Saadet Demirtaş

Atrial fibrillation induced by mad honey intoxication in a patient with Wolf–Parkinson–White syndrome

Grayanotoxins, which are extracted by bees from the leaves and fl owers of Rhododendron species, are the main compounds responsible for poisoning with honey in the Black Sea region. 1 “ Mad honey ” intoxication is usually a benign condition and is rarely fatal. In cases of toxication, bradycardia, atrioventricular (AV) block, and hypotension are commonly seen. Adequate fl uid replacement and 0.5 – 1.0 mg of atropine are suffi cient to improve the symptoms. We wish to report a case of a patient with Wolf – Parkinson – White syndrome (WPWS), who was admitted to hospital because of atrial fi brillation (AF) after “ mad honey ” ingestion. A 46-year-old man was admitted to the emergency department with dizziness and palpitations after eating a few spoonfuls of honey. He had no history of heart disease or drug usage. His blood pressure was 90/60 mmHg and his pulse rate was 172 beats per minute. A 12-lead electrocardiogram (ECG) demonstrated an irregular, wide QRS complex tachycardia (Fig. 1, top). Vital signs improved rapidly after saline infusion and sinus rhythm was restored within the following 20 – 30 min. A repeated ECG demonstrated a normal sinus rhythm, shortened PR intervals, delta waves, and minimally widened QRS complexes as WPWS (Fig. 1, bottom). All routine biochemical tests and thyroid functions were normal. Both his left atrial size and function were normal, as were his left ventricular size and function. He was monitored for 48 h, and AF did not recur. The patient was discharged with no medical therapy and transferred to an electrophysiology study for radio frequency ablation of the accessory bypass tract. Several cases of honey poisoning with bradyarrhythmia, sinus bradycardia, nodal rhythm, second-degree, or complete AV block were documented in recent literature; however, honey poisoning related to AF with WPWS has not previously been reported. 2 – 4

Two Cases of Multivessel Coronary Artery Ectasias Resulting in Acute Inferior Myocardial Infarction

The incidence of multivessel coronary artery ectasias (CAEs) among patients undergoing coronary artery angiography is very rare. All three coronary vessels can be affected by CAE, but most patients have an isolated arterial ectasia, commonly the right coronary artery. In this report we present two cases with inferior myocardial infarction that was likely caused by thrombotic occlusion of CAEs.

Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: A pilot study

BACKGROUND CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk. METHODS A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions. RESULTS Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99]). CONCLUSION Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.

Badanie służące ocenie występowania choroby wieńcowej w młodym wieku

Introduction. An increasing number of younger patients are being hospitalized with acute coronary syndromes. Earlier risk assessment is essential to prevent or delay coronary artery disease (CAD). This study aimed to assess the rate, risk factor profile, presentation, management and prognosis in young patients with CAD and compared with the same age group without CAD. Material and methods. In this retrospective study, 4325 patients who had undergone coronary angiography from 2011 to 2014 were identified. A total of 627 patients were ≤ 45 years age; 412 of them had CAD, and 215 had normal coronary arteries (control group). Results. The mean age of the patients was 41.7 ± 4.1 years in the CAD group and 41.5 ± 4.5 years in the control group. The prevalences of dyslipidemia, smoking, family history of CAD, hypertension, diabetes, and overweight were higher in the CAD than in the control group. However, the obesity rate was not significantly different between the two groups. Patients with ACS often presented with ST elevation myocardial infarction (STEMI) (49.3%), and single-vessel involvement (55.3%) predominated. Percutaneous coronary intervention (PCI) was the main myocardial reperfusion therapy (68.4%). Conclusions. Among the young patients studied, CAD had a higher incidence in males. Smoking was the most important modifiable risk factor. Also, patients showed high prevalences of dyslipidemia, overweight, diabetes, and family history of CAD. This study re-emphasizes the relationship between traditional cardiovascular risks and CAD in young.

A novel treatment approach for common carotid artery bifurcation aneurysms

An aneurysm involved in common carotid artery (CCA) bifurcation is a rare clinical condition. There are not enough natural follow-up data, and there is no evidence-based treatment algorithm [1]. An endovascular approach is used to treat CCA bifurcation aneurysms, as it offers some advantages in selected patient populations; nonetheless, closure of the aneurysmal segment in CCA bifurcation using a graft stent has some challenges, mainly occluding the ostial part of the external carotid artery (ECA). Coil embolization of a CCA bifurcation aneurysm is preferred over graft stent implantation in this condition; however, coil embolization cannot provide appropriate treatment in patients suffering from a CCA bifurcation aneurysm with significant stenosis in the proximal part of the internal carotid artery (ICA). Herein, we present a male patient whose CCA bifurcation aneurysm with significant stenosis in the proximal part of the ipsilateral ICA was successfully treated with the implantation of two nested self-expandable closed-cell stents.