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Öğe ACUTE ANTERIOR MYOCARDIAL INFARCTION DUE TO CORONARY ARTERY SPASM TRIGGERED BY PSYCHOSOCIAL TRAUMA IN A YOUNG ADULT PATIENT(ELSEVIER IRELAND LTD, 2011) Arıbaş, Alpay; Tekinalp, M.; Akıllı, Hakan; Alihanoğlu, Yusuf İzzettin; Özdemir, Kurtuluş[Abstract not Available]Öğe APICAL BALLOONING SYNDROME (TAKOTSUBO CARDIOMYOPATHY): A CASE REPORT(ELSEVIER IRELAND LTD, 2011) Tekinalp, M.; Akıllı, Hakan; Arıbaş, Alpay; Duman, C.; Alihanoğlu, Yusuf İzzettin[Abstract not Available]Öğe Appropriateness of the Current Guidelines on Reperfusion Treatment for Patients Applying to Our Hospital With St-Segment Elevation Acute Myocardial Infarction(2012) Karaarslan, Şükrü; Alihanoğlu, Yusuf İzzettin; Yıldız, Bekir Serhat; Sönmez, Osman; Soylu, Ahmet; Bacaksız, Ahmet; Alur, İhsan; Özdemir, Kurtuluş; Düzenli, AkifObjectives: This study investigated the appropriateness of treatment for patients admitted with ST-segment elevation myocardial infarction (STEMI) according to the current guidelines. We also aimed to determine in-patient and out-patient factors affecting optimal re perfusion therapy. Study design: The reperfusion therapy of 176 patients with STEMI was determined. The time period from first contact with a healthcare provider to the time of balloon inflation (door to balloon time), and from the time period of first contact with a healthcare provider to the time of initiation of a thrombolytic (door to needle time) were calculated. Similarly, the time from admission at the emergency service (ES) of our hospital after referral to the moment of balloon inflation (ES to balloon time) and the period from admission to ES at our hospital to the moment of initiation of a thrombolytic (ES to needle time) were calculated. In order to determine the amount of in-hospital delay, the time from ES admission to the call to the cardiology department and the time for the cardiologist to evaluate the patient and transfer time were recorded. Whether the referring physician was a cardiologist and the effect of work hours on the reperfusion period was also recorded. Results: The door to balloon time in the referred patient group was calculated as an average of 228 minutes, while the time for patients directly admitted to ES was calculated as an average of 98 minutes. Patients referred for the mechanical reperfusion period compared to American Heart Association (AHA) guidelines consisted of only 6% of the eligible patients, while according to the European Society of Cardiology (ESC) guidelines 13% of patients were appropriate. Patients who were directly admitted to ES, experienced rates according to AHA guidelines and 73% experienced these rates according to ESC guidelines. We also found no significant effect of working hours or referring physician's specialty (cardiologist or other) on reperfusion time. Conclusion: Compliance rates of reperfusion therapy for patients presenting with STEMI was very low. We realized, when taking into consideration the reasons for delay in terms of both health community and the policy of the country, it is obvious that we have to take strict measures. © 2012 Turkish Society of Cardiology.Öğe Assessment of Left Ventricular Systolic and Diastolic Function With Conventional and Tissue Doppler Echocardiography Imaging Techniques in Patients Administered Tyrosine Kinase Inhibitor(2012) Alihanoğlu, Yusuf İzzettin; Kaya, Zeynettin; Arı, Hatem; Karaarslan, Şükrü; Yıldız, Bekir Serhat; Karanfil, Mustafa; Yazıcı, Mehmet; Börüban, Melih Cem; Özdemir, Kurtuluş; Ülgen, Mustafa SıddıkObjectives: The aim of this study was to use echocardiographic techniques to determine the possible cardiotoxic effects of low molecular weight tyrosine-kinase inhibitors (TKI) in patients receiving the therapy for the first time. Study design: Thirty patients (17 females; 13 males; mean age 49±16; range 22 to 76 years) who met the exclusion criteria and were diagnosed as having malignancy were enrolled. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI) prior to the treatment. The conventional echocardiogram was repeated 2 months later as the patients were concurrently receiving therapy. Myocardial Performance Index was obtained by conventional echocardiography and by TDI techniques to evaluate left ventricular systolic and diastolic function. Results: Statistically significant increase occurred in mean left ventricle (LV) end-systolic volume. However, there was significant decrease in both mean LV ejection fraction and LV stroke volume values (64±3, 62±4, p=0.000 and 67±13, 61±13, p=0.000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0.99±0.49, 0.90±0.41, p=0.03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12.8±2.9, 11.6±2.3, p=0.004). Conclusion: Tyrosine-kinase inhibitors therapy can be administered safely to patients without predisposing factors for cardiotoxicity in short treatment intervals, and low molecular TKIs may cause subtle or clinically significant cardiotoxicity following the treatment period even in patients without predisposing factors for cardiotoxicity, so clinicians should consider this possibility.Öğe A case of exercise-induced sinus node deceleration without evident coronary artery disease(AVES YAYINCILIK, 2009) Kayrak, Mehmet; Alihanoğlu, Yusuf İzzettin; Arı, Hatem; Sönmez, Osman; Keser, Ahmet; Gök, Hasan[Abstract not Available]Öğe Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction(ELSEVIER SCIENCE INC, 2016) Arı, Hatem; Sönmez, Osman; Koç, Fatih; Demir, Kenan; Alihanoğlu, Yusuf İzzettin; Özdemir, Kurtuluş; Vatankulu, Mehmet AkifBackground We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). Methods We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48 hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. Results A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p = 0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06: 00-noon compared with period of noon-18: 00 and 18: 00-midnight (p = 0.029 and p = 0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9 +/- 7.3% versus 47.3 +/- 7.9%, p = 0.018, and 7.6 +/- 1.4 cm/s versus 8.2 +/- 1.6 cm/s, p= 0.003, respectively). Conclusions This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06: 00-noon period.Öğe A Comparison of Blood Pressure and Pulse Pressure Values Obtained by Oscillometric and Central Measurements in Hypertensive Patients(Taylor & Francis Ltd, 2010) Kayrak, Mehmet; Ülgen, Mehmet Sıddık; Yazıcı, Mehmet; Yılmaz, Remzi; Demir, Kenan; Doğan, Yıldız; Özhan, Hakan; Alihanoğlu, Yusuf İzzettin; Koç, Fatih; Bodur, SaitObjective. Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. Method. A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defined as a systolic blood pressure (SBP) >= 140 mmHg and a diastolic blood pressure (DBP) < 90 mmHg. MHT was defined as a SBP >= 140 mmHg and a DBP >= 90 mmHg. Results. The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (-5 mmHg, -3 mmHg, p=0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p=0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (-16 mmHg, -19 mmHg, p=0.15), whereas the sum of overestimation of DBP was significantly higher in the ISH than in the MHT group (+6 mmHg, - 1 mmHg, p=0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. Conclusion. Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.Öğe Diagnostic importance of aVR derivation in exercise stress testing for interpreting of multivessel and proximal LAD disease(AVES YAYINCILIK, 2011) Arı, Hatem; Alihanoğlu, Yusuf İzzettin; Arı, Mehtap; Tokaç, Mehmet[Abstract not Available]Öğe Does Spironolactone Have a Dose-Dependent Effect on Left Ventricular Remodeling in Patients with Preserved Left Ventricular Function After an Acute Myocardial Infarction?(WILEY-HINDAWI, 2013) Vatankulu, Mehmet Akif; Bacaksız, Ahmet; Sönmez, Osman; Alihanoğlu, Yusuf İzzettin; Koç, Fatih; Demir, Kenan; Gül, Enes ElvinAims The aim of this study was to investigate the effects of spironolactone on left ventricular (LV) remodeling in patients with preserved LV function following acute myocardial infarction (AMI). Methods and Results Successfully revascularized patients (n=186) with acute ST elevation MI (STEMI) were included in the study. Patients were randomly divided into three groups, each of which was administered a different dose of spironolactone (12.5, 25mg, or none). Echocardiography was performed within the first 3days and at 6months after MI. Echocardiography control was performed on 160 patients at a 6-month follow-up. The median left ventricular ejection fraction (LVEF) increased significantly in all groups, but no significant difference was observed between groups (P=0.13). At the end of the sixth month, the myocardial performance index (MPI) had improved in each of the three groups, but no significant difference was found between groups (F=2.00, P=0.15). The mean LV peak systolic velocities (S-m) increased only in the control group during the follow-up period, but there is no significant difference between groups (F=1.79, P=0.18). The left ventricular end-systolic volume index (LVESVI) and the left ventricular end-diastolic volume index (LVEDVI) did not change significantly compared with the basal values between groups (F=0.05, P=0.81 and F=1.03, P=0.31, respectively). Conclusion In conclusion, spironolactone dosages of up to 25mg do not augment optimal medical treatment for LV remodeling in patients with preserved cardiac functions after AMI.Öğe Exercise does not increase QTcmax and QTcd in diabetic patients with autonomic neuropathy(BLACKWELL PUBLISHING, 2007) Yazıcı, Mehmet; Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; Yazıcı, Raziye; Kayrak, Mehmet; Ülgen, Mehmet Sıddık; Alihanoğlu, Yusuf İzzettinBackground: The purpose of this study was to examine the effects of exercise on maximum QTc interval (QTcmax) and QTc dispersion (QTcd) in diabetic patients without clinically evident heart disease. Methods: Seventy-six diabetic patients who had no coronary artery disease or hypertension (group I; mean age 48 +/- 9 years old) and 40 healthy volunteers (group II; mean age 46 +/- 13 years old) were enrolled in the study. Cases with clinically evident heart disease were excluded from the study. Resting 12-lead electrocardiogram (ECG) and maximal treadmill exercise test (according to Bruce protocol) were performed in all cases. The QTcmax interval was determined at rest (RQTcmax) and during peak exercise (PQTcmax). Also, the QTcd was measured at rest (RQTcd) and during peak exercise (PQTcd). Autonomic neuropathy was assessed by measuring the heart rate variability (HRV). Results: There was no significant difference between clinical characteristics of two groups. In group I, HRV parameters were significantly lower than group II. RQTcd, PQTcd, RQTcmax, and PQTcmax were significantly longer in group I (56 +/- 16 vs 34 +/- 11; P < 0.001, 62 +/- 22 vs 40 +/- 15; P < 0.001, respectively). In diabetic patients, there was no significant difference between RQTcmax and PQTcmax (428 +/- 19 vs 420 +/- 31; P > 0.05), and no significant difference was present between RQTcd and PQTcd (56 +/- 16 vs 62 +/- 22; P > 0.05, respectively). Conclusion: Exercise does not affect QTcd in patients with diabetes mellitus and without clinically evident heart disease.Öğe The Impact of Central Blood Pressure Levels on the Relationship Between Oscillometric and Central Blood Pressure Measurements: A Multicenter Invasive Study(WILEY, 2013) Alihanoğlu, Yusuf İzzettin; Kayrak, Mehmet; Ülgen, Mehmet S.; Yazıcı, Mehmet; Yılmaz, Remzi; Demir, KenanThe aim of this study was to investigate impact of central blood pressure (BP) levels and sex on the difference between central and upper arm oscillometric BP values. Oscillometric arterial BP measurements of 675 patients were simultaneously compared with values measured from the ascending aorta. The patients were divided into 3 groups according to systolic BP levels. The upper arm oscillometric device overestimated systolic BP (SBP) at low and medium BP levels but it underestimated SBP at high BP level. As for the effect of sex on differences in central and oscillometric BP, SBP was overestimated to a lesser degree in women than in men at low BP levels, but it was more highly underestimated in women than in men at high BP levels. The difference between oscillometric upper arm BP and aortic BP was directly affected by the patient's central BP level. In addition, the difference between central and oscillometric BP was also affected by sex factor.Öğe Intravenous N-acetylcysteine Plus High-dose Hydration Versus High-dose Hydration and Standard Hydration for the Prevention of Contrast-induced Nephropathy: CASİS-A Multicenter Prospective Controlled Trial(Elsevier Ireland Ltd, 2012) Koç, Fatih; Özdemir, Kurtuluş; Kaya, Mehmet Güngör; Doğdu, Orhan; Vatankulu, Mehmet Akif; Ayhan, Selim; Erkorkmaz, Ünal; Sönmez, Osman; Aygül, Meryem Ülkü; Kalay, Nihat; Kayrak, Mehmet; Karabağ, Turgut; Alihanoğlu, Yusuf İzzettin; Günebakmaz, ÖzgürBackground: Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. We investigated the efficacy of prophylactic intravenous (IV) N-acetylcysteine (NAC) and hydration for the prevention of CIN in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: A total of 220 patients who had mild to moderate renal dysfunction with serum creatinine (SCr) >= 1.1 mg/dL or creatinine clearance <= 60 mL/min were randomized in 3 groups: 80 patients were assigned to IV NAC plus high-dose hydration with normal saline, 80 patients to only high-dose hydration with normal saline and 60 patients to standard hydration with normal saline (control group). The primary end point was the alteration of SCr level. The secondary end point was the development of CIN after the procedure. Results: SCr levels changed the least in the NAC plus high-hydration group (P=0.004). The rate of the CIN in the NAC plus high-dose hydration group was also lower than the high-dose hydration group (P=0.006). No significant differences in the primary and secondary end points were found between high-dose hydration and control group. Conclusion: The results of this study suggest that NAC plus high-dose hydration was superior to high-dose hydration alone as well as standard hydration for the protection of renal functions in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or PCI. High-dose hydration without NAC was not better than standard hydration alone.Öğe Metabolik sendromlu hastalarda nondipper kan basıncı seyrinin hedef organ hasarı üzerine etkisi(2009) Soylu, Ahmet; Güleç, Hakan; Alihanoğlu, Yusuf İzzettin; Sönmez, Osman; Ayhan, Selim Suzi; Gök, HasanAmaç: Hem metabolik sendromun (MetS) hem de nondipper durumun (gece kan basıncı düşüşündeki yetersizlik) hedef organ hasarı ile ilişkili olduğu gösterilmiştir.Bu çalışmada MetS’li kişilerde nondipper durumun hedef organ hasarına etkisi araştırıldı. Ça lış ma pla nı: Metabolik sendrom tanısı konan 82 hasta, 24 saatlik ambulatuvar kan basıncı izleme sonuçlarına göre dipper (n35, 19 kadın, 16 erkek; ort. yaş 48.46.4) ve nondipper (n47, 35 kadın, 12 erkek; ort. yaş 50.44.7) olarak iki gruba ayrıldı. Tüm çalışma grubunda kardiyak hasar konvansiyonel ve doku Doppler ekokardiyografi ile, böbrek hasarı ise 24 saatlik idrarda albümin atılımı ile değerlendirildi. Bul gu lar: İki grup, yaş, beden kütle indeksi, diyabet varlığı, klinik ve 24 saatlik kan basıncı, gece ve gündüz kan basın- cı değerleri, plazma lipit düzeyleri, sigara kullanımı, MetS ölçütlerinin dağılımı ve toplam MetS ölçütü sayısı bakımından benzer özellikteydi. Sol ventrikül tepe diyastolik erken miyokardiyal hız (Em)/tepe diyastolik geç miyokardiyal hız (Am) oranı nondipper grupta anlamlı derecede daha düşük bulundu (p0.016). Sol ventrikül kütle indeksi, miyokart performans indeksi ve 24 saatlik idrar albümin atılımı nondipper grupta daha yüksek olmakla birlikte, fark anlamlı değildi (sırasıyla p0.110, p0.099 ve p0.093). Çokdeğişkenli regresyon analizi sonucunda yaş artışı ve nondipper durumun bağımsız olarak Em/Am oranında azalmaya neden olduğu görüldü (sırasıyla; ?-0.25, p0.020 ve ?-0.22, p0.042). So nuç: Metabolik sendromlu kişilerdeki nondipper durumu diğer MetS bileşenlerinden bağımsız olarak hem kardiyak hem de böbrek hasarı ile ilişkili olabilir. Nondipper gruptaki diyastolik disfonksiyonun albüminüri düzeyindeki artıştan daha belirgin olması, bu kişilerde kardiyak hasarın böbrek hasarından daha ön planda olabileceğini düşündürmektedir.Öğe Metabolik Sendromlu Hastalarda Nondipper Kan Basıncı Seyrinin Hedef Organ Hasarı Üzerine Etkisi(2009) Soylu, Ahmet; Güleç, Hakan; Alihanoğlu, Yusuf İzzettin; Sönmez, Osman; Ayhan, Selim Suzi; Gök, HasanObjectives: Both metabolic syndrome (MetS) and non-dipping status (insufficient reduction in nocturnal blood pressure) have been linked with target organ damage. We evaluated the effect of nondipping status on target organ damage in subjects with MetS. Study design: Eighty-two patients diagnosed as having MetS were divided into two groups according to the findings of 24-hour ambulatory blood pressure monitoring as dipper (n=35, 19 women, 16 men; mean age 48.4±6.4 years) and nondipper (n=47, 35 women, 12 men; mean age 50.4±4.7 years). Cardiac damage was assessed by conventional and tissue Doppler echocardiography, and renal damage by 24-hour urinary albumin excretion. Results: The two groups were similar with regard to age, body mass index, presence of diabetes, smoking, clinical and 24-hour, daytime and nighttime blood pressures, plasma lipid profile, distribution of and the mean total number of MetS criteria. The ratio of early (Em) to late (Am) left ventricular peak diastolic myocardial velocities (Em/Am) was significantly lower in nondippers (p=0.016). Nondippers also had higher values of left ventricular mass index, myocardial performance index, and 24-hour urinary albumin excretion, but these differences did not reach a significant level (p=0.110, p=0.099, p=0.093, respectively). Multivariate regression analysis showed increasing age and nondipping status as independent factors associated with decreased Em/Am ratio (?=-0.25, p=0.020 and ?=-0.22, p=0.042, respectively). Conclusion: In subjects with MetS, nondipping status may be associated with both cardiac and renal damage independent of other components of MetS. Since the degree of diastolic dysfunction is more marked than that of albuminuria in nondippers, it may be extrapolated that the extent of cardiac damage surpasses renal damage in these subjects.Öğe A Rare but Serious Complication of Percutaneous Coronary Intervention: Spinal Cord Embolism(Taylor & Francis Ltd, 2010) Vatankulu, Mehmet Akif; Kayrak, Mehmet; Alihanoğlu, Yusuf İzzettin; Sallı, Ali; Ülgen, Mehmet SıddıkBackground/Objective: Many atherothrombotic complications are associated with coronary angiography. Spinal cord embolism with high morbidity and mortality is one of these complications. Methods: Case report. Results: A 65-year-old woman was admitted to the hospital with acute myocardial infarction. Immediately after coronary angiography, she complained of paresthesia and paraparesis of her legs. Magnetic resonance imaging (MRI) detected hyperintensity at the level of the conus medullaris. Antiaggregant therapy and a physiotherapy program continued. After 2 months, clinical and MRI findings had improved. Conclusions: Invasive procedures such as coronary angiography can lead to serious atherothrombotic complications.Öğe The Relationship between Coronary Sinus and Impaired Right Ventricular Myocardial Performance Index in Mitral Stenosis(WILEY-BLACKWELL, 2013) Vatankulu, Mehmet Akif; Koç, Fatih; Gül, Enes Elvin; Bacaksız, Ahmet; Sönmez, Osman; Demir, Kenan; Alihanoğlu, Yusuf İzzettinObjectives: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). Methods: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 +/- 12 years) and 20 age-and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 +/- 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical fourchamber view during the ventricular systole. Results: The RV MPI was significantly higher in the MS group compared to the control group (0.60 +/- 0.11 vs. 0.41 +/- 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 +/- 1.1 mm vs. 6.5 +/- 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). Conclusion: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.Öğe Relationship between heart-type fatty acid-binding protein levels and coronary artery disease in exercise stress testing: an observational study(TURKISH SOC CARDIOLOGY, 2011) Arı, Hatem; Tokaç, Mehmet; Alihanoğlu, Yusuf İzzettin; Kıyıcı, Aysel; Kayrak, Mehmet; Arı, Mehtap; Sönmez, OsmanObjective: Although, there has been great improvement on the diagnosis and early treatment of acute coronary syndromes, especially in terms of myocardial damage biochemical markers, we do not have a specific marker yet, for using the diagnosis of stable coronary artery disease (CAD). This study aimed to evaluate the relationship between CAD and the changes of heart-type fatty acid binding protein (H-FABP) levels before and after exercise stress testing (EST). Methods: A total of 47 patients were enrolled in this observational study. Of 47 patients, 21 had normal coronary anatomy; the remaining 26 patients had coronary lesions over 70% in at least one major coronary artery. All patients performed EST. Along with this, H-FABP levels before EST and at peak exercise, 1(st) hour, 3(rd) hour (3h), were measured in all patients. Differences among the measurements were evaluated through the Friedman test and Wilcoxon test, and the Bonferroni correction was applied to determine which measurement caused the difference. Results: Contrary to expectations, the means of the H-FABP values measured at particular intervals for each group tended to decline from the basal level to the 3h level. When the difference between the 3h measurement and the basal level was compared in each group, the decreasing was statistically significant in both groups (p<0.05). A statistically significant decrease at the 3h measurement compared to the basal level in the CAD group was more apparent than in the control group (2.790 +/- 2.569ng/ml vs. 0.837 +/- 2.070ng/ml, p=0.009). Conclusion: We found that H-FABP levels did not increase during EST and contrary to expectation, were inclined to decrease. We thought that decreasing H-FABP levels likely resulted from exercise-induced proteinuria. (Anadolu Kardiyol Berg 2011; 11: 685-91)Öğe A successful thrombolysis with tissue-type plasminogen activator in a case of pulmonary embolism after failed streptokinase therapy(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012) Kayrak, Mehmet; Alihanoğlu, Yusuf İzzettin; Gül, Enes Elvin; Abdulhalikov, Turyan; Sönmez, Osman; Yazıcı, MehmetA 76-year-old male patient diagnosed with acute, massive pulmonary embolism due to deep vein thrombosis of a lower extremity developed significant cardiovascular and respiratory instability. Subsequently, streptokinase infusion was administered over two hours. Spiral computed tomography was performed due to the persistent hemodynamic instability following the thrombolytic therapy. Computed tomography showed persistent massive pulmonary embolism. In the light of literature data, the patient was recommended for surgical pulmonary embolectomy, however he refused surgery. Therefore, he was administered intravenous recombinant tissue type plasminogen activator over two hours. Clinic status of the patient and radiological findings were significantly improved following therapy. The patient was discharged with effective anticoagulant therapy.Öğe Tirozin kinaz inhibitörü alan hastalarda sol ventrikül sistolik-diyastolik fonksiyonlarının konvansiyonel ve yeni ekokardiyografik parametrelerle değerlendirilmesi(Selçuk Üniversitesi Tıp Fakültesi, 2010) Alihanoğlu, Yusuf İzzettin; Ülgen, M. Sıddıkİlk kez küçük moleküllü tirozin kinaz inhibitörü (TKİ) tedavisi alacak hastalarda konvansiyonel ve doku Doppler ekokardiyografik değerlendirme ile bu sınıftaki ilaçlara bağlı muhtemel gelişebilecek kardiyotoksisiteyi erken dönemde belirlemek, böylece kardiyotoksisitenin önlenmesi ve tedavisi konusunda hasta takibini sağlayabilmektir Materyal ve Metod: Çalışmaya malignensi tanısı konulan, kardiyotoksisite yönünden bilinen risk faktörlerinin dışlandığı ve ilk kez küçük moleküllü tirozin kinaz inhibitörü verilmesi planlanan 30 hasta (kadın-erkek oranı, 17:13; ortalama yaş, 49±16 median 52; minimum:22, maksimum:76 yıl) dahil edildi. Bütün hastalara tedaviye başlamadan hemen önce ve tedavi başlangıcından 2 ay sonra, hem konvansiyonel hemde kardiyak fonksiyonlardaki minimal değişiklikleri saptamada hassas bir yöntem olan doku Doppler görüntüleme tekniği kullanılarak ekokardiyografik değerlendirmeler yapıldı. Ayrıca ventrikül sistolik ve diyastolik fonksiyonlarını değerlendirme amacıyla, konvansiyonel ekokardiyografi ile elde edilen miyokardiyal performans indeksi (MPİ) ve doku Doppler ile elde edilen MPİ (DDMPİ) ölçümleri değerlendirildi. Bulgular: Çalışmamızda hastalarda bazal ve 2. ayın sonundaki değerler karşılaştırıldığında; konvansiyonel yöntemle elde edilen SVSSH ort. değerinde anlamlı artış, SVEF ort. değerinde (64±3, 62±4, p=0,000) ve SV atım hacminde (67±13, 61±13, p=0,000) ise anlamlı azalma tespit edildi. Doku Doppler görüntülemede ise anterior duvar Em/Am değerinde anlamlı düşme (0,99± 0,49, 0,90 ± 0,41, p=0,03) saptandı, ayrıca Sm değerinde gerek ayrı ayrı SV dört duvarında, gerekse bunların ortalamalarını yansıtan Sm ort. değerinde düşme saptanırken, bu düşüş sadece lateral duvar Sm değeri için istatistiki anlamlılığa ulaştı (12,8±2,9, 11,6±2,3, p=0,004). Sadece inferior DDMPİ değerinde anlamlı artış (53,7±7,4, 56,4 ± 7,7, p=0,03) saptanırken, diğer 3 duvar DDMPİ ve konvansiyonel yöntemle elde edilen MPİ değerinde anlamlı değişiklik gözlenmedi. Sonuç: Elde ettiğimiz veriler: 1- Kardiyotoksisite yönünden predispozan faktörlere sahip olmayan hasta grubunda kısa tedavi intervallerinde bu ajanların güvenle kullanılabileceğini, 2-Risk faktörlerinin dışlandığı hastalarda bile her şeye rağmen KMTKİ ile ilişkili ilerde klinik veya subklinik kardiyotoksisite gelişebileceğini ve tedavinin devam eden periodunda dikkatli olunması gerektiğini göstermektedirÖğe Wilson's Disease with Wolff-Parkinson-White Syndrome: Case report(2013) Karaarslan, Şükrü; Karakaş, Mustafa Serkan; Alihanoğlu, Yusuf İzzettinWilson hastalığının kardiyak tutulumunda sol ventrikül hipertrofisi, aterosklerozis, ani kardiyak ölüm ve çeşitli aritmiler görülebilir. Bu yazıda Wolff-Parkinson-White sendromunun eşlik ettiği Wilson hastalığı literatürler ışığında tartışılmıştır. Wilson hastalığı tanısı olan 22 yaşında erkek hasta göğüs ağrısı şikâyeti ile hastaneye başvurdu. 2 yıldır kısa süreli çarpıntı şikâyetleri olan hastanın 4 saatlik elektrokardiyografik holter incelemesinde herhangi bir taşikardi saptanmamış. Hastanın elektrokardiyografisinde Wolff-ParkinsonWhite sendromunu destekleyen kısa PR aralığı ve delta dalgası bulunmaktaydı. Hasta hastaneye yatırıldı; sonrasında elektrofizyolojik haritalama yapıldı ve radyofrekans ablasyon yöntemi ile aksesuar yolak sonlandırıldı. Çarpıntı şikâyeti ve Wilson hastalığı olan hastalar olası aritmiler yönünden değerlendirilmeli ve bu hastaların elektrokardiyografileri aritmi açısından incelenmelidir. Bu yazıda Wilson hastalığı ve Wolff-Parkinson-White sendromu olan bir vaka ilgili literatürler eşliğinde sunulmuştur.
