Clinical characteristics and prognosis of cardiac tamponade patients: 5­year experience at a tertiary center.

BACKGROUND: Cardiac tamponade (CT) is characterized by compression of the cardiac chambers due to pericardial fluid accumulation. The etiology and prognosis may vary in different regions, and thus patient series from various regions can be useful for exploring the etiological and prognostic disparities. The aim of this study was to determine the clinical characteristics of patients with imminent CT, to evaluate the diagnostic performance of biochemical, microbiologic, and pathologic laboratory analysis, and to ascertain the prognosis of CT patients. METHODS: We enrolled all patients with imminent CT who underwent percutaneous pericardiocentesis between July 2012 and December 2017 in this retrospective study. The patients were classified into three etiology groups: (a) malignancy (MRCT); (b) iatrogenic/mechanical complication of myocardial infarction (IMCT); and (c) other causes (OCT). Clinical information, laboratory findings, and survival data were recorded. RESULTS: In total, 186 pericardiocentesis procedures were performed on 153 consecutive patients with CT. The median follow-up was 137 days (range: 1-1937). The MRCT group had the highest mortality rate (79%) in 12 months, while the OCT group had the lowest rate (27%). We determined that increased age, higher serum urea levels, and malignancy-related CT were independent predictors of mortality. The mortality rates of the MRCT and IMCT groups were similar, with both of them being significantly higher than the rate of the OCT group. In all, 15 patients were diagnosed with a new malignancy via pericardial fluid cytology. CONCLUSION: Patients in the MRCT and IMCT groups had a poor prognosis. The presence of malignancy was found to be the most powerful predictor of mortality in CT patients.

Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease.

PURPOSE: The aim of this study was to investigate the relationship between monocyte count/high density lipoprotein cholesterol (HDL-C) ratio (MHR) and the severity of coronary atherosclerosis, as assessed by the SYNTAX score (SXscore), in patients with stable coronary artery disease (CAD) undergoing coronary angiography. MATERIALS AND METHODS: A total of 428 patients were included in the study between March 2012 and February 2015. The SXscore was determined with baseline coronary angiography. An SXscore ≥ 23 was regarded as severe CAD by definition, and the patients were divided into two groups: those with low SXscores (< 23) and those with high SXscores (≥ 23). RESULTS: MHR and C-reactive protein (CRP) were significantly higher in patients with high SXscores (p < 0.001 and p < 0.001, respectively). Left ventricular ejection fraction (LVEF) was lower in the group with high MHR and high SXscores. The cutoff value of MHR that predicted a high SXscore was 24, with a sensitivity of 66 % and a specificity of 65.1 %. CONCLUSION: To the best of our knowledge, this is the first study in the literature showing that MHR is significantly associated with SXscores. Our results suggest that MHR can be used as a prognostic marker in patients with stable CAD, since it is an easily available and inexpensive test.

The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias.

PURPOSE: We aimed to determine the effect of intravenous thrombolytic therapy on QT dispersion (QTd) and its role in the prediction of reperfusion arrhythmias. MATERIALS AND METHODS: Twenty patients with acute myocardial infarction (MI) were enrolled in the study. Measurements of QTd were carried out prior to thrombolytic therapy and before discharge. The patients were examined for ventricular arrhythmias with 24-h Holter electrocardiography monitoring after treatment and the relationship between ventricular arrhythmias and the QTd values in the early phase of MI was investigated. RESULTS: The values of QTd were significantly higher during the early phase of MI (60 ± 5.32 ms) than those in the late phase (53.35 ± 4.07 ms) (P = 0.032). There was no correlation between isolated, bigeminal, trigeminal and total ventricular premature beats, accelerated idioventricular rhythm (AIVR) with QTd values. However, the patients with sustained ventricular tachycardia (VT), prolonged VT and sustained AIVR had higher corrected QTd (92 ms 1/2 , 97.8 ms 1/2 , 81.7 ms 1/2 , respectively) than the patients without these arrhythmias (74 ms 1/2 , 56.3 ms 1/2 , 58.28 ms 1/2 , respectively) (P = 0.022, 0.013, 0.018). CONCLUSION: The values of QTd may be significantly reduced in the 1 st week of acute MI and measurement of QTd in the early phase of MI may have a correlation with the following reperfusion arrhythmias: Sustained VT, prolonged VT and AIVR.

Renal impairment and coronary collaterals in patients with acute coronary syndrome.

OBJECTIVE: We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS). METHODS: We enrolled 461 patients with ACS who underwent coronary angiography for the first time. The development of CCV was assessed with the Rentrop score. Kidney function was classified according to the estimated glomerular filtration rate (eGFR). The Gensini score was used to show the extent of atherosclerosis. RESULTS: The mean eGFR value was 89.9 ± 24.3 U/l for patients with no development of collaterals and 82.7 ± 20.5 for patients who had CCV. The mean age was 59 ± 11 years and 349 patients (75.7 %) were male. Rentrop classifications 1-2-3 (presence of CCV) were determined in 222 (48.1 %) patients. The presence of CCV was significantly associated with low levels of eGFR (p = 0.001), increased serum creatinine levels (p = 0.034), high levels of serum albumin (0.036), and the Gensini score (p < 0.001). Multivariate analysis showed that the Gensini score was an independent predictor of the presence of CCV (OR = 1.090, 95 % CI: 1.032-1.151, p = 0.002). CONCLUSION: We suggest that the association between mild-to-moderate renal impairment and the presence of CCV may be explained by increased myocardial ischemia and severe CAD.

Acute coronary syndrome triggered by honeybee sting: a case report.

A 56-year-old previously healthy man was admitted to our hospital with a severe chest pain that started shortly after being stung by a honeybee. He did not have any allergic symptoms and there was no cutaneous or respiratory evidence of allergy on physical examination. Electrocardiographic and biochemical markers were consistent with an acute coronary syndrome. Coronary angiography demonstrated a significant thrombotic lesion in the right coronary artery. Here, a rare and unexpected event is presented, the development of acute coronary syndrome after a bee sting.

A massive calcified left ventricular aneurysm with normal coronary arteries and without myocardial infarction. A case report.

Most cardiac aneurysms develop after myocardial infarction. Calcification in the aneurysmal wall is seen rarely. In this case report the authors present a thirty-nine-year-old man, who had been free from symptoms until eight months before, when he began to experience palpitations due to monomorphic sustained ventricular tachycardia. A chest roentgenogram disclosed an oval calcification on the left ventricular apex. Coronary angiography and left ventriculography revealed normal epicardial coronary arteries and a massive calcified and ossified left ventricular apical aneurysm. He had no chest pain, nor were there electrocardiographic findings of myocardial infarction. Attacks of ventricular tachycardia disappeared after aneurysmectomy was performed. To the author's knowledge there is no case report in the literature of a calcified left ventricular aneurysm with normal epicardial coronary arteries and without clinical and electrocardiographic findings of infarction. They discuss the possible etiology of this case.

Left circumflex coronary artery arising as a terminal extension of right coronary artery. A case report.

Many types of coronary artery anomalies have been detected, and most of them occur in the left circumflex artery. In this report a unique circumflex artery anomaly is presented. The left circumflex artery arose as a terminal extension of the right coronary artery. The main stem and obtuse marginal branches of the circumflex artery were normal and well developed.

Prevalence of coronary heart disease in Turkish adults.

The prevalence of coronary heart disease was determined by a conducted survey in a random sample of 3689 subjects 20 years of age or older in 59 communities representing the Turkish adult population. Interview with a questionnaire, physical examination of the cardiovascular system and recording of a 12-lead ECG were performed. The latter was coded according to the Minnesota code. Expressed in age-adjusted rates (for 35-64 years), prevalence rates per 100 men were as follows: typical angina 3.7, atypical angina 0.9, electrocardiographic evidence of myocardial infarction and/or ischemia 3.7, any of the stated findings suggesting coronary heart disease 8. Women had a substantially higher rate of atypical angina, positive ECG findings and of any of the stated manifestations for coronary heart disease, whereas they had a significantly lower rate of Q/QS patterns as well as of a history of myocardial infarction. Based on a probability-related point score, age-adjusted clinical coronary heart disease was estimated to prevail in 5.8% of men and 5% of women (P > 0.4) in the sample of the Turkish population. The respective rates in urban residents was 6% and in rural resident 4.8%. Among participants diagnosed coronary heart disease, 63% presented the form of angina without infarction, 27% had evidence of myocardial infarction, 7% 'silent myocardial ischemia' and 3% cardiac failure alone.

Early detection of left ventricular aneurysm rupture by two-dimensional echocardiography and surgical salvage.

A 52-year-old man was admitted to hospital emergency room with cardiogenic shock. The electrocardiogram showed normal tracing. Left ventricular aneurysm rupture at the posterolateral wall and haemopericardium was diagnosed with two-dimensional and colour Doppler echocardiography. The patient was operated on immediately and the defect was repaired. The patient made a good recovery. Four months later coronary angiography and left ventriculography were performed. The coronary vessels were found patent and there was minimal stenosis (lesser than 50%) at the proximal 1/3 portion of left anterior descending (LAD) artery. Left ventriculography showed anterolateral and posterolateral hypokinesis. The patient was symptom free and leading an active life 4 months later.

Plasma lipids and their interrelationship in Turkish adults.

STUDY OBJECTIVE: The aim was to describe the plasma total cholesterol and triglyceride profiles in a random sample of Turkish adults and analyse the effects of certain coronary risk factors on these levels. DESIGN: This was a cross sectional population based survey. SETTING: 59 communities scattered in all seven geographical regions of Turkey were surveyed in the summer of 1990. SUBJECTS: A random sample of 3689 men and women 20 years of age and over was studied. MEASUREMENTS AND MAIN RESULTS: Plasma total cholesterol, triglycerides, glucose (using Reflotron and with partial validation in reference laboratory), weight, height, and blood pressure were measured, and information on smoking, physical activity, and family income obtained. Hypercholesterolaemia (> or = 6.5 mmol/litre, 250 mg/dl) prevailed in 8.5%, and hypertriglyceridaemia (> 2.25 mmol/litre, 200 mg/dl) in 16.6% among men and women aged 40-59 years of age. Age adjusted total cholesterol values were 4.8 mmol/litre (185 mg/dl) in men and 5 mmol/litre (192 mg/dl) in women. A steep rise appeared in mean cholesterol levels between the ages of 20-29 and 40-49 years, in a ratio greater than the available data from some other populations indicated. Mean total cholesterol values increased substantially in both genders with diminishing grades of physical activity, rising serum triglyceride levels, in urban (opposed to rural) residents, in men with increasing income levels, and in the younger adults with rising body mass index. CONCLUSIONS: Turkish adults have comparatively low levels of total cholesterol and medium to moderately high levels of triglycerides. Lifestyle factors affect these levels in Turks as in other populations.