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    Acute myocardial infarction provoked by smoking and xylometazoline use in a patient with normal coronary arteries [Koroner arterleri normal olan bir hastada sigara ve ksilometazolin kullaniminin tetikledi?i akut miyokard infarktüsü]
    (2006) Kayrak M.; Ülgen M.S.; Koç F.; Soylu A.
    Coronary vasospasm is a cause of acute coronary syndrome. Many factors, in particular smoking may induce vasospasm. Xylometazoline is a commonly used sympathomimetic to provide decongestive action with topical effect. A 50-year-old male patient was admitted with typical angina pectoris that developed after heavy smoking. Coronary angiography showed normal coronary anatomy. One month later, he presented with myocardial infarction of ST elevation following high dose of xylometazoline application. There was no other cause to provoke coronary vasospasm. This case underlines the need for a thorough investigation into drug use in young and relatively low-risk patients presenting with chest pain.
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    Association of fetuin - A levels with carotid intima media thickness and valvular calcification in hemodialysis and peritoneal dialysis patients
    (2013) Solak Y.; Inal A.; Atalay H.; Kayrak M.; Biyik Z.; Türkmen K.; Yeksan M.
    Background: Fetuin-A is a negative acute-phase reactant which prevents vascular calcification. Coronary artery disease (CAD) is the most important cause of mortality in patients undergoing renal replacement therapy (RRT). The key element of cardiovascular disease (CVD) seen in end-stage renal disease patients who are on dialysis treatment is accelerated calcific atherosclerosis. There are a limited number of studies in which HD and PD is compared in terms of fetuin-A level. OBJECTIVE: We aimed to investigate the association of serum fetuin-A level with valvular calcification and predictors of CAD in hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIAL and METHODS: 39 HD (24 males, 15 females) and 39 PD (25 males, 14 females) patients were included in the study. We determined carotid artery intima media thickness (CIMT) and evaluated heart valve calcification via echocardiography. We also measured serum fetuin-A level, CRP, ferritin, fibrinogen and serum albumin level. According to fetuin-A level, patients were stratified into quartiles. RESULTS: Fetuin-A level was significantly lower in HD patients when compared with that of PD patients (28.6±5.934 ng/ml, 32±4.8 ng/ml respectively p<0.001). There was a significant negative correlation between CIMT and fetuin-A level. CIMT was found to be lower in PD patients than in HD patients. We found a positive correlation between fetuin-A and dialysis adequacy and albumin level. There was a negative correlation of fetuin-A with age, fibrinogen, ferritin and CRP. Fetuin-A level was lower in patients with aortic calcification. Conclusion: Fetuin-A level was found to be lower in HD patients. Fetuin-A may be a novel marker for CVD in patients undergoing RRT.
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    Comparison between brachial blood pressures obtained by aneroid sphygmomanometer and central aortic pressures: Factors affecting the measurements [Aneroid sfigmomanometreyle ölçülen brakiyal arter basincinin santral aortik basinçla karşilaştirilmasi ve farka etki eden faktörler]
    (2008) Kayrak M.; Ülgen M.S.; Yazici M.; Demir K.; Do?an Y.; Koç F.; Zengin K.
    Objectives: We compared brachial artery blood pressures (BP) measured by aneroid sphygmomanometer with ascending aortic blood pressures and evaluated the factors affecting the differences between the two methods. Study design: The study included 463 patients (177 women, 286 men; mean age 60±11 years) undergoing routine coronary angiography. Simultaneously, ascending aortic pressures were measured using a pigtail catheter and brachial artery pressures were measured from the right arm with an aneroid sphygmomanometer. Pulse pressure, fractional pulse pressure, and pulsatility index were calculated from systolic and diastolic BP values. Results: Overall, systolic (-3.1±10 mmHg) and diastolic (+3.0±7.1 mmHg) brachial pressures showed significant deviations from aortic pressures (p=0.001). Although systolic BP did not differ significantly in both methods for men and women, brachial diastolic BP was significantly different in women (+4.8 mmHg, p=0.0001). Brachial diastolic BP showed a greater deviation from the aortic diastolic pressure in patients ?60 years of age (+4.5 mmHg and +1.1 mmHg, respectively; p=0.0001). Deviation of systolic BP in hypertensive patients (-4 mmHg) was greater than that in normotensives (-2.0 mmHg, p=0.04). Deviation of brachial systolic BP was highly correlated with increases in aortic systolic pressure (p=0.0001). Differences between the two methods in systolic (-5.8 mmHg, p=0.01) and diastolic (+4.2 mmHg, p=0.03) BP were significant in patients with coexisting diabetes and hypertension. Body mass index and arm circumference were not correlated with deviations between the two methods. Conclusion: The main factors (female gender, age, hypertension, diabetes) affecting BP differences between the two methods should be considered in clinical practice.
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    Congenitally Corrected Transposition of Great Arteries with Severe Rhythm Disturbances
    (2010) Kayrak M.; Kaya Z.; Gul E.E.; Ulgen M.S.; Yazici M.; Gumus S.; Paksoy Y.
    Within recent years, much scientific attention has been devoted to adults with congenital heart disease (CHD) and probable complications. Congenitally corrected transposition of the great arteries (CCTGA) is a rare, complex form of congenital heart defects. CCTGA is characterized by atrioventricular (AV) and ventriculoarterial (VA) discordance and, hence, by a physiologically normal direction of blood flow. The development of complete AV block and global ventricular dysfunction has been identified as the cause of cardiac death. Although the development of arrhythmias represents a major cause of morbidity and mortality in patients with CHD, the account of all implantations of pacemakers and implantable cardioverter defibrillators (ICD) is less than one percent. This paper presents a case of CCTGA with severe rhythm disorders, discusses probable treatment options, and offers indications of ICD implantation in patients with CHD.
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    Diastolic functions and myocardial performance index in obese patients with or without metabolic syndrome: A tissue Doppler study
    (2010) Koç F.; Tokaç M.; Kaya C.; Kayrak M.; Yazici M.; Karaba? T.; Vatankulu M.A.
    Objectives: This study was designed to evaluate left ventricular (LV) diastolic functions and myocardial performance index (MPI) in obese individuals with or without metabolic syndrome (MetS). Study design: The study included 44 obese subjects with MetS (16 men; 28 women; mean age 46±7 years) and 32 obese subjects without MetS (16 men, 16 women; mean age 43±9 years). Diagnosis of MetS was based on the ATP III criteria. Obesity was defined with a body mass index (BMI) of ?30 kg/m2. All the subjects underwent echocardiography and tissue Doppler imaging to determine LV diastolic functions and MPI. Clinical and echocardiographic characteristics of obese subjects were compared with those of a control group consisting of 21 healthy, nonobese individuals (10 men, 11 women; mean age 42±4 years). Results: Waist circumference, weight, and BMI were similar in the two obese groups. Control subjects and obese subjects without MetS had similar systolic and diastolic blood pressures, fasting blood glucose, triglyceride, and HDL cholesterol levels, but all these significantly differed in patients with MetS. Left ventricular mass, mass index, and diastolic parameters were similar in the two obese groups, but differed significantly from the controls (p<0.05). Body mass index was correlated with the LV mass (r=0.42, p=0.001) and mass index (r=0.33, p=0.001). Left ventricular MPI was similar in the two obese groups with (0.59±0.10) and without (0.59±0.11) MetS, but was higher compared to the control group (0.48±0.06, p<0.05). Left ventricular MPI was correlated with BMI, waist circumference, LV mass, and mass index (r=0.24, p=0.02; r=0.30, p=0.005; r=0.31, p=0.002; r=0.21, p=0.04, respectively). Conclusion: Our findings demonstrate that obesity with or without MetS affects LV MPI. In addition, LV MPI showed significant correlations with BMI, waist circumference, and LV mass.
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    End-systolic murmur due to membranous interventricular septal aneurysm
    (2011) Sonmez O.; Gul E.E.; Kayrak M.
    [Abstract not Available]
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    Giant left ventricular pseudoaneurysm detected three years after myocardial infarction
    (2006) Soylu A.; Gök H.; Narin C.; Kayrak M.
    A 70-year-old male patient presented with symptoms of heart failure three years after having myocardial infarction. Transthoracic echocardiography revealed severely compromised left ventricular systolic function (ejection fraction 20%) and a large left ventricular pseudoaneurysm. The diagnosis was confirmed by computed tomography. The size of the pseudoaneurysm sac was 11 x9 cm. At surgery, the pseudoaneurysmal sac was resected and a defect of 3.5x4 cm was detected in the anterolateral wall of the left ventricle. The defect was repaired by the remodeling ventriculoplasty method of Dor. The patient whose general condition improved through intensive medical treatment was discharged with medications for heart failure and coronary artery disease on the 15th postoperative day.
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    A lethal but treatable complication: Free wall rupture after acute myocardial infarction
    (2006) Ülgen M.S.; Öztürk Ö.; Kayrak M.; Soylu A.; Düzenli M.A.; Koç F.
    A 43-year-old male patient was admitted to coronary intensive care unit with the diagnosis of acute inferolateral myocardial infarction and with a picture of cardiogenic shock. In physical examination, systolic blood pressure was 50 mmHg and diastolic blood pressure could not be taken. The patient was diagnosed with cardiogenic shock and was started on saline, dopamine and dobutamine infusion. His blood pressure did not increase although the dosage of positive inotropic agents was increased. A cardiac tamponade revealed with urgent echocardiographic evaluation and pericardiocentesis was carried out. Blood pressure returned to normal range within hours after pericardiosentesis. Echocardiographic examination performed on the second day of AMI on the asymptomatic patient revealed thrombosed myocardial rupture. The patient was referred to emergency surgery with the diagnosis of three-vessel disease and myocardial rupture according to urgent angiography. In the operation, the ruptured region in the ventricle free wall was primarily repaired. By-pass surgery was performed with saphenous vein graft to the LAD and CV-OM1 coronary arteries.
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    Severe hypokalemia-associated rhabdomyolise and unusual poliuria in patient with primary aldosteronism
    (2012) Demir K.; Sonmez O.; Kayrak M.; Ozdemir K.
    Primary aldosteronism is a syndrome that is characterized with hypertension, hypopotasemia, high level of plasma aldosterone, and low plasma renin activity. The case we present is a 56-year-old male who referred to our neurology clinic with proximal muscle weakness and fatigue. Because of uncontrolled blood pressure, a cardiology consultation was performed for the planning of antihypertensive treatment. As prolonged QT intervals and giant U waves due to serious hypokalemia (K+:1,04), cardiology clinic took over the patient for risks of arrhythmia. After primary hyperaldosteronism diagnosis was established, the treatment was initiated and severe polyuria developed during the treatment (19L/day).
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    Successful stent implantation to bilateral renal artery stenosis in a case with diffuse atherosclerotic involvement.
    (2008) Yazici M.; Ulgen M.S.; Kayrak M.; Koç F.; Zengin K.
    [Abstract not Available]
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    Thrombus entrapped in a patent foramen ovale presenting with acute pulmonary embolism [Akut pulmoner emboli ile ortaya çkan patent foramen ovale içine tuzaklanmış trombüs]
    (AVES, 2010) Kayrak M.; Kaya Z.; Ülgen M.S.; Yazici M.; Karaaslan Ş.; Ayhan S.S.
    [Abstract not Available]
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    Uvula haematoma: a rare complication after thrombolysis and intensive anti-platelet treatment.
    (2007) Kayrak M.; Ulgen M.S.; Yazici M.; Kiliç D.; Gok H.
    [Abstract not Available]