Thrombolytic therapy (TT) using low-dose, slow, and ultra-slow infusions of tissue-type plasminogen activator (tPA) has become an established first-line treatment for prosthetic valve thrombosis (PVT). However, PVT with stuck valves represents a distinct clinical entity requiring tailored management. This study aimed to evaluate the effectiveness and safety of sequentially combining different TT regimens in patients with PVT and stuck valves. We enrolled 52 patients with PVT and stuck valves [female: 34 (65.4%), mean age: 47.5 ± 12.4 years] who underwent TT with sequential administration of slow (25 mg/6 h) and ultra-slow (25 mg/25 h) low-dose tPA regimens, based primarily on New York Heart Association (NYHA) functional class. All patients were assessed with cinefluoroscopy, transthoracic echocardiography, and transesophageal echocardiography. TT was successful in 46 patients (88.4%), with a median cumulative tPA dose of 120 mg (96-175). Major complications occurred in 3 patients (5.7%), including 1 cerebrovascular accident, 1 intracranial hemorrhage, and 1 gastrointestinal bleed requiring transfusion, while 6 patients (11.5%) experienced minor complications. One in-hospital death occurred (1.9%). Increased thrombus area was the only independent predictor of both failed TT and adverse events. A moderate positive correlation was observed between thrombus area and total tPA dose (r = 0.479; p < 0.001). In conclusion sequential use of slow and ultra-slow low-dose tPA infusion appears to be a safe and effective strategy for managing PVT with stuck valves. Nevertheless, patients with larger thrombus burden remain at increased risk for treatment failure and complications.

Background: Amiodarone, widely used in arrhythmia management, often causes phlebitis when administered via peripheral infusion. This study evaluated the effects of Nigella sativa oil and sesame oil in preventing amiodaroneinduced phlebitis. Material and method: The study was a randomized controlled trial with three parallel groups. This study included 108 patients who received amiodarone infusion in the coronary intensive care unit between November 2023 and August 2024. This three-arm, block-randomized controlled trial was conducted in line with CONSORT guidelines. Patients were randomly assigned to one of three groups: sesame oil (n = 36), Nigella sativa oil (n = 36), or control (n = 36). In the intervention groups, five drops of the respective oil were applied topically to a 10-cm area around the catheter site. The application was performed once before the infusion and then every 6 hours thereafter. The control group received no intervention. Patients were monitored hourly during the 26-hour infusion and every six hours for 48 hours after the infusion, for a total monitoring period of 74 hours. Phlebitis was assessed using the Visual Infusion Phlebitis Scale. This study was prospectively registered on ClinicalTrials.gov (NCT06030141) on November 15, 2023. Results: Phlebitis was observed in 25% of patients in the sesame oil group, 33.3% in the Nigella sativa oil group, and 80.6% in the control group. A significant difference in phlebitis severity was observed between the groups (p < 0.001), with the highest severity in the control group, the lowest in the sesame oil group, and moderate levels in the Nigella sativa oil group. Conclusion: This study demonstrated that sesame and Nigella Sativa oils were effective in both preventing and reducing the severity of amiodarone-induced phlebitis. The use of sesame oil and Nigella sativa oil in peripheral intravenous catheter care may help reduce amiodarone-induced phlebitis, maintain vascular access integrity, and improve patient comfort. As natural, safe, and cost-effective agents, these oils can be readily incorporated into clinical nursing practice to enhance patient safety and quality of care.

BACKGROUND:The supine position given to patients after femoral angiography causes pain. Pain causes changes in vital signs, impaired comfort, and vascular complications. AIMS:To investigate the effect of position change on pain, vital signs, comfort, and vascular complications after femoral angiography was the aim of this study. METHODS:This is a double-blind randomized controlled trial. The study included 60 volunteer patients undergoing femoral angiography. Data were collected using the Patient Information Form, the Visual Analog Scale, the Immobilization Comfort Scale, and a Vascular Complications Form. Experimental group patients were given supine position with 15° head angle, semi-fowler position with 30° head angle, and right or left lateral position with 15° head angle every 2 h after sheath removal. Control group patients were given supine position for 6 h as a routine practice of the clinic. RESULTS:Following the position change, the mean visual analog scale pain score and systolic and diastolic blood pressure scores decreased significantly in the experimental group, and the Immobilization Comfort Scale score increased. In the control group, the mean visual analog scale pain score increased significantly, and the Immobilization Comfort Scale score decreased. No significant difference was found between the experimental and control groups in terms of bleeding/leakage and ecchymosis/hematoma. CONCLUSIONS:This study revealed that position changes after femoral angiography had positive effects on pain, vital signs, and comfort. However, no significant difference was observed in vascular complications. Future studies should evaluate different position change protocols and their long-term effects on larger groups.

Background Pain and anxiety are common issues experienced by patients after coronary angiography, often negatively impacting recovery and causing changes in vital signs. Objective This study aimed to compare the effects of reflexology and classical hand massage on pain, anxiety, and vital signs in patients after coronary angiography. Methods It was designed as a single-blind randomized controlled trial with 70 patients who underwent coronary angiography in a hospital. Patients were randomly assigned into two groups via block randomization: reflexology hand massage (n = 35) and classical hand massage (n = 35). Data were collected using the Patient Information Form, State Anxiety Inventory, Visual Analog Scale, and Vital Signs Form. Both massages were applied to both hands for 20 min after angiography. Measurements were taken before the intervention and at 30, 60, and 120 min afterward. Results In the reflexology group, a significantly greater reduction was found in pain (effect size=0.926) and anxiety (effect size=0.680) compared to the classical massage group (p < .05). Systolic blood pressure decreased significantly in both groups (reflexology: 0.971; classical: 0.986), while diastolic pressure dropped significantly only in the reflexology group (effect size = -1.019). A significant reduction in pulse rate was also noted only in the reflexology group (effect size=0.985). No significant change was observed in respiratory rate; however, oxygen saturation increased significantly in the reflexology group (effect size=0.998). Conclusions Reflexology was more effective than classical hand massage in reducing pain, anxiety, and certain vital signs after coronary angiography.

OBJECTIVE:This study aimed to determine the frequency of methemoglobin development and identify associated factors in patients undergoing Implantable Cardioverter-Defibrillator (ICD) and Cardiac Resynchronization Therapy (CRT) procedures with the local anesthetic prilocaine. METHOD:Data from 64 patients were analyzed. The patients' methemoglobin levels before and after the procedure were measured and compared. The relationships between the results and factors such as creatinine, hemoglobin, BMI, and the amount of prilocaine used were examined. Exclusion criteria included: age under 18 years, pregnancy, breastfeeding, malignancy, chemotherapy, hemoglobin chain disorders, liver failure, and renal failure (GFR <60 ml/min), chronic obstructive pulmonary disease, other hypoxic lung diseases and smoker patients. RESULTS:Methemoglobin levels were significantly higher in the first hour after the procedure (p < 0.001). Oxygen saturation levels were significantly lower during the first hour post-procedure (p < 0.001). In the group with elevated methemoglobin levels after the procedure, creatinine levels were significantly higher (p < 0.001), while BMI (p < 0.001) and hemoglobin levels (p < 0.001) were significantly lower. No significant relationship was found with ALT levels (p = 0.425). CONCLUSION:While significant methemoglobin elevation was observed following ICD/CRT procedures with prilocaine, clinically significant methemoglobinemia cases are rare. A significant relationship was identified between methemoglobin elevation and BMI, hemoglobin, and creatinine.

BACKGROUND:Atrial fibrillation (AF) is a major public health issue associated with thromboembolism and mortality. Real-world data from Türkiye are limited despite expanding use of non-vitamin K antagonist oral anticoagulants (NOACs). The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study aimed to characterize the demographic features, risk profiles, treatment patterns, and 2-year clinical outcomes of patients with non-valvular AF (NVAF) in Türkiye. METHODS:TRAFFIC was a national, prospective, multicenter, observational registry enrolling 1659 NVAF patients from 36 centers with 6-monthly follow-up for 24 months. Baseline data included demographics, comorbidities, CHA₂DS₂-VASc, HAS-BLED, AF subtype, European Heart Rhythm Association (EHRA) score, and antithrombotic therapy. Outcomes were ischemic stroke/systemic embolism (SE), major bleeding, and all-cause mortality. Predictors of mortality were evaluated using adjusted Cox regression, and associations of risk scores were explored using univariate Cox models with restricted cubic splines. RESULTS:Median age was 70 years, 48% female, with intermediate CHA₂DS₂-VASc (most 2-5) and low-to-intermediate HAS-BLED scores (most 0-2). Permanent AF was the most common subtype (48%). Antithrombotic therapy largely reflected risk profiles, with NOACs being the dominant treatment (65%). Over 2 years, all-cause mortality was 8.9%, ischemic stroke/SE 2.4%, and major bleeding 1.3%. In adjusted analysis, age, congestive heart failure, and diabetes mellitus were independent predictors of mortality. Both CHA₂DS₂-VASc and HAS-BLED scores showed threshold effects for mortality and thromboembolic risk but not for bleeding. CONCLUSION:TRAFFIC provides contemporary Turkish NVAF data, showing lower event rates than historical cohorts. Outcomes are comparable with international registries; persistent mortality burden highlights the need for AF care beyond anticoagulation.

Double-inlet left ventricle (DILV) are rarely encountered congenital heart defects which are also known as single-ventricle defects and have a complex structure in which the blood exiting both atriums flows into a single ventricle, and they constitute approximately 1.5% of all congenital heart diseases. The 37-year-old female patient who did not have a history of cardiac disease visited our outpatient clinic for routine cardiological assessments. Transthoracic echocardiography (TTE) was performed upon hearing a 3/6 pansystolic murmur at the mesocardiac focus and a 3/6 systolic ejection murmur at the pulmonary focus on cardiac auscultation. The TTE of the patient revealed that the atrioventricular valves opened into one ventricular chamber in four-chamber apical imaging. There was no noticeable interventricular septum, while a rudimentary right ventricle and a ventricular septal defect (VSD) were observed. There was a gradient of 38 mmHg in the pulmonary valve. Mild-to-moderate pulmonary stenosis was present. In the transesophageal echocardiography (TEE), a rudimentary interventricular septum and the right ventricle were observed. Because the patient did not have any symptoms or cyanosis, the patient was given information about a potential need for occasional infective endocarditis prophylaxis and phlebotomy, and close medical follow-up was decided. A double-inlet left ventricle is known as a severe congenital heart anomaly that is typically symptomatically diagnosed in childhood and requires surgical intervention. However, in the literature, cases with an asymptomatic course reaching adulthood without surgical intervention, albeit very rare, have been reported.

BACKGROUND:Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin. This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs. METHODS:All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH + 2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT). Any fetal loss was determined as primary fetal outcome. RESULTS:The study included 78 pregnancies in 65 women with MHVs. Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively. The rates of primary maternal outcome (44 vs 3.5%, P < .001), obstructive MVT (16 vs 0%, P = .04), MVT requiring treatment (28 vs 0%, P = .003), and cerebral embolism (24 vs 3.4%, P = .041) were found to be significantly higher in lone LMWH group compared to LMWH + 4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, P = .015) and treatment for MHV thrombus (4.2 vs 28%, P = .049) were significantly lower in LMWH + 2.5 mg warfarin group compared to lone LMWH group. The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH + 2.5 mg warfarin group, and 11 (37.9%) in LMWH + 4 mg warfarin group (P = .890 for 3-group).Warfarin related-embryopathy was not observed in any case. CONCLUSIONS:The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs. CONDENSED ABSTRACT:Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women (median age 32 [27-35] years) were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality.The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. Methods:The TRAFFIC study is a national, prospective, multicenter, observational registry.The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye.The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients.For patients who use warfarin, international normalized ratio levels will be monitored.Follow-up data will be collected at 6, 12, 18, and 24 months.Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis).The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. Results:The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. Conclusion:The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye.Additionally, it will provide insights into how current treatments are reflected in this population.Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

BACKGROUND:The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population. METHODS:The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021. RESULTS:A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of high-risk patients have been using a high-intensity statin regimen, only 24.5% of very-high-risk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%). CONCLUSION:The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients.

A superior sinus venosus atrial septal defect (SVASD) results from a defect in the atrial wall that forms the posterior wall of the superior vena cava (SVC) and the anterior wall of the right upper pulmonary vein (RUPV), with the posterior wall of the RUPV typically connected to the left atrium. While surgery is usually recommended for SVASD, percutaneous technique may serve as an alternative to surgery in selected patients. Here, we report on the percutaneous closure of the defective posterior wall of the SVC using a covered stent, thereby closing the superior SVASD and redirecting the anomalous RUPV behind the stent into the left atrium.

Multidisipliner Kardiyoloji Yoğun Bakım Tanımı ve Teknik Özellikleri Servet Altay Kardiyoloji Yoğun Bakımda Fizik Muayene Esasları Sena Sert Şekerci Kardiyoloji Yoğun Bakımında İnvaziv Hemodinamik Ölçümler Songül Usalp Arter Kan Gazı Değerlendirme Ethem Yıldız Yoğun Bakımda Beslenme Esasları Hande Özportakal Hipo/Hiperglisemi ve Diyabetik Komalara Yaklaşım Seydahmet Akın Songül Aktaş Koroner Yoğun Bakımda Akut Koroner Sendrom Hastalarının Yönetimi Efe Yılmaz Muhammet Gürdoğan Akut Koroner Sendrom Mekanik Komplikasyonları Mustafa Ferhat Keten Akut Kalp Yetersizliği ve Kardiyojenik Şok Yusuf Bilen Akut Fulminan Miyokardit Ertan Ekici Havva Tuğba Gürsoy Takotsubo Kardiyomiyopatisi Melik Demir Yoğun Bakım Ünitesinde Ventriküler Taşikardilere Yaklaşım Gökay Taylan Supraventriküler Taşiaritmilere Yaklaşım Çağan Yıldırım Alper Kepez Digoksin İntoksikasyonu Tuğba Kayhan Altuner Akut Doğal Kapak Yetersizlikleri Semih Kalkan Akut Protez Kapak Patolojileri Mustafa Ozan Gürsoy Hipertansif Aciller Mehmet Murat Yiğitbaşı Hülya Çiçekçioğlu Akut Aortik Sendromlar Hasan Ali Sinoplu Ersan Oflar Pulmoner Emboli ve Kateter Bazlı Tedavi Yöntemleri Ümit Öztürk Halil Ataş İnotrop ve Vazopressör Ajanlar Mehmet Ali Astarcıoğlu Yoğun Bakımda Diürez ve Aldığı Çıkardığı Takibi Esasları Flora Özkalaycı Kaçar Burcu Candan Renal Replasman Tedavisi Serap Yadigar Elif Arı Bakır Kardiyorenal Sendrom Ferdi Karagöz İlhan Kurultak Yoğun Bakımda Terapötik Hipotermi Mustafa Ebik Kardiyak Travma Safa Özçelik Elektriksel Fırtınaya Yaklaşım Abdulkadir Uslu Perikardiyal Efüzyon ve Kardiyak Tamponad Kadriye Memiç Sancar Gamze Babur Güler Yoğun Bakımda Geçici Kalp Pili Uygulamaları Sedat Sakallı Veysel Özgür Barış Geçici Mekanik Destek Cihazları Ahmet Can Topçu Şeyhmus Külahçıoğlu Ventriküler Destek Cihazları Hakan Hançer Mehmet Kaan Kırali Kalp Nakli Sonrası Takip, Tedavi ve Hasta Yönetimi Mustafa Mert Özgür Antikoagülan ve Antiplatelet Tedavi Altında Kanamaya Yaklaşım Tuba Unkun Vasküler Giriş Yeri Komplikasyonları Doğancan Çeneli Kadir Bıyıklı TAVI Sonrası Komplikasyonlar Mehmet Aytürk Münevver Sarı Yoğun Bakımda Deliryum Yönetimi Mengühan Araz Altay Akut İskemik İnmeye Yaklaşım Ayşenur Önalan Erdem Gürkaş Akut Solunum Yetmezliğine Yaklaşım Nezihe Çiftaslan Gökşenoğlu Nalan Adıgüzel Yoğun Bakımda Enfeksiyonun Kontrol ve Önlenmesi İnşa Gül Ekiz İşcanlı Acil Bronkoskopi Barış Yılmaz Gökay Güngör Akut Respiratuar Distres Sendromu Temel Güner Esra Adıyeke Kardiyoloji Yoğun Bakımda Sedasyon ve Analjezi Münire Deniz Mustafa Emre Gürcü

Background: Pain is one of the common postoperative issues that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. It leads to prolonged recovery and sleep disturbances in patients. Aim: This study was conducted to examine the effect of eye mask use on sleep quality and pain in patients undergoing CABG surgery. Study Design: A double-blind randomized trial design was employed. The study included 60 patients undergoing CABG surgery. They were divided into intervention and control groups through block randomization. Data were collected using a 'Demographic Characteristics Form', the 'Richards-Campbell Sleep Questionnaire (RCSQ)' and a 'Visual Analogue Scale' (VAS) through face-to-face interviews. While patients in the control group received standard care throughout the night, patients in the intervention group received standard care and used eye mask. All patients were followed up for three nights. The CONSORT was used to report the study. Results: The main outcome of the study, the RCSQ score, was higher in the intervention group at baseline. The intervention group had higher RCSQ scores than the control group at time 1 and time 2. There were no differences between the groups in the secondary outcome, pain levels. The control group had higher pain scores at time 1 and time 2 than the intervention group. Conclusion: The use of an eye mask after CABG surgery is an effective, safe and simple nursing intervention to improve sleep quality and control pain. Relevance to Clinical Practice: Because the use of an eye mask is an independent and unique nursing intervention, nurses should be supported and allowed to practise it.

Giant Coronary Artery Aneurysm with a ThrombusA 29-year-old man presented with angina pectoris who was referred to our hospital because of an abnormal radiographic finding along the left edge of the heart (Figure 1A).Coronary computed tomography showed a huge aneurysm of the proximal left anterior descending artery (dimensions 62 × 46 mm) with intramural thrombus (Figure 1B-D).Subsequent cardiac catheterization revealed that blood was flowing from the first diagonal coronary artery into the aneurysm and also into the pulmonary artery through a fistula (Figure 2A, Video 1).After informed written consent was obtained from the patient, the first diagonal was then thrombosed by deployment of 3 × 0.018" Concerto Helix and 3D detachable embolization coils (Medtronic, USA) proximal to the aneurysm neck using an over-the-wire balloon (Boston Scientific, USA) occluding the aneurysm and fistula (Figure 2B, Video 2).Giant coronary artery aneurysms are often

Acute coronary syndrome (ACS) is an urgent clinical condition of cardiovascular diseases. The present study evaluated the predictive efficacy of the hemoglobin to serum creatinine ratio (Hgb/Cr) on long-term mortality in patients with ACS. The ratio, representing the proportion of the 2 values, is cheap, practical, and very easy to calculate at the bedside. Our study included 475 patients who were admitted to the coronary intensive care unit with a diagnosis of ACS and who underwent coronary angiography. The Hgb/Cr ratio was calculated by dividing the admission hemoglobin by the admission serum creatinine. All patient data were collected from the electronic hospital information system, patient files, and the hospital's archive. A comparison of the patients laboratory findings revealed that the Hgb/Cr ratios differed significantly between the survivor and non-survivor group [16.6 (7.7-49) vs 13.8 (4.91-32.8), respectively; P < .001]. A univariate Cox regression analysis showed that the Hgb/Cr ratio was statistically significant in predicting long-term mortality (0.836; 95% confidence interval [CI]: 0.781-0.895; P < .001). After adjusting the model by adding clinically and statistically significant variables, the Hgb/Cr ratio was still an independent predictor of long-term mortality (0.886; 95% CI: 0.815-0.963; P = .004). The Hgb/Cr ratio's discriminant ability was tested with an receiver operating characteristic curve analysis. The Hgb/Cr ratio's area under the curve value was 0.679 (95% CI: 0.609-0.750; P < .001). A survival analysis using the Kaplan-Meier curve of the 2 Hgb/Cr ratio groups (according to cutoff value) revealed that the low-Hgb/Cr group had a significantly higher mortality rate than high-Hgb/Cr group. The Hgb/Cr ratio was found to be an independent predictor of long-term mortality in ACS patients.