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    Complete atrioventricular block and syncope during acute pulmonary thromboembolism: a case report
    (Turkish Soc Cardiology, 2007) Alyan, Omer; Ozdemir, Ozcan; Kacmaz, Fehmi; Topaloglu, Serkan
    The most common electrocardiographic (ECG) findings in acute pulmonary thromboembolism (PTE) are right bundle branch block, T wave, and ST-segment changes. Complete atrioventricular (AV) block has hitherto been reported in only one patient with PTE. A 63-year-old female patient presented with recurrent syncope and sudden-onset dyspnea. There was complete AV block in the admission ECG. She never had similar complaints before and an ECG taken three months before was completely normal. A temporary pacemaker was placed through the femoral vein. Physical and laboratory findings were suggestive of acute pulmonary embolism. Pulmonary artery angiography demonstrated nearly total occlusion of the proximal right pulmonary artery. Her coronary arteries were normal. Thrombolytic therapy with streptokinase infusion followed by standard heparin infusion resulted in clinical improvement and resolution of complete AV block. The patient was discharged on the 15th day with oral warfarin treatment.
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    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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    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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    High levels of high-sensitivity C-reactive protein and impaired autonomic activity in smokers
    (Turkish Soc Cardiology, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Karahan, Zulkuf; Taskesen, Tuncay; Iyem, Hikmet; Alan, Sait
    Objectives: We investigated the relationship between high sensitivity C-reactive protein (hs-CRP) activity and autonomic nervous activity using heart rate variability in smokers. Study design: The study consisted of 136 healthy subjects, including 66 smokers (35 women, 31 men; mean age 36 years) and 70 nonsmokers (43 women, 27 men; mean age 34 years). Serum samples were collected from all the subjects. Three-channel, 24-hr Holter monitoring was performed to derive the mean heart rate, standard deviation of normal NN intervals (SDNN), standard deviation of 5-minute mean NN intervals (SDANN), root mean square differences of successive NN intervals (RMSSD), high-(HF) and low-(LF) frequency power components, and the LF/HF ratio. Results: In smokers, the mean duration of smoking was 13.6 +/- 8.2 years (range 3 to 45 years), and the mean number of cigarettes consumed per day was 16.3 +/- 7.1 (range 5 to 40). Smokers exhibited significantly higher mean heart rate, hs-CRP and fibrinogen levels, mean platelet volume, white blood cell count, LF, and LF/HF ratio, with significantly lower SDNN, SDANN, RMSSD, and HF values. In smokers, hs-CRP was correlated with the number of cigarettes consumed per day, duration of smoking, fibrinogen level, mean platelet volume, white blood cell count, LF, and LF/HF ratio, and inversely correlated with HF, SDNN, and SDANN. Even smoking a single cigarette resulted in an acute, 0.07-fold increase in the hs-CRP level (p< 0.0001). In linear regression analysis, both the number of cigarettes consumed per day (beta= 0.52, p= 0.011) and duration of smoking (beta= 0.073, p< 0.0001) had an independent effect on the hs-CRP level. Conclusion: Smoking both impairs the sympathovagal balance and increases the hs-CRP activity in otherwise healthy smokers, the combination of which would probably contribute to a higher rate of cardiovascular events.
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    Sympathetic overactivity in patients with pulmonary stenosis and improvement after percutaneous balloon valvuloplasty
    (Wiley, 2008) Alyan, Omer; Ozdemir, Ozcan; Kacmaz, Fehmi; Topaloglu, Serkan; Ozbakir, Cemal; Gozu, Ayfer; Korkmaz, Sule
    Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. . Methods and Results: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r = -0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r = -0.4, P = 0.03). Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.