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Biomedical subjects

Can Hasdemir

Publications and source records attributed to Can Hasdemir.

14 recordsLinked to original sources

Acute myocardial infarction following an arthropod bite: is hereditary thrombophilia a contributing factor?

Acute myocardial infarction (AMI) due to arthropod envenomation has rarely been reported in the literature. In the present report, we describe two cases who developed AMI following an arthropod bite. Coronary angiograms revealed normal coronary arteries in both patients. Both events were probably secondary to coronary artery thrombosis and/or coronary artery vasospasm. Both patients were subsequently found to be heterozygous for prothrombin mutation (G20210A). As a result, we recommend ruling out the possibility of hereditary thrombophilias in young patients with AMI developing after an arthropod bite.

Adolescent↗

Endothelial functions in Behçet's disease.

Behçet's disease (BD) is a systemic vasculitis, capable of involving all types of vessels. Endothelial dysfunction (ED) has been previously documented in BD. The aim of the study was to see whether ED was more prominent in Behçet's patients with vascular involvement (VI) than in those without. The study population consisted of 65 patients with BD, 27 of whom had VI, and 30 healthy controls. High-resolution ultrasound was used to measure endothelium-dependent vasodilatation (EDVD) of brachial artery. Overall, regardless of VI, EDVD was significantly impaired in patients with BD compared with controls (11.4 +/- 6.3 vs 20.4 +/- 9.1%,P = 0.001); however, EDVD was similar in BD patients with and without VI (9.7 +/- 6.3% vs 12.6 +/- 6.1%, P = 0.07). Patients with BD had significantly-higher plasma homocysteine levels than controls (13 +/- 6 micromol/L vs 9 +/- 3 micromol/L, P = 0.001). Plasma homocysteine levels were significantly higher in the subgroup with VI than in those without (15 +/- 7 micromol/L vs 12 +/- 4 micromol/L, P = 0.03); however, we found no positive/significant correlation between plasma homocysteine levels and EDVD. ED is a constant feature of BD, regardless of VI. Etiology of ED in BD is probably multifactorial, including high homocysteine levels. As both ED and elevated homocysteine levels may represent an early atherosclerotic process, a more structured approach to risk factor assessment is needed in BD.

Adult↗

Homozygous factor V Leiden mutation in two siblings presenting with acute myocardial infarction: a rare cause of myocardial infarction in the young.

Although factor V Leiden mutation, is the most common established genetic risk factor for venous thrombosis, its effect on the development of myocardial infarction remains unclear. We describe a family case of homozygous factor V Leiden mutation in two siblings presenting with acute myocardial infarction as a rare cause of myocardial infarction in the young.

Adult↗

Isotretinoin (13-cis-retinoic acid) associated atrial tachycardia.

We describe a 16-year-old boy who presented with palpitations for 1 week while being on isotretinoin treatment for nodulocystic facial acne for 3 months. Twenty four-hour Holter monitoring showed frequent premature atrial beats and episodes of nonsustained atrial tachycardia. He never had any episodes of palpitations previously. His complaints almost disappeared within a week after stopping the treatment. He remained asymptomatic since the discontinuation of the drug. The temporal relationship between isotretinoin treatment and patient's symptoms in the presence of documented arrhythmia suggests a drug-related cause. As a result, clinicians should be aware of the possible arrhythmogenic effect of isotretinoin.

Acne Vulgaris↗

Relation between pulmonary vein firing and extent of left atrial-pulmonary vein connection in patients with atrial fibrillation.

BACKGROUND: The purpose of this study was to measure the extent of left atrial-pulmonary vein (LA-PV) connections and determine the relation to PV firing in patients with atrial fibrillation (AF). METHODS AND RESULTS: Ten close-bipolar (1 mm-spacing) Lasso electrograms were recorded circumferentially around 210 PVs (excluding 2 right middle PVs and 4 left common trunks) in 62 patients with AF. PV firing was provoked by isoproterenol (4 microg/min) and cardioversion of pacing-induced AF. The width of each LA-PV connection was measured in tenths of PV circumference, based on number of continuous close-bipolar Lasso electrode sites required for ablation (10% for each close-bipolar electrode site). One, 2, or 3 to 4 discrete LA-PV connections (discrete connection defined by ablation along 10% to 30% of PV circumference) were present in 18 (9%), 31 (14%), and 32 (15%) of 210 PVs, respectively: 1 broad connection (ablation along continuous 40% to 80% circumference) in 46 (22%) PVs; 1 broad plus other broad or discrete connections in 54 (26%) PVs; and a circumferential connection (ablation along 90% to 100%) in 29 (14%) PVs. Circumferential LA-PV connections were more common in superior than in inferior PVs (20% versus 7%, P<0.01). There was no major difference in distribution of the other types of LA-PV connections between the four PVs. PV firing occurred in 27%, 47%, and 72% of PVs with discrete only, broad and circumferential connections, respectively (P<0.01). Dissociated PV potentials after isolation were more common in arrhythmogenic (firing) PVs (32% versus 8%, P<0.01). CONCLUSIONS: The extent of LA-PV connections corresponds with arrhythmognesis. The incidence of PV firing increases with progressively wider LA-PV connections (discrete versus broad versus circumferential).

Action Potentials↗

Endovascular stimulation of autonomic neural elements in the superior vena cava using a flexible loop catheter.

It has been previously shown that parasympathetic nerve stimulation (PNS) can be achieved via basket electrode catheters (BEC) positioned in the superior vena cava (SVC). Since questions have been raised regarding formation of thrombi between and/or on the splines of the BECs, we investigated the use of a flexible loop "Lasso" catheter (LC) to achieve autonomic nerve stimulation in the SVC without clot formation. In 5 dogs, anesthetized with Na-pentobarbital, standard ECG leads II and aVR, blood pressure and right atrial electrograms were continuously monitored. The LC is a 7-French catheter at the end of which is a circular ring, 25 mm in diameter, equipped with ten 1-mm electrodes. The circular loop is made of a flexible, shape retaining, covered metal, which can be straightened in order to be inserted transvenously. The catheter was inserted through a sheath in the external jugular vein and positioned in the SVC. Stimulation was performed sequentially across each of the five bipolar pairs of electrodes, and consisted of square wave stimuli, each 0.1 msec duration, frequency 20 Hz at voltages from 1-40 V. The average voltage required to produce a 50% decrease in heart rate was 15 +/- 7 V, compared to 22 +/- 12 V with the standard BEC and 10 +/- 5 V with a modified BEC. We did not observe any thrombus formation at the end of a four-hour period during which the catheter was stabilized in the SVC. PNS can be achieved safely and effectively by the LC in the SVC in dogs.

Animals↗

Analysis of troponin I levels after spontaneous implantable cardioverter defibrillator shocks.

INTRODUCTION: Serum cardiac troponin I (cTnI) is a sensitive and specific marker for myocardial injury. Myocardial ischemia and/or injury can be a trigger for ventricular arrhythmias. The aim of this study was to assess the frequency and significance of elevated serum cTnI levels after spontaneous implantable cardioverter defibrillator (ICD) shocks. METHODS AND RESULTS: Serial cTnI measurements and ECGs were performed in 35 patients with transvenous ICDs who were admitted after spontaneous ICD shocks. Elevated cTnI levels were found in 18 patients (51%). Acute coronary syndrome was diagnosed in 5 (22%) of 23 patients with known coronary artery disease. After excluding the patients with acute coronary syndrome, elevated cTnI levels were present in 13 (43%) of 30 patients: 18% of patients with < or =3 shocks and 58% of patients with >3 shocks. Patients with elevated cTnI levels received a higher number of shocks (16+/-18 vs 5+/-7; P < 0.05) and had higher total delivered energies (475+/-538 J vs 128+/-184 J; P < 0.05) compared with patients with normal cTnI. Patients with acute coronary syndrome had higher peak cTnI levels (18+/-16 ng/mL) compared with patients with elevated cTnI without acute coronary syndrome (3.8+/-4.3 ng/mL; P < 0.01). CONCLUSION: Serum cTnI rises occur in the majority of patients after multiple (>3) spontaneous ICD discharges but are due to acute coronary syndrome only 14% of the time (22% of the time in patients with known coronary artery disease).

Aged↗

Sinus node dysfunction in a heart transplant patient secondary to severe sinus node artery obstruction--a case report.

A case of sinus node dysfunction is reported secondary to severe sinus node artery obstruction 3 years after orthotopic heart transplantation. The patient first presented with frequent dizzy spells and presyncopal episodes for 3 months and then recurrent syncope in the presence of an acute myocardial infarction. Coronary angiography showed a diffusely narrowed sinus node artery without any apparent collateral vessels. The sinus node artery had had only minimal distal disease 3 months previously. A dual chamber permanent pacemaker was implanted with significant improvement in clinical symptoms.

Arterial Occlusive Diseases↗