Emre Altekin

Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis.

OBJECTIVES Systemic inflammation plays an important role in the pathogenesis of atherosclerosis in psoriasis patients. Therefore, persistent skin inflammation in psoriasis patients may contribute to the development of premature atherosclerosis, as it occurs in rheumatoid arthritis and systemic lupus erythematosus. We aimed to evaluate the relationship between subclinical atherosclerosis and psoriasis by using pulse wave velocity (PWV) and the measurement of carotid intima media thickness (CIMT) in psoriatic patients. STUDY DESIGN Fifty-seven plaque-type psoriasis patients (31 males, 26 females; mean age 41±10.8 years) and 60 healthy individuals (32 males, 28 females; mean age 40±9.4 years) were included. Atherosclerotic risk factors were excluded in both of the groups. Demographic, bio-chemical data, psoriasis area and severity index (PASI) score of the psoriasis group, and disease duration were recorded. Carotid-femoral artery PWV and CIMT values were compared. RESULTS PWV, and the maximum and average CIMT values of psoriasis patients were higher than those of the healthy group (PWV: 7.04±1.1 m/sn vs. 6.03±0.61 m/sn, p<0.001; maximum CIMT: 0.86±0.09 mm vs. 0.77±0.06 mm, p<0.001; mean CIMT: 0.73±0.09 mm vs. 0.66±0.06 mm p<0.001, respectively). Although there was no difference in the lipid levels of the groups, total/HDL cholesterol (4.40±1.26 vs. 3.88±1.18, p=0.02, respectively), and LDL/HDL cholesterol ratios (2.78±0.98 vs. 2.32±0.92, p=0.01, respectively) of the psoriasis group were higher than those of the healthy group. A positive correlation was observed between PASI and the PWV (r=0.417, p=0.001). CONCLUSION Despite the nonexistence of atherosclerotic risk factors, the risk of development of atherosclerosis is higher in psoriasis patients compared to healthy individuals. In addition to damage of the artery wall caused by systemic inflammation, lipid metabolism disorders may contribute to the development of atherosclerosis in these patients.

WELLENS SYNDROME WITH A PACEMAKER RHYTHM

An 80-year-old woman presented to the Emergency Department at 11:00 a.m. with squeezing chest pain in the left chest radiating to the neck. The pain started at 2:00 a.m. and lasted 30 min. She had a history of coronary artery disease and a pacemaker implantation, along with medical therapy. The physical examination was unremarkable, with normal vital signs. Cardiac enzymes troponin T and creatine kinase-MB Mass were within normal limits during the admission. An electrocardiogram (ECG) performed during the visit demonstrated deep and symmetrically inverted T waves, concordance

Acquired QT interval prolongation and ventricular arythmias associated with brucellosis: A case report and review of literature

Brucellosis is a zoonosis caused by Brucella species and usually involves the lymphoreticular system. Cardiovascular involvement is rare but fatal. Endocarditis is the most common cardiovascular manifestation of brucellosis. Herein we report a case of brucellosis with a presentation of acquired QT prolongation and ventricular tachycardia without a clear clinical picture of endocarditis and myocarditis.

A complication of mitral stenosis: free floating ball thrombus in left atrium

Left atrial (LA) ball thrombus is a rare disorder. These ball thrombi are generally associated with mitral stenosis, and the restricted mitral orifice encloses the free-floating thrombus in the LA. There is a potential for fatal systemic emboli or mitral valve orifice occlusion that may result in sudden death. We report a rare case of free-floating ball thrombus (FFBT) in the left atrium with mitral stenosis. A 52-year-old woman with chronic mitral stenosis was admitted to the hospital for progressive dyspnea, palpitation and unconsciousness. Electrocardiography showed atrial fibrillation (AF). Echocardiography revealed rheumatic, thickened, and stenotic mitral valve, and FFBT in the left atrium. She was treated successfully with removal of ball thrombus and mitral valve replacement. The size of the ball thrombus was 30×25×15 mm and postoperative course was uneventful.