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Introduction/Objective Patients who have had symptoms for more than 12h before receiving treatment are considered to be myocardial infarction late presenters. The literature contains scarce and often controversial data about treating such patients. The objective of the paper is to present treatment outcome in patients with acute ST-elevation myocardial infarction (STEMI), whose therapy was initiated more than 12h and less than 48 hours after the onset of symptoms. Methods the research included 130 patients who had suffered from acute STEMI in 2017, all of whom presented more than 12h and less than 48h after the onset of symptoms. A primary percutaneous coronary intervention (PPCI) was used to treat 109 patients, while 21 patients were treated conservatively. An analysis was performed correlating treatment results, intrahospital mortality, one-year survival rate depending on the type of treatment, risk factors and comorbidity. Results A statistically significant difference (x 2 =7,119; p=0,017) has been verified when comparing the mortality of STEMI patients treated with PPCI(8.3%) and those treated conservatively (28.6%). A statistically significant difference (t=9,385; p=0,005) has been verified when it came to treating STEMI patients that were also suffering from diabetes. In the group treated with PPCI, 77.8% of the patients that had died had diabetes. No comorbidity showed a statistically significant difference in distribution depending on the type of treatment and treatment results. Conclusion When deciding on the type of treatment these patients shall receive, the following should be taken into consideration: clinical presentation, hemodynamic status and presence of life-threatening arrhythmias. There is still no clear guideline for treating such patients.

Introduction The ventricular septal defect (VSD) incidence today is less than 1%. It presents with a rapid clinical deterioration and acute heart failure. A loud systolic murmur appears over the precordium. Doppler echocardiography is the golden standard for diagnosis. Case Report A female patient was admitted to the hospital with the diagnosis of an acute myocardial infarction with the involvement of the inferior wall and right ventricle. At admission, a loud systolic murmur above the precordium was noted and an emergency echocardiography was performed. A suspected interruption of the interventricular septum continuity was registered at the inferoseptal level. An emergency coronography was immediately performed to uncover a subocclusion of the medial segment of the right coronary artery. Ventriculography was performed in the same act and passage of contrast was registered from the left ventricle to the right at the septal level. A cardiac surgeon was consulted, but the patient died while being prepared for surgery. Conclusion Keeping in mind the high mortality rate, a prompt diagnosis and aggressive treatment with a timely surgical intervention are necessary to enable a favorable outcome. Poor prognosis parameters are advanced age and a myocardial infarction involving the inferior wall, which were both present in our patient.

Introduction/objective a myocardial infarction without coronary artery obstruction (MINOCA) is defined by universal acute myocardial infarction criteria with no obstructive coronary artery disease and no defined cause of the acute clinical presentation at angiography at that time. We are presenting an interesting case of hyperthyroidism as a potential cause of MINOCA. Case report the patient was admitted to the Clinic of Cardiology, Institute for Cardiovascular Disease Vojvodina under the suspicion of an inferior myocardial infarction with ST elevation. An emergency coronary angiogram was indicated and came back with normal coronary artery lumens. Echocardiography registered akinesia of the medioinferior and mediolateral wall with hypokinesia of the basal inferior wall accompanied by high levels of cardio specific enzymes. A working diagnosis of MINOCA was made and further diagnostic procedures were undertaken. Laboratory findings indicated hyperthyroidism, so the patient was put on suppressive therapy and low doses of beta blockers, nitrates an Ca antagonists. The hyperthyroidism most probably led to a coronary vasospasm, which is considered to have caused the MINOCA in our patient. Conclusion In younger patients, smokers who complain of chest pain early in the morning, hyperthyroidism should be considered to be a potential cause of MINOCA myocardial infarction.