A 23-year-old man was hospitalized with the complaint of exertion dyspnea. Physical examination revealed a third degree diastolic murmur best heard at the left parasternal area. Electrocardiogram showed normal sinus rhythm. Transthoracic echocardiography revealed aneurysmatic dilatation of the left main coronary artery (CA) in addition to the large coronary cameral fistula between the left CA and left ventricle. The fistula travels in the interventricular septum and drains into the left ventricular cavity (Fig.1a, b, Video 1, 2) Coronary angiography and coronary computed tomography confirmed the huge fistula between the left CA and left ventricle (Fig. 1c–f, Video 3–5). The maximum diameter of fistula was 18 mm. CA fistulas are reported in 0.1%–0.2% of all patients undergoing selective coronary angiography. The major sites of origin of fistulas are right coronary artery (55%), left coronary artery (35%), and both (10%). The major sites of terminations are right ventricle (40%), right atrium (26%), and pulmonary artery (17%), and the relatively less frequent sires are SVC and CS, with the least frequency in the left atrium and left ventricle (2%). Herein, we have reported a huge coronary cameral fistula that connects the left main CA to the left ventricle.

Methylphenidate is a drug with central nervous stimulating action and with similar effects as amphetamines. A 14-year-old child was diagnosed with attention-deficit hyperactivity disorder (ADHD) 3 months before admission. He was started on methylphenidate (Concerta ) 18 mg daily for a month. Six days before admission, methylphenidate dose was increased to 36 mg by the pediatric psychiatrist. Patient was admitted to our hospital suffering from sweating, palpitation, dyspnea and chest pain. There was no murmur on auscultation. ECG demonstrated tachycardia and bigeminal ventricular premature complexes. His temperature was 37.6 C , white blood cell and hemoglobin were in normal range, creatinine kinase, creatine kinase MB fraction levels were elevated, troponin I was 6.29 IU(upper limit of normal: 0.1), cRP was 24.2 mg/l with a sedimentation of 14 mm/h. Screening for infectious pathogens, immunological markers were all negative. Thyroid function tests were normal. Echocardiography showed a left ventricular ejection fraction (EF) of 50% without segmental wall motion abnormality. Methylphenidate was discontinued following hospitalization. Coronary angiography showed normal coronary arteries. Eight days after hospitalization, creatinine kinase and troponin I levels decreased to normal levels. Recovery was achieved completely. On follow up, transthoracic echocardiography was repeated and EF was noted to be 60%. The investigation yielded tentative diagnosis of temporary drug-induced myocarditis. Previously, Tollofsrud et al presented a case describing treated with methyphenidate 17 year old boy, who died from dilated cardiomyopathy (Tollofsrud C et al 2006). An adolescent with a normal baseline echocardiogram, who was administered up to 36 mg of methylphenidate for 3 months, was also reported in the literatüre to suffer from cardiac arrest with pulseless electrical activity, associated with methylphenidate (Daly MW et al). Cardiac adverse effects of methylphenidate have been shown to affect myocardial ultra-structure in rats (Henderson TA et al). Increase in adrenergic action that is believed to be cardiotoxic over time, is considered to cause cardiomyopathy. Clinicians should be aware that despite performing an exhaustive cardiac examination before methylphenidate treatment for ADHD, patients may still be under threat for a serious cardiac event. The risks and benefits of using methylphenidate and the other central nervous stimulators must be acknowledged by clinicians and shared with patients and parents.

The etiology of Behçet’s disease (BD) has not been fully elucidated. However, immunological and environmental factors, endothelial dysfunction (ED), and genetic susceptibility have been proposed to play a role. In this study, we aimed to evaluate epicardial fat thickness (EFT) together with serum asymmetric dimethylarginine (ADMA), carotid intima media thickness (CIMT), and neutrophil-to-lymphocyte ratio (NLR) in BD patients with ocular involvement. Thirty-six ocular BD patients (17 active and 19 inactive ocular involvement), and 35 age and sex-matched healthy controls were enrolled to this cross-sectional study. All patients underwent examinations with transthoracic echocardiography and carotid Doppler ultrasound. Serum ADMA levels, CIMT, EFT, and NLR were compared between groups, and their association with disease activity was evaluated. Behçet’s disease patients had higher WBC counts, neutrophil counts, NLR, CIMT, EFT values, and serum ADMA levels than do healthy controls. The other biochemical, hematological, and echocardiographic parameters were comparable between the two groups. Behçet’s disease duration was positively correlated with EFT and CIMT. Multivariate logistic regression analysis revealed that increased serum ADMA concentration and CIMT are independently associated with BD. Neutrophil counts, NLR, and serum ADMA level were higher, and lymphocyte count was lower in patients with active ocular BD compared to those of inactive ocular BD group. Carotid intima media thickness, serum ADMA level, EFT, and NLR were increased in ocular BD patients compared to healthy subjects. In addition, both serum ADMA level and NLR were associated with disease activity of ocular involvement. Increase in disease duration was associated with increase in CIMT and EFT which suggests that anatomical changes occur in time during the disease course. Increased CIMT, serum ADMA level, EFT, and NLR may provide new clues about the role of ED and inflammation in the etiopathogenesis of BD.

Paraoxonase-1, a high-density lipoprotein linked enzyme complex, was shown to be decreased in several cardiovascular diseases. We aimed to explore whether serum paraoxonase and arylesterase activities differ in dipper and non-dipper prehypertensive subjects compared to healthy controls.Sixty prehypertensive subjects and 30 controls were enrolled. All subjects underwent echocardiographic assessment and 24-hour ambulatory blood pressure monitoring (ABPM). According to the blood pressure (BP) course on ABPM, prehypertensive subjects were categorized into two: non-dipper prehypertensive (NDPH) and dipper prehypertensive (DPH) groups. Serum paraoxonase and arylesterase activities were detected spectrophotometrically.Paraoxonase and arylesterase activities were significantly lower in patients with NDPH compared to both DPH and control groups. Both paraoxonase and arylesterase activities showed significant negative correlations with BP and left ventricular mass index.We have demonstrated that NDPH subjects have lower paraoxonase and arylesterase activities compared to DPH subjects and normotensives. Further prospective studies are needed to clarify the role of paraoxonase and arylesterase activities in the development of overt hypertension in prehypertensive subjects.

51 years old male patient with palpitations, who had ischemic T changes and nonsustained ventricular tachycardia attacks in the electrocardiography was admitted at another hospital. There was no any cardiac symptom before addmission in medical history. In echocardiography , Ejection Fraction: 35%, left ventricular global hypokinesia and apical hypertrophy were detected. Coronary angiography was revealed normal coronary arteries. The patient was referred to our clinic for further treatment. We took cardiac magnetic resonance image for etiology of cardiomyopathy. According to MRI results, we determined very wide scar areas in the left ventricle. We implanted ICD to the patient and discharged him without any complication.

Objective: Cardiac involvement in systemic sclerosis can be seen, and often remains silent. Leptin, which is often associated with hypertension and regulation of sympathetic tone, has been reported to contribute to the development of atherosclerosis, endothelial dysfunction and thrombosis by acting directly. The aim of this study was to investigate the effects of leptin on the cardiovascular system in patients with systemic sclerosis.Materials and Methods: Twenty-seven patients with systemic sclerosis and 28 healthy subjects as a control group were included in the study. Clinical and laboratory parameters, 24-hour Holter ECG and ambulatory blood pressure monitorings were recorded and serum leptin levels were measured in all subjects.Results: Mean leptin levels were lower in patients with systemic sclerosis than in controls. In 24-hour ambulatory blood pressure Holter recordings, the mean systolic and diastolic blood pressure, daytime systolic and diastolic blood pressure, systolic and diastolic blood pressure values at night were lower in patients when compared with controls. There was no relationship between leptin and heart rate variability parameters. A positive correlation was found between leptin levels and 24-hour ambulatory blood pressure parameters.Conclusion: Decreased serum leptin levels and increased mean heart rate in patients with systemic sclerosis may be the result of increased sympathetic tone.

Coronary collateral vessels, provide link between coronary arteries, decreased both mortality and morbidity in patients with myocardial infarction. Palmar collateral circulation locates between ulnar and radial arteries, and its adequacy can be evaluated by noninvasive tests. We aimed in this study to investigate relationship between coronary collateral circulation and palmar collateral circulation. 96 patient, detected in coronary arteries at least 70% stenosis, were included the study. Coronary collateral circulation was evaluated according to rentrop classification as adequate and inadequate collateral circulation. Hand circulations of the patients were evaluated with Allen Test and Modified Allen Test. Incomplete palmar arch were detected in patients with adequate and inadequate coronary collateral circulation 22% and 29%, respectively. There was no significant different between two groups according to presence of incomplete or complete palmar circulation.In our study, we demonstrated that there was no relationship between coronary collateral circulation and palmar collateral circulation.

Although many causes of hydonephrosis due to ureteric obstruction well-known, graft occlusion or fibrosis are generally found in the end of the cause list. Graft occluded hydronephrosis is firstly described in the 1960s, but it has been reported rarely in recent years. In this paper, we presented a 62 year old man who had applied to a cardiology department with the complaint of intermittant claudicatio. The patients had undergone aortofemoral by-pass surgery five years ago, and hydroureteronephrosis was incidentally found in control Computed tomography angiography.

Figure 1. ECG records that show both the absence of hypertrophy and presence of ischemic T changes. 51 years old male patient with palpitations, who had ischemic T changes (Figure 1) and nonsustained ventricular tachycardia attacks in the electrocardiography was admitted at another hospital. There was no any cardiac symptom before addmission in medical history. In echocardiography , Ejection Fraction: 35%, left ventricular global hypokinesia and apical hypertrophy were detected. Coronary angiography was revealed normal coronary arteries. The patient was referred to our clinic for further treatment. We took cardiac magnetic resonance image for etiology of cardiomyopathy. According to MRI results, we determined very wide scar areas in the left ventricle (Figure 2). We implanted ICD to the patient and discharged him without any complication (1).

Giriş: Ankilozan spondilit kronik infl amatuvar bir hastalık olup, kardiyovasküler komplikasyonlarla ilişkili olabilmektedir. Bu çalışmada amacımız, kardiyak tutulum olmayan ankilozan spondilit hastalarında aortun elastik özellikleri ile serum asimetrik dimetilarjinin (ADMA) düzeylerinin araştırılmasıdır. Hastalar ve Yöntem: Elli beş ankilozan spondilit hastasıyla benzer yaş ve cinsiyette 30 sağlıklı birey çalışmaya alındı. Açlık glukoz, serum lipidleri, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ve ADMA düzeyleri çalışıldı. Aortik strain, distensibilite ve sertlik indeksi transtorasik ekokardiyografi de aort çapı ölçümleri ve eş zamanlı kan basıncı ölçümleriyle hesaplandı. Bulgular: Ankilozan spondilit grubunda ESH ve CRP düzeyleri yüksekti. Serum ADMA düzeyleri ankilozan spondilit grubunda kontrol grubuna göre anlamlı olarak yüksekti (0.76 ± 0.19 ve 0.55 ± 0.12, p< 0.001). Alt grup analizinde, anti-TNF-alfa tedavisi alan grupta konvansiyonel tedavi grubuna göre daha düşük ADMA düzeyi ölçüldü (0.68 ± 0.15 ve 0.87 ± 0.18, p< 0.001). Ortalama aortik strain ve distensibilite değerleri ankilozan spondilit grubunda daha düşük iken, sertlik indeksi daha yüksek saptandı. Korelasyon analizinde ADMA düzeyleri ile aortun elastik özellikleri arasında ilişki izlenmezken, ankilozan spondilit grubunda hastalık süresi ile aortik strain ve distensibilite arasında ters yönde anlamlı korelasyon izlendi. Sonuç: Çalışmamızda elde ettiğimiz sonuçlar kardiyak tutulumun olmadığı ankilozan spondilit hastalarında aortik elastisitenin bozulduğunu ve ADMA düzeylerinin arttığını göstermektedir. Ayrıca, aortun elastik özellikleri ile ADMA düzeyleri arasında anlamlı ilişki saptanamamıştır.

It is known that a number of drugs caused acquired long QT syndrome. Although the often use of famotidine, acquired long QT syndrome associated with this drug has rarely been reported. We presented a case of famotidine associated with acquired long QT syndrome.

Ingestion of acid-containing household products, either accidentally or as a suicide attempt, is a common form of intoxication. A clear and odorless liquid, hydrogen peroxide is an oxidizing agent found in most households and many industrial environments. Cardiovascular manifestations of hydrogen peroxide ingestion are extremely rare. Here we report a 60 year-old woman with acute inferolateral myocardial infarction (MI) after hydrogen peroxide ingestion, who had no history of coronary artery disease. Physicians dealing with hydrogen peroxide ingestion in the emergency department should be aware of the probability of MI and obtain an electrocardiogram, even if the patient has no cardiac complaint.

Aim: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). Material and methods: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. Results: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). Conclusion: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.

Warfarin is an effective anticoagulant which is used for the prevention of arterial and venous thrombosis. Currently, this type of oral anticoagulant drugs are often used with various indications and rarely leads life-threatening bleeding. Although bleeding into the gastrocnemius muscle, is usually associated with trauma, it may very rarely result from warfarin overdose. In this article, we report a-41-year-old female case with hematoma in the gastrocnemius muscle due to low doses (i.e. 1.25 mg) of warfarin every other. day.

BACKGROUND:The aim of this study is to investigate the frequency of metabolic syndrome (MS) in patients with rheumatoid arthritis (RA) and to determine the relationship between the clinical and laboratory parameters of RA and the components of the metabolic syndrome (MS).METHODS:Fifty-four patients with RA and 52 healthy individuals were enrolled in this study. The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology criteria and the diagnosis of the metabolic syndrome was made according to the criteria set out in the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). The functional status and disease activity were also recorded in patients with RA.RESULTS:MS was diagnosed in 42.6% of the patients with RA and in 9.6% of the healthy controls. The systolic and diastolic blood pressure values were observed to be significantly higher in the patients with RA in comparison to the controls. Also, the frequency of MS was higher in the inferior functional group in relation to the higher functional group. A positive correlation was observed between the DAS28 scores and hypertension in patients with RA.CONCLUSIONS:In this study, MS was more frequently detected in the patients with RA compared to the control group. Also, an inferior functional status in RA was also found to be associated with the presence of MS. Thus, the presence of MS in patients with RA may be associated with a higher cardiovascular risk.