APRIL 5–8, 2018
20 mg IV prednisolone. On the fifth day of treatment, minimal pericar-
Topic: AJC » Cardiac Imaging -
Echocardiography
PP-612
Acute Pericarditis Due to the Use of Sulphalazine in Rheumatoid
Arthritis Patient. Hakki Simsek, and Ahmet Ferhat Kaya. Dicle
University Cardiyology Hospital, Diyarbakir.
Pericarditis is a life-threatening condition that can be seen in rheu-
matic diseases. It may also depend on the medication used as well as
the disease itself.
A 47-year-old woman was admitted to the emergency department with
complaints of chest pain, palpitation and shortness of breath. 6 years before
methotrexate and corticosteroid treatment were started with diagnosis
RA. And 3 weeks before sulphasalazine treatment was added. Physical
examination showed decreased heart sounds and dyspnea and orthop-
nea. There was minimal ral in the bilateral lung sub-zones. Blood pressure
was 110/70 mm Hg, pulse rate was 96/min and fever was 37°C. His labo-
ratory showed leucocyte: 18,000, Hgb: 11.5 g/dl, platelet count: 365,000,
erythrocyte sedimentation rate (ESR): 34 mm/h, CRP: 18.5 mg/dl. On
ECG we found sinus tachycardia (102/min). Transthoracic
echocardiography revealed pericardial effusion in the moderate to severe
(Figure 1). The patient’s fluid was evacuated with pericardiocentesis. There
was no identified any microorganism in the patient’s pericardiocentesis
fluid and blood cultures. Pericarditis due to sulfalazine use was diagonsed
finally. Sulphalazin therapy was cessasieted and the patient was given
Figure 1.
Figure 2.
® th
The American Journal of Cardiology APRIL 5–8, 2018 14 INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND e161
CARDIOVASCULAR SURGERY / Poster
dial effusion was detected in the ECO (Figure 2).
When symptoms of cardiac disease occur in a RA patient, cardiac in-
volvement associated with drug use should be kept in mind and the drug
should be discontinued immediately.
Topic: AJC » Arrhythmias and
Antiarrhythmic Therapy
PP-622
A Life-Threatening Condition: Hyperkalemia-Induced Complete
Heart Block. Uğur Aksu1, Zakir Lazoglu2, Kamuran Kalkan1,
Selim Topcu2, and Ibrahim Halil Tanboga2. 1Erzurum Regional
Training and Research Hospital, Erzurum; 2Ataturk University,
Erzurum.
Hyperkalemia is a frequently encountered electrolyte abnormality. Peaked
T waves are usually the first ECG findings. If left untreated, progres-
sion of hyperkalemia leads to slowing of conduction, wide, low p waves,
long PR interval, and a wide QRS complex. Ultimately it might cause
malignant ventricular arrhythmias and asystole. Renal dysfunction and
electrolyte imbalances caused by cardiac procedures and chronic medi-
cations may be precipitate hyperkalemia. Therefore physicians should
be aware of this procedures and medications during medical history taking.
In this case, we present a case of malignant AV block resolved by di-
alysis, in a patient who was receiving medical treatment for cardiac failure.
Case report: A 69-year-old female was admitted to the hospital with
a new onset dyspnea. Two months ago, she underwent to coronary an-
giography due to severe coronary artery stenosis and her home drug
regimen included metoprolol 50 mg daily, perindopril 10 mg daily, aspirin
100 mg daily, clopidogrel 75 mg daily and atorvastatin 20 mg daily. The
patient’s vital signs on admission were temperature, 36,4°C; pulse rate,
P
30 beat per minute and regular; blood pressure, 140/90 mm Hg, equal
in both arms. Respiratory rate 24 breaths/minute. She was in acute re-
O
spiratory distress with fluctuating consciousness, oxygen saturation 85% S
while she was breathing room air. Initial ECG showed wide QRS complex
with an S wave that merges with a peaked T wave without an isoelec- T
tric ST segment (Figure 1A). After initial examination patient clinical
and electrocardiographic features hyperkalemia was suspected and calcium
E
gloconate was administered. After a while patient’s heart block was re-
solved (Figure 1B). Laboratory tests revealed a significantly high potassium
R
(K) level (8,1 meq/ml). Patient was immediately transferred to hemo-
dialysis unit for normalization of K levels. Through 3 hours of
hemodialysis, serial control ECGs revealed that hyperkalemia related wide A
QRS complex pattern at a rate of 75 beats per minute were transform-
ing to a normal sinus rhythm at a rate of 95 beats per minute (Figure 1C)
B
as the K levels were brought to normal range. S
T
R
A
C
T
S
Figure 1.

Increasing cardiac interventions and anti hypertensive medication use
are frequently encountered reasons for acute renal failure. Moreover,
cardiac failure may also result in prerenal azotemia. Therefore, cardiac
history, medication use and interventions requiring intravenous con-
trast media are points of interest for emergency room, targeting early
recognition of precipitating factors and prompt initiation of appropri-
ate therapy.
Topic: AJC » Diagnosis and Treatment of
Pulmonary Hypertension
PP-625
Pulmonary Artery Aneurysm. Şahin Karakılıç. Dokuz Eylül
University Hospital, Izmir.
Objective: Pulmonery artery aneurysm is a rare abnormality of pulmo-
nary arteries.1 Etiology of disease are caused trauma, infections, Behcet’s
disease, pulmonary hypertension, congenital heart disease and neoplasm.2
Isolated or idiopathic pulmonary artery aneurysms are more rare.3,4 Big
part of patients are asymptomatic.5 Another part of patients has symp-
toms; cough, hemoptysis, chest pain and the other non-spesific symptoms.
We write this presantation about a patient who has pulmonary artery an-
eurysm with infundibular stenosis.
Methods: This patient is 58 aged women who earlier had aortic an-
eurysm and treated endovascular technique. Her physical examination
was smoothly. Her control echocardiography results are pulmonary arter
aneurysm, pulmonar valv failure, 52/20 mm Hg gradient and pulmonar
stenosis. The next examination was right heart catheterisation angiog-
raphy. Images showed patient’s aneurysms size 7 cm and an infundibular
stenosis. Aneurysm treated a conduit with bioprosthetic pulmonar valv.
P And the infundibular stenosis was repaired with resection. Right ven-
triculotomy closed with bovine pericardium.
O Results: Aortic aneurysm caused a treatment with endovascular re-
paired patient’s control examination showed us an asymptomatic
S pulmonary artery aneurysm. Most rare pulmonary arter aneurysm with
T infindibular stenosis are replaced by a valved conduit. Postoperative process
was smoothly. She discharged with no problem.
E Conclusions: When pulmonary truncus’ diameter is over 30 mm, it’s
called pulmonary artery aneurysm.1 Autopsy results shows 1/14,000 rate
R and it’s a rare disase. Pulmoner artery hypertension, some infections (etc.
tbc, syphilis), syndromes (etc. marfan, hughes-stovin), traumas are related
between pulmonary artery aneurysm. Idiopathic one is more rare than
A others.1–7
Usually it’s asymptomatic, when it shows symptoms, like cough, he-
B moptysis, fever, breath disorders, chest pain, more dangerous.6,7 Most
important complication is disection which cause of death. Thats’s the
S reason why pulmonary artery aneurysm have to fix by surgery.6,7
T preexisting peripheral arterial pathologies can be detected and solved in
1. Shih HH, Kang PL, Lin CY, Lin YH. Main pulmonary artery aneu-
R rysm. J Chin Med Assoc 2007;70:453–455.
A 2. Hammad AM, Al-Qahtani SM, Al-Zahrani MA. Huge pulmoner artery
aneurysm. Can Respir J 2009;16:93–95.
C 3. Bartter T, Irwin RS, Nash G. Aneurysms of the pulmonary arteries.
Chest 1988;94:1065–1075.
T 4. Fang CC, Tsai CC. Idiopathic pulmonary artery aneurysm. J Formos
Med Assoc 1996;95:873–876.
S 5. Zhao YJ, Cheng XS. An analysis of 21 cases of idiopathic dilata-
tion of the pulmonary artery. Zhonghua Nei Ke Za Zhi 1992;31:24–
25.
6. Smalcelj A, Brida V, Samarzija M, Matana A, Margetic E, Drinkovic
N. Giant, dissecting, high-pressure pulmonary artery aneurysm: case
e162 The American Journal of Cardiology® APRIL 5–8, 2018
APRIL 5–8, 2018
report of a 1-year natural course. Tex Heart Inst J 2005;32:589–
594.
7. Yazkan R, Çeviker K. Pulmoner arterin cerrahi gerektiren edinsel
hastalıkları. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2015;23:792–
801.
Topic: AJC » Interventions for Peripheral
Arterial Diseases
PP-632
Endovascular Approach for Acute Limb İschemia: Mechanical
Thrombectomy With Angiojettm Thrombectomy
System. Onur Saydam1, Deniz Serefli1, Aysen Yaprak Engin1,
Mehmet Atay2, and Ayse Gul Kunt1. 1Tepecik Education and Research
Hospital, İzmir; 2Bakırköy Dr. Sadi Konuk Training and Research
Hospital, İzmir.
Acute arterial occlusion (AAO) is defined as a sudden loss of limb per-
fusion and considered a vascular emergency. AAO is associated with
increased morbidity, significant disability, and emergent operation in high-
risk patients. The most common cause is in situ thrombotic occlusion
and initiating event is a preexisting history of peripheral artery disease
(PAD). AAO require emergent vascular surgery consult. Open Surgery
is still the gold standard. However recent advances in endovascular in-
terventions suggest that the endovascular approach can represent an
alternative therapeutic strategy especially high-risk patient with preex-
isting chronic peripheral arterial disease. We present a 65-year-old man,
with a history of chronic obstructive pulmonary disease and peripheral
arterial disease who was consulted to our clinic with 2-day history of
progressive limb pain after radical cystectomy operation. Computed to-
mography (CT) angiography revealed acute left iliac artery and common
femoral artery occlusion. Initially the patient received subcutaneous low
molecule weight heparin. Considering his severe clinical status and pre-
existing peripheral arterial disease, we decided to perform percutaneous
mechanical thrombectomy. Retrograde cannulation of right common
femoral artery and left superficial femoral artery with 7 Fr introducer
sheath. Pelvic arteriography revealed total occlusion of left iliac artery
and common femoral artery occlusion. Under heparinization mechani-
cal thrombectomy with AngioJetTM Thrombectomy System was
performed. After mechanical thrombectomy severe stenosis was de-
tected in left common iliac artery and thromboembolic formation in
common femoral artery. 8 mm × 37 balloon expandable stent was de-
ployed at left common iliac artery and 7 mm balloon angioplasty was
performed at common femoral artery. Control arteriography showed total
revascularization of iliac and femoral arteries and the patients no longer
demonstrated the above-mentioned symptoms. Duration of the proce-
dure was approximately 35–40 min. These less invasive techniques
constitute an option that is bettertolerated in medically compromised pa-
tients. Unlike open surgery during endovascular procedures acute
same session.
Management of Hypertension in Patients with Chronic Kidney
Disease. Burak Sayin. Asst. Prof. Dr, Department of Nephrology,
Baskent University.
Introduction
Chronic kidney disease (CKD) may be described as documented kidney
damage and/or loss of kidney function with a glomerular filtration rate
(GFR) lower than 60 ml/min/1.73m2 for over 3 months of period. Chronic
kidney disease is a growing public health problem that has been affect-
ing more than 500 million people worldwide. CKD has a close and
reciprocal relationship with hypertension, because they are both a cause
14th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY
AND CARDIOVASCULAR SURGERY / Poster