Amaç: Bu çalışmada anlamlı karotid arter darlığı olmayan olgularda karotid arter akım hızları ve rezistans indeksleri (RI) ile koroner arter hastalığı (KAH) arasındaki olası ilişki araştırılmıştır. Yöntem: Çalışma KAH ön tanısı ile koroner anjiografi yapılan 74’ü erkek olan 114 olgu (yaş ortalaması 53Æ10, yaş aralığı 33-72) üzerinde yapıldı. Anjiografi öncesi sağ, sol ana karotid arterler (sağ-sol CCA) ve sağ, sol internal karotid arterler (sağ-sol ICA) akım hızları ve RI Doppler ultrasonografi (US) ile ölçüldü. Olgular KAH varlığı ve hastalıklı koroner arter sayısına göre gruplandırılarak Doppler parametreleri ve ejeksiyon fraksiyonu (EF) yönünden karşılaştırıldı. Bulgular: Otuz üç olguda koroner arterlerde daralma saptanmazken (normal grup), 81 olguda anlamlı koroner arter darlığı saptandı (22 olguda bir arterde, 27 olguda iki arterde ve 32 olguda üç koroner arterde). Akım hızları Kah olan grupta anlamlı olarak daha düşük, RI ise daha yüksek bulundu. Akım hızları normal grup;ta en yüksek 3 damar hastalığı (DH) olan grupta en düşüt.ü RI ise normal grupta en düşük iken 3 DH olan grupta en yüksekti. Korelasyon analizinde yaş, EF ve hastalıklı damar sayısı ile özellikle minimal akım hızları arasında ters, RI değerleri arasında doğru ve anlamlı korelasyon saptandı. Sonuç: Bu çalışma bu konu ile ilgili ilk çalışma olup elde edilen bulgular; KAH varlığı ve aterosklerozun yaygınlığının Doppler US ile ölçülen CCA, ICA akım hızları ve RI değerlerini değiştirdiğini düşündürmektedir.

Objective: Atherosclerosis causes functional vasomotor changes as well as atheromatous carotid plasques and luminal stenosis resulting in mechanical effect. The relation between functional vasomotor changes in carotid arteries and extent of coronary artery disease is unknown. In our study, the probable relationship between carotid arterial flow velocities and resistance indexes (RI) with the extent of coronary artery disease (CAD) in patients who do not have significant carotid luminal stenosis was evaluated. Methods: One hundred and fourteen patients (74 males, mean age 53±10 years, range 33-72 years) were studied. All patients underwent color Doppler sonography before coronary angiography. Peak systolic flow velocity, end-diastolic flow velocity and resistance index (RI) of right and left common carotid and internal carotid arteries were measured by color Doppler sonographic technique. Doppler parameters were correlated with the extent of CAD and left ventricular ajection fraction. Results: Patients were classified on the basis of presence of significant CAD and the number of affec ted coronary arteries. Thirty-three patients did not have (normal group) and 81 patients had significant coronary arterial stenosis (22 patients with one-vessel disease, 27 with two-vessel disease and 32 patients with three-vessel disease). Flow velocities were the highest in normal group but the lowest in CAD patients, especially when 3 coronary arteries were affected. Correlation analysis demonstrated negative relationship of age, ejection fraction and number of affected coronary arteries with end-diastolic flow velocity, but positive and significant correlation with RI value. Conclusion: Our study is the first on this object. The results suggest that presence and extent of CAD changes flow velocities and RI values of common and internal carotid arteries. However, further investigations are required before these parameters can be applied as diagnostic criteria.

Objectives: Many studies have proved high plasma cholesterol and triglyceride levels as determinant major risk factors for coronary artery disease. It is also well known that coronary artery disease incidence and related mortality and morbidity is low in comunities applying Mediterranean diet. Turkey, having a high incidence of coronary artery disease, is unique because of the diversity of eating habbits in different regions of the country. The inhabitants of Antalya, region of interest in our study, are generally kept Mediterranean diet. We thought to determine the clinical and demographic features of the coronary artery disease patients living in the district of Antalya, and to find out if t hey correlate with Turkey’s averages when compared. We also searched for the preventive effect of Mediterranean diet, if there was any. Methods: 516 patients, who were admitted to the department of cardiology, were investigated in terms of age, sex, smoking habbits, hypertension, hyperlipidemia, diabetes, family history, angina class, usage of aspirin and nitrates. Results: The results revealed that clinical and demographical features of the coronary artery disease in the district of Antalya were similar with Turkey’s averages and that the benefits brought by the preventive effects of Mediterranean diet, might have been compromised by smoking.

Objective: This study assessed the effects of calcium chanelle blocker Amlodipine on the cerebral circulation in patientsz with essential hypertension. Methods: Cerebral circulation in 37 patients with essential hypertension and 10 healthy subjects was assessed using rheoplethysmography. In patients with essential hypertension cerebral circulation values were also re-estimated after treatment with Amlopidine (5-10 mg daily). Results: The cerebral circulatory parameters in hypertensive patients before treatment with Amlodipine were different from those in healthy persons. Amlodipine along with the reduction in systemic blood pressure caused attenuation of cerebrovascular abnormalities: decrease in spastic signs and incrase in cerebral blood supply in patients with essential hypertension. Conclusion: Amlodipine causes reduction of cerebral vascular resistance and promotes improvement in arterial blood filling in patients with essential hypertension. These changes in cerebral circulation may be secondary to the increase of cardiac output-known effect of Amlodipine.

Objective: Contraction and relaxation of the heart cause decrease and increase in myocardial video intensity (MVI) recorded from echocardiographic images, respectively. The present study was planned to compare this physiological cyclic variations of MVI in patients with type I diabetes mellitus and healthy subjects. Methods: For this purpose, standard echocardiographic examination was performed to 18 young patients (age 23.2±6.4; range: 15-37 years) with insulin dependent type I diabetes mellitus (diabetes duration: 7.8±5.6; range: 1-17 years) and 14 age and sex matched controls. In all subjects, end-diastolic end end-systolic *D echocardiographic images of 3 consecutivite beats that had been recorded on videotapes were digitized. The quantitative analysis of the digitized imaging was performed with the help of a calibrated digitization system in order to calculate the septum and the posterior wall textural parameters. The cyclic variation index (CVI) of the mean gray level (MGL) was calculated according the formula: (MGL diast-MGL syst)/MGL diast x 100. Results: Among the groups, left ventricular diastolic dimension-index, fractional shortening, E/A ratio, and isovolumic relaxation time showed no statistically significant differences, while septum (8.3±1.1 vs. 7.3±0.9 mm; p=0.016) and posterior wall thickness (8±0.6 vs. 6.8±1.1mm; p=0.004) and E,deceleration time (167±23 vs. 140±19 msec.; p=0.003) were significantly higher in diabetics. The diabetic patients showed significantly lower CVI both for septum (18.2±11.5 % vs. 39.3±11.5 %; p=0.0001) and posterior wall (16.4±16% vs. 40.5±9.2%; p=0.0001), respectively. Conclusions: Altered videodensitometric parameters possibly represent a preclinical alteration, conceivably related to the myocardial collagen content increase, which does not necessarily indicate an actual disease but may be cansidered an early marker of the histopathologic findings of diabetic cardiomyopathy.

Objective: Sildenafil, an inhibitor of cGMP-speicific phosphodiesterase 5 (PDE5), is currently beign used as oral therapy for penil erectile dysfunction. The aim of this study was to investigate the relaxing effect of sildenafil on vascular tissue and compare it with the known vasodilatator agents, sodium nitroprusside and acetylcholine. Method: Rat thoracic aorta samples were out into rigns, mounted on steel hooks, and immersed in areated Krebs solution maintained at 37 oC. Isometric responses were recorded by strain gauge transducers connected to a polygraph. Graded relaxations were induced using increasing concentrations of acetylcholine sodium nitroprusside and sildenafil. Results: The agents all dose-dependently relaxed rat aorta stripts. The relaxing potential of sildenafil was found to be similar to sodium nitroprussideş, but higher than acetylholine. Conclusion: In the absence of regulatory mechanisms, sildenafil citrate has noticable vasodilatatory effect in vitro

It is known that application of anti-arrhythmic drugs for the acute treatment of arrhythmic can not only result in succesfull termination or prevention, but also can lead to unwanted pro- arrhythmic effects. On the basis of two arrhythmias, atrial fibrilation and Torsade de Pointes arrhythmias, we will highlight the relevance of differential atrial and ventricular electrical remodeling to explain the delicate and dynamic balance between anti- arrhythmic efficacy and pro- arrhythmogenic consequences of class III anti- arrhythmic drugs.

Mortality and major complications during primary coronary artery bypass operation has decreased substantially during the past 20 years. However, patients undergoing reoperative myocardial revascularization still face markedly elevated perioperative mortality and morbidity. On the other hand, the incidence of reoperative coronary bypass surgery continues to increase. Agressive perioperative care and optimal myocardial protection is mandatory in these patients. In this article we reviewed the patient profiles, indications for operation, operative techniques and their impact on the surgical results for patients undergoing reoperative coronary artery bypass surgery.

The efficacy of implantable cardioverter defibrillator (ICD) therapy and medical therapy in the treatment of patients with ventricular fibrillation and sustained ventricular tachycardia had been compared in large randomized studies. In this section, we aimed to summarize what we have learned from large studies on the effects of amiodarone and ICD therapy in prevention of cardiac arrest n patients with malignant ventricular arrhythmias. The analyzed studies are; The Multicenter Unsustained Tachycardia Trial (MUSTT), Antiarrhythmics vs. Implantable Defibrillator (AVID), Cardiac Arrest Stduy Hamburg (CASH) and the Canadian Implantable Defibrillator Stduy (CIDS).

It is known that pulmonary embolism is accompanied by quite complex pathophysiological changes in cardovascular system. From cardiovascular point of view, the diagnosis of pulmonary thromboembolism may be easily based on echocardiographic signs of right ventricular hypokinesia. Physiologic abnormalities caused by venous emboli are related to the cross-sectional area of occluded pulmonary arterial bed. Recent studies has demonstrated, that in patents with massive pulnonary thromboembolism and signs of pulmonary hypertension, increase of right ventricular afterload can lead to both right ventricular failure and reduction of left ventricular preload. Despite development of pulmonary hypertension in acute massive pulmonary thromboembolism, there are no signs of right ventricular hypertrophy. The main ECG changes include right ventricular overloadl Previous Normal ECG is of special importance. Documentation of serious increase of pulmonary arterial pressure by Doppler echocardiography will assist to link right ventricular pressure overload and dysfunctional with embolia. Transesophageal echocardiography had the similar diagnostic value as transhoracic one, but especially is helpful in bedside diagnosis in patients with signs of shock secondary to pulmonary thromboembolism.