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Accurate information on the cause of death is obtained from expert teams based on pathological or forensic expertise. Reliable information can be obtained from physicians in hospital settings if the deceased person has been treated in such an institution and has previously been diagnosed with an illness (intrahospital mortality). Intrahospital mortality analysis provides reliable data that can be used in the planning of a bed fund, the amount of medication purchased, the purchase of equipment, the organization and creation of highly specialized medical teams (resuscitation team), the number of resuscitation procedures, the number of pathologists required for autopsy procedures, etc. The aim of the study was to determine the total number of deaths, to identify the most common causes of death and 10 leading diagnoses of deceased patients at the Internal Medicine Clinic, University Clinical Center Tuzla (UKC) during one calendar year (2011). Material and methodes: Archive material (case histories and reports of deceased patients of the Internal Medicine Clinic) were used. Results: During this period, 6 488 patients were treated at the Internal Medicine Clinic and 451 patients died. According to the analyzed data, the most common diagnoses and causes of death at the Internal Medicine Clinic were: cerebrovascular incidents 104 (20.84%), cardiogenic shock in 24 (5.31%), heart failure 59 (10.86%), hepatic coma with cirrhosis of the liver 25 (5.33%), sudden cardiac death 30 (6.53%), respiratory failure 15 (3.32%), myocardial infarction 41 (9.99%), multiorgan failure 18 (4.00%) , pulmonary edema 14 (3.10%), sepsis 6 (1.38%), pulmonary emboli 17 (3.82%), valvular heart disease 9 (1.92%), cardiorespiratory arrest 9 (1.92%) , malignant abdominal neoplasms in 23 (5.28%), pancreatitis 2 (0.44%), hematemesis 8 (1.76%), diabetes mellitus 4 (0.88%), lung tumor 1 (0.22%), chronic renal insufficiency 12(2.54%), suicidal intoxication 4 (0.88%), ileus 4 (0.88%), cachexia 3 (0.66%), restrictive cardiomyopathy 2 (0.44%), mesenteric thrombosis arteries 2 (0.44%), disseminated lupus erythematosus 2 (0.44%), coffee vein thrombosis inferior 2 (0.44%), and 1 (0.22%) died of an aneurysm aortic abdominalis, ventricular septal defect, amyloidosis, disseminated intravascular coagulation, systemic sclerosis, rheumatoid arthritis and breast tumors. Conclusion: During the analyzed period, 6488 patients were treated at the Internal Medicine Clinic and a total of 451 patients died. The most common cause of death in hospitalized patients is cardiovascular disease (n = 208; 41.68% of deaths), with cerebrovascular disease (n = 104; 20.84% of deaths) totaling 312 (62.25%) of deaths from cardio and cerebrovascular disease.

Introduction: Among long term athletes there is always present hypertrophy of the left ventricle walls as well as increased cardiac mass. These changes are the result of the heart muscle adaptation to load during the years of training, which should not be considered as pathology. In people suffering from hypertrophic cardiomyopathy (HCM), there is also present hypertrophy of the left ventricle walls and increased mass of the heart, but these changes are the result of pathological changes in the heart caused by a genetic predisposition for the development HCM of. Differences between myocardial hypertrophy in athletes and HCM are not clearly differentiated and there are always dilemmas between pathological and physiological hypertrophy. The goal of the study is to determine and compare the echocardiographic cardiac parameters of longtime athletes to patients with hypertrophic cardiomyopathy. Material and methods: The study included 60 subjects divided into two groups: active athletes and people with hypertrophic cardiomyopathy. Results: Mean values of IVSd recorded in GB is IVSd=17.5 mm (n=20, 95% CI, 16.00–19.00 mm), while a significantly smaller mean value is recorded in GA, IVSd=10.0 mm (n=40, 95% CI, 9.00-11.00 mm). The mean value of the left ventricle in diastole (LVDd) recorded in the GA is LVDd=51 mm (n=40; 95% CI, 48.00 to 52.00 mm), while in the group with hypertrophic cardiomyopathy (GB) mean LVDd value is 42 mm (n=20; 95% CI, 40.00 to 48.00 mm). The mean value of the rear wall of the left ventricle (LVPWd) recorded in the GA is LVDd=10 mm (n=40; 95% CI, 9.00-10.00 mm) while in the group with hypertrophic cardiomyopathy (GB) mean LVDd is 14 mm (n=20; 95% CI, 12.00 to 16.00 mm). The mean of the left ventricle during systole (LVSD) observed in GA is LVSD=34 mm (n=40; 95% CI, 32.00 to 36.00 mm), while in the group with hypertrophic cardiomyopathy (GB) mean LVSD is 28 mm (n=20; 95% CI, 24.00 to 28.83 mm). The mean ejection fraction (EF%) observed in GA is EF=60% (n=40; 95% CI, 56.41 to 63.00%), while in the group with hypertrophic cardiomyopathy (GB) mean EF value is 69% (n=20; 95% CI, 62.00 to 70.83 mm). Somewhat higher mean diastolic left ventricular function (E/A) was observed in GA, E/A=1.76±0.15, and lower average values in the group with hypertrophic cardiomyopathy: (GB) E/A=0.78±0.02. Conclusion: Mean values of parameters intraventricular septum thickness in diastole (IVSd), the thickness of the rear wall of the left ventricle (LVPWd), the diameter of the left ventricle during systole (LVSD) were statistically different between groups of athletes (GA) compared to the group of patients with hypertrophic cardiomyopathy (GB).

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p

In the last several decades the development of information-communication technology (ICT) and related fields has assisted medicine in many aspects. This paper tends to contribute to this ongoing trend by testing the accuracy of probabilistic neural network (PNN) trained to determine the results of cardiac stress test used for diagnosis of coronary/ischemic heart disease (CHD). The obtained results show that the network can determine the patients who really need immediate diagnosis treatments in the shortest time with the satisfactory accuracy. Therefore, the proposed simulations can be used for the physicians in the training process and additionally ease the work to cardiologists and improve the treatment of cardiac patients.

Introduction. Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. Patients and methods. In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Results. Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. Conslusions. If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation.

The aim of this study was to analyze (i) ratios between pro-inflammatory cytokines interleukin 6 (IL-6), interleukin 1 (IL-1), tumour necrosis factor α (TNF-α) and anti-inflammatory cytokine interleukin 10 (IL-10) in patients with acute myocardial infarction (AMI) and stable angina pectoris (ii) as well as correlation between IL-6 and IL-10 in AMI and (iii) correlation between IL-6 and lipoproteins in AMI.The total of 71 patients were enrolled in this study, 41 of them with AMI (study group) and 30 with stable angina pectoris (control group). The concentrations of cytokines and lipoproteins were measured from blood samples. Pro-inflammatory to anti-inflammatory cytokine ratios were calculated by dividing concentrations of pro-inflammatory cytokines with IL-10. In statistical analyses we used descriptive statistics, normality tests and analysis of correlation.IL-6: IL-10 ratio is significantly higher in AMI than in stable angina (P < 0,001), TNF-α: IL-10 is also higher in study group but the difference is not significant. We found positive linear correlation between IL-6 and IL-10 (r =0,43; p = 0,015) and negative linear correlation between IL-6 and high density lipoprotein HDL (r = -0,47; p= 0,008) in AMI.IL-6: IL-10 ratio is higher in AMI than in stable angina. There is linear correlation between IL-6 and IL-10 and IL-6 and HDL in AMI.

The most significant discoveries in the area of heart failure are the recognition of natriuretic peptide system and its multiple effects on cardiac structure and function with special effect on its natriuretic and hemodynamic processes. First information’s that heart, beside its function as a mechanical pump also has an important endocrine functions, exists for over 50 years. Chemical structure of atrial natriuretic peptide has been identified in 1984. and four years later a brain natriuretic peptide has been discovered owning its name because it has been identified in pig brain. Primary site of brain natriuretic peptide synthesis in heart has been identified in 1991. Natriuretic peptides are neither neurohormones that influence body fluid homeostasis through natriuretic and diuretic effect; regulate vascular tone by decreasing angiotensine II level and they inhibit nor epinephrine synthesis and increase parasympathetic tone. They are natural antagonists of renin-angiotensine-aldosteron system, and they have a great role in inhibition of ventricular hypertrophy and remodeling, protective effects in endothelial dysfunction are important; they increase effects of nitrite oxide, inhibit lipid deposition in vascular wall and inhibit thrombocyte activation, regulate coagulation and fibrinolytic processes as well. Natriuretic peptides clinical use is in early evaluation of heart failure, prognostic stratification and detection of systolic and diastolic dysfunction of left ventricle, assessment of prognosis during patient monitoring period, differential diagnosis of dyspnea, treatment adjustment and dosage titration, assessment during hospital admittance and discharge and forecast and reduction of coronary events.

The aim of this trial was to examine the effects of antihypertensive fixed combination of lisinopril plus hydrochlorothiazide (Lopril H, Bosnalijek dd, Bosnia and Herzegovina) on regression of left ventricular hypertrophy in patients with essential arterial hypertension. We included 297 patients in our trial, aged 54,65±9,6 years, with treated or untreated hypertension and with high risk of cardiac events, in an opened trial of therapy based on lisinopril plus hydrochlorothiazide. Patients from five European countries were followed up for a period of 12 weeks. Duration of treatment was 12 weeks. We adjusted daily doses of lisinopril plus hydrochlorothiazide after every clinical examination and recorded adverse effects of drugs.In the beginning and after 12 weeks of treatment, 277 patients (93,2%) underwent 2-dimensional echocardiography and there were 186 patients evaluated for efficacy of treatment on left ventricular hypertrophy (LVH). We recorded a regression of index mass LVH (168,56 vs 161,51 g/m2, P

The objective of this work was to determine the quality of life in patients with heart failure using the SF-36 and Minnesota questionnaire and to determine the importance of applying Framingham criteria as predictors of the value of these questionnaires.This cross-sectional study analyzed the quality of life in 120 subjects of both sexes and all age groups suffering from heart failure, according to the severity of clinical presentation. Subjects were divided into 4 equal groups according to NYHA classification of heart failure. Selection of subjects was made using the Framingham criteria for confirming already diagnosed heart failure. Control group included 30 patients not suffering from heart failure. Quality of life was assessed by use of the SF-36 and Minnesota questionnaire.In the study population of 150 subjects, there were 76 (51%) male and 74 (49%) female subjects divided into 4 NYHA groups of 30 subjects (20.0%) and control group of 30 subjects (20.0%). The analysis of within-group sex representation yielded no statistically significant difference (chi2 = 1.70, df = 4; p = 0.79). There was no statistically significant between-group age difference either (ANOVA, F = 0.74; p = 0.57). The values of SF-36 and Minnesota score expressed as median in the control and 4 NYHA groups were 98.6, 90.76, 70.14, 36.45 and 25.41 (Ht = 116.84; p0.0001) and 0.0, 0.47, 1.64, 2.99 and 3.42 (Ht = 113.42; p0.0001), respectively. The correlation coefficient r between heart failure NYHA classes expressed in the values of SF-36 and Minnesota score was r = -0950; p0.0001 and r = 0.931; p0.0001, respectively. The correlation coefficient r between the number of major and minor Framingham criteria and the values of SF-36 and Minnesota score was r = -0.790, -0.660; p0.0001 and r = 0.774, 0.671; p0.0001, respectively.The findings suggested that the quality of life in patients with heart failure was impaired and associated with the severity of clinical presentation, and that Framingham criteria could serve as significant predictors of the value of SF-36 and Minnesota scores and quality of life in patients with heart failure.

PP-079 Accurate information about the cause of death is given by expert teams based on pathological or forensic expertise. Reliable information can be obtained from doctors from clinical-hospital institutions if the deceased person was treated in such an institution and with previously diagnosed

Background and aim: Hormonal and immunological aspects of acute myocardial infarction (AMI) are in the past decade in focus of interest of researchers. We investigated concentrations of insulin like growth factor 1 (IGF-1), growth hormone (GH), insulin and markers of insulin resistance as like as inflammatory markers in order to find out their role and relationship in AMI. Material and methods: A prospective study was performed at University Clinical Center Tuzla from January to October 2010. Study group was consisted of 75 patients with AMI. There were 30 healthy controls. Blood samples were taken within first 24 hours of admission and analyzed for GH, IGF-1 and insulin at the Department of Nuclear Medicine. Glucose, glycolised hemoglobin HbA1c, C-reactive protein (CRP), fibrinogen etc. were analyzed by standard methods at Biochemistry unit. Results: Median of GH in the study group (0,96) was higher than in controls (0,26); p

Srčana insuficijencija zahtijeva od oboljelih svakodnevnu odgovornost i brigu za svoje zdravlje pridržavanjem raznih uputa u okviru svakodnevnog života. Poboljšanje kvalitete života je značajno s obzirom na činjenicu da je prognoza srčane insuficijencije lošija nego kod karcinoma dojke ili prostate. Cilj istraživanja bio je ocijeniti kvalitetu života oboljelih od srčane insuficijencije primjenom SF-36 i Minessota upitnika te utvrditi značenje primjene Framinghamskih kriterija kao prediktora vrijednosti SF-36 i Minnesota upitnika. Presječnom studijom analizirana je kvaliteta života 120 ispitanika oboljelih od srčane insuficijencije, podijeljenih u 4 skupine prema klasifikaciji NYHA. Kontrolnu skupinu činilo je 30 ispitanika koji ne boluju od srčane insuficijencije. Za potvrdu već postavljene dijagnoze srčane insuficijencije korišteni su Framinghamski kriteriji. Procjena kvalitete života učinjena je pomoću SF-36 i Minnesota upitnika. Utjecaj srčane insuficijencije na kvalitetu života bio je u uskoj vezi s težinom kliničke slike. Utvrđena je negativna i statistički značajna korelacija između klase NYHA i parametara SF-36 skora, a pozitivna i statistički značajna korelacija s vrijednosti Minnesota skora. Broj velikih i malih Framinghamskih kriterija značajno je pozitivno korelirao s vrijednostima Minnesota skora, dok je sa SF-36 skorom postojala negativna korelacija. Autori zaključuju da srčana insuficijencija utječe na kvalitetu života pacijenata s tom dijagnozom i u vezi je s težinom kliničke slike. Framinghamski kriteriji mogu poslužiti kao prediktori kvalitete života takvih pacijenata., Objective: The objective of this work was to determine the quality of life in patients with heart failure using the SF-36 and Minnesota questionnaire and to determine the importance of applying Framingham criteria as predictors of the value of these questionnaires. Patients and Methods: This cross-sectional study analyzed the quality of life in 120 subjects of both sexes and all age groups suffering from heart failure, according to the severity of clinical presentation. Subjects were divided into 4 equal groups according to NYHA classification of heart failure. Selection of subjects was made using the Framingham criteria for confirming already diagnosed heart failure. Control group included 30 patients not suffering from heart failure. Quality of life was assessed by use of the SF-36 and Minnesota questionnaire. Results: In the study population of 150 subjects, there were 76 (51%) male and 74 (49%) female subjects divided into 4 NYHA groups of 30 subjects (20.0%) and control group of 30 subjects (20.0%). The analysis of within-group sex representation yielded no statistically significant difference (χ2=1.70, df=4; p=0.79). There was no statistically significant between-group age difference either (ANOVA, F=0.74; p=0.57). The values of SF-36 and Minnesota score expressed as median in the control and 4 NYHA groups were 98.6, 90.76, 70.14, 36.45 and 25.41 (Ht=116.84; p

Cardiovascular disease is the most frequent cause of morbidity and mortality after renal transplantation and remains a significant barrier to improve long-term outcomes.Although transplantation improves life expectancy compared with dialysis, survival remains well below general population estimates. Approximately 50% of patients die with a functioning transplant, with approximately 50% of these deaths from cardiovascular disease or stroke.[3] Cardiovascular death rates underestimate the full impact of this disease process given the large number of nonfatal events, including acute myocardial infarction, cardiac arrhythmias, heart failure, and stroke, that affect quality of life.

BACKGROUND: Heart failure is a common disease that requires frequent and long hospitalizations, the active participation of health workers and family members in the care of such patients, and it leads to reduction of physical activity and lifestyle changes with the patient, which significantly affects the quality of life of patients with heart failure. OBJECTIVE: To determine the quality of life of patients with heart failure in relation to severity of the clinical features. RESPONDENTS AND METHODOLOGY: Analysis of life quality was performed for 120 patients suffering from heart failure, both genders, all age groups in relation to severity of the clinical features. Patients were divided into 4 groups according to NYHA classification of heart failure. The control group consisted of 10 subjects who do not suffer from heart failure. Assessment of quality of life was performed using the SF-36 questionnaire which consists of 8 segments classified in the dimension of physical and mental health. RESULTS: Study group consisted of 130 participants with heart failure had 66 (51%) of male, and other were females, divided into 4 NYHA groups, where every group had 30 subjects (23.1%), and one control group of 10 subjects (7.7%). The analysis of gender and age distribution within the groups found no statistically significant difference (X2=1.70; df=4; p=0.79), (ANOVA; F=0.74; p=0.57). The values of SF-36 score expressed as the median in the control and 4 NYHA groups were decreasing as the functional class progressed. The Spearman Correlation Coefficient showed that there is a strong negative correlation between the scores of SF 36 (total, segments and dimensions) and heart failure expressed through the NYHA classes. CONCLUSION: Quality of life in patients with heart failure was exacerbated and associated with severity of the clinical features.

Diagnosis of primarly cardiomypathies refers to genes discorders in chromosomes. Aim of this paper is to show genetics and molecular knowledges published so far. Familiar form hypertrophic cardiomyopathy is hereditable autosomatically dominantly in any of 10 genes that regulate contractile, structural and regulative function with predomination of mutation in gene for heavy chaire of myocardiac beta myosin localized at 14 chromosome (more than 200 mutation). Sporadic forms appears autosomatically recessively as the result of new mutation or as non-genetic form. Familiar dilated cardiomyopathy is associated with mutation more than 10 genes with frequent mutation of genes (beta myosin of heavy chain, cardiac T throponin, phospholamban and cardiospecific free methavinculin genes) and with clinical features that are mainly uknown (associated with peripheral myopathies). Restrictive cardiomyopathy is considered that the idiopathic restrictice cardiomyopathies has, also, hereditable atiology. A lot of the ries explain genes of this cardiomyopathy with predomination of heredithy with autosomatically dominant type (desmoplacin mutation) with variable expression of genes at 14, 1, 2, 3, 17 and 18 chromosome with programmed myocit death-apoptosis.

Poremećaj dijastoličke funkcije lijeve klijetke (LK) je jedan od prvih poremećaja funkcije LK, koji se registriraju prije poremećaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom košu, što bitno mijenja prognozu pacijenata sa akutnim koronarnim sindromom. Poremećaj relaksacije LK često se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremećaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraženija dijastolička abnormalnost uzrokovana ishemijom miokarda je produžena i usporena relaksacija miokarda. Ehokardiografske tehnike omogućavaju evaluaciju dijastoličkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoličku funkciju LK u bolesnika s AIM i usporediti varijable dijastoličke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraživanje uključeno je 60 bolesnika (37 muškaraca, prosječne životne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Praćene su varijable dijastoličke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u plućnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoličkog punjenja nije se statistički značajno razlikovala u obje skupine, ali je bila niža u odnosu na prosječnu vrijednost brzine ranog dijastoličkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoličkog protoka plućnih vena registrirana je statistički značajna razlika (p, Left ventricular (LV) diastolic function disorder is one of the first LV function disorders, which is detected before the regional disorder of contractility, ECG changes and chest pains, which significantly changes the prognosis of patients with acute coronary syndrome. The disorder of LV relaxation is often detected in patients with acute myocardial infarction (AMI), a disorder of LV stiffness in patients with anterior wall AMI. The most pronounced diastolic abnormality caused by myocardial ischemia is prolonged and delayed myocardial relaxation. Echocardiographic techniques allow the evaluation of diastolic filling of the both atria and ventricles. The aim of this study was to determine the LV diastolic function in patients with AMI and compare the diastolic function variables in the groups of patients with anteroseptal and inferior wall AMI. The prospective trial included 60 patients (37 men; mean age 59 ± 10) with first AMI who were divided into two groups according to the localization of ECG changes (anteroseptal vs. inferior wall). LV diastolic function variables were monitored that were analyzed by continuous (mitral flow) and pulsed color Doppler echocardiography technique (flow in the pulmonary veins and mitral ring motions). The value ​​of velocity of early diastolic filling was not statistically significantly different in the both groups, but it was lower compared to the average value of the velocity of the early diastolic filling of LV in healthy persons. In the maximum velocity of systolic pulmonary venous flow, a statistically significant difference was recorded (p

Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p

The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67+/-9.96 and whose disease lasted 3.8+/-4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention.

The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67±9.96 and whose disease lasted 3.8±4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention., Cilj rada je evaluirati prisustvo aterosklerotskog plaka na krvnim sudovima glave i vrata te procjeniti promjene u cirkulaciji kroz krvne sudove mozga u bolesnika sa sistemskim eritemskim lupusom (SLE). U 35 pacijenata sa SLE prosječne životne dobi 37,67±9,96 godina i dužine trajanja bolesti od 3,8±4,51godina uradila se Doppler ultrasonografija karotidnih arterija da bi se ustanovilo eventualno prisustvo zadebljanja intima-media zida krvnog suda ili prisustvo aterosklerotskog plaka. Perfuziona scintigrafija mozga uradi se u 15 od 35 pacijenata sa ciljem procjene promjena u cirkulaciji kroz krvne sudove mozga. Mjereno ultrazvučno 2/35 pacijenata sa lupusom su imali aterosklerotski plak, a 2/35 zadebljanje zida krvnog suda. Rezultati scintigrafije mozga su pokazali blage cirkulatorne promjene na karotidogramu u 5/15 pacijenata, 4/15 pacijenata su imali blage promjene u cirkulaciji kroz aa. cerebri mediae. 1/15 je imao teške promjene u karotidnoj cirkulaciji, dok je u 5/15 pacijenata nalaz bio uredan. U pacijenata sa SLE postoji određen stepen aterosklerotskih promjena te samo rana dijegnoza može doprinjeti pravodobnoj terapijskoj intervenciji.

Aim of this study is to examinate time period from the beginning of symptoms in acute coronary syndrome to the arrival time in Department of emergency medical service Zivinice where electrocardiogram is only one exact method for diagnosis of the myocardial ischemia. In retrospectively-prospectively study during one year, every patient with symptoms of acute coronary syndrome were taken beside and performed physical survay. We recorded ECG, performed ECG monitoring and/or serial ECG records. We investigated reasons for the lete arrival, sex and age and risk factors. In 167 patients with diagnostic acute coronary syndromes, average time period from beginning symptoms to the arrival time was 8.12 (+/-5,87) hours, significant longer from optimal 2 hours (p=0,001). Average age of these patients was 60,4 years. Male subjects were ill for about 9,2 years earlier than women and 1,6 times higher incidence than female subjects in all age groups. Most important risk and precipitating factors were hypertension, smoking, diabetes, hyperlipidemia, obesity. Leading factors for late arrival was unadequate attributing for importance of the acute chest pain and nonexistance of emergency medical service "on call".It is necessary to informe citizens about risiko factors of acute coronary syndrome development, its symptoms, characteristic and consequences . Necessity is to organize emergency medical service "on call" and establish modern emergency centers. It is necessery to adequately equip stationary emergency medical services and train doctors and other medical staff to point out and adopt the usage of algoritms and protocols for acute coronary syndromes management. To educate members of public services about basic principles of cardiopulmonary reanimation.

Introduction: “Athlete’s heart syndrome” is a condition characterized by structural, electrophysiologic and functional adaptation of the myocardium to physical activity (training), depending on the activity intensity, duration and type. In athletes left ventricular hypertrophy often resembles comorbid conditions (hypertension or hypertrophic cardiomyopathy) so the differential diagnosis of the disease is very important and crucial, especially in people who are in active training. In fact, if an athlete has finding which indicate thickening of the left ventricle walls, should be distinguished hypertrophy which occurred as a result of many years of training from accidental existence of hypertension or hypertrophic cardiomyopathy in the same person. Therefore, it is important to make a diagnostic difference between healthy and sick heart. Material and methods: The study involved male persons aged 20-45 which have increased muscle mass of the left ventricle due to different etiology. Definite sample included 80 respondents divided into two groups. All respondent underwent interview, clinical examination, ECG and echocardiography. Results: Average systolic blood pressure (SBP) for the athletes were 115.8±7.2 mmHg, and in patients, with hypertension 154.4±3.5 mmHg, average values of diastolic blood pressure (DBP) for the athletes were 74.2±8.1 mmHg in patients, hypertensive 96.2 ± 3.9 mmHg. Values of SBP and DBP were significantly lower in the group of athletes compared to patients with hypertension (p=0.001). The value of the SFO/min was significantly lower in the group of athletes compared to patients with hypertension (p

Hypertension is a major risk factor for cardiovascular diseases; drugs that reduce blood pressure and simultaneously improve or reverse endothelian dysfunction, as nebivolol, may be advantageous in terms of cardiovascular protection. The objective of this study is to show the anti-hypertensive efficacy and safety of nebivolol (5 mg once a day) given to patients with arterial hypertension for 3 months. It should also provide information about drug's influence on laboratory tests--fasting blood glucose and serum cholesterol, triglyceride and creatinine concentrations. Six centers--Tuzla, Sarajevo, Mostar, Bihac, Zenica and Banja Luka participated in this prospective study with follow-up period of 3 months that included 3 visits. The study group consisted of 328 hypertensic patients. Results showed a significant decrease in both systolic and diastolic blood pressure and heart rate at the end of the study. Fasting blood glucose level and serum cholesterol, triglyceride and creatinine changed significantly during the study, with lower levels of all the tests. Nebivolol seems to be free from some of the problems that generally accompany not only the classical beta- blockers but sometimes also newer classes of antihypertensive drugs. With its high anti-hypertensive efficiency and safety, and presence of statically significant difference in laboratory tests and beneficial effects, absence of adverse interaction with glucose and lipid metabolism, patients treated with Nebivolol may show an optimal adherence to therapy.

In the LBBB (the block of the left branch) control group there were 2 examinees Hi (6.45%). LAH and LHP were not found. The block of the left branch often creates problems in electrocardiographic diagnosis of coronary disease. It can be registered as complete LBBB, anterior-left hemiblock (LAH) and posterior-left hemiblock (LPH). The combinations are possible with the block of the right branch (RBBB) and A-V blocks. The most frequent cause is coronary disease, and next is sclerodegenerative changes in heart intrinsic-conduction system. Our study involves 98 of examinees with coronary disease, and 78 of that number are males and 24 are females, all average-aged 60.83+/-12.6. Control group (examinees who do not suffer from coronary disease) is made of 31 subjects, and 24 of that number are males, and 7 are females, all average-aged 57.16+/-10.4. Those diagnosed with coronary disease, as the examinees from control group, had the indications for the coronagraphy. The coronagraphy was performed and electrocardiographic findings were analyzed. The average degree of coronary arteries stenosis of the ill examinees was 77.5+/-14.9%, and in the examined group 23.5+/-12.5%. Of the examinees with the block of the left branch, 4 Hi examinees had one-artery illness (4.08%), 3 Hi had two-artery illness (3.06%) and 1 Hi had three-artery illness (1.02%). In one-artery coronary disease LAD stenosis was most frequent. Disruptions in conduction LBBB+LAH was found in 17.34% ill examinees, and 8.16% of those from LBBB and 9.8% from LHH. Of examinees with LAH, one-vessel coronary disease was found in 5.1% and two-vessel coronary disease in 4.08%. The most frequent was LAD stenosis, rarely combined with CX stenosis, and in one case LAD combined with RCA stenosis. In group with coronary disease LPH was not found.

Dysfunction of the left chamber of the heart happens when the function is not sufficient to supply all organs with needed quantity of blood, oxygen and nourishing materials. Consequence is an exhaustion of the heart compensatory and peripheral mechanisms. The research is based on the results of the analysis of residual changes that remained since acute myocardium infarct got over (scar, contracture changes, conductivity) and analysis of the remained functional part of the left chamber myocardium. Electrocardiogram, echocardiography and exercise test were used. 60 patients were examined. 6 varieties of chronic myocardium infarcts were found: anteroseptal, inferior, anterolateral and anterior-broaden, high-lateral and posterior localisation. Wagner's method QRS-scoring system and scores for wall motion by the American of ehocardiography were found the damage size of the myocardium mass. Correlative coefficient is full (r = 1.0). In chi2-test there is no significant difference (Wagner, echocardiography) in dimensions of old infarct (p0.05). Dyastolic dysfunction was set by echocardiographic method for 75%, systolic 41.11% examinees, remodelling in 80%, extended isovolumetric relaxation time and time of deceleration in 100% cases, speed ratio E-wave and A-wave below 1.0 in 82.66% cases. Exercise test was made for 85% examinees. Dysfunction was registered in 84.37%, diastolic in 80.39%, systolic in 43.17% cases. On the base of coronarographie results (23.33% examinees) the sensitivity was set for: exercise test in systolic dysfunction is 42.86%, in dyastolic is 71.43% and echocardiography in systolic disfunction is 57.14%, in dyastolic 100%. According to echocardiographic analysis of parameters the greatest influence has reduction of ejection fraction with 36.67% in systolic and extension of the period of deceleration with 38.79% in diastolic dysfunction. There is a good complement of the tested methods (p0.05). There is possibility, with these methods to appraise dysfunction of the left chamber in old myocardium infarct with conclusion that echocardiography is more sensitive since gives more data and direct visualization of changes.

Precondition to prevention and control of morbidity and mortality of myocardial ischemia--coronary disease, is its good diagnostic. Goal of this study is to asses diagnostic significance of positive trademill stress test in diagnosis of coronary disease.we analyzed 120 patients with markedly positive classic trademill stress test using Bruce protocol in the year 2003. In all cases, positive stress test was followed by selective angiography, using standard technique with multiple sections. Blood vessel narrowing of more than 50% was chosen as the criteria for positive angiographie finding. With the help of coronary angiography, it was found that 62 (51.7%) of patients has stenosis of less than 50% or normal angiographic finding. 58 (48.3%) of patients had stenosis of more than 50%. Of that number, 24 (41.4%) had one-vessel coronary disease, 12 (20.7%) two-vessel coronary disease, and 10 (34.5%) three-vessel coronary disease. 2 patients (3.4%) had stenosis of the trunk of left coronary artery. Results of this study show that the sensitivity of trademill stress-test is less than optimal, and should be supplemented by other non-invasive techniques (such as myocardial perfusion scintigraphy, radionuclide ventriculography and stress echocardiography) in diagnostics of coronary disease.

The occurrence of U-wave in electrocardiogram appears after T-wave. It is period of the greatest excitability of the myocardium in heart electrical activity usually of the some direction as its own T-wave. AIM OF THE WORK ANALYSE: U-wave with ischaemia and dysfunction of the myocardium in exercise test.The prospective study has been done for 51 patients. Electrocardiogram, exercise test vas made for all patients and immediately after test, echocardiography with Doppler and colour-Doppler. In the analysis of dysfunction of the left chamber these important parameters were followed: METS; decrease of blood pressure, devaluation of ST-segment, U-wave, heart rate, dyspnea, sweating and paleness.Positive U-wave was noticed in 51%, negative in 24% examinees. Sensitivity of U-wave on the base of the breakdown of segmental vall motion in echocardiography (ischaemia) is 66.67% with false negative resists of 33.33%. Systolic dysfunction with influential parameters correlates in the best way with decrease of blood pressure and regressive coefficient is 66.93, but the weabest correlation is with U-wave (0.53). Correlative coefficient for U-wave in systolic function is 0.263. Regressive coefficient with influential parameters in diastolic dysfunction is 3.34, correlative coefficient is 0.108.U-wave in registered at rest after exercise test when heart rate is equal or below 95 in a minute. Registration of U-wave is an additional parameter in diagnostics of ischaemia and dysfunction of the myocardium of the left chamber (small influence).

To establish the presence of pericarditis and exudative pleuritis in patients with systemic lupus erythematosus (SLE) prior to and after glicocorticoid and cytotoxic therapy.In 43 patients, 39 women and 4 men, with SLE (disease was diagnosed according to revised American College of Rheumatology ACR criterias, 1997), aged between 20 and 61 and averaged disease duration of 5.54 +/- 5.74 years, heart/lung radiology and heart echosonography were performed in order to discover possible serositis (pericarditis and exudative pleuritis) prior to and after cytotoxic and glucocorticoid therapy.The presence of pericarditis and exudative pleuritis was established in 20 patients (47%) before the therapy. After the therapy pericarditis was present in 2 patients, average volume of 150 ml, and exudative pleuritis was also present in phrenicocostal sinus, but its volume was minimal. This table is showing the results of our study on patients with SLE and serositis. The results were compared with the results of European and Belgrade group in year 2000. [table: see text]Higher frequency of serositis (pericarditis and exudative pleuritis) in our study is probably a result of more active disease, and the effects of cytotoxic and glucocorticoid therapy were satisfing exept in two patients who were resistant on therapy. That is the reason why we had to consider plasmapheresis.

Long time ago lipids increased in blood have been known as risk factor for atherosclerosis that causes coronary heart disease among which myocardial infarction is the most complicated. Aim were to present the lipids status structure in patients with acute myocardial infarction and on the basis of that to suggest corresponding statin in treatment. Our research involved 202 patients with acute myocardial infarction, patients were both gender and from 37 to 89 year. Out of total number of patients, 100 of them were with anterior myocardial infarction (group I) and 102 with inferior myocardial infarction (group II). Whole cholesterol, low density lipoproteins, high density lipoproteins and triglycerides were followed. Hi square test and variance analysis were used to prove statistically significant difference. In the sample of group I increased LDL was found in 92 patients and increased TGL in 46 patients while decreased HDL was found in 61 patients. In the sample of group II increased LDL was found in 64 patients, increased TGL in 44 patients, while decreased HDL was found in 51 patients. We analysed the next combinations in both groups: LDLwith HDL; LDLwith TGL; HDLwith TGL; LDL, TGLwith HDL. Combination decreased HDL with increased TGL was found in group I in 5 patients, and in group II in 12 patients. Other combinations in both groups were similarly values. On the basis of the obtained results we found statistically significant difference between the two groups of patients. Patients in group I have more frequently increased values of LDL in comparison to patients in group II (p0.00005). In patients in group II who had decreased HDL and increased TGL statistically significant difference was found in comparison to the patients in group I (p0.02). On the basis of the obtained results and up to now studies on statins effects we suggest Atorvastatin for treatment the patients with anterior myocardial infarction, increased LDL with normal values of HDL and Simvastatin for treatment the patients with inferior myocardial infarction, decreased HDL.