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Amaç: Total kolesterol (TK) ile yüksek-yoðunluklu lipoprotein kolesterol (HDL-C) düzeylerinin TEKHARF Çalýþmasý’nda kapsanan orta yaþlý katýlýmcýlarda genel mortalite ile öne dönük iliþkisini ayrýntýlý biçimde belirlemektir.
Yöntemler: Baþlangýçtaki lipid deðiþkenleri cinsiyete özgü ondabir dilimlerde analiz edildi. Baþlangýçtaki yaþýn 45–84 olarak alýnma ölçütü 2121 erkek ile kadýnýn içerilmesine izin verdi. Cox regresyon analizleri uygulandý.
Bulgular: Ortalama 8.85±4.4 yýllýk izlemede ölüm 237 kadýn ile 306 erkekte saptandý. Yaþ sigara içiciliði, lipid düþürücü ve antihipertansif ilaç kullanýmý, baþlangýçta diyabet ve koroner kalp hastalýðýna ayarlamadan sonra ve en alt ondabir dilim referent olarak alýnýnca, ne TK (sýrasýyla, p trend =0.94 ve 0.96), ne de HDL-C kategorileri (sýrasýyla, p trend =0.20 ve 0.31) iki cinsiyette de mortaliteyi anlamlý öngörmedi. TK dilimleri, kadýnlardaki hazard oranlarýnýn 2.–5. dilimlerde erkektekilere göre ayna halini sergileme eðilimleri ile ayrýþtýlar.
Sonuç: Total kolesterol ondabir dilimlerine iliþkin bulgular, erkektekine kýyasla, kadýnda en alt dilimde göreli yüksek ölüm oranýna atfedilebilir ki bu da anýlan dilimde otoimmün sürecin indüklediði yüksek riski yansýtýr. Yüksek-yoðunluklu lipoprotein kolesterole iliþkin gözlemlerimiz >50 mg/dL düzeylerinin yangýsal dönüþüme uðradýðýný desteklemektedir. Bu saptamalar önemli klinik çýkarýmlar taþýr.

Objective: The aim of this study was to delineate in detail the longitudinal association of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels with overall mortality in middle-aged participants of the biennial Turkish Adult Risk Factor study.
Methods: Baseline lipid variables were analyzed in sex-specific deciles. A baseline age of 45 to 84 years as an inclusion criterion led to the enrollment of 2121 men and women. Cox regression analyses were performed.
Results: Deaths were recorded in 237 and 306 women and men, respectively, during a mean 8.85±4.4 years of follow-up. After adjustment for age, smoking status, lipid-lowering and antihypertensive drug usage, prevalent diabetes, and coronary heart disease, and using the lowest decile as referent, neither TC (p trend=0.94 and 0.96, respectively), nor HDL-C categories (p trend=0.20 and 0.31, respectively) were significantly predictive of mortality in either gender. TC deciles exhibited a gender difference insofar as hazard ratios in females tended to be reciprocal to those in males in deciles 2 through 5.
Conclusion: The findings on TC deciles may be attributed to a comparatively higher death rate in the female (compared with male) bottom decile, reflecting the autoimmune process-induced elevated risk in the lowest decile. Observations on HDL-C confirmed presumed pro-inflammatory conversion in levels >50 mg/dL. These results have important clinical implications.

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Amaç: Bu çalýþmanýn amacý kararlý koroner arter hastalýðý (KAH) olan hastalarda, hastalýðýn tanýsýnda, kompleksitesi ve yaygýnlýðýnýn deðerlendirilmesinde serum oksidatif ve antioksidatif stress belirteçlerinin yerinin olup olmadýðýnýn araþtýrýlmasýdýr.
Yöntemler: Çalýþmaya toplam 145 hasta dahil edildi. Koroner anjiyografi (KAG) sonuçlarýna göre hastalar KAH’ý olmayan (grup 1) ve olan (grup 2) olmak üzere 2 gruba ayrýldý. Grup 2’deki hastalar SYNTAX skorlarýna göre düþük skorlu ve orta-yüksek skorlu olmak üzere tekrar 2 gruba ayrýldý. Serum malondialdehit (MDA) ve total antioksidan kapasitesi (TAK) seviyeleri hem grup 1 ve grup 2 arasýnda hem de düþük skorlu ve orta-yüksek skorlu gruplar arasýnda karþýlaþtýrýldý.
Bulgular: Grup 1 ile grup 2’nin TAK ve MDA deðerleri arasýnda istatistiksel olarak anlamlý fark saptandý (sýrasýyla, p=0.036 ve p=0.029). SYNTAX skoru 1-22 olan grup ile SYNTAX skoru >22 olan grup arasýnda da TAK ve MDA seviyeleri yönünden istatistiksel olarak anlamlý fark bulunmadý (sýrasýyla, p=0.582 ve p=0.85).
Sonuç: Kararlý KAH olan hastalarda, KAH olmayanlara göre serum MDA seviyesi yüksek, TAK seviyesi ise düþüktür, ancak bu parametreler hastalýðýn kompleksitesi göstermede yeterli deðildir.

Objective: The aim of this study was to investigate the relationship between oxidative/antioxidative stress markers and the diagnosis and complexity of coronary artery disease (CAD) in patients with stable CAD.
Methods: A total of 145 patients were enrolled in the study. Based on coronary angiography results, the patients were categorized into 2 groups: those without CAD (Group 1) and those with CAD (Group 2). The patients in Group 2 were also categorized into low score and moderate/high score groups according to their SYNTAX score. The serum malondialdehyde (MDA) and total antioxidant capacity (TAOC) levels of Group 1 and Group 2 were compared. Finally, MDA and TAOC levels were compared between the moderate/high-risk and low-risk groups formed according to SYNTAX score.
Results: There was a significant difference with respect to both serum TAOC and MDA levels between Group 1 and Group 2 (p=0.036 and p=0.029, respectively). The groups with a SYNTAX score 1-22 and with a SYNTAX score >22 were not significantly different with respect to serum TAOC or MDA level (p=0.582 and p=0.85, respectively).
Conclusion: The serum MDA level was significantly higher and the TAOC level was significantly lower in patients with stable CAD compared to those without; however, these molecule levels failed to predict disease complexity in patients with stable CAD.

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Amaç: Histolojik plak özellikleri koroner darlýklarýnýn yol açtýðý hemodinamik sonuçlarý etkileyebilmektedir. Kalsiyumun topografik daðýlýmýnýn koroner darlýklarýnýn yol açtýðý fizyolojik sonuçlarý nasýl etkilediði konusunda henüz bilimsel araþtýrma yapýlmadý. Bu çalýþma fraksiyonel akým rezervi (FAR) ile kalsifikasyon paternleri arasýndaki olasý iliþkiyi ortaya koymayý hedeflemektedir. Ayrýca, kalsifikasyon þekillerinin koroner yeniden þekillenmesi üzerindeki etkisi de araþtýrýlmaktadýr.
Yöntemler: Kararlý angina pektorisli 26 ve kalýcý ST yükselmesiz akut koroner sendromlu 34 hasta bu çalýþmaya dahil edildi. Orta derece (gözle %50 ile %80 arasý darlýða sahip olduðu deðerlendirilen) 70 lezyon FAR ile deðerlendirildi. Hemodinamik ölçümler alýndýktan sonra damar içi ultrason ile gri skala ve gerçek histolojik parametreler en küçük lümen alaný ve tüm lezyon için deðerlendirildi. Lezyonlar kalsifikasyonun derinliði, uzunluðu ve dairesel daðýlýmýna göre sýnýflandýrýldý.
Bulgular: Analiz edilen segmentte, FAR ile en yüksek derin kalsifikasyon açýsý (r=-0.396, p=0.001) ve kalýnlýðý (r=-0.285, p=0.021) arasýnda korelasyon saptandý. Kalsifikasyon açýsý 180 dereceden geniþ olanlarda ortalama FAR deðerinin anlamlý derecede daha düþük olduðu tespit edildi (0.64±0.17 ve 0.78±0.08, p=0.024). Koroner yeniden þekillenmesi ile en yüksek yüzeysel (r=-0.437, p<0.001) ve derin (r=0.425, p<0.001) kalsifikasyon açýsý arasýnda korelasyon vardý. Koroner yeniden þekillenmesi ile en yüksek yüzeysel (r=-0.357, p=0.003) ve derin (r=0.417, p<0.001) kalsifikasyon kalýnlýðý arasýnda korelasyon vardý, koroner yeniden þekillenmesi ile FAR arasýnda korelasyon saptandý (r=-0.477, p<0.001).
Sonuç: Bu çalýþma, koroner arter plaðýndaki kalsifikasyonun geometrisi, yerleþim yeri ve daðýlýmýnýn fonksiyonel olarak anlamlý darlýklarda hemodinamik sonuçlarý etkileyebildiðini gösterdi. Ayrýca koroner arter kalsifikasyon þekilleri ile koroner yeniden þekillenmesi arasýnda korelasyon olabileceði ortaya kondu.

Objective: The histological characteristics of plaque may affect the hemodynamic outcome of a given coronary stenosis. In particular, the potential effect of volumetric calcium content and the topographical distribution in the lesion segment on physiological outcome has not yet been investigated. The aim of this study was to identify any potential correlation between patterns of calcification and the fractional flow reserve (FFR) and the coronary remodeling index (RMI).
Methods: A total of 26 stable angina pectoris and 34 acute coronary syndrome patients without persistent ST-segment elevation constituted the study population. FFR was used to assess 70 intermediate coronary stenosis lesions. After obtaining hemodynamic measurements, quantitative grayscale and virtual histology-intravascular ultrasound analyses were performed. The depth, length, and circumferential distribution of calcification of the lesions were also recorded.
Results: Within the analyzed segment (area of interest, lesion segment), FFR was correlated with maximal thickness of deep calcification (r=-0.285; p=0.021) and calcification angle (r=-0.396; p=0.001). In lesions with a calcification angle >180°, the mean FFR value was significantly lower compared with those <180° (0.64±0.17 vs. 0.78±0.08; p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437; p<0.001) and deep (r=0.425; p<0.001) calcification. RMI was correlated with maximal thickness of superficial (r=-0.357; p=0.003) and deep (r=0.417; p<0.001) calcification. RMI was also correlated with FFR (r=-0.477; p<0.001).
Conclusion: This study demonstrated that the geometry, location, and amount of calcification of a plaque could affect hemodynamic and anatomical outcome measures in functionally significant stenoses by affecting vessel wall compliance.

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Amaç: Tamamlayýcý ve alternatif týp (TAT) uygulamalarý günümüzde giderek yaygýnlaþmaya baþlamýþtýr. TAT geleneksel týp uygulamalarý dýþýnda kalan bütün saðlýk hizmetlerini, yöntemlerini, uygulamalarýný ve bunlara eþlik eden kuram ve inançlarý kapsayan geniþ bir saðlýk alanýdýr. Bu çalýþma bir kardiyoloji kliniðine yatan kalp hastalarýnda kullanýlan bitkisel ürünleri, nasýl kullanýldýklarýný incelemek üzere planlanmýþtýr.
Yöntemler: Kesitsel-tanýmlayýcý nitelikteki bu çalýþma, Nisan 2016–Haziran 2016 tarihleri arasýnda Özel Defne Hastanesi Kardiyoloji Servisi’nde yatan 18 yaþ üstünde olup görüþmeyi kabul eden 199 hastada 20 sorudan oluþan anket yüz yüze görüþme yöntemi ile yapýlmýþtýr.
Bulgular: Çalýþmamýza katýlan hastalarýn %28.6’sý (n=57) bitkisel ürün kullandýklarýný, %71.6’sý (n=142) bitkisel ürün kullanmadýklarýný söylemiþtir. Bitkisel ürün kullananlarýn sadece %14.03’ü (n=8) ürünü hekimine danýþarak kullandýðýný söylerken, %85.9’u (n=49) hekimine danýþmadan kullandýðýný söylemiþlerdir. Çalýþmaya katýlan hipertansiyonlu hastalarýn %35.7’si bitkisel ürün kullanmaktadýr. En sýk kullanýlan bitkisel ürünler %22.5 limon, %17.5 nar ekþisi ve %17.5 yeþil çay idi. Çalýþmaya katýlan kalp damar hastalarýnýn %23.5’i bitkisel ürün kullandýðýný beyan etmiþlerdir. Bitkisel ürün kullananlarýn %25’i yeþil çay, %25’i zencefil, %18.8’i ada çayý kullandýklarýný söylemiþlerdir.
Sonuç: Kardiyoloji hastalarýnýn önemli bir kýsmý bitkisel ürün kullanmaktadýr. Büyük bir kýsmý sorumlu hekimlerine danýþmadan kullandýklarýný belirtmektedirler. Hastalarýn hekimlerine danýþmadan bitkisel ürün kullanmalarý istenmeyen sonuçlara yol açabilir.

Objective: Complementary and alternative medicine (CAM) has become more and more widespread around the world. CAM is a broad term that refers to all medical healthcare services, methods, and practices that are not part of standard medical care, as well as the accompanying theories and beliefs. The aim of the present study was to investigate the use of herbal medicinal products in cardiac patients, as well as the methods of administration of the products.
Methods: This descriptive cross-sectional study included 199 patients aged over 18 years who were hospitalized in the Defne Hospital department of cardiology and volunteered to participate in a 20-item survey between April 2016 and June 2016.
Results: The study results indicated that 28.6% (n=57) of patients were using herbal products and 71.6% (n=142) said they did not. Only 14.03% (n=8) of those who used herbal products said they used them in consultation with their physician; 85.9% (n=49) had used herbal medicine without consulting their doctor. Of the participants with hypertension, 35.7% of them reported using herbal medicinal products. Of these, 22.5% of them were consuming lemon, 17.5% pomegranate syrup, and 17.5% green tea. Of the participants with cardiovascular diseases, 23.5% of them stated that they were taking herbal products. Of these, 25% were consuming green tea, 25% ginger, and 18.8% sage.
Conclusion: Herbal medicinal supplements were used by a large portion of the cardiac patients in this study. Furthermore, most of the patients stated that they were using these products without informing their physician, a practice that can have unwanted consequences.

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Amaç: Çalýþmamýzda Avrupa Kardiyoloji Derneði (ESC) kýlavuzunun statin tedavisi endikasyonlarýnýn yeterliliðini ve güncel Saðlýk Bakanlýðý, Saðlýk Uygulama Tebliði (SUT) kurallarýnýn ESC’ye göre kapsamýný inceledik.
Yöntemler: Ýlk akut koroner sendrom (AKS) tanýsý ile 582 hasta çalýþmaya dahil edildi. Koroner anjiyografide (KAG) kritik olmayan darlýðý ve geçirilmiþ AKS þüphesi oluþturan lezyonlarý olanlar çalýþma dýþýnda býrakýldý. Risk hesaplamasý yaþ, cinsiyet, sigara içiciliði, diabetes mellitus ve lipid deðerlerine göre yapýldý. Statin tedavisi endikasyonlarý 2016 ESC kýlavuzuna göre, SUT geri ödeme kapsamýysa 2016 güncel tebliðine göre deðerlendirildi.
Bulgular: Statin tedavisi endikasyonu diyabetik hastalarda %96 iken diyabeti olmayan hastalarda ESC ve SUT’ta sýrasýyla %13.5 %13.3 oranýnda statin tedavisi baþlanabiliyordu. (p<0.05). Ýlk AKS yaþý <60 olan hastalarda SUT geri ödemesi ESC endikasyonundan daha fazla hastayý kapsýyordu. 60–79 yaþ arasý grupta ise SUT ESC endikasyonlarýnýn gerisinde kalýyordu. Diðer gruplarda ise her iki sistem de ayný oranda hastayý kapsýyordu. Hastalar LDL-K seviyelerine göre ayrýldýðýnda LDL-K >190 mg/dL olduðunda SUT, ESC endikasyonlarýndan daha fazla kapsama sahipti. Saðlýk Uygulama Tebliði LDL-K deðeri 190 mg/dL olan bütün hastalarý geri ödeme kapsamýna almaktadýr. LDL-K <160 mg/dL olan grupta ise ESC daha geniþ kapsama sahipti.
Sonuç: SUT geri ödeme kapsamý genel olarak ESC endikasyonundan daha dar deðildir. Altmýþ yaþ üstü ve LDL-K <160 mg/dL olan hastalarda kapsam ESC’den dar olduðu için bu grupta yeniden deðerlendirme yapýlmalýdýr. Güncel ESC statin kullanma endikasyonlarýnýn kapsamýnýn yeterli geniþlikte olmadýðý, yeni algoritma ya da risk faktörü tanýmlamalarýna ihtiyaç duyulduðu söylenebilir.

Objective: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health’s Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention.
Methods: A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016).
Results: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p<0.05). For patients younger than 60 years of age, the SUT had more guidelines than the ESC; however, for patients aged 70 to 90, the ESC had more guidelines than the SUT. For patients over 90, the indications were the same. For patients with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDL-C <160 mg/dL.
Conclusion: The scope of the SUT guidelines is generally not narrower than the ESC indications. However, the indications for patients >60 years of age and those with LDL-C >160 mg/dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.

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Amaç: Kardiyologlar birçok riskli hastaya teþhis, tedavi ve giriþimsel tedavide bulunurlar. Bu çalýþmada Türkiye'deki mevcut “malpraktis” sisteminin kardiyologlarýn taný ve tedavi yaklaþýmlarýný nasýl etkilediðini ve önerdiðimiz yeni hasta tazminat sistemine yaklaþýmlarýný inceledik.
Yöntem: Kesitsel çalýþmamýzda Türk saðlýk sisteminin farklý seviyelerinde çalýþan kardiyologlarýn mesleki risk algýlarýnýn uygulamalarýna etkisini araþtýrdýk. 24 soruluk bir anketi asistan, uzman ve öðretim üyelerine e-posta, basýlý evrak ve cep telefonu mesajý ile gönderdik.
Bulgular: Ankete cevap veren 253 kardiyologdan 29’u (%11.6) geçmiþte “malpraktis” nedeni ile mahkemeye gitmiþti. Bunlardan ikisi (%6.9) para, biri (%3.4) hapis cezasý almýþtý. Bunun yanýnda 132 (%52.8) kardiyolog “malpraktis” korkusu nedeni ile pratiklerinde deðiþiklik yaptýklarýný bildirmekteydi. Ayrýca 232 (92.8%) kardiyolog önerdiðimiz hasta tazminat sistemini tercihe deðer buluyordu. Kardiyologlarýn %78.8'i bilgisayarlý tomografik anjiyo (BTA) veya talyum, %71.6'sý koroner anjiyo, %20'si stent implantasyonu, %83.2'si ise yüksek riskli hastalardan kaçýnma kararlarýnda malpraktisten kaçýnmanýn etkili olduðu kanaatindeydi.
Sonuç: “Malpraktis” korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, giriþim yapma veya yüksek riskli hastalardan kaçýnma eðilimi yaratmaktadýr. Önerdiðimiz yeni “malpraktis” sistemi çalýþmaya katýlan kardiyologlarýn büyük çoðunluðu tarafýndan mevcut sisteme tercih edilir bulunmuþtur.

Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists’ diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system.
Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message.
Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients.
Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.

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Sað ventrikül delinmesi perikardiyosentezin seyrek fakat ölümcül olabilen bir komplikasyonudur. Tamponat nedeniyle acil perikardiyosentez uygulamasý sýrasýnda sað ventrikülde perforasyon olan bir olgu sunuldu. Bu olgu, drenaj kateteri çýkartýlýp, 10 dk’lýk aralýklarla küçük boyutlu kateterler kademeli olarak deðiþtirilerek baþarýyla tedavi edildi. Kalp cerrahisi ve damar kapatma cihazý olmaksýzýn perikardiyosentez sýrasýnda iyatrojenik sað ventrikül ponksiyonunun tedavisi için ilk yerleþtirilen kateterin daha küçük boyutlu kateterlerle adým adým deðiþtirilerek çýkarýlmasý bir tedavi seçeneði olabilir.

Right ventricle perforation is an uncommon, but potentially fatal, possible complication of pericardiocentesis. We presented a case of right ventricular perforation that developed during urgent pericardiocentesis due to tamponade. This case was successfully treated with the incremental removal of the drainage catheter, replacing it with a smaller catheter at 10-minute intervals. This may be an alternative option to treat iatrogenic right ventricle puncture occurring during pericardiocentesis without cardiac surgery or a vascular closure device.

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Prinzmetal angina olarak da bilinen vazospastik angina, birçok faktörün tetikleyebileceði bir damar aþýrý duyarlýlýðý olarak düþünülmektedir. Týbbi tedaviye yanýt sýklýkla iyidir, ancak her beþ hastadan birinde dirençli semptomlar görülmektedir. Nadiren vazospazma baðlý ölümcül aritmiler görülebilmektedir ve bu hastalarda prognoz daha kötüdür. Burada, kalsiyum kanal blokeri ve nitrat tedavisine raðmen semptomlarý devam eden dirençli bir vazospastik anginalý olguyu sunduk. Hasta, hemodinamik bozukluða yol açan ve tekrarlayan kardiyoversiyonlara dirençli yüksek hýzlý ventriküler taþikardi ile baþvurdu. Týbbi tedavisine ek olarak, koronerlerdeki belirgin vazospastik segmentlere stent yerleþtirilerek tedavi edildi. Ayrýca, vazospazm kesin bir tedavisi olmayan yaygýn bir vasküler hastalýk olduðundan, ventrikül aritmilerine karþý ikincil korunma amaçlý implante edilebilir defibrilatör yerleþtirildi.

Vasospastic angina, also known as Prinzmetal’s angina, is thought to occur due to vascular hyper-reactivity to various stimuli. Response to medical therapy is usually good; however, 1 out of 5 patients has resistant symptoms. Rarely, potentially lethal arrhythmias can occur due to vasospasm, and those patients are reported to have a poorer prognosis. Presently described is a case of resistant vasospastic angina with persistent symptoms under calcium channel blocker and nitrate treatment. The patient presented with hemodynamically unstable rapid-rate ventricular tachycardia, which was quite resistant to recurrent cardioversion. She was treated with stent implantation for definite vasospastic segments of the coronaries, in combination with medical therapy. An implantable cardioverter defibrillator was also implanted for secondary prevention of ventricular arrhythmia, as vasospasm was considered to be a diffuse disease without a certain definitive treatment.

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Ventriküler ekstrasistoller (VES) kalp yetersizliðinde kötüleþmeye ve implante edilebilen kardiyoverter defibrilatör (ICD) þoku sýklýðýnda artýþa neden olabilmektedirler. Epikart kaynaklý VES’ler iskemik kardiyomiyopatide daha az sýklýkla gözlenmektedir. VES tedavisinde radyofrekans kateter ablasyonu en etkili tedavi yöntemidir ve kalp fonksiyonlarýnda düzelme saðlayabilmektedir. Bu yazýda sunulan iskemik kardiyomiyopatili, sýk VES/ventriküler taþikardi ataklarý nedeniyle sýk ICD þoku olan hastada, ön intervenriküler ven içinden epikardiyal VES ablasyonu ve ayný iþlemde kardiyak resenkronizasyon tedavisine yükseltme iþlemi sunulmuþtur.

Premature ventricular contractions (PVCs) can cause clinical deterioration in patients with heart failure and increase the frequency of shocks delivered by an implantable cardioverter defibrillator (ICD). Epicardial PVC/ventricular tachycardia (VT) is seen less often in ischemic cardiomyopathy. Radiofrequency catheter ablation is the most effective treatment option for the management of PVC/VT and can improve cardiac function. Presently described is a patient with ischemic cardiomyopathy and frequent PVCs and VT runs with multiple ICD therapies who was treated with simultaneous radiofrequency catheter ablation in the anterior interventricular vein and cardiac resynchronization therapy defibrillator upgrade in the same procedure.

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Brugada sendromu sað prekordiyal EKG derivasyonlarýnýn (V1-3) en az ikisinde ≥2 mm coved tipte J noktasý ve ST yükselmesi ile karakterize kalýtsal bir kalp hastalýðýdýr. Psikotropik ve anestetik ilaçlar da dahil olmak üzere artan sayýda kalp dýþý ilacýn ölümcül ventrikül aritmilerine yatkýnlýðý artýran Brugada fenokopisini tetiklediði gösterilmiþtir. Ancak bu durumun klinik önemi ile ilgili net veri bulunmamaktadýr. Bu olgu serisinde hastalarýmýzdaki tipik Brugada paterninin; lityum, valproik asit ve tiyokolþikosid ile maskelenmiþ olabileceði düþünülmüþtür. Ancak klinik senaryonun her üç olguda da farklý olduðu, semptomsuz ve ani kalp durmasý arasýnda deðiþtiði izlenmiþtir.

Brugada syndrome is an inherited cardiac arrhythmia condition characterized by coved-type ST elevation and J point elevation of at least 2 mm in at least 2 of the right precordial electrocardiogram (ECG) leads (V1–3). An increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce a characteristic Brugada ECG pattern, predisposing the patient to fatal ventricular arrhythmias. However, there are scarce data regarding the clinical significance. In this case series, a typical Brugada pattern was unmasked by lithium, valproic acid, and thiocolchicoside; however, the clinical scenario was different in all 3 cases, ranging from an asymptomatic patient to sudden cardiac arrest.

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Ýdiyopatik çýkan aortit genellikle kalp damar ve bað dokusu hastalýklarýnýn araþtýrýlmasý sýrasýnda saptanan sinsi bir hastalýktýr. Bildiðimiz kadarýyla, idiyopatik çýkan aortite baðlý olarak göðüs aðrýsý ile acil servise baþvuru daha öncesinde bildirilmemiþtir. Bu yazýda, göðüs ve sýrt aðrýsý semptomlarý sadece idiyopatik çýkan aortite sekonder olduðu farkedilen 46 yaþýndaki erkek hasta sunuldu.

Idiopathic ascending aortitis is an insidious disease most often encountered during an evaluation for other cardiovascular and connective tissue diseases. To the best of our knowledge, admission to an emergency department with chest pain due to idiopathic ascending aortitis has not been reported before. Herein, the case of a 46-year-old man with chest and back pain symptoms that were discovered to be secondary solely to idiopathic ascending aortitis is described.

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Kronik granülomatöz hastalýk (KGH) tanýsý konmuþ üç yaþýnda bir kýz çocuðu bronkopnömoni ve konjestif kalp yetersizliði tanýlarý ile hastaneye yatýrýldý. Týbbi öyküsünde mide çýkým yolunda otoimmün darlýk nedeniyle metilprednizolon tedavisi bulunmaktaydý. Bilgisayarlý tomografide pnömonik infiltrasyonlar ve perikart kalýnlaþmasý saptandý. Darbeli-dalga Doppler incelemesinde E/A >1 saptandý. Perikardiyektomi sýrasýnda fibrinöz eksuda içeren çoklu adalar þeklinde, kalýn duvarlý apse oluþumlarý mevcuttu. Perikardýn histopatolojik incelemesinde granülomatöz enflamasyon saptandý. Apse’den yapýlan kültürde aspergillus fumigatus üredi. Sonuç olarak, KGH’li olan hastalarda konstriktif aspergillus perikarditi dkkate alýnmalýdýr çünkü beklemeden anti-fungal tedavinin baþlanmasý ile birlikte agresif cerrahi tedavi hayat kurtarýcýdýr.

A 3-year-old girl with the diagnosis of chronic granulomatous disease (CGD) was hospitalized for bronchopneumonia and congestive heart failure. Her medical history included methylprednisolone medication for autoimmune gastric outlet obstruction. Computed tomography revealed pneumonic infiltrations and pericardial thickening. A pulsed-wave Doppler recording revealed E/A >1. During a pericardiectomy, multiple islands of thick, firm-walled, fibrinous exudate-containing, small abscess formations were observed. Histopathological evaluation of pericardial tissue revealed granulomatous inflammation. Aspergillus fumigatus was cultured from the abscess. In conclusion, development of constrictive aspergillus pericarditis should be considered in patients with CGD because immediate initiation of anti-fungal management with aggressive surgical treatment is life-saving.

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Düþük testosteron seviyeleri ve hipogonadizm kalp-damar hastalýklarý ile iliþkilidir. Yaþlanma, kronik saðlýk sorunlarý ve obezite hem düþük testosteron seviyeleri hem de kalp damar hastalýklarýnýn ciddiyeti ile baðlantýlýdýr. Klinik hipogonadizmi ve düþük testosteron seviyesi olan hastalara testosteron sýklýkla reçete edilmektedir. Testosteron yerine koyma tedavisi ile olumsuz kardiyovasküler olaylar arasýndaki iliþki hakkýndaki bilgiler tartýþmalýdýr. Yaþlý ve kardiyovasküler olaylara yatkýn olan hastalar, testosteron tedavisi sonrasýnda risk altýnda olabilirler. Bu nedenle testosteron yerine koyma tedavisinin kalp damar hastalýklarý yönünden güvenilirliðini tartýþmak için literatürü derledik.

A low testosterone level and hypogonadism are associated with cardiovascular disease. Aging, chronic health problems, and obesity are all associated with a low testosterone level as well as the presence and severity of cardiovascular disease. Testosterone is increasingly prescribed for patients with clinical hypogonadism and a low testosterone level. The information we have is still contradictory regarding testosterone replacement therapy (TRT) and its association with adverse cardiovascular events. Older patients and patients who are susceptible to cardiovascular diseases could be at risk with a testosterone prescription. This is a review of the literature to discuss the cardiovascular safety of TRT.

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