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Öğe The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients(2012) Kayrak, Mehmet; Acar, Kadir; Gül, Enes Elvin; Özbek, Orhan; Abdulhalikov, Turyan; Sönmez, Osman; Alibaşiç, HayruddinPrevious studies have demonstrated impaired ventricular repolarization in patients with ?-TM. However, the effect of iron overload with cardiac T 2 * magnetic resonance imaging (MRI) on cardiac repolarization remains unclear yet. We aimed to examine relationship between repolarization parameters and iron loading using cardiac T 2 * MRI in asymptomatic ?-TM patients. Twenty-two ?-TM patients and 22 age- and gender-matched healthy controls were enrolled to the study. From the 12-lead surface electrocardiography, regional and transmyocardial repolarization parameters were evaluated manually by two experienced cardiologists. All patients were also undergone MRI for cardiac T 2 * evaluation. Cardiac T 2 * score <20msec was considered as iron overload status. Of the QT parameters, QT duration, corrected QT interval, and QT peak duration were significantly longer in the ?-TM group compared to the healthy controls. T p - T e and T p - T e dispersions were also significantly prolonged in ?-TM group compared to healthy controls. (T p - T e) / QT was similar between groups. There was no correlation between repolarization parameters and cardiac T 2 * MRI values. In conclusion, although repolarization parameters were prolonged in asymptomatic ?-TM patients compared with control, we could not find any relation between ECG findings and cardiac iron load. Copyright © 2012 Mehmet Kayrak et al.Öğe A Bizarre Electrocardiographic Pattern Due to Chronic Lithium Therapy(Wiley, 2010) Kayrak, Mehmet; Duman, Çetin; Gül, Enes Elvin; Sönmez, Osman; Kaya, Zeynettin; Arı, HatemCardiotoxicity that results from lithium overdose is uncommon and electrocardiographic (ECG) changes are rarely reported. However, some authors have specifically reported the occurrence of ischemic ECG changes due to a lithium overdose. This article describes a case that is demonstrating ECG changes that mimic inferior myocardial infarction during the course of chronic lithium treatment and showing QTc prolongation in this patient. The patients’ ECG changes were partially recovered after hemodialysi.Öğe Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?(TURKISH SOC CARDIOLOGY, 2013) Arıbaş, Alpay; Akıllı, Hakan; Gül, Enes Elvin; Kayrak, Mehmet; Demir, Kenan; Duman, Çetin; Alibaşiç, HayruddinObjective: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated. Methods: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student's t -test. Logistic regression analysis was used to determine predictors of recurrence. Results: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR:14.25) vs. 12 (IQR: 11) months, p=0.01], baseline hs-CRP [9.80 (IQR:8.50) mg/dL vs. 4.28 (IQR:5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5 +/- 0.4 cm, 4.3 +/- 0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR:2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence. Conclusion: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence. (Anadolu Kardiyol Derg 2013; 13: 123-30)Öğe A Case of Late-Term Lead Endocarditis Causing Pacemaker Dysfunction(Churchill Livingstone Inc Medical Publishers, 2010) Kayrak, Mehmet; Sönmez, Osman; Gül, Enes Elvin; Gündüz, MehmetWith regard to pacemakers, lead endocarditis is a rare condition noted for causing difficulties in patient management. It has been reported in the literature that lead endocarditis may occur even after 10 years. In general, the incidence of pacemaker infections has not been carefully documented.1,2 The prevalence and incidence of pacemaker lead dysfunctions due to lead endocarditis have not been researched previously. We present a case of pacemaker dysfunction related to infective endocarditis.Öğe Distal sol sirkumfleks arterden köken alan sağ koroner arter(2011) Sönmez, Osman; Gül, Enes Elvin; Altunbaş, Gökhan; Özdemir, Kurtuluş- Sağ koroner arterin distal sol sirkumfleks koroner arterden köken alması nadir bir anomalidir. Altmış üç yaşında kadın hasta subakut anteroseptal miyokart enfarktüsü tanısıyla yatırıldı. Elektrokardiyografide, prekordiyal V1-V3 derivasyonlarda QS formasÖğe 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 The End of Good Luck-Long-Term Survival Without Anticoagulation: A Case Report and Review of the Literature(SAGE PUBLICATIONS INC, 2012) Gül, Enes Elvin; Altunbaş, Gökhan; Kayrak, Mehmet; Özdemir, KurtuluşLong-term anticoagulation in patients with metallic prosthetic valve disease is required according to current guidelines. We describe a patient with a functioning mitral mechanical valve without anticoagulation for 27 years. A 46-year-old man admitted to the emergency department with complains of palpitation. The patient had a mitral valve replacement because of severe mitral stenosis. He discontinued warfarin treatment 1 month after surgery because of the unavailability of this drug in Turkey. Transthoracic echocardiography revealed functioning metalic mitral valve with a mean gradient of 9 mm Hg. Fluoroscopy showed normal excursions of the mechanical mitral valve. Transesophageal echocardiography was performed and revealed fresh thrombus formation in the left atrial appendix. Admission international normalized ration (INR) level was 1.79. Due to the higher INR level and long-term survival, genetic analysis of warfarin polymorphism was performed. There was a homozygous mutation in the vitamin K epoxide reductase complex 1 (VKORC1) 1173C>T and 1639G>A genotypes. The possible explanations of long-term survival and baseline higher INR level were linked to the mutation in warfarin metabolism. We also briefly review the literature.Öğe Hyperkalemia-Induced Accelerated Idioventricular Rhythm in a Patient with Acute Renal Failure(Informa Healthcare, 2012) Gül, Enes Elvin; Erdoğan, Halil ibrahim; Yıldırım, Oğuzhan; Soylu, Ahmet; Nikus, Kjell C.Electrolyte disorders can alter cardiac ionic currents and depending on the changes can promote proarrhythmic effects. Potassium (K+) is the most common intracellular cation related to arrhythmic disorders. Hyperkalemia is mainly seen in the setting of impaired renal function. Severe hyperkalemia may lead to rhythm disorders. Herein, we report a patient with accelerated idioventricular rhythm (AIVR) due to hyperkalemia, which was successfully treated with glucose-insulin (GI) infusion.Öğe Ischemia-modified albumin and total antioxidant status in patients with slow coronary flow: a pilot observational study(TURKISH SOC CARDIOLOGY, 2011) Koç, Fatih; Erdem, Sami; Altunkaş, Fatih; Özbek, Kerem; Gül, Enes Elvin; Kurban, Sevil; Taşyürek, ErkanObjective: Slow coronary flow (SCF) is defined as late opacification in the epicardial coronary arteries without significant stenosis. The underlying mechanism of SCF is similar to coronary atherosclerosis. Free radical damage may be responsible for the pathology. In this study, we aimed to investigate ischemia-modified albumin (IMA) levels and differences with regard to total antioxidant status (TAS) between patients with normal coronary arteries and patients with SCF without significant stenosis. Methods: Thirty patients who were diagnosed with SCF using coronary angiography were included in this cross-sectional observational study 113 male; mean age, 56 10 years). The control group consisted of 30 patients who had normal coronary arteries as shown by coronary angiography (13 male; mean age, 53 11 years). In this study, we assessed serum IMA levels, albumin-adjusted IMA and TAS. The Student t-test was used to compare serum IMA levels and TAS between the two groups. Pearson's correlation test was used to explore the relationship between TAS and serum IMA levels. Results: Serum IMA levels and albumin-adjusted IMA were similar in both groups (p=0.432, p=0.349). The mean value of TAS was significantly lower in the SCF group compared to control group (p=0.011). The TAS was negatively correlated with the levels of IMA and albumin-adjusted IMA in the SCF group (r=-0.457, p=0.011; r=-0.509, p=0.004). Conclusion: This study shows that serum IMA levels and albumin-adjusted IMA were similar between the groups, however the mean value of TAS was significantly lower in the SCF group compared to control group and negatively correlated with IMA. These results are important in terms of understanding the pathophysiological basis of SCE (Anadolu Kardiyol Derg 2011; 11:582-7)Öğe Lithium Intoxication Causing ST Segment Elevation and Wandering Atrial Rhythms in an Elderly Patient(VIA MEDICA, 2010) Kayrak, Mehmet; Arı, Hatem; Duman, Çetin; Gül, Enes Elvin; Ak, Ahmet; Atalay, HüseyinLithium overdoses causing cardiotoxicity are uncommon and electrocardiographic changes suggesting myocardial ischemia are rare. However, some authors have specifically reported the occurrence of ischemic electrocardiography changes due to a lithium overdose. This paper describes a case where electrocardiography changes mimic inferior myocardial infarction during the course of chronic lithium treatment in an elderly patient. The patient's electrocardiography changes were partially resolved after hemodialysis.Öğe Mobile right heart thrombus as a manifestation of homozygous mutation of MTHFR 1298 A > C(Turkish Soc Cardiology, 2012) Gül, Enes Elvin; Erdoğan, Halil İbrahim; Bayram, Ufuk Tan; Özdemir, Kurtuluş; Taşçı, İlkerMobile right heart thrombus (MRHT) is uncommon pathology but the true prevalence is still unknown. Previous studies reported that MRHT occurs in 7% to 18% of patients with pulmonary embolism with high mortality rate (44.7%) (1). The main manifestations of venous thromboembolism (VTE) are deep venous thrombosis (DVT) and pulmonary embolism. In addition, genetic factors play an important role in pathogenesis of VTE. The relationship between common genetic mutations such as factor V Leiden, prothrombin factor II G 20210A, methylenetetrahydrofolate reductase (MTHFR), deficiencies of protein C, protein S, and antithrombin III, and VTE have been reported (2).Öğe Mobile right heart thrombus as a manifestation of homozygous mutation of MTHFR 1298 AC(2012) Gül, Enes Elvin; Erdoğan, Halil İbrahim; Bayram, Ufuk Tan; Özdemir, Kurtuluş[Abstract not Available]Öğe Nadir bir birliktelik: pankreas kanseri hastasında dev aort trombüsü ve pulmoner emboli(2011) Kayrak, Mehmet; Gül, Enes Elvin; Gümüş, Serter; Özdemir, Kurtuluş[Abstract not Available]Öğe Prediction of Atrial and ventricular Arrhytmias by Twelve-lead Electrocardiography in Patients with Polycythemia Vera(ELSEVIER IRELAND LTD, 2011) Kayrak, Mehmet; Acar, Kadir; Gül, Enes Elvin; Bağlıcaklıoğlu, Murat; Kaya, Zeynettin; Abdulhalikov, Turyan; Arı, Hatem[Abstract not Available]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 Right coronary artery arising from the distal left circumflex artery(2011) Sönmez, Osman; Gül, Enes Elvin; Altunbaş, Gökhan; Özdemir, KurtuluşOrigination of the right coronary artery from the distal left circumflex artery is a rare anomaly. A 63-year-old woman was admitted with subacute anteroseptal myocardial infarction. Electrocardiography showed a QS pattern in V1-V3 precordial leads without ST elevation. Cardiac enzyme levels were elevated (CK-MB 186 ng/ml, troponin I 27.1 ng/ml). Echocardiography showed hypokinesia of the anterior and lateral walls without valvular pathology. Coronary angiography revealed origination of the right coronary artery from the circum-flex artery. The right coronary artery had a normal flow pattern and there were atherosclerotic plaques in the circumflex artery without a significant stenosis. Distal to the first diagonal branch of the left anterior descending artery, a 95% stenotic lesion was detected, which was treated with balloon dilatation followed by implantation of a bare metal stent. The patient was discharged with near-complete patency and without any complication. © 2011 Türk Kardiyoloji Derne?i.Öğe Soluble CD40 Ligand Levels in Acute Pulmonary Embolism: A Prospective, Randomized, Controlled Study(SPRINGER, 2012) Kaya, Zeynettin; Özdemir, Kurtuluş; Kayrak, Mehmet; Gül, Enes Elvin; Altunbaş, Gökhan; Duman, Çetin; Kıyıcı, AyselCD40 ligand is a thromboinflammatory molecule that predicts cardiovascular events. Platelets constitute the major source of soluble CD40 ligands (sCD40L), which has been shown to influence platelet activation. The main aim of this study was to evaluate sCD40L levels in patients with acute pulmonary embolism (PE). Sixty-five PE patients (32 males, mean age 58 +/- A 12 years) and 29 healthy controls (15 males, mean age 56 +/- A 14 years) were enrolled in the study. sCD40L levels were evaluated at the enrollment by ELISA method. Multislice detected pulmonary computed tomography was performed on all patients with a suspected diagnosis of PE. In addition, echocardiography was performed to evaluate right ventricular (RV) dysfunction. There was no statistically significant difference between the two groups regarding demographic features. sCD40L levels were significantly higher in acute PE group compared to healthy controls (5.3 ng/ml and 1.4 ng/ml, respectively; < 0.001). sCD40L levels of patients with and without RV dysfunction were similar. Correlation analysis between echocardiographic findings and sCD40L levels did not show significant difference. The present study demonstrated a role of sCD40L in pathogenesis of PE for the first time. Further studies are needed to clarify a predictive and prognostic value of sCD40L levels in acute PE patients.Öğe SOLUBLE CD40 LIGAND LEVELS IN PATIENTS DIAGNOSED WITH ACUTE PULMONARY EMBOLISM(ELSEVIER IRELAND LTD, 2011) Kaya, Zeynettin; Özdemir, Kurtuluş; Kayrak, Mehmet; Gül, Enes Elvin; Altunbaş, Gökhan; Duman, Çetin; Kıyıcı, Aysel[Abstract not Available]Öğe Successful pericardiocentesis for cardiac tamponade in a patient with thrombocytopenic acute lymphocytic leukemia(2012) Sönmez, Osman; Gül, Enes Elvin; Soylu, Ahmet; Acar, Kadir; Almaz, EmineLenfomaların klinik belirtisi olarak kardiyak tamponadların (KT) görülme sıklığı çok nadirdir. Perikardın lösemik infiltrasyonunun post-mortem dönemde sık görülmesine rağmen klinik olarak kardiyak tamponadların görülmesi nadirdir. Biz lösemide gelişen kardiyak tamponad vakasını sunmak istiyoruz. Tekrarlayan ve refraktör akut lenfositik lösemiden (ALL) dolayı kemoterapi alan hastanın kardiyak tamponadı ve ciddi trombositopenisi mevcuttu. On beş gün başarılı bir şekilde ibuprofen-kolşisin tedavisi gören hastada acil ve zorunlu perikardiyosentez sonrası herhangi bir kanama komplikasyonu gelişmeden perikardiyal effüzyonun tamamen rezolüsyonunu gözlemledik. Ağır trombositopeni gibi kritik durumlara rağmen acil perikardiyosentezin hayat kurtarıcı olması bu olgunun heyecan verici özelliğidir.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.
