Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir最新文献

Takotsubo syndrome is a cardiomyopathy characterized by transient ventricular dysfunction caused by excessive sympathetic discharge, which may potentially lead to a fatal outcome. This case report presents the successful management of a 41-year-old female patient with iatrogenic Takotsubo syndrome complicated by cardiogenic shock. The condition was triggered by the inadvertent administration of norepinephrine, which occurred due to a medication error in which it was mistaken for amiodarone because of look-alike/sound-alike packaging and name similarity. The management strategy focused on the use of mechanical support devices rather than agents that perpetuate the adrenergic discharge underlying the pathophysiology.

Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal cause of acute coronary syndrome (ACS), often associated with younger individuals and women without traditional cardiovascular risk factors. Carbon monoxide (CO) poisoning, a known cause of systemic hypoxia, has been implicated in various cardiovascular complications; however, its role in triggering SCAD remains scarcely reported. We present the case of a 55-year-old woman who developed SCAD following acute CO poisoning caused by a domestic gas leak. The patient presented with altered mental status and respiratory failure, requiring hyperbaric oxygen therapy. Following stabilization, typical anginal symptoms emerged, with rising cardiac biomarkers suggestive of myocardial injury. Coronary angiography revealed spontaneous dissections in both the distal left anterior descending artery and the distal right coronary artery without critical flow limitation. The patient was managed conservatively with medical therapy and remained asymptomatic at six month follow-up. This case highlights the importance of considering SCAD in patients presenting with cardiac symptoms following CO poisoning and underscores the need for vigilance in atypical presentations of myocardial injury.

Objective: The aim of this study was to assess autonomic dysfunction via heart rate variability (HRV) in residents with on-call shifts.

Method: A cross-sectional study of 140 residents (104 on-call, 36 non-on-call) was conducted. HRV parameters, stress indices, and physical activity (International Physical Activity Questionnaire, IPAQ) were compared using parametric and non-parametric tests.

Results: On-call residents showed elevated heart rates (84 vs. 79 bpm, P = 0.006), higher stress indices (12.1 vs. 9.96, P = 0.003), and reduced parasympathetic markers (root mean square of successive differences [RMSSD], standard deviation of normal-to-normal intervals [SDNN], parasympathetic nervous system index [PNS index]; all P ≤ 0.006). Physical activity did not differ between groups.

Conclusion: An association between on-call shifts and altered autonomic balance was observed, suggesting a potential increase in cardiovascular risk independent of lifestyle factors. These findings may be considered by policymakers when planning resident physician workloads.

Objective: The aim of this study was to investigate the impact of the T-786C polymorphism of the NOS3 gene on the onset and progression of renal dysfunction in patients of the Uzbek population with chronic heart failure (CHF).

Method: The study included 200 patients of Uzbek nationality diagnosed with CHF. Among them, 110 patients had a glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m², while in 90 patients this indicator was lower. The control group consisted of 120 conditionally healthy donors of Uzbek nationality. Analysis of the NOS3 T-786C polymorphism was performed using commercially available test kits developed by NPF Litex LLC (Moscow, Russia) in accordance with the manufacturer's standard protocol. Amplification of the polymorphic region of the NOS3 promoter was carried out using a Rotor-Gene Q thermal cycler (QIAGEN, Hilden, Germany). Polymerase chain reaction (PCR) was performed in a total volume of 25 µL under the following cycling conditions: initial denaturation at 95°C for 5 minutes; 35 cycles of denaturation at 95°C for 30 seconds, primer annealing at 60°C for 30 seconds, and DNA extension at 72°C for 1 minute; followed by a final extension at 72°C for 10 minutes. The resulting data were analyzed using the SPSS statistical package (IBM Corp., Armonk, NY, USA) and OpenEpi v9.2 (OpenEpi, Emory University, Atlanta, GA, USA).

Results: Differences were observed in the distribution of genotypic and allelic variations. In the main group, the frequency of the C allele was 35.5%, compared to 28.3% in the control group. Patients with eGFR < 60 mL/min/1.73 m² were more likely to have the C/C genotype (15.6% versus 10.8% in the control group). The T-786C polymorphism may exacerbate renal impairment by reducing NOS3 activity and lowering nitric oxide (NO) production.

Conclusion: The genetic variant C of the T-786C NOS3 polymorphism is associated with impaired renal function in patients with CHF.

Objective: When liquid medications are administered intravenously, the first cellular defense encountered by the drug is erythrocytes. Catalase is the main antioxidant system in erythrocytes. Drug-related catalase inhibition can cause adverse effects. Although catalase is a well-known enzyme, studies investigating drug-catalase interactions are scarce in the literature. Therefore, we investigated the impact of liquid cardiac drugs on human erythrocyte catalase activity in vitro.

Method: Catalase activity was determined by a spectrophotometric method using a procedure developed by Aebi. Liquid cardiac drugs were incubated with human blood in vitro. IC50 values were compared among the drugs.

Results: The most potent inhibitors were noradrenaline (IC50: 4.61 µM), adrenaline (IC50: 32.58 µM), and amiodarone hydrochloride (IC50: 41.86). Dopamine hydrochloride (IC50: 429.15 µM) and lidocaine hydrochloride (IC50: 453.1 µM) showed less inhibitory effects on catalase activity compared with adenosine (IC50: 58.49 µM), atropine sulfate (IC50: 68.75 µM), dobutamine hydrochloride (IC50: 80.79 µM), glyceryl trinitrate (IC50: 86.66 µM), and heparin sodium (IC50: 92.4 µM).

Conclusion: Noradrenaline, adrenaline, and amiodarone hydrochloride have strong inhibitory effects on catalase activity. Catalase inhibition may be responsible for the side effects of these drugs. Therefore, when these drugs are used in treatment, their dosages and duration of administration should be carefully controlled to prevent adverse effects due to catalase enzyme inhibition.

Pulmonary vein isolation (PVI) for atrial fibrillation is typically performed via femoral venous access. When inferior venous access is unavailable, alternative approaches are required. We report a case of successful cryoballoon PVI performed via a single right internal jugular vein access using fluoroscopy alone under conscious sedation in a patient with complete bilateral lower-extremity venous occlusion. Following failed femoral access and venographic confirmation of occlusion, transseptal puncture and ablation were achieved using biplane fluoroscopic guidance without transesophageal or intracardiac echocardiography, coronary sinus catheterization, or general anesthesia. All pulmonary veins were successfully isolated without complications, and the patient was discharged the following day in sinus rhythm. This case demonstrates that a minimalist, superior-only approach to cryoballoon PVI is feasible and effective when standard inferior access is not possible.

Objective: The aim of this study was to investigate longitudinal changes in biventricular diastolic function and myocardial deformation during pregnancy and the early postpartum period using tissue Doppler imaging (TDI), speckle-tracking echocardiography (STE), and rotational mechanics.

Method: In this prospective observational study, 65 healthy, normotensive women with singleton pregnancies underwent echocardiography at four standardized time points: first trimester (10-12 weeks), second trimester (20-24 weeks), third trimester (36-38 weeks), and early postpartum (6-12 weeks post-delivery). Comprehensive evaluation included conventional Doppler, TDI-derived parameters, longitudinal strain rates, atrial strain, and left ventricular (LV) twist mechanics.

Results: Pregnancy was characterized by a progressive rise in cardiac output and ventricular volumes, with parallel declines in diastolic indices and atrial function. Although LV ejection fraction remained preserved, early diastolic strain rate decreased by 19% (1.59→1.29 s-¹, P < 0.001), lateral Em velocity declined by 20%, and global LV twist was reduced by 20% (17.8°→14.2°, P = 0.002). The mitral E/A ratio progressively decreased, while deceleration time remained prolonged postpartum (203→243 ms, P < 0.001). Atrial strain analysis revealed chamber-specific remodeling: left atrial conduit strain showed near recovery, whereas right atrial parameters showed only partial normalization. Collectively, these findings indicate that diastolic and torsional mechanics did not fully normalize within 6-12 weeks, suggesting heterogeneous recovery trajectories even among healthy pregnancies.

Conclusion: In healthy women, pregnancy-induced myocardial adaptation appears to involve progressive diastolic and deformation changes that may persist into the early postpartum phase. The observation of residual subclinical alterations-despite otherwise physiological remodeling-suggests that longitudinal surveillance could be valuable, even in low-risk populations. Advanced echocardiographic modalities may improve early detection and contribute to refined risk stratification in pregnancy-related cardiac adaptation.