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Öğe Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus(2011) Erden, Ismail; Erden, Emine Çakcak; Özhan, Hakan; Basar, CengizThe prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The clinical presentation of myocarditis varies and often mimics myocardial infarction. Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection. © 2011 Via Medica.Öğe Assessment of cardiac functions in patients with adenotonsillar hypertrophy(Duzce University Medical School, 2011) Ordu, Serkan; Ozhan, Hakan; Uzun, Hakan; Alemdar, Recai; Erden, Ismail; Yazici, Mehmet; Gultekin, ErolBackground: The aim of this study is to compare cardiac function in children with and without adenotonsillar hypertrophy (ATH). Materials and methods: Ninety-one children (26 female 65 male) who were diagnosed as ATH in the pediatric outpatient clinic and twenty-three completely healthy, age-sex matched children (10 female 13 male) were included in the study. All patients underwent a complete twodimensional transthoracic echocardiographic and Doppler study. Results: Mean mitral E, A and deceleration time were significantly longer in ATH group. Also chamber areas and volumes were bigger. Pulmonary and mitral regurgitation were statistically more frequent in ATH group. Adenotonsillar grade was positively related with mean pulmonary arterial pressure (r: 0.44 p: <0.001). Mitral valve thickness was strongly correlated with tonsillar hypertrophy grade (r: 0.73; p.<0.001). Conclusions: ATH may lead to mild diastolic dysfunction and chamber dilatation. Mitral valve thickness was strongly correlated with adenotonsillar grade. © 2011 Düzce Medical Journal.Öğe A case of acute stent thrombosis treated successfully with intracoronary tirofiban(Via Medica, 2010) Erden, Ismail; Ozhan, Hakan; Ordu, SerkanAcute stent thrombosis (AST) is occasionally observed during percutaneous coronary intervention in patients with acute coronary syndrome (ACS). It may jeopardize hemodynamic status. Currently, there is no adequate solution for this problem. We report our experience with an ACS patient who developed AST associated with cardiogenic shock after percutaneous coronary stent deployment. Intracoronary administration of tirofiban immediately restored the coronary flow of the target vessel, and the disastrous condition was reversed. Our experience suggests that intracoronary administration of tirofiban can be considered as an option in cases of AST during percutaneous coronary intervention.Öğe Effect of dipping status on QRS morphology in patients with hypertension(2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Yalçin, Subhan; Basar, Cengiz; Aydin, MesutBACKGROUND: Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. MethodS: A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. RESULTS: There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P=0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r=-0.482, P<0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. Conclusion: QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension. Copyright © 2010 Lippincott Williams & Wilkins.Öğe Efficacy of olmesartan therapy on fibrinolytic capacity in patients with hypertension(2011) Bulur, Serkan; Ozhan, Hakan; Erden, Ismail; Alemdar, Recai; Aydin, Mesut; Caglar, Onur; Basar, CengizThe efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 ?g/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals(2012) Erden, Emine C.; Erden, Ismail; Türker, Yasin; Sivri, Nasir; Dikici, Süber; Ozşahin, MustafaBackground: Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. Patients and methods: After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. Results: In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P=0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio=0.43, 95% confidence interval=0.21-0.83; P=0.013) and the nondipping BP patterns (odds ratio=1.96, 95% confidence interval=1.05-3.67; P=0.035). Conclusion: We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.Öğe OUTCOME OF PRIMARY PERCUTANEOUS INTERVENTION IN PATIENTS WITH INFARCT RELATED CORONARY ARTERY ECTASIA(Elsevier Ireland Ltd, 2010) Erden, Ismail; Ordu, Serkan; Alemdar, Recai; Aydin, Mesut; Ozhan, Hakan; Yazici, Mehmet; Basar, CengizÖğe Outcome of primary percutaneous intervention in patients with infarct-related coronary artery ectasia(2010) Erden, Ismail; Erden, Emine Çakcak; Diezhan, Hakan; Karabulut, Ahmet; Ordu, Serkan; Yazici, MehmetData related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 31 patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P =.006). © 2010 The Author(s).Öğe Poor-quality sleep score is an independent predictor of nondipping hypertension(Lippincott Williams and Wilkins, 2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Basar, Cengiz; Aydin, Mesut; Dumlu, Talha; Alemdar, Recaiobjective: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. METHODS: One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. RESULTS: There were 71 nondipper patients (mean age 44.3±5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3±6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. CONCLUSION: We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients. © Lippincott Williams & Wilkins.Öğe The prognostic value of mean platelet volume in decompensated heart failure(2011) Kandis, Hayati; Ozhan, Hakan; Ordu, Serkan; Erden, Ismail; Caglar, Onur; Basar, Cengiz; Yalcin, SubhanBackground: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. Aim: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). Methods: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. Results: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). Conclusion: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.Öğe The relationship between the level of serum uric acid and no-reflow phenomenon after primary percutaneous coronary intervention in patients with St segment elevated myocardial infarction(2010) Erden, Ismail; Erden, Emine Çakcak; Sözen, Serhat Bahadir; Kayapinar, Osman; Ça?lar, Sabri Onur; Başar, CengizNo-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. Uric acid (UA) release during ischemia and washout from the ischemic zone during reperfusion is adenine nucleotide breakdown product. Therefore uric acid may play reperfusion injury and no-reflow. İn this study, we aimed to compare serum uric acid value of ST segment elevated Mİ patients groups whith no-reflow phenomenon and normal miyocardial perfusion after primary coronary intervention. 47 patients was enrolled consecutively to this study. During hospital admission, patients blood samples were taken for serum uric acid value. Patients was grouped as no reflow and normal perfusion groups according to myocardial blush grades (MBG). Patient with myocardial blush grades 0-1 were accepted as no-reflow group, patients with MBG 2-3 normal perfusion group. When the serum uric acid value of no-reflow and normal perfusion groups was compared, there was statistificaly significant difference (respectively 6,680±1,11 mg/dl versus 5,066±0,68 mg/dl. p<0,05). A significant correlation was found between the serum uric acid level and the presence of no-reflow phenomenon (r=0.598; p<0.025). Multivariate logistic regression analysis showed an independent relationship between no-reflow phenomenon and serum uric acid level (OR 1.815; 95% CI 1.098-1.493; p<0.031). In ST segment elevated Mİ patients with higher serum uric acid value before primary coronary intervention, no-reflow phenomenon is developed more frequently. Uric acid may play important role in mechanism of no-reflow phenomenon. © 2010 Düzce Medical Journal.Öğe Silent interrupted aortic arch in an elderly patient(Via Medica, 2011) Erden, Ismail; Kayapinar, Osman; Erden, Emine C.; Yalçin, SubhanPatients with complete interruption of the aortic arch (IAA) very rarely reach late adulthood without having undergone surgical intervention. Only a few cases of IAA in adults have beenne surgical intervention. Only a few cases of IAA in adults have been reported in the medical literature. In this case report, we present a late diagnosis of interrupted aortic arch in a 68 year-old male. Our patient was relatively asymptomatic until he presented with fatigue after walking quickly. A guidewire could not be passed to the aortic arch via the femoral approach; descending thoracic aortography revealed complete occlusion of the descending thoracic aorta. Cardiac catheterization via the right brachial artery confirmed the diagnosis of a complete interruption of the aortic arch distal to the left subclavian artery and showed distinct collateral circulation predominantly via the internal mammary arteries. Also, magnetic resonance angiography showed cuttings that reveal the interruption in the aortic arch and the prominent collateral vessels to the descending aorta. This case report was also interesting in that pressure measurements at a proximal point of the interrupted aortic arch were not hypertensive. Using both catheters, placed proximally and distally to the point of the interruption, by simultaneous pressure measurement, it was measured as 120/75 mm Hg at the proximal point, 60/40 mm Hg at the distal point. © 2011 Via Medica.
