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Öğe Acute Occlusion of the Left Main Trunk Presenting as ST-Elevation Acute Coronary Syndrome(Churchill Livingstone Inc Medical Publishers, 2010) Aygül, Nazif; Salamov, Elvin; Doğan, Umuttan; Tokaç, MehmetAcute obstruction of the left main coronary artery (LMCA) is not frequently encountered Electrocardiographic findings are important to early diagnosis in determining an acute obstruction of the LMCA, which requires immediate aggressive treatment, in this extremely unstable condition However, there is no single typical electrocardiographic pattern representing acute occlusion of the LMCA We describe a rare electrocardiographic finding that suggested ST-elevation acute coronary syndrome of the anterior zone due to left main trunk total occlusion.Öğe Akut kalp yetersizliği nedeni ile kardiyoloji yoğun bakım ünitesine yatırılan hastaların klinik ve demografik özelliklerinin ve bu özelliklerin hastanede kalış süresi ile ilişkisinin incelenmesi(2012) Şahin, Sami; Doğan, Umuttan; Özdemir, Kurtuluş; Gök, HasanAmaç: Görülme sıklığındaki artışa rağmen, akut kalp yetersizliği (KY) nedeniyle kardiyoloji yoğun bakım ünitesine (YBÜ) kabul edilen hastaların klinik ve demografik özellikleri ile ilgili veriler yetersizdir. Çalışmamızın amacı, bu hasta grubundaki başvuru özelliklerinin ve hastanede kalış süresini etkileyen faktörlerin incelenmesidir. Yöntemler: Birincil akut KY tanısıyla kardiyoloji YBÜ’ne yatırılan 150 hastanın dahil edildiği tek-merkezli, ileriye dönük bir çalışma düzenlendi. Kategorik ve sürekli değişkenlerin analizi için sırasıyla Ki-kare ve Student-t testleri kullanıldı. Hastanede kalış süresini etkileyen bağımsız faktörleri belirlemek için lineer regresyon analizi kullanıldı. Bulgular: Hastaların %49’unda yeni başlangıçlı KY ve %25’inde korunmuş sol ventrikül ejeksiyon fraksiyonu (EF) tespit edildi. Hastaların %25.3’ünde, yeni başlangıçlı KY hastalarının ise %46.6’sında tetikleyici faktör akut koroner sendromdu. Korunmuş EF’li hastalarda tetikleyici faktör olarak atriyal fibrilasyon ve kalp kapak hastalıklarına düşük EF’li hastalara göre daha fazla oranda rastlandı. Lineer regresyon analizi, anemi (?1.62; %95 GA 0.08-3.15; p0.039) ve ciddi mitral yetersizliği (?2.55; %95 GA 0.06-5.05; p0.045) ile sistolik kan basıncı (?-0.03; %95 GA -0.06 -0.002; p0.039) ve kan üre azotunun (?0.034; %95 GA 0.006-0.06; p0.016) hastanede kalış süresinin bağımsız belirleyicileri olduğunu gösterdi. Sonuç: Altta yatan kardiyovasküler risk faktörlerinin, eşlik eden hastalıkların ve tetikleyici patolojilerin çeşitliliği AKY sendromlarının heterojen yapısını ortaya koymaktadır. Bununla birlikte, hastane içi ölüm oranları yüksektir ve başvuru sırasındaki klinik özellikler hastane içi seyir ile önemli bir ilişki gösterir.Öğe Anthropometric Indexes, Insulin Resistance, and Serum Leptin and Lipid Levels in Women With Cryptogenic Epilepsy Receiving Topiramate Treatment(Elsevier Sci Ltd, 2010) Genç, Bülent Oğuz; Doğan, Ebru Apaydın; Doğan, Umuttan; Genç, EmineWe aimed to investigate the effects of topiramate monotherapy on anthropometric indexes, insulin resistance, and serum leptin and lipid levels in 33 premenopausal women (mean age +/- standard deviation: 26.7 +/- 7.1 years) with cryptogenic epilepsy. Body mass index (BMI), waist circumference and serum leptin, insulin and lipid levels were measured at baseline and at 6 months after initiation of topiramate. We found reductions in BMI (p < 0.001), waist circumference (p < 0.001) and serum high-density lipoprotein (HDL) cholesterol levels (p = 0.011). We also found significant improvements in insulin resistance (p = 0.023), but not in serum leptin levels (p = 0.45). Our results suggest that topiramate treatment in women with epilepsy is associated with reduced BMI and waist circumference and improvement in insulin resistance; however, according to our data, topiramate treatment is also associated with lower HDL cholesterol levels, which may substantially increase vascular disease.Öğe Electrical Storm Associated with H1N1 Infection(Elsevier Ireland Ltd, 2010) Doğan, Umuttan; Can, İlknur; Arıbaş, Alpay; Düzenli, Mehmet Akif; Yazıcı, Mehmet; Erayman, İbrahimA 47-year old male was admitted to the emergency department with the complaint of recurrent shocks from his ICD. The monitorization of the patient with the ECG showed that he was experiencing recurrent ventricular tachycardia (VT) attacks which resolved successfully with the shocks of the ICD. Due to repetetive shocks at the first evaluation in the emergency department, the patient was sedated. His past medical history was remarkable for an inferior myocardial infarction 2 years ago and a cardiopulmonary arrest and a subsequent implantation of an ICD after the electrophysiologic study in which VT had been documented. He had not received any shocks after the implantation of ICD and no signs or symptoms of either acute coronary syndrome or heart failure were present at the time of presentation. No other pathologies other than a body temperature of 37.5 was found at the physical examination. The patient stated that he had been suffering from high body temperature, nasal flow, a sore throat and myalgia in the past three days. He was on aspirin, atorvastatin, ramipril and 5 mg/d bisoprolol treatments, intravenous amiodarone infusion was added to these treatments and the dose of bisoprolol was increased to 10 mg/d. The patient was hospitalized in the cardiology intensive care unit and it was documented that he had received 89 electrical shocks due to repetetive VT attacks in the last 6 hours. The frequency of the attacks subsided after the infusion of amiodarone and electrical shocks completely resolved after 8 hours of the treatment. The transthoracic echocardiography showed that left ventricular ejection fraction was 40%. Hemogram, serum electrolyte levels, kidney, liver and thyroid functions were in normal ranges, however the blood analyses showed that he had HINI infection. Coronary angiography was performed at the 10th day of treatment to rule out any ischemia which might lead to VT. Distal segments of the circumflex and right coronary arteries were totally occluded whereas LAD was patent. These findings were consistent with the coronary an- giogram which was performed 6 months ago. As new onset ischemia, heart failure, thyrotoxicosis, anemia and electrolyte disturbances were ruled out, repetetive VT attacks were thought to be associated with H1N1 infection. Ventricular tachycardia attacks are known to be associated with infectious diseases under some circumstances. To the best of our knowledge, our patient is the first case report of an electrical storm associated with HINI infection.Öğe Embolization of Atrial Septal Occluder Device Into the Pulmonary Artery(Elsevier Ireland Ltd, 2010) Doğan, Umuttan; Özdemir, Kurtuluş; Narin, Cüneyt; Akıllı, Hakan; Güleç, Hakan; Gök, HasanObjective: Percutaneous device closure of atrial septal defects (ASD) has been established as a safe and attractive alternative to surgical management. Besides advantages such as lower morbidity and hospital stay when compared to surgical closure, the number of the complications increase day by day as the number of percutaneous procedures increase. We present a case with embolization of a septal occluder device (SOD) to the main pulmonary artery. Methods: A 20–year old woman was referred to our cardiology department for percutaneous device closure. TTE findings were consistent with secundum type ASD occupying the entire fossa ovalis and percutaneous closure was scheduled as the left to right shunt ratio was >1.5. The length of superior, inferior and aortic rims were measured as 14, 9 and 4 mm respectively. It was noted that the aortic rim was thin and had a membranous appearance. Following general anesthesia, balloon stretched diameter was measured as 31 mm by using stop-flow method. A 34-mm Amplatzer SOD was employed after properly positioning the SOD on the atrial septum under the guidance of transesophageal echocardiography. The release of the device was performed after Minnesota Maneuver to ensure the stability. The views obtained by TEE were satisfactory with absence of a flow across the interatrial septum and the procedure was finalized. The patient did not have any symptoms.Öğe Evaluation of Cardiac Repolarization Indices in Well-Controlled Partial Epilepsy: 12-Lead ECG Findings(Elsevier, 2010) Apaydın Doğan, Ebru; Doğan, Umuttan; Ünal Yıldız, Gülce; Akıllı, Hakan; Genç, Emine; Genç, Bülent Oğuz; Gök, HasanPurpose: To evaluate the cardiac repolarization indices in terms of QT intervals in patients with well-controlled partial epilepsy. Methods: Seventy-six adult patients with well-controlled partial epilepsy and 66 healthy controls were enrolled into the study. 12-Lead ECGs were obtained from all participants. Corrected QT (QTc) intervals including maximum QTc (QTmaxc), minimum QTc (QTminc) and QTc dispersion (QTcd) were calculated. Results: QTmaxc and QTcd intervals were significantly longer in the epilepsy group when compared to control group (439 +/- 27 ms vs. 422 +/- 25 ms, p < 0.001 and 55 +/- 18 ms vs. 41 +/- 18 ms, p < 0.001). The proportion of patients with pathologically prolonged QTcd intervals (>50 ms) was significantly higher in the epilepsy group (25 of 76 vs. 7 of 66, p = 0.002). QTmaxc was significantly correlated with age (beta = 0.29, p = 0.012) after adjusting for gender, body mass index and duration of epilepsy. No correlation was observed between the duration of epilepsy and any of the QT intervals. There were no significant differences between the subgroups regarding QT intervals according to the etiology of the seizures (symptomatic/cryptogenic), being on mono- or polytherapy and treatment regimens (carbamazepine/non-carbamazepine). Conclusion: The results highlight the importance of cardiac evaluation even in patients with well-controlled epilepsy. 12-lead ECG recordings might help to uncover serious cardiovascular events.Öğe Kounis Syndrome: First Case Due to Propyphenazone in Turkey(ELSEVIER IRELAND LTD, 2010) Arıbaş, Alpay; Sizer, Murat; Doğan, Umuttan; Akıllı, Hakan; Gök, HasanObjective: Kounis syndrome (KS) is a syndrome characterized by the concurrence of acute coronary syndrome with hypersensitivity or anaphylaxis induced by mast cell activation. Many precipitants such as food allergy, environmental exposures (insect bite), bronchial asthma, angioedema, urticaria, serum sickness, drugs (antibiotics, corticosteroids, dextran, nonsteroidal antiinflammatory drugs, skin disinfectants, tetanus toxoid, analgesics, antineoplastics, thrombolytics, anticoagulants, proton pump inhibitors, contrast media) have been reported to be associated with KS. We present the first case of KS in Turkey which might be associated with the use of propyphenazone.Öğe Left Ventricular Apical Thrombus Secondary to Takotsubo Syndrome(ELSEVIER IRELAND LTD, 2010) Akıllı, Hakan; Arıbaş, Alpay; Doğan, Umuttan; Karaarslan, Şükrü; Düzenli, Mehmet AkifObjective: Takotsubo syndrome is a cardiac syndrome mimicking acute myocardial infarction and characterised by reversible left ventricular dysfunction in the absence of significant coronary disease. We present a case of left ventricular apical thrombus which might be secondary to takotsubo syndrome.Öğe Oral Anticoagulation in Atrial Fibrillation: Are the Problems Solved?(2010) Doğan, UmuttanThe prevalence of atrial fibrillation (AF) is high and it is expected to increase in the near future (1). AF is a strong independent risk factor for ischemic stroke and systemic arterial embolisation (2). Oral anticoagulation (OAC) has been shown to decrease the risk of stroke. In a meta-analysis of 6 randomized trials including 2900 participants, the estimated relative risk reduction is reported as 64% (3). Despite the evident benefits, OAC is underused even in high risk AF patients (4, 5).Öğe Oral Anticoagulation in Atrial Fibrillation: Are the Problems Solved?(Aves Yayıncılık, 2010) Doğan, UmuttanThe prevalence of atrial fibrillation (AF) is high and it is expected to increase in the near future (1). AF is a strong independent risk factor for ischemic stroke and systemic arterial embolisation (2). Oral anticoagulation (OAC) has been shown to decrease the risk of stroke. In a meta-analysis of 6 randomized trials including 2900 participants, the estimated relative risk reduction is reported as 64% (3). Despite the evident benefits, OAC is underused even in high-risk AF patients (4, 5). The study by Elezi et al. (6) provides an interesting retrospective analysis of the prescription of OACs in patients with AF in a single tertiary centre in Kosovo. The main finding is the low percentage of OAC use in patients with AF when compared with the previous studies. It is reported that only less than 1/3 of patients with primary or secondary diagnosis of AF were discharged on anticoagulation therapy. Elder age, normal left atrial size, and preserved ejection fraction were the independent predictors of underprescription of anticoagulants.Öğe P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke(IVYSPRING INT PUBL, 2012) Doğan, Umuttan; Doğan, Ebru Apaydın; Tekinalp, Mehmet; Tokgöz, Osman Serhat; Arıbaş, Alpay; Akıllı, Hakan; Özdemir, KurtuluşBackground: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P-d) might be a useful marker in predicting PAF in patients with acute ischemic stroke. Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared. Results: Maximum P-wave duration (p=0.002), P-d (p<0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis P-d was the only independent predictor of PAF. The cut-off value of P-d for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p<0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%. Conclusion: P-d on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.Öğe PACEMAKER STRESS ECHOCARDIOGRAPHY FOR DIFFERANTIAL DIAGNOSIS OF LOW OUTPUT, LOW GRADIENT AORTIC STENOSIS(ELSEVIER IRELAND LTD, 2010) Doğan, Umuttan; Akıllı, Hakan; Arıbaş, Alpay; Arslan, Ramazan; Soylu, Ahmet; Tokaç, Mehmet[Abstract not Available]Öğe A Successful Fibrinolytic Therapy of Trombus Entrapped in a Patent Foramen Ovale with Acute Pulmonary Embolism(Elsevier Ireland Ltd, 2010) Kaya, Zeynettin; Altunbaş, Gökhan; Doğan, Umuttan; Özdemir, Kurtuluş; Gök, HasanA 75-year old male patient without prior history of chronic disease was admitted to hospital with worsening dyspnea for three days. On admission he was hypotensive (90/60 mmHg) and tachycardic (121 beat/pm). Electrocardiogram showed right bundle branch block, deep S waves in DI, Q waves and negative T waves in DIII. Transthoracic echocardiography (TTE) which was performed in emergency service revealed dilated right heart chambers (right ventricle area/left ventricle area: 1.27), depressed right ventricle (RV) systolic functions (RV ejection fraction: 22%, RV lateral wall basal segment tissue doppler Sm: 11.2 cm/s), elevated pulmonary artery pressure (45mmHg). In 2-D images, there was a mobile thrombus entrapped in a patent foramen ovale (PFO) which was also entering RV via tricuspid valve. The condition was considered as having high surgical risk since the patient was hemodynamically unstable with decreased O2 saturation (SaO2: 83%), high creatinine levels (2.6 mg/dl) and advanced age. Slow intravenous. infusion of alteplase (100 mg/2 hours) was administered after carefully ruling out contraindications. Thereafter, blood pressure and SaO2 rapidly improved. Control TTE after infusion showed that the thrombus had been dramatically resolved and disappeared. Pulmonary artery pressure decreased (36 mmHg), RV ejection fraction (36%) and RV systolic wall motion improved (Sm:15.1 cm/s), RV dilatation regressed (RV area/left ventricle area: 0.87) shortly after initial therapy. After full recovery, the patient was discharged with oral anticoagulant therapy.Öğe Supraventricular Tachycardia Associated with Cilostazol Use(ELSEVIER IRELAND LTD, 2010) Doğan, Umuttan; Görmüş, Niyazi; Yazıcı, Mehmet; Can, İlknur; Gök, HasanObjective: We present a case of supraventricular tachycardia which might be associated with the initiation of cilostazol treatment. Methods: A 46-year old male was admitted to the outpatient clinics of the cardiology department with the complaint of sudden onset of palpitations lasting for approximately 30 minutes. He stated that though most of his episodes terminated spontaneously, he had to receive several medical interventions in the emergency department. His past medical history was remarkable for a lower extremity pain which suggested intermittant claudication. His MR-angiography of the lower extremities was consistent with a total occlusion of bilateral posterior tibial artery and right anterior tibial artery. Revascularization had not been planned due to distal arterial disease, therefore the patient was put on oral cilostazol and acetylsalicylic acid treatments. His palpitations started after the initiation of this new treatment regimen. It was also learned that the tachycardia attacks persisted after 90 mg/d diltiazem and 50 mg/d metoprolol treatments which were given to avoid the attacks. The rhythm was sinus and both the physical examination and the echocardiographic investigation were in normal range. The ECG which was obtained during the course of an tachycardia attack revealed a narrow QRS with a long RP interval. Hemogram, blood chemistry (electrolytes, kidney, liver and thyroid functions) and 24-h Holter were within normal limits. Although a further electrophysiologic study was planned, it could not be performed as the patient disagreed any other evaluation. Results: The cilastazol which is a phosphodiesterase inhibitor was discontinued and regarded as the probable precipitant of tachycardia attacks. Metoprolol 50 mg/d was continued for 3 more months. The patient did not experience any tachycardia attacks during a follow up period of 2 years. Conclusions: Cilostazol is a peculiar phosphodiesterase III inhibitor that is indicated for intermittant claudication. An increase in mean heart rate and atrioventricular nodal rhythm and sustained and non-sustained ventricular tachycardia associated with cilostazol treatment have been reported previously. These effects have been thought to originate from increased levels of cAMP as is in other phosphodiesterase inhibitors. To the best of our knowledge, the patient presented here is the first case report of a supraventricular tachycardia precipitated by cilostazol treatment. We suggest that it might be beneficial to monitorize the patients during the course of cilostazol treatment for any possible arrhythmias and it is reasonable to discontinue cilostazol in the presence of new onset arrhythmias if no other explanation is available.Öğe AN UNUSUAL CASE: REPEATED NEEDLE PERICARDIOCENTESIS IN A PATIENT WITH CARDIAC TAMPONADE(ELSEVIER IRELAND LTD, 2011) Doğan, Umuttan; Arslan, R.; Altunbaş, Gökhan; Tokaç, M.[Abstract not Available]
