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Introduction: Anaphylactic shock and pulmonary edema are unusual but life-threatening adverse reactions to drugs. We encountered a case of serious anaphylactic shock and acute pulmonary edema caused by a single oral intake of acetazolamide, a frequently used medication by several medical specialties especially in ophthalmology. Case presentation: An 80-year-old female was admitted to our emergency Coronary Unit presenting symptoms and signs of shock with acute pulmonary edema. Patient was hospitalised at the Opthalmological Department with intention to undergo cataract surgery. Approximately, four hours before operation, half a tablet of acetazolamide 250 mg was given, in order to control her pre-operative intraocular pressure. Half an hour later, she complained of nausea, became cyanotic, and suffered acute respiratory failure with characteristic massive pulmonary edema. Ventilatory support was initiated and O2 saturation increased to 89%. She was administered 2 ampoules of intravenously furosemide. The blood chemistry panel was normal, as well as myocardial cytolysis tests. Chest radiograph showed enlarged cardiothoracic index, illdefined vessels, peribronchial cuffing, alveolar edema. An echocardiogram showed normal atria and ventricles, normal systolic function, and excluded pulmonary hypertension. Furosemide (40 mg/IV, S: 1x3) and oxygen (8 Lt/min) were administered for the following 24 hours. Clinical improvement was seen and the O2 saturation was normalized. ECG controls were normal. The patient experienced a full recovery and was discharged 3 days later. Conclusion: The relationship between anaphylactic shock with acute pulmonary edema and acetazolamide seems highly probable in this case, considering the short time between drug assumption and onset of symptoms (about 30 minutes) and the absence of previous diseases to which symptoms could be related. The patient was not previously treated with acetazolamide. Nowadays, the clinical use of acetazolamide is very limited. Its principal uses are in the preoperative treatment of closed angle glaucoma and continuative therapy of open angle glaucoma. [ABSTRACT FROM AUTHOR]

Introduction: Hospitalizations of patients with atrial fibrillation (AF) lead to an explosion of expenditure on the public health system or private health expenses in family budgets. This study aims to estimate the duration and the cost of hospitalization for the public health system or the private cost to patients hospitalized after an AF episode., Material and Methods: Two hundred thirty-five consecutive patients (141 men and 94 women with an average age of 71.91 ± 12.2 years) who presented with AF to the Emergency Department of the General Hospital of Veroia during a single year were studied. We assessed the possible causes of arrhythmia, the duration and outcome of hospitalization, and the cost of hospitalization. We estimated the total cost by adding the price of the drugs used to cardiovert and the money spent on the patient's hospitalization., Results: The average hospitalization time was 2.37 ± 1.17 days, and the average cost of hospitalization (total cost) was € 488.22 ± 170.34. There was a significant correlation between the severity of the episode and the total cost (r =0.78, p<0.0001), with 87.6 % of the total cost (€ 427.76 ± 135.86) being related to the cost of hospitalization (imaging, laboratory, hospitalization) and the rest to the drug therapy cost. Amiodarone (97 patients, 41.1 %), flecainide (52 patients, 22 %), propafenone (68 patients, 28.8 %), vernakalant (two patients, 0.8 %), and quinidine (eight patients, 3.4 %) were utilized., Conclusion: The average cost of hospital care in patients with AF is significantly related to the severity of the episode. Effective drug therapy to reduce AF-provoking factors, such as antihypertensive therapy, combined with cardiovascular disease prevention in general, could reduce the morbidity and costs of AF-related hospitalizations. HIPPOKRATIA 2023, 27 (1):18-21., Competing Interests: The authors declare no conflicts of interest., (Copyright 2023, Hippokratio General Hospital of Thessaloniki.)

Competing Interests: The authors declare no conflict of interest.

Introduction: During recent years, several recommendations and guidelines regarding cardiac pacing have been published in the literature. However, only a few studies have examined the implementation of these guidelines in clinical practice. The current study aimed to record and evaluate the effects of the mainstream studies, and the experience gathered by all patients who have been followed-up at the pacemaker Unit of Veroia Hospital, which is a secondary care center., Methods and Results: Epidemiological, clinical, and electrocardiographic data were collected and studied for patients with a permanent pacemaker that have been followed-up in our hospital from 2002 to 2017. The total number of patients of the study was 3,902 (2,164 men; 55.45 %) with a mean age of 73.4 ± 12.6 years. Third degree atrioventricular (AV) block was the most common cause of pacing. Dysfunction of the sinus node involved the majority of cases with bradycardia-tachycardia syndrome. At 18 patients, the cause of permanent pacemaker implantation was carotid sinus syndrome and at 13 of them, cardio-vascular type of neurocardiogenic syncope. Dizziness and syncope were the most common symptoms. Dual-chamber pacing was the most common type of pacing, which has been increasing in recent years. In follow-up visits, the most frequent examinations concerned battery condition, as the stimulation and sensing threshold. Reprogramming of the device was required in 1,434 patients (36.75 %), especially during the first year after implantation., Conclusion: Pacing indications have been unchanged during all the years of the study and have been based on confirmed bradycardia and major symptoms. Reprogramming of the device was needed in an increased number of patients. HIPPOKRATIA 2018, 22(2): 75-79., Competing Interests: Nothing to declare.

Background: The pharmacological cardioversion of recent-onset atrial fibrillation (AF) is a challenge for the clinician. The aim of the study was to compare the efficacy, the safety, and the overall cost of intravenous (iv) administration of vernakalant, which is a relatively new atrial-selective antiarrhythmic agent, versus ibutilide, in cardioversion of recent-onset AF., Methods: We enrolled in this study 78 patients (56 men, 22 women; mean age 63.72 ± 6.67 years) who presented with recent-onset AF. Cardioversion was attempted in 36 patients (group A: 24 men, 12 women; mean age 62.44 ± 7.24 years) by iv administration of vernakalant (3 mg/kg over 10 min and if needed after 15 min, a second dose 2 mg/kg over 10 min) while in 42 patients (group B: 32 men, 10 women; mean age 64.81 ± 6 years) iv ibutilide was administered (1 mg over 10 min and if needed after 10 min, a second dose 1 mg over 10 min)., Results: AF was successfully converted in 52.78 % of (n =19) patients of group A vs 52.38 % of (n =22) patients of group B (p =0.58), with an average time of conversion 11.8 ± 4.3 min for group A patients vs 33.9 ± 20.25 min for group B patients (p <0.0001). The average length of hospital stay for patients of group A was 17.64 ± 15.96 hours vs 41.09 ± 17.6 hours for patients of Group B (p <0.0001). In one patient of group A, the administration of vernakalant was discontinued due to hypotension while two other patients reported dysgeusia during their hospitalization. In three patients of group B, the administration of ibutilide was discontinued due to development of nonsustained ventricular tachycardia, which resolved with discontinuation of the drug. The cost of administered drugs was estimated at 488.22 ± 170.34 € for patients of group A vs 142.43 ± 54.45 € for patients of group B (p <0.0001), however, hospitalization costs were significantly lower in patients of group A (258.5 8± 124.73 € over 414.43 ± 100.32; p =0.002)., Conclusion: There was no significant difference in the efficiency of converting recent-onset AF between vernakalant and ibutilide. Although vernakalant is an expensive drug, we recorded fewer side effects and more rapid restoration, which reduced the overall cost of hospitalization of these patients. HIPPOKRATIA 2017, 21(2): 67-73.

Background: Atrial fibrillation is a rare but important nonatherosclerotic cause of ST elevation myocardial infarction., Case Description: We report the case of a 69 years old woman who presented to our hospital with ST elevation myocardial infarction and permanent atrial fibrillation and eventually treated with thrombus aspiration from the left descending coronary artery., Conclusion: We have to notice the importance of the appropriate antithrombotic treatment in atrial fibrillation to prevent systemic embolism. In selected cases with ST elevation myocardial infarction due to coronary embolism, aspiration thrombectomy with or without balloon dilatation or stenting can be safely performed. Hippokratia 2016, 20(2):160-162.

Background: Coronary artery dissection is a rare complication of blunt thoracic trauma which can become rapidly lethal necessitating prompt diagnosis and treatment. Most reported cases of coronary artery injury, including dissection, involve the left anterior descending coronary artery, given its anatomical location in relation to the impact., Description of Case: A 72-year-old male, who was involved in a vehicular accident, sustained blunt thoracic trauma which resulted in isolated right coronary artery dissection and acute myocardial infarction. The culprit lesion was found in coronary angiography in the proximal right coronary artery and was successfully repaired with percutaneous coronary intervention and one drug-eluting stent placement., Conclusion: Traumatic dissection of coronary arteries must be suspected in blunt thoracic trauma. It can be treated with interventional management and results in a fairly good prognosis. Hippokratia 2015; 19 (3): 278-280.

Right sided heart thrombi may develop within the right heart chambers or they may be peripheral venous clots that on their way to the lungs, accidentally lodge in a patent foramen ovale, tricuspid chordae or Chiaris network. Type A thrombi have a worm-like shape and are extremely mobile. These pleomorphic thrombi are mainly localized in the right atrium, frequently move back and forth through the tricuspid orifice and may cause cardiovascular collapse when entrapment occurs. Type B thrombi attach to the atrial or ventricular wall indicating that they are probably of local origin. We describe the case of a middle age man (48 years old) with no cardiovascular history and a massive pulmonary embolism where transthoracic echocardiography revealed many type A thrombi in both right atrium and ventricle. He presented with acute dyspnea, diaphoresis and hemodynamical instability. He was treated with thrombolysis and after three hours was greatly improved and the thrombi were disappeared. After ten days of hospitalization he was discharged. Thrombi were originated in the popliteal region of the inferior vena cava of both legs and were totally treated.

Angioedema due to use of angiotensin-converting enzyme inhibitors (ACEIs) is a rare side-effect but is seen more often because of the increase in the use of these drugs due to their effectiveness and good tolerance in the treatment of hypertension and congestive heart failure. Other types of angioedema, which should be included in the differential diagnosis, are the hereditary type, which results from deficiency of C1 esterase inhibitor and the allergic angioedema. Angioedema is a potentially life-threatening condition when it is located to the mucosal and submucosal layers of the upper airway. Some times an angioedema case can be very severe, resistant to the usual treatment and even rarely fatal. The last eight months, six patients with angioedema due to ACEIs (5 cases) or angiotensin II receptor blockers (1 case), were examined and hospitalized at our department. We describe the case of a 65 year old woman with severe migratory angioedema of the tongue, the floor of the mouth and the oropharynx, which was rather resistant to the usual treatment.

Clinical manifestations of Q fever infection are fever, productive cough, decrease in exercise tolerance and chills. Cardiovascular involvement is well recognized and usually presents as endocarditis and infection of an aneurysm or vascular graft. Myocarditis has only rarely been described as a manifestation of acute Q fever infection. In this report we describe a case of a young adult who presented with angina-like symptoms and ECG and biochemical markers indicative of acute coronary syndrome. The diagnosis of myocarditis was ultimately made based on the results of a normal coronary angiography and increased anti-Coxiella burnetii antibody titer. The patient has not developed dilated cardiomyopathy after two years of follow up.