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Öğe Biatrial thrombosis in dilated cardiomyopathy(2006) Iltimur K.; Karabulut A.; Karahan Z.; Toprak N.[No abstract available]Öğe Clinical investigation: thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome.(2005) Iltumur K.; Olmez G.; Ariturk Z.; Taskesen T.; Toprak N.INTRODUCTION: It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. METHOD: Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction (AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (<5 min, 5-10 min and >10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), free T3, thyroxine (T4), free T4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. RESULTS: The T3 and free T3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups (P < 0.0001). On the other hand, there were no significant differences between T4, free T4 and TSH levels between the three groups (P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T3 and free T3 levels in the cardiac arrest group (P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T3, free T3, T4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min (P < 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). CONCLUSION: TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.Öğe Glucose-insulin-potassium therapy and its effects on signal-averaged electrocardiography in acute myocardial infarction(2000) Ulgen M.S.; Iltimur K.; Karadede A.; Alan S.; Toprak N.Low amplitude signals (LP) at the end of the QRS in patients with acute myocardial infarction (AMI) are related to fragmentation of the electrical impulse in ventricular myocardium and detected on signal-averaged electrocardiography. In this study, we investigated the use of glucose- insulin-potassium (GIK) solution and its effects on the SAECG in AMI. Methods: Seventy-two consecutive patients diagnosed with first Q-wave AMI were prospectively studied. Thrombolytic therapy was given to all patients unless contraindicated. The patients were randomly given glucose-insulin- potassium (GIK, n=34) solutions which consisted of 300 g of glucose, 50 units of insulin and 80 mEq of KCl in 1000 cc water placebo (saline, n.38). Ambulatory electrocardiographic examinations were performed in all patients between 24-48th hours. Sub-maximal exercise testing (if not contraindicated), signal-averaged electrocardiogram (SAECG) and echocardiographic records were obtained before discharge (6-9, mean 7 days). In postdischarge early period (in 30-40 days after index infarction) SAECG and echocardiography recordings were repeated. Results: There were no differences found between both groups in view of ages, number of risk factors, localization of infarction. In pre- discharge evaluations total filtered QRS duration (FQRS1: 103±7 msec vs 108±11 msec p<0.05), low-amplitude terminal signal duration (HFLA1: 25±8 msec vs 32±11 msec, p<0.01) and frequency of VLP1 (%20 vs %45 p<0.05) were found to be lower while root mean square voltage of the terminal 40 msec of the QRS (RMS-401: 45±18?V vs 36±20?V p<0.05), left ventricle ejection fraction (EF: 54±9 vs 48±8, p<0.05) to be higher in GIK when compared with the placebo group. In post discharge evaluations, FQRS2 (105±8 vs 110±10, p=0.05), HFLA2 (26±7 vs 34±10, p<0.01) and frequency of VLP2, (%25 vs %38, p>0.05) were found to be lower while RMS-402 (47±21 vs 33±19 p<0.05) and EF2 (59±10 vs 52±11, p<0.05) were higher in the GIK compared with the placebo group. The incidence of post-MI angina pectoris was significantly lower in the GIK-administered group (p<0.005) than in the placebo groups. The incidence of premature ventricular contraction was insignificantly lower in the GIK-administrated group (p>0.05). We concluded that using GIK solutions at the early stages of AMI may be beneficial on the SAECG, angina incidence, and left ventricular systolic performance in the pre-and postdischarge early period of AMI.Öğe Heart failure and anemia(2006) Karahan Z.; Iltümür K.; Toprak N.Anemia is commonly observed in patients with heart failure and is associated with aggravating symptoms. The cause of anemia in heart failure is not completely understood, but it is likely to be the result of a combination of factors including hemodilution, inflammatory activation, renal dysfunction, malnutrition due to right-sided heart failure, and drug therapy. Correcting anemia results in beneficial effects on cardiac function and morbidity in patients with heart failure. However, it should be recalled that aggressive treatment of anemia may also lead to adverse effects such as hypertension, thrombosis, and endothelial activation.Öğe The relation between infarction localization and late potentials(2001) Iltümür K.; Karabulut A.; Temamogullari A.V.; Karadede A.; Alan S.; Siddik Ulgen M.; Toprak N.OBJECTIVE: There are controversies about the relation between infarction localization and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q-wave AMI fulfilling the inclusion criteria were enrolled in this signal--averaged ECG (SAECG) study. METHODS: The patients were divided into three groups according to infarction localization: anterior (Group I n = 62; 50%), inferior (Group II: n = 42; 34%) and both inferior and right ventricular (RV) involvement (Group III n = 20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40 > 38 ms, RMS < 20 V) were obtained. Tukey--Cramer multivariate analysis was performed. RESULTS: Positive LP results were obtained in 29% of group I, 35.7% of group II and 55% of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction. CONCLUSION: Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.Öğe The relation between ST segment elevation shape and low dose dobutamine stress echocardiography and clinical course in early period of anterior myocardial infarction(2001) Karadede A.A.; Temamo?ullari A.V.; Aydinalp Ö.; Ülgen M.S.; Alan S.; Iltümür K.; Toprak N.Although a relation between magnitude of ST segment elevation and myocardial damage was shown in early period of acute myocardial infarction, such a relation among shape of the ST segment elevation, myocardial damage and clinical course remains obscure. Sixty-two patients with acute anterior MI, in the first six hours of their first heart attack were enrolled for the study. Based on the precordial V3 derivation prior to thrombolytic treatment, the shape of the ST elevation was separated into three groups as concave (n=26), straight (n=24) or convex types (n= 12). The relation between the shape of the elevation recorded on admission and both results of low dose (5 and 10 ?g/kg/min) dobutamine stress echocardiography (LDSE) performed (n=53) in early period (the sixth day) of infarction and clinical course were investigated. Wall Motion Score Index (WMSI) was evaluated based on a 16-segmented scoring system of which nine segments were supplied by left anterior descending artery (LAD) and points were given for each segment from one (normal) to four (dyskinetic). Basal WMSI and response to LDSE were better in LAD region. Additionally both average akinetic segment number in infarct zone was higher and improvement in these segments were less in convex and straight groups (Concave 3,78±2 vs. 2,17±2.1 p<0.01; straight 5,15±2.7vs. 4,45±2,8, NS; convex 5,4±2,3 vs. 4,8±2,1 NS; basal vs. LDSE). Although only 13% (3/23) of the patients had no improvement in LDSE in Group A (p<0.05 v.s. group B and p<0.01 v.s. group C), 35% (7/20) of group B and 60% (6/10) of Group C patients were without improvement in LDSE. Although no relation was found between better left ventricular function (WMSI <2) and shape of the ST elevation in basal evaluation in multiple logistic regression analysis (p=0.06), an independent relation was found following LDSE (p=0.01, OR 4.5, %95CI 1.3-14.7). There was no in-hospital death in concave group whereas five patients died in either straight or convex group. Arrhythmia occurrence was lower in concave group during this period (p<0.05), and exercise capacities were lower. Conclusively, we suggested that there was an increased viability in infarct zone and decreased in-hospital mortality in patients with concave ST elevation on admission. This simple classification would be beneficial to estimate left ventricular functions at discharge.Öğe The relation of coronary artery disease with Doppler flow velocity and resistance index in cases without significant carotid artery stenosis(2001) Ulgen M.S.; Bilici A.; Acar M.; Onder H.; Sucu M.; Toprak N.OBJECTIVE: Atherosclerosis causes functional vasomotor changes as well as well as atheromatous carotid plaques and luminal stenosis resulting in mechanical effect. The relation between functional vasomotor changes in carotid arteries and extent of coronary artery disease is unknown. In our study, the probable relationship between carotid arterial flow velocities and resistance indexes (RI) with the extent of coronary artery disease (CAD) in patients who do not have significant carotid luminal stenosis was evaluated. METHODS: One hundred and fourteen patients (74 males, mean age 53+/-10 years, range 33-72 years) were studied. All patients underwent color Doppler sonography before coronary angiography. Peak systolic flow velocity, end-diastolic flow velocity and resistance index (RI) of right and left common carotid and internal carotid and internal carotid arteries were measured by color Doppler sonographic technique. Doppler parameters were correlated with the extent of CAD and left ventricular ejection fraction. RESULTS: Patients were classified on the basis of presence of significant CAD and the number of affected coronary arteries. Thirty-three patients did not have (normal group) and 81 patients had significant coronary arterial stenosis (22 patients with one-vessel disease, 27, with two-vessel disease and 32 patients with three-vessel disease). Flow velocities were the highest in normal group but the lowest in CAD patients, especially when 3 coronary arteries were affected. Correlation analysis demonstrated negative relationship of age, ejection fraction and number of affected coronary arteries with end-diastolic flow velocity, but positive and significant correlation with RI value. CONCLUSION: Our study is the first on this object. The results suggest that presence and extent of CAD changes flow velocities and RI values of common and internal carotid arteries. However, further investigations are required before these parameters can be applied as diagnostic criteria.Öğe Two mitral stenosis cases without anticoagulant therapy with signs of left atrial thrombus(2004) Karabulut A.; Iltimur K.; Toprak N.[No abstract available]
