Therapeutic single-dose mirtazapine-induced symptomatic bradycardia: a case report Cardiotoxicity is an important adverse effect of some psychotropic drugs. However, cardiac side effects with mirtazapine, which is used for an effective treatment of depression and anxiety, are rare. In this article, a forty-eight-year-old woman referred to psychiatric clinics with depressive symptoms. According to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria, major depressive disorder was diagnosed and mirtazapine 30mg/day was started. 30 minutes after the first dose of mirtazapine was brought to the emergency room with syncope, nausea, vomiting. She was examined in emergency service. Routine blood tests and ECG was studied. During the examination, the patient was followed up with a heart rate of 33 beats per minute, blood pressure arterial 80/50mmHg and a temperature of 36.1°C. 0.5mg atropine IV and theophylline inhaler were administered and cardiology consultation was requested. After atropine and theophylline administration, the heart rate was 48 beats/min in the second ECG. To the best of our knowledge, it is the first bradycardia developed after mirtazapine use in the literature. Bradycardia has been resolved after the half-life of mirtazapine has passed (37 hours for women). The initial heart rate of our patient was within normal limits prior to mirtazapine administration. There was no reason to explain bradycardia, we think that symptomatic bradycardine is caused by mirtazapine. In conclusion, this case report suggests that mirtazapine may cause bradycardia in patients. Risk factors for bradycardia caused by mirtazapine are unknown. Although in many patients this bradycardine does not cause a clinical outcome, clinicians should be aware of this and should perform ECG monitoring in patients with underlying cardiac disease, especially when prescribing mirtazapine.

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Introduction Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. Methods Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. Results Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. Conclusion The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.

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The Brugada syndrome is one of the common causes of sudden cardiac arrest in healthyappearing adults. The use of drugs in the treatment of this disease may give variable and unwanted results. Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioural disorder which has begun to be noticed in adults as much as children. In our case, we present a 39-year-old male patient with an ADHD who was diagnosed with the Brugada syndrome during a routine examination and we discuss the treatment of this case. The association of ADHD and Brugada syndrome has not been previously reported in any clinical study. As far as we know, the present case is the first article in the literature to discuss the follow-up and treatment of ADHD in a patient with the Brugada syndrome. We observed all medical and non-medical treatment methods for ADHD treatment and discussed these methods such as psychostimulants, atomoxetine, bupropion, and psychotherapy.

Objective: The transthoracic echocardiography (TTE) is the primary method to evaluate the right ventricular (RV) functions, but the assessment of the RV by TTE can be difficult due to the complex structural and anatomical position of the RV. The transesophageal echocardiography (TEE) is a good alternative to TTE when faced with difficulties in obtaining images. In this study, we investigated the agreement between TTE and TEE for the evaluation of the RV functions.Material and Methods: This study was carried out on 78 patients between January 2017 and May 2017. The TTE and TEE records of the patients were compared by using Bland Altman analysis, and the mean difference and confidence interval between them were analyzed.Results: Seventy-eight patients were involved in this study. The mean age of patients was 42 years, and 34% of the participants were female. In Bland Altman analysis, there was a moderate agreement between TTE and TEE in terms of mean difference of the E velocity, the A velocity, E’, A’. In contrast, there was a good agreement between TTE and TEE in terms of mean difference of RV strain, RV strain rate E, RV strain rate A, RV strain rate S which means that it could be appropriate to use them interchangeably.Conclusion: The deformation parameters are essential for analyzing the RV functions, making a clinical decision, and estimating adverse events. The deformation parameters measured using TEE may yield information as accurate and useful as those measured using TTE, and they may be used interchangeably in making a clinical decision.