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Öğe Atorvastatin did not prevent recurrence of atrial fibrillation in addition to antiarrhythmic therapy after electrical cardioversion(OXFORD UNIV PRESS, 2007) Can, İlknur; Demir, Kenan; Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; Tokaç, M.; Gök, Hasan[Abstract not Available]Öğe Atorvastatin Given prior to Electrical Cardioversion Does Not Affect the Recurrence of Atrial Fibrillation in Patients with Persistent Atrial Fibrillation Who Are on Antiarrhythmic Therapy(KARGER, 2011) Demir, Kenan; Can, İlknur; Koç, Fatih; Vatankulu, Mehmet Akif; Ayhan, Selim; Akıllı, Hakan; Arıbaş, AlpayObjective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 +/- 31 vs. 129 +/- 25 mg/dl, p = 0.001, and 112 +/- 23 vs. 62 +/- 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 +/- 26 vs. 182 +/- 29 mg/dl, p = 0.07, and 99 +/- 18 vs. 108 +/- 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy. Copyright (C) 2011 S. Karger AG, BaselÖğe Calcific constrictive pericarditis in a patient presenting with right heart failure(2008) Can, İlknur; Kerimoğlu, Ülkü; Özdemir, KurtuluşKırk beş yaşında erkek hasta, altı aydır var olan nefes darlığı, karında şişkinlik ve ayak ödemi yakınmaları ile başvurdu. Yandan çekilen akciğer filminde yoğun perikardiyal kalsifikasyon izlendi. İkiboyutlu ve nabız dalgalı Doppler incelemesinde konstriktif perikardit bulguları vardı. Göğüs tomografisinde, diffüz, perikardı tamamen sarmayan kalsifikasyon ve genişlemiş superior vena kava izlendi. Hasta perikardiyektomi ameliyatını kabul etmediği için ilaç tedavisine başlandı.Öğe Cardiovascular Abnormalities in Hyperthyroidism(Excerpta Medica Inc, 2006) Çakır, Mehtap; Can, İlknurAnthonisen et al in 1987 continues to be the landmark study. 3 The inclusion criteria required COPD with a FEV1 70% and FEV1/forced vital capacity 70%. It must be kept in mind that patients in the former study had a mean FEV1 of only 33.9% predicted. In another trial carried out in Italy, in which patients with a mean FEV1 of 35-40% predicted were included, clear and significant differences were observed between the antibiotic and placebo treatments.4 Moreover, in a new analysis of the same data, the authors demonstrated that patients with severe functional impairment are those who derive the greatest benefit from antibiotic therapy.Öğe A Case of Peripartum Cardiomyopathy Presenting With Complete Heart Block(2007) Can, İlknur; Düzenli, Akif; Altunkeser, Bülent Behlül; Soylu, AhmetA 33-year-old woman presented with unconsciousness and complete heart block 20 days postpartum. On admission, her blood pressure was 70/50 mmHg and heart rate was 30/min. Immediately, a temporary transvenous pacemaker was inserted via the right femoral vein and her blood pressure increased to 100/70 mmHg with restoration of consciousness. Echocardiographic examination showed reduced left ventricular systolic function. The following day, complete heart block resolved spontaneously to sinus rhythm with right bundle branch block. Ten days later, right bundle branch block resolved together with improvement in left ventricular ejection fraction. To our knowledge, a case of peripartum cardiomyopathy presenting with complete heart block has not been reported.Öğe Correlation of Tissue Selectin Expression and Hemodynamic Parameters in Rheumatic Mitral Valve Disease(I C R Publishers, 2006) Tokgözoğlu, Lale; Can, İlknur; Korkusuz, Petek; Asan, Esin; Özer, Necla; Demircin, MetinBackground and aim of the study: The study aim was to examine tissue expression of the adhesion molecules E-selectin and P-selectin on atrial, valvular and atrial myocardial blood vessel endothelium in patients with rheumatic mitral stenosis, and to investigate whether such expression was correlated with hemodynamics. Methods: Thirteen patients (eight women, five men; mean age 51 10 years) with severe rheumatic mitral stenosis who underwent mitral valve replacement surgery were examined on preoperative day 1, using cardiac catheterization and echocardiography. Specimens from the mitral valve and left atrium of each patient were evaluated for CD 62E and CD 62P expression using indirect immunoperoxidase and immunofluorescence techniques Results: A great majority of patients presented E and/or P selectin expression of variable intensity on atrial, valvular and atrial myocardial blood vessel endothelium. A more diffuse and stronger reaction for CD 62P was noted compared to that for CD 62E. The left ventricular end-diastolic diameter and left atrial diameter were positively correlated with endocardial. CD 62P and CD 62E expression. Right atrial pressure was also strongly and positively correlated with endocardial expression of CD 62E (r = 0.80, p = 0.03) and CD 62P (r = 0.8, p = 0.02). Conclusion: Marked tissue expression of CD 62E and CD 62P was identified on atrial, valvular and atrial myocardial blood vessel endothelium. Moreover, the degree of expression of adhesion molecules was significantly correlated with the left atrial and left ventricular chamber diameters, as well as right atrial pressure.Öğe Effect of preload and heart rate on the Doppler and tissue Doppler-derived myocardial performance index(WILEY, 2007) Özdemir, Kurtuluş; Balcı, Sibel; Düzenli, Mehmet Akif; Can, İlknur; Yazıcı, Mehmet; Aygül, Nazif; Altunkeser, Bülent BehlülDoppler-derived myocardial performance index (MPI) has been described as a noninvasive measurement of LV function. Our aim was to investigate the effect of hemodialysis related volume reduction and heart rate changes on the Doppler-derived LV MPI, and Doppler tissue imaging (DTI) derived left and right ventricular MPI. Method: The study group comprised 32 consecutive patients (mean age: 43 18 yrs) undergoing hemodialysis. Patients underwent echocardiography before and immediately after hemodialysis session. Left and right ventricular MPI derived from conventional pulsed-wave Doppler and DTI was calculated. The difference in MPI, heart rate and body weight was calculated before and after hemodialysis. Results: Doppler-derived LV MPI, and right ventricular MPI obtained by DTI were increased (p = 0.05) but the LV MPI obtained by DTI was unchanged after hemodialysis. There is a significant positive correlation between the Doppler-derived LV MPI difference and volume reduction (r = 0.38, p = 0.032). The heart rate difference was correlated with Doppler-derived LV MPI difference, and DTI derived right ventricular MPI difference (r = 0.38, p = 0.034; r = 0.48, p = 0.006, respectively). Whereas, DTI derived LV MPI difference was not correlated with heart rate difference. By the multivariate analysis, there was no correlation between Doppler-derived LV MPI difference with heart rate difference, and volume reduction. Right ventricular MPI difference correlated with heart rate difference (r = 0.41, p = 0.021) but not with volume reduction. Doppler-derived MPI is partially influenced by preload and heart rate changes. However, DTI derived LV MPI is not influenced by preload and heart rate changes.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 İnaortik Balon Pompasına Bağlı Damar Komplikasyonlarını Önlemede Dekstran 40 Kullanımı(2007) Narin, Cüneyt; Özkara, Ahmet; Sarkılar, Gamze; Can, İlknur; Ege, Erdal; Sarıgül, Ali; Yeniterzi, MehmetAmaç: Intraaortik balon pompası (IABP), dolaşım desteği sağlamak amacıyla, kardiyoloji ve kalp cerrahisinde yaygın olarak kullanılmaktadır. IABP kaynaklı tromboembolik damar komplikasyonlarını önlemek amacıyla, antitrombotik ajanlardan Dekstran 40 kullanılması araştırılmıştır. Gereç ve yöntemler: Kasım 2004 ile Ekim 2006 tarihleri arasında, koroner bypass operasyonu olan 37 hastaya IABP yerleştirilmiştir. Böbrek yetmezliği ve aşırı cerrahi drenaj tanısı alan hastalar dışındaki tüm hastalar, kateterin çekilmesinden 0.5 saat öncesine kadar Dekstran 40 infüzyonu almışlardır. Bu grupta heparin kullanılmamıştır. Bulgular: Olguların 26'sı (%70) erkek, 11'i (% 30) kadındır. Ortalama yaş, 63.4 + 8.4 yıl ve ortalama IABP kullanma süresi, 56.3 saat (6 ile 162 saat arası) bulunmuştur. Yirmidokuz hastaya (% 78.4) sadece koroner bypass operasyonu (CABG), 8 hastaya da (% 21.6) CABG'ye eşlik eden diğer açık kalp operasyonları uygulanmıştır. Hiçbir hastada Dextran 40 kullanımına bağlı yan etki görülmemiştir. Üç olguda (%8) bacak iskemisi gelişmiş olup, 2 olguda kateterin çekilmesi ile iskemi düzelmiş, I olguda Fogarty kateteri ile tromboembolektomi gerekli olmuştur. Hiçbir hastada büyük cerrahi girişim gereksinimi olmamıştır. Kateterin giriş yerinde belirgin kanama görülmemiştir. Olguların hiçbirinde trombositopeni gözlenmemiştir. Sonuç: Dekstran 40, IABP ilişkili damarsal yan etkileri azaltmak için güvenle kullanılabilir. Bu çalışma, IABP kaynaklı damar komplikasyonlarını önlemek açısından Dekstran 40 ile heparinin karşılaştırılacağı yeni çalışmalara öncülük edebilir.Öğe Initial Evaluation of "Syncope and Collapse" the Need for a Risk Stratification Consensus(Elsevier Science Inc, 2010) Benditt, David G.; Can, İlknurPatients presenting with transient loss of consciousness (TLOC) in whom clinical findings suggest a diagnosis of “syncope” account for approximately 1% of emergency department (ED) and urgent care clinic visits (1,2). On average, 30% to 40% of these patients are admitted to hospital (3,4), resulting (on the basis of data from the year 2000 evaluating “syncope and collapse” [DRG-141] as primary diagnosis) in excess of 200,000 hospital admissions annually in the U.S.; a comparable number of admissions also list “syncope and collapse” as a secondary diagnosis. The approximate hospital-stay cost of caring for these patients in the year 2000 was estimated to approach $2.5 billion (3), and it is reasonable to assume that this calculation is a substan tial underestimate of the total cost inasmuch as it did not account for either payments by private insurers or for physician fees. Additionally, the total cost has almost certainly increased during the past 10 years since the evaluation by Sun et al. (3) was completed.Öğe Isolated mitral valve prolapsus does not affect left ventricular function ınsights from tissue-doppler echocardiography(2011) Demir, Kenan; Koc, Fatih; Can, İlknur; Vatankulu, Mehmet Akif; Yazıcı, Mehmet; Ülgen, Mehmet SıddıkAmaç: İdiopatik Mitral Kapak Prolapsusu (MVP), mitral kapağın miksomatöz dejenerasyonuyla karakterizedir. MVPli hastalarda kardiyovasküler mortalitenin en önemli belirleyicisi Sol Ventrikül (LV) disfonksiyonudur. Bu yüzden biz izole MVP hastalarında doku doppler ekokardiyografi (TDE) ile LV fonksiyonunu değerlendirmeyi amaçladık. Metod: MVPli 25 hasta (ortalama yaş, 3112) çalışmaya MVP grubu olarak dahil edildi. Kontrol grubu ise yaş ve cinsiyet eşleştirilmiş 20 hastadan oluşturuldu (ortalama yaş, 349). LV fonksiyonları konvansiyonel ekokardiyografi ve TDE ile incelendi. Miyokardiyal zirve sistolik (Sm), erken (Em) ve geç (Am) diastolik dolum hızları, Em/Am, isovolumetrik kontraksiyon zamanı (ICT), isovolu- metrik relaksasyon zamanı (IRT) ve ejeksiyon zamanı (ET) ölçümleri inferior-septal ve lateral duvarın bazal segmentlerinden ölçüldü. Miyokardial performans indeksi (MPI) hesaplandı. Bulgular: MVPli hastaların 10unda (%40) hafif derecede mitral yetmezlik, 2sinde (%8) orta derecede mitral yetmezlik vardı. Diastolik parametreler açısından 2 grup arasında fark bulunamadı. TDEden hesaplanan MPI değerleri iki grupta tüm segmentlerde benzerdi. Sol ventrikül ortalama Sm ve lateral duvar Smde iki grup arasında anlamlı fark vardı (11.62.8 vs. 9.41.0, p0.001; 13.03.9 vs. 9.22.3, p0.001 sırasıyla). Sonuç: Belirgin mitral yetmezliği olmayan izole MVP sol ventrikül diastolik fonksiyonunu ve MPIyi etkilemez. Fakat, MVPli hastaların lateral duvar Sm ve LV ortalama Smsi MVPsi olmayanlara göre daha yüksekti.Öğe Normotansif kişilerde tuz tüketiminin sol ventrikül kitlesi ile ilişkisi(2009) Soylu, Ahmet; Düzenli, Mehmet Akif; Yazıcı, Mehmet; Can, İlknurAmaç: Artmış tuz alımının hipertansif kişilerde sol ventrikül kitlesini (SVK) artırdığı gösterilmiş olmasına rağmen normotansif kişilerde tuz tüketimi ile SVK arasındaki ilişki yeterince araştırılmamıştır. Bu çalışmada normotansif kişilerde diyetle alınan tuz miktarının sol ventrikül kitlesi ile ilişkisi araştırıldı. Gereç ve Yöntem: Hipertansiyon hikayesi olmayan, herhangi bir antihipertansif ilaç kullanmayan ve hem klinik hem de 24-saatlik ambulatuar kan basıncı takibi (AKBT)’ne göre normotansif olan (klinik KB 140/90 mmHg, 24-saatlik ortalama kan basıncı 130/80 mmHg) toplam 47 kişi (28 bayan, yaş: 47,07,3 yıl) çalışmaya alındı. Tüm kişilerin diyetle aldıkları tuz miktarını değerlendirebilmek amacıyla 24 saatlik idrarda sodyum miktarları ölçüldü. Ayrıca çalışmaya alınan kişiler ekokardiyografi ile değerlendirilerek SVK indeksi (SVKİ) ve rölatif duvar kalınlığı (RDK) hesaplandı. Bulgular: Yirmi dört saatlik idrarda ölçülen sodyum miktarı ile SVKİ ve RDK arasında pozitif korelasyon tespit edildi (r0,44, p0,002 ve r0,33, p0,025). SVKİ ve RDK’nı etkilemesi muhtemel faktörler lineer regresyon analizi ile değerlendirildi. SVKİ’nin diğer faktörlerden bağımsız olarak hem gündüz ortalama sistolik kan basıncı (SKB) seviyesinden hem de idrar sodyum miktarından etkilendiği (sırasıyla; ?1,12, p0,004 ve ?0,28, p0,040), RDK’nın ise sadece gündüz ortalama SKB seviyesinden etkilendiği (?0,40, p0,005) görüldü. Sonuç: Artmış SVKİ’nin kardiyovasküler morbidite ve mortaliteyi artırdığı düşünüldüğünde, normotansif kişilerde tespit edilmiş olan artmış tuz tüketimi ile SVKİ arasındaki ilişki tuz alımını kısıtlamanın hipertansiyon gelişmesi ihtimalini azaltmaktan daha fazla yararları olabileceğini düşündürmektedir.Öğe Proximity of Right Coronary Artery to Cavotricuspid Isthmus as Determined by Computed Tomography(Wiley-Blackwell, 2010) Al Aloul, Basel; Sigurdsson, Gardar; Can, İlknur; Li, Jian-Mingi; Dykoski, Richard; Tholakanahalli, Venkatakrishna N.Background: Radiofrequency ablation of atrial flutter is a commonly performed procedure. Ablation success depends upon complete transmural atrial tissue injury to achieve bidirectional cavotricuspid isthmus (CTI) block. Transmural ablation increases risk of injury to the adjacent right coronary artery (RCA). Distance between the RCA and the endocardium within the CTI area is not well described. We aimed to perform in vivo measurements of the distance between the CTI area and adjacent RCA. Methods: Thirty-three consecutive patients underwent electrocardiogram-gated contrast-enhanced computed tomography. CTI area was divided into nine segments based on three common catheter locations (paraseptal, central, and lateral or 5, 6, and 7 o'clock) and ventricular to atrial ablation line. Results: Mean age was 64 +/- 11 years and 97% of the participants were male. Paraseptal, central, and lateral measurements at the tricuspid annulus ridge showed endocardial to RCA distance 9 +/- 3, 6 +/- 2, and 5 +/- 3 mm, respectively (range 2-17 mm). Corresponding measurements for the ventricular side were 5 +/- 3, 4 +/- 2, and 4 +/- 2 mm and atrial side measurements were 3 +/- 2, 3 +/- 2, and 3 +/- 3 mm. Distance was < 2 mm in 14% of segments on the ventricular side and 39% of segments on the atrial side. Paired t-test showed significant difference (P < 0.001) between tricuspid annulus ridge measurements and adjacent atrial or ventricular measurements. Conclusions: Distance between endocardium and RCA lumen is reduced in areas adjacent to the tricuspid annulus ridge.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 Transit Thrombus Entrapped in Patent Foramen Ovale Resolved Without Clinical Embolic Events(Mosby Inc., 2006) Can, İlknur; Altunkeser, Bülent Behlül; Yavaş, Özlem; Düzenli, Akif; Özdemir, Kurtuluş; Gök, HasanWe describe a case of impending paradoxic embolism in a 35-year-old woman who had a diagnosis of metastatic breast carcinoma. The patient presented with acute pulmonary embolism and was treated with anticoagulation therapy without any sign of a clinical embolic event. © 2006 American Society of Echocardiography.
