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8. How to avoid system delay in the managing of patients with ST-segment elevation myocardial infarction – experience from Western Slavonia

Author

Cvitkušić Lukenda, Katica, primary, Knežević Praveček, Marijana, additional, Dunđer, Ivica, additional, Raguž, Antonija, additional, Bitunjac, Ivan, additional, Mišković, Domagoj, additional, Jakab, Jelena, additional, Grgić, Ivana, additional, Miškić, Blaženka, additional, Bardak, Branka, additional, Lukenda, Anto, additional, and Gabaldo, Krešimir, additional

Published
2023
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13. Acute coronary syndrome and cancer

Author

Knežević Praveček, Marijana, primary, Gabaldo, Krešimir, additional, Mišković, Domagoj, additional, Bitunjac, Ivan, additional, Grgić, Ivana, additional, Jakab, Jelena, additional, Vučić, Domagoj, additional, Dunđer, Ivica, additional, Miškić, Blaženka, additional, and Cvitkušić Lukenda, Katica, additional

Published
2022
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15. Diagnostic complexity of rifampicin-induced coagulopathy in a patient with spontaneous muscle bleeding

Author

Vučić, Domagoj, Cvitkušić-Lukenda, Katica, Dunđer, Ivica, Gabaldo, Krešimir, Knežević-Praveček, Marijana, and Miškić, Blaženka

Subjects
Vitamin K, infective endocarditis, Abdominal Wall, Disseminated Intravascular Coagulation, Staphylococcal Infections, rifampicin, coagulopathy, Anti-Bacterial Agents, Plasma, case report, Humans, Female, Clinical Case Report, Rifampin, disseminated intravascular coagulation, Research Article, Aged
Abstract

Introduction: Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium. Patient concerns: A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock. Diagnosis: Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy. Interventions: By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound. Outcomes: At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram. Conclusion: Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.

Published
2021

17. Relationship Between Serum Ferritin Levels, Arterial Hypertension and Shift Work in Women. A Cross-sectional Analysis

Author

Cvitkušić Lukenda, Katica, Vučić, Domagoj, Raguž, Antonija, Bitunjac, Ivan, Mišković, Domagoj, Gabaldo, Krešimir, Miškić , Blaženka, Knežević Praveček, and Marijana

Subjects
serum ferritin levels, arterial hypertension, shift work, daytime work
Abstract

Introduction: The aim of this study was to use cross-sectional research to determine the relationship between serum ferritin levels and arterial hypertension in women who work in shifts and women with regular daytime working hours. Methods: The respondents included 67 female nurses divided into two groups: nurses working in 12-hour shifts (7 am to 7 pm/7 pm to 7 am) were the test group, while nurses regularly working for 8 hours (7 am to 3 pm) were the control group. Data collection included information on associated diseases, chronic medication, last menstruation, duration of menopause, cigarette smoking, number of years of employment in shift work and regular daytime work, laboratory and anthropometric parameters and blood pressure levels. Results: In all respondents, there was a significant and positive relationship between ferritin and CRP levels, i.e. the higher the CRP levels, the higher the ferritin levels (Rho = 0.401 ; P = 0.001). Among respondents who have regular daytime working hours, there was no significant association between ferritin and other indicators, while in the group of those who work in shifts, there was a significant and positive association between ferritin and CRP (Rho = 0.468 ; P = 0.002). Finally, a positive correlation was found between the number of years of employment in shift work and systolic blood pressure levels, i.e. higher systolic pressure was observed in those respondents who worked longer in shifts (Rho = 0.424, P = 0.03). Conclusion: The study demonstrated a significant correlation between the number of years of employment in shift work and systolic blood pressure. A positive correlation between serum CRP and ferritin levels was also observed in all respondents, and especially in shift workers.

Published
2021

18. Kardiovaskularni rizici i šećerna bolest, prevencija i liječenje

Author

Miškić , Blaženka, Ćosić, Vesna, Stojkov , Željka, Bitunjac , Ivan, Vučić , Domagoj, Mišković , Domagoj, Cvitkušić Lukenda , Katica, Knežević Praveček , Marijana, Gabaldo , Krešimir, Strinavić Bakunić , Valentina, Kajinić , Ivan, Moser , Nataša, Zukanović , Sidbela, Jurić Samardžić , Maja, Pavković , Gorana, Jakab , Jelena, and Miškić , Karla

Subjects
kardiovaskularni rizici, šećerna bolest, kardiometabolička ambulanta
Abstract

The book describes the most important risk factors for the development of cardiovascular incidents in patients with diabetes. CVOT studies and recommendations on the latest therapy of type 2 diabetes mellitus are presented, as well as ways of its prevention and effective treatment.

Published
2021

21. Cardiovascular Disease Continuum

Author

Miškić, Blaženka, primary, Ćosić, Vesna, additional, Knežević Praveček, Marjana, additional, Vučić, Domagoj, additional, Mišković, Domagoj, additional, Bitunjac, Ivan, additional, Gabaldo, Krešimir, additional, and Cvitkušić Lukenda, Katica, additional

Published
2021
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24. Complicated infarction of the saphenous vein graft.

Author

Praveček, Marijana Knežević, Gabaldo, Krešimir, Raguž, Antonija, Mišković, Domagoj, Bitunjac, Ivan, Pavlov, Marin, Dunđer, Ivica, Vujeva, Božo, Jakab, Jelena, Miškić, Blaženka, Lukenda, Katica Cvitkušić, and Unić, Daniel

Subjects
*MYOCARDIAL infarction, *SAPHENOUS vein, *INFERIOR wall myocardial infarction, *CORONARY artery bypass, *VENTRICULAR septal rupture, *ANKLE brachial index, *GASTRIC bypass, *INFARCTION
Abstract

Introduction: Saphenous vein graft (SVG) occlusion usually occurs in degenerated vein grafts.1-4 In this case report, we present the case of a patient who presented with total occlusion of an Aorta-Posterior descending SVG during inferior myocardial infarction (MI), complicated with ventricular septal rupture (VSR) over a fifteen-day period after failed percutaneous coronary intervention (PCI). Case report: 63-year-old man with a history of coronary artery bypass graft surgery (CABG) eleven years ago, including hypertension, diabetes mellitus, peripheral artery disease, dyslipidemia, and smoking habits, was admitted to Cardiology Department with atypical chest pain and fatigue. Fifteen days before admission, the patient had been hospitalized for subacute inferior myocardial infarction. Angiogram showed complete thrombotic occlusion of the SVG to tile posterior descending artery (Figure 1). Primary PCI to the SVG was unsuccessful. Fifteen days after the initial hospitalization, the control coronary angiogram was unchanged. Transthoracic echocardiography showed VSR of the mid inferoposterior septal segment. Color Doppler evaluation showed a turbulent flow jet at the basal septum between the left and right ventricles. The patient was hemodynamically stable, so surgery was performed after one week. Magnetic resonance imaging was performed before surgery to identify the dissected area and to determine the surgical strategy (Figure 2). The VSR was closed by a modified double patch repair. The patient was discharged from the hospital 10 days after surgery without complications. At six-month follow-up, the patient is stable. Conclusion: Patients with prior CABG represent a high-risk population for future cardiovascular events. Acute MI with SVG involvement is difficult to treat and associated with higher long-term event rates such as procedural complications and no-reflow. This case highlights the role of the interprofessional team in the successful management of patients with VSR after myocardial infarction with prior CABG. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Kasna antraciklinska kardiotoksičnost: prikaz mladića s osteosarkomom

Author

Knežević Praveček, Marijana, Cvitkušić Lukenda, Katica, Raguž, Antonija, Dunđer, Ivica, Bitunjac, Ivan, Gabaldo, Krešimir, Pevec, Damira, Prvulović, Đeiti, Vujeva, Božo, and Miškić, Blaženka

Subjects
nuspojave, karcinom, kardioonkologija, kemoterapija
Abstract

Uvod: Kardioonkologija je novo interdisciplinarno područje u kardiologiji usmjereno na značajno smanjenje kardiovaskularnog morbiditeta i smrtnosti te poboljšanje kvalitete života u bolesnika oboljelih od zloćudnih bolesti. Stope preživljavanja zloćudnih bolesti su u stalnom porastu, uglavnom zbog pojave nove, učinkovitije i ciljane terapije. Međutim, mnogi novi lijekovi zajedno s nekim od starijih kemoterapijskih lijekova, kao što su antraciklini, potencijalno su kardiotoksični. Kardiotoksičnost nepovoljno utječe na prognozu bolesnika oboljelih od zloćudne bolesti pa je njena prevencija kao i liječenje ključno za poboljšanje kvalitete života.1 Prikaz slučaja: Prikazujemo slučaj mladića koji je u dobi od 18 godina izliječen od osteosarkoma femura amputacijom noge i kemoterapijskim liječenjem koje je uključivalo antraciklin. Nažalost, dalje nije bio u kardiološkom praćenju. Hospitaliziran je četrdesetoj godini života zbog teške zaduhe, navodeći da je proteklih godina slabije tolerirao fizički napor i imao povremeno palpitacije. Utvrđena je dilatativna kardiomiopatija s reduciranom ejekcijskom frakcijom (LVEF od 35%). Daljnji klinički tijek je kompliciran s ventrikularnom tahikardijom te je implantiran kardioverter-defibrilator. Sad se liječi optimalnom medikamentoznom terapijom koja uključuje karvedilol, male doze furosemida, eplerenon, sacubitril-valsartan i u redovitom je kardiološkom praćenju. Zaključak: Antraciklinska kardiomiopatija se prezentira kao rana i kasna. Rana kardiotoksičnost se javlja unutar godinu dana po aplikaciji antraciklina i to sa znacima kongestivnog srčanog popuštanja. Kasna prezentacija antraciklinske kardiomiopatije odnosi se na bolesnike koji razviju srčano popuštanje 10-20 godina po antraciklinskom liječenju. Bolest može dugo biti i asimptomatska te stoga svi bolesnici koji su primali antracikline trebaju dugogodišnji kardiološki nadzor. Veliko ograničenje je samo praćenje LVEF jer se promjene LVEF obično se javljaju u kasnijoj fazi kada je već došlo do značajne toksičnosti. Danas se u bolnici počinjemo koristi s global longitudinal strain za rano otkrivanje promjena u kontrakciji srca. Cilj je rano otkrivanje znakove toksičnosti i uvođenje terapije radi poboljšanja LVEF i smanjenja rizika od razvoja ireverzibilne kardiomiopatije.

Published
2018
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27. Otapanje tromba u aurikuli lijevog atrija dabigatranom nakon neuspjelog liječenja rivaroksabanom

Author

Cvitkušić Lukenda, Katica, Knežević Praveček, Marijana, Gabaldo, Krešimir, Dunđer, Ivica, Vujeva, Božo, Prvulović, Đeiti, Raguž, Antonija, Bitunjac, Ivan, Miškić, Blaženka, and Lukenda, Anto

Subjects
fibrilacija atrija, tromb, dabigatran
Abstract

Uvod: Tromb u aurikuli lijevog atrija (LAA) važan je uzrok cerebralnih tromboembolijskih incidenata. Prevalenciju i liječenje tromba u LAA s novim oralnim antikoagulansima (NOAK) i dalje ostaje za razjasniti. NOAK-i su superiorniji od varfarina u prevenciji moždanog udara ili sistemske embolije, uzrokuju manje krvarenja i rezultiraju nižom smrtnošću u bolesnika s atrijskom fibrilacijom. U literaturi nema previše izvješća o otapanju tromba u LAA primjenom NOAK-a. Zlatni standard za dijagnozu tromba u LAA je transezofagealna ehokardiografija (TEE). U bolesnika s dijagnozom tromba u LAA, optimalna duljina terapije je nejasna. Prikaz slučaja: Predstavljamo 59-godišnjeg muškarca s perzistentnom fibrilacijom atrija i trombom u LAA. Početno liječenje je bilo s rivaroksabanom 1x20 mg tijekom 30 dana. Unatoč činjenici da je bio na rivaroksabanu 30 dana prije, odlučili smo se učiniti TEE, kojom smo pronašli formirani mali tromb (12x10 mm) u LAA. Trideset dana liječenja dabigatranom pokazalo je potpuno otapanje tromba te se potom učini uspješna kardioverzija sa 120 J bez znakova kardijalnih embolizama i bolesnik otpusti u dobrom stanju pod antikoagulantnom terapijom dabigatranom 2x150 mg. Zaključak: U ovom slučaju odabrali smo dabigatran nakon rivaroksabana. Prema našem saznanju, ovo je prvi dokumentirani slučaj otapanja tromba u LAA na terapiji dabigatranom nakon neuspješnog liječenja rivaroksabanom 20 mg jednom dnevno. Stoga bi se dabigatran mogao razmotriti u smislu važne uloge u strategiji kontrole ritma u sličnim slučajevima, što zahtijeva daljnja ispitivanja na većoj populaciji.

Published
2018
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29. Cardiovascular Disease Continuum - Peripheral Artery Disease Versus Coronary Heart Disease.

Author

Miškić, Blaženka, Ćosić, Vesna, Lukenda, Katica Cvitkušić, Gabaldo, Krešimir, Bitunjac, Ivan, Mišković, Domagoj, Vučić, Domagoj, and Praveček, Marijana Knežević

Subjects
PERIPHERAL vascular diseases, CORONARY disease, CARDIOVASCULAR diseases, CORONARY artery disease, CARDIOVASCULAR system, HABIT, SMOKING
Abstract

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2021
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30. Primjena integriranog algoritma u dijagnostici i liječenju periferne arterijske bolesti u bolesnika s dijabetesom.

Author

Gabaldo, Krešimir, Vučić, Domagoj, Bitunjac, Ivan, Praveček, Marijana Knežević, Lukenda, Katica Cvitkušić, Krčmar, Tomislav, and Miškić, Blaženka

Subjects
*PERIPHERAL vascular diseases, *LEG amputation, *COMPUTED tomography, *POPLITEAL artery, *DIABETES complications, *FOOT care, *ANKLE brachial index
Abstract

Diabetes and its complications causes up to 9% of total mortality worldwide. Peripheral arterial disease is, in addition to cardiovascular diseases, the most common complication of diabetes with a prevalence that increases with age and the duration of diabetes. The specificity of peripheral artery disease in diabetics is the diffuse involvement of the arterial system, especially the popliteal arteries. Consequently, diabetes is still the main cause of small and large limb amputations, which, in addition to a reduction in the quality of life, significantly affects the survival of patients. Since the developed of atherosclerotic disease involves a number of complications from the professional domain of various subspecialties, such as diabetic foot, it is necessary to organize multidisciplinary teams for the diagnostic and therapeutic purposes. For this purpose, the General Hospital “Dr. Josip Benčević” in Slavonski Brod organized a multidisciplinary team with the goal of early recognition of peripheral artery disease and application of timely treatment. Experience from everyday clinical practice indicates that proper functioning of the team requires an accurate diagnostic and therapeutic algorithm to avoid long waiting lists for imaging, which includes Color Doppler and multislice computed tomography. The diagnostic algorithm was based on the ankle-brachial index, and its value and clinical picture guided and determined the degree of urgency and the type of image processing. By integrating the algorithm into the online database registry, we were able to more easily monitor the incidence rate, treatment success, and dependence on the entered variables. We hope that this approach will result in earlier detection of symptomatic disease and thus a significant reduction in lower limb amputations and, ultimately, mortality. [ABSTRACT FROM AUTHOR]

Published
2021
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35. Endovascular treatment in critical limb ischemia - “When inflow is enough”.

Author

Gabaldo, Krešimir, Krčmar, Tomislav, Praveček, Marijana Knežević, Mišković, Domagoj, Bitunjac, Ivan, Dunđer, Ivica, Raguž, Antonija, Miškić, Blaženka, and Lukenda, Katica Cvitkušić

Subjects
*ENDOVASCULAR surgery, *LEG pain, *TIBIAL arteries, *PERIPHERAL vascular diseases, *ISCHEMIA, *FEMORAL artery
Abstract

Introduction: Critical limb ischemia (CLI) is a clinical syndrome characterized by chronic ischemic at-rest pain, ulcers, or gangrene in one or both legs attributable to objectively proven arterial occlusive disease¹ . Patients with CLI have a one-year risk of amputation greater than 25%. Endovascular treatment is preferred as the first option of revascularization treatment because of lower morbidity and mortality compared to open surgery². The main goal of the treatment is to establish flow through at least one vessel to the foot. CLI is often associated with multilevel disease usually requires outflow (tibial) revascularization as well as treating inflow disease. It remains unclear whether revascularization of both inflow and outflow vessels yields better outcomes than treating only inflow vessels in patients with critical limb ischemia³. Case report: We present the case of 75-year-old male patient with CLI presented with non-healing ulcer of right foot. Risk factors for peripheral artery disease were diabetes, hypertension, and previous stroke. WIfI (Wound, Ischemia, foot Infection) index was 2-2-0 which addressed high risk of amputation. MSCT scan showed superficial femoral artery (SFA) occlusion in inflow region, while in outflow region both tibial arteries were occluded, and a peroneal artery was patent. We performed an SFA intervention with a good result in inflow region. In 3 months, follow-up the ulcer healed completely. Conclusion: Concomitant inflow and outflow revascularization in CLI did not offer an advantage over just inflow revascularization in reducing the rate of amputation, total death, target lesion revascularization, if there is at least one patent artery in tibial region. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Is the ankle brachial index a useful tool for assessing appropriateness?

Author

Mišković, Domagoj, Gabaldo, Krešimir, Lukenda, Katica Cvitkušić, Miškić, Blaženka, and Krčmar, Tomislav

Subjects
*ANKLE brachial index, *TRANSLUMINAL angioplasty, *PERIPHERAL vascular diseases, *SYSTOLIC blood pressure, *VASCULAR surgery, *ENDOVASCULAR surgery, *RADICULOPATHY, *POLYNEUROPATHIES
Abstract

Introduction: In 1950, the American physician Travis Winsor was the first to report connection between peripheral arterial disease of the lower extremities with a systolic pressure in the ankle¹ . Today, ABI (ankle brachial index) is the first line of non-invasive diagnostics for the screening and diagnosis of peripheral arterial disease of the lower extremities². However, the indication for endovascular treatment is based on the patient’s symptoms and the anatomical characteristics and localization of the lesions. Case report: 58-year-old male patient with previously known coronary artery disease, arterial hypertension, and diabetes was in outpatient follow-up with due to symptoms of lumbosacral radiculopathy. On CT scan in 5/2021 L2-S1 disc bulging was described and in in 6/2021, the patient underwent L4-L5 laminectomy. Electromyoneurography of the legs showed L3-S1 radiculopathy and diabetic polyneuropathy. In 3/2022, he underwent an ultrasound scan where 50% calcified stenosis of the right common femoral (CFA) artery and 75% stenosis of the distal segment of the left superficial femoral artery (SFA) was verified. At the vascular surgery outpatient office, he reported a walking distance of 200 meters. He was recommended an ABI, CT angiography of the lower extremities and exercise therapy. In 5/2022, the right ABI was 0.96 and the left 0.75. At the next control, the walking distance was still 200 meters, and the left ABI was 0.66. The decision of the multidisciplinary team was to perform percutaneous transluminal angioplasty of the left SFA. The intervention was done by right femoral approach, after which crossover was performed in the left CFA and DCB (drug-coated balloon) was applied to the lesion in the left SFA. The control ABI after the intervention was 0.93 on the left, with no change in the ABI on the right. At the follow-up after 3 months, the patient had a walking distance of more than 200 m with an ABI index equal to the post-intervention. Conclusion: ABI can be a useful tool for appropriateness, especially in atypical and unclear clinical conditions. It is also an important tool for follow up after endovascular interventions³. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Statin-naive patients with acute coronary syndrome in Slavonski Brod.

Author

Mišković, Domagoj, Gabaldo, Krešimir, Lukenda, Katica Cvitkušić, Dunđer, Ivica, Praveček, Marijana Knežević, Bitunjac, Ivan, Raguž, Antonija, Vujeva, Božo, Gudelj, Ivan, and Hadžibegović, Irzal

Subjects
*ACUTE coronary syndrome, *NON-ST elevated myocardial infarction, *CHOLESTEROL content of food, *ST elevation myocardial infarction, *ORTHOPEDIC shoes, *PERCUTANEOUS coronary intervention, *LDL cholesterol
Abstract

During the research on the influence of plasma protein glycosylation on achieving LDL cholesterol target values1,2, we analyzed statin-naive patients with the first presentation of acute coronary syndrome. Between September 2022 and September 2023, a total of 61 statin-naive patients with acute coronary syndrome were hospitalized. Patients transferred from local hospitals and patients older than 75 years were excluded from the study. Out of 61 patients, 36 had STEMI (ST-segment elevation myocardial infarction) and 25 NSTEMI (Non-ST elevation myocardial infarction). More than 50% of patients were men (35), and the average age of all patients was 58.34 years. 40 % of patients are smokers. 55% of patients had a BMI greater than 25 kg/m². The average value of the initial high-sensitivity troponin was 2337 pg/ml. All patients underwent percutaneous coronary intervention (PCI), and the average number of implanted stents was 1.02. In the largest percentage (38%), the infarct related artery or culprit lesion was on right coronary artery. In patients with STEMI, 57% received a loading dose of prasugrel and the rest ticagrelor. In patients with NSTEMI, after coronary angiography, 83% of patients received prasugrel, the rest ticagrelor and clopidogrel. All patients were discharged with a recommendation to take atorvastatin at a dose of 80 mg per day. The average value of LDL (low-density lipoprotein) cholesterol during hospitalization was 3.97 mmol/L. At the first control, 2 months after PCI, the average value of LDL cholesterol was 2.26 mmol/L, and 4 patients (6%) achieved target values of 1.4 mmol/L. Ezetimibe was recommended to all patients who did not reach the target values. At the second control, 3 months after PCI, the average value of LDL cholesterol was 1.95 mmol/L, and the target values were achieved by 6 patients (9.8%). The plan is to recruit statin-naive patients with acute coronary syndrome until September 2024, and clinical and laboratory follow-up for 1 year after PCI. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Treatment of ectatic coronary arteries in acute coronary syndromes.

Author

Gabaldo, Krešimir, Praveček, Marijana Knežević, Mišković, Domagoj, Bitunjac, Ivan, Dunđer, Ivica, Raguž, Antonija, Miškić, Blaženka, and Lukenda, Katica Cvitkušić

Subjects
*ACUTE coronary syndrome, *MYOCARDIAL infarction, *INFERIOR wall myocardial infarction, *CORONARY arteries, *PERCUTANEOUS coronary intervention
Abstract

Introduction: Coronary artery ectasia (CAE) is a focal or diffuse dilatation of an epicardial coronary artery, more than 1.5 times the normal adjacent segment. Its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography¹ . These changes are mostly asymptomatic, some patients present as stabile effort angina and minority develop acute coronary syndrome. Percutaneous coronary interventions (PCI) is a treatment of choice in acute coronary syndrome but it presents a major challenge with possible unpredictable complications². Case report: We present a case of 78-year-old male, presented with inferior ST elevation myocardial infarction. Right coronary artery (RCA) was ectatic and occluded distally. We performed balloon dilatation and thromboaspiration with Export catheter to establish TIMI 3 flow, and a residual stenosis of 70% with high thrombotic burden remain, so we decided to treat the patient with triple anticoagulant therapy initially and postpone stent implantation because of possible no flow phenomenon. After one month we did the angiogram which showed resolution of thrombus and we put the large drug eluting stent 5.0/22mm, postdilated up to 6mm with a good apposition. Conclusion: Percutaneous coronary interventions in ectatic / aneurismal vessels carry a high risk of complications, primarily a no-reflow phenomenon. No-reflow is common in patients with acute coronary syndrome. Restoration of TIMI 3 flow can be achieved with thrombectomy or balloon dilatation. In case of large aneurysm consider initial medicament treatment with triple therapy and postpone definite PCI with stent implantation to avoid distal embolization and no reflow phenomenon. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Ferritin in the prediction of cardiovascular risk in women - preliminary results.

Author

Lukenda, Katica Cvitkušić, Jakab, Jelena, Praveček, Marijana Knežević, Gabaldo, Krešimir, Lukenda, Anto, and Ćosić, Vesna

Subjects
CARDIOVASCULAR diseases risk factors, SYSTOLIC blood pressure, BODY mass index, FERRITIN, SMOKING
Abstract

Introduction: Over the past two decades, the prevalence of myocardial infarction (MI) has trended downward in both sexes in the United States and Europe, although this decline has been smaller in women.1 According to the available literature, only two models predicting cardiovascular risk (CVD) in women included risk factors specific to women, which were reproductive risk factors.2 Our previous research showed a significant association between ferritin, hsCRP, and systolic blood pressure in women working shift work.3 In women, iron stores increase during menopause. We started a prospective study of CVD risk factors and CVD outcomes in women in Brod-Posavina County. Aim: To determine the association between ferritin level and menopause age as female-specific CVD risk factors in women and the influence of body mass index (BMI), non-HDL and hsCRP on cardiovascular risk in women. Patients and Methods: Women aged 35 to 75 years, divided into two groups: women without coronary artery disease (CAD) and women with CAD (angiography, medical history of MI). The variables included in the evaluation are: age, BMI, menopause age and status, systolic blood pressure (SBP), non-HDL, ferritin, hsCRP, and smoking habits. Results are mean±SD. For the comparison of continuous variables, we used the Student t-test, whereas for the comparison of categorical variables, we used the Fisher exact test. P < 0.05 is considered statistically significant. Results: We analyzed a total of 32 subjects matched by age. Women without CAD had a statistically significant lower BMI and higher SBP compared to women with CAD (Table 1). There was no statistically significant difference in menopause age, presence of menopause, smoking habits, and non-HDL. Ferritin and hsCRP levels were statistically significantly higher in the group of women with CAD. Conclusion: The preliminary results of our study show that women without CAD have statistically lower BMI, ferritin and hsCRP levels compared to women with CAD. There were no differences in menopause age and status, non-HDL or smoking habits. Further research is needed to improve women’s health. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Dehiscence of a mechanical aortic valve due to endocarditis complicated with cardiogenic shock and an embolic event: a case report.

Author

Grljušić, Filipa, Praveček, Marijana Knežević, Gabaldo, Krešimir, Dunđer, Ivica, Lukenda, Katica Cvitkušić, Mišković, Domagoj, Bitunjac, Ivan, and Raguž, Antonija

Subjects
INFECTIVE endocarditis, CARDIOGENIC shock, AORTIC valve, BUNDLE-branch block, ENDOCARDITIS, AORTIC valve transplantation, MITRAL valve
Abstract

Introduction: Prosthetic valve endocarditis (PVE) is a serious condition commonly caused by bacterial microorganisms in patients with a mechanical or biological valve prosthesis that can lead to complications such as abscess, valve dehiscence, paravalvular regurgitation, heart failure, conduction disturbance, as well as embolic events and multiorgan failure.1,2 Case report: 52-year-old male, who had surgical aortic valve replacement with a mechanical prosthesis two years earlier due to complications of the bicuspid aortic valve, presented to the emergency department with shortness of breath at rest. During the last three weeks, he had fever, chills, cough, fatigue, myalgias, dyspnea, and exertion intolerance, along with weight loss. He was taking two antibiotics at home, but his condition was gradually worsening. Clinically, he was somnolent, pale, ortopnoic, hypotensive, and respiratory insufficient, with an auscultatory precordial diastolic murmur and mechanical valve sound, as well as bilateral lung crepitations and leg edema. The 12-lead electrocardiogram showed PR interval prolongation with a left bundle branch block. Laboratory findings indicated a septic condition with a myocardial injury. The chest radiography showed pulmonary edema with cardiomegaly. Echocardiography revealed severe prosthetic aortic paravalvular regurgitation with dehiscence greater than 50% of the prosthetic valve circumference (in aortic short-axis view). The left ventricle was dilated with an ejection fraction of 35%. The empirical antibiotic treatment for late PVE was administered promptly. All blood cultures were negative for bacterial infection. He was accepted for urgent valve replacement surgery, but his hemodynamic and neurological status rapidly deteriorated. The patient developed status epilepticus. A cranial CT scan revealed multiple acute and subacute ischemic lesions. Additionally, he had postictal respiratory failure, hypotension, bradycardia, and renal shutdown. Despite treatment measures, the patient died within 96 hours of admission in refractory cardiogenic and septic shock with respiratory insufficiency caused by mechanical and systemic complications of prosthetic valve endocarditis. Conclusion: PVE represents the most serious form of infective endocarditis.1,2 Embolism to the brain is a relatively frequent occurrence in patients with infective endocarditis that is associated with increased in-hospital mortality and morbidity as well as shortened long-term survival.1,3 [ABSTRACT FROM AUTHOR]

Published
2024
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41. Acute coronary syndrome accompanied with flaccid paraplegia: a case report in a 70-year-old patient.

Author

Špoljarić, Mario, Lukenda, Katica Cvitkušić, Mišković, Domagoj, Vorkapić, Kristina, Vučić, Domagoj, and Gabaldo, Krešimir

Subjects
CHEST pain, ACUTE coronary syndrome, NON-ST elevated myocardial infarction, PATIENTS' families, PARAPLEGIA, HEART failure
Abstract

Introduction: Acute coronary syndrome (ACS) includes unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).1 Acute flaccid paraplegia is a clinical syndrome with symmetrical and dramatic onset of weakness in the lower extremities with many underlying causes and generally poor prognosis.2 Case report: We present a case of a 70-year-old female who was admitted to the Emergency Room with the sudden onset of chest pain, fatigue and nausea. 12-lead electrocardiogram showed horizontal STsegment denivelation in V3-V6 leads, the baseline cardiac high sensitive troponin I was slightly elevated and there were no regional wall motion abnormalities detected by transthoracic echocardiography. Two hours after being admitted the patient experienced sudden paralysis of the lower extremities and a discrete loss of sensitivity below the Th10 dermatome. A computerized tomography (CT) scan of the brain, of the lumbosacral spine and a CT aortogram showed no abnormalities. A second troponin measurement was performed three hours after the initial measurement, and was significantly elevated. The patient was then admitted to the Coronary Care Unit under the diagnosis of NSTEMI, and the urgent coronary angiography was performed. Coronary angiograms revealed a proximal right coronary artery subocclusion and the patient underwent percutaneous coronary intervention with the implantation of 3 drug-eluting stents in the culprit lesion. On the fourth day of hospitalization, the patient was transferred to the Department of Neurology for the management of persistent paraplegia. Because of deteriorating of patient’s condition, MRI of the thoracic and lumbar spine was not realized. The patient experienced acute respiratory failure due to cardiac insufficiency and sepsis (C-reactive peptide was 375 mg/L, procalcitonin 2.9 ng/mL and Escherichia coli was isolated in the urine culture) and was transferred to the Intensive Care Unit. The patient died on the 17th day of the hospitalization. Conclusion: Although there is limited information and no similar cases in available medical literature, we suspect that the cause of paraplegia was concomitant ACS and spinal cord infarction and that the cause of death was acute respiratory insufficiency due to urosepsis and cardiac insufficiency. Autopsy was declined by the patients’ family [ABSTRACT FROM AUTHOR]

Published
2024
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42. Clinical significance of radial artery occlusion after coronary angiography.

Author

Grgić, Ivana, Lukenda, Katica Cvitkušić, Praveček, Marijana Knežević, Mišković, Domagoj, Didović, Ema, and Gabaldo, Krešimir

Subjects
RADIAL artery, ARTERIAL catheterization, CORONARY angiography, CORONARY occlusion, CORONARY artery bypass, FISTULA, ARTERIAL occlusions, PARESTHESIA
Abstract

Introduction: Transradial approach (TRA) is preferred vascular access site for coronary angiography resulting in lower 30-day mortality, major bleeding and access site complications when compared with transfemoral access. Radial artery occlusion (RAO) is the most common complication of TRA with an incidence of 0.8-10%¹ . In most cases RAO is asymptomatic, but some patients feel pain at the site of occlusion, have paresthesia, and very rarely signs of acute ischemia of the arm². Methods and Results: We analyzed 40 subjects who underwent diagnostic coronary angiography using TRA in a period of one month. All patients received 5000 IU of heparin and 200mcg of nitroglycerin after sheath insertion. After intervention hemostasis was performed with Terumo TR Band radial compression device according to standardized protocol. Three patients (8%) reported pain and paresthesia and we confirmed radial artery occlusion using doppler imaging. One patient was hospitalized because of severe pain but without signs of critical ischemia. The patient was treated with aspirin and enoxaparin by subcutaneous injection for 5 days, following with rivaroxaban 20mg for 3 weeks and completely recovered. Conclusion: Radial artery occlusion is the most common complication of TRA, but with a low clinical significance. Patency of radial artery is important for future coronary artery procedures, coronary artery bypass grafting, arteriovenous fistula formation or intra-arterial pressure monitoring. Proper medication application together with patent hemostasis reduce the risk of RAO3. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Postperikardiotomni sindrom kod bolesnika sa zamjenom aortne valvule – učestalost, dijagnoza i liječenje

Author

Gabaldo, Krešimir, Hadžibegović, Irzal, Mišković, Domagoj, Sutlić, Željko, Prvulović, Đeiti, Vujeva, Božo, Knežević Praveček, Marijana, and Cvitkušić Lukenda, Katica.

Subjects
perikarditis, pleuralni izljev, kardiokirurške komplikacije
Abstract

Postperikardiotomni sindrom (PPS) je klinički sindrom koji nastaje u sklopu autoimune upalne reakcije perikarda i pleure, a klinički se manifestira novonastalim ili pogoršanjem prisutnog perikardijalnog ili pleuralnog izljeva. Javlja se od prvog do šestog tjedna nakon kardiokiruških zahvata i spada među najčešće komplikacije kardijalne kirurgije. Učestalost pojavnosti bolesti je raznolika od 2-30% i ovisi o tipu kardiokirurškog zahvata.1-3 Retrospektivnom analizom PPS registra u Općoj bolnici “Dr. Josip Benčević” Slavonski Brod u razdoblju od 1. ožujka 2009. do 1. listopada 2015. godine učestalost PPS- a sveukupno, neovisno o tipu kardiokiruškog zahvata, iznosila je 10, 1 % , dok je učestalost PPS-a kod bolesnika podvrgnutih kirurgiji aortne valvule iznosila 26 %. Rutinskim probirom bolesnika dva do četiri tjedna iza operativnog zahvata moguće je na osnovu jednostavnih dijagnostič- kih kriterija postaviti dijagnozu i započeti adekvatno liječenje, s postizanjem remisije u više od 95 % bolesnika. U dijagnostici bolesti povišen CRP i febrilitet imaju snažnu prediktivnu vrijednost te su uz prisutnost pleuralnog/perikardijalnog izljeva dovoljni kriteriji za dijagnozu bolesti. Liječenje se provodi primjenom NSAR, kolhicina ili kortikosteroidima. Profilaktička primjena kolhicina prema COPPS studiji smanjuje učestalost pojave PPS. Iako za sada nema jasnih preporuka za profilaksu, prema našem istraživanju, identifikacija bolesnika s visokim rizikom na osnovu tipa operacije, dobi i drugih kliničkih parametara podupire hipotezu o korisnosti profilakse.

Published
2016

44. Development of radial access for primary percutaneous coronaryintervention in ST-segment elevation myocardial infarction in Slavonski Brod: the long road to success

Author

Hadžibegović, Irzal, Vujeva, Božo, Gabaldo, Krešimir, Čančarević, Ognjen, and Prvulović, Đeiti

Subjects
ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, radial access
Abstract

Background: Current ESC/EACTS Guidelines on myocardial revascularization emphasized benefit of radial access over femoral access in ST-segment elevation myocardial infarction (STEMI) if performed by an experienced radial operator. There are several definitions of an experienced radial operator. One of them is less than 10% of conversions from radial to femoral approach, and is often used in practice. The other is certainly volume, with 100 procedures as a primary operator needed to be securely on the upslope of the learning curve.1, 2 We present our experience of long transition from femoral to radial access for primary percutaneous coronary intervention (PCI) in STEMI, mostly due to technical limitations and practical and organizational issues.Patients and Results: Data from catheterization laboratory registries in Slavonski Brod from 2004 to 2016 were analyzed. Radial approach was first introduced systematically in mid 2012 after a 3-day radial access workshop in Slavonski Brod. Proportions of patients with radial access in 2012, 2013, 2014, and 2015 were 5%, 22%, 15%, and 18%, respectively. In 2012 70% of radial access was right radial, but in 2013 right radial access was used in only 25% of radial cases. In 2014 and 2015 right radial was used again in most patients (86% and 83% of all radial, respectively). From 2012 to 2015, proportions of radial access in STEMI were small, varying between 3% and 6%, and were mostly driven by impossible femoral access. In first two moths of 2016, after the installation of new coronary angiography suite with adequate room and table options for radial access, and additional education in a high volume radial center in University Hospital Centre Rijeka, Croatia, routine right radial access climbed suddenly to 76%, with 4% of left radial access reserved mainly for left internal mammary artery bypass graft coronary angiography. Conversion to femoral access varied among operators from 6% to 14% during first two months in 2016, that led to routine introduction of radial access in STEMI by the end of January 2016 for 2 out of 5 operators. In first two months of 2016, 40% of STEMI patients had right radial access, with no prolongation of door to balloon time noted. Conclusion: Very long transition from femoral to radial access in STEMI, expected to reach a maximum of 90% of STEMI cases by June 2016, was mainly driven by technical limitations of catheterization laboratory suite, and organizational issues with varying approaches and equipment used in the learning curve.

Published
2016

45. Neurološke komplikacije nakon uvođenja rutinskog desnog transradijalnog pristupa koronarnoj angiografiji

Author

Hadžibegović, Irzal, Prvulović, Đeiti, Gabaldo, Krešimir, Čančarević, Ognjen, Menegoni, Martina, Mišković, Domagoj, and Vujeva, Božo

Subjects
koronarografija, radijalni pristup, femoralni pristup, komplikacije
Abstract

Uvod: Lokalne vaskularne komplikacije, hematomi i krvarenja najčešće su komplikacije invazivnih koronarnih zahvata i značajno su rjeđe u slučaju radijalnog pristupa u odnosu na femoralni. Neurološke komplikacije invazivnih koronarnih zahvata vrlo su rijetke te za sada nema dokaza o njihovoj povećanoj učestalosti nakon radijalnog pristupa.1 Pacijenti i metode: Analizirane su razlike u vaskularnim i neurološkim komplikacijama nastalim unutar 24 sata od koronarnih intervencija između dva 9-mjesečna razdoblja u kateterizacijskom laboratoriju u Slavonskom Brodu: od siječ- nja do rujna 2015. godine kada je 82% procedura bilo učinjeno transfemoralno i od siječnja do rujna 2016. godine kada je 87% procedura bilo učinjeno transradijalno. Razdoblje tranzicije s rutinskog femoralnog u predominantno desni radijalni pristup između rujna 2015. i siječnja 2016. nije uključen u analizu. Rezultati: U navedenom razdoblju 2015. bilo je ukupno 584 procedura, od čega 18% transradijalno i to uglavnom zbog očekivanog neuspješnog femoralnog pristupa. Zabilježeno je 11 (1, 88%) lokalnih vaskularnih komplikacija ili krvarenja te 1 slučaj (0, 17%) prolazne cerebralne ishemične atake (TIA), i to sve nakon femoralnog pristupa. Tijekom istog perioda 2016. bilo je ukupno 913 koronarnih procedura, od čega 87% transradijalno. Udio neuspješnih radijalnih procedura s konverzijom u femoralni pristup bio je 6%. Zabilježene su 4 (0, 44%) lokalne vaskularne komplikacije ili krvarenja, i to sve nakon femoralnog pristupa. Zabilježena su ukupno 4 (0, 44%) cerebrovaskularna incidenta, i to 2 TIA i 2 ishemijska inzulta od čega jedan sa zaostalim deficitom i jedan sa smrtnih ishodom. Zajednič- ke značajke bolesnika s neurološkim komplikacijama bile su: ženski spol, dob veća od 80 godina, šećerna bolest, poznata vaskularna bolest, prethodni cerebrovaskularni incident, akutni koronarni sindrom i desni radijalni pristup. Zaključak: Radijalni pristup pokazao se sigurnim i učinkovitim, uz značajno smanjenje broja vaskularnih komplikacija i bezna- čajno povećanje broja neuroloških komplikacija, čija je učestalost ostala ispod 0, 5%. U slučaju bolesnika s pridružene više od dvije navedene “neurorizične” kliničke značajke izbor bi trebao biti lijevi radijalni pristup ili alternativno femoralni pristup.

Published
2016

46. Akutni inferiorni infarkt miokarda kao prva manifestacija miksoma lijevog atrija

Author

Menegoni, Martina, Vujeva, Božo, Mišković, Domagoj, Hadžibegović, Irzal, Cvitkušić Lukenda, Katica, Prvulović, Đeiti, and Gabaldo, Krešimir

Subjects
miksom, embolizacija, infarkt miokarda
Abstract

Uvod: Primarni tumori srca su rijetki, a među njima najčešći su miksomi najčešći. Najčešće se prezentiraju simptomima kongestivnog srčanog zatajivanja, a iznimno rijetko embolizacijom koronarne arterije.1 Prikaz slučaja: Šezdesetpetogodišnji muškarac, s od ranije poznatom arterijskom hipertenzijom, dislipidemijom i kroničnom opstruktivnom plućnom bolesti (KOPB) primljen je zbog subakutnog infarkta miokarda s elevacijom ST segmenta u inferiornim odvodima trajanja oko 24 sata. Hitna ehokardiografija pokazala je tvorbu lijeve pretklijetke veličine 5, 4 x 4, 0 cm, ehogenosti miokarda koja se peteljkom drži za interatrijski septum i vrhom flotira kroz mitralnu valvulu te hipokineziju inferiorne stijenke lijeve klijetke. Bolesnik je bio visokofebrilan, ali sterilnih hemokultura te je isključen endokarditis mitralne valvule, a febrilitet objašnjen infektivnom egzacerbacijom KOPB. Provedena je antimikrobna, bronhodilatacijska, diuretska i ostala suportivna terapije i tek nakon potpune kliničke stabilizacije učinjena je koronarografija. Nađena je okluzija distalnog segmenta cirkumfleksne arterije, bez drugih značajnih stenoza. Postavljena je dijagnoza miksoma lijevog atrija s embolizacijom u cirkumfleksnu koronarnu arteriju te je premješten na Kardijalnu kirurgiju KB Dubrava u Zagrebu gdje učinjena uspješna ekscizija. Bolesnik je nakon oporavka otpušten kući u dobrom stanju. Zaključak: Ovaj klinički slučaj pokazuje nužnost i vrijednost rane ehokardiografije uz krevet bolesnika s kliničkom slikom akutnog te pogotovo subakutnog infarkta miokarda uvijek kada je to moguće.

Published
2016

47. Rezultati primjene Protokola za zbrinjavanje akutnog koronarnog sindroma u zapadnoj Slavoniji

Author

Hadžibegović, Irzal, Prvulović, Đeiti, Gabaldo, Krešimir, Knežević Praveček, Marijana, Cvitkušić Lukenda, Katica, Dunđer, Ivica, Menegoni, Martina, Mišković, Domagoj, and Vujeva, Božo

Subjects
akutni koronarni sindrom, perkutana koronarna intervencija, protokol
Abstract

Uvod: Nacionalne mreže liječenja akutnog infarkta miokarda sa ST elevacijom (STEMI) ključni su segment standardizacije kvalitete zdravstvene skrbi bolesnika s akutnim koronarnim sindromom (AKS), uz strogo definirane protokole, koji bi trebali biti prilagođeni svakoj regiji ovisno o organizacijskim mogućnostima.1 Bolesnici s akutnim koronarnim sindromom bez ST elevacije (NSTE-AKS) za sada najčešće nisu liječenu u sklopu mreža te zahtijevaju dodatne napore u standardizaciji pristupa. Pacijenti i metode: Analizirani su podatci o liječenju bolesnika s AKS perkutanom koronarnom intervencijom (PCI) u kateterizacijskom laboratoriju u Slavonskom Brodu u razdoblju između 2014. i 2015. godine te uspoređeni s podatcima dobivenim od početka 2016. godine nakon usvajanja standardiziranog Protokola za cijelu regije Zapadne Slavonije2. Rezultati: U periodu nakon usvajanja protokola zabilježen je porast broja primarne PCI u STEMI za 36 % te porast udjela transportiranih bolesnika s primarnom PCI u STEMI, koji je do kraja rujna 2016. god. iznosio 48 %. Čak 36 % bolesnika sa STEMI dolazi do prvog medicinskog kontakta vlastitim prijevozom. Svi transportirani bolesnici prošli su kroz hitnu bolničku službu nadležne bolnice bez mogućnosti PCI. Do kraja rujna 2016. godine, 96 % bolesnika sa STEMI liječeno je s acetisalicilatnom kiselinom, tikagrelorom i nefrakcioniranim heparinom prije koronarografije. Udio primarne PCI u kardiogenom šoku povećan je s 2, 5 % na 7, 8 %. Ukupna bolnička smrtnost nakon primarne PCI u STEMI porasla je nesignifikantno s 5, 2 % na 6, 9 % u 2016. god. Zabilježen je porast udjela PCI u NSTE-AKS za 14 %, od čega je 81 % bolesnika zbrinuto s PCI unutar 72 sata. Za 13 % porastao je udio PCI u transportiranih bolesnika s NSTE-AKS unutar 24 sata. Ukupna bolnič- ka smrtnost nakon PCI u NSTE-AKS bila je vrlo niska i nije se značajno mijenjala. Zaključak: Podatci prikupljeni uporabom protokola liječenja AKS pomažu u podizanju kvalitete liječenja i prepoznavanju problema koji zahtijevaju nova rješenja. Standardizirani protokoli liječenja svih bolesnika s AKS korak su do formiranja regionalnih i nacionalnih mreža za hitno zbrinjavanje cijelog spektra AKS koje jamče podizanje i održanje najviše kvalitete zdravstvene skrbi.

Published
2016

48. Prikaz dva atipična slučaja bolesnica s kliničkom slikom akutnog infarkta miokarda s elevacijom ST- segmenta i potpuno urednim koronarogramom

Author

Vujeva, Božo, Prvulović, Đeiti, Gabaldo, Krešimir, and Hadžibegović, Irzal

Subjects
infarkt miokarda s elevacijom ST-segmenta, Takotsubo kardiomiopatija, koronarografija
Abstract

Uvod: Klinička slika akutnog infarkta miokarda s elevacijom ST-segmenta (STEMI) i potpuno urednim koronarogramom ne susreće se tako rijetko u intenzivnoj kardiologiji. Uglavnom se može objasniti sindromom apikalnog baloniranja miokarda – potpuno reverzibilnoj Takotsubo kardiomiopatiji koja je gotovo uvijek praćena s akutnom elevacijom ST-segmenta u prekordijalnim odvodima. Prikaz slučaja: Ovdje prikazujemo dva atipična slučaja sindroma apikalnog baloniranja miokarda u dvije bolesnice koje su liječene s kliničkom slikom akutnog infarkta miokarda bez elevacije ST- segmenta (NSTEMI) i akutnog STEMI. Prva bolesnica se prezentirala u suradnoj ustanovi sa slikom NSTEMI nakon udara groma, s pozitivnim nalazom kardiosepcifičnih enzima i razvojem vrlo diskretnih nespecifičnih elektrokardiografskih promjena u lateralnim odvodima. Na koronarografiji je nađen uredan nalaz, uz diskretnu apikalnu diskineziju koja se potpuno oporavila do kraja liječenja. Druga bolesnica je upućena na urgentnu koronarografiju iz suradne ustanove s tipičnom kliničkom slikom akutnog STEMI inferiorne stijenke. Nalaz koronarografije bio je potpuno uredan, a nalaz ventrikulografije pokazao je jasan ispad kontraktilnosti apikalno, iako su promjene ST-segmenta bile jasno izražene u inferiornim odvodima i potpuno reverzibilne do kraja hospitalizacije. Zaključak: Na Takotsubo kardiomiopatiju trebalo bi se posumanjati i u atipičnim slučajevima akutnog STEMI inferiorne regije s urednim koronarogramom.

Published
2014

49. Povezanost serumske koncentracije vitamina D i akutnog koronarnog sindroma

Author

Knežević Praveček, Marijana, Hadžibegović, Irzal, Prvulović, Đeiti, Cvitkušić Lukenda, Katica, Dunđer, Ivica, Vujeva, Božo, Gabaldo, Krešimir, Samardžić, Pejo, and Miškić, Blaženka

Subjects
akutni koronarni sindrom, 25-hidroksi vitamin D, deficit vitamina D
Abstract

Uvod: S obzirom na to da ekstraskeletni učinci vitamina D, posebice njegova uloga u održavanju kardiovaskularnog sustava dobivaju sve više pažnje, cilj je bio odrediti serumsku koncentraciju vitamina D u ispitanika s akutnim koronarnim sindromom i u kontrolnoj skupini. Pacijenti i metode: U istraživanje su uključeni bolesnici liječeni zbog akutnog koronarnog sindroma (AKS) na Odjelu kardiologije OB , , Dr J. Benčević'' u Slavonskom Brodu i kontrolna skupina ispitanika koji nisu do uključenja liječeni zbog bilo kakvog oblika koronarne bolesti srca(KBS). Skupinu ispitanika s AKS-om čini 60 bolesnika (40 muškaraca, srednja dob 58) hospitaliziranih zbog AKS-a i podvrgnuti koronarnoj angiografiji i revaskularizacijskim postupcima. Kontrolnu skupinu čini 60 bolesnika (38 muškaraca, srednja dob 58, 5), bez AKS-a, ali uz prisutan barem jedan klasični čimbenik rizika za kardiovaskularne bolesti. Serumska vrijednost 25-hidroksi vitamina D određivala se elektrokemiluminiscentnom metodom. Insuficijencija vitamina D je definirana kao razina 25-hidroksivitamin D u plazmi ≤50nmol/L. Rezultati: Nije bilo značajne razlike u demografskim i relevantnim kliničkim obilježjima između bolesnika s AKS-om i kontrola. Prosječna vrijednost koncentracije vitamina D izmjerene u bolesnika s AKS-om iznosila je 35, 19 nmol/L uz (SD 17, 54) i bila je statistički značajno niža u usporedbi s kontrolnom skupinom ispitanika čija je prosječ- na vrijednost iznosila 58, 08 nmol/L uz (SD 16, 29) (Student T-test, p˂0, 001). Vrijednosti vitamina D kod pacijenata s infarktom miokarda s elevacijom ST-segmenta su niži u odnosu na infakt miokarda bez elevacije ST-segmenta (Student t- test, p=0, 702). Bolesnici s višežilnom bolesti imali su najniže izmjerene vrijednosti vitamina D. Zaključak: Razina vitamina D značajno je niža u bolesnika s AKS-om u usporedbi s kontrolnom skupinom. Postoji trend prema nižim razinama vitamina D s povećanjem težine KBS, no te razlike nisu statistički značajne. Potrebne su daljnje studije na većem broju ispitanika koje će potvrditi naše rezultate.

Published
2014

50. Akutni infarkt miokarda kao posljedica embolizacije u fibrilaciji atrija — prikaz slučaja

Author

Vujeva, Božo, Hadžibegović, Irzal, Prvulović, Đeiti, and Gabaldo, Krešimir

Subjects
fibrilacija atrija, tromboembolizacija, infarkt miokarda
Abstract

Uvod: Fibrilacija atrija je jedna je od najčešćih aritmija i nosi veliki rizik kardioembolizacije, s moždanim udarom, akutnom ishemijom udova ili crijeva kao jednim od najtežih posljedica. Infarkt miokarda rjeđe se povezuje s tromboembolizacijom u sklopu fibrilacije atrija. Prikaz slučaja: Prikazujemo slučaj 73-godišnje žene liječene u Koronarnoj jedinici u Općoj bolnici Slavonski Brod zbog akutnog infarkta miokarda bez elevacije ST- segmenta (NSTEMI). Bila je u sinus ritmu pri prijemu. Liječena je s acetilsalicilatnom kiselinom (ASK), klopidogrelom i niskomolekularnim heparinom (LMWH) i predviđena za koronarni angiogram u istom boravku u bolnici. Trećeg dana hospitalizacije, prije planirane koronarografije razvila je veliki retroperitonealni hematom bez znakova aktivnog krvarenja CT-om iz bilo kojeg velike krvne žile. Liječena je konzervativno s dobrim oporavkom. Tijekom liječenja dokumentirano je nekoliko epizoda fibrilacije atrija. Nakon uvođenja amiodarona bila je u stabilnom sinus ritmu. Nakon povlačenja hematoma učinjena je koronarna angiografija koja je pokazala potpuno normalne koronarne arterije. Otpuštena je kući u sinus ritmu s ASK-om, ACE inhibitorom, beta- blokatorom i statinom. Nakon 2 mjeseca primljena je u bolnicu s kliničkim znakovima akutne ishemije lijeve ruke. Color Doppler pretraga je pokazala znakove akutne okluzije na razini aksilarne arterije. Bazalni EKG pokazivao je sinus ritam. Hitno je embolektomirana Foleyevim kateterom uz potpun i brz oporavak cirkulacije. Rana transezofagealna ehokardiografija pokazala je tromb u lijevoj atrijskoj aurikuli. Kontinuirano praćenje EKG pokazalo je kratke epizode atrijske fibrilacije i undulacije. Uz LMWH, uvedena je antikoagulantna terapija varfarinom s kojom je i otpuštena kući, bez znakova krvarenja. Zaključak: Prethodni NSTEMI s normalnim nalazom koronarne angiografije i akutna ishemija lijeve ruke pripisane su tromboembolizaciji iz lijeve atrijske aurikule. Optimalna strategija liječenja u ovom konkretnom slučaju raspravljena je u ovom prikazu.

Published
2014

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