Cardiovascular Surgery

What does cardiology mean? What does Cardiology do?

What is cardiology is one of the most common questions about health. The branch of science that studies cardiovascular diseases is called cardiology. Cardiology specialists are concerned with the diagnosis and treatment processes of people with cardiovascular diseases. After a cardiology examination, if a surgical operation is required in the treatment, patients are directed to the cardiovascular surgery department. The answer to the difference between cardiovascular surgery and cardiology, which is one of the frequently asked questions, can be summarized briefly in this way.

Why is heart surgery performed?

If the problem detected in the heart cannot be solved with medication, lifestyle changes or interventional cardiology methods, heart surgery is performed.

How is heart surgery performed?

Cardiac surgery can be done as open, closed, or as robotic surgery. It can be performed with general anesthesia, with the support of a heart-lung machine, by stopping the heart or it can be done on a working heart. However, when a heart surgery decision is made, the patient's evaluation is made based on the road map of the surgery. Accordingly, it is understood whether the patient needs open, closed or robotic heart surgery. The patient's lungs, kidneys, and brain, organs such as the brain, are subjected to a comprehensive control and it is decided with which technique to perform heart surgery.

Which diseases concern cardiology? Who can be a candidate for heart surgery?

Those with congenital heart anomalies, those with coronary vascular occlusion above a certain level, those with heart valve problems, and those with heart failure may be candidates for heart surgery.

What are the criteria required for heart surgery?

Cardiac surgery can be planned if there are critical strictures in the coronary arteries feeding the heart muscle.

What should be done before heart surgery?

Before the heart surgery, all body functions of the patient are evaluated during the preparation phase. The cardiology doctor assesses the patient's general condition, functions of the lung, kidney, liver and other vital organs with appropriate examinations.

What should be done after heart surgery?

Those who undergo heart surgery should make changes in lifestyle. The support of a specialist should be obtained for proper nutrition planning, especially the two-day daily movements after surgery should be somewhat controlled. After the operation, more than 5 kilos of weight should not be lifted for at least one month, medications given by the doctor should be taken on time, and care should be taken not to be overly tired. You should walk every day, except in very hot or very cold weather. After surgery, the doctor's recommended chest corset should be used, embolism socks should be worn as recommended by the doctor. Respiratory exercises given by the doctor should be performed correctly. If it is difficult to breathe or if there are some problems, the doctor should be contacted.

What are the advantages of cardiac surgery?

Cardiovascular diseases are among the first diseases that cause death in our country. The biggest advantage of cardiac surgery is that it reduces the risk of cardiovascular disease death. It gives a new and healthy life to people with heart surgery.

What are the disadvantages of cardiac surgery?

There may be risks in cardiac surgery depending on the age, gender and concomitant diseases of the patient before the operation. Diabetes, previous stroke, having a previous heart surgery may be risk factors. However, a competent cardiovascular surgeon can turn the disadvantages into an advantage.

Is heart surgery painful?

Of course, there may be some pain sensation after an operation in the heart. However, in order to relieve pain, the doctor definitely makes an appropriate pain relief planning.

Is heart surgery safe?

Heart surgeries include similar processes like other surgeries. Patients may have various questions and concerns regarding the surgery. This situation should be shared with the doctor. It is important to be psychologically ready for the operation. However, the most important point to know is that heart surgeries are performed in a very safe way in Turkey, thanks to successful surgeons, experienced operation teams and modern technology.

Is there an age limit for heart surgery?

Although there is no age limit for heart surgery, the general condition of the patient is evaluated and the technique to be performed is determined.

Are there any risks of heart surgery?

You can learn the most accurate information about the risks of heart surgery in consultation with the doctor.

Will there be pain after heart surgery?

In particular,coronary bypass surgeries are the operations that can be performed with an extremely low risk, which definitely prolongs the life span, as well as the relief of pain in coronary artery patients.

The team that performs the heart surgery will monitor your surgical problems after surgery and will be in constant contact with your cardiologist, coordinator, physiotherapist, education nurse and service nurse. The surgical team will monitor the condition of the surgical incisions in the chest, arm and leg, drains, pacing wires placed during the surgery, and the healing process of the chest bone. After surgery, the chest brace will accelerate the healing of the breastbone, and the small pillow provided will also have less pain when coughing. In addition, this feeling will be reduced to a minimum with painkillers after heart operations that may cause some pain.

Coronary angioplasty (vein opening with balloon):

What is Coronary angioplasty (vein opening with balloon)?

Coronary angioplasty is an attempt to open the diseased vein. Balloon is applied to the diseased vein.

How is Coronary angioplasty (vein opening with balloon) applied?

The thin and pressure-resistant balloon catheter is placed in the narrowed area in the coronary vein and inflated. Thus, the plaque that causes the narrowing of the vein is crushed and opened by cracking.

Who can be a candidate for Coronary angioplasty (vein opening with balloon)?

Coronary angioplasty is applied to patients who experience coronary artery disease caused by narrowing of the coronary arteries feeding the heart muscle and cessation of blood flow due to obstruction. It is applied immediately in patients who have had a heart attack.

What are the necessary criteria for Coronary angioplasty (vein opening with balloon)?

Coronary angioplasty would not be applied for some patients. For coronary angioplasty, the age of patients, the structure of the heart vessels, diabetes, kidney failure or whether there are heart valve disease are evaluated. The criteria for coronary angioplasty is determined by patients' conditions. Angioplasty should be applied to correct the symptoms of a blocked vein, such as chest pain and shortness of breath.

What should be done before Coronary angioplasty (vein opening with balloon):

Patients must be fasted for 8 hours before their coronary angioplasty. It is important that the patient arrives by shaving the groin area before the appointment. The patient needs to bring someone with him for hospitalization. Also, previous examinations, reports should be with the patient. The cardiology doctor will do what is necessary for the ECG, blood test and procedure.

What should be done after Coronary angioplasty (vein opening with balloon):

After the procedure, the cannula in the groin area is removed after approximately 4-5 hours. Then the patient is mobilized as standing up. If there is no problem within 1 day, the patient is sent home. After the intervention, the cardiologist periodically calls the patient for control. In these controls, the treatment is reviewed by checking the blood tests.

What are the advantages Coronary angioplasty (vein opening with balloon)?

A normal function vessel structure will remain after balloon angioplasty. Blood thinner duration will decrease, quality of life will increase. Applying angioplasty to the blocked vein during heart attack will reduce the damage caused to the heart. Coronary angioplasty is used to treat anterosclerosis disease. Atherosclerosis is the gradual accumulation of fatty plaques in the arteries. The cardiologist may recommend coronary angioplasty when anginal symptoms (chest pain, shortness of breath) do not improve with lifestyle change and medication, or when you have a heart attack.

What are the disadvantages Coronary angioplasty (vein opening with balloon)?

Stricture may develop again at veins. A clot may form in the vein during or after the procedure. Very rarely, a heart attack can occur after the procedure. Therefore, it is very important to get help from expert cardiology doctors.

Is Coronary angioplasty (vein opening with balloon) painful?

Most people do not feel pain during the coronary angioplasty procedure. Some patients say they feel mild pain. Since anesthetic medication is given to the area where the catheter will enter, only the needle prick is felt. Generally, coronary angioplasty is not a painful procedure.

Is Coronary angioplasty (vein opening with balloon) safe?

The life-threatening risk in coronary angioplasty is less than 0.5 percent. The need for emergency bypass surgery is less than 1 percent. The life-threatening risk is very low.

Is there an age limit for Coronary angioplasty (vein opening with balloon):

There is no age limit for coronary angioplasty, but whether the patient has different concomitant diseases and vascular condition of the patient are very important.

Are there risks for Coronary angioplasty (vein opening with balloon):

Every surgical intervention has a certain risk. The probability of a problem after coronary angioplasty is low. One of the most undesirable negative consequences is the sudden clot in the vein during the procedure or in hospital follow-up. This can cause a heart attack. This risk may continue for a month, so aspirin and other blood thinning medications are mandatory. Apart from this, negative events that may occur during the transaction; There are risks such as heart attack, sudden death, urgent need for bypass surgery, tearing of a heart vein and tearing in the aortic vein, but the rate of these risks is less than 1 percent.

Coronary Bypass

What is Coronary Bypass?

The basic principle in bypass surgeries to form a jump-bridge to the front for blocked or narrowed coronary vein (the vein which feeds the heart) with a saphena vein (from the leg), radial artery (from the arm) or mammaria interna vein (from the chest).

How is coronary bypass performed?

The most classic way of reaching the heart is the method in which the sternum (sternum) is opened in the middle. In some special methods, the length and location of these incisions vary. Some valve and ASD surgeries can be performed with a 5-6 cm incision (window).

While the arrival of blood from the mammary interna taken from the chest is from the vein leading to the arm, the upper ends of the other free vessels (radial artery and saphena vein) are sutured to the aortic vein. In this way, a blood flow that carries energy and oxygen to the heart muscle in the region where there is stenosis or obstruction is provided with a new vessel (bypass graft). The number of bypass vessels performed during the surgery varies from 1 to 6. Generally, 2-4 vessels are bypassed. The veins used by the surgeon during the operation are the vessels in the patient's own body that do not leave any deficiencies in place where they are taken. In these surgeries, priority is given to the mammary interna vein taken from the chest, then the radial artery taken from the arm and finally the saphena vein taken from the leg. However, the vessel to be used may vary depending on the location and severity of the stenosis in the vessel to be bypassed. Sometimes the saphena vein may be the best option for the vessel at that target. Sometimes, mammary interna may not be used for patient with advanced age, chronic lung disease or who are highly overweight. Arm vein is not used in advanced age, in diabetic patients who use insulin and chronic kidney patients unless it is compulsory. The final selection of the vessels to be used will be made by the surgeon during surgery. Two mammary interna is not preferred in patients with advanced age, COPD, diabetes and for female patients.

The first step in cardiac surgery is to stop the heart by connecting the blood flow between the heart and lung to a machine (heart-lung machine) during surgery. Some of the coronary bypass surgeries (in special cases such as COPD, Chronic kidney disease) can be performed on the working heart (beating heart, off-pump).

Who can be a candidate for Coronary Bypass?

People, whose heart problems are considered as could not be treated or sufficiently treated by medical treatments or via methods such as stent after the evaluation of their cardiac tests, can be candidate for coronary bypass. Coronary Bypass is one of the safest and best treatment methods.

What should be done before coronary bypass?

Preparations before coronary bypass surgery will be arranged by the cardiology doctor. Some medications may not be used before surgery. It is possible to learn about this through a cardiologist. Smokers should quit smoking to relieve blood flow and breathing. In addition, the functions of all organs and stroke risks are examined before the coronary bypass. Accordingly, cardiovascular surgeon takes precautions against possible risks. The anesthesiologist, who will be involved in coronary bypass surgery, carefully listens to the patient's medical history and gives information about the drugs that will make the patient sleep. It is also necessary to stop eating and drinking the night before without coronary bypass. The patient's weight is taken for fluid treatment after the operation. In addition, hairs in the chest, leg, arm and groin should be shaved to prevent infection that may occur during surgery. It is recommended to take a bath the night before the operation. A simple enema is necessary before going to bed in the evening before the surgery, so that you will be comfortable after the surgery. Patients are given medicine by the doctor to sleep comfortably the night before the operation.

What should be done after coronary bypass?

After the coronary bypass, the patient is taken to intensive care. Experienced intensive care doctors and nurses monitor the patient in the intensive care unit. There is a nurse at the head of each patient. The duration of stay in intensive care varies between 1-3 days. However, this may also vary depending on the patient's condition. Intensive care period may extend after 3 days. In case of long hospitalization, visitors are not admitted to the intensive care unit. Responsible nurse and doctor regularly inform the relatives of the patients. Drain, pacing wire, serum and urinary catheter are attached to the patient after the operation. During the transfer from intensive care to room, drains are removed and serums are reduced. The urine catheter is removed on the second day after going to the room. After surgery, water and juicy foods are consumed. The patient must force himself to eat and drink after leaving the room. However, at this point, it is not necessary to eat additional foods without consulting a doctor. If there is difficulty in defecation after surgery, the doctor should be informed immediately. The doctor will give the necessary exercises. The physiotherapist will take care of the patient to increase the exercises and movements. In this process, the patient should follow what the doctors say. Weight monitoring is performed after surgery. After going home, the recovery period varies from patient to patient. At this point, it is important to do the exercises recommended by the physiotherapist. To protect the chest bone, it is necessary to use the chest pad recommended by the doctor. The method of use will be explained by the doctor again.

What are the advantages of Coronary Bypass?

When narrowing of the coronary arteries rises above a certain level, it prevents blood flow, which prevents the heart from performing its task. In this context, coronary bypass eliminates chest pain and prevents a possible heart attack. Negative habits are abandoned with coronary bypass, and stepping into a healthier and higher quality life is among the advantages of the operation. One of the advantages of coronary bypass is the elimination of existing vessel stiffness. Coronary bypass nourishes the narrowed or obstructed vein, and nourishes the heart muscle.

What are the disadvantages of Coronary Bypass?

Coronary heart diseases are the most common causes of death. However, the disadvantages of coronary bypass have been eliminated with the development of technology, equipment and the experience of surgical teams. Coronary bypass surgeries can also be performed by stopping the heart or on a working heart. Both techniques have different advantages and disadvantages. All the advantages and disadvantages are described by the doctor. Since the same technique is not applied to every patient, the disadvantage and advantage varies from patient to patient.

Is Coronary Bypass Painful?

As with any surgery, coronary bypass can cause pain. However, the pain is minimized with painkillers given during and after surgery. In case of pain, it is necessary to give information to the nurse and doctor who take care of the patient.

Is Coronary Bypass safe?

All body functions are evaluated with the examinations performed before the surgery. Cardiologist, physiotherapist, cardiovascular surgeon, anesthesiologist, intensive care doctor, intensive care nurse take care of the patient. Coronary bypass surgery, with technology, equipment and experienced team is one of the safest operations.

Is there an age limit for coronary bypass?

There is no age limit for coronary bypass. The technique of surgery varies according to the age and condition of the patient.

Are there any coronary bypass risks?

The risk of coronary bypass varies according to the patient's gender, age, lifestyle habits, and accompanying diseases. The risk of death after coronary bypass is very low. However, since most of the elderly patients may have different diseases, there may be a postoperative risk. Some patients may experience psychological traumas after coronary bypass. In this process, the problem can be overcome by getting psychological support. There may be risks after coronary bypass in patients who smoke and do not stop smoking; getting the information from the doctor about this issue will be the most correct behavior.

Open Heart Surgery

What is Open Heart Surgery?

Operations in which the chest bone is opened and the devices that support the heart and lung during the operation are called open heart surgery.

How is open heart surgery performed?

Open heart surgery is performed by opening the sternum. In this way, the heart becomes visible. Circulation is connected to the lung-heart device. Sometimes it is applied by stopping the heart and sometimes by starting it. This varies depending on the patient's condition.

Who can be a candidate for open heart surgery?

This situation varies according to the patient's preoperative status, age, gender and other concomitant diseases.

What are the criteria required for open heart surgery?

It is necessary to provide weight control in the patient and to quit smoking. Not having any problems in vital organs is one of the most important criteria of open heart surgery. Surgery coordinator, cardiovascular surgeon will inform you about open heart surgery criteria.

What should be done before open heart surgery?

Before the operation, the operation areas are shaved by the hospital barber. Bathing should be done before surgery to reduce the risk of infection from the skin. Special antiseptic solutions should be used by the doctor during the bath. Fasting is required for 6 hours before surgery. A simple enema will be done in the evening before the surgery. The patient may be given medication to sleep comfortably at night before the operation. A sedative can be given before being taken to the operating room. All information about what to do before the surgery can be obtained from the cardiovascular surgeon.

What should be considered after Open Heart Surgery?

After the operation is completed, the patient is hosted in the intensive care unit. There are experienced intensive care doctors and nurses here. Intensive care hospitalization is between 1-3 days on average. This varies depending on the patient's condition. During the surgery, pacing wire will be placed on the heart. If there is no rhythm problem after the operation, these wires are taken by the surgeon. The physiotherapist will inform how to act in the care process after open heart surgery. Doctors will also inform the patient about the diet after open heart surgery. If there is no defecation, the floor nurse should be notified. If the wound condition is available it is okay to take a shower 4 days after the operation. Weight monitoring is performed after surgery, during hospitalization. Care should be taken to maintain the sternum for 8 weeks after leaving the house. The patient will receive information from his doctor about what to do when coughing or sneezing. If necessary, a chest brace is provided. For the first two months after the operation, no heavy lifting should be done. If necessary, psychological help can be obtained in the postoperative period if sleep problems occur.

What are the advantages of open heart surgery?

It is known that surgeries performed by seeing the heart are more advantageous. When the doctor says that an open heart surgery should be done, it should not be averted. It is the advantage of the patient to have such surgeries without wasting time. The mortality rate in open heart surgeries is below 1 percent. After the operation, patients maintain their lives healthy in terms of heart.

Is open heart surgery painful?

Since general anesthesia is used during open heart surgery, there is no pain. After that, pains are minimized thanks to painkillers. Cardiovascular surgery team will explain what should be done to avoid pain in the postoperative period.

Is open heart surgery safe?

When open heart surgeries are performed by specialist cardiovascular surgeons, the life risk is below 1 percent. It is quite safe.

Is there an age limit for open heart surgery?

Elderly patients may not have open heart surgery.

Are there any risks of open heart surgery?

As with any surgical procedure, open heart surgery may have some risks. Cardiovascular surgery will provide necessary information about the risks.

Heart Surgery With Small Incision

What is heart surgery with small incision?

The small incision, namely the minimally invasive surgery method, which allows the difficult process in the heart surgeries to pass much faster and painless,, is performed with smaller incisions instead of cutting the chest (sternum) by 20-25 cm.

How does the heart surgery with small incision performed?

Operations are performed with incisions made under the right or left nipple, under the collarbone or with a very small opening of the breast bone. In open heart surgeries, the chest bone is completely opened, however, thanks to the technological advances in cardiac surgery, bypass surgeries and valve surgeries can be performed with the small incision method.

Which patients can have heart surgery with a small incision?

Heart surgeries with small incisions can be performed for patients who need repair and replacement of heart valve surgeries, patients who need coronary bypass surgery, patients who need to close some heart holes, patients who need intra-cardiac tumors to be removed.

What are the criteria required for heart surgery with small incision?

First of all, the patient must be at a certain age and weight. In general, it can be applied in children 20-25 kilograms and above, after 8-10 years of age. Because some equipment used in minimally invasive cardiac surgery may not be suitable for infants and young children. Apart from this, for people who have previously had problems with lung-related pneumonia, tuberculosis, or underwent lung surgery, and as a result, a small incision cannot be applied to the lung membrane adhering to the chest wall. The lungs cannot be separated from that adhesion and the heart cannot be reached. These patients must be operated by cutting the sternum. It cannot be made under the right or left breast but small incisions can be made over the breastbone. If the position of the aortic vessel is far to the left in the tomography taken before the surgery in the interventions to be performed on the aortic valve, the small incision cannot be made under the collarbone. However, a method called mini-sternotomy (opening the breastbone) can be applied. In addition, small incision would not be preferred for patient with highly disfunctional heart, if an intervention would be performed to mitral valve, for patients who have serious leaks at aorta valve, and for patient who had small incision operation before.

What should be done before heart surgery with a small incision?

Things to be done during the preparation process for classical surgeries are also valid for small incision surgery. In other words, the patient stops eating and drinking 1 day in advance. Necessary blood tests are performed before surgery. Kidney, liver functions, respiratory tests, jugular stenosis are investigated. If there is a problem with these, necessary treatment is applied, then the patient is operated.

What should be done after heart surgery with a small incision?

The postoperative process in small incision is much easier than open surgery. For example, after open surgery, patients have limitations such as not lying on their side for 1 month and not carrying more than 5 kilograms of load. However, since there are no such restrictions in mini-thoracotomy, that is, in small incision surgeries, the patient returns to daily life much faster. Apart from this, there may be some special situations that need attention, which vary depending on the type of surgery to be performed. This information would be provided to the patient.

What are the advantages of heart surgery with small incision?

In these operations, which are performed with a very small incision compared to open heart surgeries, the chest wall integrity is preserved since the bone in the anterior chest wall is not cut.This causes the respiratory system problems, which are the most common postoperative problems, to be seen much less frequently. The amount of bleeding is very low during and after the operation and the patient is discharged mostly without the need for blood transfusion.With the acceleration of recovery, the duration of stay in intensive care decreases to 1 day and the time to stay in the service is to 3 or 4 days.In classical open surgeries, the boiling time of the bone takes about 2 months. During this period, the patient should not turn left or right while lying down, raise her arms above the head level and bear no load. In the operations performed with a small incision, the patient can lie as desired from the moment the drain is removed after the operation, and can easily perform any action before the operation such as driving, swimming and carrying loads from the moment she feels good. Surgeries where the breastbone is opened are also quite troublesome in terms of cosmetics. Especially young patients have problems in terms of cosmetics and psychology; this causes the healing process to prolong. The length of the incision, which is opened with the minimally invasive method, varies between 6-7 cm, and no surgical scar is seen unless the arms are raised. In addition, for patients, especially women, who have osteoporosis, it is much more beneficial to perform the operation with small incision under the breast. Because in osteoporosis patients, the sternum bone is very fragile and there may be discomfort after open surgery.

What are the disadvantages of heart surgery with small incision?

The disadvantage is the cost in the small incision compared to the open surgery. Even though its cost is higher than open heart surgery in regards to the devices that are used, with its recovery time and shorter period for returning to work life, it can be said it eliminates this disadvantage.

Is heart surgery with small incision painful?

Although there is no pain such as pain in cutting the sternum, there may be pain that can be eliminated with simple painkillers.

Is heart surgery with small incision safe?

Small incision is a method with a long education period for surgeons. In other words, in order for the surgeons to apply the small incision method, they should be trained and have a certain experience, surgical maturity and skill. Even if the surgeon is very experienced in classical surgeries, he needs to receive special training in order to apply minimally invasive method. In this sense, it is a safe method if done in competent hands and equipped centers.

Is there an age limit for heart surgery with small incision?

Although there is not a certain age limit, additional risk factors brought by the diseases that may occur in advanced age are checked. There is no upper age limit for small incision unless there are problems such as kidney problems, respiratory problems brought by advanced age. As a lower limit, the patient should reach a certain age and weight. In general, it can be applied in children 20-25 kilograms and above, after 8-10 years of age.

Are there any risks of heart surgery with small incision?

The standard risks of classical surgery are also valid for the small incision method.

Heart Operation with Robotic Surgery

What is heart operation with robotic surgery?

da Vinci Robotic Surgery, or robotic technology, is considered as the most advanced technology in the field of health. When using robotic technology in cardiac surgeries, much smaller incisions are made than those made with minimally invasive method. While the chest cavity is opened 6-7 cm with minimally invasive method, operations are performed with a 3-4 cm incision with the robot.

How is robotic surgery heart operation performed?

In the da Vinci Robot; there is a console, a 3D display of the console and joysticks just like in computer games. In addition, there are 3 or 4 arms in the area of the patient's body to be operated. These arms are managed by joysticks from the console and surgery is performed. The procedures can be performed with very small incisions, or in operations such as coronary artery bypass surgery even without any incision. In valve operations, a 2-3 cm incision is opened and surgery is performed from here. Robotic surgery is a team work. During the operation, a second surgeon should control the console alongside the surgeon, and the nurse should be trained in robotic surgery.

Who can be a candidate for heart operation with robotic surgery?

Everyone can be candidates for heart operations with robotic surgery. Many surgeries such as coronary artery bypass surgery, congenital heart surgeries, arrhythmia surgeries, heart valve surgeries, heart hole surgery with robotic surgery, and removal of intraocular tumors can be performed with robot technology.

What are the criteria required for heart operation with robotic surgery?

Robot technology cannot be applied to small children under certain age and weight, as in small incision surgeries. Generally, children over 20-25 kg and 8-10 years old are accepted as the lower limit. Because some equipment used in robot technology may not be very suitable for children. Tubes, called cannula, that are inserted into vessels to connect the heart to the lung machine cannot be used for infants or young children. Apart from this, for people who have previously had problems with lung-related pneumonia, tuberculosis, or underwent lung surgery, and as a result, the lung membrane is adhered to the chest wall, robotic surgery cannot be applied. The lungs cannot be separated from that adhesion and the heart cannot be reached. In addition, robotic surgery is not preferred in valve operations in patients with very impaired heart function. Robotic surgery is not preferred if there is serious leakage in the aortic valve if an attempt is made for the mitral valve. In patients who previously had valve surgery with robotic surgery, a small incision or robotic surgery is not preferred for the second time when surgery is required.

What should be done before heart operation with robotic surgery?

Things to be done during the preparation process for classical surgeries are also valid for robotic surgery. In other words, the patient stops eating and drinking 1 day in advance, because of anesthesia. Necessary blood tests are performed before surgery. Kidney, liver functions, respiratory tests, jugular stenosis are investigated. If there is a problem with these, necessary treatment is applied, then the patient is operated.

What should be done after heart operation with robotic surgery?

The postoperative process in robotic is much easier than open surgery. Many limitations that the patient should be aware of after open surgeries do not apply to robotic surgery. For example, after open surgery, patients have limitations such as not lying on their side for 1 month and not carrying more than 5 kilograms of load. However, robotic surgery does not have such restrictions, and you can return to daily life much earlier. Apart from this, there may be some special situations that need attention for da Vinci robotic surgery, which vary depending on the type of surgery to be performed, such as bypass or valve operation. This information would be provided to the patient before discharge.

What are the advantages of heart operation with robotic surgery?

In robotic surgeries, which are performed with incisions smaller than the small incision method, the chest wall integrity is maintained since the bone in the anterior chest wall is not cut.This causes the respiratory system problems, which are the most common postoperative problems, to be seen much less frequently. The amount of bleeding is very low during and after the operation and the patient is discharged mostly without the need for blood transfusion. With the acceleration of recovery, the duration of stay in intensive care decreases to 1 day and the time to stay in the service is to 3 or 4 days.In classical open surgeries, the boiling time of the bone takes about 2 months. During this period, the patient should not turn left or right while lying down, raise her arms above the head level and bear no load. In the operations performed with robotic surgery, the patient can lie as desired from the moment the drain is removed after the operation, and can easily perform any action before the operation such as driving, swimming and carrying loads from the moment she feels good. Classic surgeries where the breastbone is opened are also quite troublesome in terms of cosmetics. Especially young patients have problems in terms of cosmetics and psychology; this causes the healing process to prolong. While the chest cavity is opened 6-7 cm with minimally invasive method, operations are performed with a 3-4 cm incision with the robot, and no scar can be seen unless you lift your arms.

What are the disadvantages of heart operation with robotic surgery?

The factor that can be considered as a disadvantage of robotic surgery is cost. The use of special robots also increases the cost compared to the small cut method. However, it can be said that it eliminates this disadvantage with the short period of recovery and return to work life compared to the classical open surgery and even the small cut method. Much more movement than the surgeon could make via hands in minimal invasive surgery can be achieved with 360 degrees and very clear 3D images. In classical heart surgeries, surgeons use special lenses called loops in order to obtain good images, there is no need for them in robot surgery thanks to the clear 3D image. Therefore, procedures are carried out much more clearly. For example, Bypass surgeries are very sensitive operations performed using ropes as thin as hair. Thanks to the good image in robotic surgery, vascular sutures can be applied much cleaner and clearer. A much clearer image is provided than the human eye can see.

Is heart operation with robotic surgery painful?

Although there is no pain such as pain in cutting the sternum, there may be pain that can be eliminated with simple painkillers.

Is heart operation with robotic surgery safe?

Robotic is a method with a long education period for surgeons, just like small cut method. In other words, in order for the surgeons to apply the robotic surgery method, they should be trained and have a certain experience, surgical maturity and skill. Even if the surgeons are very experienced in classical surgeries, they need to receive special training in order to apply the robotic method. In this sense, it is a safe method if done in competent hands and equipped centers.

Is there an age limit for heart operation with robotic surgery?

Although there is not a certain age limit, additional risk factors brought by the diseases that may occur in advanced age are checked. There is no upper age limit for robotic surgery unless there are problems such as kidney problems, respiratory problems brought by advanced age. At the lower limit, it is not suitable for young children and infants until they reach a certain age and weight. Children above 20-25 kg and 8-10 years old are accepted as the limit.

Are there risks for heart operation with robotic surgery?

The standard risks of classical surgery are also valid for the robotic method. In order to consider these risks, and to take precautions during the procedure, all the necessary tests are performed before the operation. Kidney, liver functions, respiratory tests, jugular stenosis are investigated. If there is a problem with these, necessary treatment is applied, then the patient is operated.

MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

What is MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

Mitraclip is a minimally invasive treatment method applied to the leak of mitral valve. Classically leaks at mitral valves are treated with open heart surgery. In many patients, the breastbone needs to be cut. It is possible to do this treatment with the robot, but open heart surgery is also possible with the robot. In other words, a number of incisions are made in the chest with the robot. The Mitraclip method is applied entirely by the angio method. It is an operation made from the groin with no incision in the chest.

How is MITRACLIP (Non-Surgical Mitral Valve Failure Repair) performed?

The standard method of treatment is repair of the mitral valve. This is done by heart surgery. Mitraclip is a somewhat experimental method at this stage. Mitraclip is the name of the device. This is a device that looks like a small latch. Mitral valve consists of front and back leaves. With the angio method, we enter from the groin vena with catheter, pass through the large vena in abdomen and reach the heart. Meanwhile, the patient is applied local anesthesia from the groin. Then, the mitraclip device is delivered up to the level of the mitral valve through the catheter channel in the vein. The wings of the Mitraclip open when it reaches this point. The problematic mitral valve parts are taken under the wings of the mitraclip, the suture rings are released and the stitches are held together when the targeted valve structure is provided. At this point, it is tested if adequate closure of the lid is achieved. In this way, the valve is repaired.

Who can be a candidate for MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

Mitraclip is occasionally applied in high-risk patients with other concomitant diseases and advanced age, as it is lower risk in patients who cannot have open heart surgery. However, the standard treatment method is to see and repair the valve. Cardiovascular surgeons do this, and the mitraclip procedure is performed by interventional cardiology specialists.

What are the necessary criteria for MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

Although the criteria are not very clear in mitraclip, advanced mitral regurgitation is required. The cause of mitral regurgitation should not be rheumatic heart disease. These types of valves are calcareous and that such processes cannot be successful. Today, mitraclip is mostly used in mitral insufficiency accompanied by heart failure. It can also be used in patients with mitral valve prolapse. However, the most important treatment method is surgery. Applying mitraclip for everyone is not the right approach. Patients who are considered to be unable to handle the operation, who have severe heart failure, advanced age, severe problems in their kidneys and other organs, and who cannot manage to recover from a major surgery, are ideal patients for mitraclip.

What should be done before MITRACLIP (Non-Surgical Mitral Valve Failure Repair) performed?

Echocardiography should be performed from the esophagus prior to Mitraclip. The cardiologist organizes this whole process. Although there is no special attention to the patient, the cardiology specialist informs the patients appropriately.

What should be done after MITRACLIP (Non-Surgical Mitral Valve Failure Repair) performed?

After it, some blood thinning drugs should be used Special attention should be paid to this. Again, after the mitraclip, patients are informed by the cardiology doctors who apply the mitraclip.

What are the advantages MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

The biggest advantage is that it is a minimally invasive procedure and the chest of the patient is not cut. According to surgery, the length of hospital stay is shorter.

What are the disadvantages MITRACLIP (Non-Surgical Mitral Valve Failure Repair)

The success rate may not be as high as open surgery. It is a healthier approach for the cardiovascular surgeon to see and repair the mitral valve. In terms of cost, it is more disadvantageous than open heart surgery.

Is MITRACLIP (Non-Surgical Mitral Valve Failure Repair) painful?

It will cause a minimal pain since it is a procedure performed by giving local anesthesia to the groin.

Is MITRACLIP (Non-Surgical Mitral Valve Failure Repair) safe?

Research shows that it is a safe procedure. In addition, according to researches, it is known that it provides serious reductions in mitral regurgitation and decreased hospitalizations due to heart failure. According to surgery, the length of hospital stay is shorter.

Is there an age limit for MITRACLIP (Non-Surgical Mitral Valve Failure Repair)?

There is no age limit. It can be applied potentially at any age. In general, it should be applied in patients with high surgical risk. A young patient with mitral insufficiency is not recommended unless there is a high risk.

Are there risks for MITRACLIP (Non-Surgical Mitral Valve Failure Repair)?

There are patients to be avoided. After the procedure, it is necessary to use a blood thinner for a period. Stronger blood thinners are used during the procedure. it cannot be applied if the patient is unable to use blood thinners, if the patient has an active bleeding. If the problem is endocarditis in the valve, it cannot be applied again. If there is rheumatic mitral valve disease, it should not be applied since there would be calcification in the valve. Since the procedure is done angiographically, the procedure is applied by entering through the vein in the groin. Catheters enter the large vein inside the abdomen, and then enter the heart. If there is a clot anywhere on this road, the procedure should not be applied again.

Arrhythmia Treatment

What is Arrhythmia Treatment?

Arrhythmia is when the heart rhythm is unusual. Irregular heartbeat is referred to as heart rate slowdown or acceleration arrhythmia. Treatment of arrhythmia is called procedures for regulating the heart rhythm.

How is arrhythmia treated?

Treatment of arrhythmia varies depending on the patient's condition. Accordingly, sometimes drug treatments, sometimes electro-physiological ablation, and sometimes pacemaker treatments can be applied. Different ways can be tried according to the patient's characteristics and treatment response status. Treatments can also vary depending on the type of arrhythmia.

Who can be a candidate for the treatment of arrhythmia?

Those who have complaints such as palpitations, fainting, and fatigue due to the rhythm disorder, especially in people at risk for sudden cardiac arrest without any complaints, are treated. In patients with diseases such as hypertension - heart attack - heart valve disease - diabetes - heart failure - toxic goiter, rhythm disorder may develop. In addition, rhythm disturbances may be in people with abnormalities in genetic or congenital conduction pathways and treatment can be applied. The treatment and prioritization of which treatment to which patient is determined by the doctor of cardiology. The cardiology doctor will inform you whether or not you are a candidate for arrhythmia treatment.

What are the criteria required for the treatment of arrhythmia?

Complaints in the heart beats in a way that impairs the quality of life or pose a risk for their subsequent life lead to the need for treatment.

What should be done before arrhythmia treatment?

For the treatment of arrhythmia to be performed by an interventional method (electrophysiological study and ablation) in the angio processing room, the patient must be fasted for 8 hours. Shaving the pubic area and taking a bath are important issues before the procedures. The patient should bring the tests that make the decision. They should consult with their doctor about whether their medications should be interrupted.

What should be done after arrhythmia treatment?

No difficult movements should be done for at least two days after the procedure, and should not be lifted heavily. The treatment area should be checked for bleeding, swelling and bruising. If a process using contrast material is used, it should be taken into consideration to take more than 2 liters of fluid daily.

What are the advantages of arrhythmia treatment?

After the treatment of arrhythmia, the patient's quality of life will increase. With arrhythmia treatments, complaints such as palpitations, irregular heartbeat, heart-like stopping, shortness of breath, and dizziness will disappear.

What are the disadvantages of arrhythmia treatment?

Arrhythmia treatments do not have a disadvantage unless there are complications during the procedure. The most common unexpected event is the failure of the process or the recurrence of the disease. Quality of life is improved in patients with appropriate treatment.

Is arrhythmia treatment painful?

If the arrhythmia treatments are performed in the angio room, anesthetic needle to be inserted into the groin may be felt during the procedure. Other than that, interventional procedures are not painful.

Is arrhythmia treatment safe?

Arrhythmia treatments are safe because they are performed by a specialist cardiologist.

Is there an age limit for the treatment of arrhythmia?

There is no age limit in the treatment of arrhythmia.

Are there any risks of arrhythmia treatment?

The most important risk that can be seen during ablation therapy is the damage to normal conduction paths. If this condition is permanent, a pacemaker is usually required. This possibility is in particular the type of arrhythmia known as AVNRT or SVT in the community, and the probability of developing complications during the procedure is less than 1 percent in experienced hands. Another rare and serious negative consequence is damage and perforation of the wall of the heart chamber during ablation. This condition is very rare but may require urgent heart surgery. Ancak bu durum da çok nadir görülmektedir.

Freezing process in the treatment of atrial fibrillation

Atrial fibrillation is the most frequently observed rhythm disorder that increases with the advancement of age. In the treatment of this rhythm disorder, which reduces the quality of life of patients and may cause stroke or even death in some patients, success can be achieved in a short time with the freezing method. Patients who do the freezing process without feeling any pain can return to their normal life after a day.

What is the freezing process in the treatment of atrial fibrillation?

Atrial fibrillation is the most common rhythm disorder and its incidence increases with age. Freezing treatment in atrial fibrillation is the method of freezing the area of ​​the veins in the mouth of the veins that bring blood from the lung to the heart and trigger palpitations, thereby preventing palpitations due to atrial fibrillation.

Freezing in the treatment of atrial fibrillation is applied to which patients?

This procedure is applied to patients with rhythm disorders called atrial fibrillation.

How is freezing done in the treatment of atrial fibrillation?

It was found that some firing foci that trigger atrial fibrillation are located in the mouths of veins that return from the lung to the heart. Therefore, it has been shown that the development of atrial fibrillation can be prevented if electricity from the mouth of these main veins opening to the left atrium is prevented from passing the electricity to the left atrium. This process can be achieved by freezing the mouths of the veins coming from the lungs with balloons or burning them with radio frequency energy.

The freezing process starts with the delivery of a special balloon through a tube that is accessed through the groin with local anesthesia with light sedation (giving relaxing medication) to the left atrium. After sitting in the vein mouth with a balloon, liquid nitrogen that provides freezing is given and the balloon is inflated and freezing at minus 40-50 degrees starts. Thus, the triggers in the veins coming from the lung with a circular line are prevented from sending electricity to the left atrium to initiate atrial fibrillation. By fixation and freezing of the mouths of two right and two left lung veins, which carry clean blood to heart from left and right lungs, isolation is achieved.

How long does the arterial fibrillation freezing treatment take?

This process takes about an hour.

When can the patient return to his daily life?

After atrial fibrillation treatment, the patient is discharged from the hospital the next day. If he wants, he can immediately return to his work and daily life.

Is the freezing process painful?

Patients do not feel any pain during and after the procedure.

Should drugs be used after the procedure?

Blood thinning medication should be used shortly after the procedure.

Who will benefit from this process?

Some types of atrial fibrillation (especially those that come and go) benefit particularly from this procedure. It was determined that the freezing process was equivalent to the radiofrequency energy burning (ablation) process.

What is atrial fibrillation?

In the four-chambered heart, the two upper chambers are called “auricle” and the lower two are called “ventricle”. "Atrial fibrillation" means when the upper chambers of the heart are vibrating instead of contraction, while "atrial" means "originating from the atria" and combined with the term "fibrillation" known as vibration. Normally, the warnings coming out of the auricle are balanced and regular. Heart muscle fibers in the left atrium sometimes surround the mouths of the veins. Rhythm disturbances can be triggered when unexpected extra warnings emanate from this area spread to the atria. In the case of atrial fibrillation, the auricles are irregularly stimulated very quickly outside of the normal. When the rhythm is broken, the heart beats irregularly and usually faster than normal. Atrial fibrillation is the most common rhythm disorder.

What are the causes of atrial fibrillation?

Atrial fibrillation may occur without any reason. However, it is often known that it may be associated with thyroid diseases (overwork of the thyroid gland), hypertension, diabetes, heart failure, lung diseases and obesity.

How is atrial fibrillation diagnosed?

Pulse irregularity is most common in this disease. One can even understand this himself. However, atrial fibrillation is definitive with ECG test.

Does arterial fibrillation increase the risk of stroke?

Atrial fibrillation is not a direct life-threatening rhythm disorder; however, the presence of atrial fibrillation increases the risk of stroke. Strokes due to atrial fibrillation are severe, with a high probability of crippling and killing.

What are the advantages of freezing in the treatment of atrial fibrillation?

• Processing time is short
• The patient receives less radiation
• Complication risk is less
• Success rate is high.
• Patients stay in the hospital only one night
• Patients can return to their normal life the next day.

Is there a possibility of recurrence of atrial fibrillation after freezing?

As with the burning of radiofrequency, there is the possibility of recurrence in the treatment with freezing. Although it varies from patient to patient, this possibility is 20-30 percent.

Hypertension

What is hypertension?

Hypertension, which is common in the world and is one of the chronic diseases, is high blood pressure.

Why does hypertension occur?

It is caused by the disruption of the balance of the cardiovascular system of the circulatory system, which ensures that the blood pressure is within certain limits. The exact cause, however, has not yet been discovered.

What are the symptoms of hypertension?

In fact, hypertension does not cause symptoms in most patients. Sometimes shortness of breath, nosebleeds, headache, pain in the nape, hypertension can be seen. If blood pressure is higher than 140 mmm Hg and / or small blood pressure is above 90 mm Hg in regular blood pressure measurements on different days, hypertension may be diagnosed.

What are hypertension medications?

Hypertension drugs are determined as a result of various tests performed by cardiology doctors. Drug treatment in hypertension can vary according to the additional diseases in the person, the characteristics of the person, the side effects of the drugs, the blood pressure response given to the drug. Some patients may require a single drug and others may require a lot of medication. The cardiology specialist decides on drug therapy based on the patient's condition. Rarely, some interventional treatments can be applied.

How is the hypertension diet?

People with hypertension should make some changes in lifestyle. It is important to make salt restrictions under the hypertension diet. Weight-bearing, fatty, carbohydrate-rich foods should not be consumed. Drinks containing caffeine should be consumed in moderation. Smoking should be stopped. By losing weight, exercise and the diet given by cardiology doctors and dietitians, blood pressure can be reduced.

What are the types of hypertension?

There are two types of hypertension. These are called primary hypertension and secondary hypertension. Primary hypertension is the most common type of unknown cause. In secondary hypertension, it is seen because there are other underlying problems in people. For example, sleep apnea, kidney, thyroid problems, congenital problems in blood vessels, contraceptives, and high alcohol consumption can cause secondary hypertension.

How should hypertension nursing care be done?

Hypertension is properly explained to the patient in nursing care. As the cardiology doctor says, information about hypertension diet and exercises is given. It is explained how important it is to comply with the diet in hypertension. You are informed about smoking cessation and medicines.

Good Cholesterol (HDL) - Bad Cholesterol (LDL)

Good Cholesterol (HDL) - What is Bad Cholesterol (LDL)?

Cholesterol is an fat-like substance found in all cells in the body. Good cholesterol (HDL) collects and excretes cholesterol in the tissues. Bad cholesterol (LDL) carries cholesterol to the tissues and causes accumulation in the walls of the arteries. Normalizing bad cholesterol is not enough. Good cholesterol needs to be increased. It is necessary to know the level of not only bad cholesterol, but also good cholesterol.

Why does Good Cholesterol (HDL) - Bad Cholesterol (LDL) occur?

The biggest reason is genetics. The biggest source of cholesterol is the liver. The processes that produce it in the liver are genetically determined. The second big source comes with diet. However, someone who eats well may also have high cholesterol, or someone who eats poorly may not have high cholesterol. If both malnutrition and genetics tend to have bad cholesterol, the risk of heart attack increases dramatically.

What are the symptoms of Good Cholesterol (HDL) - Bad Cholesterol (LDL)?

Bad cholesterol is a silent condition. It is not understood by a mere examination. In some extremely high bad cholesterol situations, we can sometimes see the accumulation of fat in the eyelids, accumulation of fat and cholesterol in the hands and tendons. However, this is a rare condition. Most patients may have high cholesterol, but no external examination can be obtained. Just as high blood pressure is called a "silent killer", high bad cholesterol can also be a "silent killer".

What to eat for Good Cholesterol (HDL) - Bad Cholesterol (LDL)?

Fats that appear on the meat should be separated before cooking. Offal consumption should be reduced. Processed meat such as sausages, salami and sausage should not be consumed. While white meat is preferred; cooking method should be grilled, boiled, steamed. Fish is the most useful. In addition, consumption of cereals, fresh vegetables and fruits should be increased. Less fat products should be preferred to whole milk and dairy products. Cake, cream, margarine, bakery products, frying foods, fast food foods should be avoided. Nuts such as nuts, peanuts, and walnuts are known to provide modest reductions in bad cholesterol. Small decreases can occur with consumption of 100 grams of nuts or peanuts.

How much should Good Cholesterol (HDL) - Bad Cholesterol (LDL) be?

These values ​​are somewhat variable. In the past, the threshold for LDL cholesterol was 130 mg / dl. But now it is possible to say that bad cholesterol above 100 mg / dl is not ideal. However, the results of such tests are called “continuous-variable”. In other words, 170 mg / dl bad cholesterol is evaluated as better than 200 mg / dl and better than 130 mg / dl at 100 mg / dl. The lower the value of bad cholesterol in the context of the risk of stroke, the better. The same is true for good cholesterol. Good cholesterol also has a lower limit. It should be over 55 mg / dl in women and over 45 mg / dl in men. Women are slightly more advantageous in good cholesterol. In a man, 30 mg / dl is worse than 50 mg / dl, 50 mg / dl is worse than 70 mg / dl. In general, the upper limit of bad cholesterol is 100 mg / dl; In good cholesterol, the lower limit is 45 mg / dl for men and 55 mg / dl for women. If the patient has stiff blood vessels, or had a heart attack, bad cholesterol should be below 70 mg / dl. Having good cholesterol below lower limits may cause serious problems.

What is Good Cholesterol (HDL) - Bad Cholesterol (LDL) treatment?

Drug, diet and exercise are used in treatment of bad cholesterol. But the most effective method is made with statin type drugs. The effect of exercise on cholesterol is extremely limited. The effect of diet is greater than exercise. Good results can be obtained if people avoid too much fast food, processed meats, and red meat, if they stay away from such foods during bad cholesterol treatment. If a good diet is followed, a great success can be achieved in treatment. If the patient's diet is good, if there is genetically high cholesterol, the treatment effect of the diet is limited. Medicines provide a 50 percent drop in bad cholesterol. PCSK-9 inhibitors, used in the form of injections, have been introduced in recent years. These drugs, which are administered by injection every two weeks, can provide 60 percent decrease in bad cholesterol. But first, statin type drugs are given orally, if the target is not reached, PCSK-9 inhibitors are activated as an injection. Even if bad cholesterol is too high, it is possible to lower it with medication. Statins lower bad cholesterol, while raising good cholesterol.

What does Good Cholesterol (HDL) - Bad Cholesterol (LDL) cause?

Although it causes heart attack, stroke, obstruction in other vessels, peripheral arterial disease, plaques in the aorta, problems in the arteries of the body; it can even cause a process that could lead to losing a leg. It can even cause the loss of the patient.

What is good for Good Cholesterol (HDL) - Bad Cholesterol (LDL)?

Poor cholesterol diet and lifestyle changes are good. Patients should not stop taking cholesterol medications without their doctor's approval. Cutting cholesterol medications without asking a doctor can cause serious problems such as heart attack and stroke.

Vasculitis

Zühre Sarı Sürmeli, MD

Memorial Şişli Hospital, Department of Rheumatology

What is vasculitis?

Vasculitis, which means inflammation of the blood vessel (arterial, vein and capillary) walls, causes changes in the vessels such as thickening, narrowing and weakening. As a result, tissue and organ damage occurs as blood flow to the tissues and organs fed by the vein will be limited. Since vessels of any type and size can be affected at any location, vasculitis is not a single disease, but a group of diseases caused by a wide variety of diseases. One organ, multiple organs and systems may also be affected. It can be acute (short-term) or chronic (long-term). Behçet's disease, giant cell arteritis (temporal arteritis), Takayasu disease, polyarteritis nodosa, granulomatous polyangiitis, eosinophilic granulomatous polyangiitis, henoch schönlein purpura, cutaneous small vascular vasculitis are examples of some vasculitis. It can affect people of all ages, races, but certain types of vasculitis are more likely to occur in certain age groups.

Why does vasculitis occur?

The exact cause of vasculitis is not yet known. The immune system (immune system) works incorrectly, perceiving vessels as a foreign invader and waging war on them. The person's genetic predisposition can occur in the presence of certain environmental factors such as infections. Smoking, being a carrier of chronic hepatitis B and hepatitis C, having other rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus may cause vasculitis. Some foreign substances, drugs and cancers can also cause vasculitis.

What are the symptoms of vasculitis?

Fever, headache, fatigue, weakness, weight loss, shortness of breath, bloody sputum, chronic sinusitis, bloody crusted nasal discharge, recurrent mouth ulcers, sores in the sexual area, chronic ear infections, hearing loss, joint pain and swelling, muscle aches, night sweating, skin rashes, wounds on the skin, numbness and muscle weakness, eye redness, loss of vision may occur together.

How is vasculitis diagnosed?

Findings, clinical examination, laboratory tests, biopsy and imaging techniques (radiographs, ECO, doppler, CT angio, MR angio) are evaluated together in diagnosis. Since vasculitis are rare diseases, the differential diagnosis should be made well with other diseases causing similar symptoms. Vasculitis should be considered especially in the case of an undiagnosed disease affecting systems. It is very important to exclude infections especially since immunosuppressive drugs will be given.

How is the treatment of vasculitis?

The treatment of vasculitis varies according to the vein, the damaged organ-system and the severity of the disease. While some types of vasculitis regress spontaneously and it is not necessary to give treatment other than simple pain relievers, some patients should start treatment with drugs containing cytotoxic and cortisone before the life-threatening organ damage develops and vascular inflammation should be controlled. Long-term follow-up treatments are usually given, as some of the vasculitis tend to recur. Some vasculitis may be accompanied by chronic hepatitis B and chronic hepatitis C infections. In such cases, these infections should be treated first. Sometimes, rheumatic diseases such as cancer diseases, rheumatoid arthritis and connective tissue diseases may occur under vasculitis. Again, these underlying diseases should be treated first.

What causes vasculitis?

Some vasculitis can lead to organ damage (kidney failure, lung damage), blood clots, stroke, vascular dilation called aneurysm, permanent vision loss, and serious infections if left untreated.

What to eat and not to eat for vasculitis?

Vasculitis does not have a special diet. Healthy, Mediterranean type nutrition, abundant and balanced nutrition from fibrous foods, low-fat dairy products, lean meat products, fruits and vegetables are important. Fatty and sugary foods should be avoided. Plenty of water should be drunk. Alcohol should not be consumed because it can affect the liver along with inflammatory suppressants. Since these patients usually use cortisone, they should eat salt-free, and it is beneficial for the drugs with cortisone to get calcium and vitamin D supplements due to the bone-loss side effects.

What is good for vasculitis?

Regular exercise (walking, swimming, aerobics, Pilates, cycling, dancing) is beneficial in patients with vasculitis, as they give happiness, protects from bone resorption, keeps the patient fit and vigorous. Everybody should do their favorite exercises that are good for them and not force themselves to exercise. Since vasculitis can cause fatigue and malaise, patients with vasculitis should also have enough rest and pay attention to their sleep. Quitting smoking is very important as smoking will cause narrowing of the vessel walls and lung disease. Social support, spending as much time with family and friends as possible is effective in reducing stress. Creating patient groups with other patients with vasculitis can also be helpful in terms of helping patients feel lonely.

Atherosclerosis

What is atherosclerosis?

It is a systemic disease known as vascular stiffness among the people. It can hold all the vessels in the body. However, the vessel it holds the most is the heart vessels, that is, the coronary artery vessels. Then, it continues as neck veins, brain and knee veins, respectively. Renal vascular involvement can cause serious omplications. Atherosclerosis is a vascular disorder consisting of atheroma plaques. Atheroma plaques are a form of disease formed by fatty bodies, that is, determined by blood lipid levels called cholesterol. There are many factors that cause this to occur.

Why does atherosclerosis occur?

There are many causes that cause atherosclerosis. The most important of these is genetic predisposition. The second most important reason is smoking. Then comes the presence of diabetes, diabetes. Many factors also affect, such as obesity, high blood lipid levels, sedentary life, i.e. immobile life.

What are the symptoms of atherosclerosis?

Generally, it progresses silently for many years. It begins to give evidence after a period of approximately 15-20 years from the occurrence of the disease, the beginning of which took years. It has many complaints that vary depending on where he is involved. The most common form of atherosclerosis caused by the heart vessels. As a first finding, it usually manifests itself as chest pain. This chest pain is called angina. There are two forms that are stable and unstable. Generally, patients experience pain in the middle of the chest in the form of burning, compression and pressure during a light effort. The pain is said to pass when the effort is ended. This is the first sign of a vascular occlusion. Some patients say that they have pain in their breasts even when they are at rest. This is the finding that a very serious vascular occlusion occurs.

What to eat for atherosclerosis?

The most important factors to avoid atherosclerosis are healthy eating and to avoid smoking. Smoking should stop. Another important issue, especially known as Mediterranean diet, is far from red meat and animal fats; A diet based on vegetables, fruits and olive oil, and especially where fish are preferred as a source of protein, is very important in terms of heart health and preventing atherosclerosis. Another important factor is to stay away from carbohydrate-based foods. Carbohydrates have shown in recent years to trigger atherosclerosis much more seriously than animal fats.

What are the treatments for atherosclerosis?

The first treatment is preventive treatment, which should be done before the disease comes out. For this, it is important to set the weight balance well, to have a healthy nutrition program and to be at the center of life. It is recommended to minimize alcohol consumption and completely avoid cigarette consumption. When the disease starts, when it is considered as heart disease, that is, when there is involvement of the heart vessels, it has a 3-phase treatment method. The first is the step where the drugs are sufficient, and the second is the stent procedures to be applied to that area if a serious stenosis is detected as a result of angiographic studies. The third stage is advanced surgical procedures where stents are not sufficient and surgery is required.

What causes atherosclerosis?

Atherosclerosis is a general name and causes different diseases depending on the organ it holds. It causes vascular occlusion. Depending on the vein it clogs, it can cause many serious illnesses. If the heart vessels are blocked, it can lead to heart attack and heart disease. If it holds the vessels of the brain, it can cause paralysis. It may cause chronic kidney failure if it involves kidney vessels, very serious diseases leading up to intestinal necrosis if it holds the intestinal vessels, and peripheral vascular diseases that occur when holding the leg vessels.

What is good for atherosclerosis?

Apart from nutrition, the most important factor is sports and active life. It is important to keep the Body Mass Index (BMI) within normal limits, pay attention to the diet and avoid stress. Stress is another important reason for the presence of atherosclerosis. Therefore, stress management is one of the important factors in dealing with atherosclerosis.

Echocardiography

What is Echocardiography?

Echocardiography, ECHO, is the name given to the examination and evaluation of the heart's internal structure and functions through sound waves. Echocardiography is also known as heart ultrasound. In echocardiography, a device that transmits sound waves to the heart, a device that records images, measures and has a screen is used.

Does the echocardiography device have a sound?

In general, echocardiography measurement does not have a sound; the device operates silently. However, during some Doppler recordings, sounds are synchronized with the heartbeat from the device.

How much echocardiography costs?

Information for the price of echocardiography can be learned by consulting the cardiology counters in the hospital or the call center of the hospital.

How is echocardiography performed?

In echocardiography, the patient is first laid on his left side and the transducer is applied to the heart of the patient's chest and is circulated in the heart area. X-ray is not used in the process. Echocardiography is an ultrasound technology. It is a painless examination; it does not cause a side effect in patients. Very comprehensive data about the heart can be seen on the screen of the echocardiography device. All results are evaluated by the cardiology specialist who conducts the examination or wants.

What does echocardiography do?

To find the source of the murmurs, unexplained chest pain - shortness of breath - to investigate the cause of irregular heartbeat, to measure the heart cavities, to check the thickness of the heart wall, to examine the heart valve structure, to check the heart's functions, to check for a clot or tumor in the heart, to check if a heart related surgery has been passed used for.

Rhythm Holter

What is the Rhythm Holter?

The procedure for taking the ECG recording of the heart rhythm for 24 hours, or longer, is called Rhythm Holter.

Does the Rhythm Holter make sounds?

Whether or not Rhythm Holster makes a noise is a curious issue. Rhythm Holter is not a sounding device.

How much is the Rhythm Holter?

Rhythm Holter price is one of the topics sought on the internet. It is possible to find out the price of the Rhythm Holter from the consultation of the cardiology department or by calling the call center.

How to install the Rhythm Holter?

The Rhythm Holter consists of cables and a recording device connected to the cables. These cables are connected with disposable washers that can stick to the body. There are electrode cables on it. Electrodes are glued to the points determined in the chest area of ​​the patient. The recorder records the incoming ECG signals. The results are examined by a specialist cardiologist, the course of treatment is determined.

What does the Rhythm Holter do?

It helps to diagnose problems with rhythm distortion, rhythm disturbances, whether there is a fatal rhythm disorder after a heart attack.

Blood Pressure Holter

What is a Blood Pressure Holter?

Blood Pressure Holter is a device for measuring blood pressure for 24, 48 or 72 hours and at regular intervals. Blood Pressure Holter usually measures every half an hour during the day and hourly at night.

Does the Blood Pressure Holter make a sound?

The Blood Pressure Holter makes the sound of an automatic blood pressure measuring device. A small signal tone is also heard during the measurement.

How much is the Blood Pressure Holter?

Blood Pressure Holter price is a curious issue. It is possible to find out the prices of Blood Pressure Holter from the cardiology consultation counters of the hospital or call center.

How is a Blood Pressure Holter installed?

The Blood Pressure Holter is a smaller device than the rhythm Holter. Blood pressure Holter cuff is put on the patient's arm. Then this sleeve is connected to the unit, which can be called the brain of the Holter device. This device is fixed to the patient's waist with a belt. The first measurement is taken at the hospital. Then the patient is sent home.

What does Blood Pressure Holter do?

Measuring blood pressure once or twice a day cannot catch blood pressure fluctuations of patients. However, the Blood Pressure Holter captures and records blood pressure fluctuations within 24, 48 or 72 hours of patients. Blood Pressure Holter is used to diagnose hypertension. In addition, it is an indispensable device in the regulation of the treatment of patients with hypertension, giving the data of what the patient's blood pressure fluctuates at what time of day.

Where is the Blood Pressure Holter installed?

Blood Pressure Holter, like every blood pressure device, is wrapped around the patients' right or left arm through the cuff. The device on which the measurement is recorded is fixed on the patient's waist.

Why does the Blood Pressure Holter crow?

Since the Blood Pressure Holter is digital, there is a sound when the air pressure goes to the sleeve while measuring. As the cuff empties, the patient's arm relaxes and blood flow continues. When the stream starts, a sound comes from the device. After a while, this sound will decrease. As the working principle of the device is like this, sound is heard.

What is Cardiac MR?

Cardiac MR is an advanced cardiovascular imaging method that provides detailed images of the heart using radio waves, magnetic field and computer. Cardiac MR is also defined as a highly effective diagnostic method that provides fast diagnosis and accurate treatment planning by providing detailed information about the type and characteristics of heart diseases.

What are the advantages of Cardiac MR?

• Unlike other cardiac imaging methods, echocardiography and heart tomography, detailed information at tissue level is the most important feature of this method. There is no other diagnostic method that can evaluate the tissue of the heart muscle in this way. For example, when echocardiography is performed on a patient with heart failure, only the presence and degree of heart failure are detected. However, when cardiac MR is taken, very important information is obtained about what causes heart failure. Heart failure; Cardiac MRI is the best method to answer the question of whether coronary artery disease, an inherited genetic type of heart failure, or an inflammatory process due to infection in the heart. In this way, the diagnosis and treatment process of the patients is accelerated and a great contribution is made to the course of the disease. 
• While providing all this, the fact that it does not cause radiation exposure for the patients is an important feature of this technique.  
• Besides the diagnosis and treatment of the patients, it is also important to follow up the patients after starting the treatment process. For example, when a patient is evaluated with cardiac MR before bypass surgery, the amount of tissue that can heal after surgery can be predicted. Cardiac MR can be used for detailed measurements and tissue-based evaluation.
• In chemotherapy patients, some medications can have a toxic effect on the tissue of the heart. Especially in-patient groups with poor echocardiographic image quality, heart functions can be monitored in detail by MR. It is also of great importance for cancer patients, as there is no radiation.
• It is also possible to investigate whether there is any permanent damage left after heart muscle inflammation (myocarditis) treatment or after a heart attack.
• Heart muscle may also be affected due to some rheumatological diseases. If there is an involvement in the heart, and heart failure is thought to be due to these diseases, the treatment can change completely. For this reason, cardiac MRI is also quite guiding about whether there is any involvement in the heart in rheumatological diseases.
• The image quality of cardiac MR is far superior to echocardiography. Detailed analysis can be made regarding the volume, contractile strength and entire anatomy of the heart. In particular, the right ventricle has a different, difficult, funnel-shaped anatomy, and detailed assessment of the right ventricle is difficult with echocardiography, while detailed assessment of both volume and function can be easily performed with cardiac MR. Cardiac MR is one of the diagnostic criteria in the guideline, called arrhythmogenic right ventricular dysplasia (ARVD), which can progress with life-threatening rhythm disorders.
• In some diseases that go along with thickening of the heart muscle, such as hypertrophic cardiomyopathy and genetic origin, connective tissue changes in the heart muscle provide advanced information about possible rhythm disturbance. In addition, since this disease has the genetic transition form, which we call 'autosomal dominant', if there are suspicions or early-stage disease when the family members are evaluated by echocardiography, it may be considered to check the family members with cardiac MR for detailed evaluation and tissue-based evaluation.
• It provides detailed information about what kind of mass the mass is and its dissemination.
• It is used quite frequently in congenital (congenital) heart diseases as it provides advanced information in terms of both anatomy, volume and hemodynamically. It is a preferred diagnostic method in terms of deciding the type of surgery and subsequent routine follow-up, without radiation, possibility of hemodynamic evaluation and detailed images.

In which diseases is Cardiac MR used?

One of the most frequently used areas is heart failure. It provides advanced information on the degree of heart failure, changes in chambers and valves, and whether or not heart failure is reversible. Apart from that, as mentioned above, pericardium (cardiac membrane), congenital heart diseases, valve diseases, aortic diseases; In coronary artery disease, the degree of affection of the heart muscle and whether there is an oxygenation disorder are the areas where cardiac MR can easily guide.

Cardiac MR is also used to investigate whether there is a focus or anatomical, hemodynamic cause that may cause it in patients with palpitations, fainting, dizziness, and rhythm disturbances. In congenital heart diseases, in aorta diseases with low echocardiography images, and in patients who could not be diagnosed, it provides a painless, radiation-free diagnosis, and it helps with the follow up and treatment process. 

How is cardiac MR performed / How is it applied? What process awaits the person?

First of all, medical history is taken from the patients; detailed information is obtained about the patient's kidney functions, allergic conditions, pacemaker, whether there is any metal in the body and pregnancy status. Since the procedure and image quality are very important for the correct interpretation of the examination, procedure; It is a part of the process that requires extra care and needs extra care. The vascular access is opened to give the patient contrast agent and other medicines that may be required. After the vascular access is opened, the patient is taken to a comfortable and wide cardiac MR machine. Cardiac MR is a device with a magnet feature, a tunnel in the middle of which the patient bed enters. Electrodes recording the heart rate are attached to the patient's chest. From the outside, the patient is told to breathe with voice commands. Each breath holding time can usually take up to 10 or 20 seconds. During this process, the patient's compliance with breathing commands and not moving at all is very important in terms of image quality. Before the procedure, the patient makes attempts in this regard to ensure correct process. The procedure takes about 50-60 minutes and there is no pain. Afterwards, the images are analyzed in detail and the reports are delivered to the patients quickly. 

To which patients should Cardiac MR not be applied?

This procedure is not applied to patients who have severe claustrophobia, that is, fear of confined spaces and who do not agree to enter the device. In addition, if urea and creatinine levels are above a certain level in patients with kidney failure, these patients should be evaluated by their physicians beforehand. General MR rules also apply to cardiac MR. It is not recommended to do this if the patient has a metal prosthesis or a battery incompatible with MR anywhere on his body. If available, pacemakers or metal covers must be compatible with MR shots. Before deciding on the procedure, the patient should be asked whether there is a metal prosthesis on the prosthetic cap, battery or any other area on the body. Also, metals such as piercings need to be removed.

Is there a preparation process in cardiac MR?

Although there is no special preparation process, it is important for the success of the examination that the patient shaves the hair on his chest before coming, if any, due to the electrodes that are inserted into the chest and record the heart rhythm in cardiac MR procedure. In addition, if there is an allergic condition while using drugs before the procedure, 4-5 hours of fasting is required to minimize the risk of nausea-vomiting and aspirating the patient. Also, the medications used can continue to be used until the day of the examination, unless otherwise stated. It will be beneficial to bring all the previous examination results and reports about the heart before processing, for a more complete examination of the patient.

What are the points to be considered after cardiac MR?

There is no situation to be considered after the procedure. Following the patient procedure, daily life is resumed immediately. 

How long is the cardiac MR?

It takes about 50-60 minutes. 

Is cardiac MR harmful to the kidneys?

If the patient's kidney functions are impaired, hydration (intravenous serum administration) is performed or some precautions are taken. If there is a serious kidney problem, the process is carried out together with nephrology. Those with kidney problems should definitely inform the physician before cardiac MR. Creatinine value is routinely checked before cardiac MR. If the patient has a creatinine value recently, it is not requested again. However, if it is not available recently, creatinine would be re-examined. 

Is there any side effect?

As mentioned above, there is no side effect of cardiac MR except for the possibility of allergy to the contrast agent to be given during the procedure or the progress of kidney disease if no precautions were taken. 

Is it routinely taken in the checkup program?

If the patient does not have any indications, it is not necessary to routinely perform it. However, if the patient has a disease that requires follow-up such as heart failure, valvular disease, congenital heart disease, and aortic enlargement, follow-up and evaluation of these patients with cardiac MR may be recommended. Especially in patients with aortic enlargement and close follow-up in some years / 2 years, performing follow-up with cardiac MR instead of computed tomography will eliminate radiation exposure.

Is contrast material given in cardiac MR?

Contrast agent is given in cardiac MR. There are cases of late or early gadolinium uptake in cardiac MR. In early uptake, it is checked whether there are any clots or problems called microvascular obstruction in the heart. In the late gadolinium phase, contrast is necessary to see if there is a connective tissue change in the muscle tissue of the heart called myocardium. If contrast material is not given, it is not possible to see connective tissue changes in the heart muscle, localization or amount of dead heart cells. 

TAVI (NON-SURGERY HEART CAP REPLACEMENT)             

What is TAVI?

TAVI (Transcatheter Aortic Valve Implantation) is an interventional treatment method that enables the surgical replacement of the aortic valve. While surgical aortic valve replacement is the only treatment option for many years, it has been possible to change the aortic valve without surgery without opening the chest in recent years.

In which patients is TAVI procedure used?

Non-surgical aortic valve replacement, the TAVI method, is used in the treatment of aortic valve diseases. While it was initially applied only to patients with no chance of surgery, it was later accepted as an option for patients with very high risk of surgery, patients with moderate high risk of surgery, and patients with low risk of surgery recently.

How is TAVI procedure applied?

The procedure is performed with local anesthesia and mild sedation (giving relaxing medication). The aortic valve of the heart is reached with the help of a tube with a valve inserted into the groin artery. After reaching the point where the valve should be placed with the tube delivered to the heart, the valve mounted on a large stent is placed in that area. The process is terminated after it is demonstrated by the imaging methods that the valve is placed correctly and works well. In the TAVI method, absolutely no incision is made.

MOST ASKED QUESTIONS ABOUT TAVI PROCESS:

When are the patients discharged after the TAVI procedure?

After the TAVI procedure, which lasts for about an hour, the patient stays in the hospital overnight for control purposes and is usually discharged from the hospital the next day or one day later.

Who can be a candidate for TAVI?

Aortic valve disease is an advanced age disease. In particular, TAVI can be applied to aortic valve patients who have advanced age, who have additional health problems beside heart disease, who have general anesthesia and whose general health condition is not suitable for surgery. However, with the increased experience of the procedure and successful results, it has become applicable in patients with moderate or low risk of surgery.

Is TAVI a painful procedure?

The patient does not experience any pain during and after the treatment.

What should be done after TAVI procedure?

After the procedure, the patients are followed up periodically by the cardiologist. After the procedure, patients use blood-thinning medication for a short time.

Are there any risks of the TAVI procedure?

Procedure risk is essentially low. The results are equivalent to or even better than surgery.

Is there an age limit in the TAVI procedure?

It is not recommended for very young patients (up to 9 years), since the TAVI procedure has not yet been available for many years of follow-up results.

What are the advantages of TAVI compared to open aortic valve surgery?

The replacement of the aortic valve with the TAVI procedure is carried out without opening the chest, without any incision. General anesthesia is not required, it is a very important advantage due to the problems and complications related to anesthesia. After the TAVI procedure, the patients stay in the hospital for a very short time and return to their daily lives in a very short time.

How long should the patient come for control after TAVI procedure?

Heart valve patients should come to the physician control periodically. After TAVI, 1-3-6-month controls are important.

What is aortic stenosis?

The aortic valve is the valve at the mouth of the main vein originating from the heart. With age, calcification can be seen in this valve and the valve cannot be opened and closed well. Aortic valve stenosis is usually an advanced age disease.

Is TAVI applied to people with leak in the heart valve and those with aortic valve insufficiency?

Today, for patients with pure aortic valve insufficiency; If there is no calcification on which the valve to be attached, TAVI process is not recommended.

What is 3D echocardiography?

Anatomy details of the heart may be vital in some structural diseases such as heart holes, heart valve disease. In the past, predictable situations can only be determined through 2-dimensional photographs. Thanks to 3-dimensional echocardiography, they can be determined precisely. It is a great advantage in the treatment to determine the method to be applied in the procedure by printing the patient's real heart model before the operation with echocardiography images and 3D printers.

What are the advantages of 3D echocardiography?

In structural heart diseases, heart anatomy should be displayed in detail. Previously, this was done by overlapping 2-dimensional heart images and acquiring a virtual image that was made in 3D. However, real-time images can be taken with 3D echocardiographs in recent years. With 3D echocardiography images and 3D printers, not only the true heart images of the patient can be made, but also a true heart model. With this application, previously performed procedures are calculated without leaving any place for estimation. For a patient with stenosis in the mitral valve, it is necessary to know how open the valve or the area of ​​the valve. According to these data, the treatment method such as balloon or surgery is determined for the patient. If you get the wrong section in 2D views, calculations may be wrong. With 3D echocardiography, the real image is obtained, not the photo of the heart. Many procedures that used to be based on estimates are now calculated and performed with exact results. Data such as the location and size of the holes in the heart can be found and measured by 3D echocardiography. When a cardiac surgeon wants to operate a person with a mitral valve, they have to stop the heart to see the valve during the surgery. However, the heart valve, which has a dynamic structure, can change and enter different forms while the heart is beating. The surgeon's ability to see the heart valve in 3 dimensions by 3D echocardiography and planning the surgery accordingly also increases the success rate of the treatment. Achieving real-time 3D images without radiation with 3D echocardiography method and obtaining real information based on measurements rather than estimation on these images increases both the interventional cardiology and surgical precision in terms of treatment.

How is 3D echocardiography performed?

With the help of 3D echocardiography images and 3D printers, the true heart model of the patient can be printed as plastic, metal or silicon. Thanks to this revolutionary development, it is possible to determine which method and device will be used before the operation by working on the patient's heart model before the procedure. Images obtained with 3D echocardiography and 3D printers benefit not only interventional cardiologists, but also surgeons.

General Questions

1. What is Cholesterol?
   Fats are found in various structures in the body, such as free fatty acid, cholesterol and triglycerides. Cholesterol is a fat-like natural substance produced in the liver, found in all cells of our body. While cholesterol is produced in the liver, it is also taken with nutrients. It is found in foods of animal origin such as meat, dairy products, eggs, and not in herbal products. 
2. Why is Cholesterol Important?
   Cholesterol is used in the body to make cell membranes and some hormones. However, high blood cholesterol level increases the risk of cardiovascular disease. Considering that the most common cause of deaths in the world is cardiovascular diseases, it is understood how important cholesterol is. 
3. What is Good Cholesterol (HDL-Cholesterol) - Bad Cholesterol (LDL-Cholesterol)?
   Cholesterol is transported in blood as well as depending on lipoproteins.
   Lipoproteins are large molecular compounds necessary for circulating cholesterol and triglycerides in the circulation. LDL and HDL are also members of the five main families of liporotein that carry cholesterol in the blood. Low-density lipoprotein cholesterol (LDL cholesterol = bad cholesterol) carries cholesterol formed in the liver. When it is high in the blood, it can cling to the inner surface of the veins and cause a condition known as vein stiffness among the people called plaque . With the addition of some substances other than cholesterol, these plaques can grow over time and narrow the vein. The narrowing of the vein leads to disruption of the feeding of the heart, that is, ischemia. More dangerously , sudden ruptures of these plaques and sudden complete occlusion of the vein by adding a clot. In this case, a heart attack occurs.    
4. Since HDL-K is a cholesterol, how good can it be?
   HDL-K has the opposite effect of LDL-K. It collects cholesterol circulating in the blood and brings it to the liver. Thus, it reduces the exposure of blood vessels to the harmful effects of cholesterol and prevents them from accumulating in the vessels. 
5. What Should Be Normal Blood Cholesterol Levels?
   Normal blood cholesterol levels should be determined individually. Whether the person has previous cardiovascular disease (heart attack, stent, bypass etc.) and whether there are factors that increase the risk of cardiovascular disease are also very effective in determining the target level and making the drug treatment decision. While a diet suggestion may be sufficient in one of two people with the same cholesterol level, the other may require intensive drug therapy.   
6. What value should be below to say good cholesterol or HDL-K low?
   There are different values ​​for males and females for HDL-K abortion. If it is below 50 mg / dl in women and below 40 mg / dl in men, it is mentioned that HDL-K is low.
   Although HDL levels are not as sharp as LDL cholesterol, the increase in HDL levels reduces the risk of cardiovascular disease, while low HDL levels have been proven to increase the risk of coronary artery disease even in the presence of normal LDL levels.
7. How is the risk of cholesterol estimated?
   In our case, Tom guidelines recommend determining the total risk of cardiovascular disease in preventing cardiovascular disease. Personal specific risk of total cardiovascular disease is determined and lifestyle recommendations and drug treatment options are evaluated. HDL and LDL cholesterol levels are also very effective in determining this risk. In certain patient groups, specific cholesterol measurements such as Lp (a) or ApoB are used to determine risk.  
8. Who should have cholesterol measurement and how often?
   Serum cholesterol level should be measured in people over 20 years of age, and it should be checked every 5 years in normal patients. People who have high cholesterol, have known cardiovascular disease or who are at high risk of cardiovascular disease need closer follow-up.
9. Which complaints are caused high cholesterol?
   High cholesterol accumulates in the vascular wall rather than making a direct complaint, leading to blockages and related events. Blockage of the heart vessels causes a heart attack, while blockage of the brain vessels causes paralysis.
10. Why Is Cholesterol High?
    Our arteries in the body are like empty tubes, through which blood can flow freely. The inner surface of these vessels is covered with a layer of cells called endothelium. The endothelium creates a physical barrier between the blood flow and the arterial walls. Many risk factors, especially the advancement of age, damage this endothelial layer and increase the risk of cardiovascular disease. Fat lines begin to appear on the blood vessel walls before puberty. As the person ages, fat builds up, causing minor damage to the blood vessel walls. Other substances such as fat and cellular waste products, calcium come together to form a substance called plaque. Over time, these plaques that form inside the arteries can grow and narrow the vessels or cause sudden tears. High cholesterol level is one of the most important risk factors that cause blockage of the heart and other arteries.    
11. Do lifestyle changes lower cholesterol values?
    Lifestyle changes reduce the risk of cardiovascular disease both directly and indirectly. Lifestyle changes, total cholesterol, triglycerides and bad cholesterol levels to reduce the other outside the traditional risk factors for high blood pressure, the risk for conditions such as diabetes, cardiovascular disease and the positive effect is significantly reduced.    
12. Is it necessary to treat cholesterol with medication?
    In patients with proven cardiovascular disease or patients at high risk of developing cardiovascular disease, drug therapy is often required in addition to lifestyle changes independent of cholesterol values. Even if the risk of developing cardiovascular disease is low, drug treatment may be required in those with very high cholesterol levels.
13. Which drugs are used in drug treatment?
    Several types of drugs are used to lower cholesterol. Among these, medicines called statins are the most commonly used drugs that lower LDL-K today. These drugs act by reducing cholesterol production in the liver. Apart from statins, there are different drugs. Drugs that reduce the passage of cholesterol from the intestines into the blood (ezetimibe) can be used in patients who cannot use statins or when statins are not effective alone. Bile acid extracts, a new group of PCSK9 inhibitors, are other options. Fibrate group drugs are used to lower triglyceride. 
14. Do cholesterol-lowering drugs have an advantage over each other?
    There are differences in the effectiveness and side effects of cholesterol drugs. It is important to achieve target LDL cholesterol values. For this, the most commonly used today is to increase the doses of statins or to combine them with drugs from another group.   
15. How low should our cholesterol value be? Is there a normal or abnormal value for everyone?
    Target LDL cholesterol value for protection for very high-risk patients or patients who have had a cardiac event: 50% or more reduction from basal LDL levels or <55 mg / dL. 50% or more reduction in basal cholesterol levels in high-risk patients and target LDL value <70 mg / dL. The target LDL value is <100 mg / dl in moderate-risk patients and <116 mg / dL in low-risk patients.        
16. What should be done in low HDL-K?
    The first suggested thing about HDL low cholesterol is lifestyle change. In addition to a diet that protects the heart health, if it is used with regular and sufficient exercise, quitting smoking provides positive effects. Trans fats should be removed from the diet, excess weight should be lost, carbohydrate consumption should be reduced. Even small increases in HDL cholesterol are valuable in preventing cardiovascular disease.     
17. Do fish oil or vitamin drugs have cholesterol-improving effects?
    Although the use of fish oil has some positive effect on HDL levels, it does not have an effect as it is thought to prevent cardiovascular diseases. It is effective in the treatment of triglyceride elevation. Overuse may lead to gastrointestinal discomfort and an increased risk of bleeding, especially in patients who use blood thinners.
18. How often should I have my blood cholesterol values ​​checked?
    Even if there is no health problem, it should be checked once over the age of 20 and if normal, it should be repeated every 5 years. Patients with familial hyperlipidemia, those with cardiovascular disease, patients at risk for cardiovascular disease and patients using cholesterol-lowering medications should be checked according to the physician's recommendation.
19. What is Triglyceride? What Should Be Its Normal Levels?
    Triglyceride, like cholesterol, is made both in the body and taken with nutrients. Although not as high as LDL cholesterol, its height in the blood increases the risk of cardiovascular disease. It is preferred that the triglyceride level is below 150 mg / dl. When there are high values, other cardiovascular risk factors should also be screened. Its very high values ​​also cause other problems such as acute pancreatitis outside the heart.   
20. Why Are Blood Fats Low in Some and High in Some?
    This situation is related to both the genetic structure of the person and the lifestyle. Genetically, fat can be absorbed from person to person in many stages such as absorption, production in the liver and transport to cells. This affects blood cholesterol levels. Even in the same person, cholesterol levels can be very different depending on the nutritional habits and exercise status in different times. 
21. What are the other risk factors that lead to cardiovascular disease?
    There are many risk factors, some of which can increase the risk of cardiovascular disease, some of which cannot be changed. For example, male gender, advanced age, family history are risk factors that cannot be changed. The use of cigarettes and other tobacco products, high cholesterol, high blood pressure, diabetes, physical inactivity, being overweight, especially a high waist circumference, uncontrolled stress, saturated fat and cholesterol-high diet, drinking too much alcohol are risk factors that can be changed. 
22. What are the features of a protective diet from heart disease?
    There are some basic rules that people of all ages should follow to protect their cardiovascular health, not just those with a history of heart disease. Paying attention to daily calorie intake is necessary and weight gain should be avoided.  
    • Excess sugar and salt should not be consumed. Daily salt consumption should be under 5 gr.
    • Avoid processed foods, fatty, fried foods.
    • Vegetable, fruit and fish consumption should be increased in an amount that will not cause weight gain.
    • Unsaturated fats such as olive oil should be preferred.
    • A sufficient amount of vegetables (at least 200 g) and 1-2 portions of fruit should be consumed every day.
    • Fish should be consumed at least 2 times a week and more if possible.
    • 25-30 g unsalted raw nuts can be consumed per day
    • Fiber foods should be preferred.
    • Low-fat dairy products should be preferred.
    • Consumption of animal fats should be limited.
23. What is the function of the Coronary Intensive Care Unit?
    Coronary Intensive Care Units are specialized units in which patients who are at serious risk of heart disease are constantly monitored intensely, and the slightest change in vital signs will be detected and intervened immediately.
24. Is it possible to prevent cardiovascular diseases? How Should We Be Protected?
    The higher the risk factors for coronary artery disease, the higher the risk of coronary artery disease. Therefore, reducing or treating and controlling these risk factors greatly reduces the risk of developing vascular disease.
    The basic principles are healthy diet, smoking cessation, regular exercise, not gaining excess weight, avoiding stress, hypertension and regular treatments if there are diseases such as diabetes. It is also very important to determine risk factors and to perform regular heart checks for early diagnosis.
25. Why are heart medications used for life?
    Since heart diseases continue for life, medications used in treatment should never be left without consulting the doctor. For example, the most common cardiovascular diseases in the world are life-long diseases. If the person's vein is opened with a method such as bypass or stent, the main disease process that causes narrowing or blockage in the heart vessels continues. Lifetime drug therapy slows down this process. It often protects the person from recurrent vascular occlusion. Again, patients with mechanical prosthetic valves have to take blood thinners for life. Drugs used for hypertension, diabetes and high cholesterol should also be used mostly for life. It should not be left without consulting your doctor.     
26. You cannot quit smoking. You have tried many times. What would you say to try again=
    Smoking is one of the most important risk factors for cardiovascular obstruction except for advanced age. The life expectancy of smokers compared to non-smokers throughout their life is one decade or less. All risks related to smoking include not only active smokers but also passive smokers. The risk of heart disease increases by 25-30% even in those who do not smoke themselves and are exposed to cigarette smoke at home or at work. Especially for those who already have heart disease, the risk of heart attack is higher. Therefore, although there are numerous unsuccessful attempts, it should not be abandoned without trying to quit.  
27. Stent or Bypass?
    This decision varies depending on many factors such as the current diseases of the person, age, number and structure of the vessels, the experience of the center where the procedures are performed, and the preference of the patient. For a patient, for whom bypass could be decided by just examining the coronary angiography, stent may be decided after evaluating the patient completely and if the operation would be considered too risky. 
28. Are Herbal Treatments That Are Not Based on Scientific Foundations Really A Cure for All?
    These treatments are not included in guidelines used worldwide to protect heart health. Although they have no proven efficacy, they can be harmful. They can interact with medications that the person uses for other reasons. They can change the effect of drugs and increase their side effects. They can negatively affect liver or kidney function. Therefore, it should not be used without consulting a doctor.
29. Do Hypertension Patients Need to Use Lifetime Drugs?
    Hypertension is a systemic disease that concerns the whole body. Hypertension patients should generally use medication to keep their blood pressure values ​​within their normal range. If hypertension is detected, if the values ​​are not too high, a lifestyle change may be tried for a while under the control of the physician. However, this should also be under the control of a physician, and if it is not successful, the given drugs should be used. In a small proportion of patients with hypertension, an underlying spike may increase blood pressure. With the detection and treatment of this, blood pressure values ​​may return to normal and the drug may be discontinued. However, this should also be under the control of a physician. 
30. How Does Our Heart Work?
    The heart is an organ with 4 chambers, consisting of muscles, carrying liters of blood to the body every day. Like the other muscles, continuous blood flow is required for the heart to function properly. The heart muscle draws the blood it needs from the coronary arteries located on it. Electrical stimulation is required before the heart contracts. Following this electrical stimulation, the heart contracts and pumps blood to the body. Also, the lids located in the heart and between the large vessels and the heart play a role in these contraction and relaxation functions.  
31. What is Blood Pressure?
    Blood pressure is, in short, the pressure inside the arteries. While the heart pumps clean blood from the lungs through the arteries to the whole body, it transmits the dirty blood from the body to the lungs through the veins. In each beat, the heart pumps blood first and then relaxes so that the blood fills into the heart again. The highest pressure in the arterial wall, which occurs when blood is pumped, creates systolic blood pressure (large blood pressure), and the lowest pressure at rest creates diastolic blood pressure (small blood pressure).         
32. How Should Normal Blood Pressure Be?
    Normal blood pressure values ​​should be below systolic blood pressure (large blood pressure) below 130 mmHg and diastolic blood pressure (small blood pressure) below 85 mmHg.
33. What is Low Blood Pressure (Hypotension)?
    Hypotension is defined as measuring high blood pressure beloe 90 mmHg, low blood pressure below 60 mmHg, or a 40-50mmHg decrease compared to the normal value of large blood pressure.  
34. How often do cardiovascular diseases occur in our country?
    Cardiovascular diseases are the leading cause of death worldwide. Every year, 17 million people in the world die due to cardiovascular diseases. Unfortunately, the situation is not different in our country, 40% of all deaths develop due to cardiovascular diseases.  
35. Does stress cause a heart attack?
    Chronic stress is an important risk factor both directly and indirectly in the development of cardiovascular diseases. People with cardiovascular disease base in acute stress can experience plaque rupture and have a heart attack. 
36. Why do heart diseases take the first place in deaths?
    Today, factors such as the increase in education and income levels in the world and control of infectious diseases have caused the expected life expectancy to increase. With the prolongation of life, the frequency of non-communicable chronic diseases increases. Environmental factors and lifestyle of the person are very effective in increasing cardiovascular diseases. Increasing ready-made and unhealthy food consumption, smoking increases especially in developing countries and women, chronic stress and sedentary life brought by life in big cities play an important role.   
37. How do we know that we have cardiovascular disease?
    When cardiovascular diseases progress, they often cause some complaints. For example, there may be complaints such as chest pain, rapid fatigue, shortness of breath and pain in the legs when the veins are blocked. In case of any complaint, the relevant physician must be visited. Apart from this, it is possible to make a diagnosis with the right tests at the right time without making any findings yet. It is especially important for people with cardiovascular risk factors to have their checks done without waiting for complaints.
38. When to apply angiography method?
    Coronary angiography, which is made traditionally from arm or groin, is the gold standard method for determining cardiovascular obstructions. It is not a treatment, but a diagnostic method.
    Often, if the person has complaints that may lead to a heart attack or a heart attack, test results (such as a positive effort test) that suggest congestion in the heart vessels are performed. It is based on the imaging of coronary arteries during the administration of contrast media (a type of medical dye) and the shooting of motion pictures using "X" rays. The data obtained are very valuable in guiding the treatment and are the main determinant for the choice of treatment strategy in most patients. Apart from the traditional coronary angiography, another angiographic method that shows the heart vessels is coronary CT angiography (Virtual angiography), and this test is performed to determine the risk of early diagnosis without any signs and symptoms of cardiovascular disease.
39. What should a person suspect of heart disease do?
    A person who suspects heart disease should contact a cardiologist immediately.
40. Why is heart disease so much in the foreground in various platforms, especially in the media?
    Cardiovascular diseases are among the most common diseases that cause death and disability worldwide. Another point is to fight risk factors with sufficient awareness and early diagnosis is lifesaving. It is a very effective method if the correct information is provided in terms of creating media awareness and information. Thanks to awareness, early diagnosis both contributes to the economy of the country by protecting the health of the person and reducing deaths and preventing the disease before it occurs.  
41. How many types of heart disease are there and are all patients treated the same?
    It is a vital organ that sends the blood to the aorta and lungs through large veins that exchange blood with the valves located in the heart muscle, which is fed with veins called coronary vessels and contracts with electrical stimulation. There are a wide variety of diseases that cause problems anywhere in this system. It can be a single disease or multiple interconnected problems can occur. The diagnosis and treatment of each disease varies considerably. Even with the same disease, different treatments may be required in two different people.
42. Can these diseases be understood beforehand, without a crisis?
    Today, individuals now have risk scoring that individually indicates the risk of a heart attack. With the measures to be taken and tests to be made according to the individual risk factor of the person, it can often be diagnosed early and prevented without a crisis. In this regard, even if there is no known cardiovascular disease, personalized heart health protection programs are very important. Again, it can lead to warning complaints some time before a heart attack occurs. These should not be neglected, see a doctor.
43. What complaints can be a sign of heart disease?
    Pain associated with a heart attack can be felt not only in the chest, but in any area from the navel to the lower jaw. During a heart attack, pain or pressure behind the sternum is felt in most patients. In addition, pain can radiate to the left arm, chin and neck. There may also be pain in the shoulders, arms, wrist, fingers and stomach area. It can often have an effect in the form of pressure, feeling of heaviness, feeling of suffocation, burning. Sometimes it can feel like something is sitting on the chest. Its severity is very variable and is not related to the severity of vascular disease that caused the condition. Chest pain may be the only complaint, but also shortness of breath, weakness, fainting, nausea, restlessness, fainting, excessive sweating, and abdominal pain. Especially in women, the elderly, diabetics, patients with kidney failure and patients with dementia, complaints similar to a heart attack can be misleading. In addition, there may be shortness of breath, fatigue, weakness, swelling in the legs and abdomen, anorexia in valve diseases or heart failure. Rhythm disturbances can include palpitations, dizziness, a feeling of badness, fainting, a feeling of singing or stopping in the heart.
44. When should the symptoms be checked if the above symptoms are not present?
    Heart-related checks: those with early family heart disease, those with high family cholesterol, people with significant risk factors in the development of cardiovascular disease (such as smoking, high blood pressure, obesity, diabetes, high cholesterol), or those who have increased the risk of cardiovascular disease ( cancer, rheumatic disease, chronic lung disease). In addition, men over the age of 40 and women over the age of 50 or after menopause are candidates for heart check-up, even if there are no risk factors. Apart from these, people who may affect the lives of other people (such as pilots those who use public transportation) and those who start active sports or do sports and professional athletes should also have a heart checkup periodically.       
45. If angiography shows vascular occlusion precisely, why not Angio is requested from every patient?
    In traditional coronary angiography, the heart vessels are displayed by entering the arm or groin with the help of a catheter to reach the arteries of the heart and dye the vessel. X rays are used during procedure, i.e. radiation is taken. It is not right to do it to everyone because of the radiation intake during the procedure, the use of contrast material excreted from the kidneys and, even very rarely, the possibility of complications in the heart vessels or access points by catheter. It should be done only by experienced people in the required patients.
46. What methods are used in the diagnosis of valve diseases? Does every valve patient have to have surgery?
    The most important imaging method in the diagnosis of valvular diseases is echocardiography. Echocardiography can be performed in two-dimensional, 3-dimensional or as transesophageal (endoscopic) for patients. Most patients can be diagnosed without additional testing. In some cases, heart tomography, heart MRI, or heart catheterization may be required. Not every valve patient has to have surgery. In the follow-up, if there is a high surgical risk in patients with aortic and mitral valve diseases, when the valve has time to change or repair, there are interventional methods of treatment. 
47. What to do if you have palpitations?
    Although palpitation is a complaint in rhythm disorders, it may be the first symptom of cardiovascular obstruction or an important valve disease. Again, an underlying thyroid disease or anemia may present with palpitations. Sometimes it can be of psychological origin for no reason. Someone with palpitations should consult an absolute cardiologist for detailed evaluation.
48. What should you pay attention to when coming to the examination?
    When coming to a heart examination, it is especially useful for people with previously known heart diseases to bring their current reports. Depending on the complaint, it is also a good idea to take the day for the examination, as the examinations can be prolonged and take time. Apart from this, it is recommended to choose comfortable clothes and if possible, come on an empty stomach.

Why should I choose Memorial for heart health?

1. Memorial Health Group Cardiac Health Centers provide services in the diagnosis and treatment of all heart diseases.
2. Memorial Health Group Cardiac Health Centers is recognized as a reference center in the world with its experienced cardiology specialists, surgical teams and modern technologies. Some heart diseases that can only be cured by cardiac surgeries in the past years can be treated with modern interventional cardiology procedures.
3. Safe and radiation-free imaging method for your heart has been offered to patients at the Cardiac MR Memorial Bahçelievler Hospital.
4. With cardiac CT cardiac vessels can be visualized within 5 minutes without angiography.  
5. With the “da Vinci Robotic Surgery” at the Memorial Bahçelievler Hospital Cardiovascular Surgery Centers serves with special treatment options such as cardiac surgeries, minimally invasive cardiac surgery (small incision method), bypass surgery, heart valve replacement and repair, aortic aneurysm surgery, varicose therapy, and endovascular stent applications.
6. In the Memorial Health Group Cardiac Health Centers, the diagnosis and treatment of heart diseases are carried out with a multidisciplinary approach and personalized methods.
7. In Memorial Pediatric Cardiology departments, the diagnosis and treatment of heart diseases in children are successfully carried out.
8. In heart diseases, the success rate in the treatment is increasing thanks to the 3D echocardiography images and the real heart model obtained with the 3D printers.
9. For patients who need repair and replacement of heart valve surgeries , coronary bypass surgery, closing some heart holes or removing intra-cardiac tumors, instead of a 25 cm incision in the chest bone; The operation can be performed under the right or left breast, under the collarbone or smaller incisions made by opening the breastbone a little .       
10. Many operations such as coronary artery bypass surgery, congenital heart surgeries, arrhythmia surgeries, cardiac valve surgeries, robotic surgery and heart hole surgery, and removal of intraocular tumors can be performed at the Memorial Bahçelievler Hospital.