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Öğe Accessory mitral valve tissue: anatomical and clinical perspectives(Elsevier Inc., 2021) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Yalta, K.Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events. © 2020Öğe An antiarrhythmic approach to hydroxychloroquine-induced QT prolongation(Bohn Stafleu Van Loghum Bv, 2020) Yetkin, Ertan; Yalta, K.; Waltenberger, J.Derivatives of quinolone, namely quinidine, quinine and hydroxychloroquine (HCQ, hydroxylated form of aminoquinone), have been used for decades in the treatment of different diseases, including malaria, rheumatological diseases, cardiac arrhythmias and, most recently, the new coronavirus disease 2019 (COVID-19). Although quinidine is no longer widely used for the termination and prevention of arrhythmias, quinine and HCQ are still in common use for rheumatological diseases and malaria. Their common side-effects, QT prolongation and a risk of proarrhythmia, have re-emerged as a result of the widespread use of HCQ in the treatment of COVID-19. In fact, they all show the main electrophysiological aspects of class Ia antiarrhythmic drugs. This antiarrhythmic effect is mainly characterised by the inhibition of fast Na channels and to a lesser extent by K-channel inhibition. However, this class I antiarrhythmic effect is accompanied by a proarrhythmic effect by prolonging the QT interval, thereby facilitating the occurrence of torsades de pointes or ventricular arrhythmias. Therefore, being a derivative of quinolone, like quinidine, and manifesting class Ia antiarrhythmic drug effects, HCQ has been given all the attention regarding theÖğe Atypical variants of takotsubo cardiomyopathy: mechanistic and clinical implications(Science Press, 2020) Yalta, K.; Yetkin, Ertan; Taylan, G.Over past decades, takotsubo cardiomyopathy (TTC) has drawn a substantial interest as a unique form of acute and reversible cardiomyopathy that usually emerges in response to adrenergic hyperactivation associated with a variety of emotional and physical triggers.[1,2] Even though, this phenomenon is generally characterized by an apical balloning pattern (classical variant), it might occasionally present with atypical morphological variants including mid-ventricular, inverted and focal forms of myocardial involvement.Öğe Cardiac biomarkers in the setting of asthma exacerbations: a review of clinical implications and practical considerations(Current Medicine Group, 2020) Yalta, Kenan; Yalta, Tülin; Gürdoğan, Muhammet; Palabıyık, Orkide; Yetkin, ErtanPurpose of Review The present paper aims to highlight clinical implications of elevated cardiac biomarkers and associated myocardial dysfunction in a variety of cardiac and non-cardiac scenarios in patients with an asthma exacerbation, and to propose a basic algorithm for cardiovascular evaluation and triage (and hence, for further management) of these patients primarily based on evaluation of cardiac biomarkers along with basic diagnostic modalities and specific cardiac symptoms in the hospital setting. Recent Findings Elevation of cardiac biomarkers in the setting of an asthma exacerbation mostly signifies a new-onset subclinical myocardial dysfunction/injury generally associated with certain asthma-related factors including acute hypoxemia and bronchodilator therapy, and usually has a limited prognostic value in these patients. On the other hand, elevation of these biomarkers in patients with an asthma exacerbation might also denote a variety of certain life-threatening cardiac or non-cardiac conditions associated with significant myocardial dysfunction (acute coronary syndromes (ACSs), sepsis, etc.) that might be masked by the rampant course of the asthma exacerbation, and hence, might possibly go undetected potentially aggravating the prognosis in a portion of these patients. In patients with an asthma exacerbation, it seems imperative to timely diagnose and manage emerging diverse clinical conditions particularly through the guidance of cardiac biomarkers and associated myocardial dysfunction patterns in an effort to improve overall prognosis in these patients.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 Comment On "Vein Size and Disease Severity in Chronic Venous Disease" by Radhakrishnan et al Afflicted Vein Diameter or Signs and Symptoms in Chronic Venous Disease: Which One Really Matters?(Thieme Medical Publ Inc, 2019) Özturk, Selçuk; Çuğlan, Bilal; Turhan, Hasan; Yetkin, Ertan[No Abstract Available]Öğe COVID-19 pandemic: a glimpse into newly diagnosed hypertensive patients(LIPPINCOTT WILLIAMS & WILKINS, 2021) Yetkin, Ertan; Taylan, Gokay; Yalta, KenanThe coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as an immediate and global problem just within a few months after its first description in Wuhan-China. Beyond its alarming mortality rate and easily transmissible nature through air droplets, it has also resulted in significant challenges in the cardiovascular area not only due to its higher mortality rates in cardiovascular disease and certain associated conditions, including diabetes mellitus and hypertension, but also due to the theoretically facilitated inoculation of lung tissue by the culprit agent, SARS-CoV-2 in these conditions [1,2]. This worrisome concern has been largely attributed to the potential upregulation of angiotensin enzyme 2 (ACE2) in hypertensive and diabetic patients, and more interestingly; in those receiving angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) [3].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 Enhanced external counterpulsation effects on venous leg symptoms(Kare Publishing, 2022) Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanBackground: Venous diseases encompass a large spectrum of abnormalities in the venous system with complaints, such as aching and swelling. Enhanced external counterpulsation, proven safe and effective in patients with coronary artery disease and chronic heart failure, is a technique that increases venous return and augments diastolic blood pressure. This study assessed the effects of enhanced external counterpulsation on symptoms of venous disease using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire. Methods: This study was designed prospectively for evaluating venous symptoms before and after enhanced external counterpulsation treatment. The study population consisted of 30 consecutive patients who were admitted to the cardiology clinic. The Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms questionnaire was applied to assess venous symptoms one day before and after enhanced external counterpulsation treatment. Results: The mean age of the patients was 64.62 ± 9.67 years. After 35 hours of enhanced external counterpulsation, 28 patients (93%) had at least 1 New York Heart Association functional class reduction compared with baseline and 43% of patients had 2 New York Heart Association functional classes improvement. The New York Heart Association class significantly decreased after enhanced external counterpulsation treatment (P< .001). There was a significant improvement in their swelling and night cramps symptoms compared with baseline (P< .001 and P = .05, respectively). Also, The left ventricular ejection fraction significantly increased after the enhanced external counterpulsation treatment (P = .02). Conclusions: The findings obtained in the present study suggested that patients treated with enhanced external counterpulsation showed a significant reduction in swelling and night cramps symptoms. Although the total VEIN score did not change after the enhanced external counterpulsation procedure, improvement in swelling and night cramps underlines the beneficial effects of enhanced external counterpulsation through the venous vascular territoryÖğe Golden ratio in congestive heart failure: a promising proportion for prognosis and decompensation(2020) Yetkin, Ertan; Özturk, Selçuk; Çuğlan, Bilal; Turhan, HasanThe article published by Kowalczys et al. [1] was read with great enthusiasm and interest. Briefly, the prognostic value of daytime heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure (BP), and their multiplication products and ratios was assessed in congestive heart failure (CHF) patients. Accordingly, it was found that daytime DBP and products including HR × DBP and HR × SBP may be valuable risk stratification factors for predicting death and decompensation in stable patients [1]. Beyond the prognostic implication of HR, BP and their products in patients with stable CHF, attention was paid to the value of SBP and DBP itself, in terms of the golden ratio. In the study population, Kowalczys et al. [1] found mean daytime SBP and DBP of patients with stable CHF as 114 mmHg and 70 mmHg, respectively. The ratio of SBP to DBP gives 1.62, which is very close to the golden ratio as described previously by the famous mathematicians Euclid and Fibonacci [2]. In addition, it is also noteworthy to calculate the ratio of SBP to DBP in patients with decompensated (107.0/60.7 mmHg) and non-decompensated (115.3/72.1 mmHg) status during the follow-up period. SBP/DBP in patients without decompensation is 1.59; whereas it is 1.76 in decompensated patients, which shows a distinct deviation from the golden ratio.Öğe Hypertension and diabetes mellitus in patients with COVID 19: a viewpoint on mortality(Lippincott Williams and Wilkins, 2020) Akal Taşcıoğlu, Didem; Yalta, Kenan; Yetkin, ErtanThe outbreak of coronavirus disease 2019 (COVID 19) by the novel corona virus SARS-CoV2 is the leading worldwide healthcare problem due to its contagious nature, high morbidity and mortality rates. The present pandemic has also brought an emerging situation regarding the cardiovascular complications and comorbid disease mainly pointing out hypertension (HT) and diabetes mellitus (DM). Early clinical bservations have shown that HT and DM are the main comorbid disease along with cardiovascular disease, chronic obstructive lung disease and malignancies.Öğe Ignored identity of age-dependent increase in pulmonary embolism atrial fibrillation(Elsevier, 2019) Yetkin, Ertan; Çuğlan, Bilal; Turhan, Hasan; Öztürk, Selcuk; Yetkin, ÖzkanWe read with great interest the article published recently in CHEST (October 2019) by Pauley et al1 in which their goal was to evaluate national trends in admission rates, discharge disposition, and length of stay in patients hospitalized with pulmonary embolism (PE) by assessing patient demographic and hospital characteristics. They found a continued increase in admissions for PE between 2000 and 2015. Elderly patients have been shown to be affected disproportionally and experience higher mortality rates compared with the other age groups. Increased age and comorbidity burden, including congestive heart failure, paralysis, and metastatic cancer, have been found to be independently associated with poor outcomes. The authors also noted that targeted clinical trials designed to improve survival and quality of life in all age brackets are needed.Öğe Letter by cuglan et al regarding article, "Characteristics of intracranial aneurysms according to levels of coronary artery calcium"(Lippincott Williams & Wilkins, 2019) Çuğlan, Bilal; Turhan, Hasan; Yetkin, ErtanWe have read with great enthusiasm the article recently published by Cho et al.1 In their retrospective, cross-sectional study they investigated the relationship between the presence of intracranial aneurysms (IAs) and the level of coronary artery calcium (CAC) in 4934 subjects. Briefly, they have found that the prevalence of IA increased with CAC score; 172 (4.8%) subjects with a zero CAC score had IAs, 49 (5.4%) with a low CAC score, 22 (6.4%) with an intermediate CAC score, and 15 (11.1%) with a high CAC score (P for trend, 0.004). Additionally multivariate logistic regression has shown that high CAC score is an independent risk factor for the presence of IA compared with zero CAC score (adjusted odds ratio, 2.16; 95% CI, 1.18–3.95). And they have underlined the role of atherosclerosis in development of IAs.Öğe Low pulmonary artery size might be associated with subclinical systemic ventricular dysfunction in the Fontan circulation(Bmj Publishing Group, 2019) Yalta, Kenan; Palabıyık, Orkide; Yetkin, ErtanPersistent symptoms and long- term complications in the setting of Fontan circulation (FC) (systemic ventricular failure, etc) still remain as significant clinical challenges in clinical practice.1 In their recently published interesting article,2 Ridderbos et al have suggested pulmonary artery (PA) size (as measured with Nakata index) as an independent predictor for functional clinical status (defined as peak oxygen consumption) in Fontan patients. The authors should be congratulated for the design and novel findings of the study. However, we would like to make a few comments regarding further implications of PA size in Fontan patients: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 Recurrent takotsubo cardiomyopathy: further insights into morphological patterns(Elsevier Science Inc, 2020) Yalta, Kenan; Yetkin, Ertan; Yalta, TülinTakotsubo cardiomyopathy (TTC) has been widely recognized as a specific form of transient myocardial dysfunction, and is well known to have a potential recurrence risk following the index event [1-11]. In a recent systematic review [3], certain factors in-cluding female gender, temporal proximity to the first TTC event, lower body mass index (BMI) and an existing mid-ventricular gra-dient (MVG) (potentially suggestive of a mechanical basis for TTC evolution) have been suggested as fundamental predictors of TTC recurrence. On the other hand, extreme adrenergic discharge in the setting of index TTC (regardless of its association with these sug-gested predictors) might potentially be regarded as central to the evolution of future TTC recurrences, and might present with in-direct clinical signs including left ventricular outflow tract (LVOT) gradient and coronary slow flow (CSF) in this setting [5-7]. In their recently published article [1], Ahmadjee A, et al have reported a female patient who had suffered a recurrent TTC episode with a completely different morphological pattern compared with the in-dex TTC (classical followed by a reverse TTC pattern). Accordingly; we would like to make a few comments on this interesting case and potential implications of morphological patterns in the setting of TTC recurrencesÖğe Relationship between cerebral lateralization, coronary artery disease, coronary artery anomalies and coronary arterial dominance(DergiPark, 2021) Coşgun, Mehmet; Yetkin, ErtanINTRODUCTION: Besides the well-known classic risk factors and newly described minor risk factors of Coronary Artery Disease (CAD); novel risk factors so-called “geometric risk factors” are recently being investigated. The association of cerebral lateralization (CL) with other diseases has been defined formerly. The aim of this study was to investigate the relationship between CL and CAD, coronary artery anomaly, coronary artery dominance. METHODS: 1069 consecutive patients who underwent coronary angiography in our Clinics between May 2009 and March 2010 were included in the study. The presence and the stage of coronary arterial stenosis, the anatomic variations and coronary artery anomalies, coronary artery dominance and the shape of RCA (S or C) were defined. Hand preferences of the patients in regard to CL were defined with “10 Items Edinburgh Questionnaire” and subjects were divided into three groups as follows: lefthanded, right-handed and mixed-handed. Age, height, weight and the presence of CAD risk factors of the patients were recorded. RESULTS: There was no statistical difference between the three groups in terms of CAD, coronary artery anomalies and coronary artery dominance. The median age was significantly lower in the left-handeds compared to the right-handeds. There was no difference between 38 lefthandeds and 38 right- handeds in terms of coronary artery anomalies and coronary artery dominance. DISCUSSION and CONCLUSION: Lower rates of coronary artery stenosis and number of involved arteries were lower in the left-handed patients, suggesting that right-handed people may be at a higher risk of CAD than the left-handed ones.
