Objectives: We evaluated the effect of a nationwide media campaign on hypertension awareness in the population, which was implemented with the aim of spreading key messages related to optimal blood pressure levels and encouraging blood pressure measurements.
Study design: A nationwide project called “12/8 Awareness Campaign” was implemented between October 2005 and January 2006 using all available mass and outdoor media aiming to improve the knowledge of people on normal blood pressure values and to encourage regular blood pressure measurements. Four survey questions to inquire the level of awareness related to optimal blood pressure levels, hypertension, and hypertension-related disease conditions were directed via face-to-face interviews to two separate samples representing the general Turkish population before (n=1716) and after (n=1725) the campaign, respectively. The answers of the pre- and post-campaign individuals were compared.
Results: After the campaign, the percentage of participants who did not know their blood pressure levels decreased from 54.8% to 47.8%, the percentage of those who checked their blood pressure within the past two months increased from 34.3% to 39.6%, and the percentage of those who were aware of the optimal blood pressure levels rose from 51.8% to 58.6% (p<0.001).
Conclusion: The campaign contributed significantly to the awareness of hypertension in general population, which is highly encouraging for future efforts for early detection of hypertension and prevention of related morbidity and mortality.

Objectives: We investigated the prevalence and indications of digoxin use in elderly patients presenting to a cardiology outpatient clinic of a tertiary hospital in Turkey.
Study design: On a prospective basis, the study included 800 consecutive patients aged 70 or over (mean age 77±6 years) who presented to our cardiology outpatient clinic. There were 124 patients (15.5%) receiving digoxin. All the patients underwent transthoracic echocardiography. Digoxin use was considered inappropriate if the patient had normal left ventricle systolic function or if there was no atrial fibrillation (AF).
Results: The reasons for use of long-term digoxin were persistent AF (n=55, 44.4%), heart failure (HF) (n=51, 41.1%), and paroxysmal AF (n=8, 6.5%). The exact reason could not be determined in 10 patients (8.1%). Digoxin use was based on appropriate indications in 76 patients (61.3%), whereas 48 patients (38.7%) were taking digoxin with inappropriate indications. Of 51 patients for whom HF was the only reason for digoxin therapy, diagnosis of HF was incorrect in 30 patients (24.2%). Other inappropriate indications were paroxysmal AF and undetermined indication for digoxin prescription. Concerning digoxin dose, 24 patients (19.4%) received one tablet (0.25 mg) and 30 patients (24.2%) received a half tablet (0.125 mg) on a daily basis, while 10 patients (8.1%) used six tablets per week with one day off (0.214 mg/day) and 60 patients (48.4%) took five tablets per week with two days off (0.179 mg/day). The median daily dose was 0.182 mg/day. Digoxin dose was higher than the recommended doses for elderly patients in 75.8% of the patients.
Conclusion: Our findings show that nearly 40% of elderly patients receive digoxin with inappropriate indications and 75% of these patients take digoxin at higher doses than the recommended doses for this age group.

Objectives: We investigated the correlation of serum paraoxonase-1 (PON-1) activity with coronary artery disease (CAD) in patients with metabolic syndrome (MetS).
Study design: The study included 21 patients (mean age 55±9 years) with MetS, stable angina pectoris, and angiographically shown CAD, 24 patients (mean age 51±10 years) with MetS and angiographically normal coroner arteries, and 28 healthy controls (mean age 49±12 years). Demographic and clinical characteristics, insulin levels, homeostasis model assessment of insulin resistance index, and PON-1 activity were assessed in all the groups. Severity of CAD was assessed using the Gensini score.
Results: Paraoxonase-1 activity was significantly lower in patients with MetS compared to the control group (p=0.02). The two MetS groups with and without CAD exhibited similar characteristics in all the parameters including PON-1 activity (p>0.05). Univariate correlation analysis performed in MetS-CAD patients showed a significant negative correlation between the Gensini score and PON-1 activity (r=-0.48, p=0.02). The overall PON-1 activity of all the subjects showed no correlation with the parameters examined.
Conclusion: Decreased PON-1 activity in patients with MetS compared to the control group suggests increased oxidative stress in MetS. Detection of similar PON-1 activity levels in MetS groups with and without CAD suggests that disturbance of oxidative-antioxidative balance occurs before the development of CAD. The negative correlation between the Gensini score and PON-1 activity implies that decreased PON-1 activity may be one of the etiologic causes of atherosclerotic progress in MetS.

Objectives: We evaluated regional left ventricular myocardial functions by strain (S) and strain rate (Sr) echocardiography in patients with type II diabetes mellitus (DM) without microvascular complications.
Study design: The study included 40 DM patients (20 women, 20 men; mean age 52.4±7.9 years) without microvascular complications, and 40 healthy controls (20 women, 20 men; mean age 52.8±10.1 years). Left ventricular functions were evaluated by conventional Doppler, tissue Doppler, and S-Sr echocardiography. Longitudinal peak systolic S and Sr were measured from the basal, mid and apical segments of the left ventricle walls. Patients with DM duration of >3 years (n=24) and receiving medical therapy for DM (n=30) were also evaluated.
Results: Conventional Doppler findings were similar in the patient and control groups. Among tissue Doppler variables, only early diastolic mitral annular velocity (Em) was significantly decreased (10±2.9 vs. 11.4±3.2 cm/sec, p<0.05), and accordingly, mitral inflow E/Em ratio was significantly increased (7.3±2.5 vs. 6.3±2, p<0.05) in patients with DM. The two groups were similar with respect to systolic S and Sr values, except for apical-lateral S, mid-anterior S, basal-anteroseptal S, apical-anterior Sr, and mid-anteroseptal Sr (p<0.05, for all). Patients with DM duration of >3 years and receiving medical therapy showed similar changes as the overall patient group.
Conclusion: The frequency of left ventricular diastolic dysfunction was higher in patients with DM. Irregular distribution of systolic S and Sr indices in the left ventricular segments may indicate that DM leads to heterogeneous myocardial involvement also in the early period.

Objectives: We evaluated short- and mid-term results of percutaneous closure of atrial septal defects (ASD) and patent foramen ovale (PFO) using various closure devices.
Study design: The study included 278 patients (128 men, 150 women; mean age 39±12 years; range 17 to 66 years) who underwent percutaneous closure of secundum ASD (n=134) or PFO (n=144). All the patients were assessed by transthoracic (TTE) and transesophageal (TEE) echocardiography before the procedure. Percutaneous closure was performed with the Amplatzer (n=180), Occlutech Figulla (n=92) or BioSTAR (n=6) devices. Closure of ASDs was performed under general anesthesia with TEE guidance, and closure of PFOs was performed under local anesthesia with TTE guidance. Follow-up controls were at 1, 6, and 12 months, and annually thereafter. The mean follow-up period was 35.1±24.6 months for ASD cases, and 24.9±15.5 months for PFO cases.
Results: The mean device size was 20.2±5.6 mm for ASD cases and 24±2.9 mm for PFO cases. The mean procedural and fluoroscopy times were 28.4±6.1 min and 4.9±2.1 min for ASD closure, and 18.2±5.3 min and 3.6±1.2 min for PFO closure, respectively. Procedural device embolization occurred in only one patient. No recurrent embolic events occurred after PFO closure, and no residual shunts were seen after ASD closure. Device thrombosis developed in two patients during the procedure and in one patient at one-year follow-up.
Conclusion: Percutaneous closure of secundum ASDs and PFOs using the Amplatzer, Occlutech Figulla, and BioSTAR devices is an effective and safe treatment option.

Objectives: Several studies have shown that psychosocial risk factors such as stress and depression make substantial contribution to the pathogenesis of coronary artery disease. This study aimed to investigate acute stress factors prior to acute myocardial infarction (AMI), and stress, depression, and anxiety levels during the subacute period in AMI patients aged ≤40 years, in comparison with AMI patients aged >40 years.
Study design: The study included 200 first-time AMI patients aged ≤40 years (n=100; mean age 35±4 years) and >40 years (n=100; mean age 54±9 years). The DASS 21 scale (Depression Anxiety Stress Scales) was administered via face-to-face interviews in the early recovery period of AMI. The patients were also questioned whether they had experienced acute stress factors such as severe emotional or physical stressful events within two hours before the onset of chest pain. In addition, coronary angiography results were assessed based on the two age groups.
Results: Comparison of the two age groups showed significantly higher frequencies of family history of CAD and smoking in the younger group, and significantly higher frequencies of hypertension, diabetes mellitus, and dyslipidemia in the older group (p<0.05). History of acute stress factors was significantly more common (52% vs. 20%, p<0.01) and stress, depression, and anxiety scores of the DASS 21 scale were all significantly higher in the younger group (p<0.01). On coronary angiography, younger patients predominantly had normal coronary arteries and single-vessel disease, whereas multi-vessel disease was more prevalent in the older age group (p<0.01).
Conclusion: Triggers of acute stress and psychosocial risk factors may contribute to the occurrence of AMI in individuals younger than 40 years.

A 74-year-old male patient presented with complaints of fatigue, fever, and worsening health status. He had a 34-month history of cardioverter-defibrillator (ICD) implantation due to ischemic cardiomyopathy. Transthoracic and transesophageal echocardiography showed a mobile mass, 24x11 mm in size, consistent with a vegetation attached to the right ventricular ICD lead. Surgical removal of the electrode was considered to be highly risky for the patient, thus percutaneous removal was decided. Due to adhesions, manual traction of the lead with a standard stylet was ineffective. Complete lead extraction was accomplished using the Evolution Mechanical Dilator Sheath, which is a new mechanical sheath with a stainless steel bladed tip. No complications occurred during or after the procedure. Following a histopathologic diagnosis of vegetation, the patient received a six-week antibiotic therapy, after which a new ICD was implanted on the contralateral side. To our knowledge, this case represents the largest lead vegetation extracted by this new device. Although its safety should be validated by increasing number of cases, it seems that its simple use would make this device a new interesting tool among the instruments available for lead extraction.

Acute pericarditis may result from many etiologies. Pericarditis as a complication of Epstein-Barr virus (EBV) infection is quite rare and is usually self-limited in immunocompetent patients. In particular, pericardial tamponade associated with EBV infection has been reported in only one case. An 18-year-old woman presented with chest pain and shortness of breath. Upon suspicion of pulmonary embolism, the patient was examined with computed tomography, which showed no pulmonary embolism, but massive pericardial fluid surrounding the whole pericardium. Transthoracic echocardiography revealed pericardial fluid collections in the posterolateral wall (3.5 cm), right ventricle (2 cm), and right atrium (1.4 cm), and a diastolic collapse of the right ventricular apical wall. Emergency pericardiocentesis was performed and a total of 750 ml fluid was removed, which resulted in hemodynamic improvement and disappearance of the diastolic collapse on echocardiography. Serum EBV VCA IgM and EBV PCR assays were found positive and medical therapy was instituted with the diagnosis of EBV-associated pericarditis. The patient showed complete improvement and was discharged. At one-month control, she was free of symptoms and her echocardiogram was normal.

Pulmonary embolism is a rare complication of abdominoplasty and liposuction that may result in a fatal consequence. A 65-year-old obese woman presented with complaints of shortness of breath, palpitation, and hypotension (90/60 mmHg) seven weeks after abdominoplasty and liposuction. The electrocardiogram showed sinus tachycardia, right axis deviation, and right bundle branch block. The chest X-ray showed atelectatic and focally infiltrated areas, and minimal bilateral pleural effusion. Laboratory findings were normal except for D-dimer level (3500 ng/ml). Echocardiography revealed dilated right heart chambers and a thrombus in the right ventricle. Ejection fraction was normal and pulmonary artery pressure was 50 mmHg. Doppler ultrasound showed no signs of thrombosis. Following the diagnosis of pulmonary thromboembolism, the patient received oxygen therapy and heparin infusion. However, the clinical course did not improve, hemodynamic deterioration continued, and the echocardiographic appearance of the thrombus persisted, so thrombolytic therapy with tissue plasminogen activator was administered, which also resulted in no response. In the end, pulmonary embolectomy was performed and the thrombus was successfully extracted. The patient had an uneventful postoperative course and was discharged on the seventh postoperative day.

The ideal treatment for acute myocardial infarction in patients with idiopathic thrombocytopenic purpura (ITP) is not well-known. A 42-year-old male patient with a previous diagnosis of chronic and refractory ITP was admitted with chest pain of four-hour onset. Findings of electrocardiography was consistent with acute anteroseptal myocardial infarction. He had no risk factors for coronary heart disease and was not receiving treatment for ITP, and his platelet count varied between 11,000 and 40,000/µl before presentation, without any event of bleeding. Transthoracic echocardiography showed hypokinesia of the anterior, middle, and apical segments. Cardiac enzyme levels were elevated and platelet count was 41,000/µl. Coronary angiography revealed total occlusion of the left anterior descending artery. Primary percutaneous coronary intervention (PCI) was performed, which included predilation and stenting of the lesion. There were no bleeding or ischemic complications during or after PCI and the patient was discharged on the fifth day without any symptoms. He was instructed to take 75 mg clopidogrel daily for two weeks. He was symptom-free at a control visit after this period, with normal left ventricular wall motion on echocardiography.

Coronary stent dislodgement or embolization before deployment is a rare but serious complication in interventional cardiology. A 60-year-old male presented with unstable angina five years after coronary artery bypass surgery. There was a stenosis (70%) in the obtuse marginal branch of the circumflex artery. During percutaneous coronary intervention, a sirolimus-eluting stent was stripped from its balloon mainly because of significant proximal angulation and incarcerated within the proximal circumflex artery. A smaller balloon dilatation catheter was advanced and pushed through the inside of the slipped stent. Using this technique, the stent could be advanced into the lesion and was successfully deployed. To our knowledge, this is the first case report on sirolimus-eluting stent dislodgement.

Aiming to increase mixing at the atrial level, atrial septal stenting was performed in two pediatric cases with cyanotic congenital cardiac diseases. The first case was a 3-month-old male infant with transposition of the great arteries. The second case was an 18-month-old male infant with increased central venous pressure due to postoperative right ventricular outflow tract obstruction. Premounted bare stents of 8 mm in diameter were used in both cases. The length of the stent was 20 mm in the first case and 30 mm in the latter. The procedure was accomplished without any complications. In the first case, oxygen saturation increased approximately 20-25% with no significant interatrial gradient. In the latter, central venous pressure decreased from 16 to 8 mmHg immediately after the procedure. The patient was weaned from the ventilator on the second day and discharged from intensive care unit on the fifth day. Follow-up echocardiograms of both patients showed patent stents with good position relative to the atrial septum. Stenting of the atrial septum seems to be a safe and effective method to create a reliable, nonrestrictive interatrial communication.

Diagnosis and management of acute heart failure syndromes are described in the most recent ESC/ESICM guidelines. However, physicians dealing with these patients in their daily practice may need guidance in choosing therapeutic alternatives as soon as the dyspneic patient arrives to the emergency department. Herein, practical recommendations for the very early management of patients with acute heart failure syndromes are presented. Blood pressure- and symptom-driven strategy along with early initiation of goal-directed therapies are key take-home messages. Furthermore, early and frequent reassessment is also an imperative part of management so that adjustments in the initial therapeutic plan can be achieved in a timely fashion.

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İstirahat EKGsinde preeksitasyon olan herkese ablasyon- Erdem Diker