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The article presents a case study of a 39-year-old female who admitted to hospital because of drowsiness, and her electrocardiography (ECG) results showed complete atrioventricular block and heart rate of 16-19 beat per minute (bpm), and also diagnosed with severe acidosis which caused cardiac complications. It mentions that her relative found an empty drug acetazolamide box. It informs about bicarbonate treatment for metabolic acidosis resulting from acetazolamide intoxication.

Competing Interests: None.

Background and Aim of the Study: New, quantitative, reliable and practical echocardiographic parameters are required for grading the severity of mitral regurgitation (MR). Thus, an investigation was made of tissue Doppler imaging (TDI) parameters in MR patients with a preserved left ventricular ejection fraction (LVEF)., Methods: Transthoracic echocardiography was performed in 96 consecutive patients with varying degrees of MR but with a preserved LVEF. In addition, TDI-derived systolic velocities of the mitral and tricuspid annulus were recorded. The results obtained were compared with those from 31 age- and gender-matched healthy controls., Results: The study patients were classified according to MR severity: mild-moderate (n = 65) or severe (n = 31). Although isovolumic myocardial acceleration (IVA) and peak myocardial velocity during isovolumic contraction (IVV) showed similar values in all groups, the acceleration time (AT) was higher in the severe MR group than in mild or moderate MR patients (p < 0.001). The AT cut-off value to predict severe MR was 35 ms (sensitivity 74.2%, specificity 58.5%)., Conclusion: AT has the potential to differentiate severe MR from non-severe MR in patients with a preserved LVEF. These findings suggest that TDI of the mitral annulus might serve as a novel method for assessing MR severity.

Congenital absence of the pericardium is a rare cardiac defect with variable clinical presentations and is usually discovered incidentally. The pathology may lead to serious complications such as incarceration of cardiac tissue, myocardial ischemia, aortic dissection or valvular insufficiency. Diagnosis is not difficult so long as some tips are remembered. We present the cases of two patients with congenital absence of left pericardium.

A 54-year-old man was transferred to our emergency department because of acute inferior myocardial infarction. However, ST-segment elevation resolved after intravenous nitrate administration on admission and coronary angiography revealed a nonobstructive atherosclerotic plaque at the mid-portion of the circumflex artery and a giant tortuous fistula from the right sinus of Valsalva to the superior vena cava. The patient was diagnosed with variant angina and coronary arteriovenous fistula after vasodilator treatment and maximal treadmill stress test. After effective medical treatment of variant angina and successful percutaneous coil embolization of the fistula, the patient had not experienced any angina episodes for 1 year. However, control coronary angiography revealed partial persistence of fistula flow because of new collateral vessels, bridging distal and proximal parts of the occluded segment. We present the first coexistence of coronary to superior vena cava fistula and variant angina in the literature. This report also shows the ability of coronary fistulas to develop collateral vessels, like coronary arteries.

A 41-year-old male bodybuilder was admitted with acute inferior myocardial infarction. The patient had been using oxymetholone and methenolone to increase his performance for 15 years and quitted smoking three years before. He underwent successful primary percutaneous coronary intervention (PCI) and bare metal stenting for total occlusion of the proximal right coronary artery. Angiography also showed a critical lesion in the left anterior descending (LAD) coronary artery. Five hours after primary PCI, the patient had severe right flank pain. Abdominal computed tomography showed a large renal infarction in the right kidney. Subcutaneous enoxaparin was added to dual antiplatelet treatment. Doppler renal ultrasound performed on the eighth day showed findings of reperfusion in the right kidney and normal-size kidneys. Transthoracic echocardiography demonstrated disappearance of previously detected thrombus remnant in the left ventricle and only mild hypokinesia around the apical and middle segments of the inferior and inferoseptal walls. The patient was discharged on the 10th day. Renal arteriography during elective LAD intervention 18 days after discharge showed complete revascularization, stent patency, and improved blood flow. This is the first case of renal infarction that developed in the early hours of primary PCI, despite effective anticoagulant and antiplatelet treatment. Intensive coronary artery and left ventricular thrombi may be explained by the use of anabolic steroids.