Nazmi Gültekin

The efficacy of valsartan in essential hypertension and its effects on left ventricular hypertrophy.

Recent studies demonstrate that, treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers may decrease left ventricular hypertrophy (LVH) in hypertensive patients. We wanted to assess the efficacy of valsartan on echocardiographic variables of LVH in 30 mild to moderate hypertensive patients. Valsartan was found effective in controlling hypertension, also echocardiographic indices of LVH such as interventricular septum and posterior wall thickness were reduced and left ventricular mass decreased significantly. Thus valsartan favorably influences cardiac structure in hypertensive patients.

Acute and sustained antianginal effects of nitroglycerin patches: Objective evaluation with training-effect-eliminated exercise performance index

A randomized within-patient double-blind acute and sustained study was performed to compare transdermal nitroglycerin (NTG) patches (5 and 10 mg) and matching placebo in 10 patients with chronic stable angina pectoris confirmed on exercise thallium scintigraphy or coronary angiography, or both. Patients performed treadmill tests 2 and 24 hours after application of patches on the first and last days of each of the 3 treatment periods. Effects caused by sequence of treatments and training with serial testing were prominent so the changes in the well-known parameters did not favor either of the active doses over placebo. Quantification of training effects and its subtraction from performance index disclosed that 10 mg of transdermal NTG caused significant increase in performance in both the acute and sustained stages of therapy in comparison to pretreatment performance. This was not observed with 5 mg and placebo treatments. To our knowledge, this is the first trial to study the efficacy of transdermal NTG with a more objective parameter that permitted elimination of training effects of serial exercise testing.

A Coronary Septic Embolism in Double Prosthetic Valve Endocarditis Presenting as Acute Anteroseptal ST-Segment-Elevation Myocardial Infarction.

Acute myocardial infarction caused by septic embolism is usually fatal. A 40-year-old male patient who presented within 30 minutes of severe chest pain was admitted to the emergency department. An electrocardiogram showed a maximum 6 mm of acute ST elevations at V1-V4 derivations. His body temperature was as high as 38.5ºC. Blood cultures were taken three times before parenteral ampicillin/ sulbactam treatment was administered. Later, coagulase negative staphylococci (Methicillin Sensitive Staphylococcus epidermidis) were identified from his blood cultures. Coronary angiographic examination was performed. Lobulated contours of a septic embolus was shown in the mid region of left anterior descending artery as an outcome. Trans-esophageal echocardiography showed; mobile multiple vegetations on the prosthetic mitral and aorta valves. After six weeks of antibiotherapy, he was completely healed and discharged from hospital.Six months later, he was rehospitalized and died because of complications of recurrent infective endocarditis.

Warfarin-induced bilateral renal hematoma causing acute renal failure

Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.

Left ventricular posterior wall rupture contained by posterolateral pseudo-aneurysm with calcified thrombus

Presently described is case of left ventricular (LV) posterior wall rupture contained by posterolateral pseudoaneurysm with calcified thrombus. A 63-year-old male was admitted to coronary intensive care unit with acute pulmonary edema and required mechanical ventilation for 2 days. He had undergone coronary angiography with diagnosis of unstable angina 1 year prior, and drug-eluting stent had been implanted for 90% stenosis of proximal left anterior descending artery (LAD). Chest radiography revealed enlarged mediastinal and cardiac silhouette. Computed tomography scan of the chest displayed LV posterior wall rupture contained by posterolateral pseudoaneurysm with calcified thrombus (Figure A, B, arrows). Transthoracic echocardiogram showed dilated, hypokinetic LV with inferoposterior hypokinesia and confirmed pseudoaneurysm 7.1x4.7 cm in size at widest diameter and with neck length of 4 cm, extending from posterolateral to anterolateral wall (Figure C and supplementary video 1*). Coronary angiography revealed double vessel disease with significant stenosis diagonal LAD and total occlusion in the proximal left circumflex artery (Supplemental video 2 and 3*). Patient underwent open-heart surgery. Dor technique was used for endo-exclusion of pseudoaneurysm with endopatch. Rupture was repaired with pericardial patch and polypropylene running suture. Coronary artery bypass grafting was performed, and procedure was completed without complications (Figure D-G and supplementary video 4*). Unfortunately, the next day, the patient died due to malignant arrhythmia and severe bleeding. 104