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    Akut miyokard infarktüsünde prekordiyal ve inferior derivasyonlarda eşzamanlı ST-segment yükselmesi
    (2007) Alyan, Ömer; Topaloğlu, Serkan; Metin, Fatma; Kaçmaz, Fehmi
    T-segment yükselmesi, akut miyokard infarktüsünde (AMİ) prekordiyal ya da inferior derivasyonlarda en sık görülen elektrokardiyografi (EKG) bulgusudur. Bu hastalarda derivasyonların her ikisinde de görülen ST-segment yükselmesi ise nadir bir durumdur. Acil serviste çekilen EKG’de DI, aVL, V1-6 derivasyonlarında ST-segment yükselmesi ve inferior derivasyonlarda resiprokal değişiklikler görülen 48 yaşında erkek hasta anterior AMİ tanısıyla yatırıldı. Kateter laboratuvarına alınmadan önce çekilen ikinci EKG’de anterior derivasyonlardaki ST-segment yüksekliğinin izoelektrik hata yaklaştığı, ancak D2, D3 ve aVF derivasyonlarında devam ettiği görüldü. Koroner anjiyografide, sol ön inen koroner arterde %95 darlık ve distalde tam tıkanıklık, sağ koroner arterde ise kritik olmayan darlıklar görüldü. Sol ön inen koroner artere çıplak stent yerleştirildi; distaldeki lezyon ise balonla genişletildi. Hasta yatışının yedinci gününde taburcu edildi.
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    Öğe
    Effects of cigarette smoking on heart rate variability and plasma N-terminal pro-B-type natriuretic peptide in healthy subjects
    (Wiley, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Maden, Orhan; Topaloglu, Serkan; Ozbakir, Cemal; Metin, Fatma
    Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. Methods: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 +/- 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 +/- 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. Results: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. Conclusion: These findings could contribute to the higher rate of cardiovascular events in smokers.
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    Öğe
    High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis
    (Springer, 2009) Alyan, Omer; Metin, Fatma; Kacmaz, Fehmi; Ozdemir, Ozcan; Maden, Orhan; Topaloglu, Serkan; Demir, Ahmet Duran
    Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 +/- 0.3 cm(2), mean wilkins valve score value was 8.9 +/- 1.7, left atrial diameter was 5.0 +/- 0.7 cm, left atrial area was 37.2 +/- 12.6 cm(2), and systolic pulmonary arterial pressure (SPAP) was 44 +/- 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.
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    Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions
    (Churchill Livingstone Inc Medical Publishers, 2008) Maden, Orhan; Kacmaz, Fehml; Selcuk, Mehmet Timur; Selcuk, Hatice; Alyan, Oemer; Aksu, Tolga; Metin, Fatma
    Background: Although QRS-complex changes during ischemia have been described previously, their relation with no-reflow is not clear. Purpose: To evaluate relation of admission QRS duration with angiographic no-reflow, we studied 162 patients who underwent primary angioplasty. Methods: Twelve-lead electrocardiogram with a paper speed of 50 mm/s was recorded on admission and repeated after angioplasty. Patients were divided into reflow and no-reflow groups based on postangioplasty coronary thrombolysis in myocardial infarction flow grade. Results: Patients in the no-reflow group (26 patients) were older (P = .001) and had significantly longer pain-to-balloon interval (P = .007). The patients in the no-reflow group had significantly longer QRS duration on admission electrocardiogram compared with patients in the reflow group (interquartile range, 80-93 [median, 84] milliseconds vs 60-80 [median, 76] milliseconds, respectively; P < .001). After adjusting all variables, QRS duration on admission was found to be independently related to angiographic no-reflow (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .003). Conclusion: QRS duration on admission may be valuable in predicting no-reflow. (C) 2008 Elsevier Inc. All rights reserved.
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    Öğe
    Simultaneous ST-segment elevation in the precordial and inferior leads in acute myocardial infarction
    (Turkish Soc Cardiology, 2007) Alyan, Omer; Metin, Fatma; Topaloglu, Serkan; Kacmaz, Fehmi
    In general, ST-segment elevation in either the precordial or inferior leads is the most common electrocardiography (ECG) finding in patients with acute myocardial infarction (AMI). However, simultaneous ST-segment elevation in the precordial and inferior leads is a rare finding. A 48year-old male patient was admitted with a diagnosis of AMI upon detection of ST-segment elevation in the DI, aVL, and V1-6 leads and reciprocal changes in inferior leads. A subsequent ECG taken before submission to the cardiac catheterization laboratory showed that the STsegment approached the isoelectric line in the anterior leads, while remaining elevated in the D2, D3, and aVF leads. Coronary angiography revealed 95% stenosis in the left anterior descending (LAD) coronary artery with total occlusion distally, and some insignificant stenoses in the right coronary artery. A bare metal stent was placed in the LAD, with balloon dilatation of the distal lesion. He was discharged on the seventh day of admission.