Barış Akdemir

Relation of Neutrophil-to-Lymphocyte Ratio With GRACE Risk Score to In-Hospital Cardiac Events in Patients With ST-Segment Elevated Myocardial Infarction

In this study, we aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) risk score in patients with ST-segment elevated myocardial infarction (STEMI). We analyzed 101 consecutive patients with STEMI. Patients were divided into 3 groups by use of GRACE risk score. The association between NLR and GRACE risk score was assessed. The NLR showed a proportional increase correlated with GRACE risk score (P < .001). The occurrence of in-hospital cardiac death, reinfarction, or new-onset heart failure was significantly related to NLR at admission (P < .001). Likewise, NLR and GRACE risk score showed a significant positive correlation (r = .803, P < .001). In multivariate analysis, NLR resulted as a predictor of worse in-hospital outcomes independent of GRACE risk score. Our study suggests that the NLR is significantly associated with adverse in-hospital outcomes, independent of GRACE risk score in patients with STEMI.

Primer aşırı pıhtılaşma eğilimi olan hastada foramen ovale\'ye tuzaklanmış sağ kalp trombüsü ve pulmoner emboli

Thromboembolic disease is a potentially severe pathology. When its clinical feature implies a massive occlusion of the arterial pulmonary tree and a cardiac failure is ensued, it can be seriously life threatening even for young patients. Less frequent features as right or left atrium thrombosis could increase morbidity and mortality of this disease. We report a case of massive right pulmonary embolism (PE) with entrapped thrombus in patent foramen ovale and right heart failure in a 32- year-old man. Transthoracic echocardiography showed a right atrial thrombus attached to the inter-atrial septum. Following the diagnosis of right heart thrombosis with massive PE, infusion of tissue type plasminogen activator (100 mg in two hours) was administered. Echocardiography performed two days after thrombolysis showed a significant decrease in the right ventricular size and complete lysis of the thrombus in the right heart. By genetic examination, he proved to have factor V ’Leiden’ gene and two thrombophilia genes, all of which were positive in the heterozygous state. He had also a high serum homocysteine.

Vagus nerve stimulation: An evolving adjunctive treatment for cardiac disease

The vagus nerve is a major component of the autonomic nervous system and plays a critical role in many body functions including for example, speech, swallowing, heart rate and respiratory control, gastric secretion, and intestinal motility. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, with electrical stimulation being the most important. Implantable devices for VNS are approved therapy for refractory epilepsy and for treatment-resistant depression. In the case of heart disease applications, implantable VNS has been shown to be beneficial for treating heart failure in both preclinical and clinical studies. Adverse effects of implantable VNS therapy systems are generally associated with the implantation procedure or continuous on-off stimulation. The most serious implantation-associated adverse effect is infection. The effectiveness of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, heart failure, and other conditions remains under investigation. VNS merits further study for its potentially favorable effects on cardiovascular disease, especially heart failure.

Arrhythmias in Cardiomyopathy

The morbidity and mortality of patients with cardiomyopathy are related to either pump failure or arrhythmia-induced death or decompensation. Cardiomyopathy can also be induced by arrhythmias. Adequate and prompt therapy of arrhythmias is an essential part in the multidisciplinary approach to these patients. We review the arrhythmias seen in patients with multiple types of cardiomyopathy and the therapeutic options available. The implantable cardioverter defibrillator has become the main therapy for sudden cardiac death prevention. We also review the different oral antiarrhythmics available. Ablation therapy has become an effective means of curing or controlling arrhythmias. Finally, we discuss arrhythmias in specific cardiomyopathies and patient with left ventricular assist devices.

Premature ventricular contractions: Reassure or refer?

When patients present with palpitations, the primary care physician can perform the initial evaluation and treatment for premature ventricular contractions (PVCs). Many patients need only reassurance and do not need to see a cardiologist. Many patients need only reassurance and do not need to see a cardiologist.

Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic.

Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i) the patients immediate (usually considered 1 week to 1 month) mortality risk and risk for physical injury (e.g., falls risk), ii) the patients ability to care for him/herself, and iii) whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation). However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

Metabolik sendromlu hastalarda sol atriyal volüm indeksi'nin subklinik ateroskleroz ile ilişkisi 3,4, 3,

Metabolic syndrome (MetS) increases the frequency of cardivovascular events by causing atherosclerosis and impairment at left ventricle structure and function. Diastolic dysfunction (DD) is an early finding of subclinical cardiac injury. Left atrial volume may be used as an indicator for demonstrating severity and duration of DD. With this study, we investigated the relationship between subclinical atherosclerosis ,evaluated by carotid intima-media thickness (CIMT) measurement and subclinical cardiac injury evaluated by diastolic functions and left atrial volume index (LAVI) in MetS patients. 82 patients with MetS were enrolled to the study. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT≥1.0 mm were at group 1 and 47 patients with CIMTBu calismada, karin agrisi sikâyeti ile hastaneye basvuran hastalarin karin agrisi nedenlerini, eslik eden semptomlari, etken patojenlerin belirlenmesi ve gerekli tedavi yaklasimlarinin tartisilmasi planlandi. Cocuk acil poliklinigine karin agrisi sikâyeti ile basvuran, yaslari 2 ile 16 yil arasinda olan 626 hasta retrospektif olarak incelendi. En sik karin agrisi nedeni olarak, %40,8 oraninda akut gastroenterit saptandi. Bunu, uriner sistem enfeksiyonu %15, kabizlik %9,3, ust solunum yolu enfeksiyonu % 3,6 ve parazitozlar %3,6 orani ile izledi. Acil cerrahi tedavi gerektiren akut karin agrisi nedenleri %6,2 oraninda bulundu. Karin agrisi yaninda 512 hastada (%81,8) ek semptom bulunmaktaydi. Karin agrisina en sik eslik eden semptomlar, ishal %38, istahsizlik %29, kusma % 24, bulanti %16, ates %16 olarak bulundu. Hastalarin, klinigimize basvuru sirasinda alinan anamnezlerinde, karin agrisinin %55 hastada 0-24 saat, %22 hastada 24-72 saat, %11 hastada 72 saat-1ay, %7 hastada 1-6 ay ve %5 hastada 6 aydan fazla surdugu saptandi. Karin agrisi sikâyeti, cok genis bir hastalik grubunun semptomu olarak ortaya cikabilir. Karin agrisi sikâyeti ile basvuran hastalarin ayrintili anamnezlerinin alinmasi ve dikkatli bir sekilde fizik muayenelerinin yapilmasi, hastalarin buyuk bir kisminda taniyi koymada ve tedaviyi belirlemede yeterli olmaktadir.

Relation of left atrial volume index with subclinical atherosclerosis at patients with metabolic syndrome

Metabolic syndrome (MetS) increases the frequency of cardivovascular events by causing atherosclerosis and impairment at left ventricle structure and function. Diastolic dysfunction (DD) is an early finding of subclinical cardiac injury. Left atrial volume may be used as an indicator for demonstrating severity and duration of DD. With this study, we investigated the relationship between subclinical atherosclerosis ,evaluated by carotid intima-media thickness (CIMT) measurement and subclinical cardiac injury evaluated by diastolic functions and left atrial volume index (LAVI) in MetS patients. 82 patients with MetS were enrolled to the study. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT≥1.0 mm were at group 1 and 47 patients with CIMT<1.0 mm were at group 2. Systolic and diastolic functions were evaluated, LAVI was calculated. Frequency of DD was found statistically significantly higher in group 1 (p=001). There was no difference between groups for grade I DD and grade (p=0079). LAVI values were calculated as 32.6±6.0 ml/m2 and 26.6±4.7 ml/m2 at group 1 and 2,respectively.There was a statistically significant difference between two groups.When correlation with LAVI was investigated,a positive correlation with CIMT was observed. When correlation between data from conventional and tissue Doppler imaging and LAVI was evaluated,there were positive correlations for left ventricle mass index, septal and lateral E/Em rates, and negative correlations for septal and lateral Em/Am rates. LAVI was found to be high in-patient with higher CIMT value which is non-invasive indicator of subclinical atherosclerosis. In addition, in all patients, a relation was observed between presence and severity of diastolic dysfunction and increase in LAVI value.