A b s t r a c t Background and aim:We aimed to investigate the role of the Duke treadmill score (DTS) in predicting the presence and severity of coronary artery disease (CAD) by using the SYNTAX score (SS), and also to determine the cut-off value of DTS for both the presence and severity of CAD.
An 83-year-old female patient was admitted to the emergency department with progressive dyspnea and orthopnea for 3 days. She was discharged with warfarin therapy (5 mg per day) due to pulmonary embolism 5 months previously. On admission she was orthopneic and tachypneic. Her arterial blood pressure was 90/60 mmHg and heart rate was 115/min with sinus rhythm. On cardiac auscultation, S1 and S2 intensity were decreased, and pathologic murmur and pericardial friction were not observed. Other physical examination findings were unremarkable. An increased cardio-thoracic ratio was revealed on chest X-ray ( Figure 1a). Decreased QRS voltage and sinus tachycardia was evaluated on electrocardiogram. The internalised normalised ratio (INR) level was 8.6 and the prothrombin time was 70 seconds. Haemoglobin was determined to be 11.1 g/dL. The other laboratory findings were normal. An emergency thoracic computed tomography (CT) scan was performed to exclude recurrent pulmonary embolism, and surprisingly showed a massive pericardial effusion (Figure 1b). However, echocardiography revealed severe pericardial effusion that was compressing the right ventricle. Therefore, vitamin K and fresh frozen plasma infusion were administered promptly. As a result, the INR was decreased to 1.4 and 800 mL haemorrhagic fluid was drained percutaneously (P/S) with the apical approach. The patient's blood pressure, orthopnoea and dyspnoea improved dramatically. There was no other source of bleeding except haemopericardium. Consequently, the cardiac tamponade in our patient, secondary to haemopericardium, was considered to be the result of the incorrect dosage of Warfarin. Spontaneous Isolated Pericardial Tamponade Associated with Warfarin
Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: ≥50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5±3.1 years) aged ≥80 years and 4596 patients (male, 50.2 %; mean age, 71.1±4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were ≥80 years and 27.1% for patients 65–79 years old. For patients aged ≥80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p<0.01), whereas CAD had a higher prevalence in the HFrEF group (p=0.02). Among patients aged 65–79 years, 43.9% (548) had HFpEF, and 56.1% (700) had HFrEF. In this group of patients aged 65-79 years with HFrEF, the prevalence of DM was significantly higher than in patients aged ≥80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.
Axitinib is a novel tyrosine kinase inhibitor which is a second-line option for the treatment of metastatic renal cell carcinoma with progression after previous therapy (1, 2). We present the first reported case of acute myocardial infarction in a patient receiving axitinib.In July 2010, a 40-year-old male with no history of smoking, hypertension, diabetes or hypercholesterolemia, and no family history of coronary artery disease, underwent right nephrectomy due to renal cell carcinoma. Chest computed tomography, at the time of diagnosis, revealed the presence of multiple nodules in both lung areas, the largest of which was in the right middle lobe measuring 1.2 cm. Pathologic examination of a transbronchial lung biopsy showed metastatic clear-cell type renal cell carcinoma. Abdominal magnetic resonance imaging detected no metastatic lesion. Normal bone scan was observed in technetium-99m methylene diphosphonate scintigraphy. Whole-body fluorodeoxyglucose positron emission tomography imaging exhibited increased uptake in proven metastatic pulmonary lesions while the rest of the body showed physiological distribution. Transthoracic echocardiography documented normal left ventricular systolic and diastolic function, and normal valvular structures. Adjuvant systemic therapy was initiated to treat residual metastatic disease. After the failure of three consecutive chemotherapeutic agents (interpheron-alpha for 3 months, everolimus for 2 years, sunitinib for 1 year, consecutively), treatment with oral axitinib was started at Ordu State Hospital, in November 2013. One week after beginning axitinib, he developed chest pain with sudden onset. The electrocardiogram (ECG), which was recorded during chest pain, demonstrated ST segment elevation in leads II, III, aVF and V3 to V6, reciprocal ST depressions in lead I, aVL, and third-degree atrioventricular block. On physical examination, there were no abnormal findings. The patient was diagnosed with acute myocardial infarction of inferolateral wall, and transthoracic echocardiography showed mildly hypokinetic myocardium (involving the right coronary artery territory), with an estimated left ventricular ejection fraction of 55%. After pretreatment with clopidogrel (600 mg of oral loading dose), aspirin (300 mg, oral) and heparin (10000 U, intravenous), he was immediately transferred to the catheter laboratory for a primary percutanous coronary intervention. Coronary angiography revealed that the right coronary artery (RCA) was totally occluded by a thrombus in the proximal segment, while the left main, the left anterior descending and the circumflex artery showed no significant stenosis. After successful wire crossing in the RCA, the totally occluded lesion was pre-dilated with a 2.5 x 15 mm balloon at 10 atms. Subsequently, 3.0 x 20 mm bare-metal stent was implanted at 15 atms and thrombolysis in myocardial infarction (TIMI) 3 flow was achieved. The patient's symptoms were relieved, and ST elevations on ECG regressed. A week after the procedure, he was discharged from the hos...
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