Serkan Saygı

High Inflammatory Activity Related to the Number of Metabolic Syndrome Components

J Clin Hypertens (Greenwich). 2010;12:136–144. ©2009 Wiley Periodicals, Inc.

Digoxin intoxication: An old enemy in modern era.

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusions This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

Non ST-segment elevation myocardial infarction in patient with essential thrombocythemia

A 68-year-old woman presented with acute chest pain and a greatly increased platelet count. Cardiac catheterization revealed subtotal occlusion and a thrombus-like filling defect in the right coronary artery. The patient was successfully treated with intravenous tirofiban. Essential thrombocythemia was diagnosed based on bone marrow findings, clinical presentation and laboratory analysis. The relationship between intracoronary thrombus and essential thrombocythemia is discussed.

Decreased left ventricular torsion in patients with isolated mitral stenosis

BackgroundLeft ventricular (LV) torsion is a sensitive indicator of myocardial contractility and cardiac structure, and has recently been recognized as a sensitive indicator of cardiac performance. The aim of our study was to assess the effect of isolated mitral stenosis on LV torsion.Patients and methodsWe enrolled 19 patients with isolated mitral stenosis and 19 age- and gender-matched healthy subjects in the study. All patients had a normal sinus rhythm. All study subjects underwent two-dimensional echocardiography. Basal and apical LV rotations and LV torsion were evaluated using speckle-tracking echocardiography.ResultsDemographic characteristics, basic echocardiographic measures of LV ejection fraction, LV wall thickness, and LV mass index were similar between the two groups. The degrees of LV torsion (11.3 ± 4.7, 15.4 ± 4.9°, p=0.014) and LV basal rotation (− 3.7 ± 1.9, − 6.5 ± 2.1°, p< 0.001) were significantly decreased in the mitral stenosis group. There was a moderate positive correlation between mitral valve area and LV torsion (r=0.531, p=0.019).ConclusionWe showed significant reductions in LV torsion and LV basal rotation in patients with mitral valve stenosis. Structural and anatomical changes occurring during the progression of mitral stenosis may be responsible for these impaired movements.ZusammenfassungHintergrundDie linksventrikuläre (LV-)Torsion ist ein empfindlicher Indikator der Myokardkontraktilität und der Herzstruktur und ist vor Kurzem auch als empfindlicher Indikator der Herzleistung identifiziert worden. Ziel der vorliegenden Studie war es, die Auswirkungen einer isolierten Mitralstenose auf die LV-Torsion zu untersuchen.MethodenIn die Studie aufgenommen wurden 19 Patienten mit isolierter Mitralstenose und 19 diesen in Alter und Geschlecht entsprechende gesunde Personen. Sämtliche Patienten wiesen einen normalen Sinusrhythmus auf. Bei allen Studienteilnehmern wurde eine 2-dimensionale Echokardiographie durchgeführt. Mit der Speckle-Tracking-Echokardiographie wurden die basale und apikale LV-Rotation sowie die LV-Torsion bestimmt.ErgebnisseIn beiden Gruppen waren die demographischen Kennzeichen sowie grundlegende Echokardiographieparameter wie LV-Ejektionsfraktion, LV-Wanddicke und LV-Massenindex ähnlich. Der Grad der LV-Torsion (11,3 ± 4,7; 15,4 ± 4,9°; p=0,014) und der basalen LV-Rotation (− 3,7 ± 1,9; − 6,5 ± 2,1°; p< 0,001) waren in der Gruppe mit Mitralstenose signifikant vermindert. Es bestand eine mäßige positive Korrelation zwischen dem Mitralklappenbereich und der LV-Torsion (r=0,531; p=0,019).SchlussfolgerungIn dieser Studie wurde eine signifikante Verminderung der LV-Torsion und der basalen LV-Rotation bei Patienten mit Mitralklappenstenose nachgewiesen. Möglicherweise sind strukturelle und anatomische Veränderungen, die im Verlauf der Progression der Mitralstenose auftreten, für diese eingeschränkte Beweglichkeit ursächlich.

Long pentraxin-3 measured at late phase associated with GRACE risk scores in patients with non-ST elevation acute coronary syndrome and coronary stenting.

OBJECTIVES We analyzed pentraxin 3 (PTX3) levels and the relation of PTX3 levels with GRACE risk scores in 39 patients with non-ST elevation acute coronary syndrome (ACS) and stabile angina after stenting. STUDY DESIGN Seventeen patients with ACS and 22 patients with stabile angina who underwent coronary stenting were included in the study. PTX3 levels were measured serially at admission, at the 8th hour and at the 24th hour after stenting. RESULTS While diabetes and hypertension were more frequent in the stabile angina group, leukocyte counts were significantly higher in the ACS group. PTX3 levels measured at the 8th hour were significantly higher in the ACS group compared to the stabile angina group (p=0.003). Strong correlations were observed between 24th hour PTX3 levels and GRACE scores calculated for risk of death and death/MI at admission (in-hospital/to 6 months), and for risk of death/MI at discharge to 6 months (R=0.571, p=0.01, R=0.564, p=0.01; R=0.558, p=0.02, R=0.512, p=0.03; R=0.653, p=0.004, respectively). CONCLUSION The serum PTX3 levels may provide important information for the early risk stratification of patients with ACS who underwent coronary stenting.

Decreased circulatory erythropoietin in hyperacute phase of myocardial ischemia

PURPOSE Erythropoietin provides cellular protection by inhibiting apoptosis. Myocardial damage related to the cardiac ischemia is more prominent especially in the first 6 h. In the present study, circulatory erythropoietin levels in response to cardiac ischemia were evaluated. MATERIALS AND METHODS Patients with stable angina who underwent balloon angioplasty (study group, n = 55) and hospitalized for coronary angiography (as control group, n = 23) were enrolled into the study. Serum erythropoietin levels were measured in both groups in baseline, 6 and 18 h after the procedure. RESULTS Coronary balloon inflation time was accepted as duration of myocardial ischemia. Study group showed significant erythropoietin reduction at sixth hour compared to control group. Erythropoietin reduction at sixth hour was significantly correlated with duration of myocardial ischemia. CONCLUSION Decreased circulatory erythropoietin levels in the early phase of acute cardiac ischemia may accelerate the apoptotic activity. Recombinant erythropoietin replacement to prevent erythropoietin decrease following cardiac ischemia may have negative effect on myocyte loss.

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach

Objective: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. Methods: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18–58), the mean height was 168.75 cm (Range 155–185cm), and the mean body mass index was 23.4 (Range 17.3–28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. Results: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn’t encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. Conclusion: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length.

Association Between Inherited Thrombophilia and Impaired Right Ventricular Function in Deep Vein Thrombosis Without Symptomatic Pulmonary Embolism

The aim was to evaluate the right ventricular function in patients with inherited thrombophilia and deep vein thrombosis (DVT) without pulmonary embolism. A total of 38 patients with DVT without symptomatic pulmonary embolism and 30 patients with varicose veins were enrolled. Clinical data, echocardiography, and 2 thrombophilic mutations were analyzed. Factor V Leiden (FVL) polymorphism was significantly frequent in the study group (P = .007). The difference in prothrombin G20210A polymorphism between the study and control groups was at a near-significant level (P = .058). There was statistically significant decrease in tricuspid annular plane systolic excursion values in patients with FVL and prothrombin G20210A polymorphism. Combined FVL and prothrombin G20210A polymorphisms were more closely related to the decrease in this value (P = .006). Deep vein thrombosis had no additional adverse effects on right ventricle. Impaired right ventricular systolic function occurs in FVL and prothrombin G20210A polymorphisms.

PP-089 DECREASED LEFT VENTRICULAR TORSION IN PATIENTS WITH ISOLATED MITRAL STENOSIS

Background Left ventricular (LV) torsion is a sensitive indicator of myocardial contractility and cardiac structure, and has recently been recognized as a sensitive indicator of cardiac performance. The aim of our study was to assess the effect of isolated mitral stenosis on LV torsion.

Reel syndrome: dislodgement of an active fixation lead.

A 79-years-old woman was admitted to hospital with presyncope, lightheadedness, and right pectoral pulsation. Patient had been undergone a dual-chamber pacemaker implantation 1 week ago because of total AV-block. Chest radiography showed the tined atrial lead near the superior tricuspid annulus. The active right ventricular lead was retracted under the right clavicle (Fig. 1). A fluoroscopic image performed just after the first implantation demonstrated that the tined atrial lead was placed near the superior tricuspid annulus and active ventricle lead implanted to right ventricular apex (Fig. 2). Comparison of fluoroscopic image with new chest radiography showed the rotation of generator (Fig. 1b, 2a). The atrial lead was in same location and ventricular lead was retracted under the right clavicle. A new surgical procedure was performed after 24 hours. During revision procedure we observed a large and deep sub pectoral pocket containing hematoma. The ventricular lead was out of the vein and coiled around the generator. The generator was not sutured to the fascia of the pectoral muscle, and only single loose sleeve sutures were observed on both leads. The ventricular lead was implanted successfully after performing a new vein puncture. The atrial lead was successfully repositioned to right atrial appendage. The sleeves and the generator were tightly sutured to the fascia. During 1 month follow-up period no new complications occurred.