Legionnaires' disease (LD) is a systemic infectious disease caused by Legionella species.It mainly presents with lung involvement.Herein, we present a case with suspected myocarditis associated with LD and review of the relevant literature.An 81-year-old male tourist patient with high fever, cough, imbalance while walking, and confusion presented to the emergency department.The patient was diagnosed with LD based on increased density in the left lower zone on chest x-ray and a positive Legionella urine antigen test.He was administered a combination of claritromycin and levofloxacine on the day of admission.The diagnosis of acute myocarditis was made after worsening of the cardiac functions, ST elevation and troponin I positivity.The patient's symptoms regressed with antibiotic therapy and the patient was transferred to his home country by ambulance plane ten days after admission.A search of PubMed and Web of Science using the keywords "Legionella and myocarditis" revealed 15 case reports, nine of which were in English and were reviewed.There were three female and six male patients with a mean age of 44 years (range: 32-56 years).Seven were diagnosed with LD by urine antigen testing, one by serological testing and culture, and one by direct fluorescent-antibody staining and culture.Myocarditis was diagnosed by biopsy in two patients and by clinical and laboratory findings in the rest.Myocarditis without existing pneumonia was detected in one case.Electrocardiography abnormalities such as atrial flutter, atrioventricular block, torsade de pointes, sinus tachycardia, QT prolongation, ST elevation, and T wave inversion were detected in seven patients.Ventricle dysfunction on echocardiography and cardiac marker abnormality were detected in all but one of the patients (not tested in one patient).Antimicrobial monotherapy was chosen for three of the cases.One patient died due to myocarditis.In conclusion, myocarditis may develop rarely during the course of LD.Clinical suspicion is essential for the diagnosis.Early diagnosis and appropriate treatment may be life-saving.

AIMS:Cardiac autonomic dysfunction (CAD) is associated with both prediabetes and metabolic syndrome (MS). Heart rate variability (HRV) and heart rate turbulence (HRT) are reliable 24-h Holter-ECG findings of cardiac autonomic function. This study aimed to investigate the relation between MS and its components and CAD using HRV and HRT. MATERIALS AND METHODS:The study included 80 non-diabetic patients with MS and 70 control subjects. All study population and the patients with MS were further analyzed for each diagnostic component of MS to investigate which criteria impaired HRV and HRT. RESULTS:HRV and HRT parameters were disturbed in patients in the MS group. While impairment in HRV and HRT was significantly related to the presence of the fasting plasma glucose (FPG) criterion, there were no differences between groups in terms of the other 4 MS criteria. Moreover, FPG level was significantly correlated with SDNN (r=-0.352, p<0.001), SDNN index (r=-0.423, p<0.001), SDANN (r=-0.301, p<0.001), RMSSD (r=-0.237, p<0.001), pNN50 (r=-0.237, p<0.001), turbulence onset (TO) (r=0.365, p<0.001) and turbulence slope (TS) (r=-0.365, p<0.001). Among the MS diagnostic criteria, only FPG level was an independent determinant of all HRV and HRT parameters. CONCLUSIONS:This study confirms the relation between MS and CAD. Increased FPG alone appears to be responsible for the mentioned findings among the 5 diagnostic criteria. Accordingly, CAD may be the result of prediabetes, not MS in patients with MS.

BackgroundEpicardial adipose tissue (EAT) is a local source of various hormones, cytokines, and vasoactive substances affecting the myocardium. EAT contains abundant ganglionic plexi that interact with the autonomic nervous system. Evidence of the association between EAT and arrhythmia is limited, with the exception of atrial fibrillation. This study aimed to investigate the relation between EAT and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) parameters.MethodsAll subjects underwent a 24-hour Holter recording to assess HRV and HRT parameters and a transthoracic echocardiography to measure EAT thickness. Patients were divided into two groups according to the median EAT thickness (3.9 mm). The higher EAT group consisted of 111 patients with a >3.9-mm thickness and the lower EAT group 113 patients with a 3.9-mm EAT thickness.ResultsHRV and HRT parameters were significantly influenced in the higher EAT group. Moreover, we observed significant correlations between EAT thickness and Holter findings (standard deviation of all NN intervals [SDNN]: r = -0.462, P < 0.001; SDNN index: r = -0.349, P < 0.001; standard deviation of the average NN intervals: r = -0.465, P < 0.001; root mean square of successive differences: r = -0.251, P < 0.001; pNN50: r = -0.354, P < 0.001; turbulence onset: r = 0.172, P = 0.010; turbulence slope: r = -0.279, P < 0.001, HRT category: r = 0.169, P = 0.011). In multivariate regression analysis, EAT thickness was independently associated with all measures of HRV and HRT, with the exception of turbulence onset.ConclusionsSympathovagal imbalance, detected by HRV and HRT parameters, is related to EAT thickness. As sympathovagal imbalance is a predictor of arrhythmic events, EAT may play an important arrhythmogenic role not limited to atrial fibrillation.

Ivabradine is a specific and dose dependent inhibitor of If and shows antiischemic effect only by reducing heart rate. It is used in the symptomatic treatment of chronic stable angina pectoris in patients who has normal sinus rhythm and contraindication or intolerance for beta blockers. We report a case in which we used ivabradine for rate control in a patient who has pacemaker.

Objectives: We retrospectively investigated the prevalence of coronary artery disease (CAD), distribution of lesions, and associated risk factors in patients who underwent coronary angiography during treatment of chronic renal failure (CRF).Study design: A total of 112 chronic hemodialysis patients (33 women, 79 men; mean age 55.7 years) were examined by coronary angiography for angina or angina-like symptoms, ischemic findings, or for further evaluation before renal transplantation. Angiographically, significant CAD was defined as the detection of narrowing (50% or more) in at least one coronary artery.Results: Coronary artery disease was detected in 80 patients (71.4%). Patients with CAD exhibited significant differences with regard to age (p=0.002), male gender and the presence of angina (p=0.03), triglyceride level (p=0.02), and diabetes mellitus (p=0.04). Isolated stenosis of the left main coronary artery was detected in one patient (1.3%); 17 (21.3%), 20 (25%), and 42 patients (52.5%) had one-, two-, and three-vessel disease, respectively. The left main coronary artery was involved in four patients (5%), the left anterior descending artery in 70 (87.5%), the circumflex artery in 56 (70%), and the right coronary artery in 57 (71.3%) patients. Though not significant, systolic and diastolic dysfunction of the left ventricle was more common in CAD patients, whereas two groups had a similar left ventricular ejection fraction (p>0.05). Multivariate logistic regression analysis showed that age (p=0.01) and male gender (p=0.02) were independent predictors for CAD. Treatment consisted of monitoring in 21 (26.3%), percutaneous coronary intervention in 15 (18.8%), and coronary artery bypass surgery in 44 (55%) patients.Conclusion: The occurrence of CAD is frequent in patients with CRF, with the lesions showing diffuse involvement. Treatment should not be delayed especially in the presence of risk factors.