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Bearing in mind the prevalence and dramatic clinical picture of acute cardiogenic pulmonary edema (ACPE), as well as impermissibly great early and late mortality, the goal of this paper was to examine if blood pressure (BP) is a predictor of in-hospital outcomes in ACPE. The analysis includes 1.397 patients with ACPE, treated at the Department for Cardiovascular Diseases, Clinical center, Niš, from 1993-2005. According to systolic blood pressure (SBP) on admission, patients were divided into three groups: low SBP (L;

In 1992, Brugada syndrom was introduced as a new clinical entity linking typical but variable ST segment changes in the right precordial leads to an increased vulnerability for lethal ventricular arrhythmias. The diagnosis of Brugada syndrome is based on clinical and electrocardiographic features. Recent studies illustrate the dynamic character of these ECG patterns. Whenever a large number of baseline ECGs was available during a follow-up, the diagnostic pattern could be documented only in approximately 25% of the tracings. Because the presence of the spontaneous coved type I ECG pattern is thought to be a useful predictor of future arrhythmic events in asymptomatic patients, these findings are of great clinical importance. ICD implantation is an option for the patients with Brugada syndrome and ventricular tachycardia or fibrillation. Extensive research is ongoing to find alternative pharmacological options for these patients, especially for patients in whom ICD implantation is contraindicated for various reasons.

Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in life quality and prognosis.Aim. The aim of study was to examine acute hemodynamic changes with different of CRT device modalities throughout optimization procedure and its impact on one year prognosis.Material and methods. The study comprised 62 patients with severe left ventricular systolic dysfunction (LVEF 24,6±4,4%, QRS duration 154,71±14,92 ms, NYHA class III/IV 47/15) with implanted CRT device. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left (LVPEI) and right (RVPEI) ventricular pre-ejection intervals, interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Stroke volume derived from the left ventricular outflow tract velocity–time integral (VTI) of left ventricular outflow tract (LVOT VTI) was measured as well. After one year patients underwent clinical, echocardiographical examination and 6 minute walking test.Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 175,4±21,5 to 142,6±16,7 (p < 0,01), RVPEI from 108,6±18,9 to 127,3±18,3 (p < 0,001), IVD from 71,3±14,8 to 24,7±7,6 (p < 0,001) and dP/dt from 532,2±74 to 675,2±111 (p < 0,001). Left ventricular outflow tract VTI increased after optimization procedure from 18±3,4 to 21±1,5 cm (p

Technology development in the recent years has enabled that both prevention and treatment of life-threatening heart rhythm disorders are managed by implantable cardioverter-defibrillators. Clinical studies have confirmed the advantage of this type of therapy in the prevention of sudden cardiac death in the recent years, so the use of ICDs has became a clinical routine. Rarely functional disturbances of those devices could be seen as undetected malignant arrhythmias (undersensing) or false detection of a normal heart rhythm (oversensing). Patient N.S. aged 67 years was admitted to Cardiology Clinic, Clinical Center Niš because of inappropriate sequential therapy of implantable cardioverter-defibrillator (ICD) (12 shocks were delivered within 48 hours before admission). ICD pacemaker was implanted four years before the admission due to dilated cardiomyopathy (LVEF 25%). Based on a detailed analysis of the device’s parameters the rapid increase in ventricular lead impedance was established (it was > 3000Ω; and the normal range is 250-2000 Ω). It was found that oversensing was the cause of sequential shocks delivery with energy of 35 J. The damaged lead of the ICD detected false signals as VF (ventricular fibrillation) and applied therapy. On the third day of hospitalization, the patient received an ICD Medtronic Maximo II device with the active electrode Medtronic Sprint Quattro 6947 but the left atrial electrode was not displaced. Prophylactic antibiotic therapy was given and patient was discharged 5 days after implantation. After one month at the control visit device parameters were satisfactory, the sensing function was appropriate with good impedance of the lead. Special feature of these devices is the need for individual programming, tailored to each patient, so it is necessary for a center that performs the implantation to have a medical team that has experience in the application of this type of therapy.

Aim. The implantable cardioverter-defibrillator [ICD] has been proven to reduce the risk of sudden cardiac death through the termination of ventricular fibrillation and life-threatening ventricular tachycardia. The simplest measure of defibrillation effectiveness is the DFT, defined as the lowest delivered shock strength required to defibrillate. Improved technology and use of ICDs for primary prevention have led some to question the need for either defibrillation testing or any assessment of defibrillation efficacy after implantation. Experts disagree about optimal testing because data are insufficient to define the trade-off between accuracy and risk of testing. However there are specific cases in which DFT is necessary.Material and methods. Authors describe the case of a patient with persistent left vena cava, a rare congenital anomaly, with no clinical importance which is usually accidentally revealed during the implantation of pacemaker or when placing a central vascular catheter. However, it represents a major problem and challenge for positioning of the standard pacemaker electrodes.Results. After a successful implantation via unconventional anatomic path authors carried out DFT testing to check that the device is functioning appropriately.Conclusion. Persistent left vena cava should not represent a contraindication for implantation of complex pacemaker systems such as ICD and DFT testing is advisable in this cases.

Prognosis in heart failure (HF) is poor and mortality widely ranges - 15-60% per year. Cardiac resynchronization therapy (CRT) is a therapeutic concept for patients who have NYHA III or IV class, LVEF ≤ 35%, left bundle branch block with wide QRS ≥ 120ms and ventricular dyssynchrony on optimal medical therapy. The aim of the study was to determine the effects of resynchronization therapy in patients with moderate to severe HF. In our study, 140 patients with HF were treated with different modalities of therapy in the Clinical Centre Niš. The first group of patients received CRT, and the second, control group were HF patients without echo criteria for CRT. In the control group, 36 patients received an implantable cardioverter-defibrillator (ICD). Results of the study showed that resynchronization therapy in patients with HF improves different parameters: clinical symptoms, echocardiographic parameters, decreases QRS duration, increases 6-minute walk test distance and decreases mortality rate. The benefit of cardiac resynchronization therapy in combination with optimal medical therapy is proven to be beneficial in patients with HF and asynchrony. CRT improved clinical symptoms of heart failure and had influence on disease progression.

No-reflow has been defined as “inadequate myocardial perfusion through a given segment of coronary circulation without angiographic evidence of a mechanical obstruction”. Important components of the process are thought to include endothelial ischemic injury producing “blebs” of tissue that directly obstruct the microvasculature, leukocyte plugging of capillaries, and the vascular effects of reactive oxygen species. No-reflow can complicate any percutaneous intervention (PCI), though it is more common following acute myocardial infarctions (MI), particularly with prolonged occlusion times. A 59-year-old woman presented to the hospital after two hours of continuous chest pain. Because of acute myocardial infarction of the inferior and lateral wall, she underwent direct stenting to an occlusion in the right coronary artery. Despite successful implantation of stents revascularization failed. In absence of aspiration devices and other pharmacological agent we decide to apply 30 mg (6000 IU) tenecteplase intracoronary. Three min after administration TIMI flow grade improved from TIMI 0 to TIMI 3. Managing no-reflow can be approached in a number of different ways and needs to be tailored to the type of intervention being performed. As confirmed in practice, prevention is better than cure and both mechanical and pharmacological approaches can be employed in high risk cases. In the setting of acute myocardial infarction the most effective preventative measure is the rapid opening of the vessel and as such the development of a robust and efficient primary PCI service is integral to the avoidance of this complication. Managing no-reflow will become increasingly important with the wider development of primary PCI. Within the setting of acute myocardial infarctions with no reflow as primary percutaneous intervention complication, there are potential important future pharmacological regimens that may become established and one of them can be tenecteplase.

Persistent left superior vena cava represents a congenital vascular defect of the venous system, and is usually discovered accidentally. Temporary pacemaker lead placement should be performed under the fluoroscopy control, but also by using the ECG QRS morphology. Echocardiography also represents a reliable noninvasive diagnostic tool for the assessment of temporary pacemaker lead position.

mulate two heart chambers (usually the right atrium and right ventricle) were de-signed. Those pacemakers were able to detect signals from the same heart chamber, and each of its functions (detection of intrinsing and application of artificial pacemaker signal) was performed as previously programmed. Essential hemodynamic improvement of this type of stimulation was the achievement of AV synchronization allowing that optimized function of the atria and ventricles mimics their natural functioning - timely contraction of the atria in relation to the AV valves and the ventricular outflow tracts. This study included 130 patients who had VDD pacemaker implanted at the Department of Cardiology, Clinical Center Niš, during 2009-2013. At the time of implantation, atrial sensing was 2.1±1.2 mV. Patients had follow up visits at one month, six months and one year after pacemaker implantation. After one year, the floating sensing in the atrium was 1.6±0.7 mV which was lower but not clinically significant. Bearing in mind the aforementioned, VVD pacing systems may be considered as the first line therapy in patients with AV block and normal SA node function, particularly in elderly patients and in patients with unsuitable anatomical structures of musculoskeletal and venous systems of the upper thoracic part, in cases of which it is sometimes difficult to place two DDDR electrode systems.

In our work we describe the case of a patient with a Brugada syndrome. It is a rare syndrome which carries a potential risk of sudden cardiac death which occurs usually at an early age. Unfortunately it is most frequently the first clinical manifestation of this genetic disease. Sometimes, as in our patient it could co-exist with other cardiovascular abnormalities which give us an opportunity to establish the right diagnosis and apply adequate preventive measures. It is of paramount importance to explore the possibility of the existence of this syndrome in the patient’s family members. The first diagnostic procedure is an ECG which is an inexpensive and readily available diagnostic tool.

A total of 175 H. influenzae strains were collected between 1994 and 2009 from all aged patient groups. The strains were isolated from patients with invasive and community-acquired respiratory tract infections. All strains were identified according to standard microbiological methods. Serotyping was done by a coagglutination test and by molecular PCR capsular genotyping. Beta-lactamase production was determined by the chromogenic cephalosporin test with nitrocephin as substrate. Most of the isolated H. influenzae strains were from children under 5 years of age (57.7%). Overall, 61 strains belonged to serotype b (34.9%) by the means of PCR capsular typing, 1 strain was type f, and 113 isolates (64.6%) were non-typeable (non-encapsulated) H. influenzae. Among the infants and children with meningitis or other invasive infections, aged 2 month to 5 years, all strains, except one, were serotype b. In respiratory tract infections (pneumonia, otitis media, sinusitis and people with chronic pulmonary diseases - exacerbations of COPD, bronchiectasis, cystic fibrosis) the most common - 96.5% were non-typeable strains in both groups children and adults. Overall, the prevalence of beta-lactamase production was 19.4%. But, it was much higher for invasive strains from CSF isolates - 37.7%, 25% in blood samples, and 37.5% in otitis media causative strains. Beta-lactamase production was less frequent in respiratory tract isolates - in sputum 13.3% and in URT samples - 2.3%. The rate of beta-lactamase production in CSF isolates has not changed for the last 10 years.PCR capsular genotyping method has to be performed for all non-b-type strains. The implementation of Hib vaccine in our country will be accompanied by a reduction in invasive diseases caused by H. influenzae type b in children, but it is not useful in preventing infections caused by non-typeable H. influenzae strains.

Sudden cardiac death poses an immense problem in the middle and highly developed countries because its first expression is at the same time the last one. Ventricle tachycardia, the monomorphous and the polymorphous ones, and ventricular fibrillation are rhythm disorders that are most frequently associated with the phenomenon of sudden cardiac death. Ventricular fibrillation is the most common cause of sudden cardiac death within the first hours of the acute myocardial infarction. A 60-year-old man was admitted to our Clinic from a local hospital due to acute onset of chest pain and ECG signs of anterior ST segment elevation myocardial infarction. He had severe rhythm disturbances, about 70 epizodes of ventricular fibrilation (VF). Due to rhytmical instability of the patient, we decided that along with PCI it was necessary to implant ICD twenty-two days after the first acute coronary event.The ICD implantation ensures the best prevention against sudden cardiac death (secondary and primary) in selected high-risk patients and has no alternative for any medicine known so far. It is significant that, lately, the field of application has extended to indication areas of primary prevention of sudden cardiac death, and especially to development of resynchronization implantable cardioverter defibrillator in the heart failure therapy.

Evaluating functional status in the patients with rheumatoid arthritis defines the presence of functional limitations and incapacitation. Patients’ ability to perform daily activities is reduced during the disease, and parameters influencing its reduction are numerous. The aim of this research was to examine the relation between joint damage and functional capacities of patients suffering from rheumatoid arthritis.The analysis included 98 patients with rheumatoid arthritis treated at the Institute «Niska Banja». The examinees’ HAQ score was determined, after which they were separated into three functional groups, while standard hands and feet radiography determined the level of radiological damage (Larsen score). The majority of patients (41,8%) were characterized by functional disability (HAQ>2,01). The difference in values of Larsen score between the HAQ groups was statistically significant (p0.05). The investigation showed that the increase of joint destruction reduces functional ability of patients with rheumatoid arthritis.

The paper compares the major unwanted coronary events in patients with surgical revascularization of myocardium and with percutaneous transluminal coronary angioplasty during the period of 36 months. The frequency of major unwanted coronary events, above all mortality, was higher in group of patients with surgical revascularization of myocardium, but the difference was not statistically significant.

Ventricular perforation is a rare complication of permanent pacemaker implantation. We report a case of 61-year-old woman with sick sinus syndrome who had the dual chamber pacemaker implanted. Five days after the implantation, the perforation of right ventricle by active ventricular fixation lead was detected. 12-lead surface electrocardiography and multislice chest scan are necessary for detection of rare complications after the pacemaker implantation.