The effect of anabolic androgenic steroids on heart rate recovery index and electrocardiographic parameters in male bodybuilders.

BACKGROUND: The control of the cardiovascular system depends on the autonomic nerve system. Chronic anabolic andorogenic steroids (AAS) use causes sympathovagal imbalance and increases sympathetic nerve activity. OBJECTIVE: The reduction in heart rate from the peak exercise rate following the end of the exercise stress test is known as the heart rate recovery index (HRRI). Several methods have been utilized to assess myocardial repolarization, such as QT interval (QT), corrected QT interval (QTc), and T-wave peak-to-end interval (Tp-e interval). Based on a growing number of data a higher Tp-e/QT ratio is linked to malignant ventricular arrhythmias, and an increased Tp-e interval may correlate with the transmural dispersion of repolarization. Our hypothesis is that the use of chronic AAS was decrease HRRI during maximal exercise and increased risk of cardiac arrhythmias and sudden cardiac death. METHODS: This study included 44 male bodybuilders, with an average age of 29.7 ± 8.14 years, divided into AAS abuse [AAS users (n = 21) and AAS nonuser (n = 23)]. RESULTS: The first (p = 0.001) and second minute (p = 0.001) HRRI of the subjects with AAS users were significantly lower than those of the control group. Additionally, HRRI after the third (p = 0.004) and fifth minutes (p = 0.007) of the recovery period were significantly lower in AAS group compared with the control group. Who used AAS had significantly higher QT, QTc, Tp-e, Tp-e/QT, and Tp-e/QTc values than non-users (all p = 0.001). CONCLUSIONS: Chronic AAS use has been shown to cause sympathetic dominance, which may be a pro arrhythmic state.

A guidewire-free approach for percutaneous closure of left ventricular pseudoaneurysm.

A 78-year-old male patient with a history of coronary artery disease (he had undergone coronary artery bypass surgery 4 years ago), heart failure with mildly reduced ejection fraction, diabetes mellitus, and transient ischemic attack presented to the emergency department with complaints of dyspnea (New York Heart Association Class 4) despite the optimal medical therapy.

In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction in COVID-19 Positive Patients Undergoing Primary Percutaneous Intervention. / Desfechos Hospitalares do Infarto do Miocárdio com Supradesnivelamento do Segmento ST em Pacientes Positivos para COVID-19 que Passaram por Intervenção Percutânea Primária.

BACKGROUND: Concomitant coronavirus 2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) are associated with increased adverse in-hospital outcomes. OBJECTIVES: This study aimded to evaluate the angiographic, procedural, laboratory, and prognostic differences in COVID-19-positive and negative patients with STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: A single-center, retrospective, observational study was conducted between November 2020 and August 2022 in a tertiary-level hospital. According to their status, patients were divided into two groups (COVID-19 positive and negative). All patients were admitted due to confirmed STEMI and treated with primary PCI. In-hospital and angiographic outcomes were compared between the two groups. Two-sided p-values < 0.05 were accepted as statistically significant. RESULTS: Of the 494 STEMI patients enrolled in this study, 42 were identified as having a positive dagnosis for COVID-19 (8.5%), while 452 were negative. The patients who tested positive for COVID-19 had a longer total ischemic time than did those who tested negative for COVID-19 (p=0.006). Moreover, these patients presented an increase in stent thrombosis (7.1% vs. 1.7%, p=0.002), length of hospitalization (4 days vs. 3 days, p= 0.018), cardiogenic shock (14.2% vs. 5.5 %, p= 0.023), and in-hospital total and cardiac mortality (p<0.001 and p=0.032, respectively). CONCLUSIONS: Patients with STEMI with concomitant COVID-19 infections were associated with increased major adverse cardiac events. Further studies are needed to understand the exact mechanisms of adverse outcomes in these patients.

FUNDAMENTO: A infecção concomitante por coronavírus 2019 (COVID-19) e o infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) estão associados ao aumento de desfechos adversos hospitalares. OBJETIVOS: O estudo teve como objetivo avaliar as diferenças angiográficas, de procedimentos, laboratoriais e prognósticas em pacientes positivos e negativos para COVID-19 com IAMCSST submetidos à intervenção coronária percutânea primária (ICP). MÉTODOS: Realizamos um estudo observacional retrospectivo e unicêntrico entre novembro de 2020 e agosto de 2022 em um hospital de nível terciário. De acordo com o seu estado, os pacientes foram divididos em dois grupos (positivo ou negativo para COVID-19). Todos os pacientes foram internados por IAMCSST confirmado e foram tratados com ICP primária. Os desfechos hospitalares e angiográficos foram comparados entre os dois grupos. P-valores bilaterais <0,05 foram aceitos como estatisticamente significativos. RESULTADOS: Dos 494 pacientes com IAMCSST inscritos nesse estudo, 42 foram identificados como positivos para COVID-19 (8,5%) e 452, como negativos. Os pacientes que testaram positivos para COVID-19 tiveram um tempo isquêmico total maior do que os pacientes que testaram negativos para COVID-19 (p = 0,006). Além disso, esses pacientes apresetaram um aumento na trombose de stent (7,1% vs. 1,7%, p = 0,002), no tempo de internação (4 dias vs. 3 dias, p = 0,018), no choque cardiogênico (14,2% vs. 5,5%, p = 0,023) e na mortalidade hospitalar total e cardíaca (p <0,001 e p = 0,032, respectivamente). CONCLUSÕES: Pacientes com IAMCSST com infecções concomitantes por COVID-19 foram associados ao aumento de eventos cardíacos adversos maiores. Mais estudos são necessários para compreender os mecanismos exatos dos desfechos adversos nesses pacientes.

An unusual approach for platypnea-orthodeoxia syndrome due to isolated pulmonary arteriovenous malformations.

A 27-year-old man presented to the emergency department with complaints of syncope, dyspnea, and fatigue. Physical examination revealed left-sided mild hemiparesis, platypnea, and continuous murmur on right middle lobe lung auscultation.

Predictive value of P wave parameters, indices, and a novel electrocardiographic marker for silent cerebral infarction and future cerebrovascular events.

BACKGROUND: Silent cerebral infarction (SCI) is a neuronal injury without a clinically apparent stroke or transient ischaemic attack. Left atrial cardiomyopathy is closely associated with SCI. P wave changes in the electrocardiogram (ECG) provide significant information about the development of atrial cardiomyopathy. This study evaluated the role of P wave parameters and indices and a novel ECG parameter in predicting SCI, future cerebrovascular events, and atrial fibrillation/flutter. MATERIALS AND METHODS: A total of 272 patients were retrospectively screened and divided into two groups according to SCI. Cerebrovascular events and atrial fibrillation/flutter were defined as the study's outcomes. P wave parameters, indices, and a novel ECG parameter called the P wave ratio (PWR) were calculated from ECGs, and the relationship between SCI and outcomes was investigated. RESULTS: The maximum P wave duration (PWD), P wave dispersion (PWdisp), PWD measured from the D2 lead (PWDD2), P wave peak time measured from the D2 lead (PWPTD2), PWPT measured from the V1 lead (PWPTV1), and P wave terminal force (PWTFV1) were significantly longer in the SCI group. Both partial and advanced inter atrial block (IAB) were significantly high in the SCI group. The novel parameter P wave ratio (PWR) was significantly longer in the SCI group (0.55 ± 0.08 vs. 0.46 ± 0.09; p < 0.001). In multivariate regression analysis, PWdisp (OR: 1.101, p < 0.001), PWPTD2 (OR: 1.095, p = 0.017), and PWR (OR: 1.231, p < 0.001) were found to be independent predictors of SCI. Cox regression analysis revealed that the PWR (HR 1.077; 95% CI 1.029-1.128; p = 0.001) was associated with cerebrovascular events and atrial fibrillation/flutter. CONCLUSION: In our study, we observed that PWR could be a valuable parameter for predicting SCI and future cerebrovascular events.

Euglycemic diabetic ketoacidosis associated with ST segment elevation myocardial infarction following SGLT-2 inhibitor therapy.

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the latest approved class of oral antidiabetic agents that inhibit renal SGLT-2 receptors and increase urinary glucose excretion in the luminal membrane of the proximal tubule. Diabetic ketoacidosis (DKA) is a triad of hyperglycemia, ketosis, and a high anion gap with metabolic acidosis. We present the case of 61 years-old men with severe euglycemic DKA (EDKA) complicated ST-segment elevation myocardial infarction following SGLT-2 inhibitor therapy for type 2 diabetes mellitus. Atypical presentation of ketoacidosis without hyperglycemia can delay diagnosis and may result in catastrophic complications. Quick diagnosis, appropriate clinical and biochemical assessment, and effective treatment protocols ensure successful resolution of EDKA.

Prevalence of different echocardiographic abnormalities in a large Turkish workers population.

OBJECTIVE: We aimed to investigate the echocardiographic characteristics of workers with resting major electrocardiography (ECG) anomalies and risk factors of sudden cardiac death in the large Turkish workers population in different heavy industry sectors. METHODS: Between April 2016 and January 2020, 8668 consecutive ECGs were obtained and interpreted during health examinations of working in Istanbul, Turkey. ECGs were classified as major, minor anomaly, and normal according to the Minnesota code criteria. The workers with major anomaly on ECGs, recurrent syncope attacks, and family history (FH) of sudden or inexplicably death under the age of 50 and with a positive FH of cardiomyopathy were also referred to further transthoracic echocardiographic (TTE) examination. RESULTS: The mean age of the workers was 30.47 ± 9.4 years, most of them were male (97.1%) and under the age of 30 (54.2%). Major ECG changes were detected in 4.6%, and minor anomalies were 28.3%. A total of 663 workers were referred to our cardiology clinic for advanced TTE examination, but only 578 (87.17% of the selected) attended the appointment. Four hundred and sixty-seven (80.7%) echocardiography examinations were within normal limits. Echocardiographic imaging revealed abnormal findings in 98 cases (25.7%) in the ECG abnormalities group, three (4.4%) in the syncope group, and 10 (7.6%) in the positive FH group (p < .001). CONCLUSIONS: This work demonstrated the ECG findings and echocardiographic features of a large sample of Turkish workers from high-risk employment sectors. This is the first study conducted in Turkey on this subject.

Role of the coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT in predicting mortality in SARS-CoV-2 infection.

BACKGROUND: The potential effects of cardiovascular comorbidities on the clinical outcomes in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remain unclear. Identification of the coronary and non-coronary cardiovascular findings may help to stratify the patients' prognosis. Therefore, we aimed to evaluate the prognostic impact of the coronary and the non-coronary cardiovascular findings in SARS-CoV-2 patients. METHODS: We studied a total of 594 SARS-CoV-2 patients who were hospitalized and performed a non-cardiac gated thoracic computed tomography. Two blinded radiologists assessed the coronary artery calcification segment involvement score (CACSIS) and non-coronary atherosclerosis cardiovascular findings (NCACVF). The baseline characteristics of the patients and CT findings were evaluated according to survival status. Logistic regression analyses were performed to identify the independent predictors of mortality. RESULTS: At a mean follow-up of 8 (4-12.5) days, 44 deaths occurred (7.4%). Compared to survivors, non-survivors had increased CACSIS [27.3% (CACSIS = 0) vs 25% (CACSIS 1-5) vs 47.7% (CACSIS >5), p < 0.001]. Similarly, on NCACVF, non-survivors had much more major findings compared to survivors (29.5% vs. 2.7%, respectively, p < 0.001). At multivariable analysis, age (p = 0.009), creatinine (p < 0.001), hs-cTnI (p = 0.004) and NCACVF (HR 1.789; 95% CI 1.053-3.037; p = 0.031) maintained a significant independent association with in-hospital mortality. CONCLUSION: Our study shows that coronary and non-coronary cardiovascular findings on non-cardiac gated thoracic CT may help to predict mortality in patients with SARS-CoV-2 infection.

Electrocardiographic Findings and Anomaly Frequency in Turkish Workers Groups: A Cross-sectional and Observational Study.

OBJECTIVE: Although electrocardiography scanning is routinely performed during the employ ment of employees in business sectors and during periodic controls, there is no large-scale study in our country that scans these electrocardiography data. The purpose of this study was to analyze the resting electrocardiography properties and basal clinical characteristics of the worker groups in a wide age range working in different business lines in the heavy industry sector. METHODS: Between April 2016 and January 2020, 9102 consecutive electrocardiographs were obtained during health examinations of working in Istanbul. In this study, 8607 electrocardio graphs suitable for interpretation were included. Electrocardiographs were classified by 2 dif ferent cardiologists as major, minor anomaly, and normal according to the Minnesota code criteria. RESULTS: Average age of the population was 30.47 ± 9.4 and 97% were males. A completely normal ECG was detected in 67.6%. Major electrocardiograph changes were detected in 4.6%, and minor anomalies were detected in 28.3%. Being 50 years older (P < .001) and working in a heavy chemical industry (P=,014) was found to be associated with major anomaly on elec trocardiograph. In the multiple logistic regression analysis, the business line and electrocardio graph were found to be independently associated with major and minor anomalies (P=,022) Conclusion: This study shows the electrocardiography findings of a large sample of Turkish workers from high-risk employment sectors. Electrocardiograph abnormalities were observed more frequently in heavy chemical industry and those who were 50 years and older. This is the first study conducted in Turkey on this subject.

The frequency of aspirin resistance and its risk factors in patients with metabolic syndrome.

BACKGROUND: Although different populations were examined for the incidence of aspirin resistance, the frequency and related risk factors for aspirin resistance in patients with metabolic syndrome have not been reported yet. This study aimed to determine the frequency of aspirin resistance and its risk factors in patients with metabolic syndrome. METHODS: We performed a cross-sectional study in 110 patients with metabolic syndrome. After one week of 100 mg/day aspirin, blood samples were obtained. Platelet function analyzer (PFA-100) was used to determine the frequency of aspirin resistance. Endothelial functions, carotid intima media thickness, and the presence of plaques in the carotid arteries were evaluated for subclinical atherosclerosis and the levels of inflammatory markers were assessed as risk factors for aspirin resistance. The presence of subclinical atherosclerosis was defined as a maximum carotid intima media thickness of > or = 0.9 mm and/or the presence of carotid atheroma. RESULTS: Aspirin resistance was detected in 21.9% of the patients. In the multivariate analysis, hs-CRP levels (odds ratio [95% CI]=2.8 [1.3-5.9], p=0.009), diastolic blood pressure, (0.9 [0.8-1.0], p=0.007), and the presence of subclinical atherosclerosis (4.1 [1.4-12.2], p=0.012) were statistically significant risk factors for aspirin resistance. CONCLUSIONS: We concluded that the frequency of aspirin resistance confirmed in this cohort of patients with metabolic syndrome was higher in patients with a lower diastolic blood pressure, higher hs-CRP levels and atherosclerotic changes in their carotid arteries.