Mehmet Yazici

Cardiac emergencies caused by honey ingestion: a single centre experience

An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study is a retrospective case series of 19 patients admitted to an emergency department in 2002, poisoned by “mad” honey. All of the patients had the complaints of nausea, vomiting, sweating, dizziness, and weakness, several hours after ingesting “mad” honey. Physical examination showed hypotension in 15 patients, sinus bradycardia in 15, and complete atrioventricular block (AVB) in four patients on admission. Two patients with bradycardia and two with AVB fell and injured their heads. Three of them presented with local haematoma. One patient had a 6 cm cut on his head without any neurological deficit and his cranial computed tomography imaging was normal. Hypotension and conduction disorders resolved with atropine treatment, resulting in complete recovery within 24 hours.

Cross-sectional study of complement C3 as a coronary risk factor among men and women.

In the present study, we examined (i) whether C3 (complement C3) was an independent marker of prevalent CHD (coronary heart disease), and (ii) which preferential associations existed between C3 and some cardiovascular risk factors when jointly analysed with CRP (C-reactive protein) and fibrinogen. In a cohort of 756 unselected adults, 39% of whom had the metabolic syndrome, C3 and other risk variables were evaluated in a cross-sectional manner. In a logistic regression model for the likelihood of CHD, a significant OR (odds ratio) of 3.5 [95% CI (confidence intervals), 1.27 and 9.62)] for C3 was obtained after adjustment for smoking status, TC (total cholesterol) and usage of statins. A similar model, also comprising systolic blood pressure, with a cut-off point of >or=1.6 g/l C3 exhibited a 1.9-fold risk (95% CI, 1.01 and 3.58) compared with individuals below the cut-off point. Both analyses displayed an adjusted OR of 1.37 for each S.D. increment in C3. The significant relationship of C3 with a likelihood of CHD also proved to be independent of CRP. In multiple linear regression models, associations were tested for each acute-phase protein with measures of obesity, fasting insulin, triacylglycerols (triglycerides), TC, HDL (high-density lipoprotein)-cholesterol, physical activity, smoking status, diagnosis of metabolic syndrome and family income. When both genders were combined, C3 was independently associated with serum triacylglycerols, waist circumference, BMI (body mass index) and TC. CRP was independently associated with waist circumference, TC, family income (inversely) and physical activity, and fibrinogen with BMI, TC, smoking status and metabolic syndrome. In summary, elevated levels of complement C3 are associated with an increased likelihood of CHD independent of standard risk factors and regardless of the presence of acute coronary events, suggesting that C3 might be actively involved in coronary atherothrombosis. Unlike CRP and fibrinogen, C3 was preferentially associated with waist girth and serum triacylglycerols.

Correlation of Plasma B-Type Natriuretic Peptide with Shunt Severity in Patients with Atrial or Ventricular Septal Defect

The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70 ± 129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Qp/Qs ratios derived from quantitative Doppler flow measurements. Mean BNP was 29 ± 42 pg/ml, with a range between <5 pg/ml and 208 pg/ml. Sixteen patients had Qp/Qs values >1.5 and 19 had values <1.5. The difference of mean BNP in these patient groups was statistically significant (45 ± 56 vs 14 ± 17, p = 0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of ≥20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.

Isolated Interrupted Aortic Arch: A Case Report and Review of the Literature

An 18-years-old male presented to emergency department after a car accident with the diagnosis of femoral bone fracture. Arterial blood pressure was 160/90 mmHg in both arms. Bilateral femoral and popliteal pulses were extremely weak and there was systolic ejection murmur on the left second intercostals area. Chest X-ray showed rib notching with normal cardiac silhouette. Transthoracic echocardiography showed the aortic interruption just below the left subclavian artery. Aortography showed a complete interruption of the aortic arch (IAA) just distal to the origin of the left subclavian artery. Femoral bone fracture was treated by conservative strategy. A gadolinium contrast-enhanced magnetic resonance angiogram (1.5 T scanners) clearly reaffirmed a complete interruption of the descending aorta, 3.6 cm from the left subclavian artery with extensive collateralizations. Mild degree hypertension was controlled by a long acting calcium channel blocker. Later the patient has been scheduled for elective surgical repair. We aimed to discuss the diagnostic and treatment options of the interrupted aortic arch as being a rare anomaly.

A Case of Myocardial Infarction with Sumatriptan Use

Sumatriptan is widely used in the treatment of acute attacks of cluster headache. It is a serotonin-1 (5HT-1) agonist. Several studies have reported an association between sumatriptan use and myocardial infarction, possibly due to the generalized vasoconstrictive nature of this agent. We report a 16-year-old male patient presenting with acute inferior myocardial infarction after sumatriptan use without any known risk factors of coronary artery disease.

Effect of Reperfusion on P‐Wave Duration and P‐Wave Dispersion in Acute Myocardial Infarction: Primary Angioplasty versus Thrombolytic Therapy

Background: Atrial fibrillation (AF) is a common arrhythmia occurring in about 10–20% of patients with acute myocardial infarction (AMI). P‐wave dispersion (PWd) and P‐wave duration (PWD) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P‐wave duration and dispersion in patients with acute anterior wall myocardial infarction.

Predictive value of total atrial conduction time measured with tissue Doppler imaging for postoperative atrial fibrillation after coronary artery bypass surgery

ObjectivePostoperative atrial fibrillation (POAF) complicating coronary artery bypass grafting surgery (CABG) increases morbidity and stroke risk. Total atrial conduction time (PA-TDI duration) has been identified as an independent predictor of new-onset atrial fibrillation (AF). We aimed to assess whether PA-TDI duration is a predictor of AF after CABG.MethodsIn 128 patients who had undergone CABG, preoperative clinical and echocardiographic data were compared between patients with and without POAF. The PA-TDI duration was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from left atrium (LA) lateral wall just over the mitral annulus.ResultsPatients with POAF (38/128, 29.6xa0%) were older (68.1u2009±u200911.1 vs. 59.3u2009±u200910.2xa0years; pu2009<u20090.001), had higher LA maximum volume, had prolonged PA-TDI duration, and had lower ejection fraction compared with patients without POAF. PA-TDI duration was found to be significantly increased in POAF group (134.3u2009±u200919.7 vs. 112.5u2009±u200917.7xa0ms; pu2009=u20090.01). On multivariate analysis, age (95xa0% CIu2009=u20091.03–1.09; pu2009=u20090.003), LA maximum volume (95xa0% CIu2009=u20091.01–1.06; pu2009=u20090.03), and prolonged PA-TDI duration (95xa0% CI, 1.02–1.05; pu2009=u20090.001) were found to be the independent risk factors of POAF.ConclusionsIn this study, LA maximum volume and PA-TDI duration were found to be the independent predictors of the development of POAF after CABG. Echocardiographic predictors of left atrial electromechanical dysfunction may be useful in risk stratifying of patients in terms of POAF development after CABG.

Elastic Properties of the Ascending Aorta and Left Ventricular Function in Patients with Hypothyroidism

Background: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 ± 8.9 years) and 29 control subjects were studied. Ascending Aortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed‐up for 6 months. Thyroid function tests and echocardiographic measurements were repeated at the end of the study. Results: AoD (cm2 dyn−1 10−3) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0.001; respectively), whereas AoSI was decreased significantly (3.7; P < 0.001). Also, early/late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.01), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r =−0.61/P < 0.001); AoD, (r =−0.57/P < 0.002); AoSI, (r = 0.53/P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and E/A ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.

Atrial conduction time and atrial mechanical function in patients with impaired fasting glucose

BackgroundProlonging atrial conduction time, as measured by tissue Doppler imaging (TDI), is an independent predictor of new onset or recurrent atrial fibrillation (AF). We investigated atrial conduction time and cardiac mechanical function in patients with impaired fasting glucose (IFG) using echocardiography.MethodsThirty patients with IFG (19 males and 11 females; age, 46.9u2009±u20099.5xa0years) and 30 control subjects (18 males and 12 females; age, 46.7u2009±u20098.2xa0years) were included. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Inter- and intra-atrial electromechanical delays (EMDs) were calculated. Left atrial (LA) volumes were determined according to the biplane area–length method. LA mechanical function parameters were calculated.ResultsLA passive emptying volume and LA passive emptying fraction decreased significantly in patients with IFG as compared with control subjects (pu2009<u20090.001 and pu2009<u20090.001, respectively). PA lateral and PA septal durations were significantly higher in patients with IFG than in the control group. However, no difference in PA tricuspid duration was observed between the two groups. Inter- and intra-atrial EMDs were significantly higher in patients with IFG as compared with the control subjects (median [interquartile range], 34.0 [17.0] vs. 17.0 [4.0], pu2009<u20090.001 and 15.0 [8.5] vs. 7.5 [2.0], pu2009<u20090.001, respectively). Positive correlations were detected between both inter- and intra-atrial EMD and glucose levels (ru2009=u20090.76, pu2009<u20090.001 and ru2009=u20090.68, pu2009<u20090.001, respectively). Additionally, a multiple linear regression analysis revealed that glucose levels were independently associated with inter-atrial EMD (βu2009=u20090.753, pu2009<u20090.001).ConclusionWe showed that IFG was associated with inter- and intra-atrial EMD. Our findings suggest that IFG is an etiological factor for the development of AF.

In vivo effect of losartan on platelet aggregation in patients with hypertension

The angiotensin II receptor, losartan, has been found to inhibit platelet aggregability to some extent in in vitro experiments. There have been conflicting results about the in vivo effects of losartan. We sought to clarify the in vivo effect of losartan on platelet aggregation. Forty patients with grade I essential hypertension were treated with losartan for 3 weeks. Platelet aggregation tests with adenosine diphosphate (ADP) and ristocetin were analyzed and compared before and at the end of the study. Losartan effectively decreased systolic (SBP) and diastolic (DBP) blood pressure. Mean SBP before and after treatment was 159.6 ± 12.8 and 149.2 ± 17.3u2009mmHg, respectively. Mean DBP decreased from 93.7 ± 8.2 to 87.7 ± 10.3u2009mmHg after treatment. The results of the platelet aggregation tests with ADP and ristocetin were not significantly different when both rate and amplitude of maximal aggregation were included. Peak platelet aggregation with ADP regarding the lowest light transmission in the aggregometer was 59.8% ± 24.3% before and 58.3% ± 18.1% after the treatment. The same variables with ristocetin were 66.8% ± 21.6% and 60.8% ± 23.3%, respectively. In vivo effects of losartan on platelet aggregation with ADP and ristocetin were insignificant.