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Amaç: Koroner yavaþ akým fenomeni (KYAF) en az bir majör epikardiyal koroner arterde kan akýmýnýn distal damar yataðýna geç ulaþmasý olarak tanýmlanýr. Serbest hücresel DNA (shDNA), hücre nükleuslarýndan serbestleþen ve dolaþýmda serbest olarak tespit edilebilen DNA tipidir. Bu çalýþmada, KYAF’de hücresel düzeyde iskeminin göstergesi olan shDNA düzeylerinin artýp artmadýðýný göstermeyi amaçladýk.
Yöntemler: Bu çalýþmaya, 23 KYAF’lý ve 23 anjiyografik olarak normal koroner arterlere (NKA) sahip toplam 46 hasta alýndý. Gruplarýn shDNA düzeyleri, klinik, biyokimyasal ve anjiyografik özellikleri karþýlaþtýrýldý.
Bulgular: Ortalama yaþ KYAF grubunda 53.8±10.3 ve NKA grubunda 56.6±9.4 idi. Laboratuvar bulgularý ve bazal klinik karekteristikleri yönünden gruplar arasýnda istatistiksel anlamlý fark yoktu. Plazma shDNA düzeyleri KYAF’da 5.04±2.37 ng/µL, NKA’da 2.28±1.09 ng/µL olarak tespit edildi (p<0.001).
Sonuç: Farklý invaziv ve noninvaziv çalýþmalar KYAF’da miyokardiyal iskeminin varlýðýný göstermiþtir. Çalýþmamýzda KYAF’lý hastalarda mikrovasküler bozukluða baðlý olarak, hücresel düzeyde iskemi ve hasarýn göstergesi olan shDNA düzeyinin anlamlý þekilde arttýðýný gösterdik.

Objective: Coronary slow-flow phenomenon (CSFP) is defined as the delayed arrival of coronary blood flow to the distal vascular bed in at least 1 major epicardial coronary artery. Cell-free DNA (cfDNA) is a type of DNA that circulates freely in the blood once released from nucleated cells. The aim of this study was to determine if the level of cfDNA, which is an indicator of ischemia at the cellular level, was increased in CSFP.
Methods: The study included 46 patients in total: 23 patients with CSFP and 23 with a normal coronary angiogram (NCA). The level of cfDNA, and clinical, biochemical, and angiographic features of the groups were compared.
Results: The mean age was 53.8±10.3 years for the CSFP patient group and 56.6±9.4 years for the NCA patient group. There was no statistically significant difference between the groups in terms of basal clinical characteristics or laboratory data. The plasma cfDNA level was 5.04±2.37 ng/µL in the CSFP patients and 2.28±1.09 ng/µL in the NCA group (p<0.001).
Conclusion: Several invasive and noninvasive studies conducted on patients with CSFP have revealed myocardial ischemia. The results of this study demonstrated that the level of cfDNA was significantly increased in patients with CSFP as a result of ischemia at the cellular level caused by microvascular disruption.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Protez kapak trombozu (PKT) geliþimi protez kalp kapaklý hastalarda ciddi bir komplikasyondur. Son zamanlarda trombolitik tedavi (TT) PKT tedavisinde ilk tercih olarak yaygýn olarak kullanýlmaktadýr. Daha önceki çalýþmalarda PKT hastalarýnda endotel disfonksiyonunun varlýðý bildirilmiþtir. Bu çalýþmada, PKT hastalarýnda TT sonrasýnda endotel fonksiyonlarýnda olan deðiþiklikleri araþtýrmayý amaçladýk.
Yöntemler: Bu çalýþmaya TT öncesi ve sonrasý prospektif olarak takip edilen 85 PKT hastasý [kadýn: 53 (%62,3), ortalama yaþ: 48,7±13,9 yýl] dahil edildi. Tüm hastalar transtorasik ve transözofajiyal ekokardiyografi ile deðerlendirildi. Tüm hastalarda düþük doz ultra yavaþ infüzyon rejimine göre TT uygulandý. Endotel fonksiyonlarý reaktif hipereminin neden olduðu akým aracýlý geniþleme (Flow Mediated Dilation, FMD) ölçülmesi ile deðerlendirildi.
Bulgular: Çalýþmaya 38 (%44,7) týkayýcý ve 47 (%55,3) týkayýcý olmayan PKT hastasý alýndý. Týkayýcý PKT hastalarý týkayýcý olmayan PKT hastalarýna göre daha düþük bazal FMD deðerlerine sahiplerdi (%5,31±0,76 ve %5,87±0,84; p=0,003). TT 79 (%92,9) PKT hastasýnda baþarýlý idi. Ortama FMD deðerleri baþarýlý TT grubunda TT sonrasýnda anlamlý olarak yükseldi (%5,65±0,86 ve %7,13±1,26; p<0,001). Baþarýsýz TT grubunda TT sonrasý FMD deðerlerinde anlamlý deðiþiklik izlenmedi (%5,07±0,61 ve %5,38±0,95; p=0,371). Týkayýcý PKT olan hastalarda TT sonrasýnda FMD deðerleri anlamlý olarak yükseldi (%5,31±0,76 ve %8,22±1,15; p<0,001). Fakat, týkayýcý olmayan PKT hastalarýnda TT sonrasý FMD deðerlerinde anlamlý deðiþiklik izlenmedi (%5,87±0,84 ve %6,11±0,95; p=0,276).
Sonuç: Bu çalýþmada, týkayýcý PKT hastalarýnda baþarýlý TT’nin bozulan endotel fonksiyonlarýnýn düzelmesine katký sunabildiði gösterilmiþtir.

Objective: Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients.
Methods: The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7±13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia.
Results: The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31±0.76% vs. 5.87±0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65±0.86% vs. 7.13±1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07±0.61% vs. 5.38±0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31±0.76% vs. 8.22±1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87±0.84% vs. 6.11±0.95%; p=0.276).
Conclusion: This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.

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Amaç: Doðruluðu açýsýndan herhangi bir yasal veya medikal uygulama ortaya koyulmamýþ olmasýna raðmen, Google medikal konularda bilgi kaynaðý olarak çok yaygýn kullanýlmaktadýr. Çalýþmamýzýn amacý içerik geçerliliklerine göre kolesterol konusunda çok okunan Türkçe yazýlarýn deðerlendirilmesiydi.
Yöntemler: Google trends 5 Ocak 2019 tarihinde Türkiye’de ‘kolesterol’ ve kolesterol kelimesini içeren en popüler dokuz sözcük grubu açýsýndan taratýldý. Her aratýlan sözcük veya sözcük grubu açýsýndan 100 adet baðlantý elde edildi ve sonuçta 1000 baðlantýya ulaþýldý. Bu ulaþýlan baðlantýlar oluþturduðumuz veri tabanýnda birden fazla yer alýyorsa silindi, tekrar sýnýflandýrýldý ve sonuç olarak 604 adet baðlantý çalýþma grubunu oluþturdu. Bu amaçla literatürde herhangi bir skorlama sistemi yer almadýðý için, yazarlar kolesterol konusuna odaklanan ve genel kabul gören son zamanlarda yayýnlanmýþ rehberleri kullanarak kontrol listesi oluþturdu. Yazýlarýn içerikleri yanlýþ yönlendiren, yetersiz ama uygun, yeterli ve uygun olarak sýnýflandýrýldý.
Bulgular: Yazýlarýn kaynaklarý þu þekildeydi: Üniversiteler n=8, %1.3, hastaneler n=6, %0.9, kiþisel bloglar n=200, %33.1, saðlýk internet siteleri n=183, %30.2, gazete kaynaklý yazýlar n=207, %34.2. 235 yazý (%38.9) yeterli ve uygun olarak, 35 yazý (%5.7) yanlýþ yönlendiren olarak sýnýflandýrýldý. 378 yazýda (%62.5) týbbi hekimlere yazýnýn herhangi bir kýsmýnda yer verildiði görüldü. Üniversite veya hastaneden yayýnlanan yazýlar uygun olan grupta sýnýflandýrýldý. Yanlýþ yönlendiren ve uygun olan yazýlar arasýnda kelime sayýsý bakýmýndan istatistiksel olarak fark saptandý.
Sonuç: Google kolesterol konusunda yanlýþ yönlendirenden uygun olana kayda deðer sayýda yazýya baðlantý saðlamaktadýr. Google ile ulaþýlan sitelerdeki kolesterol ile iliþkili yazýlarda kalite düþüklüðü okunacak yazýlarýn çok ciddi özenle seçilmesi gerektiðini göstermektedir.

Objective: The Google search engine is widely used as a source of medical information; however, legal and medical governance of the accuracy of the content retrieved is lacking. The aim of this study was to assess the most read Turkish-language texts related to cholesterol during a specific period according to the validity of the content.
Methods: Google Trends was queried on January 5, 2019 for the search term “cholesterol” and the 9 other most popular search phrases used in Turkey that included the word cholesterol. In all, 100 links were obtained for each phrase, generating a total of 1000 links. Once duplicates were eliminated, a total of 604 links was used for the study. Since there is currently no validation scoring system for this purpose in the literature, the authors created a checklist according to well-accepted recent guidelines focused on cholesterol. The content of the texts acquired was classified as misleading, insufficient but favorable, or sufficient and favorable.
Results: The source of the online texts studied was universities (n=8, 1.3%), hospitals (n=6, 0.9%), personal blogs (n=200, 33.1%), health websites (n=183, 30.2%), and medical journals (n=207, 34.2%). In all, 235 texts (38.9%) were classified as sufficient and favorable and 35 (5.7%) were categorized as misleading. A medical practitioner was named in 378 texts (62.5%). All of the results from universities and hospitals were ranked in the favorable group. A statistical difference in the word count was seen in a comparison of the misleading and favorable texts.
Conclusion: Google can connect users to a significant quantity of material related to cholesterol that includes a wide range from misleading information to sufficient and favorable texts. The variation in the quality of the content on websites accessible via Google necessitates that cholesterol resource material should be selected with great care.

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Amaç: Transkateter aort kapak implantasyonu (TAVÝ), ciddi aort darlýðýnda orta-yüksek riskli veya cerrahiye uygun olmayan hastalarda, cerrahi aort kapak deðiþimine iyi bir alternatiftir. TAVÝ çoðunlukla yaþlý hastalara uygulanmaktadýr. Geleneksel risk faktörleri birçok komorbiditeyi içermesine raðmen yaþlý hastalara özgü fonksiyonel bozukluklarý içermemektedir. Nütrisyonel ve enflamatuvar durumlarýn her ikisini içeren basit ve kullanýþlý bir parametre olan prognostik nütrisyon indeksi (PNÝ), yaþlýlardaki bu fonksiyonel bozulmayý yansýtýr. Çalýþmanýn amacý, PNÝ’nin TAVÝ sonrasý kýsa dönem sað kalým üzerine etkisini araþtýrmaktýr.
Yöntemler: TAVÝ yapýlan 302 hastada PNÝ deðeri hesaplandý. Çalýþma popülasyonu PNÝ’nin kestirim deðerine göre iki gruba ayrýldý: PNÝ >43.37 (n=213; %70) ve PNÝ <43.37 (n=89; %30). TAVÝ sonrasý 30 günlük sað kalýmda PNÝ’nin prediktif deðerini deðerlendirdik.
Bulgular: Düþük PNÝ deðeri olan hastalarýn 30 günlük mortalitesi yüksek PNÝ deðeri olanlara göre daha yüksekti. (%3.3–%31.5; p<0.001). Majör vasküler komplikasyonlar ve kardiyak tamponadýn düþük PNÝ grubunda daha yüksek olduðu bulundu. 30 günlük sað kalým için PNÝ’nin kestirim deðeri olan 43.37’nin özgüllüðü %94.3, duyarlýlýðý %74.3 ve negatif prediktif deðeri %96.7 idi. PNÝ, TAVÝ sonrasý 30 günlük mortalite için baðýmsýz risk faktörü olarak tespit edildi.
Sonuç: Yüksek PNÝ deðerleri, kýsa dönemde yüksek sað kalým ve düþük TAVÝ sonrasý komplikasyonlarla iliþkili olarak bulundu.

Objective: Transcatheter aortic valve implantation (TAVI) is a good alternative to surgical aortic valve replacement (SAVR) in severe aortic stenosis patients who are at intermediate or high risk, or other cases that are considered unsuitable for SAVR. TAVI is most often performed on elderly patients, and although conventional risk scores include a number of comorbidities, they do not take into account functional decline specific to elderly patients. The prognostic nutritional index (PNI), which is a simple and effective parameter for both nutritional and inflammatory status, reflects functional decline in the elderly. The aim of this study was to determine the effect of the PNI on short-term survival after TAVI.
Methods: The PNI values of 302 patients who underwent TAVI were analyzed. The study population was divided into 2 groups according to a PNI cut-off value: PNI >43.37 (n=213; 70%) and PNI <43.37 (n=89; 30%).
Results: Patients with a lower PNI score had a significantly higher mortality rate in the initial 30-day period following the procedure than patients with a higher PNI score (3.3% vs. 31.5%; p<0.001). Major vascular complications and cardiac tamponade were significantly more frequent in the lower PNI group. The cut-off value of the PNI for 30-day survival was 43.37, with 94.3% specificity and 73.4% sensitivity and the negative predictive value of the PNI was 96.7%. The PNI score was found to be an independent risk factor for 30-day mortality after TAVI.
Conclusion: A higher PNI score was associated with short-term survival and fewer post-TAVI complications.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Obezitenin kalp yetersizliði için bir risk faktörü olduðu bilinmesine raðmen, bu konuda yapýlmýþ çalýþmalarýn çoðunda obezitenin sol kalp fonksiyonlarý üzerine etkisi incelenmiþtir. Bu çalýþmada, obezite derecesinin sað kalp fonksiyonlarý üzerine etkisini incelemeyi, farklý ekokardiyografik modalitelerin sað ventriküler disfonksiyonu belirlemedeki duyarlýlýk ve özgüllüðünü karþýlaþtýrmayý amaçladýk.
Yöntemler: Toplam 116 hasta çalýþmaya dahil edildi. Dahil edilen hastalar beden kitle indeksine (BKÝ) göre, yaþ ve cinsiyet açýsýndan eþleþtirilmiþ 4 gruba ayrýldý. Transtorasik ekokardiyografi ile sað kalp fonksiyonlarý deðerlendirildi.
Bulgular: Sað atriyum (RA) çapý; obez ve morbid obez grupta, sað ventriül (RV) çapý ise sadece morbid obez grupta anlamlý derecede daha büyüktü. Sað ventriküler isovolumetrik akselerasyon (R-IVA); fazla kilolu gruptan itibaren anlamlý derecede daha düþüktü (sýrasýyla, p=0.020;
p<0.001; p<0.001). Miyokart performans indeksi (MPÝ) ise fazla kilolu gruptan itibaren anlamlý derecede daha yüksekti (sýrasýyla, p=0.015; p<0.001; p<0.001) MPÝ ile BKÝ arasýnda güçlü pozitif korelasyon r=0.833, p<0.001), R-IVA ile BKÝ arasýnda ise orta derecede negatif korelasyon = (-0.547, p<0.001) mevcuttu. Reciever operator curve analizi BKÝ 30.50 kg/m2 kestirim deðerinin R-IVA için %76.7 duyarlýlýk ve %72.3 özgüllük ile, BKÝ 30.45 kg/m2 kestirim deðerinin ise MPÝ için %93.3 özgüllük ve %94.3 duyarlýlýkla RV sistolik disfonksiyonunu öngördürdüðünü göstermiþtir.
Sonuç: Bu çalýþmada, bilinen hastalýðý olmayan saðlýklý bireylerde obezitenin sað kalp fonksiyonlarýný anlamlý derecede etkilediði ve obezite derecesi ile sað kalp fonksiyonlarýndaki bozulma arasýnda anlamlý korelasyon olduðu gösterilmiþtir. Ayrýca BKÝ’nin RV sistolik disfonksiyonunu
öngörmede tek baþýna kullanýlabileceði gösterilmiþtir.

Objective: Although obesity is a risk factor for heart failure, studies analyzing the effect of obesity on heart functions have primarily examined the left side of the heart. This study is an analysis of the effect of the severity of obesity on right heart functions and a comparison of the sensitivity and specificity of different echocardiographic modalities in the detection of right heart dysfunction.
Methods: A total of 116 subjects were included and divided into 4 age- and sex-matched groups according to body mass index (BMI) values. Right heart functions were evaluated with transthoracic echocardiography.
Results: The right atrium (RA) diameter was significantly larger in the obese group (OBG) and the morbidly obese group (MOG); the right ventricle (RV) diameter was significantly larger only in the MOG. In the overweight group, the OBG, and the MOG, the RV isovolumic acceleration (R-IVA) was significantly lower (p=0.020; p<0.001; p<0.001, respectively) and the myocardial performance index (MPI)
value was significantly higher (p=0.015; p<0.001; p<0.001, respectively). There was a strong positive correlation between the MPI and the BMI (r=0.833, p<0.001), and a moderate negative correlation between the R-IVA and the BMI (r=-0.547, p<0.001). A cut-off value of 30.45 kg/m2 was associated with 93.3% sensitivity and 94.3% specificity in the prediction of RV systolic dysfunction defined by the MPI. A cut-off value of 30.50 kg/m2 was associated with 76.7% sensitivity and 72.3% specificity in the prediction of RV systolic dysfunction defined by the R-IVA.
Conclusion: Obesity significantly affected right heart function and there was a significant correlation between the degree of obesity and right heart functional deterioration. The BMI could be used to predict RV systolic dysfunction.

Makale Özeti | Ýngilizce Tam Metin

Amaç: Prematüre yenidoðanlarda duktus arteriyozusun kendiliðinden kapanmasý sýklýkla baþarýsýz olur ve bu durum artmýþ morbidite ve mortalite ile iliþkilendirilebilir. Açýklýðýn kapanmasýný saðlamak için ilk olarak farmakolojik tedavi uygulanmakta olup çeþitli steroid olmayan anti-enflamatuvar ilaçlar kullanýlabilir. Bu çalýþmanýn amacý, asetaminofeni ibuprofen ile birleþtirmenin patent duktus arteriyozus (PDA) tedavisinde bu ilaçlarýn tek tek kullanýmýndan daha etkili olup olmadýðýný belirlemekti.
Yöntemler: Bu randomize, kontrollü çalýþmaya, PDA’lý 154 prematüre yenidoðan alýndý. Hastalar 3 gruba randomize edildi: Asetaminofen grubu (n=67), ibuprofen grubu (n=68) ve kombinasyon ilaç grubu (n=19). Ýlaca baþlamadan önce ve birinci ve ikinci tedavi kürünü tamamladýktan sonra ekokardiyografi yapýldý. Üç tedavi yönteminin güvenliðini deðerlendirmek için kan belirteçleri ölçüldü.
Bulgular: Ýlk tedavi küründen sonra asetaminofen grubundaki bebeklerin %76.1’inde, ibuprofen grubundakilerin %76.4’ünde ve kombinasyon tedavi grubunun %78.9’unda PDA’nýn kapandýðý görüldü (p=0.97). Ýkinci bir tedavi küründen sonra kapanma oraný asetaminofen grubunda %43.7, ibuprofen grubunda %62.5 ve kombinasyon grubunda %100 idi. Kullanýlan üç tedavi yöntemine iliþkin herhangi bir komplikasyon yoktu.
Sonuç: Asetaminofen ve ibuprofenin birlikte kullanýmý PDA’nýn kapatýlmasýnda etkili bir seçenek olabilir. Bu sonuçlarý doðrulamak için daha büyük örneklem büyüklüðüne sahip baþka çalýþmalarýn yürütülmesi tavsiye edilir.

Objective: Spontaneous closure of the ductus arteriosus often fails to occur in premature newborns and this condition can be associated with increased morbidity and mortality. The initial treatment to achieve closure of the opening is pharmacological, and various nonsteroidal anti-inflammatory drugs may be used. The aim of this study was to determine whether combining acetaminophen with ibuprofen is more effective than the individual use of these drugs to treat patent ductus arteriosus (PDA).
Methods: The present randomized, controlled trial study included 154 premature newborns with PDA. The patients were randomized into 3 groups: the acetaminophen group (n=67), ibuprofen group (n=68), and combination drug group (n=19). Echocardiography was performed before initiating the medication and after completing a first and second course of treatment. Blood markers were measured to assess the safety of the 3 types of therapy.
Results: After the first course of treatment, PDA closure was seen in 76.1% of the infants in the acetaminophen group, 76.4% of those in the ibuprofen group, and 78.9% of the combination therapy group (p=0.97). The closure rate after a second course of treatment was 43.7% in the acetaminophen group, 62.5% in the ibuprofen group, and 100% in the combination group. There were no complications attributed to the 3 methods of treatment used.
Conclusion: Concomitant use of acetaminophen and ibuprofen can be an effective option for closure of PDA. Other studies with a larger sample size are recommended in order to confirm these results.

Makale Özeti | Ýngilizce Tam Metin

Karotis arter stentlemesi, karotis arter stenozunun tedavisinde son 30 yýldýr yaygýn olarak kullanýlan giriþimsel bir tedavi yöntemidir. Güncel literatürde, majör kardiyovasküler komplikasyonlarýn tersine karotis psödoanevrizmasýna (PA) daha az vurgu yapýlmýþtýr. Karotis arter PA’sý, travma, spontan enfeksiyon, vaskülit veya iyatrojenik nedenlerden kaynaklanabilir. Ancak, karotis stentlemeye ikincil PA oluþumu insidansý oldukça nadirdir. Daha nadir olarak tamamen semptomsuz olabilse de genellikle semptomlu (boyun þiþmesi, sinir sýkýþmasý, solunum sýkýntýsý, ses kýsýklýðý, disfaji ve iskemik serebrovasküler olaylar) seyreder. Doppler ultrasonografi, kontrastlý bilgisayarlý tomografi ve konvansiyonel anjiyografi temel taný aracýdýr. Tedavide cerrahi seçenek olarak primer kapatma, greft interpozisyonu dahil tarif edilmiþtir. Endovasküler yaklaþým ile kapalý/çýplak metal stentin yerleþtirilmesi cerrahiye alternatif bir tedavi yöntemidir.

Carotid artery stenting has been a widely used interventional treatment method for the last 3 decades in the treatment of carotid artery stenosis. In the current literature, unlike major cardiovascular complications, less emphasis has been placed on carotid pseudoaneurysm (PA). A carotid artery PA can be caused by trauma, spontaneous infection, vasculitis, or it may be iatrogenic. However, the incidence of PA secondary to carotid stenting is extremely rare. Although it may be completely asymptomatic in rare instances, it usually progresses symptomatically (neck swelling, nerve compression, respiratory distress, hoarseness, dysphagia, and ischemic cerebrovascular events). Doppler ultrasound, contrast-enhanced computed tomography, and conventional angiography are the main diagnostic tools. Primary closure, including graft interposition, has been described as a surgical therapeutic option. An endovascular approach with placement of a covered or bare metal stent is an alternative treatment method to surgery.

Makale Özeti | Ýngilizce Tam Metin

Ýdiyopatik pulmoner fibroz (ÝPF) ilerleyici bir parankimal hastalýktýr. Pulmoner hipertansiyon (PH), ÝPF seyrinde ortaya çýkabilen potansiyel olarak ölümcül bir komplikasyondur. ÝPF-PH olgularýnýn saðlýk durumu genellikle tedrici olarak kötüleþirken bazen hastalarýn saðlýk durumu hipoksi nedeniyle aniden bozulabilir. Bu olgu raporu, 73 yaþýnda bir erkekte 2 hipoksik atak epizodunda gözlenen farklý ekokardiyografik deðiþiklikleri göstermektedir. Baþvuru anýnda, triküspit yetersizliði pik gradyaný (TRPG) 21 mmHg ve oksijen satürasyon oraný %94 (O2: 4 L / dak) idi. Hastaneye kabulden beþ gün sonra, TRPG ve oksijen satürasyonu kötüleþti [TRPG: 85 mmHg, oksijen satürasyonu: %72 (O2; 4 L / dak)]. Hipoksik pulmoner vazokonstriksiyon nedeniyle hastaya ÝPF-PH tanýsý konuldu. Oksijen tedavisi ve metilprednizolon puls tedavisi (MPT) uygulandý. MPT tedavisinden beþ gün sonra, hipoksi ve PH iyileþti [TRPG: 21 mmHg, oksijen satürasyonu: %95 (O2: 4 L / dak)]. MPT’den 20 gün sonra oluþan ÝPF’nin akut eksaserbasyonu (ÝPF-AE) nedeniyle ikinci bir MPT dozu uygulandý. TRPG ve oksijen satürasyonu düþmedi [TRPG: 27 mmHg, oksijen satürasyonu: %94 (O2: 4 L / dak)]. Hasta ikinci MPT dozundan 10 gün sonra hayatýný kaybetti. ÝPF-PH varlýðýnda ÝPF-AE’nin bozulmasýyla sýradýþý ekokardiyografik bulgular gözlendi.

Idiopathic pulmonary fibrosis (IPF) is a progressive parenchymal disease. Pulmonary hypertension (PH) is a potentially lethal complication in the course of IPF. In almost all cases of IPF-PH there is gradual deterioration, but patients can also decline suddenly due to hypoxia. This case report describes the different echocardiographic changes observed in 2 episodes of hypoxic attack in a 73-year-old man. On admission, the tricuspid regurgitation peak gradient (TRPG) was 21 mmHg and the oxygen saturation rate was 94% (O2: 4 L/min). Five days after admission, the TRPG and oxygen saturation rate deteriorated [TRPG: 85 mmHg, oxygen saturation: 72% (O2; 4 L/min)]. He was diagnosed with IPF-PH due to hypoxic pulmonary vasoconstriction. Oxygen therapy and methylprednisolone pulse therapy (MPT) were administered. Five days after the MPT treatment, the hypoxia and PH improved [TRPG: 21 mmHg, oxygen saturation: 95% (O2: 4 L/min)]. Acute exacerbation of IPF (IPF-AE) occurred 20 days after the MPT, and a second dose of MPT was administered. The TRPG and oxygen saturation rate did not decline [TRPG: 27 mmHg, oxygen saturation: 94% (O2: 4 L/min)]. The patient died 10 days after the second dose of MPT. Divergent echocardiographic findings were observed during the deterioration of IPF-AE in the presence of IPF-PH.

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Obezite, yaygýn bir saðlýk sorunudur ve dünyada giderek artmaktadýr. Geleneksel olmayan tedavilerin, özellikle bitkisel tedavi yöntemlerinin uygunsuz ve kontrolsüz kullanýmý, kolay bulunabilirlik nedeniyle artmýþtýr. Bizim vakamýzda, 41 yaþýnda erkek hastada evde çarpýntý, bilinç bulanýklýðý ve ardýndan bayýlma geliþti. Bilinç kaybýnýn ardýndan kalp durmasý meydana geldi. Acil týbbi ekip çaðrýldý ve acil týbbi ekip gelene kadar eþi tarafýndan hastaya kalp masajý yapýldý. Kardiyak arrestten beþ dakika sonra monitörde ventriküler fibrilasyon saptandý ve hasta defibrile edildi. Fizik muayenede hipotansiyon ve taþikardi saptandý. Elektrokardiyografide hýzlý idiyoventriküler ritim, yakalama ve füzyon vurularýyla birlikte DII, DIII, aVF derivasyonlarýnda belirgin J dalgasý izlendi. Beyin manyetik rezonans görüntüleme, torasik tomografide kliniði açýklayacak bir patoloji saptanmadý ve koroner anjiyografi normal koroner arterler olarak raporlandý. Laboratuvar parametreleri K=2.23 mEq/L, kan gazýnda iyonize K=2.43 mEq/L, Na=142 mEq/L, Ca=9.3 mg/dL, kreatinin=1.6 mg/dL, pH=7.29, cTnI=0.12 (0–0.11 ng/mL) ve kütle CK-MB=8.3 (0–3.23 ng/mL) olarak tespit edildi. Sývý ve elektrolit replasman tedavisinden sonra elektrokardiyografide sýrasýyla atriyal fibrilasyon ile birlikte dar QRS ve sonra düzeltilmiþ QT deðeri 490 msn ile birlikte normal sinüs ritmi görüldü. Hasta takipte ekstübe edildi. Koroner arter hastalýðý için bir risk faktörü, ilaç ya da madde kullanýmý öyküsü ve duygusal veya fiziksel strese maruziyet yoktu. Kilo vermek için beþ gündür yoðun bir þekilde “Teff” çayý aldýðýný belirtti. Hasta komplikasyonsuz taburcu edildi ve dokuz aydýr asemptomatik takip edilmektedir. Kilo kaybý için uygun olmayan alternatiflerin kullanýmý, özellikle Teff çayý gibi bitkisel tedaviler ve iliþkili yan etkiler, geniþ kullanýlabilirlik ve kolay eriþim nedeniyle artmaktadýr. Toplum bu konuda uyarýlmalýdýr.

Obesity is a common health problem and the prevalence is increasing worldwide. The improper and unregulated use of unconventional therapies, especially herbal treatment methods, has grown due to widespread availability. In our case, a 41-year-old male patient developed palpitation, confusion, loss of consciousness, and cardiac arrest while at home. An emergency medical team was called and chest compressions were performed by his wife until the medical team arrived. Ventricular fibrillation was detected on the monitor 5 minutes after the cardiac arrest occurred and the patient was defibrillated. A physical evaluation revealed hypotension and tachycardia. Electrocardiography (ECG) showed a fast idioventricular rhythm with capture and fusion beats and evident J waves in leads DII, DIII, and aVF. Brain magnetic resonance imaging and thoracic tomography revealed no pathology to explain his clinical condition and the coronary angiography results were not significant. The laboratory parameters included potassium (K): 2.23 mEq/L, ionized K (arterial blood): 2.43 mEq/L, sodium: 142 mEq/L, calcium: 9.3 mg/dL, creatinine: 1.6 mg/dL, pH: 7.29, cardiac troponin I: 0.12 (normal range: 0–0.11 ng/mL) and creatinine kinase mass: 8.3 (normal range: 0–3.23 ng/mL). After fluids and electrolyte replacement therapy were administered, the ECG results revealed narrow QRS complex atrial fibrillation followed by a normal sinus rhythm with a 490 ms corrected QT interval. The patient was extubated in follow-up. There were no risk factors for coronary artery disease, no history of drug or other substance use, and no exposure to excessive emotional or physical stress. The patient said that he had been consuming a large quantity of teff tea for 5 days to lose weight. He was discharged without any complications and has been asymptomatic in 9 months of follow-up. The inappropriate use of weight loss alternatives, especially herbal therapies such as teff tea, and the incidence of associated side effects are increasing due to wide availability and easy access. The general population should be warned about this issue.

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