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Arrow Cause of Angina Pectoris: Single Coronary Artery Anomaly in Elderly Patient
(Trakya Üniversitesi, 2020) Göztepe, Aslı; Altay, Servet
Aims: Coronary artery anomalies are rare diseases among the population. These anomalies, which are usually noticed by chance, can remain silent for many years without symptoms. We aimed to present a patient with a coronary artery anomaly withouthaving any symptoms for many years. Case Report: A 73-year-old female patient presented to the Department of Cardiologyof the Trakya University School of Medicine. The patient stated that she had chest pain that decreased with rest and increasedwith exercise for the last 2 months. After the cardiac examination of the patient, imaging procedures were deemed necessary.After imaging, the patient was diagnosed with a single coronary artery anomaly. The patient was recommended to have surgery,but she refused. Upon this, the patient was discharged on condition that she was kept under frequent follow-up. Conclusion:Coronary artery anomalies have reached higher rates of diagnosis thanks to increased imaging technologies in recent years. Ifthese congenital diseases that can even cause death are noticed early, there are various treatment options. First of all, medicaltreatment is preferred, and surgery is recommended in patients with no response to the medical treatment. This disease, whichis closely related to the patient's life, should be carefully evaluated by the doctors. Keywords: Coronary arteries, cardiac anomaly,angiography
Arı Sokması Sonrasında Gelişen Atipik Klinikli Akut Koroner Sendrom Vakası ve Primer Tedavisi
(2020) Kaya, Çağlar; Zeybey, Utku; Altay, Servet
Arı sokmaları da böcek sokmaları içinde sıklıkla karşılaşılan bir durumdur. Genellikle lokal allerjik reaksiyonlar oluşturmaktadır. Nadir deolsa hayatı tehdit eden ciddi klinik tablolara yol açabilmektedir. Akut koroner sendromlar da bu ciddi klinik durumlar içerisinde yer almaktadır. Arı sokması sonrasında kana karışan zehir trombüs aktivasyonu yaparak iskemik tablolara yol açabilir ve nadir de olsa akutkoroner sendromlara neden olabilir. Hastalar allerjik semptomlar ya da anafilaksi ile birlikte göğüs ağrısı olabileceği gibi herhangi biranafilaktik tablo oluşturmadan ya da çok hafif belirtiler vererek göğüs ağrısı olmadan da karşımıza miyokard enfarktüsü şeklinde kliniktablolarla gelebilirler. Burada hipertansiyon ve geçmişte sigara içiciliği dışında hikayesi olmayan 69 yaşındaki bir erkek hastada arı sokması ile tetiklenen ancak belirgin anafilaksi tablosu oluşturmadan gelişen akut ST yükselmeli miyokard enfarktüsü vakası sunmaktayız.
Atypical 'de Winter pattern' mimicking acute left main coronary artery lesion
(Kare Publ, 2020) Gurdogan, Muhammet; Yalta, Kenan; Altay, Servet; Zeybey, Utku; Akkus, Omer Ferudun
[Abstract Not Available]
Autoimmune activation as a determinant of atrial fibrillation among Turks A prospective evaluation
(Lippincott Williams & Wilkins, 2018) Simsek, Baris; Altay, Servet; Ozbilgin, Nazmiye; Onat, Altan
Although low-grade inflammation has been linked to the prediction of atrial fibrillation (AF), evidence from some reports suggest that autoimmune activation might potentially be a relevant mechanism. We assessed the predictive value of inflammation and other markers for the risk of incident AF. A score of age-controlled anthropometric, lipid, and nonlipid variables was compared in participants with recorded nonvalvular persistent/permanent AF (n=110) to those of a nested cohort sample (n=1126) of the Turkish Adult Risk Factor study. Available values preceding by 2 (1) years the development of AF were used regarding incident AF (n=87) in multivariable regression. Comparing age-controlled inflammation and other markers across the 2 groups, low apolipoprotein (apo) B and total cholesterol levels differed highly significantly in each sex. Moreover, low-density lipoprotein (LDL)-cholesterol and fasting insulin concentrations were significantly lower, sex hormone binding globulin (SHBG), glucose and systolic blood pressure higher in women alone, while C-reactive protein levels were similar. A model of multivariable logistic regression analyses for overall AF and 2 models for incident AF demonstrated a consistent inverse predictive value for apoB in each gender [relative risk (RR) 0.44 (95% confidence interval (CI), 95% CI 0.30-0.66], along with age, as main determinants. SHBG in females and waist circumference in males were further significantly associated with initial AF. Never smoking (compared with ever smoking) tended to predict AF. These findings, collectively, are highly consistent with an autoimmune process in which damaged epitope of apoB due to proinflammatory state emerge as a basic mechanism in the development of AF. ApoB level is likely only apparently reduced due to partial escape from assay.
Balkan Medical Journal Policy on the Use of Chatbots in Scientific Publications
(Galenos Publ House, 2023) Kocak, Zafer; Altay, Servet
[Abstract Not Available]
Bradyarrhythmia development and permanent pacemaker implantation after cardiac surgery
(Kare Publ, 2018) Turkkan, Ceyhan; Osmanov, Damirbek; Yildirim, Ersin; Ozcan, Kazim Serhan; Altay, Servet; Hasdemir, Hakan; Alper, Ahmet Taha
OBJECTIVE: Bradyarrhythmia is one of the complications that may develop after cardiac surgery. Only a few studies have previously dealt with this concern, and in our study, we investigated the factors affecting the development of atrioventricular block or sinus node dysfunction and the requirement of permanent pacemaker following cardiac surgery. METHODS: A total of 62 patients who developed the atrioventricular (AV) block or sinus node dysfunction and required a permanent pacemaker following cardiac surgery were included in the study. Among these, 31 patients were evaluated prospectively, and the information regarding 31 patients was evaluated retrospectively based on hospital records. Demographic, clinical, and surgical information was recorded. Patients were grouped according to the types of procedures, including the coronary artery bypass graft, valve surgery, congenital heart disease, and combinations of these. Patients were evaluated by standard 12-lead electrocardiogram and transthoracic echocardiography preoperatively. The postoperative development of bradyarrhythmia and requirement of permanent pacemaker were evaluated. RESULTS: The mean age of patients with preoperative conduction abnormality and wide QRS was statistically significantly higher than those without these disorders. The odds ratio for preoperative conduction abnormality risk in patients over 70 years of age was found as 4.429 (95% confidence interval, 1.40-13.93). There was no gender-related statistically significant difference in terms of left ventricular ejection fraction, left ventricular dilatation, interventricular septum thickness, the time interval from operation to the development of AV block, concomitant diseases, and complication rates. CONCLUSION: Preoperative conduction abnormality and wide QRS in patients over 70 years of age was determined as a risk factor.
Cardio-intestinal inflammatory syndromes: What do we know for understanding this new entity?
(Elsevier Ireland Ltd, 2023) Aksit, Ercan; Altay, Servet
[Abstract Not Available]
Cardiovascular disease risk in psoriatic arthritis-common soil due to proinflammatory state and autoimmune activation: comment on the article by Polachek et al
(Wiley, 2017) Onat, Altan; Altay, Servet; Karakoyun, Suleyman
[Abstract Not Available]
Constrictive Pericarditis: An Overlooked Cause of Ascites
(Trakya Üniversitesi, 2021) Koçyiğit, Beliz; Özyiğit, Irmak; Altay, Servet
Aims: Constrictive pericarditis is a well-known but unusual and rare cause of ascites. The diagnosis of constrictive pericarditis in most patients who have chronic ascites is challenging. We aimed to present a patient with constrictive pericarditis with chronic ascites and pericardial calcifications seen in chest radiography. Case Report: A 66-year-old male patient presented to the emergency room of Trakya University School of Medicine. The patient had abdominal swelling and ascites for the last 5 years and underwent large-volume paracentesis in his previous emergency admissions. After the electrocardiography of the patient, he was directed to the cardiology department for further examinations. The chest radiography revealed significant pericardial calcifications. Following imaging procedures confirmed radiological findings, and the patient was diagnosed with constrictive pericarditis. Furthermore, his cardiac catheterization findings were consistent with constrictive pericarditis. The patient was recommended to have a pericardiectomy operation and there was a significant reduction in the patient's symptoms after surgery. Conclusion: The absence of specific symptoms and resemblances of existing symptoms to liver disease make the early diagnosis of con- strictive pericarditis difficult. Physicians should consider constrictive pericarditis as a differential diagnosis when dealing with a patient who has chronic ascites.
Create a Syndrome When Treating a Disease: Acquired Lutembacher Syndrome
(2019) Kaya, Çağlar; Gürdoğan, Muhammet; Altay, Servet
Combination of atrial septal defect (ASD) and mitral stenosis(MD) is defined as Lutembacher syndrome (LS). MD ismostly acquired (rheumatic heart disease), as congenitalMD is very rare. The percutaneous interventions for MDhave become widespread. The ASD may become eithercongenital or iatrogenic. The coexistence of spontaneous oriatrogenic ASD and acquired MD is known as acquired LS.Here, we report a case of acquired LS.
Effect of nutritional status on mortality in patients undergoing coronary artery bypass grafting
(Elsevier Science Inc, 2018) Keskin, Muhammed; Ipek, Goktuk; Aldag, Mustafa; Altay, Servet; Hayiroglu, Mert Ilker; Borklu, Edibe Betul; Inan, Duygu
Objectives: The prognostic effects of poor nutritional status and cardiac cachexia on coronary artery disease (CAD) are not clearly understood. A well-accepted nutritional status parameter, the prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and those under-going gastrointestinal surgery, was introduced to patients requiring coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the prognostic value of PNI in patients with CAD undergoing CABG. Methods: We evaluated the in-hospital and long-term (3-y) prognostic effect of PNI on 644 patients with CAD undergoing CABG. Baseline characteristics and outcomes were compared among the patients by PNI and categorized accordingly: Q1, Q2, Q3, and Q4. Results: Patients with lower PNI had significantly higher in-hospital and long-term mortality. Patients with lower PNI levels (Q1) had higher in-hospital mortality and had 12 times higher mortality rates than those with higher PNI levels (Q4). The higher PNI group had the lower rates and was used as the reference. Long-term mortality was higher in patients with lower PNI (Q1)-4.9 times higher than in the higher PNI group (Q4). In-hospital and long-term mortality rates were similar in the non-lower PNI groups (Q2-4). Conclusion: The present study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients undergoing CABG. (C) 2017 Elsevier Inc. All rights reserved.
The Effect of Thyroid Stimulating Hormone Level Within the Reference Range on In-Hospital and Short-Term Prognosis in Acute Coronary Syndrome Patients
(Mdpi, 2019) Gurdogan, Muhammet; Altay, Servet; Korkmaz, Selcuk; Kaya, Caglar; Zeybey, Utku; Ebik, Mustafa; Demir, Melik
Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3-5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and <0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and <1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 +/- 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p < 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p < 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p < 0.001). In multivariate logistic regression analysis, the high-normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%; CI: 1.769-22.480; p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High-normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.
THE ETIOLOGY AND AGE-RELATED PROPERTIES OF PATIENTS WITH DELIRIUM IN CORONARY INTENSIVE CARE UNIT AND ITS EFFECTS ON INHOSPITAL AND FOLLOW UP PROGNOSIS
(Literatura Medica, 2020) Altay, Servet; Gurdogan, Muhammet; Kaya, Caglar; Kardas, Fatih; Zeybey, Utku; Cakir, Burcu; Ebik, Mustafa
Objective - Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. Methods - This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. Results - A total of 1108 patients (mean age: 64.4 +/- 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Conclusion - Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.
Evaluation of Demographic, Clinic and Genetic Characteristics of Patients Admitted to Trakya University Hospital With Hypertrophic Cardiomyopathy
(Trakya Üniversitesi, 2021) Bardakçı, Burak; Tan, Berfin; Kızılkaya, Sarper; Yüksel, Ceren; Altay, Servet
Aims: This study aims to evaluate the genetics, clinical characteristics, and functional abnormalities of patients diagnosed with hypertrophic cardiomyopathy in Trakya University Hospital. Methods: This retrospective study was conducted with patients who were diagnosed with hypertrophic cardiomyopathy between November 2009 - November 2019 in Trakya University Hospital. The data were obtained from the hospital’s database. Patients’ data (regarding age, gender, ge- netics, transthoracic echocardiogram findings, medications, types of hypertrophic cardiomyopathy, and first diagnoses) were examined. Numbers, percentages, means, and standard deviations were used as descriptive statistics. Results: Eleven patients with hypertrophic cardiomyopathy were evaluated. Five (45.45%) were female and 6 (54.54%) were male. The mean age of the female patients was 58.20 ± 8.57 years. The most common type of hypertrophic cardiomyopathy was found to be asymmetrical septal cardiomyopathy [7 (63.63%)]. Three (27.27%) patients presented with hypertension. There were gene mutations in three patients. Among these three patients, two (18.18%) patients have MYBPC3, and one (9.09%) patient has TTN gene mutations. Conclusion: Hypertrophic car- diomyopathy is usually accompanied by comorbidities such as arrhythmias, myocardial infarction, coronary artery disease. Therefore, these patients must be paid attention to in these matters.
An extreme case of vasospastic angina mimicking acute STEMI: Severe three-vessel disease with critical stenoses
(Turkish Soc Cardiology, 2019) Kaya, Caglar; Altay, Servet
[Abstract Not Available]
A Fatal Disaster: Accompanying Aortic Dissection Obscured by Acute Coronary Syndrome
(Sage Publications Inc, 2023) Ulkucu, Attila; Altay, Servet
The present study investigated the characteristics of rare but often fatal cases of acute coronary syndrome and aortic dissection and the factors affecting mortality. HEART score, aortic dissection detection risk score, and Global Registry of Acute Coronary Event (GRACE) Score were calculated by evaluating biochemical tests and symptoms/signs of the 20 patients who were admitted to our clinic with a preliminary diagnosis of acute myocardial infarction and subsequently diagnosed with aortic dissection. The assumption of normal distribution was checked with the Shapiro-Wilk test, and independent group comparisons were made with the t test or the Mann-Whitney U test. Relationships between qualitative variables were analyzed with chi-square tests. Relationships between quantitative variables were analyzed with Pearson or Spearman correlation coefficients. Patients with conditions like hypertension and diabetes are at higher risk for aortic dissection. We recommend the use of the GRACE Score with the risk parameters we have determined for the prediction of operative mortality. We suggest that the axillary region and antegrade cerebral perfusion may be preferred as the cannulation area in dissection repair. We emphasize preliminary risk assessment according to the aortic dissection detection risk score and remind physicians that ECG ST-T and troponin changes may be misleading.
Feokromasitoma Hastasında Akut Miyokard Enfarktüsü: Obstrüktif-Nonobstrüktif İkilemi
(2022) Çakır, Burcu; Öztürk, Cihan; Altay, Servet
Feokromasitomalar, kromaffin dokudan köken alan, katekolamin salgılayarak klinik etkilerini oluşturan ve nadir görülen nöroendokrin tümörlerdir. Katekolaminlerin geniş etki spektrumuna bağlı olarak miyokard enfarktüsü gibi çok fazla hastalığı taklit edebildikleri gibi, yine katekolaminlerin çeşitli kardiyak patofizyolojik etkileri nedeni ile kardiyovasküler hastalık riskini ve mortaliteyi önemli oranda arttırırlar. Feokromasitomalı bir hasta akut koroner sendrom tablosunda başvurduğunda, miyokard enfarktüsünü taklit eden stres kardiyomiyopatisi ve gerçek miyokard enfarktüsü tanılarından ikisi de olasıdır ve tanı algoritmasında kafa karışıklığı yaratabilir ve bazen daha sık görülmesi nedeni ile stres kardiyomiyopatisi düşünülerek hastaya daha az ivedi yaklaşılabilir. Bu olgu sunumu ile feokromasit? o ma öyküsü olan ve akut koroner sendrom tablosunda başvuran bir hastaya yaklaşım ve tedavi tartışılmıştır.
First Experience of Cardiac Device Implantation with Remote Cardiac Support System in Turkey
(Galenos Publ House, 2022) Taylan, Gokay; Gok, Murat; Ozkan, Ugur; Altay, Servet; Yalta, Kenan
[Abstract Not Available]
High-Normal Thyroid-Stimulating Hormone in Euthyroid Subjects is Associated with Risk of Mortality and Composite Disease Endpoint only in Women
(TERMEDIA PUBLISHING HOUSE LTD, 2018) Altay, Servet; Onat, Altan; Can, Gunay; Tusun, Eyyup; Simsek, Baris; Kaya, Adnan
Introduction: The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events. Material and methods: In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender. Results: In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments. Conclusions: The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.
Hydatid Cyst in a Heart Failure Patient Mimicking Phantom Tumor
(Trakya Üniversitesi, 2021) Özyiğit, Irmak; Koçyiğit, Beliz; Altay, Servet
Aims: We aimed to present a heart failure patient with a hydatid cyst of the lung, mimicking a phantom tumor. Case Report: A 71-year-old male patient pre- sented to the cardiology department of Trakya University School of Medicine with increasing shortness of breath and cough. His hospital admission complaints, heart failure history, and chest radiology results were consistent with a phantom tumor of the lung secondary to congestive heart failure. The patient was given diuretics; however, there was no evidence of resolution or change in the size of the observed cystic lesion. A hydatid cyst as a differential diagnosis was consid- ered, and subsequent questioning of the patient revealed animal contacts. The patient was offered the option of surgical removal of the cyst, which he declined due to the high mortality risk. The patient was prescribed 400 mg of albendazole and was advised to have regular check-ups. In the long term, he showed no further signs and symptoms of hydatid cyst. The hydatid cyst was neither removed nor disappeared, and it continued to be visible on radiological follow-up examinations. Conclusion: Due to the similarities present in admission complaints and chest examinations, it is challenging to differentiate hydatid cyst of the lung in heart failure patients. Physicians should be aware of the hydatid cyst in the differential diagnosis of pleural cysts and consider patients’ occupation and residency in order to not overlook zoonotic diseases.

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