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Immune thrombocytopenia (ITP) is an acquired disorder caused by immune-mediated attack, enhanced clearance, and insufficient compensatory production of platelets. Historically, ITP treatment strategies have suppressed platelet destruction with glucocorticoids, intravenous immune globulin (IVIG), cytotoxic agents, and splenectomy (1). Eltrombopag is an oral nonpeptide thrombopoietin receptor agonist (TPO-RA) approved for use in several countries for the treatment of ITP with insufficient response to corticosteroids, immunoglobulins, or splenectomy. In this study, we present a patient with ITP who developed recurrent myocardial infarction and intense thrombus in the stent after increasing the eltrombopag dose.
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In light of because of its improved procedural and clinical success, transcatheter aortic valve implantation (TAVI) has become a significant alternative treatment option to surgery in patients with severe aortic valve stenosis. However, TAVI has its own contraindications and limitations, such as access route problems with transfemoral (TF) access being the safest and most widely used route. However, in patients in whom this route is unsuitable, axillary artery is the preferred alternative access route. Although TAVI valves are not licensed for axillary artery access, off-label use of balloon-expandable (Edwards Lifesciences, Irvine, CA, USA) and self-expandable (Evolute/CoreValve systems, Medtronic, Dublin, Ireland, as well as the Lotus valve system Boston Scientific Inc., Marlborough, MA, USA) valves have been reported. The Meril’s MyvalTM transaortic valve is a new-generation transaortic balloon-expandable valve, and transaxillary TAVI with this valve has not been reported previously. Here, we report our experience with a Meril’s MyvalTM valve in a patient with severe aortic stenosis, peripheral artery disease, and a permanently implanted pacemaker.
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Objective: Although left atrial (LA) expansion index is associated with cardiovascular prognosis, whether it affects recurrent strokes is still unknown. Methods: This study enrolled 176 patients hospitalized with first ischemic stroke. Their stroke subtypes were classified as cardioembolic stroke (CE), noncardioembolic stroke (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack. The LA expansion index was calculated as (Volmax−Volmin) × 100%/Volmin, where Volmax was defined as maximal LA volume and Volmin as minimal LA volume. The study endpoint was recurrent ischemic stroke. Results: Over a five-year (mean 4.9 years) follow-up period, 21 (11.9%) participants reached the study endpoint, including 10 with CE, five with NCE, and six with ESUS. The LA expansion index was lower in the event groups compared with the non-event group. For predicting recurrent stroke, LA expansion index <62.5% (76% sensitivity and 68% specificity) was superior to LA volume and E/e’. Kaplan-Meier curves revealed that the five-year cumulative recurrent stroke rate in patients with LA expansion index <62.5% was 23.9%, which was significantly higher than the five-year cumulative recurrent stroke rate of 4.6% in patients with LA expansion index >62.5% (log rank p<0.001). The LA expansion index was a significant independent predictor of recurrent stroke (hazard ratio=0.873; 95% confidence interval: 0.790–0.973 per 10% increase in LA expansion index; p=0.009). Conclusion: The LA expansion index is useful for predicting recurrent stroke.
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Objective: This study aimed to evaluate the acute effect of cryoballoon ablation (CB-A) on electrocardiographic parameters that have been suggested to reflect heterogeneity in atrial conduction and ventricular repolarization. Methods: A total of 67 patients (52.6±13.2 years, 43 men) without any exclusion criteria who had undergone CB-A for atrial fibrillation (AF) between January 01, 2015, and December 31, 2018, constituted our study population. Electrographic recordings obtained before and after the ablation procedure on the same day were retrospectively evaluated for the P-wave dispersion, QTc dispersion, Tp-Te interval, and Tp-Te/QT ratio. The pre- and post-ablation values were tested for significant differences. The association of the possible CB-A-related changes in these parameters with AF recurrence during follow-up was evaluated. Results: P dispersion (30.1±6.8 vs. 35.9±9.4 ms, p<0.001), QT dispersion (20.7±7.5 vs. 24.0±8.8 ms, p<0.001), Tp-Te duration (on V5 83.6±8.1 vs. 110.2±9.5 ms, p<0.001), and Tp-Te/QT ratio (on V5 0.22±0.03 vs. 0.28±0.02, p<0.001) were observed to increase significantly after CB-A. There was no association between the magnitudes of change in any parameter and AF recurrence. Conclusion: CB-A had significant effects on electrocardiographic parameters related to atrial conduction and ventricular repolarization in the acute phase after CB-A. Further prospective studies are required to examine the time-related course of these alterations and their impact on clinical outcomes.
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Objective: Pediatric ventricular tachycardias (VTs) have heterogeneous etiology and different clinical features. This study aimed to evaluate the clinical spectrum and long-term course of pediatric sustained VTs. Methods: Patients diagnosed as having sustained VT between 2010 and 2020 were evaluated retrospectively. Results: A total of 129 patients with VT were evaluated; 74 patients were male, and the median age was 12.5 years (0.25–18 years). Patients were grouped as having idiopathic VT (IVT) [n=85 (65.9%)], cardiomyopathy-associated VT (CMP-VT) [n=24 (18.6%)], catecholaminergic polymorphic VT [n=17 (13.2%)], and myocarditis-associated VT [n=3, (2.3%)]. Palpitations (n=61) and syncope (n=24) were the most common symptoms. VT originated from the right ventricle in 53.6% of the patients. Half of the patients underwent electrophysiological study, 64 patients received radiofrequency ablation therapy, and 29 patients had implantable cardiac defibrillators. During the follow-up, 70.4% of all patients had complete resolution, whereas 19 patients had a partial resolution and 23 patients (19.5%) had stable disease. Monomorphic VTs and VTs with left bundle bunch block were more thriving controlled (p=0.02 vs. p=0.04). In terms of long-term results, no statistical difference was found among the VT groups (p=0.39). Deaths were observed only in IVT (n=1) and CMP-VT (n=8) groups (p<0.001), and the overall mortality rate of pediatric sustained VT was observed at 6.9% in this study. Conclusion: VTs, which can cause sudden cardiac arrest, are potentially life-threatening arrhythmias. Identifying the heterogeneity of this VT and its peculiar characteristics would facilitate appropriate diagnosis and therapy.
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Mustafa Kemal EROL ,
Meral KAYIKÇIOĞLU ,
Mustafa KILIÇKAP ,
Arda GULER ,
Önder ÖZTÜRK ,
Burcu TUNCAY ,
Sinan İNCİ ,
İsmail BALABAN ,
Fatih Paşa TATAR ,
Ömer Faruk ÇIRAKOĞLU ,
Emine GAZİ ,
Eftal Murat BAKIRCI ,
Çağrı YAYLA ,
Mehmet Ali ASTARCIOĞLU ,
Bilge Duran KARADUMAN ,
Ekrem AKSU ,
YAKUP ALSANCAK ,
Nadir EMLEK ,
Mustafa Kürşat TİGEN ,
Nihan TURHAN ,
Ramazan DUZ ,
Mehmet İNANIR ,
Öner ÖZDOĞAN ,
Oğuz YAVUZGİL
Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15–180) min and from EMS call to EMS arrival 15 (10–20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25–63) min, and median TIT was 195 (115–330) min. TIT was significantly prolonged from 151 (90–285) min to 250 (165–372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment. Keywords:
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Kounis syndrome (KS) was first described by Kounis as an allergic angina syndrome progressing to allergic myocardial infarction (1). Further research about KS revealed that it is a multi-organ and multidisciplinary condition (2). In this case report, we present a case of myocardial infarction caused by intravenous (IV) ceftriaxone and IV metronidazole administration.
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