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Takotsubo cardiomyopathy(TCM) is a reversible cardiomyopathy characterized by left ventricular dysfunction due to transient left ventricular apical hypokinesia or akinesia and basal hyperkinesis following some trigger factors like physical or emotional stressful events and may mimic myocardial infarction especially in middle age females. Pathophysiology of TCM is not clear but it is associated with excessive adrenergic stimulation[1-3]. TCM is usually precipitated by acute physical and emotional stresssors, use of exogenous catecholamines or exacerbation of chronic illnesses like asthma attack. We report a case of TCM after an asthma attack as a potential stressor. This is an interesting association between asthma attack and TCM.

BACKGROUND: Low vitamin D status has been associated with increased risk of cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia. We evaluated the association between low vitamin D and AF. METHODS: We analyzed data from 162 Chinese patients with nonvalvular persistent AF and no other cardiovascular disease whose serum 25‐hydroxyvitamin D [25(OH)D] levels were measured in our hospital (AF group). Healthy subjects without AF who underwent health screening at our hospital served as controls (non‐AF group, n = 160). 25(OH)D was measured by chemiluminescence assay. RESULTS: The serum 25(OH)D level was significantly lower in the AF group than in the non‐AF group (18.5 ± 10.3 vs 21.4 ± 10.7 ng/mL, P < 0.05). The high‐sensitivity C‐reactive protein (hsCRP) level was significantly higher in the AF group than in the non‐AF group (0.35 ± 0.19 vs 0.2 ± 0.17 mg/dL, P < 0.01). The average left atrial diameter was significantly larger in the AF group than in the non‐AF group (P < 0.01). The serum 25(OH)D level showed a negative correlation with left atrial diameter, hsCRP level, and pulmonary artery systolic pressure. Logistic regression analysis identified that 25(OH)D was related to AF. Patients whose vitamin D levels were in the lowest 25(OH)D category (30 ng/mL). CONCLUSIONS: Low vitamin D levels are associated with AF. It may be involved in its development.

Snakebites are common in people living or working in rural area. Military personnel are among the risk groups for viper envenomation. In this study, we presented seven cases of vipera snakebites in military personnel and discussed how to minimize functional loss and maximize the outcome. All of the bites were located in extremities and 5 were at hands. All patients were admitted at the day of snake bite which is an indicator of good triage. Hematological complications were the most common systemic complications. Antivenom therapy was performed according to the severity of the envenomation. Local wound care, grafts and flaps were used for wound coverage. Pit viper envenomation can cause serious morbidity in military personnel especially at hot climates. A suspicion of snake bite must be managed properly. Triage is the most important step to reduce the morbidity. Almost all snake bites occur in extremities, thus protective measurement must be taken especially for hands. [TAF Prev Med Bull 2012; 11(2.000): 127-130]

Dear Editor, We have read the article “Epicardial fat thickness(EFT) in patients with rheumatoid arthritis” written by Erdem et al. with a great interest.1 The authors aimed to explain the relationship between epicardial fat thickness and clinical and echocardiographic parameters in patients with rheumatoid arthritis. They concluded that EFT as an indicator of cardiovascular involvement was higher in rheumatoid arthritis patients. Thanks to the authors for their contribution of the present study which is successfully designed and documented. Epicardial tissue makes active endocrine organ function which produces several markers involved in oxidative stress, endothelial dysfunction, atherosclerosis and inflammation,2,3. Increased epicardial adiposity can lead to cardiovascular diseases due to endocrine actions that include increased production of reactive oxygen species, atherogenic and inflammatory cytokines. Various studies have highlighted EFT is also clinically related to hypertension, type 2 diabetes, metabolic syndrome, dyslipidemia, nonalcoholic fatty liver disease, and chronic kidney disease. EFT is also a cardiometabolic risk factor in various inflammatory diseases and is also independently associated with psoriasis.4 EFT may be included among the clinical parameters associated with OSA severity. The association of EFT with OSA, both cardiovascular risk factors, is independent of obesity as defined by classical measures5. Echocardiographic epicardial fat measurement in both clinical and research scenarios has several advantages, including its low cost, easy accessibility, rapid applicability, and good reproducibility. However, more evidence is necessary to evaluate whether echocardiographic epicardial fat thickness may become a routine way of assessing cardiovascular risk in a clinical setting6. In present study, EFT was calculated on the free wall of the right ventricle in the still images obtained at end diastole the parasternal long-axis view, using the aortic annulus as an anatomic reference. However, second image as short axis view may be add useful information about EFT values. Then, the mean value of two images obtained in the parasternal long-axis and short-axis views should be measured. Secondly, the echocardiography method might not be the optimal technique for quantification of epicardial tissue. The gold standard in evaluating EFT is magnetic resonance imaging (MRI); the lack of MRI use is one of the limitations of the present study. After that, because echocardiography measures EFT linearly, echocardiographic EFT may not reflect the total epicardial fat volume exactly. EFT has a 3-dimensional distribution and two-dimensional echocardiography cannot give adequate window of all cardiac segments especially in obese subjects and is highly dependent on acoustic windows2. In this point of view, it would be better to give interobserver and intraobserver variability for EAT measurement in the current study7. As a conclusion, EFT may provide information to clinicians about the systemic inflammation. So, we believe that these findings will evaluate further studies about EFT on cardiovascular risk in systemic inflammatory disease patients.

In the present study, the association between red cell distribution width (RDW) with functional significance of intermediate coronary artery lesions was investigated.Two hundred and forty-six consecutive patients, 168 males and 78 females, who underwent fractional flow reserve (FFR) measurement for angiographically intermediate coronary stenosis (40-70% in quantitative coronary analysis) in the left anterior descending coronary artery were enrolled into the study. The functional significance of intermediate coronary artery lesions was determined by FFR measurement. An FFR value0.75 was defined as functionally significant. Venous blood samples were taken within 48 h before the FFR measurement, and RDW levels were determined by a Coulter LH Series hematology analyzer. Logistic regression analysis was used to examine the association between functional significance in FFR measurement and other variables.Of the 246 patients, 62 (25.2%) exhibited significant functional stenosis (FFR0.75) in the FFR measurement. The mean RDW level was significantly higher in patients with significant stenosis (14.19 ± 0.73 vs. 13.69 ± 0.77, p0.001). In stepwise multivariate logistic regression analysis, RDW (OR = 2.489, 95% CI = 1.631-3.799, p0.001) and male gender (OR = 2.826, 95% CI = 1.347-5.928, p = 0.006) were independent predictors of significant functional stenosis.Increased RDW levels were associated with functional significance of angiographically intermediate coronary artery stenoses.

Amiloidosis is most fatal complication of FMF. Former studies recognize that endothelial functions were severely impaired in patients who have amyloidosis than the patients who have other glomerulopathies. Asymmetric dimethyl arginine (ADMA), the endogenous inhibitor of nitric oxide synthase is possibly a causative or predictive factor in endothelial dysfunction in humans.