Hypertension is a global public health problem and causes target organ damage. It may cause an increase in mortality and morbidity due to the target organ damage it causes. Although it is sometimes difficult to regulate blood pressure in HT treatment, patients often do not respond to monotherapy, so double or triple combination therapy is needed can be heard. In this case, the effect of combination therapy in a hypertensive patient with coronary artery disease is presented.

Objective: Despite the transfer of the treatment process to pre-hospital settings, shortening of intervention times, and implementation of recommended treatment options, ST-elevation myocardial infarction (STEMI) remains the leading cause of in-hospital death. In our study, the contribution of the reperfusion strategy, clopidogrel loading doses, and adjunctive therapy on platelet aggregation to mortality and morbidity was investigated. Material and Methods: Between 2015-2016, 58 patients aged 18-80 years with a diagnosis of STEMI were included in the study. Peripheral venous blood samples were collected at 2nd, 4th, and 24th hours after anti-platelet therapy to evaluate platelet functions. Patients were divided into two groups based on residual platelet aggregation levels in the 4th-hour blood samples: those with aggregation level =47U were designated as group A, and those with <47U were designated as group B. Results: Our study revealed that patients with high residual platelet aggregation at the 4th hour (group A) received fibrinolytic therapy, underwent a 300 mg clopidogrel loading dose, and used morphine due to persistent pain (p=0.003, p=0.036, p<0.001). It was found that inhospital events increased 6.637-fold in those who received fibrinolysis compared to those who did not [odds ratio (95% confidence interval): 6,637 (1,391-31,658), p=0.018]. When examining the effectiveness of morphine alone on platelet aggregation, it was observed that it was significantly associated with high residual platelet aggregation at 2nd and 4th hours, while this effect decreased at 24th hour (p<0.001, p=0.070). No significant difference was observed in clinical outcomes related to high platelet reactivity. Conclusion: Based on the findings, the inadequacy of medical reperfusion strategy and delayed effect of clopidogrel with morphine use were detected. Although this delay did not have clinical significance, it led to a significant increase in hospital admissions with chest pain and the need for repeat revascularization during three-month follow-up. Long-term follow-up results are required.

Objective: Peripheral arterial disease (PAH) is a common cardiovascular disease. PAH treatments are long-term treatments that target the control of risk factors. Endovascular treatment is considered a more comfortable option compared to surgery. In recent years, increasing evidence has emerged about the efficacy of endovascular treatment modalities. This study investigates the effect of device diameter on endovascular treatment outcomes in PAH. Material and Methods: In this retrospective cohort study, endovascular interventions on 100 patients were evaluated. The collected data was anonymized before being transferred to an electronic database for analysis. SPSS 26.0 was used for statistical analysis; chi-square, Fisher’s exact test and phi-crammer tests were used for categorical variables, while F-ANOVA test was used for continuous variables. Results: Based on the study’s findings, no significant difference was observed between the change in device diameter and factors such as female gender, age, coronary artery disease, hypertension, type 2 diabetes, and tobacco use. However, the rate of stenosis varied between different groups. Furthermore, there was no significant difference in outcomes between the use of drug-coated balloon angioplasty and bare metal stent applications. Both technical success rates and hemodynamic success rates were consistently high across all groups, with no statistically significant differences between them. Similarly, the primary patency rates remained notably high during both the 30-day and 6-month follow-up periods, showing no statistically significant variation. Conclusion: This study evaluated the effect of device diameter on endovascular treatment outcomes in PAH. Device diameters did not have any effect on revascularization, the results were high and promising in all groups. However, the limitations of the study and the lack of a randomized controlled design should be considered. Therefore, prospective studies with larger patient groups are needed.

Objective: In the literature, the tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure (TAPSE/sPAP) ratio <0.55 mm/mmHg has been expressed as a predictive risk factor for pulmonary hypertension. In addition, the TAPSE/sPAP ratio =0.32 mm/mmHg has been reported as a predictive risk marker for all-cause mortality. In this study, we compared patients with type 2 diabetes mellitus (DM) with healthy volunteers in terms of cardiovascular outcomes with TAPSE/sPAP ratio. Material and Methods: In this study, diabetic patients were compared with healthy volunteers for the TAPSE/sPAP ratio determined by transthoracic echocardiography. Echocardiographic procedures were performed by 2 different cardiologists blinded to the clinical status of the patients. The independent association between type 2 DM and TAPSE/sPAP ratio was statistically evaluated using IBM Statistics 21. Results: In this study, 37 diabetic patients were compared with 38 healthy controls in terms of echocardiographic parameters (total 75 patients, mean age: 67.1±9.5). 69.3% of the patients were male. body mass index values of diabetic patients were slightly elevated (28.6±4.4 vs. 27.3±4.6; p=0.154). Statistically significant decrease in ejection fraction (%) values was detected in diabetic patients (p=0.037). When diastolic functions were evaluated, the rate of diastolic dysfunction on a trend basis was higher in diabetic patients compared to controls (p=0.055). TAPSE values also tended to decrease in diabetics compared to non-diabetics (p=0.104). In addition, the estimated mean systolic pulmonary artery pressure values were found to be increased in diabetics (p<0.001). TAPSE/SPAP ratio, which was reported to be predictive of adverse cardiovascular outcomes, was found to be decreased in diabetics compared to non-diabetics (p<0.001). Conclusions: In this study, the TAPSE/sPAP ratio, which can be easily applied in clinical practice, was found to be lower in diabetic patients compared to non-diabetic controls. Accordingly, decreased TAPSE/SPAP ratio values in diabetic patients compared to healthy individuals may be predictive of adverse cardiovascular outcomes.

Carotid artery stenosis is an important risk factor for ischemic stroke. Stenting with percutaneous techniques is routinely applied as an alternative to surgical endarterectomy in the treatment of such lesions. In such procedures, perioperative and postoperative life-threatening hemodynamic disorders can be seen. Procedural complications show an increasing learning curve with adequate theoretical knowledge and experience. In this case report, the treatment approach for deep bradycardia and hypotension developing in a patient who underwent carotid artery stenting is described.