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Öğe Chilling-like attacks terminated by slow pathway ablation(2020) Yetkin, Gülay; Öztürk, Selçuk; Yetkin, ErtanSymptoms of patients or the way of presenting complaints by the patients may be indefinite, obscure or misleading for the diagnosis of supraventricular tachycardia. The content of the history shows variability depending on the presenting symptoms, patient concerns and priority. Herein, we report an unusual case of a young woman suffering from chilling-like attacks for one and half years and treated by slow pathway ablation.Öğe Clinical presentation of paroxysmal supraventricular tachycardia: evaluation of usual and unusual symptoms(2020) Yetkin, Ertan; Öztürk, Selçuk; Çuğlan, Bilal; Turhan, HasanObjective: Clinical presentation of paroxysmal supraventricular tachycardia may vary from asymptomatic occurrence or mild perception of palpitation to severe chest pain or syncope. This variation is the most challenging issue in the diagnostic evaluation of rhythm disturbances and paroxysmal supraventricular tachycardia as well. This study sought to evaluate the symptoms during the tachycardia attack or index event in patients who underwent electrophysiological study and ablation procedure. Methods: This retrospective study included 100 consecutive patients who underwent electrophysiological study and ablation procedures due to supraventricular tachycardia. Structural heart disease, moderate/severe valvular pathology, systemic pathologies, such as connective tissue disease and chronic obstructive lung disease, history of pacemaker implantation was defined as exclusion criteria. In addition, medically managed patients and patients with unsuccessful ablation were not included in the study. Results: Palpitation was the most frequently observed symptom in 84% of patients, followed by chest pain in 47%, dyspnea in 38%, syncope 26%, lightheadedness in 19%, and sweating in 18% of the patients. The most common symptoms after tachycardia event were fatigue and lightheadedness with frequencies of 56% and 55%, respectively. Forty-five percent of the patients reported more than one, unusually frequent urination within the following 1-3 hours after the index event. Conclusions: Paroxysmal supraventricular tachycardia might manifest itself as gastrointestinal, neurological, psychosomatic symptoms, and unusual complaints in association with or without main symptoms, including palpitation, chest pain, syncope, and dyspnea. Symptoms after tachycardia or index event should be questioned systematically.Öğe Does golden ratio reside in pulmonary circulation?(Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukWe have read the recent article in CHEST (May 2019) byChemla et al1with great enthusiasm and interest. Themost astonishing number series and ratio in theuniverse, namely the golden ratio, which arose from theFibonacci series, have been evaluated in pulmonaryhemodynamic and pressure components.Öğe Ecchymosis and coldness in peripheral varicose vein patients: observations from Vein-Turkey study(Sage Publications Inc, 2020) Öztürk, Selçuk; Akbaba, Kağan Türker; Kılıç, Süleyman Sırrı; Çiçek, Tufan; Peşkircioğlu, Levent; Tandoğan, İzzet; Gürlek, Ahmet; Aydemir, Özbay; İleri, Mehmet; Yetkin, ErtanThe purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis (r = 0.18, P < .001) and coldness (r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.Öğe Echocardiographic findings in patients with atrial septal aneurysm: a prospective case-control study(Hindawi Ltd, 2019) Atak, Ramazan; İleri, Mehmet; Öztürk, Selçuk; Korkmaz, Ahmet; Yetkin, ErtanBackground. Atrial septal aneurysm (ASA) is a congenital deformity of the interatrial septum with a prevalence of 1-2% in the adult population. Although ASA has been supposed to be an incidental finding in echocardiographic examination, its structural and clinical associations have gained an increasing interest. Aim. To investigate and compare the clinical features and echocardiographic parameters between ASA patients and age- and gender-matched control group patients. Methods. 410 patients with ASA were enrolled in the study, prospectively. After the exclusion of 33 patients, the remaining 377 patients comprised the study group. The control group consisted of 377 age- and gender-matched patients without ASA. Results. Aortic valve regurgitation and mitral valve regurgitation were more often observed in patients with ASA, and percentages of patients with ascending aortic aneurysm (AAA), patent foramen ovale (PFO), and atrial septal defect (ASD) were higher in ASA patients compared to control group patients. Aortic root diameter was larger in ASA patients compared to control group patients (29.2 +/- 3.9, 28.6 +/- 3.1, p = 0.05, respectively). Ascending aorta diameter was higher in ASA patients compared to patients without ASA (44 +/- 0.3, 41.5 +/- 0.2, p = 0.02). Logistic regression analysis revealed that mitral valve regurgitation (OR: 2.05, 95% CI:1.44-2.92, p < 0.001) and PFO (OR: 11.62, 95% CI:2.64-51.02, p = 0.001) were positively and independently associated with the presence of ASA. AAA tended to be statistically and independently associated with ASA (OR: 2.69, 95% CI:0.97-7.47, p = 0.05). Conclusions. We have demonstrated a higher incidence of mitral/aortic valvular regurgitations, AAA, PFO, and ASD in ASA patients compared to age- and gender-matched control group patients. In addition, we have shown that ASA is significantly and positively associated with mild mitral regurgitation and PFO.Öğe A novel strategy to reduce the readmission rates in congestive heart failure: intermittent empirical intravenous diuretics(Lippincott Williams & Wilkins, 2020) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukImprovements in the medical management of heart failure have changed the course of the disease. However, mortality rates, hospitalization rates, and treatment costs are not at desired levels. Diuretics have been widely used in the treatment of congestion in heart failure patients. The following case reports represent a special patient group treated and followed by cardiology clinic. Treatment approach of each case report has been tailored on an individual basis depending on the clinical course and hospitalization rates of patients. Authors have highlighted and discussed the common aspects and future perspectives of their cases in which post-discharge intermittent empirical intravenous diuretic administration dramatically improved the clinical status and readmission number due to decompensated congestive heart failure. This is a relatively new and promising approach, which has been thought to cease the recycle of diuretic resistance and silent increase of fluid congestion in patients with congestive heart failure and frequent hospitalization. Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.Öğe Sodium restriction, water intake, and diuretic regimen in patients with congestive heart failure(Mosby-Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, SelçukWe have read the article published by Riegel et al.1 with great interest and enthusiasm. Briefly, the behavioral adherence of patients with chronic congestive heart failure (HF) to dietary salt, fluid restriction and diuretic use has been prospectively evaluated. The overall adherence rates have been found to be 29% for low sodium diet, 45% for fluid restriction and 72% for diuretic regimen at the end of the 3 month follow up period. Although the restriction level of dietary sodium is not so meticulously judged by self-report, it has the lowest adherence rate among the behavioral adherence patterns as reported by the authorsÖğe Symptoms in dilating venous disease(Bentham Science Publishers, 2020) Yetkin, Ertan; Öztürk, Selçuk; Çuğlan, Bilal; Turhan, HasanLower extremity venous diseases or insufficiency include clinically deteriorating condi-tions with morphological and functional alterations of the venous system, including venous hyper-tension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruri-tis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.Öğe Synthetic cannabinoids and cardiac arrhythmia risk: review of the literature(Humana Press Inc, 2019) Öztürk, Hayriye Mihrimah; Yetkin, Ertan; Öztürk, SelçukSynthetic cannabinoids (SCBs) are widely used recreational substances especially among adults. Although they have been considered as safe during the marketing process, our knowledge about their adverse effects has evolved since years. SCBs are associated with various cardiac events including acute myocardial infarction and sudden cardiac death. There is also growing evidence that SCBs are associated with cardiac arrhythmia development both in acute and chronic exposure. SCBs have been shown to be associated with both supraventricular and ventricular arrhythmias. However, the exact mechanism of the SCB related arrhythmia remains unknown. Understanding the exact association and possible mechanisms may help us to identify high risk patients at an early stage and to develop treatment modalities to prevent or reverse the arrhythmic effects of SCBs.Öğe Venous failure and beyond(Wiley, 2019) Öztürk, Selçuk; Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanWe have read the report of Gupta et al1 with great interest. Briefly, they have reported successful treatment of pigmented purpuric lesions by venoactive drugs in a male patient. Indeed, it is really an encouraging and promising approach to treat such lesions by venoactive drugs.Öğe Venous leg symptoms in migraineurs: a potential clue on the pathophysiology of migraine(Edizioni Minerva Medica, 2022) Çuğlan, Bilal; Önalan, Ayşenur; Öztürk, Selçuk; Altuntaş, Emine; Demiral, Ahmet B.; Atmaca, Hasan; Altıntaş, Sait; Yetkin, ErtanBACKGROUND: Migraine is a neurovascular disorder which cerebral venous congestion might have role in pathogenesis. The objective was to assess the association between venous disease and migraine by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in migraineurs and non-migraineurs. METHODS: The study was designed as a non-randomized, prospective cohort study and consisted of patients diagnosed with migraine and age-, sex- matched healthy subjects without migraine. All participants were examined for the presence of chronic venous disease (CVD). VEINES-Sym questionnaire was applied to assess venous symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was used to assess the severity of disease in migraineurs. RESULTS: Participants were classified into two groups as migraine-positive group (N.=130) and migraine-negative group (N.=130). Migraine patients and control group were comparable in terms of clinical status and demographic parameters. Total VEINES-Sym score was lower in patients with migraine compared to control group (34.4±8.7, 37.6±8.12, P=0.003, respectively). Additionally, there was a significant negative correlation between VEINES-Sym score and total MIDAS disability score (r=-0.33, P<0.001) and MIDAS severity levels (little or no, mild, moderate, severe) (r=-0.266, P=0.003) of the migraineurs. Logistic regression analysis revealed that VEINES-Sym score is an independent and statistically significant associate of migraine (OR=0.95, 95% CI:0.92-0.98, P=0.001). CONCLUSIONS: We have documented an independent association between migraine and VEINES-Sym score indicating possible pathophysiological link between migraine and CVD. Further studies are warranted to figure out the pathophysiological associations between migraine and venous vascular pathology and peripheral varicose vein. © 2022 EDIZIONI MINERVA MEDICA.Öğe Venous leg symptoms in patients with varicocele: a multicenter assessment study (VEIN-TURKEY study)(Sage Publications Inc, 2019) Öztürk, Selçuk; Akbaba, Kaan Türker; Kılıç, Süleyman Sırrı; Çiçek, Tufan; Peşkircioğlu, Levent; Tandoğan, İzzet; Gürlek, Ahmet; Aydemir, Özbay; İleri, Mehmet; Yetkin, ErtanObjective The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. Material and methods The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. Results Patients were classified into two groups: varicocele (+) group (n=269) and varicocele (-) group (n=287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.415.21, 43.19 +/- 3.22, respectively, p<0.001). Grades of varicocele significantly but inversely correlated with VEINES-Sym score (r=0, -206, p=0.001). Logistic regression analysis revealed that presence of varicocele irrespective of grading significantly and independently associated with the presence of aching (odds ratio: 2.054, 95% confidence interval: 1.265-3.338, p=0.004) and throbbing (odds ratio: 2.586, 95% confidence interval: 1.353-4.943, p=0.004). Conclusion Varicocele patients have lower VEINES-Sym scores compared to patients without varicocele and this finding is inversely correlated with the degree of the varicocele. This association supports the hypothesis that there may be a systemic vessel wall abnormality in venous disease patients. Patients with symptoms related to vascular dilatation in any territory may deserve to be assessed systematically with the support of further clinical studies.
