Biomedical subjects
Publications and source records attributed to Atila Iyisoy.
Variant angina is generally a benign disease with self limiting symptoms. But in some cases serious ventricular arrhythmias which can lead to death can be seen. In this paper we present a case of variant angina who subsequently developed polymorphic ventricular tachycardia and was treated successfully with long acting nitrate and calcium channel blockade therapy.
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The coronary slow flow phenomenon is an angiographic curiosity characterized by delayed distal vessel opacification provided that the presence of significant epicardial coronary disease is excluded. Slow flow phenomenon in epicardial coronary arteries is not infrequent finding during routine coronary angiography. However, the clinical features of patients with slow flow phenomenon have not been extensively studied. ST elevation in leads without Q waves during exercise testing has not been previously reported in patients with slow flow phenomenon. In the current case, we report a 29-year-old man with angiographically normal coronary arteries associated with slow coronary flow in the absence of any significant obstructive coronary artery disease and no evidence of epicardial coronary artery spasm in whom ST segment elevation in leads I and aVL was observed at maximal exercise of treadmill test.
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Cyclooxygenase-2 (COX-2) inhibitors dilemma in cardiovascular medicine has not been resolved yet. The cardiovascular safety of selective COX-2 inhibitors other than rofecoxib is uncertain. Given the ongoing controversy surrounding the use of COX-2 inhibitors, further clinical studies with different types of drugs are required to establish safety and therapeutic benefit in patients with coronary artery disease.
OBJECTIVES: We evaluated the effects of nebivolol on platelet activation in hypertensive patients by measuring mean platelet volume (MPV) and plasma soluble P-selectin (sP-sel) levels and compared with those of the patients taking metoprolol. MATERIALS AND METHODS: Eighty newly diagnosed hypertensive patients in grade 1 hypertension were enrolled in this prospective, blinded randomized study. Seventy two patients completed the study. After baseline assessment, each patient was randomly allocated to 5 mg daily dose of nebivolol (n=37, 20 male) or 100 mg daily dose of metoprolol (n=35, 18 male) and treated for 6 months. Blood pressure, heart rate, lipid profile, plasma glucose, sP-selectin levels, platelet counts and MPV were measured before and after treatment. RESULTS: At the end of 6 months, nebivolol significantly decreased MPV and plasma sP-selectin levels (7.59+/-0.78 fl vs. 7.42+/-0.74 fl, p<0.001; 1.29+/-0.46 ng/ml vs. 1.21+/-0.36 ng/ml, p=0.002, respectively) compared to those of pretreatment. Although pretreatment sP-selectin levels of the two groups were similar, posttreatment plasma sP-selectin levels were significantly reduced with nebivolol compared with those of metoprolol group (1.21+/-0.36 ng/ml vs. 1.46+/-0.30 ng/ml, p=0.008). In contrast, metoprolol treatment did not cause any significant change in platelet activation parameters after treatment. CONCLUSION: Beneficial effects of nebivolol on platelet activation were more potent than those of metoprolol. We consider that decreased platelet activation with nebivolol might play a role to reduce thrombotic risk in hypertensive patients.
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Explore the source record for details and available documents.
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Isolated right ventricular myocardial infarction (RVMI) rarely occurs and accounts for only 3% of all myocardial infarction cases. In the literature, there are several reported isolated RVMI cases with precordial ST-segment elevation. We describe a 45-year-old man with marked ST-segment elevations in leads V1 through V4 accompanied by slight ST-segment elevations in the inferior leads (III, aVF) caused by acute occlusion of a nondominant small right coronary artery proximal to the conus branch causing isolated RVMI.
AIMS: Metabolic syndrome with its associated cardiovascular risk factors and prothrombotic, procoagulant and proinflammatory properties and its detrimental effects on coronary microcirculation may play a role in the occurrence of poor myocardial perfusion after primary percutaneous coronary intervention in patients with acute myocardial infarction. Accordingly, this study was designed to evaluate the association between metabolic syndrome and myocardial perfusion grade in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. MATERIAL AND METHODS: The study population included 283 consecutive patients (229 men, mean age=62+/-8 years) admitted to our hospital with ST-elevation myocardial infarction and who underwent primary percutaneous coronary intervention. Thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) was graded densitometrically on the basis of visual assessment of relative contrast opacification of the myocardial territory subtended by the infarct vessel in relation to epicardial density. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Patients were divided into two groups on the basis of the myocardial perfusion grade determined after percutaneous coronary intervention. Group I consisted of 223 patients with good myocardial perfusion (TMPG 2-3) after successful percutaneous coronary intervention and group II of 60 patients with poor myocardial perfusion (TMPG 0-1). RESULTS: The prevalence of metabolic syndrome was found to be significantly higher in patients with poor myocardial perfusion than in those with good myocardial perfusion (40 vs. 20%, respectively, P=0.002). Moreover, we detected an independent association between metabolic syndrome and the occurrence of poor myocardial perfusion grade (adjusted OR=2.54, 95% CI=1.35-4.75, P=0.003). CONCLUSIONS: We have shown, for the first time, a significant association between metabolic syndrome and impaired myocardial perfusion after percutaneous coronary intervention in patients with acute myocardial infarction. This data may partially explain the poor short and long-term outcomes of acute myocardial infarction in patients with metabolic syndrome.
OBJECTIVES: To determine the effects of nebivolol on oxidative stress, insulin resistance, adiponectin and plasma soluble P-selectin levels in hypertensive patients in comparison with metoprolol. MATERIAL AND METHODS: Eighty newly diagnosed hypertensive patients in grade 1 hypertension according to the European Society of Hypertension and European Society of Cardiology guidelines were enrolled in this prospective, blinded, randomized study. Seventy-two patients completed the study. After baseline assessment, each patient was randomly allocated to a 5 mg daily dose of nebivolol (n = 37, 20 male) or a 100 mg daily dose of metoprolol (n = 35, 18 male) and treated for 6 months. Blood pressure, heart rate, oxidative stress (malonyldialdehyde), homeostasis model assessment: insulin resistance, adiponectin and plasma soluble P-selectin levels were measured before and after treatment. RESULTS: At the end of treatment, nebivolol and metoprolol significantly decreased blood pressure and heart rate, with a more pronounced bradycardic effect of metoprolol. Nebivolol, but not metoprolol, significantly lowered oxidative stress (P = 0.03), the insulin resistance index (P = 0.003) and plasma soluble P-selectin levels (P = 0.008), and increased adiponectin levels (P = 0.04). CONCLUSION: Nebivolol, in contrast to metoprolol, improved oxidative stress, insulin sensitivity, decreased plasma soluble P-selectin and increased adiponectin levels in hypertensive patients. These beneficial effects of nebivolol may contribute to a reduction in cardiovascular risk in hypertensive patients.
OBJECTIVES: Although hypertension has been shown to be one of the most important predictors of reduced arterial elasticity, there is not enough data about aortic elastic properties in patients with prehypertension. Accordingly, the current study was designated to evaluate aortic elastic features in young patients with prehypertension. MATERIAL AND METHODS: The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age=34+/-6 years) and 25 healthy controls (16 men, mean age=33+/-6 years) eligible for the current study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. RESULTS: Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes than the controls: (5.77+/-1.91 vs. 8.63+/-2.67 cm dynx10, respectively, P<0.001; strain index: 13.81+/-4.50 vs. 17.47+/-4.25%, respectively, P=0.005). Aortic stiffness index beta of the prehypertensive group, however, was significantly higher than that of the control group (3.73+/-1.41 vs. 2.97+/-0.82, P=0.02). CONCLUSION: Whatever the mechanism, young patients with prehypertension have impaired aortic elasticity compared with healthy controls. This finding has suggested that the development of overt hypertension may be prevented or delayed by using the agents that have the ability to reduce arterial stiffness by regressing and/or preventing functional and structural changes on the arterial wall.
Coarctation of the aorta has been found at necropsy in approximately 1 of every 1550 individuals. The most common location for segmental coarctation (juxtaductal) is the attachment of the ductus arteriosus to the thoracic aorta, which accounts for 98% of focal lesions. Less commonly, a relatively long segment of constriction extends beyond the left subclavian artery. When longer segments of the aorta are narrowed, the term "hypoplasia" is often used. Aortic hypoplasia, an exceedingly rare cardiovascular anomaly, has been described in all portions of the thoracic and abdominal aorta. In the current case report, we described a 21-year-old man presenting with severe hypertension in whom the diagnosis of hypoplasia of the descending thoracic and abdominal aorta was made using with magnetic resonance imaging.
OBJECTIVE: We aimed to investigate the long-term cardiac mortality and the relationship between cardiac mortality and electrocardiographic abnormalities in patients with diphtheritic myocarditis who survived after hospital discharge. MATERIALS AND METHODS: Between 1991 and 1996, 32 patients (all males, mean age 21.00 +/- 3.77 years) surviving diphtheritic myocarditis were included in the study and they were followed up for an average of 16.3 months (range 10.3-26.8 months) after hospital discharge. Clinical evaluation, ECG, and echocardiography were performed on admission, daily while in hospital and at the time of discharge. ECG changes were permanent during the follow-up period. The causes of death of the patients during follow-up period were inferred from the death records of the patients and talking to the people witnessing cardiac arrest. RESULTS: We observed that the patients with left bundle branch block (LBBB) and T wave inversion at hospital discharge had lower survival rates than that of the patients without these ECG changes in the long term. Although univariate Cox regression analysis identified LBBB (P = 0.001) and T wave inversion (P = 0.014) as the predictors of survival, only LBBB was an independent predictor of survival in multivariate Cox regression analysis. Adjusted hazard ratio was calculated as 13.67 for LBBB (P = 0.001; CI = 2.81-66.28). CONCLUSION: Diphtheritic myocarditis does not only demonstrate a malignant clinical course during acute phase of the disease, but also during the long-term follow-up period, especially in patients with LBBB and T wave inversion. Besides, T wave inversion and LBBB can help us to predict survival rate of the patients in long term. Moreover, LBBB is an independent predictor of long-term survival in diphtheritic myocarditis.