Makale Arama

Aim: Cardiovascular events, including ventricular arrhythmias and sudden cardiac death (SCD), are the primary source of death in hemodialysis (HD) patients. Checking ECG parameters such as QT interval, QT dispersion (QTd), TPe interval, TPe/QT ratio, and cardiac-electrophysiological balance (iCEB = QT/QRS) can be useful for classifying patients with high arrhythmia and SCD risk. Our study aimed to compare the change of electrocardiographic parameters before and after the HD session with the healthy control group.

Methods: A total of 49 HD patients and 50 healthy volunteers were included in the study. The groups were divided into two groups as hemodialysis and control group. ECGs of the hemodialysis group were evaluated before and after dialysis. ECG data were scanned and evaluated on a digital platform. QT, cQT, QTd, TPe, TPe/QT, TPe/cQT, QT/QRS, and cQT/QRS were measured.

Results: While QTd, cQTd, TPe, TPe / QTc, and QRS decreased significantly after hemodialysis compared to pre-HD(p <0.05 for each), HR, iCEB, and iCEBc showed a significant increase after dialysis treatment (p <0.05 for each). Comparing pre-dialysis ECG parameters with the control group, QT, cQT, QTd, cQTd, TPe and iCEBc were significantly higher in pre-HD (p <0.05 for each). Comparing the ECG parameters after dialysis, HR, cQT, QTd, cQTd, iCEB, and iCEBc values were significantly higher than the control group (p <0.05 for each).

Conclusion: By evaluating the electrocardiographic parameters showing ventricular repolarization and depolarization together, the risk of arrhythmia and sudden cardiac death can be predicted in HD patients.

Pulmonary embolism(PE) is a serious disease which is one of the most important reason of cardiovascular mortality. In spite of the fact that electrocardography(ECG) has a limited effect on the diagnosis and determination of the prognosis of PE, it is an essential method for clinically differentiating PE from other diseases that might be confused with PE, such as myocardial infarction(MI) .The aim of this case report presentation is to discuss whether this stuation might be a marker on determination of the prognosis.and the fact that PE could mimic the ECG findings of ST elevation myocardial infarction even though it is rare. Fifty six years old patient with acute renal failure and disorder of liver dysfunction, who had been treating in intensive care unit of internal medicine department, complained about chest pain and shortness of breath occuring on second day of his admission to the hospital. The patient was taken from cardiology department with anteroseptal MI prediagnosis after evaulation of the ECG demonstrating about 4 mm ST elevation in V1-V4 precordial derivations. Coronary angiography was performed to the patient being thought to whom primary percutaneous coronary intervention might be neccessary and there was not any lesion determined in epicardial coronary arteries. The parameters obtained from transthoracic echocardiographic evaulation of the patient was corcordant with the diagnosis of PE. It was understood from the imaging reports performed previously that trombus in vena cava inferior had been detected. The patient had cardiac arrest and died while he was being prepared for the pulmonary embolectomy operation after diagnosing of PE. The aspect which made our case report more attractive is that there were only various case reports published about PE in literature, which indicateST elevationmimicing anterior myocardial infartion. It is thought that this situation might be observed in PE and might guide for determination of the prognosis as well when this case report is evaulated together with the other ones.

In addition to the many research about organophosphate poisoning, the fact of acute myocardial infarction and respiratory failure that happen after organophosphate exposure is firstly reported. A 46 years old patient was taken into emergency with the plaint of dispne, chest pain and somnolence. By taking anamnesis, it is understood that these plaints are occured after eating cherry of which trees are disinfected with a pesticide (Dipterex SP 80 (%80 trichlorphon 0,0 dimethyl phosphonate). General situation was miserable, tachypnea and his consciosness was somnolence. The patient was immediately intubated and connected to the mechanical ventilator. There was sinus tachycardia in his electrocardiography and the elevation of pathologic Q and ST elevation in V1-4. Troponin was high in his blood test. With these indications, it was supposed that there was heart attack and respiratory failure depending on organophosphate poisoning on the patient. After the treatment of piralidoxime, acute myocardial infarction and respiratory failure, the patient was discharged from hospital for being angiography. Finally, acute myocardial infarction and respiratory failure which evolve out of organophosphate poisoning shouldn’t be ignored.

In order to stratificate the risk of aı-rhythmi• events (AE) such as sudden cardiac death, vent-ricular fibrillation, sustained vertricular tach-ycardia in the first year after myocardial infarction, 62 patients were evaluated with echocardiography, Holter monitorisation and high resolution signal averaged electrocarcliography (H1-RES ECG). Patients were divided into 2 subgroups according ta presence on absence of AE [AE (+): 5 (%8), AE (-): 57 (%92)]. Patients with AE [(mean left ventriculaı-eje•tion fr-action (LVEF): % 48±I 3.5 showed 5 (%100) late potentials (LP). 1 (%20) malign VA and 3 (%60) LV dysfunction with LVEF 5 %40, while the other patients with AE (-) (LVEF % 55±9.7) had 28 (49%) LP (+), 2(%3.5) malign VA ve 7 (%12) LVEF5._%40 (p<0.05, p>0.05, p<0.0I ). During the 1 year follow-up, LP (+) patients (n=33) who had 6 (18%) LVEF%40 and 3(%9) malign VA showed 5 (%15) sudden death, while LP (-) patients (n=29) who had 4 (13.8%) VEF5_%40 but no malign VA, showed nn sudden death (p>0.05, p>0.05, p<0.05). Patients with VA (n=14) who had 1 1(%78.5) LP (+) and 5.(%35.7) LVEF.40 showed 4 (%28.5) sud-den death in the first year after AMI, whereas pa-tients without VA (n=48) who had 22 (%45.8) LP ( +) and 5(%10) LVEF<%40 showed 1 (2%) sudden death (p<0.05, p<0.05, p<0.01 ). Patients with LVEF5_%40 (n=10), who had 6 (%60) LP (+) and 1 (%1 O) malign VA before hospital discharge evolved 3 (%30) sudden death, wheı-eas pa-tients with LVEF>%40 (n=52) who had 27 (%51 .9) LP (+) and 2 (%3.8) malign' VA before hospital dis•-harge, showed 2 (%3.8) sudden death in the one year follow-up period (p>0.05, p>0.05, p<0.01). In conclusion, in the risk stratification of arrhy-thmic events after AM!. alt of the thı-ee methods (ec-hocardiography, Holter, HI-RES ECG) are usefill where HI-RES ECG is more sensitive.

Single coronary artery is observed in approximately 2-4% of all coronary artery anomalies. In our case, 48 years old female patient had exercise-induced angina pectoris and fatigue. After her exercise electrocardiogram revealed ST depression during 9 mets, we demonstrated a single coronary artery as an extremely rare anomaly of coronary artery in which there was no original left main artery as well as right coronary artery, left anterior descending and circumflex arteries were originated from right sinus Valsalva. On medical treatment with beta blocker, her symptoms had recovered. This type of coronary anomalies is very infrequent and may be a reason of sudden death.

We have studied the effects of Etomidate on ECG and effects on serum electrolyte levels_ Disrytrnia have not been noticed on ECG and there were not significant changings in serum electrolyte levels prior to the anesthesia or at the 15th. ıninute onset of the anesthesia. These results show that Etomidate have no side effect on CVS and serum electrolyte levels, there for it can be used safely in cardiac patient and canditions which elevated serum K+ levels.

Aim: In this study, examination of the index of cardiac-electrophysiological balance (iCEB) and of other
risk markers for cardiac arrhythmia in electrocardiography of children with acute rheumatic carditis was
aimed.
Patients and Methods: Forty pediatric patients with acute rheumatic carditis and 40 healthy children
matched in terms of gender and age were retrospectively enrolled in the study between January 2016
and August 2018. Demographic data of all cases were obtained from records. By electrocardiography, P
dispersion (Pd), dispersion durations of QT (QTd) and corrected QT (QTcd), Tpeak-to-end interval (Tpe),
ratios of Tp-e/QT and Tp-e/QTc, and measurements of iCEB and corrected iCEB (iCEBc) were all
compared between the groups. Statistically significant dif ference was accepted as p< 0.05.
Results: In the patient and control groups, mean ages were 11.40±3.48 years and 11.41±3.31 years,
respectively. Both groups had 16 female (40%) and 24 male (60%) children. In the patient group, heart
rate, PR interval, Pd, QTd, QTcd, Tp-e, Tp-e/QT ratio and iCEBc were found to be significantly increased.
Though iCEB level was higher in the patient group, there was no statistically significant difference with
healthy controls.
Conclusion: In children with acute rheumatic carditis, repolarization-depolarization balance may be
impaired. Therefore, in addition to other electrocardiographic risk parameters for arrhythmia, use of
iCEB(c) may also be beneficial. However , further studies on this issue are needed.

Aim: Temporary hemodialysis catheters inserted into the internal juguler vein are commonly used in patients who need emergent hemodialysis. During this procedure, although it is very rare, the patient may have anatomicaldifferences. Therefore, before the procedure, it should be studied whether the patient has any cardiovascular abnormality or not. Case report: Dextrocardia was detected in control chest X-ray of a 55 year old patient, who was in routine hemodialysis programme and had a history of 10 arteriovenous fistula operations and multiple transient and permanent catheter insertions because of chronic renal failure. Conclusion: For this reason, we suggest posteroanterior chest x-ray as the routine technique since it is the simplest diagnostic method.

It is not possible to determine dysrhythmias at any time, because those may occur briefly and unpredictably throughout the day. Transtelephonic electrocardiography (TTE) allows arrival to the hospital by the phone line dysrhythmia at the time. The aim of this study was to evaluate the value of TTE in the diagnosis and treatment of dysrhythmias, especially seen intermittently, in pediatric patients. We retrospectively evaluated records of 121 children, followed-up in Pediatric Cardiology Unit between May 2003 and May 2006. The patients were age of between 4 months to 18 years (median age 12 ± 4.4 years). The most common presenting symptoms were palpitation (42.1%), chest pain (15.7%), palpitation together with chest pain (6.6%), syncope (5%), easy fatigability (5%) and also the research of drug efficiency (3.3%). The dysrhythmia findings were determined on TTE in 21 of 110 cases whose standard electrocardiographies were normal. On TTE, supraventricular tachycardia was observed in three of 25 patients with normal HM. The dysrhythmia was detected in 24% of TTE records (supraventricular extrasystoles, ventricular extrasystoles, sinusal tachycardia, supraventricular tachycardia, sinus bradycardia, sinus tachycardia, sinus pause, Mobitz type I atrioventricular block were detected in 11, 7, 4, 3, 2, 1 and 1 cases, respectively). Four patients were using drugs (verapamil in 3 and propranolol in 1) before TTE recordings. According to the TTE records, medical treatments were started in 10 patients with previously untreated (verapamil in 5, propranolol in 3, digoxin in 1 and also amiodarone in 1). Eventually, we suggest that HM is a usefull, reliable and non-invasive diagnostic method for the detection of dysrhythmias in patients with dysrhythmia suggestive symptoms and normal ECG. Additionally, TTE should be used in follow-up and treatment of the patients with some dysrhythmias, even undetectable with HM.

Scimitar syndrome is a rare congenital partial pulmonary venous return anomaly that is characterized with anomalous pulmonary venous drainage of the right sided pulmonary veins to the inferior vena cava or the right atrium. It may be accompanied with hypoplasia of the right lung with bronchial abnormalities, dextra position of the heart and systemic arterial supply to the lung. Radiologically, this anomalous vein appears as a scimitar-like shadow (Turkish Swords) on chest x-ray, and runs from the middle of the right lung to the cardiophrenic angle. In our report, we have presented a child with scimitar syndrome who was evaluated for recurrent lower respiratory tract infection.

Aim: The aim of this study was to compare the effects of direct trocar insertion and Veress needle insertion on complication ratio, CO2 volüme and time consumption during laparoscopic procedures. Materials and Methods: 152 patients were included in this study which vvere operated forcholelithiasis laparoscopically in Selçuk University Meram Medical Faculty betvveen January 1998 - January 2001. The patients vvere divided into tvvo groups ran- domly. Group I: pneumoperitoneum was performed with direct trocar insertion after general anaesthesia, Group II: pneumoperitoneum was performed with Veress needle and trocar vvas inserted after general anaesthesia. Complication ratios and, time consumption and CO2 volüme vvere calculated in tvvo groups. Findings: Copmlication ratios vvere 11.8% in Group I and 13.2% in Group II, and the differences vvere not significant. CO2 volüme used insufflation and insufflation time vvere significantly more in group II than in group I (p<0.001). Conclusion: Direct trocar insertion vvithout pneumoperitoneum vvas superior than Veress needle insertion vvith respect of CO2 volüme and time consumption.

Fetal arrhythmias are a very rare complication of fetal life, and the fetal heart rate decreases below 1001, increases to 200-230 lysers or changes in rhythm can be defined as orthogonal. Differential calL5mas were published for the first time in 1930 as pho-nocardiographic and in 19601 electrocardiographically. The development of M-mode echocardiography and color Doppler echocardiography brought a new dimension to the introduction of fetal arrhythmia. In the following years, with the introduction of fetal umbilical cordocentesis techniques, there were great developments in the treatment of arrhythmias, in the examination of fetal blood samples and measurement of the levels of the fetus, as well as in the prenatal full-meal treatment of arrhythmias with fetal transvenous pacing.

Introduction: Our aim is to evaluate the cardiac involvement of Neurofibromatosis type 1  patients in our region and to compare them with other clinical findings. In this study, we wanted to show the frequency and variety of cardiac involvement.

Material and Methods: Patients diagnosed with Neurofibromatosis type 1  in Hatay Mustafa Kemal University Medical Faculty Pediatric Neurology Clinic between 01/09/2019 and 01/09/2020 were included in the study. The patients included in the study were examined by a Pediatric Cardiology Specialist, and echocardiography and electrocardiography were taken. Demographic information, examination findings, brain magnetic resonance images were collected from the files of the patients. Electrocardiography and echocardiography were examined and recorded by the Pediatric Cardiology Specialist.

Results: We accepted 17 patients from our center to the study. Six patients (35.3%) were diagnosed with sporadic Neurofibromatosis type 1, while 11 patients (64.7%) had familial Neurofibromatosis type 1. All of our patients had cafe au late spots on the skin. In addition, 10 (58.8%) patients also had axillary and / or inguinal freckles. We detected optic glioma in 3 of our patients with ocular involvement, and lish nodules in 3 of them with papillary edema. When we looked at central nervous system involvement, we encountered various involvements in brain MRIs of 8 (47%) patients. In our cardiac examination, we found QT length in 1 patient’s electrocardiography. In the echocardiography we performed for the detection of cardiac structural pathologies, we detected nodular appearance compatible with subendocardial neurofibroma in 3 patients, mitral insufficiency in 3 patients, patent foramen ovale in 1 patient, atrial septal defect in 1 patient, and bicuspid aorta in 1 patient.

Discussion: In our study, unlike the literature, subendocardial nodular hyperechogenic appearance was present in 3 patients. Although these findings are quite rare, subendocardial nodular hyperechogenic images in 3 of our 17 patients suggest that this pathology may be more common. In addition, one of our patients had a long QT. As far as we know, this is the first case of Neurofibromatosis type 1 and Long QT syndrome. In conclussion; Cardiac involvement in patients with Neurofibromatosis type 1 could more common than mentioned in the literature.

The aim of this prospective study is to evaluate the results of our total laparoscopic hysterectomy (TLH) cases. Forty one patients underwent TLH due to benign or malign disorders were reviewed prospectively between January 2013 and April 2014. Rigid instruments 10 mm telescope, and advanced bipolar energy modalities were used during the procedure. A primary 10-mm trocar was inserted directly through a 1-cm sub umbilical incision. The laparoscope was inserted through this trocar after insufflation of the abdominal cavity with 3–4 L of CO2. The second and third incisions were performed in the avascular right and left lower quadrant of the abdomen and two ancillary 5-mm trocars were inserted through these incisions. Uterine manipulation was performed by using RUMI® II. During the removal of the specimen, if necessary, intracorporeal myomectomy and morcellation were performed before the uterus and ovaries were delivered intact through the vagina. A 0-Vicryl suture was used for close the vaginal cuff. The sutures were passed through the left and right uterosacral and cardinal ligaments in all patients. All procedures were performed by the same surgeon. The mean age of the cases, body mass indexes (BMI), duration of operations, the amounts of blood loss, rates of complications and post operative hospital stay were assessed. The indications of for hysterectomies were, 16 myoma uteri, 6 medical treatment-resistant abnornal uerine bleeding, 5 benign ovarian cyst, 4 adenomyozis, 3 myoma uteri+ovarian cyst, 2 endometrial polyp, 2 endometrioma, 2 endometrial hyperplasia and 1 early stage cervical cancer. The mean age of patients were 47.5 (30-68 years), mean BMI of patients were 30.2 (24-44), mean specimen weight was 215.9 (90-650 gr), mean operation duration was 107.9 (60-210 min), mean blood loss was 81.1 (30-300 ml), mean preoperative hemoglobin (Hb) was 12.5±0.9 gr/ dl, mean postoperative Hb was 11.5±0.8, and the mean hospital stay was 2.5 (2-4 days). There were no intraoperative complications. Late postoperative complication was vaginal vault infection in 2 cases. Total laparoscopic hysterectomy is safe and feasible method for gynecological diseases. Careful selection of patients is critical for obtaining the best results.

Simple renal cysts are asymptomatic incidental findings; however, for a small subset of benign renal cysts, patients may present with pain, hematuria, urinary infection, pyelocaliceal obstruction or hypertension. Laparoscopic cyst ablation is an effective minimally invasive modality for the treatment of benign renal cyst. Our aim was to show the ultrasonic energy safe and effective method during laparoscopic renal cyst excision. In our clinic 14 patients underwent operated laparoscopic renal cyst excision with transperitoneal approach between January 2006 and February 2010. Trocar port for camera was inserted to the peritoneum in order to open the told line, gerato fascia and fat over the cyst. Harmonic™ scissor with the cautery was used to incise the cyst wall. Mean age of the patients was 58,1 years. Mean operation and hospitalization times were 59,2 minutes and 1,57 days, respectively. We did not need the fourth trocar during operation and the operation was finished. There was no complication in this procedure. Mean follow-up time was years. In long-term follow-up period symptomatic recurrence was observed in one patient and someone else be observed radiologic recurrence. We believe that using ultrasonic device is safe and effective method in laparoscopic cyst decortication. However, prospective controlled trials are needed to evaluate the other energy sources.

Aim: It is aimed to evaluate the necessity of echocardiographic asssesment for the patients in whom the innocent heart murmurs are heard after the cardiovascular system examination. Material and Methods: The files of 466 patients, ages varied between 1 day and 17 years-old, who were performed echocardiographic assessment and referred to our Pediatric Cardiology Outpatient Clinic because of innocent heart murmur due to physical examination, electrocardiography and telecardiograpy between June 2007- December 2007 were evaluated respectively. Result: Patients who have innocent heart murmurs were not detected any important cardiac patology for hemodynamic physiology. Also, when the innocent heart murmurs is evaluated according to types, it is determinated that the most heart murmur is the innocent pulmoner murmur (47,4%). Results: In 69% of the patients who were performed ecocardiographic assesment, minor congenital heart anomalies were establised with any hemodynamic abnormalities and also 12% of them were given infective endocarditis preventive treatment. For this reason; it is determined to be suitable that echocardiographic assesment for the children who are reffered to our outpatient clinic because of heart murmur in physical examination despite the result of innocent heart murmur.

Myocardial bridge(MB) is common congenital anomaly of coronary arteries. Altough MB is generally asymptomatic, it can manifest as angina pectoris, acute myocard infarction, very rarely fatal cardiac arrhythmias and even sudden death. 44 years old man admitted to our cardiology clinic with typical chest pain and signs of anterior ischemia at electrocardiography, coronary angiography was performed and a myocardial bridge which cause total occlusion at mid-segment of left anterior descending artery detected. In this case report we aimed to discuss mechanism of symptoms, medical and invasive theraphy options and long term follow outcomes in MB.

Iron is a medication that is used more in iron deficiency anemia. The use of iron in high doses can cause a multisystemic effect. The toxicity of iron depends upon the amount of elemental iron ingested. The minimum toxic dose and the lethal doses of iron are not firmly established. However, side effects that may be life-threatening are seen on the heart and liver. This paper presents a 16-year-old patient who used 720 mg; 12mg / kg / dose preparation of iron for suicide purposes. The control blood tests performed while planning the discharge of the patient, who had no complaints but were followed up clinically, continued to be followed up because of the increase in the value of troponin. The patient who has no record of physical examination, electrocardiogram (ECG), echocardiography (ECO) and indication for iron chelation and in whose troponin level a decrease was diagnosed in the monitoring was discharged with recommendations. Due to the rare occurrence of cardiac involvement and being the first case reported in our country, the effects of the drug on toxicity were discussed in the light of the literature.

 

Chest pain is a common complaint in children. It doesn’t usually indicate a cardiac problem but it is considered as heartache by the patients and their families. In this article, the patients with chest pain in pediatric cardiology clinic for the last 18 months have been evaluated and the etiology of chest pain has been discussed. The study includes 441 patients with chest pain, who were admitted to the Department of pediatrics, Division of pediatric cardiology, Faculty of Medicine, Selçuk University between May 2011 and November 2012. The data of the patients has been reviewed retrospectively. Medical history and family history of the patients, cardiac physical examination, electrocardiography, echocardiography, 24-hour rhythm holter monitoring, exercise testing and laboratory tests have been evaluated. In our study the mean age of the patients was 11 (5-18 year-old). 217 (49.2%) of the patients were male and 224 (50.8%) of the patients were female. Medical history, physical examination, electrocardiography and echocardiography of all the patients have been evaluated. Cardiac pathology has been recognized in 10 (2.3%) of the patients. The reasons that cause chest pain are idiopathic in 378 (85.7%) patients, psychological in 22 (5%) patients, lung diseases in 20 (4.5%) patients, gastrointestinal disorders in 6 (1.4%) patients, musculoskeletal system diseases in 3 (0.7%) patients, Familial Mediterranean Fever in 1 (0.2%) patient and pectus excavatum in 1 (0.2%) patient. According to this study, the etiology of chest pain in children is extra cardiac factors in majority. Differential diagnosis should be made carefully due to possibility of life threatening consequences of cardiac disorders. If there is no cardiac pathology as a result of medical history, physical examination and laboratory tests the patient and the family should be informed about this.

Aim: Index of cardiac electrophysiological balance (iCEB), calculated as QT interval / QRS duration, has been described as a novel indicator for predicting malignant ventricular arrhythmias. Herein, we aimed to explore the relation of coronary collateral circulation (CCC) degree with iCEB and Tp-e / QT ratio.

Patients and Methods: Forty-four patients diagnosed with chronic total occlusion (CTO) and 55 healthy subjects in comparable age and sex distribution were included. We classified the CTO patients as good (n= 24) and poor (n= 20) collateral groups. Standard 12-lead standard electrocardiogram (ECG) of all patients was recorded and Tp-Te interval, QT interval, QRS duration, Tp-Te/QT ratio and QT/QRS ratio were measured.

Results: Mean Tp-e interval and Tp-e/QT ratio were similar between groups. Also, the groups were comparable regarding iCEB or iCEBc values. In subgroup analysis, there was no relationship between the degree of CCC and ECG parameters including Tp-e/QT ratio, Tp-e and QT/QRS ratio.

Conclusion: There was no significant relationship between the iCEB and Tp-e/QT ratio, and the degree of CCC development in patients having CTO.

The electrocardiography (EKG) is a usefid di-agnostic tool, extensiyely used in either cardiac pa-tient or normal infrequent that abnormal changes are obseryed. When EKG'_ç of the elderly people, not as.sociated with a cardiac disorder, are examined. The this study 400 subjects, having been exa-mined in the outpatient department were involved. The ECG's examined, revealed nn overall «ab-normality rate of % 32. A : 53 abnoı-mality was ob-served. in cardiac patient, whereas %12 of normal subjects clemostrated an abnormal ECG. Moreoyer, these changes in ECGs were not associated with a pathological coııdition.