emrah ipek - Academia.edu (original) (raw)
Papers by emrah ipek
BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease... more BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease. Very late stent thrombosis (VLST) is a quite rare clinical entity. However, it is a serious complication that often results myocardial infarction or death. Since the stent endothelialization is considered to be completed within 4 weeks after the intervention, VLST is not common with BMS. PATIENTS AND METHODS: The pathogenesis of the VLST is poorly defined. Herein, we report two cases of VLST in which one a 62 year old male patient devoloped VLST of a BMS implanted in the right coronary artery (RCA) and presented inferior myocardial infarction and other a 48 year old male patient devoloped very late thrombosis of a BMS implanted in the RCA and presented inferior myocardial infarction, respectively. CONCLUSIONS: On the basis of these two cases and our review of the current literature we suggest that what can be done to prevent this rare but offending complication. Moreover, in the light of new imaging modalities such as optical coherence tomography (OCT), the pathophysiology of stent thrombosis will be clearly defined and preventive measures will be taken before it occurs.
European review for medical and pharmacological sciences, 2016
OBJECTIVE The aim of this study is to investigate the role of the autonomic nervous system in the... more OBJECTIVE The aim of this study is to investigate the role of the autonomic nervous system in the etiology of idiopathic sudden sensorineural hearing loss (ISSHL) by measuring heart rate variability (HRV) and night-time blood pressure levels. PATIENTS AND METHODS A total of 58 patients, 31 ISSHL patients (group 1) and 27 healthy volunteers (control group; group 2), were included in this study. Clinical and ambulatory blood pressure measurements and Holter electrocardiography were performed in both groups. After these evaluations, HRV parameters and night-time blood pressure values were determined. RESULTS Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) measured at night-time were higher in group 1 compared to group 2 (p < 0.05). Heart rate variability parameters were lower in group 1 than in group 2. CONCLUSIONS In patients with ISSHL, elevated blood pressure at night-time and reduced heart rate variability suggest that autonomic nervous system dysfunct...
The American Journal of Cardiology, 2014
population. This suggestion should make clinicians and authors to constitute prospective large st... more population. This suggestion should make clinicians and authors to constitute prospective large studies to investigate cardiac functions and prognosis in UC.
Journal of the American College of Cardiology, 2013
Background: Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numer... more Background: Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numerous xenobiotics and are known to be polymorphic in humans. Glutathione S-transferases (GSTs) detoxify environmental agents which influence the onset and progression of disease. Carcinogenic and toxic molecules produce DNA adducts that contribute to the development of atherosclerosis. Genetic polymorphisms of xenobiotic-detoxified enzymes, which control the level of DNA adducts, may affect both enzymatic activity and individual susceptibility to coronary artery disease (CAD). Dysfunctional detoxification enzymes are responsible for prolonged exposure to reactive molecules and can contribute to endothelial damage, an underlying factor in CAD. Coronary artery ectasia (CAE) is defined as local or generalized aneurysmal dilatation of the coronary arteries. Although the etiology of CAE has not been identified completely, the most frequent cause is coronary atherosclerosis. Endothelial dysfunction and enzymatic destruction of media layer plays an important role in the pathogenesis of coronary ectasia. We aimed to examine the association between GSTM1, T1 gene polymorphisms and CAE. Methods: Our study was carried out in a total of 90 cases diagnosed with CAE and a total of 91 population-matched healthy controls in respect to age and genders. After DNA isolation, polymorphisms were analyze using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) methods. Distribution of the GSTM1 and GSTT1 polymorphism genotypes were determinated as Wild (*1*/1) genotype (Normal genotype) and null (*0*/0) genotype (homozygous deletion). In our study CAE group was also divided into subgroups in respect to herbicide exposure. Results: No significant differences were obtained in terms of age, genders, risk factors, biochemical parameters and echocardiographic characteristics between study and control groups. The levels of GSTM1 and T1 polymorphisms were statistically higher in CAE cases than controls (p<0,05). Genotype distribution and the levels of GST enzymes of CAE and control groups shown in the table. GSTM1 and T1 homozygous mutations were detected significantly higher in those with exposure to herbicides in patients with coronary artery ectasia group. Conclusions: To our knowledge this is the first study examining the polymorphisms encoding GST enzymes polymorphisms in cases with CAE. Our results suggest that the deletions in GST genes associated with patients CAE. We think the data obtained in this study can be used to direct people who have deletions in GST genes to avoid chemicals and herbicide exposure.
Journal of the American College of Cardiology, 2013
Early repolarization (ER) is defined as elevation of J point at least 1mm (0.1mV) in two conseque... more Early repolarization (ER) is defined as elevation of J point at least 1mm (0.1mV) in two consequent derivations on ECG. Early Repolarization Syndrome (ERS) which is usually seen in people without structural heart disease is considered under the title of 'J wave syndromes' because of its similarities with Brugada syndrome (BS). As a result of multi-center studies, the association of ERS with sudden cardiac death (SCD) established and it is now known that ERS is a cause of life threatening ventricular arrhythmias. The studies about genetic basis of ERS have been proceeding however firstly reported KCNJ8 gene mutation, as well as for BS, was also defined for ERS. We conducted this study in order to determine the patients at risk with arrhythmia markers and search for KCNJ8 gene S422L mutation in patients who had ER. Methods: Study included 100 patients with diagnosis of ERS and 100 subjects with normal ECG as control group. Subjects without coronary artery disease and with normal echocardiography results were included in study. Mean age was 33.1AE9.7 in study group and 35.8AE9.9 in control group. The existence of arrhythmia, heart rate variability and late potentials were examined in ER group. In both groups, S422L mutation in KCNJ8 gene was genotyped using allele specific PCR. Results: In our study using 'ER ECG pattern typing', 64% of patients with ER were defined as type l, 32% as type 2 and 4% as type 3 ER pattern. It was found that corrected QT interval (QTc) was shorter in ER group than in control group without reaching statistical significance (In ER group mean QTc; 371AE28.7 ms, in the control group mean QTc; 381AE31.4 ms, p¼0.08). No couplet/triplet ventricular premature contractions (VPC) or nonsustained ventricular tachycardia was detected in Holter recordings of ERS group. Heart rate variability was found to be decreased 26% in the patient group, using the time domain methods. By using signal averaged ECG, late potentials were detected in 14% of the patients. These findings were consistent with the results of contemporary studies. History of unexplained syncope was present in two patients with normal neurologic assessment and the association of syncope with ERS was not statistically significant (p¼0.15). The S422L-KCNJ8 gene mutation which was investigated in both groups, was detected only in one subject in the control group, but not in the study group, making the association of mutation with ERS statistically insignificant. Nevertheless, it must be emphasized that the number of ERS patients included in our study was small and neither the patients nor their families had history of sudden cardiac death and most of them were found to be in low risk group. Conclusion: As a result, we observed that there was not any significant relationship between KCNJ8-S422L mutation and ERS in patients who were mostly in low risk group. Further studies are needed to clarify treatment options and management strategies in those patients.
PP-009 Huge Left Atrial Myxoma Originating from Interatrial Septum
International Journal of Cardiology, 2013
International Journal of Cardiology, 2009
Aim: P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuo... more Aim: P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate Pd in patients with obstructive sleep apnea (OSA) and to determine its relationship with severity of the disease. Methods: The study population included 67 patients referred to sleep laboratory. The Apnea-Hypopnea Index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. Of the sixty-seven patients, 48 had AHI⩾5 and were diagnosed as OSA. Nineteen of the patients had AHI b 5 and were diagnosed as OSA (−) (Group 1), 32 of the patients had AHI between 5-30 (mild and moderate, group 2), 16 of the patients had AHI N 30 (severe, group 3). The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum (Pmax) and minimum P (Pmin) wave duration was calculated and was defined as the P-wave dispersion (Pd). Echocardiographic examination was also performed. Results: Pmax was longer in group 3 compared to group 2 and group 1 (p = 0.002, p b 0.001 respectively). Pmax was longer in group 2 compared to group 1 (s b 0.001). Pd was greater in group 3 compared to group 2 and group 1 (p b 0.001 for both comparison). Pd was greater in group 2 compared to group 1 (p b 0.001). Pmin did not differ between the groups. In patients with OSA, Pd was positively correlated with AHI (r = 0.56, p b 0.001), BMI (r = 0.43, p = 0.03), and mitral early diastolic to late diastolic velocity (E/A) ratio (r = 0.37, p = 0.01). Multiple linear regression analysis showed that only AHI was independently associated with Pd (β = 0.39, p = 0.02). Conclusion: Pd was found to be greater in patients with OSA than patients without OSA and to be associated with severity of the disease.
Speckle Tracking Echocardiographic Analysis of Left Ventricular Systolic and Diastolic Functions of Young Elite Athletes with Eccentric and Concentric Type of Cardiac Remodeling
Echocardiography, 2013
In individuals who exercise regularly and for extended periods of time, some structural alteratio... more In individuals who exercise regularly and for extended periods of time, some structural alterations in the heart, called the athlete&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s heart, develop in time. These alterations vary in type, can be eccentric or concentric, depending on the nature of exercise. Speckle tracking echocardiography (STE) is a novel, angle-independent method that accurately and reliably measures systolic and diastolic functions of the left ventricle (LV) with considerably lower inter-operator variability. Twenty-two marathon runners, 24 wrestlers, and 20 healthy sedentary individuals were included in the study. The average age of subjects is 17.5 ± 2.2 in marathon runners, 16.8 ± 1.9 in wrestlers, and 16.4 ± 1.8 in control group. The parameters of LV longitudinal strain (S), LV longitudinal strain rate systolic (SRS), LV longitudinal strain rate diastolic early filling (SRE), and longitudinal strain rate diastolic late filling (SRA) were evaluated by apical two-, three-, and four-chamber grayscale imaging using the global longitudinal strain (GLS) and GLS rate (GLSR). Conventional echocardiographic parameters demonstrated increased LV diameters and wall thickness in the marathon runners and increased wall thickness without increased LV diameters in the wrestlers. Systolic and diastolic functions were comparable between the marathon runners and wrestlers with conventional echocardiography. Analysis with STE, however, yielded higher systolic strain and strain rates in the athletes. Normalized GLS parameters and end-diastolic volume (EDV) were shown to be correlated. Overall, conventional echocardiography can detect some differences between young athletes with eccentric and concentric type of athlete&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s heart but it is incapable of revealing differences in intrinsic myocardial functions. However, analysis using STE demonstrated increased systolic functions in athletes commensurate with increased load, with unaltered diastolic functions.
Coronary Artery Disease, 2010
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010
Amaç: Anjiyografik olarak normal koroner arterleri olan idiyopatik dilate kardiyomiyopatili hasta... more Amaç: Anjiyografik olarak normal koroner arterleri olan idiyopatik dilate kardiyomiyopatili hastaların koroner kan akımlarını TIMI kare sayısı ile değerlendirmeyi ve sağlıklı bireylerin sonuçlarıyla karşılaştırmayı amaçladık. Yöntemler: Bu retrospektif çalışmaya idiyopatik dilate kardiyomiyopatisi olan 62 hasta (34 erkek, 28 kadın; ortalama yaş 59.7±10.6 yıl) ve dilate kardiyomiyopatisi olmayan 62 kontrol hasta (28 erkek, 34 kadın; ortalama yaş 56.6±9.8 yıl) dahil edildi. Tüm hastalar ve kontrol bireyleri anjiyografik olarak normal koroner arterlere sahipti. Dilate kardiyomiyopatili hastaların sol ventrikül ejeksiyon fraksiyonları<%45 idi. Her hastada her bir majör koroner arter için TIMI kare sayısı belirlendi. İstatistiksel analizde Student t testi, Ki-kare testi ve Pearson korelasyon analizi kullanıldı. Bulgular: İdiyopatik dilate kardiyomiyopatili hastalar kontrol bireyleri ile karşılaştırıldıkları zaman her bir majör epikardiyal koroner arter için TIMI kare sayısı önemli olarak yüksek bulundu (Sol ön inen koroner arter için düzeltilmiş TIMI kare sayısı: 37.0±12.5 ve 28.7±11.6, sırasıyla, p<0.001; sol sirkumfleks koroner arter: 37.7±12.1 ve 31.0±12.5, sırasıyla, p=0.003; sağ koroner arter: 37.4±12.6 ve 30.7±11.6, sırasıyla, p=0.003). Ortalama TIMI kare sayısı sol ventrikül diyastol sonu çapı (r=0.350, p<0.001) ve sol ventrikül sistol sonu çapı (r=0.358, p<0.001) ile önemli ancak zayıf pozitif korelasyon gösterdi. Sonuç: Anjiyografik olarak normal koroner arterlere sahip idiyopatik dilate kardiyomiyopatili hastaların, dilate kardiyomiyopatisi olmayan kontrol bireylerle karşılaştırıldığı zaman, her üç koroner damar için daha yüksek TIMI kare sayısına sahip olduklarını gösterdik. Bu bulgu kontrol bireyleri ile karşılaştırıldığında idiyopatik dilate kardiyomiyopatili hastalarda bozulmuş koroner kan akımını gösterebilir.
The American Journal of Cardiology, 2014
PP-062 Relation of Left Atrial Functions, P-Terminal Force and Interatrial Block in Chronic Haemodialysis Patients
International Journal of Cardiology, 2013
ABSTRACT Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (EC... more ABSTRACT Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions. 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001). This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.
Hypertensive crisis
Current Opinion in Cardiology, 2017
Purpose of review Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on... more Purpose of review Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. Recent findings HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively. Recent retrospective studies have demonstrated that emergency department (ED) referrals from an outpatient clinic or rapid BP-lowering strategies in the ED do not lead to improved outcomes in patients with HTN-U. Summary HTN-C can be a de-novo manifestation or a complication of essential or secondary HTN. The presence of acute EOD is a major poor prognostic indicator in HTN-C. The main objectives of the management of HTN-C are distinction of HTN-E from HTN-U and appropriate risk stratification, prevention or regression of acute EOD due to severely elevated BP, prevention of recurrence of HTN-C with an effective long-term management plan and avoidance of rapid lowering of BP except in some special circumstances. The majority of patients with asymptomatic HTN-U can be safely managed in the outpatient setting without exposing them to the risks of aggressive BP lowering. However, patients with HTN-E require hospitalization, prompt treatment and close monitoring.
Acta Medica, 2015
We examined the hospital files of five patients who were followed in Erzurum Region Training Hosp... more We examined the hospital files of five patients who were followed in Erzurum Region Training Hospital Intensive Care Unit (ICU) due to synthetic cannabinoid (SC) use between November 24th 2014 and February 28th 2015. Age range was between 18-67. Despite all treatment two of the patients died. Three of them were discharged from the ICU with full recovery. Three of the patients were intubated and admitted after cardiopulmonary resuscitation. Coronary Angiography (CAG) was performed for these intubated patients and two of them were in normal ranges. One of the patients had diabetes mellitus (DM) and one of them had Familial Mediterranean Fever. Only the patient with diabetes mellitus history had an abnormal coronary angiography and a coronary artery stent was implanted. In this report we aimed to draw attention to synthetic cannabinoid use in patients who are admitted to emergency services with altered consciousness and describe the possible relation between acute coronary syndrome and...
Koroner Arter Hastaliği Ve Metaboli̇k Sendromu Olan Hastalarda Serum Üri̇k Asi̇t Düzeyleri̇ni̇n Koroner Timi Kare Sayilari Üzeri̇ne Etki̇si̇
Journal of Case Reports, 2014
The coronary-to-pulmonary artery fistulas are usually discovered incidentally during routine card... more The coronary-to-pulmonary artery fistulas are usually discovered incidentally during routine cardiac catheterization after the development of atherosclerotic coronary artery disease. We report the incidental finding of two cases of coronary-to-pulmonary artery fistulas who presented with acute coronary syndrome.
PP-031 Case Report: Swallowed Needle Stuck in the Heart
International Journal of Cardiology, 2013
PP-036 Coronary-To-Pulmonary Artery Fistula and Concomitant Acute Coronary Syndrome: Two Cases
International Journal of Cardiology, 2013
Corresponding Author: Dr. Selami Demirelli Email: demirelli23@yahoo.com Received: January 7, 2014... more Corresponding Author: Dr. Selami Demirelli Email: demirelli23@yahoo.com Received: January 7, 2014 | Accepted: January 24, 2014 | Published Online: February 10, 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx.doi.org/10.17659/01.2014.0014 Introduction
commons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and ... more commons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease... more BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease. Very late stent thrombosis (VLST) is a quite rare clinical entity. However, it is a serious complication that often results myocardial infarction or death. Since the stent endothelialization is considered to be completed within 4 weeks after the intervention, VLST is not common with BMS. PATIENTS AND METHODS: The pathogenesis of the VLST is poorly defined. Herein, we report two cases of VLST in which one a 62 year old male patient devoloped VLST of a BMS implanted in the right coronary artery (RCA) and presented inferior myocardial infarction and other a 48 year old male patient devoloped very late thrombosis of a BMS implanted in the RCA and presented inferior myocardial infarction, respectively. CONCLUSIONS: On the basis of these two cases and our review of the current literature we suggest that what can be done to prevent this rare but offending complication. Moreover, in the light of new imaging modalities such as optical coherence tomography (OCT), the pathophysiology of stent thrombosis will be clearly defined and preventive measures will be taken before it occurs.
European review for medical and pharmacological sciences, 2016
OBJECTIVE The aim of this study is to investigate the role of the autonomic nervous system in the... more OBJECTIVE The aim of this study is to investigate the role of the autonomic nervous system in the etiology of idiopathic sudden sensorineural hearing loss (ISSHL) by measuring heart rate variability (HRV) and night-time blood pressure levels. PATIENTS AND METHODS A total of 58 patients, 31 ISSHL patients (group 1) and 27 healthy volunteers (control group; group 2), were included in this study. Clinical and ambulatory blood pressure measurements and Holter electrocardiography were performed in both groups. After these evaluations, HRV parameters and night-time blood pressure values were determined. RESULTS Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) measured at night-time were higher in group 1 compared to group 2 (p < 0.05). Heart rate variability parameters were lower in group 1 than in group 2. CONCLUSIONS In patients with ISSHL, elevated blood pressure at night-time and reduced heart rate variability suggest that autonomic nervous system dysfunct...
The American Journal of Cardiology, 2014
population. This suggestion should make clinicians and authors to constitute prospective large st... more population. This suggestion should make clinicians and authors to constitute prospective large studies to investigate cardiac functions and prognosis in UC.
Journal of the American College of Cardiology, 2013
Background: Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numer... more Background: Glutathione S transferases (GSTs) are enzymes responsible for the metabolism of numerous xenobiotics and are known to be polymorphic in humans. Glutathione S-transferases (GSTs) detoxify environmental agents which influence the onset and progression of disease. Carcinogenic and toxic molecules produce DNA adducts that contribute to the development of atherosclerosis. Genetic polymorphisms of xenobiotic-detoxified enzymes, which control the level of DNA adducts, may affect both enzymatic activity and individual susceptibility to coronary artery disease (CAD). Dysfunctional detoxification enzymes are responsible for prolonged exposure to reactive molecules and can contribute to endothelial damage, an underlying factor in CAD. Coronary artery ectasia (CAE) is defined as local or generalized aneurysmal dilatation of the coronary arteries. Although the etiology of CAE has not been identified completely, the most frequent cause is coronary atherosclerosis. Endothelial dysfunction and enzymatic destruction of media layer plays an important role in the pathogenesis of coronary ectasia. We aimed to examine the association between GSTM1, T1 gene polymorphisms and CAE. Methods: Our study was carried out in a total of 90 cases diagnosed with CAE and a total of 91 population-matched healthy controls in respect to age and genders. After DNA isolation, polymorphisms were analyze using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) methods. Distribution of the GSTM1 and GSTT1 polymorphism genotypes were determinated as Wild (*1*/1) genotype (Normal genotype) and null (*0*/0) genotype (homozygous deletion). In our study CAE group was also divided into subgroups in respect to herbicide exposure. Results: No significant differences were obtained in terms of age, genders, risk factors, biochemical parameters and echocardiographic characteristics between study and control groups. The levels of GSTM1 and T1 polymorphisms were statistically higher in CAE cases than controls (p<0,05). Genotype distribution and the levels of GST enzymes of CAE and control groups shown in the table. GSTM1 and T1 homozygous mutations were detected significantly higher in those with exposure to herbicides in patients with coronary artery ectasia group. Conclusions: To our knowledge this is the first study examining the polymorphisms encoding GST enzymes polymorphisms in cases with CAE. Our results suggest that the deletions in GST genes associated with patients CAE. We think the data obtained in this study can be used to direct people who have deletions in GST genes to avoid chemicals and herbicide exposure.
Journal of the American College of Cardiology, 2013
Early repolarization (ER) is defined as elevation of J point at least 1mm (0.1mV) in two conseque... more Early repolarization (ER) is defined as elevation of J point at least 1mm (0.1mV) in two consequent derivations on ECG. Early Repolarization Syndrome (ERS) which is usually seen in people without structural heart disease is considered under the title of 'J wave syndromes' because of its similarities with Brugada syndrome (BS). As a result of multi-center studies, the association of ERS with sudden cardiac death (SCD) established and it is now known that ERS is a cause of life threatening ventricular arrhythmias. The studies about genetic basis of ERS have been proceeding however firstly reported KCNJ8 gene mutation, as well as for BS, was also defined for ERS. We conducted this study in order to determine the patients at risk with arrhythmia markers and search for KCNJ8 gene S422L mutation in patients who had ER. Methods: Study included 100 patients with diagnosis of ERS and 100 subjects with normal ECG as control group. Subjects without coronary artery disease and with normal echocardiography results were included in study. Mean age was 33.1AE9.7 in study group and 35.8AE9.9 in control group. The existence of arrhythmia, heart rate variability and late potentials were examined in ER group. In both groups, S422L mutation in KCNJ8 gene was genotyped using allele specific PCR. Results: In our study using 'ER ECG pattern typing', 64% of patients with ER were defined as type l, 32% as type 2 and 4% as type 3 ER pattern. It was found that corrected QT interval (QTc) was shorter in ER group than in control group without reaching statistical significance (In ER group mean QTc; 371AE28.7 ms, in the control group mean QTc; 381AE31.4 ms, p¼0.08). No couplet/triplet ventricular premature contractions (VPC) or nonsustained ventricular tachycardia was detected in Holter recordings of ERS group. Heart rate variability was found to be decreased 26% in the patient group, using the time domain methods. By using signal averaged ECG, late potentials were detected in 14% of the patients. These findings were consistent with the results of contemporary studies. History of unexplained syncope was present in two patients with normal neurologic assessment and the association of syncope with ERS was not statistically significant (p¼0.15). The S422L-KCNJ8 gene mutation which was investigated in both groups, was detected only in one subject in the control group, but not in the study group, making the association of mutation with ERS statistically insignificant. Nevertheless, it must be emphasized that the number of ERS patients included in our study was small and neither the patients nor their families had history of sudden cardiac death and most of them were found to be in low risk group. Conclusion: As a result, we observed that there was not any significant relationship between KCNJ8-S422L mutation and ERS in patients who were mostly in low risk group. Further studies are needed to clarify treatment options and management strategies in those patients.
PP-009 Huge Left Atrial Myxoma Originating from Interatrial Septum
International Journal of Cardiology, 2013
International Journal of Cardiology, 2009
Aim: P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuo... more Aim: P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate Pd in patients with obstructive sleep apnea (OSA) and to determine its relationship with severity of the disease. Methods: The study population included 67 patients referred to sleep laboratory. The Apnea-Hypopnea Index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. Of the sixty-seven patients, 48 had AHI⩾5 and were diagnosed as OSA. Nineteen of the patients had AHI b 5 and were diagnosed as OSA (−) (Group 1), 32 of the patients had AHI between 5-30 (mild and moderate, group 2), 16 of the patients had AHI N 30 (severe, group 3). The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum (Pmax) and minimum P (Pmin) wave duration was calculated and was defined as the P-wave dispersion (Pd). Echocardiographic examination was also performed. Results: Pmax was longer in group 3 compared to group 2 and group 1 (p = 0.002, p b 0.001 respectively). Pmax was longer in group 2 compared to group 1 (s b 0.001). Pd was greater in group 3 compared to group 2 and group 1 (p b 0.001 for both comparison). Pd was greater in group 2 compared to group 1 (p b 0.001). Pmin did not differ between the groups. In patients with OSA, Pd was positively correlated with AHI (r = 0.56, p b 0.001), BMI (r = 0.43, p = 0.03), and mitral early diastolic to late diastolic velocity (E/A) ratio (r = 0.37, p = 0.01). Multiple linear regression analysis showed that only AHI was independently associated with Pd (β = 0.39, p = 0.02). Conclusion: Pd was found to be greater in patients with OSA than patients without OSA and to be associated with severity of the disease.
Speckle Tracking Echocardiographic Analysis of Left Ventricular Systolic and Diastolic Functions of Young Elite Athletes with Eccentric and Concentric Type of Cardiac Remodeling
Echocardiography, 2013
In individuals who exercise regularly and for extended periods of time, some structural alteratio... more In individuals who exercise regularly and for extended periods of time, some structural alterations in the heart, called the athlete&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s heart, develop in time. These alterations vary in type, can be eccentric or concentric, depending on the nature of exercise. Speckle tracking echocardiography (STE) is a novel, angle-independent method that accurately and reliably measures systolic and diastolic functions of the left ventricle (LV) with considerably lower inter-operator variability. Twenty-two marathon runners, 24 wrestlers, and 20 healthy sedentary individuals were included in the study. The average age of subjects is 17.5 ± 2.2 in marathon runners, 16.8 ± 1.9 in wrestlers, and 16.4 ± 1.8 in control group. The parameters of LV longitudinal strain (S), LV longitudinal strain rate systolic (SRS), LV longitudinal strain rate diastolic early filling (SRE), and longitudinal strain rate diastolic late filling (SRA) were evaluated by apical two-, three-, and four-chamber grayscale imaging using the global longitudinal strain (GLS) and GLS rate (GLSR). Conventional echocardiographic parameters demonstrated increased LV diameters and wall thickness in the marathon runners and increased wall thickness without increased LV diameters in the wrestlers. Systolic and diastolic functions were comparable between the marathon runners and wrestlers with conventional echocardiography. Analysis with STE, however, yielded higher systolic strain and strain rates in the athletes. Normalized GLS parameters and end-diastolic volume (EDV) were shown to be correlated. Overall, conventional echocardiography can detect some differences between young athletes with eccentric and concentric type of athlete&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s heart but it is incapable of revealing differences in intrinsic myocardial functions. However, analysis using STE demonstrated increased systolic functions in athletes commensurate with increased load, with unaltered diastolic functions.
Coronary Artery Disease, 2010
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2010
Amaç: Anjiyografik olarak normal koroner arterleri olan idiyopatik dilate kardiyomiyopatili hasta... more Amaç: Anjiyografik olarak normal koroner arterleri olan idiyopatik dilate kardiyomiyopatili hastaların koroner kan akımlarını TIMI kare sayısı ile değerlendirmeyi ve sağlıklı bireylerin sonuçlarıyla karşılaştırmayı amaçladık. Yöntemler: Bu retrospektif çalışmaya idiyopatik dilate kardiyomiyopatisi olan 62 hasta (34 erkek, 28 kadın; ortalama yaş 59.7±10.6 yıl) ve dilate kardiyomiyopatisi olmayan 62 kontrol hasta (28 erkek, 34 kadın; ortalama yaş 56.6±9.8 yıl) dahil edildi. Tüm hastalar ve kontrol bireyleri anjiyografik olarak normal koroner arterlere sahipti. Dilate kardiyomiyopatili hastaların sol ventrikül ejeksiyon fraksiyonları<%45 idi. Her hastada her bir majör koroner arter için TIMI kare sayısı belirlendi. İstatistiksel analizde Student t testi, Ki-kare testi ve Pearson korelasyon analizi kullanıldı. Bulgular: İdiyopatik dilate kardiyomiyopatili hastalar kontrol bireyleri ile karşılaştırıldıkları zaman her bir majör epikardiyal koroner arter için TIMI kare sayısı önemli olarak yüksek bulundu (Sol ön inen koroner arter için düzeltilmiş TIMI kare sayısı: 37.0±12.5 ve 28.7±11.6, sırasıyla, p<0.001; sol sirkumfleks koroner arter: 37.7±12.1 ve 31.0±12.5, sırasıyla, p=0.003; sağ koroner arter: 37.4±12.6 ve 30.7±11.6, sırasıyla, p=0.003). Ortalama TIMI kare sayısı sol ventrikül diyastol sonu çapı (r=0.350, p<0.001) ve sol ventrikül sistol sonu çapı (r=0.358, p<0.001) ile önemli ancak zayıf pozitif korelasyon gösterdi. Sonuç: Anjiyografik olarak normal koroner arterlere sahip idiyopatik dilate kardiyomiyopatili hastaların, dilate kardiyomiyopatisi olmayan kontrol bireylerle karşılaştırıldığı zaman, her üç koroner damar için daha yüksek TIMI kare sayısına sahip olduklarını gösterdik. Bu bulgu kontrol bireyleri ile karşılaştırıldığında idiyopatik dilate kardiyomiyopatili hastalarda bozulmuş koroner kan akımını gösterebilir.
The American Journal of Cardiology, 2014
PP-062 Relation of Left Atrial Functions, P-Terminal Force and Interatrial Block in Chronic Haemodialysis Patients
International Journal of Cardiology, 2013
ABSTRACT Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (EC... more ABSTRACT Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions. 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001). This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.
Hypertensive crisis
Current Opinion in Cardiology, 2017
Purpose of review Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on... more Purpose of review Here, we review current concepts on hypertensive crisis (HTN-C) with a focus on epidemiology, causes, pathophysiology and prognosis. We also offer a practical approach to the management of HTN-C. Recent findings HTN-C is characterized by a severe and abrupt increase in blood pressure (BP) with impending or progressive acute end-organ damage (EOD). HTN-C can be divided into hypertensive emergency (HTN-E) and hypertensive urgency (HTN-U) based on the presence or absence of acute EOD, respectively. Recent retrospective studies have demonstrated that emergency department (ED) referrals from an outpatient clinic or rapid BP-lowering strategies in the ED do not lead to improved outcomes in patients with HTN-U. Summary HTN-C can be a de-novo manifestation or a complication of essential or secondary HTN. The presence of acute EOD is a major poor prognostic indicator in HTN-C. The main objectives of the management of HTN-C are distinction of HTN-E from HTN-U and appropriate risk stratification, prevention or regression of acute EOD due to severely elevated BP, prevention of recurrence of HTN-C with an effective long-term management plan and avoidance of rapid lowering of BP except in some special circumstances. The majority of patients with asymptomatic HTN-U can be safely managed in the outpatient setting without exposing them to the risks of aggressive BP lowering. However, patients with HTN-E require hospitalization, prompt treatment and close monitoring.
Acta Medica, 2015
We examined the hospital files of five patients who were followed in Erzurum Region Training Hosp... more We examined the hospital files of five patients who were followed in Erzurum Region Training Hospital Intensive Care Unit (ICU) due to synthetic cannabinoid (SC) use between November 24th 2014 and February 28th 2015. Age range was between 18-67. Despite all treatment two of the patients died. Three of them were discharged from the ICU with full recovery. Three of the patients were intubated and admitted after cardiopulmonary resuscitation. Coronary Angiography (CAG) was performed for these intubated patients and two of them were in normal ranges. One of the patients had diabetes mellitus (DM) and one of them had Familial Mediterranean Fever. Only the patient with diabetes mellitus history had an abnormal coronary angiography and a coronary artery stent was implanted. In this report we aimed to draw attention to synthetic cannabinoid use in patients who are admitted to emergency services with altered consciousness and describe the possible relation between acute coronary syndrome and...
Koroner Arter Hastaliği Ve Metaboli̇k Sendromu Olan Hastalarda Serum Üri̇k Asi̇t Düzeyleri̇ni̇n Koroner Timi Kare Sayilari Üzeri̇ne Etki̇si̇
Journal of Case Reports, 2014
The coronary-to-pulmonary artery fistulas are usually discovered incidentally during routine card... more The coronary-to-pulmonary artery fistulas are usually discovered incidentally during routine cardiac catheterization after the development of atherosclerotic coronary artery disease. We report the incidental finding of two cases of coronary-to-pulmonary artery fistulas who presented with acute coronary syndrome.
PP-031 Case Report: Swallowed Needle Stuck in the Heart
International Journal of Cardiology, 2013
PP-036 Coronary-To-Pulmonary Artery Fistula and Concomitant Acute Coronary Syndrome: Two Cases
International Journal of Cardiology, 2013
Corresponding Author: Dr. Selami Demirelli Email: demirelli23@yahoo.com Received: January 7, 2014... more Corresponding Author: Dr. Selami Demirelli Email: demirelli23@yahoo.com Received: January 7, 2014 | Accepted: January 24, 2014 | Published Online: February 10, 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx.doi.org/10.17659/01.2014.0014 Introduction
commons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and ... more commons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.