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PP-230 SPONTANEOUS RETROPERITONEAL HEMATOMA AFTER TREATMENT WITH STREPTOKINASE FOR ACUTE MYOCARDIAL INFARCTION: A CASE REPORT
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Posters / International Journal of Cardiology 155S1 (2012) S129–S227
of platelets by enhancing expressions of glycoprotein IIb-IIIa and P-selectin on platelet surface. Thus, dual antiplatelet therapy with acetylsalicylic acid and clopidogrel might not prevent future cardiovascular events associated with cannabis smoking. PP-229 MEAN PLATELET VOLUME COULD NOT PREDICT INFARCT SIZE IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCT ¨ urk ¨ u¨ 1 , S.S. Ayhan1 , S. Ozt ¨ 1 , I˙ . Do˘gan2 , K. Karaman3 , A. Erdem1 , F. Ozl 1 1 M. Yazıcı . Abant Izzet Baysal University, Faculty of Medicine, Department of Cardiology, Bolu Turkey; 2 Karadeniz Technical University, Faculty of Medicine, Department of Nuclear Medicine, Trabzon, Turkey; 3 Kahramanmaras¸ Public Hospital, Department of Cardiology, Kahramanmaras,¸ Turkey Objective: Increased mean platelet volume has been shown to associate with acute coronary syndromes, mortality following myocardial infarction and impaired reperfusion. We investigated the relationship between scintigraphic infarct size and mean platelet volume after acute ST elevation myocardial infarction (STEMI), which has not been adequately studied with imaging tools. Methods: Fifthy-four consecutive patients with acute STEMI (31 patients with anterior and 23 patients with inferior) were included in the study. In all cases, venous peripheral blood samples for hematologic and biochemical measurements were drawn. Mean platelet volume, creatine kinase-myocardial band protein (CKMB protein), and cardiac troponin (cTnT) were obtained at admission and daily during the first 72 h after a patient’s arrival. Single photon emission computed tomography studies were performed at a median interval of 4 days (range, 3–5 days) after the acute STEMI. The severity scores of perfusion defects were calculated. Results: Peak CKMB-protein, peak cTnT were positively correlated with, scintigraphic infarct size but mean platelet volume was not correlated with scintigraphic infarct size (P = 0.021, P < 0.0001, P = 0.839 respectively). There were no statistical correlations all three parameters on the second and third days (P > 0.05). Conclusions: Our study suggests that there is no direct relationship between mean platelet volume and myocardial infarct size. There is no statistical evidence that this parameter is related to size of infarct. Thus, mean platelet volume does not predict of infarct size. PP-230 SPONTANEOUS RETROPERITONEAL HEMATOMA AFTER TREATMENT WITH STREPTOKINASE FOR ACUTE MYOCARDIAL INFARCTION:A CASE REPORT 1 E. Buy ¨ ukkaya ¨ , F. Karakas¸ 1 , M. Gung ¨ or ¨ 1 , H. Bayaro˘gulları2 , 1 1 1 A.B. Akcay ¸ , P. Bilen , N. Sen ¸ , M. Kurt1 . 1 Mustafa Kemal University Faculty of Medicine, Department of Cardiology, Hatay, Turkey; 2 Mustafa Kemal University Faculty of Medicine, Department of Radiology, Hatay, Turkey Objective: Thrombolytic therapy has many complications. Bleeding is one of the most common and potentially most serious complications. There is little evidence in the literature concerning the retroperitoneal hematomas after streptokinase administration. We present the case of spontaneous retroperitoneal hematoma following streptokinase therapy for acute myocardial infarction. Here we present a case of spontaneous retroperitoneal hematoma following streptokinase administration for acute myocardial infarction. Methods: A 78-year-old woman was admitted to a hospital with Anteroseptal myocardial infarction at six hours of onset. Her medical history included hypertension, diabetus mellitus and hyperlipidemia. Her vital sings included a blood pressure of 140/90 mmHg, a heart rate of 88 beats/min and other clinical physical examination findings were unremarkable. Laboratory tests conducted in the emergency room revealed hemoglobin concentration of 12 g/dl, hematocrit level of 38%, platelets of
347,000/mm3 . Her basic metabolic panel revealed a serum creatinine 1.7 mg/dl, potassium 5.5 mg/dl and sodium 139 mg/dl. The electrocardiogram demonstrated ST-segment elevation in leads V1-V4 and ST-segment depression in leads D2, D3, aVf. The patient was treated with streptokinase via a peripheral vein. After streptokinase therapy, ST segments became normal in leads v1–4 and chest pain was vanished. Approximately 24 hours after admission with streptase, the patients complained of severe left flank pain, back pain and thigh pain. Limitation of movement, and paresthesia developed in the patient’s left lower extremity. Complete blood count was done again and hemoglobin decreased from a level of 12 g/dl to 8 g/dl. As the patient had severe left flank pain and also decreasing hemoglobin drastically without many other focus of blood loss, abdominal computed tomography was done which demonstrated a retroperitoneal hematoma 7*3 cm located anterior to the iliopsoas muscle (Figures 1, 2). The piatient had risk factors for bleeding such as advanced age and female gender. But the patient had no history of trauma, bleeding diathesis, use of anticoagulants or invasive procedure (surgery, angiography). The patient was treated conservatively and was given 3 U packed red blood cells. Her hemoglobin level rose to 10 g/dl and remained stable until discharge During abdominal usg followups no increment in the size of the hematoma was reported. The patient remained clinically stable, and was discharged. Results: Retroperitoneal hematoma is one of the rare and serious complications of thrombolytic therapy and should be taken into consideration when a complaint of abdominal pain arises after thrombolytic administration. When a patient complains abdominal pain following trombolytic therapy, clinicians should think of bleeding into abdominal region.
Figures 1, 2. Monitoring retroperitoneal hematoma.
with
computed
tomography
of
PP-231 THE IMPACT OF METABOLIC SYNDROME ON CAROTID INTIMA MEDIA THICKNESS 2 M. Aydın1 , S. Bulur2 , R. Alemdar3 , S. Yalcın ¸ 2 , Y. Turker ¨ , C. Basar ¸ 2, 2 1 ¨ Yazgan4 , E.S. Albayrak2 , H. Ozhan ¨ Y. Aslantas¸ 2 , O. . Department of Cardiology, Medicine Faculty of Dicle University, Diyarbakır, Turkey; 2 Department of Cardiology, Medicine Faculty of Duzce University, Duzce, Turkey; 3 Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 4 Department of Radiology, Duzce Ataturk State Hospital, Duzce, Turkey Objective: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. Methods: The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1) subjects
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
of platelets by enhancing expressions of glycoprotein IIb-IIIa and P-selectin on platelet surface. Thus, dual antiplatelet therapy with acetylsalicylic acid and clopidogrel might not prevent future cardiovascular events associated with cannabis smoking. PP-229 MEAN PLATELET VOLUME COULD NOT PREDICT INFARCT SIZE IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCT ¨ urk ¨ u¨ 1 , S.S. Ayhan1 , S. Ozt ¨ 1 , I˙ . Do˘gan2 , K. Karaman3 , A. Erdem1 , F. Ozl 1 1 M. Yazıcı . Abant Izzet Baysal University, Faculty of Medicine, Department of Cardiology, Bolu Turkey; 2 Karadeniz Technical University, Faculty of Medicine, Department of Nuclear Medicine, Trabzon, Turkey; 3 Kahramanmaras¸ Public Hospital, Department of Cardiology, Kahramanmaras,¸ Turkey Objective: Increased mean platelet volume has been shown to associate with acute coronary syndromes, mortality following myocardial infarction and impaired reperfusion. We investigated the relationship between scintigraphic infarct size and mean platelet volume after acute ST elevation myocardial infarction (STEMI), which has not been adequately studied with imaging tools. Methods: Fifthy-four consecutive patients with acute STEMI (31 patients with anterior and 23 patients with inferior) were included in the study. In all cases, venous peripheral blood samples for hematologic and biochemical measurements were drawn. Mean platelet volume, creatine kinase-myocardial band protein (CKMB protein), and cardiac troponin (cTnT) were obtained at admission and daily during the first 72 h after a patient’s arrival. Single photon emission computed tomography studies were performed at a median interval of 4 days (range, 3–5 days) after the acute STEMI. The severity scores of perfusion defects were calculated. Results: Peak CKMB-protein, peak cTnT were positively correlated with, scintigraphic infarct size but mean platelet volume was not correlated with scintigraphic infarct size (P = 0.021, P < 0.0001, P = 0.839 respectively). There were no statistical correlations all three parameters on the second and third days (P > 0.05). Conclusions: Our study suggests that there is no direct relationship between mean platelet volume and myocardial infarct size. There is no statistical evidence that this parameter is related to size of infarct. Thus, mean platelet volume does not predict of infarct size. PP-230 SPONTANEOUS RETROPERITONEAL HEMATOMA AFTER TREATMENT WITH STREPTOKINASE FOR ACUTE MYOCARDIAL INFARCTION:A CASE REPORT 1 E. Buy ¨ ukkaya ¨ , F. Karakas¸ 1 , M. Gung ¨ or ¨ 1 , H. Bayaro˘gulları2 , 1 1 1 A.B. Akcay ¸ , P. Bilen , N. Sen ¸ , M. Kurt1 . 1 Mustafa Kemal University Faculty of Medicine, Department of Cardiology, Hatay, Turkey; 2 Mustafa Kemal University Faculty of Medicine, Department of Radiology, Hatay, Turkey Objective: Thrombolytic therapy has many complications. Bleeding is one of the most common and potentially most serious complications. There is little evidence in the literature concerning the retroperitoneal hematomas after streptokinase administration. We present the case of spontaneous retroperitoneal hematoma following streptokinase therapy for acute myocardial infarction. Here we present a case of spontaneous retroperitoneal hematoma following streptokinase administration for acute myocardial infarction. Methods: A 78-year-old woman was admitted to a hospital with Anteroseptal myocardial infarction at six hours of onset. Her medical history included hypertension, diabetus mellitus and hyperlipidemia. Her vital sings included a blood pressure of 140/90 mmHg, a heart rate of 88 beats/min and other clinical physical examination findings were unremarkable. Laboratory tests conducted in the emergency room revealed hemoglobin concentration of 12 g/dl, hematocrit level of 38%, platelets of
347,000/mm3 . Her basic metabolic panel revealed a serum creatinine 1.7 mg/dl, potassium 5.5 mg/dl and sodium 139 mg/dl. The electrocardiogram demonstrated ST-segment elevation in leads V1-V4 and ST-segment depression in leads D2, D3, aVf. The patient was treated with streptokinase via a peripheral vein. After streptokinase therapy, ST segments became normal in leads v1–4 and chest pain was vanished. Approximately 24 hours after admission with streptase, the patients complained of severe left flank pain, back pain and thigh pain. Limitation of movement, and paresthesia developed in the patient’s left lower extremity. Complete blood count was done again and hemoglobin decreased from a level of 12 g/dl to 8 g/dl. As the patient had severe left flank pain and also decreasing hemoglobin drastically without many other focus of blood loss, abdominal computed tomography was done which demonstrated a retroperitoneal hematoma 7*3 cm located anterior to the iliopsoas muscle (Figures 1, 2). The piatient had risk factors for bleeding such as advanced age and female gender. But the patient had no history of trauma, bleeding diathesis, use of anticoagulants or invasive procedure (surgery, angiography). The patient was treated conservatively and was given 3 U packed red blood cells. Her hemoglobin level rose to 10 g/dl and remained stable until discharge During abdominal usg followups no increment in the size of the hematoma was reported. The patient remained clinically stable, and was discharged. Results: Retroperitoneal hematoma is one of the rare and serious complications of thrombolytic therapy and should be taken into consideration when a complaint of abdominal pain arises after thrombolytic administration. When a patient complains abdominal pain following trombolytic therapy, clinicians should think of bleeding into abdominal region.
Figures 1, 2. Monitoring retroperitoneal hematoma.
with
computed
tomography
of
PP-231 THE IMPACT OF METABOLIC SYNDROME ON CAROTID INTIMA MEDIA THICKNESS 2 M. Aydın1 , S. Bulur2 , R. Alemdar3 , S. Yalcın ¸ 2 , Y. Turker ¨ , C. Basar ¸ 2, 2 1 ¨ Yazgan4 , E.S. Albayrak2 , H. Ozhan ¨ Y. Aslantas¸ 2 , O. . Department of Cardiology, Medicine Faculty of Dicle University, Diyarbakır, Turkey; 2 Department of Cardiology, Medicine Faculty of Duzce University, Duzce, Turkey; 3 Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 4 Department of Radiology, Duzce Ataturk State Hospital, Duzce, Turkey Objective: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. Methods: The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1) subjects