Is Rivaroxaban a Safe Choice for Apical Thrombus in Atrial Fibrillation Patients? A Case Report.

Left ventricular thrombi are mostly seen in the akinetic segments of left ventricle and warfarin is the golden standard treatment. In our case, a 67-year-old male patient with ischemic dilated cardiomyopathy and atrial fibrillation was under warfarin treatment, but due to fluctuations in international normalized ratio, warfarin was discontinued and changed to rivaroxaban (20 mg once a day). He had a fixed thrombus measuring 1.80 × 1.12 cm2 in the left ventricle under warfarin treatment before rivaroxaban use. After 6 months of rivaroxaban treatment, the thrombus regressed to 1.54 × 1.06 cm2 without any embolic episode or bleeding. This case supports the finding that rivaroxaban can be a safe alternative to warfarin when warfarin cannot be used.

Assessment of secondary prevention awareness among patients with coronary artery disease: A survey including patients from 3 centers.

OBJECTIVE: In this study, we aimed to investigate the awareness of patients with coronary artery disease (CAD) about secondary prevention and the channels through which they obtained information on this issue. METHODS: A standard questionnaire including 45 questions was given to the patients (n=912) who were admitted to the cardiology outpatient clinics to investigate their secondary prevention awareness and lifestyle. RESULTS: Of the participants, 508 (55.7%) stated that they knew the condition of their vessels after coronary angiography; 493 (54.1%) stated that they did not exercise; 299 stated that they did not follow any specific diet. Men were more frequently aware of all risk factors except diet, blood glucose, and blood pressure compared to women (p<0.001). Women were more frequently aware that blood glucose and blood pressure are risk factors for CAD compared to men (p<0.001). The high-income patient group was more aware of all the risk factors, except blood glucose compared to the low/medium income patient group (p<0.001). The frequency of awareness, except for blood glucose and antiplatelet drugs, increased as the education level increased (p<0.001). However, the frequency of awareness of blood glucose and antiplatelet drug use was higher in the literate/elementary school/secondary school group (p<0.001). In addition, it was concluded that patients' sexual life and psychological problems after being diagnosed with the disease were rarely questioned by cardiology specialists. CONCLUSION: Awareness of patients with CAD about secondary prevention was found to be very low.

Efficacy of direct oral anticoagulants on left ventricular thrombus.

: Left ventricular thrombus (LVT) is a commonly seen complication of myocardial infarction and it also can be seen because of hypertrophic cardiomyopathies, nonischemic dilated cardiomyopathies, malignancies, and so on. Guidelines suggest the use of warfarin for left ventricular thrombi, but recent case reports show that direct oral anticoagulants (DOACs) are beginning to be used for this complication. DOACs are strong alternatives for warfarin because of their efficacy and safety even though there is no randomized controlled trial that proves the effect of DOACs against LVT. In this article, we gather the case reports of DOACs against left ventricular thrombi in various conditions.

Short term follow-up of a patient with uncomplicated type B aortic dissection under dabigatran treatment.

This case report illustrates the follow-up of a 57-year-old female with a type B aortic dissection (AD) under dabigatran treatment. The patient had been operated on 8 years earlier due to type A AD. The aortic valve was repaired and a 26-mm polyester fiber graft was applied to the ascending aorta and the aortic arch. In computerized tomography scans taken after the procedure, a dissection flap extending from the descending aorta to the iliac arteries was seen, but the patient was asymptomatic and no further surgery was performed. The patient was subsequently diagnosed with atrial fibrillation. A CHA2DS2VASc score of 3 was recorded and dabigatran treatment was initiated. The aortic aneurysm and dissection were followed up via computed tomography and echocardiography at regular intervals, and at 6 months no progression was seen. No thromboembolic or hemorrhagic events were observed. To our knowledge, this is the first case report of dabigatran treatment for a patient with a type B AD. Based on this case, the use of dabigatran would appear to be safe in a patient with an uncomplicated type B AD, but the results of this case need to be confirmed with extended follow-up and additional patients.

Acute Inferior Myocardial Infarction Caused by Lightning Strike.

Lightning strike is an infrequent natural phenomenon with serious medical complications, like multiple organ damage, and it is associated with increased risk of mortality. Cardiovascular complications are among the most hazardous complications of lightning strike. Lightning strike can cause various serious consequences ranging from electrocardiographic changes to death. We reported a 21-year-old patient with no cardiovascular risk factors struck by lightning and presented by inferior ST elevated myocardial infarction (MI). The patient was followed up in the intensive care unit and MI complication did not develop during follow-up. The patient was lost due to multi-organ failure after 20 hours. AydinF, Turgay YildirimO, DagtekinE, Huseyinoglu AydinA, AksitE. Acute inferior myocardial infarction caused by lightning strike. Prehosp Disaster Med. 2018;33(6):658-659.

How does ivabradine effect erectile dysfunction in patients with heart failure?

BACKGROUND: Erectile dysfunction (ED) is the inability or insufficiency of penile erection that causes dissatisfaction during sexual intercourse. ED is seen in patients with heart failure (HF), ranging from 56% to 81% depending on the severity. Patients usually blame their cardiovascular medications for their ED. Ivabradine is used for antianginal effects, to improve exercise intolerance, and to decrease mortality in patients with HF. Most beta-blockers are known to cause ED, but unlike beta-blockers the effect of ivabradine over ED has never been evaluated. AIM: We investigated the effect of ivabradine on ED in patients with HF. METHODS: Thirty-one patients with HF (all men) under optimal treatment for HF (except ivabradine) were recruited. Patients were evaluated with the internationally validated Sexual Health Inventory for Men (SHIM) questionnaire before the initiation of ivabradine and at the sixth month of the treatment. SHIM scores previous to treatment and at six months were compared using Wilcoxon signed rank test. A p value < 0.05 was accepted as statistically significant. RESULTS: At six months of follow-up after the initiation of ivabradine, a significant increase in patients with normal libido was found (p < 0.001). CONCLUSIONS: This is a novel study that evaluates the effect of ivabradine on human with HF. Ivabradine improved libido in patients with HF.