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    Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?
    (2008) Tatlı, Ersan; Aktoz, Meryem; Ufacık, Osman; Pirhan, Osman; Yılmaztepe, Mustafa; Altun, Armağan
    Kırk altı yaşında, koroner arter hastalığı için risk faktörü olarak hipertansiyon ve aile öyküsü olan erkek hasta akut anterior miyokard infarktüsünün ikinci saati içinde kliniğimize başvurdu. Kurtarıcı perkütan koroner girişim sırasında sol ön inen arterin tam tıkandığı gözlendi. İşlem sırasında kullanılan 150 ml non-iyonik, düşük osmolar kontrast maddenin trombüse yol açarak tam tıkanıklığa neden olabileceği düşünüldü. İntrakoroner bolus tirofiban infüzyonu sonrasında intrakoroner trombozun çözüldüğü görüldü. Lezyon bölgesine stent uygulandı ve TIMI III akımla birlikte çok iyi anjiyografik sonuç elde edildi. Beş ay sonra yapılan kontrol anjiyografide sol ön inen koroner arter tamamen açık idi. Kurtarıcı işlem sırasında gelişen akut koroner tıkanmaların tedavisinde tirofiban infüzyonuyla bareber stentleme tıkanıklığı etkin bir şekilde gidermektedir.
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    ACUTE CARBON MONOXIDE POISINING RELATED MYOCARDIAL INFARCTION
    (Elsevier Ireland Ltd, 2010) Barutcu, Ahmet; Aktoz, Meryem; Tatli, Ersan; Donmez, Emrah; Ersoy, Nedret
    [Abstract Not Available]
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    Akciğer Tutulumu Olan Sarkoidozun Kardiyak Otonom Disfonksiyon Üzerine Etkisi
    (2021) Manav, Ali; Taylan, Gökay; Aktoz, Meryem
    Amaç: Kalp hızı değişkenliği (KHD), kardiyak otonom fonksiyonun değerlendirilmesinde kullanılan non-invaziv bir yöntemdir. Çalışmamızda akciğer tutulumu olan sarkoidoz hastalarında KHD ölçüm sonuçları değerlendirilerek, kardiyak otonom fonksiyon üzerine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 18 akciğer tutulumlu sarkoidoz hastası ile yaş ve cinsiyet uyumlu 18 sağlıklı gönüllü bireyden oluşan kontrol grubu olmak üzere toplamda 36 kişi dahil edildi. Tüm hastalara transtorasik ekokardiyografi, elektrokardiyografi (EKG) ve 24-saat EKG Holter uygulandı. Holterde saptanan KHD parametreleri kullanılarak gruplar karşılaştırıldı. Bulgular: Zaman alan analizinde RMSDD ölçüm değerleri ve frekans alan analizinde düşük frekans değerleri sarkoidoz grubunda kontrol grubuna kıyasla anlamlı ölçüde düşük bulundu (p=0,043 ve p=0,045). Ayrıca korelasyon analizinde, PR süresi ile zaman alan parametrelerinden SDNN ve SDANN, frekans alan parametrelerinden yüksek frekans arasında istatistiksel olarak anlamlı negatif bir korelasyon saptandı (p=0,009, p=0,003, p=0,047 sırasıyla). Düşük frekans/yüksek frekans oranı, düzeltilmiş QT süresi ile pozitif korelasyon gösterdi. Sonuç: Akciğer tutulumlu sarkoidoz hastalarında KHD parametrelerinde saptanan değişiklikler, azalmış parasempatik tonus ve vagal düzenlemeye bozulmuş kardiyak yanıt ile ilişkili olup, bu durum kardiyak aritmilere yatkınlık, ani kardiyak ölüm ve atriyoventiküler iletim bozukluğuna sebep olabilir.
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    Akıllı Cep Telefonu Kullanımının Sık Ventriküler Ekstra Atımlar Üzerine Etkisinin Ritim Holter İle Değerlendirilmesi
    (2019) Uçar, Fatih Mehmet; Öztürk, Cihan; Kardaş, Fatih; Aktoz, Meryem
    Amaç: Sık ventriküler ekstra atımlar düzeltilebilir kardiyomiyopatinin başlıca nedenlerinden biridir ve sık ventriküler ekstra atımlarönemli ölçüde hastaların yaşam kalitesini etkiler. Cep telefonları hızla gelişen teknoloji ile birlikte günlük yaşantımızın bir parçası halinegelmiştir. Bu kadar sık kullanılan bu cihazların yaydıkları elektromanyetik enerji ile sağlığımıza negatif etkileri olabilmektedir.Çalışmamızda amacımız cep telefonu kullanımının ventriküler ekstra atım sıklığı ile ilişkili olup olmadığının değerlendirilmesidir.Gereç ve Yöntem: Çalışmamızda 48 saat ritim holter takılan 38 hasta alınmıştır. Hastalarda ilk 24 saat cep telefonu kullanılan ikinci 24saat kullanılmayan dönemlerde saptanan ventriküler ekstra atım sayıları karşılaştırılmıştır.Bulgular: Hastaların yaş ortalaması 45 ±13,2’dir ve erkek cinsiyet oranı %50’dir. 1. ve 2. gün kayıtlar kıyaslandığında 1. gün ventrikülerekstra atım sayısının ve ventriküler ekstra atım yüzdesinin 2. gün yapılan kayıtlardan daha fazla olduğunu saptanmıştır (8831 ± ‘ye kar-şı 14327807±1266, p=0,02) (10,3 ±1,67’ye karşı 7,7 ± 1,25, p<0,001).Sonuç: Ventriküler ektopik atımlar normal bireylerde sık değildir. Görülmesi kalpteki bir organik patolojiye, özellikle miyokard iskemisineişaret edebilir. Eğer erken dönemde tedavi edilmezse kalp yetmezliği gibi geri dönüşü zor olan klinik durumlara neden olmaktadır. Ceptelefonları hayatımızın vazgeçilmez ve en yoğun kullanılan teknolojik cihazlarıdır. Bu cihazlar yaydıkları elektromanyetik enerji ile kardi-yak otonom sistem üzerinde zararlı etkiler doğurabilmektedir. Çalışmamızda akıllı cep telefonu kullanımının ventriküler ekstra atım sık-lığını anlamlı olarak artırdığını holter takipleri ile saptadık.
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    The Alteration of Plasma Atrial Natriuretic Peptide Levels Induced by Postural Changes in Archery Athletes
    (Aves Yayincilik, Ibrahim Kara, 2010) Vardar, Selma Arzu; Aktoz, Meryem; Karakusoglu, Ozgul; Kunduracilar, Hakan
    Objectives: The aim of this study was to investigate plasma atrial natriuretic peptid levels in sitting and supine positions and cardiac functions in young male archery athletes. Materials and Methods: Six archery athletes and 10 sedentary males volunteered to participate in the study. Venous blood samples were taken after 10 minutes sitting and after 10 minutes in supine position. Plasma ANP levels were measured by the ELISA method. Cardiac parameters were assessed by echocardiography. Results: Plasma ANP levels in sitting position were higher in archery athletes (72.12+/-14.01 pg/ml) than sedentaries (36.22+/-14.51 pg/ml; p<0.01). Similarly, plasma ANP levels in supine position (124.41+/-14.66 pg/ml) were significantly higher in the athletes than sedentaries (36.95+/-9.83 pg/ml). Plasma ANP levels were higher in supine position than those in sitting position in archery athletes (p<0.01). No significant increase in plasma ANP levels were found in supine position than sitting position in sedentary group. Echocardiographic parameters were similar in athletes and sedentary subjects. Conclusion: It is concluded that regular archery exercises without prominent functional and morphological alterations in the heart may cause differences in plasma ANP levels. Marked posture-related alterations may occur in plasma ANP levels of trained archery athletes.
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    Anomalous origin of the right coronary artery from the left anterior descending artery in a patient with single left coronary artery: A rare coronary artery anomaly and review of the literature
    (Elsevier Ireland Ltd, 2008) Erdogan, Okan; Buyuklu, Mutlu; Aktoz, Meryem
    A 44-year-old woman with hypertension was admitted because of recent onset chest pain. Coronary angiography revealed an anomalous right coronary artery originating as a separate branch from the left anterior descending artery. Associated with the present case all published case reports were thoroughly investigated and presented as a review of the literature. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    Approach to cardiovascular disease in women
    (Kare Publ, 2018) Acar, Rezzan Deniz; Aktoz, Meryem; Atamaner, Oya; Aytekin, Saide; Polat, Evin Bozcali; Celik, Hulya Gamze; Celik, Omer
    Cardiovascular disease (CVD) in women is still not completely understood by either patients or physicians. It is perceived as a health problem that becomes manifest only after menopause; however, it is the most frequent cause of mortality in women and is often seen at an earlier age in the presence of risk factors. Moreover, the symptoms, course, and prognosis are quite different from those seen in men, and both physicians and patients remain inadequately aware of the character of the disease. In the approach to female patients, some risk factors inherent to women should be considered in addition to the classic factors. In this review article, aspects of CVD that are different in women, etiological factors, risk factors specific to women, and particular points to be taken into consideration in the treatment and diagnosis are illustrated in the form of questions and responses from experts.
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    Arrhythmias following Revascularization Procedures in the Course of Acute Myocardial Infarction: Are They Indicators of Reperfusion or Ongoing Ischemia?
    (Hindawi Ltd, 2013) Tatli, Ersan; Alicik, Guray; Buturak, Ali; Yilmaztepe, Mustafa; Aktoz, Meryem
    Objective. The most important step in the treatment of ST elevation myocardial infarction is to sustain myocardial blood supply as soon as possible. The two main treatment methods used today to provide myocardial reperfusion are thrombolytic therapy and percutaneous coronary intervention. In our study, reperfusion arrhythmias were investigated as if they are indicators of coronary artery patency or ongoing ischemia after revascularization. Methods. 151 patients with a diagnosis of acute ST elevation myocardial infarction were investigated. 54 patients underwent primary percutaneous coronary intervention and 97 patients were treated with thrombolytic therapy. The frequency of reperfusion arrythmias following revascularization procedures in the first 48 hours after admission was examined. The relation between reperfusion arrhythmias, ST segment regression, coronary artery patency, and infarct related artery documented by angiography were analyzed. Results. There was no statistically significant difference between the two groups in the frequency of reperfusion arrhythmias (P = 0.355). Although angiographic vessel patency was higher in patients undergoing percutaneous coronary intervention, there was no significant difference between the patency rates of each group with and without reperfusion arrythmias. Conclusion. Our study suggests that recorded arrhythmias following different revascularization procedures in acute ST elevation myocardial infarction may not always indicate vessel patency and reperfusion. Ongoing vascular occlusion and ischemia may lead to various arrhythmias which may not be distinguished from reperfusion arrhythmias.
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    Assessment of the relationship between asymmetric dimethylarginine and severity of erectile dysfunction and coronary artery disease
    (Springer, 2010) Aktoz, Tevfik; Aktoz, Meryem; Tatli, Ersan; Kaplan, Mustafa; Turan, Fatma N.; Barutcu, Ahmet; Atakan, Irfan H.
    The plasma concentration of asymmetrical dimethylarginine (ADMA), an inhibitor of nitric oxide synthase, has been linked to endothelial dysfunction. We investigated the relation between plasma ADMA concentration and severity of erectile dysfunction (ED) and coronary artery disease (CAD). We measured plasma levels of ADMA in 92 male patients. Patients were divided into three groups: group 1 (n = 41), patients with ED and without CAD; group 2 (n = 29), patients with stable CAD; group 3 (n = 22), control group (patients without CAD or ED). Erectile function was evaluated by the erectile function domain of the international index of erectile function (IIEF-EFD) a validated 15-item self-administered questionnaire. Erectile function is specifically addressed by six questions that form the so-called erectile function domain of the questionnaire. Each question is scored 0-5. ED is defined as any value < 26. Patients with CAD who have stable angina pectoris were selected after coronary angiography. ADMA was analyzed by ELISA method. Group 1 had significantly higher concentrations of plasma ADMA than groups 2 and 3 (respectively, 0.75 +/- A 0.40 vs. 0.50 +/- A 0.30, P = 0.013; 0.75 +/- A 0.40 vs. 0.50 +/- A 0.25, P = 0.021). There was negative correlation between ADMA and IIEF-EFD score in all groups (n = 92) (r = -0.322, P = 0.002). In a multiple logistic regression analysis adjusting for age, hyperlipidemia, ADMA remained independent predictor for severe ED. Odds ratio for plasma ADMA was 14.151 (1.101-181.940; P = 0.042). First of all, this study provides that ADMA concentrations are significantly higher in patients who have ED when compared to patients with CAD and controls. Second, there was a negative correlation between ADMA and severity of ED. Elevating levels of circulating ADMA is an independent risk factor for severe of ED, and ADMA may be a link between CAD and ED.
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    Assessment of ventricular and left atrial mechanical functions, atrial electromechanical delay and P wave dispersion in patients with scleroderma
    (Via Medica, 2011) Aktoz, Meryem; Yilmaztepe, Mustafa; Tatli, Ersan; Turan, Fatma Nesrin; Umit, Elif G.; Altun, Armagan
    Background: The aim of this study was to investigate ventricular functions and left atrial (LA) mechanical functions, atrial electromechanical coupling, and P wave dispersion in scleroderma patients. Methods: Twenty-six patients with scleroderma and twenty-four controls were included. Left and right ventricular (LV and RV) functions were evaluated using conventional echocardiography and tissue Doppler imaging (TDI). LA volumes were measured using the biplane area-length method and LA mechanical function parameters were calculated. Inter-intraatrial electromechanical delays were measured by TDI. P wave dispersion was calculated by 12-lead electrocardiograms. Results: LV myocardial performance indices (MPI) and RV MPI were higher in patients with scleroderma (p = 0.000, p = 0.000, respectively) while LA passive emptying fraction was decreased and LA active emptying fraction was increased (p = 0.051, p = 0.000, respectively). P wave dispersion and inter-intraatrial electromechanical delay were significantly higher in patients with scleroderma (25 [10-60] vs 20[0-30], p = 0.000, 16.50 [7.28-26.38] vs 9.44 [3.79-15.78] and 11.33 [4.88-16.06] vs 4.00 [0-12.90], p < 0.05, respectively). Interatrial electromechanical delay was negatively correlated with LV E wave, (p = 0.018). LV E wave was demonstrated to be a factor independent of the interatrial electromechanical delay (R(2) = 0.270, beta = -0.52, p = 0.013). Conclusions: This study showed that in scleroderma patients, global functions of LV, RV and mechanical functions of LA were impaired, intra-interatrial electromechanical delays were prolonged and P wave dispersion was higher. LV E wave was demonstrated to be a factor that is independent of the interatrial electromechanical delay. Reduced LV E wave may also give additional information on the process of risk stratification of atrial fibrillation. (Cardiol J 2011; 18, 3: 261-269)
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    Asymmetrical dimethylarginine and severity of erectile dysfunction and their impact on cardiovascular events in patients with acute coronary syndrome
    (Termedia Publishing House Ltd, 2010) Aktoz, Meryem; Aktoz, Tevfik; Tatli, Ersan; Kaplan, Mustafa; Turan, Fatma Nesrin; Barutcu, Ahmet; Atakan, Irfan Hueseyin
    Introduction: Coronary artery disease (CAD) and vascular erectile dysfunction (ED) are related to endothelial dysfunction. Elevated asymmetrical dimethylarginine (ADMA) levels and ED are common in patients with increased cardiovascular risk. Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients. Material and methods: Follow-up data were available for severity of ED in 71 patients with ACS. Plasma ADMA levels were determined by ELISA in 57 patients. Erectile dysfunction was assessed by the International Index of Erectile Function-6 (IIEF-6) score. Major adverse cardiovascular events (reinfarction, all-cause hospitalisation, stroke and all-cause death) was evaluated after a median of 10 months. Results: Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild, mild to moderate, and moderate ED (0.259 [95% CI 0.041-1.6], p = 0.147; 0.605 [95% CI 0.095-3.8], p = 0.594; 0.980 [95% CI 0.233-4.1], p = 0.978; and 0.473 [95% CI 0.052-1.3], p = 0.508). The patients who had ADMA levels 0.32 mu mol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 mu mol/l (2.018 [95% CI 0.615-6.6], p = 0.247). Conclusions: Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study. Larger prospective studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS.
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    Bidirectional tachycardia in a patient with pulmonary embolism
    (Via Medica, 2010) Tatli, Ersan; Aktoz, Meryem; Barutcu, Ahmet; Altun, Armagan
    We report a 55 year-old man with sudden cardiac arrest. Electrocardiography revealed runs of bidirectional ventricular tachycardia, and transthoracic echocardiography showed indirect findings of pulmonary embolism. (Cardiol J 2010; 17, 2: 194-195)
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    Cardiac rhabdomyoma in an adult patient presenting with right ventricular outflow tract obstruction
    (Elsevier Ireland Ltd, 2008) Aktoz, Meryem; Tatli, Ersan; Ege, Turan; Yalcin, Omer; Buyuklu, Mutlu; Aksu, Feza; Gul, Cetin
    We present a 24 year old woman with cardiac rhabdomyoma. Cardiac rhabdomyoma is the most common benign cardiac tumor in infants, but in adults, cardiac rhabdomyoma is very rare. These tumors are often spontaneously reversible because they are associated to the right or left ventricular outflow tract obstruction, tachyarrhythmias and heart failure where surgery is necessary. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    Clinical Significance of Positive Isovolumetric Relaxation Velocity of Pulsed-Wave Tissue Doppler Imaging
    (Wiley, 2009) Sueruecue, Hueseyin; Tatli, Ersan; Degirmenci, Ali; Okudan, Selnur; Aktoz, Meryem; Boz, Hakki
    Objective: Among the pulsed-wave tissue Doppler imaging (pw-TDI) parameters, there are two different pw-TDI velocities (IVRa and IVRb) after systolic velocity, but before Ea velocity. In our study, we investigated the clinical importance of these two velocities in left ventricular diastolic dysfunction (LVDDF) evaluation. Methods: One hundred and eighty cases without exclusion criteria were included in the study. Cases with a transmitral E to A flow (E/A) ratio below 1 were assigned to group 2. In cases with an E/A ratio between 1 and 2, the pw-TDI parameters were taken into consideration. Cases with an Ea/Aa ratio above 1 were assigned to group 1 and cases with an Ea/Aa ratio 1 or below than 1 were assigned to group 3. Group 1 (n: 68) represented normal diastolic left ventricular (LV) inflow while group 2 (n = 87) represented impaired relaxation and group 3 (n = 25) represented pseudonormal LV inflow. Results: In our study, we found that IVRa velocity was lower in group 1 compared to group 2 and group 3 (P < 0.001 and P = 0.038, respectively). Similarly, this velocity was significantly different in group 3 and group 2 such as it was higher in group 2 compared to group 3 (P = 0.022). There was no difference in IVRb velocity and IVRa/IVRb ratio among the groups. A negative correlation was found between IVRa velocity and Ea velocity (r = 44%, P < 0.001). Positive correlation was found between IVRa velocity and isovolumetric relaxation time (r = 18%, P = 0.014) and also between IVRa velocity and Aa velocity (r = 19%; P = 0.010). Conclusion: Based on the results of our study, we concluded that IVRa velocity is an important pw-TDI parameter in the evaluation of LVDDF, especially in differentiating pseudonormal LVDDF type from normal LV inflow. (ECHOCARDIOGRAPHY, Volume 26, January 2009).
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    Consensus paper on the evaluation and treatment of resistant hypertension by the Turkish Society of Cardiology
    (Kare Publ, 2020) Sahinarslan, Asife; Gazi, Emine; Aktoz, Meryem; Ozkan, Cigdem; Okyay, Gulay Ulusal; Elalmis, Ozgul Ucar; Belen, Erdal
    [Abstract Not Available]
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    Coronary artery ectasia in a patient with Behcet's disease
    (Saudi Med J, 2007) Tatli, Ersan; Surucu, Huseyin; Aktoz, Meryem; Buyuklu, Mutlu
    Behcet's disease is a multisysternic disease of unknown etiology. Disease manifestations consist of recurrent oral and genital ulceration, skin lesions, and relapsing ocular inflammation. Arterial involvement is an uncommon complication of Behcet's disease, and it most frequently affects the abdominal aorta followed by femoral artery, and the pulmonary artery. Coronary lesions in Behcet's disease have been little reported in the literature. A-36-year-old female with 6-year history of Behcet's disease was hospitalized with ectasia of the left main coronary artery. This unusual vascular complication Behcet's disease is presented.
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    Coronary Slow Flow and Acute Coronary Syndrome in a Patient with Spinal Cord Injury
    (Texas Heart Inst, 2011) Aktoz, Meryem; Tatli, Ersan; Barutcu, Ahmet; Ozkalayci, Flora; Umit, Elif; Altun, Armagan
    We report the case of a 55-year-old man who presented with acute coronary syndrome due to coronary slow flow after spinal cord injury. Data regarding the causes and clinical manifestations of coronary slow flow are inconclusive, but the autonomic nervous system is believed to be at least a contributing factor The predominant vagal activity causes vasodilation and hemostasis, which can lead to acute coronary syndrome. We hereby call attention to hyperactive parasympathetic tonicity, which can lead to coronary slow flow and acute coronary syndrome in acute spinal cord injury patients. (Tex Heart last J 2011;38(4):433-6)
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    CORONARY SLOW FLOW AND ACUTE CORONARY SYNDROME IN PATIENT WITH SPINAL CORD INJURY: A CASE REPORT
    (Elsevier Ireland Ltd, 2010) Aktoz, Meryem; Tatli, Ersan; Barutcu, Ahmet; Ozkalayci, Flora; Umit, Elif; Altun, Armagan
    [Abstract Not Available]
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    Diagnostic Approach to a Case with Aortic Dissection
    (Aves, 2010) Aktoz, Meryem; Erdogan, Okan; Tatli, Ersan
    Without a dear diagnosis, patients with aortic dissection often die before presentation to the hospital. Keeping a high clinical index of suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. The choice of the diagnostic modality mainly depends on the availability of the diagnostic tools and the experience of the physicians at the given institution.
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    Diagnostic value of plasma fibronectin level in predicting the presence and severity of coronary artery disease
    (Springer, 2009) Ozcelik, Fatih; Erdogan, Okan; Aktoz, Meryem; Ekuklu, Galip; Tatli, Ersan; Demir, Muzaffer
    The relation between fibronectin and coronary artery disease (CAD) according to previous study results is controversial. The aim of the present study is to investigate the predictive value of fibronectin in determining the presence and severity of CAD. Patients with stable angina (n = 62) who had angiographically documented CAD, and control patients (n = 31) who had normal coronary angiograms, were included in the study. Plasma fibronectin levels were determined in all patients. Plasma fibronectin level (milligrams per liter) in patients with CAD was higher than normal controls (364.2 +/- 171 vs 265.1 +/- 135.5, p = 0.006). The severity of CAD determined according to Gensini score and fibronectin level did not show any correlation (r = 0.13, p = 0.311). If fibronectin level 240 mg/l was determined as cutoff, it showed 76% sensitivity, 46% specificity, 46% negative predictive value, and 72.3% positive predictive value for predicting CAD. The present study showed that plasma fibronectin level in CAD is significantly higher than normal control subjects. However, it has no role in predicting the severity of CAD.