2015 European Society of Cardiology and European Respiratory Society Pulmonar Hypertension guideliene was announced in August in 2015 ESC meeting. According to this guideline, pulmonary hypertension was defined as pathophysiological disease that includes more than one clinical situation and can make it more complicated to most of respiratory diseases. We aimed to introduce the innovations that is brought to our daily practice by new guidelines.

Objective: As a highly rare congenital defect, cor triatriatum sinister represents only 0.1% of congenital cardiac anomalies. Depending on the degree of obstruction and the accompanying symptoms, cor triatriatum can be diagnosed at any age. This case series described 5 patients with cor triatriatum sinister who underwent operation.
Methods: Five patients with cor triatriatum sinister were seen at our institution between 2007 and 2013. The demographic characteristics and surgical results of these patients are outlined in this retrospective review.
Results: The surgical approach consists of left or right atriotomy, excision of the obstructing membrane, and repair of the associated intracardiac anomalies. After an uneventful postoperative hospital stay, all patients were discharged 5–10 days postoperatively. There were no instances of recurrent constriction after surgical treatment of the cor triatriatum membrane. Patients were followed up for a median of 4 years and were symptom free.
Conclusion: In the surgical management of this easily and fully treatable congenital cardiac anomaly, it is difficult to determine which atriotomy approach is comparatively more advantageous. However, in the management of cor triatriatum sinister, priority should be given to confirmation of the diagnosis and full resection of the membrane. Thus, the surgeon should not hesitate to perform additional incisions if deemed necessary.

Objective: Presence of diabetic retinopathy (DR) may be used as an early marker of atherosclerosis in type 2 diabetes mellitus (DM) patients. This study aimed to investigate the relationship between the presence of DR and carotid intimamedia thickness (CIMT), which is an indicator of early atherosclerosis in patients with type 2 DM.
Methods: Thirty DM patients with retinopathy (DR group), 28 DM patients without retinopathy (non-DR group), and 27 healthy controls (control group) were included in the study. CIMT was assessed using a high-resolution B-mode ultrasonography device. Results: Mean CIMT was found to be 0.9±0.17 mm in the DR group, 0.8±0.16 mm in the non-DR group, and 0.7±0.13 mm in the control group. CIMT was found to be statistically significantly higher in the DR group compared to the other 2 groups (p<0.001). When multivariate analysis was performed, presence of DR still remained as an independent risk factor for increased CIMT values.
Conclusion: Presence of DR in type 2 DM patients is an independent risk factor in terms of increased CIMT, which is considered to be a finding of subclinical atherosclerosis. Therefore, we believe that type 2 DM patients with retinopathy should be closely followed in terms of cardiovascular events.

Objective: Acute coronary syndrom (ACS) is a common disease that causes severe morbidity and mortality. The most important aspect of ST-elevation myocardial infarction (STEMI) as a subgroup of ACS treatment is the rapid reperfusion of arteries. Successful results depend not only on the experience of the center but also on the rapidity in which reperfusion is achieved. In our study, the transfer parameters were evaluated in patients who were admitted to our hospital with STEMI.
Methods: Two hundred consecutive patients (160 males, 40 females) who underwent primary percutaneous coronary intervention (PCI) for acute STEMI between January 2011 and March 2013 were included in our study. Transfer parameters of symptom-to-reperfusion treatment, clinical characteristics, and laboratory parameters were recorded. Results: Thirty-six patients were admitted to our hospital with ambulances; 70 patients were admitted to centers without PCI capability, with a mean transfer time to our hospital of 73.9±12.5 min. Median pain-to-first medical contact time was 105 min (range: 5–600 min), and average first medical contact- to-balloon time was 115.5 min (range: 20–414 min). Total pain-to-balloon time in females was significantly higher than males (246 min [range: 70–840 min], 195 min [range: 45–684 min], respectively, p=0.032). Mean pain-to-balloon time was significantly lower in patients delivered to the hospital by ambulance than in patients admitted to emergency departments independently (185 min [range: 45–439 min], 248 min [range: 65–840 min], respectively, p=0.017).
Conclusion: In this study, our hospital door-to-balloon time was found compatible with the target specified in the European Society of Cardiology and American College of Cardiology STEMI guidelines; however, first medical contact-to-balloon time was found to be above that advised by the current guidelines.

Objective: It is widely known that myocardial damage is not immediately terminated after the elimination of epicardial occlusion in cases of myocardial infarction. In situ thrombosis during epicardial occlusion might contribute to poor myocardial perfusion after reperfusion of an occluded epicardial artery. In the current study, we sought to determine the effects of ischemia and reperfusion on microvascular thrombotic occlusion.
Methods: Thirty male Wistar rats were included in the study. After the rats had been anesthetized and thoracotomized, the left coronary artery was occluded for 30 minutes in the first group, and it was occluded for 30 minutes and reperfused for an additional 20 minutes in the second group. Ten rats were used as a sham-operated control group. After completion of the study protocol, excised heart preparations were analyzed by immunohistochemistry and electron microscopy.
Results: A significant difference was found between the infarction plus reperfusion group and the other 2 groups, with respect to microvascular fibrin and thrombocyte deposition in immunohistochemistry analysis. These results were confirmed by morphological examination with electron microscopy.
Conclusion: In situ fibrin formation accompanies microvascular obstruction in acute myocardial infarction. Our results indicate that additional therapeutic approaches are needed in order to achieve better tissue perfusion in contemporary treatment of acute myocardial infarction after successful reopening of the infarct-related artery.

Objective: The aim of this study was to determine the role of leftsided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).
Methods: Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period.
Results: Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.631–0.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.01–1.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.36–57.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286–152.381, p<0.001), PALS (OR 0.86, CI 0.75–0.98, p=0.023), and UntwV (OR 1.02, CI 1.00–1.04, p=0.029) were the independent predictors of POAF.
Conclusion: The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.

Objective: The purpose of this study was to identify patient characteristics and statin discontinuation-related factors in patients with hypercholesterolemia.
Methods: A total of 532 patients (age mean±SD: 57.4±11.5 years; 52.4% women, 47.6% men) with hypercholesterolemia and statin discontinuation were included in this national cross-sectional noninterventional observational study. Data on socio-demographic characteristics of patients, cardiovascular risk factors, past treatment with and discontinuation of statin treatment were collected in one visit.
Results: Mean±SD duration of hypercholesterolemia was 4.9±4.2 years at time of discontinuation of statin treatment. Statin treatment was initiated by cardiologists in the majority of cases (55.8%), whereas discontinuation of statin treatment was decided by patients in the majority of cases (73.7%), with patients with higher (at least secondary education, 80.4%) more likely than those with lower (only primary education, 69.7%) to decide to discontinue treatment (p=0.022). Negative information about statin treatment disseminated by TV programs-mostly regarding coverage of hepatic (38.0%), renal (33.8%), and muscular (32.9%) side effects (32.9%)-was the most common reason for treatment discontinuation.
Conclusion: The decision to discontinue statin treatment was made at the patient’s discretion in 74% of cases, with higher likelihood of patients with higher educational status deciding to discontinue treatment and switch to non-drug lipid-lowering alternatives. Cardiologists were the physicians most frequently responsible for the initiation of the statin treatment; coverage of several non-lifethreatening statin side effects by TV programs and patients’ lack of information regarding high cholesterol and related risks were the leading factors predisposing to treatment discontinuation.

Outlining the severity of the myocardial bridge (MB) is a critical step for selecting the appropriate option among medical, surgical, or angioplasty-based treatments. Invasive treatments are usually preferred if treatment-resistant symptoms are observed or ischemia is proven by tests such as fractional flow reserve or myocardial perfusion scintigraphy (MPS). In this report, we present a patient who developed severe hypotension during treadmill exercise test, even though there were no perfusion defects during adenosine-induced MPS. This case suggests MPS with adenosine is not a good choice for evaluating ischemi

An 88-year-old woman was admitted to the emergency department after experiencing syncope while in a sitting position. Electrocardiogram showed advanced degree heart block. She has been on low-dose carbamazepine (200 mg/day) for the last year for trigeminal neuralgia (TN). After discontinuation of carbamazepine, the patient returned to normal sinus rhythm.

Capecitabine is a chemotherapeutic agent used in the treatment of metastatic colon cancer and metastatic breast cancer. It is metabolized into fluorouracil (5-FU) in the liver; hence, its mechanism of action is similar to that of 5-FU. Cardiac toxicity, although rarely seen, may be of concern in some patients. Although multiple hypotheses have been proposed for the mechanism of cardiotoxicity, coronary vasospasm is the most commonly accepted one, as patients usually present with chest pain resembling acute myocardial infarction. Electrocardiography may demonstrate ST-segment elevation, and cardiac biomarkers may be elevated. Cardiotoxicity with 5-FU has been reported widely. Capecitabine has been shown to be much less cardiotoxic compared to 5-FU, with only a handful of cases reporting cardiotoxicity with capecitabine. There are no cases reporting cardiotoxicity with both 5-FU and capecitabine in the same patient. In this case report, we present a patient with adverse cardiac effect with capecitabine whose previous 5-FU therapy was stopped due to cardiotoxicity.

Transcatheter aortic valve implantation (TAVI) is considered an alternative therapy in high-risk patients with severe aortic stenosis (AS). However, this minimally invasive procedure carries potential complications, such as valve embolization at time of TAVI. We present a case of balloon-expandable aortic valve embolization which was managed nonsurgically. Valve embolization was managed conservatively, as the patient refused open heart surgery for definitive treatment. The patient was transferred to the intensive care unit in stable hemodynamic condition and discharged 1 week following the procedure.

Presence of a cardiac pacemaker or implantable cardioverter defibrillator (ICD) is a relative contraindication to magnetic resonance imaging (MRI). Biventricular ICDs are often used in the treatment of advanced heart failure; however, reports on experience with biventricular ICDs are lacking in the literature. In this case report, we describe a pacemaker-dependent patient with a biventricular ICD on whom an MRI of the lumbar spine was performed without having realized the presence of the ICD.

The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/ IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome.