±7.7 % vs. 28.2±8.2 %, respectively; p=0.044). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls (2.6±1.8 vs. 1.6±0.6, respectively; p=0.006). There was no significant difference in the NK cell percentage between groups. Conclusion: Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC

The Effectiveness of Neutrophil-Lymphocyte Ratio in Predicting in-Hospital Mortality in Non-ST-Elevation Myocardial Infarction

Background. Myocardial infarction is the most common cause of death all over the world. There are many studies in predicting mortality. The aim of this study was to determine the effectiveness of hematologic parameters measured at the moment of admission to the emergency room in predicting in-hospital mortality and to determine cutoff values of strongly predictive values. Methods. A total of 681 patients over 18 years of age, whose date could be obtained, were included in the study. From the hemogram parameters, white blood cells (WBC), red cell distribution width (RDW), mean platelet volume (MPV), and neutrophils-to-lymphocytes ratio (NLR) values were determined and recorded. CK-MB and high-sensitive troponin T values were recorded as cardiac markers. For statistical analysis, “SPSS for Windows version 21” package program was used. Results. 62.6% (n = 426) of the patients were male, and 37.4% (n = 255) of the patients were female. The NLR was found to be the strongest predictor (area under the curve (AUC), 0.783, SD = 0.052, 95% confidence interval (CI)). It was found that the WBC value came in the second place after NLR as a strong predictor of mortality (AUC, 0.702, SD = 0.075, 95% CI). Conclusion. According to the hemogram results which were acquired with a simple and cheap method, we found that WBC and especially NLR values obtained with a simple method can be used as powerful predictors

Evaluation of coronary sinus morphology by three‐dimensional transthoracic echocardiography in patients undergoing electrophysiological study

Background: In this study, we aimed to evaluate the coronary sinus (CS) morphology with three‐dimensional transthoracic echocardiography (3D‐TTE) in patients with supraventricular tachycardia (SVT) who underwent electrophysiological study (EPS). Methods: This cross‐sectional study was conducted with 187 patients who underwent EPS between November 2016 and April 2017. Patients were divided into three groups: atrioventricular nodal reentrant tachycardia (AVNRT) (n = 72), non‐ AVNRT SVT (n = 58), and normal EPS (n = 57). All patients were evaluated with electrocardiography, TTE, and 3D‐TTE. Results: The CS diameter (CSD) and area (CSA) were found significantly lower in the normal EPS group than in the other groups. There was no significant difference in the CSD between AVNRT and non‐AVNRT SVT groups. However, it was found that the CSA was significantly larger in the AVNRT group than in the non‐AVNRT SVT group. In linear regression analysis, age and left atrial diameter were determined as independent predictor for CSD and CSA (P < 0.001 for each one). Conclusions: The CSD and CSA assessed by 3D‐TTE were different and dilated in the patients with SVT compared to those in the normal individuals. There was no significant difference in the CSD between the AVNRT and non‐AVNRT SVT groups. However, the AVNRT group had a larger CSA than the non‐AVNRT SVT group

Are the parameters of inflammation a measure of success of thrombolytic treatment in acute myocardial infarction?

Akut ST yükselmeli miyokard infarktüsünde (AMİ) yetersiz koroner reperfüzyon kötü prognoz ile ilişkilidir. Bu nedenle trombolitik tedavinin yeterli reperfüzyon sağlayıp sağlayamadığının hızlı ve pratik bir yöntemle kontrol edilmesi önemlidir. Göğüs ağrısının sona ermesi ve elektrokardiyografide (EKG) yükselmiş ST segmentinde çökme olması klinikte en sık ve kolay uygulanan yöntemlerdir. Bu çalışmada akut ST yükselmeli AMİ hastalarında uygulanan trombolitik tedavinin etkinliğini saptamada trombolitik öncesi incelenen yüksek hassas C-reaktif protein (hsCRP) ve serum amiloid A (SAA) düzeylerinin yeri araştırıldı. ST yükselmeli AMİ tanısıyla kliniğimize yatırılan yaşları 28-70 arası (ortalama 54.8 ± 9.4 yıl), ardışık 42 hasta (4 kadın, 38 erkek) çalışmaya dahil edildi. Hastalardan CK-MB, Troponin T, lipid düzeyleri, hsCRP ve SAA için serum örnekleri alındıktan sonra trombolitik tedavi uygulandı. Tedavinin 0. ve 3. saatinde EKG'ler çekildi ST segment yükseklikleri değerlendirildi, %70 ve üzeri ST rezolüsyonu tam, %31-69 orta ve %0-30 hafif olarak kabul edildi. Yatışların 5. gününde hassas hsCRP ve SAA için ikinci kez serum örnekleri alındı. Koroner anjiyografileri yapıldı ve TIMI akımları değerlendirildi. Trombolitik öncesi bakılan hsCRP ve SAA düzeyleri ile ST rezolüsyonu arasında negatif bir ilişki mevcuttu ve bu ilişki 5. gün devam etmekteydi. Trombolitik öncesi bakılan hsCRP düzeyi 3.5 mg/dl'nin altında ise %67 duyarlılık ve %74 özgüllük ile ST rezolüsyonunun yeterli olacağını tahmin ederken, 7.0 mg/dl'nin üzerinde ise %70 duyarlılık ve %88 özgüllük ile rezolüsyon olamayacağını tahmin ettiği görüldü. Sonuç olarak ST yükselmeli AMİ'de trombolitik öncesi incelenen serum hsCRP düzeyi uygulanacak trombolitik tedavinin etkinliğini göstermede kullanılabilecek kolay ve güvenilir bir yöntemdir.In the present study, we investigated the role of pre-treatment highly sensitive C reactive protein (hsCRP) and serum amyloid A (SAA) levels in predicting the success of thrombolytic treatment in patients with acute ST elevation pect to the initial ST elevation was accepted as complete resolution, while resolution values of respectively 31-69% and 0-30% were designated as moderate and weak resolution. On their 5th day of hospitalization, a second serum sample was collected from all patients for the determination ofhsCRP and SAA values. Their coronary angiography and TIMIflow patterns were also evaluated. There was an inverse-relationship between the initial hsCRP and SAA levels on one hand and the ST resolution after thrombolytic treatment on the other, which persisted at the 5th day after presentation. Complete resolution was predicted with a sensitivity of 67% and a specificity of 74% in patients with hsCRP levels below 3.5 mgldl. Conversely, for patients with hsCRP values above 7.0 mgldl, poor ST resolution was predicted with a sensitivity of 70% and a specificity of 8.8%. Serum hsCRP level measured before thrombolytic therapy in patients with AMI with ST elevations is a practical and reliable method in determining the efficacy of thrombolytic treatment