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    The cardiology department of Reyap Hospital Istanbul provides health care services with world-class equipment and infrastructure to protect heart health, and diagnose and treat heart diseases.
    Our department is at the service of our patients every day of the week and at any time of the day.
    Reyap Hospital Istanbul has the opportunity to diagnose and treat all kinds of heart diseases in all age ranges. Our hospital provides health care services to its patients in the examination, diagnosis, treatment, rehabilitation, and coronary intensive care in heart diseases.
    All kinds of examinations, evaluations, and laboratory analyses required for diagnosis and treatment for patients with heart disease are carried out in our outpatient clinic, inpatient service, and coronary intensive care unit.
    Cardiac Procedures
    The cardiology department provides health care for adult patients. Pediatric cardiology is a separate specialty.
    Cardiologists are involved in the diagnosis and treatment of patients with conditions such as;
    • Angina (chest pain caused by narrowing of the coronary arteries)
    • Arrhythmias
    • Heart murmurs due to valvular heart disease
    • Cardiomyopathy (heart muscle disease) with heart failure including pulmonary
    • Edema
    • Coronary artery thrombosis and myocardial infarction
    • Arterial diseases (atherosclerosis, arthritis, atheroma)
    • Joint care of pregnant women with heart disease with their babies
    • Types of congenital heart disease, such as arterial/ ventricular septal defect
    Cardiologists also must improve survival rates and quality of life following a heart attack, heart failure, or arrhythmias.
    Outpatient clinic examinations
    Examinations are carried out by our physicians between 08:30 and 17:30, 6 days a week (except Sunday).
    Electrocardiography (ECG/ EKG)
    It is the recording of the electrical activities that occur in the heart to examine the functioning of the heart muscle and the neural conduction system. ECG is one of the most important diagnostic methods in the diagnosis of heart diseases. It has essential importance especially in the diagnosis of cardiovascular occlusion, rhythm disturbances, heart valve diseases, and heart failure.
    Treadmill Stress (Exercise) Test
    The treadmill stress test investigates the presence of cardiovascular disease, determines the effectiveness of the treatment, determines whether the arrhythmia occurs because of stress, examines the stress capacity of the patient in various heart diseases, questions the effects of stress on blood pressure in patients with hypertension and helps to determine the operation time in valvular diseases.
    During the stress test, the patient walks on a treadmill. The speed and inclination of the floor gait are adjusted by the doctor to increase the heart rate. The exercise test is an examination performed by the method of taking ECGs serially and measuring the blood pressure while the person is walking on the treadmill at certain speeds. Meanwhile, the patient’s complaints, heartbeats, and blood pressure are monitored, and data are recorded by continuous ECG monitoring. It enables the detection of abnormal findings that cannot be detected in ECG at rest, after exercise. The stress test requires the attendance of medical staff from the beginning to the end. Effort test provides great convenience in the early diagnosis of heart diseases. The result is given immediately after the examination.
    Transthoracic Echocardiography
    Echocardiography is the examination of heart structure and performance by sound waves (ultrasound). The sound waves that are sent to the heart and reflected from the heart are analyzed in the echocardiography device, and information about the heart’s muscle tissue, heart valves, and large vessels emerging from the heart is obtained.
    Since it is not a method that involves radiation, and no medication is used during the procedure, it can be applied to anyone, including pregnant women and newborn babies, without any side effects and pain. During the procedure, the patient is asked to sleep on a stretcher. After a water-based gel is applied and a probe, which is the part that sends the sound, is placed doctor holds the device in various positions in the chest area, allowing the heart to be examined. Very detailed measurements and analyzes are made on these images.
    Diagnosis of all structural diseases of the heart (heart enlargement, heart muscle diseases, heart valve diseases, hypertensive heart diseases, heart failure, heart membrane diseases, heart masses, clots, heart tumors, congenital heart abnormalities, even the largest diameter vein in the body called aorta diseases) is possible with echocardiography procedure. No preparation is required for echocardiography. The result is given immediately after the examination.
    Stress Echocardiography
    Stress echocardiography is used to investigate whether there is an obstruction or constriction in the vessels feeding the heart (coronary vessels), to decide whether a treatment other than drugs is required in patients with a heart attack (myocardial infarction), and to understand the severity of the condition in valvular heart diseases. It is a safe and easy-to-apply technique that provides very important information.
    Stress echocardiography is performed by simply examining the heart with sound waves before and after the stress. The patient doesn’t feel pain during the procedure. Stress is being created by the Treadmill device or by applying certain drugs to increase the workload of the heart. The result is given immediately after the examination.
    Transesophageal Echocardiography (TEE) Test
    The heart is located in the rib cage just above the esophagus. TEE measurement is a method used when the echocardiographic recording of sufficient quality cannot be made due to the chest structure of the patient (lung disease, deformity, etc.) or when it is necessary to evaluate the intra-cardiac formations more closely.
    Transesophageal echocardiography is a procedure that enables the visualization of some regions that cannot be visualized with conventional ECG and a more detailed echocardiographic evaluation performed from the esophagus. A very clear, detailed image is obtained with a thin tube (probe) that is lowered into the esophagus through the mouth. It takes 30 minutes with preparation before the procedure. The result is given immediately after the examination.
    Rhythm (ECG) Holter
    Rhythm holter is a device consisting of 3-4 cables and electrodes which are placed on the chest. It provides long-term follow-up of the heartbeat during daily life, and thus, the entire electrical activity of the heart during the day is recorded. After a daily recording, the doctor takes off the device from the chest and analyzes the records.
    The biggest advantage of rhythm holter is that it can find the source of symptoms such as palpitations and pain that do not occur during the examination but occur during the day. The patient continues to do the routine activities during the day while the holter device is working. Thus, heart rhythm disorders can be analyzed and diagnosed, as well as how effective the treatment is. During the recording, the patient is asked to repeat the events (drinking coffee, exercise, etc.) that increase the complaints. Registration is usually 24 hours but can take up to 48 to 72 hours as per the doctor’s request.
    Another function of the rhythm holter is to evaluate the pacemaker function in patients with pacemakers.
    Event Recorder
    The event recorders, which have the same operating principle as the rhythm holter device, are used in the diagnosis of rhythm disorders that develop less frequently. In addition to being worn on the chest for 14 days, it can be placed under the skin for 6 months to 1 year. Recording time can be controlled and the device can only record when symptoms occur.
    Blood Pressure Holter
    The blood pressure holter enables the diagnosis of hypertension and the efficiency of its treatment by recording the blood pressure and pulse of the person at regular intervals for 24 to 72 hours. During the recording, the cuff of the sphygmomanometer is tied to the arm, and blood pressure and heart rate are recorded during routine activities (activity, sleep, rest, etc.) throughout the day. By analyzing this data on the computer, the moments when blood pressure elevates and drops are found. Thus, activities that increase symptoms are understood. In addition to providing early diagnosis, blood pressure holter is also useful for planning a treatment plan.
    Tilted Table Test
    The tilted table test is a test that investigates the causes of fainting as a result of changes in blood pressure and/or arrhythmia caused by sudden movements after prolonged standing, standing still, or sitting. It is used in the differential diagnosis of fainting. During the test, the patient lies on the table and the table moves to an upright position. An excessive drop in blood pressure or arrhythmia in heart rate indicates a cardiovascular disease.
    Coronary Angiography (CAG)
    Coronary angiography is a device that diagnoses narrowing and obstruction in the arteries feeding the heart. For the test, arteries in the groin or arm are used as intervention points. Thanks to the dye sent from the intervention site, the overall view of the vein is obtained. Thus, constriction, dilation, obstructions, deformities, and congenital or acquired problems throughout the vessel are detected.
    The patient’s hospitalization is required for the coronary angiography test. The patient needs to rest for 4-6 hours after the procedure, and this period is longer for patients who have been applied bypass before, patients who have undergone various previous cardiac surgeries, and patients with occlusion in the inguinal or arm vessels.
    Percutaneous Transluminal Coronary Angioplasty (PTCA) – Stent
    PTCA (stent) is the method used in the treatment for narrowing or complete occlusion in the vessels supplying the heart detected after coronary angiography. Like coronary angiography, PTCA is performed in the angiography laboratory without general anesthesia, using the same sheath that was placed in angiography. The processing time is variable. At the end of the procedure, the patient is taken to the proper service according to the doctor’s guidance.
    Coronary balloon angioplasty is performed using specially designed materials. First, the catheter is placed through the sheath placed at the intervention site, and the vessel is passed through the stenosis area with a very thin guidewire advanced through this catheter. The balloon is slid over this guidewire and delivered to the diseased location. Later, this balloon is inflated by giving liquid from the outside, and therefore the stenosis disappears.
    During this enlargement (swelling), the person may feel chest pain. This inflation and lowering procedure may need to be repeated several times for some severe cases. In the subsequent control, the process is terminated when it is determined that the opening is sufficient. It is rare to ensure a smooth opening. Besides, stents are preferred in 95% of patients to reduce the risk of restenosis in the future.
    The stent is mounted on the balloon in the form of a thin metal wire. The stent, which is tightly attached to the balloon, enlarges when the balloon is inflated and expands to the vessel wall, and remains enlarged there. Thus, the narrowing of the vein due to its flexibility is prevented. In the past, only stents made of stainless metal were used, but today, depending on the technological progress, new and different stents with drug release and soluble quality are used. The doctor decides the type of stent he is going to use by considering the patient’s needs and wants.
    Since large amounts of blood thinners are used during the procedure, the catheter in the groin or arm is not removed immediately but is removed after waiting for a while.
    PTCA is an application that requires one-day hospitalization. After one day the patient is discharged if the doctor determines it’s appropriate. Patients need to stay away from stressful environments and sexual intercourse for 15 days. Patients need to be in their home for 2 days, and they should take 15 days of work to rest. The doctor decides on the date when the patient travels by plane and goes on a road trip.
    While coronary angiography is routinely performed from an artery in the groin called the femoral artery, in our clinic, this procedure can also be performed from an artery in the wrist called the radial artery. Besides, in our clinic, occlusion of not only heart vessels but also vessels such as kidney and leg vessels called peripheral vessels can be treated with balloon and stent methods.
    Cardiac catheterization
    Cardiac catheterization is a method performed by groin and arm arteries similar to coronary angiography procedure but often requires simultaneous vein intervention. Cardiac catheterization is a diagnostic method used in the diagnosis of congenital or subsequent diseases related to the structure of the heart, anomalies, congenital or subsequent heart holes, and whether a different treatment is required. The blood sample is taken from each heart cavity entered and the pressures are measured. If necessary, a screening test is performed from these gaps by giving dye. Thus, it is determined whether the heart cavities and vessels are enlarged or whether there is a transition between the cavities in the heart.
    Cardiac catheterization is performed in patients who are believed to have a hole in the heart and whose echocardiography is diagnosed, and necessary information for the preoperative phase is determined. Defects in the functioning of the heart valves and walls can also be demonstrated with a heart catheterization. The cardiac catheterization procedure takes about 30 minutes. After the procedure, the sheaths placed in the arteries and veins are pulled and the bleeding is stopped with external pressure. The patient is taken to the appropriate service by applying a tight bandage to that area. 6 hours of rest is usually sufficient after the procedure. After 6 hours, if the doctor believes it appropriate, the patient can be discharged. Severe complication risk is extremely low in cardiac catheterization and coronary angiography.
    Peripheral Angiography and Angioplasty (Visualization of leg, neck, and arm vessels)
    The technique of performing these procedures is similar to imaging the heart vessels and enlarging the existing stenosis. However, while other procedures treat the coronary arteries (the vessels that feed the heart) peripheral angiography enlarges the stenosis in the larger vessels of the body such as the arm, leg, or neck vessels. Since the veins are wider, the materials used here are also in different sizes respectively.
    Temporary Pacemaker Implantation Procedures (Single or, Double Chamber Pacing)
    In case the heartbeat slows down due to the insufficient speed of the simulation center in the heart, or the inability of the stimulus to be transmitted from the brainstem, the patient needs implantation of pacemakers to regulate the heart rate to maintain a healthy life. The procedure is usually performed under local anesthesia by placing thin wires called electrodes through the large veins leading to the heart in the neck, chest or groin, and connecting it to a generator outside the body. This procedure can be done at the bedside or under an x-ray machine. The process usually takes 20-30 minutes. When the temporary battery requirement is removed, the wire placed inside the heart is taken out.
    Millions of people around the world have implanted a pacemaker. These high-tech small devices are used for many purposes, from preventing slow heart rate to treating heart failure, acting as a pump for the heart, and preventing sudden deaths. The device, which eliminates the complaints experienced after insertion, helps the patient return to their regular life by increasing the quality of life. There are 3 types of pacemakers:
    • One-wire and 2-wire batteries to prevent slow heart rate
    • 3-wire batteries (KRT) used to treat heart failure
    • Defibrillators (ICD) that give electroshock if the heart cannot perform its pump function due to the arrhythmia
    Pacemakers are implanted in people who have heart arrhythmia and cannot manage their lives normally. These patients can return to their regular life with the help of a pacemaker. People with pacemakers can go back to work, do household chores, drive, travel, swim, continue their hobbies, and sex lives.
    People with pacemakers should carry their pacemaker identification cards with them at all times. While traveling, they should learn the nearest clinics in their destination. After the pacemaker is inserted, its performance must be monitored. The pacemaker, which is a small computer, can be read from the outside with the help of another computer using a method called the telemetric method. In this way, information such as how the patient’s heart rate progressed, how long the pacemaker worked, did he or she experienced arrhythmia from time to time, was always connected to the pacemaker, or if there were other rhythm disorders. Besides, it is possible to externally program the pacemaker how many volts the battery should work or the values ​​that should keep the heart rate regular. The patient must go for a check every 6 months for 7 years, which is the average battery life. These examinations are very important as it can be predetermined that the battery will run out. All brands and models of batteries can be monitored in our hospital.
    Electrophysiological Studies (EPS)
    It is an interventional diagnosis and treatment method performed by placing thin cables called electrode catheters into the heart through thin sheaths placed in the inguinal vessels in the electrophysiology/angiography laboratory. The electrical signals received directly from the heart are evaluated by advanced computers and deviations are investigated. In this way, it can be understood whether the main center stimulation system of the heart works properly and whether the system that transmits the signals function well.
    In patients with heart palpitations, often in the form of rapid beats, the rapid beats, which are the cause of the patient’s complaint, are created with the stimuli given from these cables placed in the heart with special methods and the reasons for their incident are investigated. When short circuits are detected, tachycardia can be completely treated by applying special current point energy consisting of radio waves. In this way, permanent treatment of most of the fast heartbeat palpitations has become possible today. Electrophysiological examinations performed for diagnostic purposes take 30-60 minutes. If a therapeutic intervention is required, this procedure can take up to 1 to 4 hours.
    Catheter Ablation
    It is the treatment of arrhythmia by giving radio waves. This method is used in rhythm disorders that cannot be managed with drugs or when patients do not want to take medication for life. In some cases, the rhythm disturbance can be so severe that it can be life-threatening. In such cases, a direct catheter ablation method may be required. The procedure is performed by numbing the needle insertion sites with local anesthesia and, in some cases, under general anesthesia.
    During the procedure, sedative medication can be used to make the patient feel comfortable. The success rate of the treatment of rhythm disorders in the form of the fast beating of the heart with catheter ablation varies between 70-100% depending on the type of palpitation targeted to treat and the location of the short circuit. The success of this treatment is for patients to never experience palpitation again. The probability of the flutter recurrence after successful application varies according to the type of arrhythmia. For example, this possibility is between 3-5% in palpitations due to short circuits in the heart. In our hospital, in addition to the radiofrequency ablation method called the “burning” method, the “freezing” method, also called cryoablation can also be used for the treatment of arrhythmia.
    Mitral Balloon Valvuloplasty
    Mitral stenosis (acute rheumatic fever) is a childhood disease that causes symptoms in the future due to the involvement of heart valves. Mitral stenosis is the presence of stenosis in a way that makes it difficult for blood to pass from one of the chambers in the heart to the other. Therefore, blood accumulates in the lungs as water. This causes the person to experience shortness of breath. Medication is sufficient in mild cases, but mitral valvuloplasty or open-heart surgery is performed in severe cases.
    Mitral valvuloplasty is an invasive procedure performed by entering from the groin with a catheter. With a special needle sent through a sheath, it is passed from the right atrium of the heart to the left atrium by piercing the curtain in between. The needle is removed from the sheath and the guidewire is advanced through the same sheath to the left atrium. The movements of the wire are being monitored on the screen during the procedure. After the wire is placed in the right place, the balloon is advanced over the wire and placed inside the narrowed cap. The balloon is inflated where the cap is narrow. Thus, the cover is extended as much as possible. When applied to suitable patients, mitral balloon treatment results are as successful as in patients who have undergone heart surgery.
    The main advantages of mitral valvuloplasty over surgery are;
    • Since it is performed under local anesthesia, the patient remains conscious during the procedure.
    • The right or left groin area is anesthetized and the balloon is advanced to the heart through a small hole opened there, thus this procedure doesn’t need opening the chest, stopping the heart, and using the heart-lung machine.
    • After the procedure, patients are kept under control in their room instead of in the intensive care unit, and the majority of patients are discharged the next day.
    • There is no need to use blood thinners after the procedure in patients whose valve is opened with a mitral balloon and who do not have arrhythmias.
    With balloon mitral valvuloplasty, 90% of the patients regress their complaints. This improvement can continue for up to 20 years. Most patients experience relief for at least 5 to 10 years.
    Non-Surgical Treatment of Heart Holes (ASD-VSD treatment)
    In the past, atrial and ventral septal defects were mostly surgically closed, but today non-surgical methods are preferred. In patients with a congenital hole in the heart, the heart cannot continue its normal functioning. For this reason, dirty blood and clean blood are mixed. In our clinic, the holes are closed with the help of a device after passing through the artery in the groin with a catheter without surgery. Our patients are discharged within 48 hours after the procedure.
    Renal Sympathetic Denervation
    There are nerves called ‘sympathetic’ that cause blood pressure to rise around the kidney vessels. This sympathetic system is burned through the vein with a method similar to angiography, using a special material without anesthesia. This method, which is based on burning the sympathetic nerves that cause hypertension, is called ”renal sympathetic denervation” and as it is a new treatment method in resistant hypertension. This method is effective in persistent blood pressure, which seriously affects the patient’s life quality. The 80-90% success achieved by the renal denervation method used in the treatment of stubborn blood pressure ensures that the number of blood pressure medications used by patients is reduced and blood pressure is controlled. In our center, this procedure can be easily performed by our specialists and the patient can be discharged the day after the procedure.
    Other Procedures in Reyap Istanbul Hospital cardiology department:
    • Cardiac Resynchronization Therapy Insertion Procedures (CRT)
    • Intracardiac Defibrillator Insertion Procedures (WI, DDD)
    • Diagnostic Electrophysiological Study
    • Ablation Procedures with 3D Mapping
    • Pulmonary Vein Isolation with Cryoballoon (Freezing) Method (Atrial Fibrillation Treatment)
    • Vascular Resistance Measurement for Pulmonary Hypertension
    • Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy
    • Percutaneous Closure Of Atrial And Ventricular Septal Defects
    • Treatment in Patients with Risky Operation (Transcatheter Aortic Valve Implantation)
    • Evar – Tevar (Endovascular Repair of Abdominal And Thoracic Aortic Aneurysms)

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