Cengizhan Türkoğlu

Chronic mad honey intoxication syndrome: a new form of an old disease?

AIMS Although cases of acute mad honey intoxication have been reported earlier, chronic mad honey intoxication (CMHI) syndrome has not been described and we address this issue only in this study. METHODS AND RESULTS We prospectively evaluated the history of non-commercial honey intake in all patients referred to our institution for investigation of slow heart rate or atrioventricular (AV) conduction abnormalities. Between April 2008 and December 2008, 173 patients were referred to our institution for assessment of sinus bradycardia and various degrees of AV block and/or permanent pacemaker implantation. All patients were questioned about history of honey intake. Detailed evaluation revealed a history of daily honey intake for a long period of time in five of the patients (2.8%). This non-commercial honey was made by different amateur beekeepers in eastern Back Sea region of Turkey. Discontinuation of honey intake resulted in prompt normalization of conduction and significant symptomatic improvement. None of the patients were admitted to hospital and all were asymptomatic during 3 months follow-up. Holter monitoring for 24-h revealed no abnormality at first and third month. CONCLUSIONS This is the first report of CMHI. This issue should be suggested during assessment of patients with unexpected conduction abnormalities, because abandonment of honey intake results in prompt symptomatic and electrocardiographic improvement.

Slow Heart–Slow Brain: Consequence of Short‐term Occupational Exposure to Toluene in a Young Woman: What Is The Real Mechanism?

Herein we describe a case of acute occupational exposure to toluene in a 27‐year‐old female patient, presented to the emergency department of our institute. On admission she had electrocardiographic signs of profound sinus bradycardia with sinus arrhythmia and low amplitude slow wave activity recorded on her electroencephalogram (EEG). The mechanisms underlying the cerebral and cardiac effects of toluene are also discussed. Copyright

Wolff-Parkinson-White Syndrome Mimicking Acute Anterior Myocardial Infarction in a Young Male Patient A Case Report

A young male with Wolff-Parkinson-White syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V1-V6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed Wolff-Parkinson-White syndrome with two accessory pathways.

Chronic total occlusion of left circumflex artery after radiofrequency ablation of left ventricular outflow tract tachycardia

In this report, we present a 22-year-old female patient referred to our institution for evaluation of anginal chest pain. Her medical history revealed two ablation procedures of the left ventricular outflow tract tachycardia performed 1 month a part, 2 years ago. Coronary angiography revealed chronic total occlusion of the proximal left circumflex artery. To our knowledge, this is the first report of ablation-related chronic total occlusion of a coronary artery.

Effect of Seven Different Modalities of Antihypertensive Therapy on Pulse Pressure in Patients with Newly Diagnosed Stage I Hypertension

In this study, we investigated the effect of different antihypertensive agents on pulse pressure (PP). The study was designed in a prospective manner and patients were sequentially allocated to one of the seven different therapy groups, according to the order of enrollment (every first patient to group I, every second patient to group II, and etc). Patients in group I received 10 mg of lisinopril, in group II 10/6.25 mg of lisinopril/hydrochlorothiazide, in group III 80 mg of valsartan, in group IV 80/6.25 mg of valsartan/hydrochlorothiazide, in group V 5 mg of amlodipine, in group VI 1.25 mg of indapamide, and finally those in group VII received 50 mg of atenolol. The reduction in PP was more significant in patients receiving lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide, when compared with patients receiving indapamide, atenolol, and amlodipine (P < 0.05 for each group). Factors such as age, gender, and body mass index were not found to significantly influence the effectiveness of antihypertensive agents on PP. The reduction in PP was more apparent with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide in diabetic patients, when compared with those without diabetes (P < 0.001, P < 0.05). And also patients on therapy with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors had a greater reduction in PP with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide (P < 0.001, P < 0.05).

Complete transection of epicardial pacing lead during pregnancy

Herein, we presented a case of pregnancy associated complete transection of epicardial pacing lead.

Cough-induced sinus arrest resulting in recurrent episodes of syncope: is it really transient?

To the Editor A 32-year-old male patient was referred to our institution because of frequent syncopal episodes. Physical examination, 12-lead electrocardiogram and echocardiography all were unremarkable. Heart rate showed normal chronotropic response to exercise. Neurological examination and electroencephalogram also did not reveal any abnormality. All syncope episodes were associated with nonproductive cough. His medical records revealed that patient was treated with various antibacterial agents and antitussive drugs with diagnosis of atypical pneumonia. Use of statins was excluded. Statins may exert beneficial effects in terms of blood flow, but rarely they may induce fainting symptoms due to rhabdomyolisis. We did not analyze the patient using the modified Calgary syncope syndrome score for differential diagnosis between cardiac or vasovagal syncope, as score systems as clear limitations in this and other fields. More detailed evaluation of patient’s medical history revealed presyncopal spells during upper respiratory tract infection episodes in the past.

Optimization of Repolarization during Biventricular Pacing: A New Target in Patients with Biventricular Devices?

Background: Evaluation of repolarization during sequentional biventricular pacing.

Electrophysiologic Characteristics of Wide QRS Complexes during Pharmacologic Termination of Sustained Supraventricular Tachycardias with Verapamil and Adenosine: Observations from Electrophysiologic Study

Background: In this study we evaluate wide QRS complexes observed during pharmacologic termination of supraventricular tachycardias.

Unusual electrocardiographic presentation of pacemaker battery depletion with lead failure: pacing spike, artefact or native QRS? A short communication

Herein we report an unusual electrocardiographic presentation of a patient with pacemaker battery depletion and lead insulation failure.