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  • Küçük Resim
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    Abdominal wall hematoma related to severe cough in a patient under antiaggregant and anticoagulant therapy
    (Springer-Verlag Italia Srl, 2012) Özlü, Mehmet Fatih; Ayhan, Suzi Selim; Öztürk, Serkan; Erdem, Alim; Yazıcı, Mehmet
    A 56-year-old woman with coronary artery disease presented with the complaint of chest pain. She was hospitalized with the diagnosis of acute coronary syndrome. She was taking acetylsalicylic acid, metoprolol, atorvastatin and isosorbide mononitrate for coronary artery disease. The medical history included: diabetes mellitus, hypertension, and coronary artery bypass grafting surgery. The blood pressure was 170/100 mmHg and the heart rate was 94 beats/min.
  • Küçük Resim Yok
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    Acil servisden akut koroner sendrom nedeniyle yatırılan hastaların birinci derece yakınlarının kalp hastalığı bilirlilik düzeyleri: Anket çalışması
    (2013) Ocak, Tarık; Duran, Arif; Öztürk, Serkan; Tekelioğlu, Ümit Yaşar; Erdem, Alim; Ayhan, Selim S.
    Amaç: Çalışmamızda, sağlık sektörü dışındaki genel popüla syonun miyokart enfarktüsü (MI) geçiren hastaların tanınması ve yapılması gereken ilk müdahale konusunda bilgi düzeyi ve yaklaşımlarını incelemeyi amaçladık. Yöntem: Araştırmacılar tarafından, MI geçiren kişilerdeki klinik bulgular ile ilk müdahalede yapılması gerekenleri sorgulayan bir anket oluşturuldu ve 250 gönüllü kişi tarafı ndan doldurulması sağlandı. Gönüllüler özellikle sağlık sektörü dışından seçildi. Bulgular : Katılımcılara sorulan "Sizce hastalıklara bağlı en sık ölüm nedir " sorusuna kadınların %45.1’i kalp krizi, %47.2’si kanser derken aynı soruya erkeklerin ise % 63.9’u kalp krizi, %22.2’si kanser cevabı verdiler. Katılımcıl a ra sorulan "Yalnız başınıza çevrenizde MI geçirdiğini düşü n düğünüz biri ile karşılaşırsanız ne yaparsınız? " sorusuna %92.4’ü acil servisi arayacağını (ka dınlarda %57, erkeklerde %40.7), %31,2’si hastanın bulu n duğu odayı havalandıracağını (kadınlarda %31.7, erkeklerde %30.6), %20.4’ü hastaya aspirin vereceğ ini (kadınlarda %21.8, erkeklerde %18.5), %7.6’sı ise ne yap acağı konusunda bilgisi olmadığını ifade etti (kadınlarda %7.2, erkeklerde %4.3). Sonuç : Bu çalışmanın sonucunda MI yaygınlığı ve mortalitesi konusunda özellikle kadınlarda farkındalığın daha az olduğu görülmüştür. MI’daki tipik bulgular konusunda göğüs ağrısı dışında diğer bulguların yeterince bilinmediği kanısına varılmıştır. MI ile karşılaşılacak bir durumda ise popülasyonun acil servisi arama dışında yapılması gerekenler konusunda yeterli bilgi seviyesine sahip olmadığı anlaşılmıştır. MI’ne müdahalede en önemli kısmı oluşturan tanı ve ilk müdahale konusunda toplum çapında yaygın eğitim programlarının uygulanması gerekli olduğunu düşünmekteyiz.
  • Küçük Resim
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    Açıklanamayan çarpıntı nedeniyle elektrofizyolojik çalışma yapılan hastalarda yaşam kalitesi ve kaygı düzeylerinin değerlendirilmesi
    (2013) Özlü, Mehmet Fatih; Yıldırım, Osman; Erdem, Alim; Öztürk, Serkan; Ayhan, Suzi Selim; Canan, Fatih; Yazıcı, Mehmet
    Amaç: Belgelenememiş çarpıntı atakları nedeniyle yapılan elektrofizyolojik çalışma (EFÇ) sonucu normal veya anormal olan hastaların yaşam kalitesi ve kaygı düzeyleri açısındankarşılaştırılması amaçlandı. Çalışma planı: Çalışmaya çarpıntı yakınması olan, aritmileri elektrokardiyografi (EKG) ile belgelenmemiş ve EFÇ yapılan 128 hasta alındı. EFÇ ile supraventriküler taşikardi (SVT) saptanan hastalar ile EFÇ sonucu normal olan hastalar Dünya Sağlık Örgütü yaşam kalitesi ölçeğinin 26 maddelik kısa formu ve durumluk-sürekli kaygı envanteri ile değerlendirilerek yaşam kalitesi ve kaygı düzeyi açısından karşılaştırıldı. Bulgular: Tanısal EFÇ işlemi sonucunda 72 hastada SVT saptandı. SVT’li grubun yaşam kalitesi skorları EFÇ’leri normal grupdakilere göre anlamlı derecede daha kötü bulundu (p=0.000-0.001). Aynı şekilde SVT’li hastalarda kaygı skorları da EFÇ’leri normal gruba göre daha yüksekti (p=0.000). Çok değişkenli regresyon analizinde yaş, bedensel alan yaşam kalitesi, ruhsal alan yaşam kalitesi, durumluk kaygı ve sürekli kaygı SVT’nin bağımsız öngördürücüleri olarak bulundu. Sonuç: Çarpıntı yakınması SVT’ye bağlı olan hastalarda kaygı düzeyi daha yüksek ve yaşam kalitesi de daha düşük bulunmuştur. Klinik uygulamada çarpıntı yakınması olan hastalar değerlendirilirken fark edilen psikiyatrik semptomların altta yatan aritmiye sekonder olabileceği de göz önünde bulundurulmalıdır.
  • Küçük Resim Yok
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    Akut miyokard infarktüs geçiren hastalarda travma sonrası stres bozukluğu belirtileri
    (2015) Semiz, Murat; Erdem, Fatma; Erdem, Alim; Tuman, Taha Can; Oran, Meral Demir; Kayka, Nefise; Yıldırım, Osman
    Amaç: Bu çalışmanın amacı akut miyokard infarktüs (AMİ) geçiren hastalarda depresyon, anksiyete ve travma sonrası stres bozukluğu (TSSB) belirtilerini araştırmaktır. Çalışmamızda ruhsal belirtilerin klinik bulgular ile ilişkisi de incelenmiştir. Yöntem : Bu çalışmaya AMİ geçirdikten bir ay sonra kardiyoloji polikliniğine kontrol amaçlı gelen 50 hasta alınmıştı r. Hastalara sosyodemografik form, Hastane Ankiyete -Depresyon (HAD) ve Travma Sonrası Stres Bozukluğu Kontrol Listesi (Sivil Sürümü) (PTSB -CL) ölçekleri doldurtulmuştur. AMİ sonrası TSSB belirtilerine yol açabilecek bedensel, fiziksel veya ruhsal olay yaşa yan hastalar çalışmaya alınmamıştır. Bulgular: Hastaların anksiyete ölçeğinin ortalama puanı 8.7±4.3 olarak bulundu. Anksiyete ölçeğinin kesme puanına göre değerlendirme yapıldığında; hastaların % 26’sının anksiyete bozukluğu olabileceği gösterildi. Depres yon ölçeğinin ortalama puanı 7.2±3.6 idi ve ölçeğin kesme puanına göre hastaların % 36’sında (n=18) depresif bozukluk olabileceği saptandı. PCL -C ölçeğinin ortalama puanı 22.1±5.1 idi. Hastaların % 24’ü PCL -C ölçeğine göre kesme puanının üzerinde bir değerdeydi ve bu hastalarda TSSB olasılığı düşünüldü. Sonuç : Bu çalışmada AMİ geçiren hastalarda yüksek oranda TSSB belirtileri saptanmıştır. Hastanede yatış süresi ve taburculuk sonrası anjina şikayetleri TSSB belirtileri ile ilişkili bulunmuştur. AMİ geçiren hastalarda depresif bulguların yanı sıra TSSB belirtilerine de dikkat edilmesi gerektiğini düşünmekteyiz.
  • Küçük Resim Yok
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    Anjiyografi yapılan hastalarda hepatit B, hepatit C ve HIV seroprevalansı
    (2013) Taş, Tekin; Koçoğlu, Mücahide Esra; Küçükbayrak, Abdülkadir; Mengeloğlu, Fırat Zafer; Erdem, Alim; Erdem, Kemalettin; Bucak, Özlem
    Amaç: Sağlık çalışanları kan ve vücut sıvılarıyla bulaşan hep atit B (HBV), hepatit C (HCV) ve insan immun yetmezlik virü slerinin (HIV) neden olduğu infeksiyonlar açısından risk altı ndadırlar. Bu çalışmada kardiyoloji kliniğine başvuran ve anjiyografi uygulanan hastalarda HBsAg, anti -HCV ve anti - HIV seroprevalansının araştırılması amaçlanmıştır. Yöntem: Kardiyoloji kliniğinde Mayıs 2008 -2011 tarihleri arasında anjiyografi yapılan hastaların HBsAg, anti -HCV ve anti-HIV test sonuçları ile demografik verileri retrospektif olarak incelendi. HBsAg, anti -HCV ve anti -HIV testleri makro - ELISA yöntemiyle (Axsym -Abbott; Architect i2000 -Abbott, ABD) çalışıldı. İstatistiksel değerlendirme Ki -kare testi ile yapılmıştır Bulgular : Toplam 415 hastanın 177 (%42.6)’si bayan, 238(%57.3)’i erkek idi. Tüm hastaların yaş ortalaması 61.5±5.4 dir. Hastaların dokuzunda (%2.2) HBsAg pozitif olup sekizi (%2.0) erkek, biri (%0.2) bayandı. Anti -HCV pozitifliği sadece bir (%0.2) bayan hastada rastlandı. Anti -HIV pozitifl iğine rastlanmadı. HBsAg ve anti -HCV pozitiflik oranları ile cinsiyet arasında anlamlı ilişki bulunamadı. Sonuç : Çalışmamızda HBsAg, anti -HCV ve anti -HIV seropr ev a lansının toplumdakinden yüksek olmadığı görülmektedir. Anjiyografi gibi girişimsel işlemler ve cerrahi müdahaleler sırasında tüm sağlık personelinin hastaların serolojik tetki klerine bakılmaksızın virüs bulaşabilme ihtimalini düşünerek güvenlik önlemlerini alması bu etkenlerin bulaşmasını azaltacaktır.
  • Küçük Resim Yok
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    Assessment of quality of life and anxiety levels in patients who underwent electrophysiologic study due to unexplained palpitations
    (Turkish Soc Cardiology, 2013) Ozlu, Mehmet Fatih; Yildirim, Osman; Erdem, Alim; Ozturk, Serkan; Ayhan, Suzi Selim; Canan, Fatih; Yazici, Mehmet
    Objectives: To compare the quality of life and anxiety levels of the patients with normal and abnormal results detected during an electrophysiologic study (EPS) that was performed due to undocumented episodes of palpitations. Study design: The patients (n=128) with complaints of palpitations who underwent EPS because their arrhythmias could not be documented were included in the study. The quality of life and anxiety levels of patients with abnormal EPS results were compared to those with normal results using the 26-item short form of the World Health Organization quality of life scale and state-trait anxiety inventory. Results: SVT was found in 72 patients by diagnostic EPS. Quality of life scores were significantly poorer in the SVT group than those of the normal EPS group (p=0.0000.001). Likewise, the anxiety scores of the patients in the SVT group were higher than those of the group with normal EPS findings (p=0.000). Age, physical quality of life, psychological quality of life, state-and trait anxiety were found to be independent predictors of SVT in multivariate regression analysis. Conclusion: The level of anxiety was found to be higher and quality of life relatively lower in patients with palpitations due to SVT. In clinical practice during evaluation process of the patients with palpitations, it should be kept in mind that recognized psychiatric symptoms may be secondary to an underlying arrhythmia.
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    Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes
    (2013) Öztürk, Serkan; Erdem, Alim; Özlü, Mehmet Fatih; Ayhan, Selim; Erdem, Kemalettin; Özyaşar, Mehmet; Yazıcı, Mehmet
    Objectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. Study design: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Results: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). Conclusion: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients.
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    Atrial conduction time and atrial mechanical function in patients with impaired fasting glucose
    (Springer, 2012) Ayhan, Selim; Öztürk, Serkan; Alçelik, Aytekin; Özlü, Mehmet Fatih; Erdem, Alim; Memioğlu, Tolga; Özdemir, Mesut; Yazıcı, Mehmet
    Prolonging atrial conduction time, as measured by tissue Doppler imaging (TDI), is an independent predictor of new onset or recurrent atrial fibrillation (AF). We investigated atrial conduction time and cardiac mechanical function in patients with impaired fasting glucose (IFG) using echocardiography. Thirty patients with IFG (19 males and 11 females; age, 46.9 +/- 9.5 years) and 30 control subjects (18 males and 12 females; age, 46.7 +/- 8.2 years) were included. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Inter- and intra-atrial electromechanical delays (EMDs) were calculated. Left atrial (LA) volumes were determined according to the biplane area-length method. LA mechanical function parameters were calculated. LA passive emptying volume and LA passive emptying fraction decreased significantly in patients with IFG as compared with control subjects (p < 0.001 and p < 0.001, respectively). PA lateral and PA septal durations were significantly higher in patients with IFG than in the control group. However, no difference in PA tricuspid duration was observed between the two groups. Inter- and intra-atrial EMDs were significantly higher in patients with IFG as compared with the control subjects (median [interquartile range], 34.0 [17.0] vs. 17.0 [4.0], p < 0.001 and 15.0 [8.5] vs. 7.5 [2.0], p < 0.001, respectively). Positive correlations were detected between both inter- and intra-atrial EMD and glucose levels (r = 0.76, p < 0.001 and r = 0.68, p < 0.001, respectively). Additionally, a multiple linear regression analysis revealed that glucose levels were independently associated with inter-atrial EMD (beta = 0.753, p < 0.001). We showed that IFG was associated with inter- and intra-atrial EMD. Our findings suggest that IFG is an etiological factor for the development of AF.
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    Atrial electrical and mechanical dysfunction in non-diabetic, nonhypertensive hemodialysis patients
    (Carbone Editore, 2014) Tekçe, Hikmet; Öztürk, Serkan; Aktaş, Gülali; Tekçe, Buket Kın; Erdem, Alim; Üyetürk, Uğur; Özyaşar, Mehmet; Duman, Tuba Taslamacıoğlu; Yazıcı, Mehmet
    Background: Abnormalities in atrial conduction times and mechanical functions are considered as independent predictors of atrial fibrillation. However, there is no data in literature about functional parameters and electromechanical delay intervals in nondiabetic, non-hypertensive hemodialysis (HD) patients. We aimed to study atrial electromechanical conduction times and mechanical functions in this population. Methods: Forty-two non-diabetic, normotensive hemodialysis patients and age and sex matched control subjects have been enrolled in the study. Standard and Tissue Doppler Echocardiography have been performed before mid-week dialysis session for HD group and on admission for control group. Results: PA(lateral,), PA(septum) durations of the hemodialysis group were significantly longer than control group (70.6 +/- 9.1 vs 55.3 +/- 2.7, 50.8 +/- 5.2 vs 44.4 +/- 2.1; p<0.01). Interatrial and left-right intraatrial electromechanical delay intervals were significantly longer in hemodialysis group compared to controls (31.6 +/- 7.2 vs 18.0 +/- 2.6, 19.8 +/- 7.9 vs 10.9 +/- 2.7, 11.8 +/- 5.1 vs 7.1 +/- 1.2, respectively; all p<0.01). Measurements of left atrial diameter, maximum, minimum and before atrial systole, volumes and passive-active emptying volumes were both elevated in hemodialysis group compared to controls (all p<0.01). Conclusions: This is the first study enlightening deterioration in atrial mechanical and electromechanical functions in nondiabetic, non-hypertensive HD population. Results of the present study reflect not only negative effects of structural remodeling, which has been mentioned in previous studies in literature, but also negative effects of electrical remodeling. Prolonged inter- and intra-atrial electromechanical delay intervals should be the underlying pathophysiological factors increasing the rate of atrial fibrillation in hemodialysis population.
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    Atrial electrical and mechanical dysfunction in non-diabetic, nonhypertensive hemodialysis patients
    (Oxford Univ Press, 2014) Tekçe, Hikmet; Öztürk, Serkan; Aktaş, Gülali; Tekçe, Buket Kın; Erdem, Alim; Üyetürk, Uğur; Özyaşar, Mehmet
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    Batı Karadeniz bölgesindeki akut koroner sendromlu hastalarda psikiyatrik hastalıkların görülme sıklığı
    (2013) Yıldırım, Osman; Çağlar, Sabri Onur; Canan, Fatih; Erdem, Alim
    Amaç: Koroner yoğun bakım ünitesine Akut Koroner Sen drom (AKS) tanısı ile yatırılan hastalardaki yatış öncesi psik iyatrik hastalık sıklığını belirlenmesi amaçlandı . Yöntem: Bu çalışmada Ocak 2011 - Nisan 2013 yılları arasında Abant İzzet Baysal Üniversitesi Hastanesine başvurup Koroner yoğun bakım ünitesine AKS tanısı ile yatırılan hastaların retrospektif olarak dosyalar ve bilgisayar ortamındaki hasta bilgileri taranarak bu grup hastalardaki psikiyatrik ilaç kull anımı ve bu hastalara konulan psikiyatrik tanılar saptandı. Bulgular : Bu tarihler arasında koroner yoğun bakıma yatış yapılmış toplam 467 hasta saptandı. Bu hastaların 373 tanesi erkek, 94 tanesi kadın olup, bu hastaların yaş ortalaması 63,2 ± 15.4 yıldı. Bu hastaların %17.5’ünde (n=82) psikiyatrik hastalık tanısı mevcuttu. Bu hastaların % 42.2 depresyon, %30.6 anksiyete bozukluğu, %10.5’nin anksiyete bozukl uğu+depresyon, %10.2’sindede somatoform bozukluk, %4.8’nin psikotik bozukluk ve %1.7’ninde bipolar bozukluk olduğu saptandı. Psikiyatrik hastalık tanısı alan hastaların %64.6’i kadın (n=53), %35.4’ü erkekti (n=29) (p<0.05) Bu hastaların yaş ortalaması 58.2 ± 12.1 yıl iken, kadınlarda bu ortalama 52.12 ± 10.98 yıl iken erkekle rde ise 59.13 ± 13.24 yıl idi (p<0.05). Sonuç : Bu bölgedeki AKS tanısı ile koroner yoğun bakıma yatırılan hastaların psikiyatrik hastalık sıklığı literatürde bildirilen genel dağılımla benzerlik göstermekte olduğunu saptadık. Bu hasta grubunda hastalık öncesi özellikle kadın hastalarda psikiyatrik tanıya sahip olunmasının ve tedavi takibinin önemli olduğunu düşünmekteyiz.
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    Cardiac autonomic function in healthy young smokers
    (Sage Publications Inc, 2015) Erdem, Alim; Ayhan, Suzi Selim; Öztürk, Serkan; Özlü, Mehmet Fatih; Alçelik, Aytekin; Tosun, Mehmet; Gümüştekin, Kenan; Yazıcı, Mehmet
    The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (<40years) to assess the effects of smoking on cardiac autonomic function. The study included 75 smokers with a history of habitual smoking for at least 1year (41 males and 34 females; mean age, 29.3 +/- 7.3years) and 30 nonsmokers (hospital staff; 16 males and 14 females; mean age, 29.0 +/- 6.1years). Addiction to smoking was evaluated using the modified Fagerstrom test for nicotine-dependence index (NDI). HRT, HRV, basic clinical and echocardiographic, and Holter test parameters were compared between groups. No significant differences between the two groups were found in the basic clinical and echocardiographic variables. Turbulence onset (TO) was significantly higher in the smoking group than in the controls, and turbulence slope was significantly lower in the smokers, than in the controls (p<0.05). Standard deviation of all normal-to-normal (NN) interval index (SDNNI) was the only HRV parameter that was significantly different between the smoking and control groups (p<0.05). The NDI was positively correlated with the TO (p<0.05). Smoking impairs the baroregulatory function in healthy young smokers, particularly the HRT parameters and SDNNI. Our findings highlight the importance of complete smoking cessation.
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    Cardiac autonomic function in metabolic syndrome: a comparison of ethnic Turkish and Japanese patients
    (Springer, 2012) Erdem, Alim; Uenishi, Masahiro; Matsumoto, Kazuo; Küçükdurmaz, Zekeriya; Kato, Ritsushi; Şahin, Şafak; Yazıcı, Mehmet
    Metabolic syndrome (MetS) prevalence shows some differences at various regions of the world in terms of race and ethnicity. The cardiac autonomic functions between Turkish and Japanese MetS patients with heart rate turbulence (HRT) and heart rate variability (HRV) were compared as the aim of this study. This study consists of 149 nondiabetic subjects with MetS. All patients were further classified into subgroups based on ethnicity (76 from Turkey, 73 from Japan). Twenty-four-hour ambulatory Holter ECG recording was applied to all subjects whose HRV and HRT (total onset (TO), total slope (TS)) parameters were analyzed. The waist circumference was the only demographic parameter that was significantly different between the Turkish and Japanese patients with MetS (99.31 +/- 6.12 vs 91.12 +/- 6.89 for men and 91.48 +/- 7.45 vs 86.26 +/- 5.78 for woman; p < 0.001 and < 0.001). There was a significant difference between Turkish and Japanese patients with MetS in terms of the HRT values. (TO Turkish, 0.77 +/- 0.19 %; TO Japanese, 0.49 +/- 1.03 %, p = 0.031; TS Turkish, 1.93 +/- 1.26; TS Japanese, 2.44 +/- 1.37, p = 0.041, respectively). As for HRV parameters, standard deviation of all NN intervals index was only different between Turkish and Japanese patients with MetS (90.79 +/- 58.94, 128.18 +/- 105.30; p = 0.034, respectively). HRT and some HRV scores of ethnic Turkish MetS patients are worse than the scores of ethnic Japan MetS patients. We think that these differences are related to the central obesity.
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    Cardiac autonomic function measured by heart rate variability and turbulence in pre-hypertensive subjects
    (Taylor & Francis Inc, 2013) Erdem, Alim; Uenishi, Masahiro; Küçükdurmaz, Zekeriya; Matsumoto, Kazuo; Kato, Ritsushi; Hara, Motoki; Yazıcı, Mehmet
    Non-dipping blood pressure pattern was shown to be associated with increased cardiovascular events. In addition, cardiac autonomic dysfunction was found to be associated with non-dipper phenomenon. In this study, we aimed to evaluate the cardiac autonomic functions in dipper and non-dipper pre-hypertensive subjects. A total of 65 pre-hypertensive subjects were enrolled in this study. They were divided into two groups as non-dippers (40 subjects, 52% female) and dippers (25 subjects, 52.5% female). Cardiac autonomic functions of the two groups were compared with the aid of heart rate variability, heart rate turbulence (HRT), atrial premature contractions (APCs), ventricular premature contractions (VPCs), and mean heart rate (MHR). There was no significant difference between non-dippers and dippers in basal characteristics. The two parameters of HRT, turbulence onset and turbulence slope, were found to be significantly abnormal in non-dippers than in dippers (P < .011 and P < .002, respectively). Heart rate variability parameters, including SDNN, SDANN, RMSSD, and pNN50, were found to be similar in dipper and non-dipper pre-hypertensive subjects (P < .998, P < .453, P < .205, and P < .788, respectively). APCs, VPCs, and MHR were compared, and there were statistical differences between the groups (APCs 5.80 + 4.55, 9.14 + 7.33, P < .024; VPCs 8.48 + 8.83, 13.23 + 9.68, P < .044; and MHR 70.16 +/- 11.08, 76.26 +/- 11.31, P < .035; respectively). This study demonstrated a possible cardiac autonomic dysfunction in pre-hypertensive subjects with non-dipper pattern. This may be a basis for future studies related to pre-hypertension and non-dipping BP pattern.
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    Cardiac tamponade with primary certain non-malignancy in clinic: Case report
    (Düzce Univ, 2014) Duran, Arif; Ocak, Tarık; Üyetürk, Ümmügül; Erdem, Alim; Önder, Hüsnü; Maltaş, Mehmet Şakir
    Cardiac tamponade is a major life threatening condition characterized with accumulation of fluid in pericardial cavity which prevents heart contractions. Etiology includes trauma, renal failure, myocardial infarction, cardiovascular surgery, coronary angiography, and malignancies. Clinical signs vary depending on the development rate of tamponade. Malignancy related tamponade is caused by different factors that associated with the type and the extension of malignancy. We present a patient who admitted to our emergency department with cardiac tamponade caused by a malignancy of an unknown primary
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    A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension
    (ARSMB-KVBMG, 2014) Kıracı, Gökhan; Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Akkaya, Akcan; Bilgi, Murat; Erdem, Alim; Bayır, Hakan; Koçoğlu, Hasan; Yıldız, İsa
    Background: The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine.Methods: Patients with essential hypertension who were under ? 65 years old, scheduled for elective surgery with a Mallampati score of I-II were included in the study. Patients were randomly divided into three groups; group M (n=20) received magnesium sulfate, group L was prescribed lidocaine, and group C (control group) received saline. Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation.Results: There were no statistically significant differences between the groups in terms of age, sex and demographic characteristics. There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups. In group M, QTd values were significantly lower at the first and fifth minutes than before induction. There were no statistically significant differences in QTd values at different times in group L and group C.Conclusion: QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.
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    Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study
    (2012) Öztürk, Serkan; Özyaşar, Mehmet; Ayhan, Selim Suzi; Özlü, Mehmet Fatih; Erdem, Alim; Alçelik, Aytekin; Öztürk, Selçuk
    Amaç: Bizim çalışmamızın amacı, izole koroner arter ektazisi (İKAE) olan hastalarda total atriyal ileti süresi ve sol atriyal (SA) mekanik fonksiyonların araştırılmasıdır. Yöntemler: Enine-kesitli gözlemsel bu çalışmaya, herhangi bir darlığı olmayan 60 İKAE’li hasta alındı. Kontrol grubu yaş ve cinsiyet açısından eşleştirilen 40 bireyden oluşturuldu. Sol atriyal mekanik fonksiyonlar disk metoduyla apikal dört boşluktan ölçüldü. Sol atriyal mekanik fonksiyon parametreleri hesaplandı. P dalga dispersiyonu yüzey elektrokardiyografisinden (EKG) ölçüldü. Total atriyal ileti süresi, yüzey EKG’sinde P dalgasının başından, doku Doppler ile mitral lateral duvardan ölçülen A’ dalgasının tepesine kadar olan zaman aralığı olarak ölçüldü. İstatistiksel analizde; Student t, Mann-Whitney U, Pearson ve Spearman korelasyonu ve çoklu doğrusal regresyon analizi kullanıldı. Bulgular: Klinik ve laboratuvar bulgular açısından gruplar benzerdi. Her iki grupta Vmaks ve SA total boşalma oranı benzerdi (31.9±6.5 karşı 29.0±7.3 mL/$m^{2}$, p=0.082 ve 20.0±5.2 vs. 19.9±5.1 mL/$m^{2}$, p=0.821). Ancak, SA pasif boşalma hacmi ve SA pasif boşalma oranı İKAE hastalarında anlamlı olarak azalmıştı (11.1±3.2 karşı 13.5±3.8 mL/$m^{2}$, p=0.005 ve 35.2±7.2 karşı 47.8±9.4 mL/$m^{2}$, p<0.001). Fakat SA aktif boşalma hacmi ve SA aktif boşalma oranı İKAE hastalarında anlamlı olarak artmıştı (9.1±2.6 karşı 6.4±3.0 mL/$m^{2}$, p< 0.001 ve 45.3±8.1 karşı 40.7±6.7mL/$m^{2}$, p=0.002). Total atriyal ileti süresi İKAE grubunda normal gruba göre anlamlı olarak daha uzun ölçüldü (131.8±5.7 karşı 114.4±9.1 ms, p<0.001). Çoklu doğrusal regresyon analizinde ektazik segment sayısı total atriyal ileti süresinin bağımsız bir faktörü olarak tespit edildi (?=0.581, %95 GA=4.046-6.295, p<0.001). Sonuç: Bu çalışma İKAE’li hastalarda SA elektriksel ve mekanik fonksiyonlarının bozulduğunu gösteren ilk çalışmadır. Bozulmuş olan SA fonksiyonları kardiyak aritmiler, azalmış kardiyak atım hacmi ve kalp yetersizliği ile ilişkili olabilir. (Anadolu Kardiyol Derg 2012; 12: 637-43)
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    Detection of left ventricular asynchrony and its relationship with the Tei index in patients with coronary artery ectasia
    (Pulsus Group Inc, 2013) Öztürk, Serkan; Ayhan, Selim; Aslantaş, Yusuf; Erdem, Alim; Özlü, Mehmet Fatih; Ekinözü, İsmail; Yazıcı, Mehmet
    OBJECTIVE: To evaluate left ventricular (LV) systolic asynchrony and its relationship with the Tei index using tissue Doppler imaging (TDI); and to evaluate the relationship of thrombolysis in myocardial infarction frame count (TFC) and Tei index with LV asynchrony in patients with coronary artery ectasia (CAE). METHODS: A total of 50 CAE patients and 40 control subjects were evaluated. Diagnosis of CAE was made angiographically and TFC was calculated. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. Evaluation of intra-LV systolic asynchrony was performed using tissue synchronization imaging (TSI). RESULTS: In patients with CAE, the Tei index was significantly higher than in controls (0.63 +/- 0.12 versus 0.52 +/- 0.12; P<0.001). LV systolic asynchrony parameters of TSI including SD of the peak tissue velocity (Ts) of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments (Ts-12), SD of the Ts of the six basal LV segments (Ts-SD-6), maximal difference in Ts between any of the six basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism compared with controls (P<0.001, P<0.001, P<0.001 and P<0.001, respectively). In addition, a positive correlation was found between Ts-SD-12 and the Tei index in patients with CAE (r=0.841; P<0.001) and mean TFC was positively correlated with Ts-SD-12 and the Tei index (r=0.345; P=0.013 and r=0.291; P=0.021, respectively). CONCLUSION: Patients with CAE exhibit evidence of LV systolic asynchrony according to TSI. LV systolic asynchrony is related to the Tei index and mean TFC. Furthermore, the Tei index is an independent risk factor for LV systolic asynchrony.
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    Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism
    (Elsevier Masson, 2012) Ayhan, Selim; Öztürk, Serkan; Dikbaş, Oğuz; Erdem, Alim; Özlü, Mehmet Fatih; Baltacı, Davut; Alçelik, Aytekin
    Background. - Hyperthyroidism is an important cardiovascular risk factor in the development of atrial fibrillation and heart failure. Increased atrial electromechanical intervals are used to predict atrial fibrillation, measured by tissue Doppler imaging (TDI). Aims. - To evaluate atrial electromechanical delay (EMD) and left atrial (LA) mechanical function in patients with overt hyperthyroidism. Methods. - Thirty-four patients with overt hyperthyroidism and 34 controls were included. A diagnosis of overt hyperthyroidism was reached with decreased serum thyroid-stimulating hormone (TSH) and increased free T4 (fT4) concentrations. Using TDI, atrial electromechanical coupling (PA) was obtained from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). LA volumes (maximum, minimum and presystolic) were measured by the disks method in apical four-chamber view and indexed to body surface area. LA active and passive emptying volumes and fractions were calculated. Results. - LA diameter was significantly higher in hyperthyroid patients (P = 0.001). LA passive emptying volume and fraction were significantly decreased in hyperthyroid patients (P = 0.038 and P < 0.001). LA active emptying volume and fraction were significantly increased in hyperthyroid patients (P < 0.001 and P < 0.001). Left and right intra-atrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMDs were significantly higher in hyperthyroid patients (29.2 +/- 4.4 vs 18.1 +/- 2.6, P < 0.001; 18.7 +/- 4.3 vs 10.6 +/- 2.0, P < 0.001; and 10.5 +/- 2.9 vs 7.1 +/- 1.2, P < 0.001, respectively). Stepwise linear regression analysis demonstrated that fT4 and TSH concentrations were independent predictors of interatrial EMD (beta = 0.436, P < 0.001 and beta = -0.310, P = 0.005, respectively). Conclusion. - This study showed prolonged atrial electromechanical intervals and impaired LA mechanical function in patients with overt hyperthyroidism, which may be an early sign of subclinical cardiac involvement and dysrhythmias in overt hyperthyroidism. (c) 2012 Elsevier Masson SAS. All rights reserved.
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    The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations
    (Hospital Clinicas, Univ Sao Paulo, 2013) Ocak, Tarık; Erdem, Alim; Duran, Arif; Tekelioğlu, Ümit Yaşar; Öztürk, Serkan; Ayhan, Suzi Selim; Özlü, Mehmet Fatih; Tosun, Mehmet; Koçoğlu, Hasan; Yazıcı, Mehmet
    OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74 +/- 197.11 in supraventricular tachyarrhythmia group and 39.99 +/- 32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels >= 61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17 +/- 0.56 and 0.01 +/- 0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels >= 0.01:2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non-supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.