Ramazan Akdemir

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.

Myocardial bridging as a cause of acute myocardial infarction: a case report

BackgroundSystolic compression of a coronary artery by overlying myocardial tissue is termed myocardial bridging. Myocardial bridging usually has a benign prognosis, but some cases resulting in myocardial ischemia, infarction and sudden cardiac death have been reported. We are reporting a case of myocardial bridging which was complicated with acute myocardial infarction associated with inappropriate blood donation.Case presentationA 33 year-old-man was admitted to our emergency with acute anteroseptal myocardial infarction after a blood donation. The electrocardiography showed sinus rhythm and was consistent with an acute anteroseptal myocardial infarction. We decided to perform primary percutanous intervention (PCI). Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery on coronary angiogram. PCI was canceled and medical follow up was decided. Blood transfusion was made because he had a deep anemia. A normal hemaglobin level and clinical reperfusion was achieved after ten hours by blood transfusion. At the one year follow up visit, our patient was healthy and had no cardiac complaints.ConclusionsMyocardial bridging may cause acute myocardial infarction in various clinical conditions. Although the condition in this case caused profound anemia related acute myocardial infarction, its treatment and management was unusual.

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.

Evaluation of Right Ventricular Function in Patients with Thyroid Dysfunction

Background: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. Patients and Methods: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. Results: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. Conclusions: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.

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.

Acute myocardial infarction secondary thrombosis associated with ovarial hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian stimulation. Cerebral infarction, myocardial infarction, death and vascular thrombotic events associated with OHSS had been reported. We report a case of a patient with myocardial infarction associated with OHSS.

Interventricular septal hydatid cyst.

In this report we describe an unusual case of cardiac echinococcus located in the interventricular septum invaded by a cystic mass. It was demonstrated by using transthoracic echocardiography (TTE) and confirmed with magnetic resonance imaging (MRI). Surgical excision (cystopericystectomy) was performed on the patient as a curative therapy. Early recurrence was observed despite additional medical therapy with albendazole.

Left Ventricular Inflow Normal or Pseudonormal. A New Echocardiographic Method: Diastolic Change of Left Atrial Diameter

Mitral flow Doppler study has been used to evaluate left ventricle (LV) diastolic function. Through its use, greater A wave than E wave, pseudonormal pattern, and restrictive pattern were observed progressively in patients with more LV diastolic dysfunction. Differentiation of normal or pseudonormal mitral flow is very important. In this study, left atrium (LA) diameter change during diastole was used as a new method for the differentiation of normal and pseudonormal mitral flow. Method: Sixty‐eight patients (30 men, 38 women; mean age 53 ± 13 years) with echocardiographically determined diastolic dysfunction and 60 healthy volunteers (36 men, 24 women; mean age 49 ± 12 years) were included in the study. Mitral flow E/A ratio, isovolumetric relaxation time (IVRT), and deceleration time (DT) of E wave were used for determination of the diastolic dysfunction. Thirty of 68 diastolic dysfunction patients had A>E wave, 20 had pseudonormal mitral flow pattern, and 18 had restrictive mitral flow pattern. Left parasternal long‐axis echocardiographic window was used for the measurement of LA diameter. Left atrium emptying fraction (LAEF) was defined as ratio of end‐diastolic LA diameter to end‐systolic diameter. Results: LAEF was found 0.69 ± 0.01 (mean ± SE) in the control group, 0.76 ± 0.01 in the A>E group (P < 0.05, control vs A>E group), 0.83 ± 0.05 in the pseudonormal pattern group (P < 0.05, control vs pseudonormal pattern group), and 0.87 ± 0.01 in the restrictive pattern group (P < 0.001, control vs restrictive pattern group). Conclusion: (1) LV diastolic dysfunction reduces the filling of LA content to the LV during diastole; (2) LA diameter changes during diastole as a new and practical method for the differentiation of the normal‐pseudonormal mitral flow pattern.

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.

A case of coronary artery fistula with mitral stenosis

Coronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.