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Cil: CHA2DS2-VASc (srdecni selhani, hypertenze, věk > 75 let, diabetes mellitus, cevni mozkova přihoda v anamneze, cevni onemocněni, věkove rozmezi 65-74 let, pohlavi) a HAS-BLED (hypertenze, abnormalni funkce ledvin/jater, cevni mozkova přihoda, nestabilni INR, starsi osoby, drogy/alkohol) jsou skorovaci systemy, s jejichž pomoci lze hodnotit možnost vzniku cevni mozkove přihody a krvaceni při fibrilaci sini. Cilem nasi studie bylo posoudit vztah mezi implantovatelnými kardiovertery-defibrilatory (ICD) a hodnotami skore CHA2DS2-VASc a HAS-BLED. Metody: Po kontrole udajů o pacientech starsich 18 let, jimž byl v obdobi 2014-2019, bez ohledu na důvod, implantovan ICD a u nichž bylo zjistěno, že jejich kardiostimulator byl alespoň dvakrat zkontrolovan v půlrocnim intervalu, bylo do nasi retrospektivni studie zařazeno celkem 398 pacientů. Skore CHA2DS2-VASc a HAS-BLED byla vypoctena během implantace zařizeni a při poslednim kontrolnim vysetřeni. Výsledky: Lecba s použitim ICD se provaděla u 148 pacientů (vhodný výboj [n = 118] a nevhodný výboj [n = 30]); ICD nemělo implantovano 250 pacientů. Skore CHA2DS2-VASc a HAS-BLED byla v obou skupinach podobna (p = 0,64, resp. p = 0,60). Skore CHA2DS2-VASc a HAS-BLED byla při delce sledovani s medianem 5,5 roku u pacientů s vhodným a nevhodným výbojem podobna (p = 0,89, resp. p = 0,85). Podle multivariacni regresni analýzy jsou nezavislými rizikovými faktory lecby pomoci ICD snižena ejekcni frakce, použiti jednodutinoveho ICD a dlouhodobý odstup od implantace (p < 0,05). Zavěry: Hodnoty CHA2DS2-VASc a HAS-BLED nejsou spojeny s lecbou pomoci ICD. © 2021, CKS.

İntroduction: Pulmonary embolism is a common cause of death among emergency department admissions, and it has a high mortality and morbidity rate. Etiological reasons are generally associated with immobility. Radiological imaging methods are at the forefront in diagnosis. Anticoagulant and thrombolytic therapy may be preferred in treatment according to the hemodynamic condition of the patient. Case report: A 56-year-old female patient admitted to the emergency department with sudden onset of dyspnea and syncope with a condition of cardiogenic shock, and echocardiography revealed an enlargement of the right heart chambers and impaired functions, and a tomography was performed with the pre-diagnosis of pulmonary embolism. When systemic thrombolytic therapy was contraindicated in the patient who had embolism on tomography, catheter-based thrombectomy and selective low-dose thrombolytic therapy to the pulmonary artery were administered. The patient, who became hemodynamically stable and his shock condition improved, was discharged with anticoagulant therapy. Conclusion: When left untreated, pulmonary embolism is a disease with a high mortality rate. Although systemic thrombolytic treatments are contraindicated in some patients, successful results can be obtained with locally effective interventional treatments in these patient groups. Keywords: Pulmonary embolism, catheter-based thrombolysis, thrombolytic therapy

SUMMARY OBJECTIVE: Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet. METHODS: We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients’ ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed. RESULTS: Although P maximum was not different between the groups’ ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively). CONCLUSION: The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period. RESUMO OBJETIVO: Diferentes parâmetros de eletrocardiograma (ECG) têm sido investigados para predizer mortalidade e arritmia em pacientes com embolia pulmonar aguda (EPA). O efeito agudo da terapia trombolítica (TT) nesses parâmetros ainda não foi investigado. MÉTODOS: Examinamos os dados de 83 pacientes avaliados com EPA de alto risco e que receberam alta hospitalar após TT. Primeiramente, comparamos os ECGs dos pacientes com EPA de alto risco com os de indivíduos saudáveis (n = 55). Os ECGs dos pacientes com EPA foram comparados logo após a internação e 24 horas mais tarde. A frequência cardíaca, a morfologia da onda P, a duração do QRS, o intervalo QT, Tp-e e o índice de equilíbrio eletrofisiológico cardíaco (iCEB) foram analisados. RESULTADOS: Embora o valor máximo de P não tenha sido diferente entre os grupos no ECG, a frequência cardíaca, QT, intervalo QTc (QT corrigido), intervalos Tpe, razão TP-e/QT e dispersão da onda P foram significativamente mais elevados no grupo de EPA (valores de P < 0,031). Os valores do iCEB ou iCEBc (iCEB corrigido) foram inferiores no grupo de APE (P < 0,001). Após a TT, observamos uma diminuição da frequência cardíaca, do intervalo TP-e e da razão TP-e/QT ( P < 0,001). Apesar de termos observado uma diminuição do intervalo QT e QTc e da dispersão do QT (QTd), o valor de QTd não apresentou uma diferença estatisticamente significativa (respectivamente, valor de P 0,013, 0,029 e 0,096). Os níveis do iCEB e iCEBc foram menores após a TT (valor de P 0,035 e 0,044, respectivamente). CONCLUSÃO: Os valores de QT, QTc, intervalo Tp-e, razão Tp-e/QTc, iCEB e iCEBc diminuíram significativamente após TT. Pode-se concluir que a TT eficaz causa uma melhora parcial da repolarização ventricular no período inicial.

İntroduction: Aortic dissection is a disease with high mortality, which is characterized by a tear in the aortic wall. Thanks to early diagnosis and treatment, patients' survival rates are high. Chest pain is the most common symptom. Imaging methods help in diagnosis. Its treatment is surgery. Case report: A 47-year-old male patient was admitted to the emergency department with chest pain. The diagnosis of aortic dissection in computed tomography was evaluated as motion artifact and valve motion, and he was asked to be discharged from the emergency service after his diagnosis was missed. However, transesophageal echocardiography was performed because of the patient's clinical symptom and echocardiographic findings supported the aortic dissection. When a dissection flap was seen in transesophageal echocardiography, the patient was transferred to surgery. In surgery, a dacron graft was placed in the patient's aorta and a prosthetic valve was placed on the aortic valve, and left main coronary repair and right coronary is bypass were performed. The patient was discharged without any problem. Conclusion: Aortic dissection is a clinical diagnosis, it is a disease with high mortality. Imaging methods are helpful in diagnosis, but the fact that imaging methods rule out dissection does not always rule out the disease. The important thing is to suspect the disease and to consider the patient's current clinical symptoms and signs.

Although elevated red blood cell distribution width (RDW) is associated with adverse outcomes in patients with cardiovascular disease, its role in demonstrating the presence and extent of myocardial ischemia for coronary artery disease is not known. The purpose of this study is to investigate the relationship between RDW and myocardial ischemia by using dobutamine stress echocardiography (DSE).A total of 917 patients were included in this prospective study. A complete blood analysis was performed for RDW before DSE. According to DSE results, patients were divided into two groups: DSE negative and DSE positive. According to the number of ischemic segments in DSE, patients were divided into three groups: no-ischemic segment, 1-3 ischemic segments, and ≥4 ischemic segments. In addition, coronary angiography results of DSE-positive groups were assessed in respect of RDW.The RDW of the DSE-positive group (n=277) was higher than for the DSE-negative group (n=640) (13.5±1.5 vs. 12.7±1.3%, P0.001, respectively). Elevated RDW values were also related to higher number of ischemic segments (no-ischemic segment group: 12.7±1.3, 1-3 ischemic segments group: 13.2±1.5, and ≥4 ischemic segments group: 14.2±1.3, P0.001). A receiver operating curve analysis showed a cut-off value of RDW greater than 13.5% for predicting myocardial ischemia (sensitivity: 57.0%, specificity: 77.8%, positive predictive value: 52.7%, negative predictive value: 80.7%). In addition, positive predictive value of DSE was increased from 82.4 to 94.2% for detecting coronary artery disease by coronary angiography, when RDW (13.5%) was used.RDW is related to the presence and extent of myocardial ischemia in DSE. A high RDW increases the diagnostic accuracy of DSE.