Search

Introduction: Well-organized, effective secondary prevention of coronary artery disease (CAD) has a potential to improve the patients' prognosis following myocardial revascularization procedures., Aim: To evaluate overtime changes in the implementation of the ESC guidelines for secondary prevention by assessing control of the main risk factors and the rate of cardioprotective drug use in patients following myocardial revascularization procedures., Material and Methods: Patients aged < 81 years who had been hospitalized for a myocardial revascularization procedure in five hospitals serving Krakow and surrounding districts were recruited and interviewed 6-18 months following discharge. Their personal medical history, medication use and control of the main cardiovascular risk factors were evaluated using a standard questionnaire in 2006-2007, 2011-2013, and 2016-2017. The same five hospitals took part in surveys on each occasion., Results: We examined 260 patients in 2006-2007, 200 in 2011-2013 and 190 in 2016-2017. We noted a significant difference in the management of surveys participants: 62% underwent percutaneous coronary intervention (PCI) and 38% coronary artery coronary artery bypass grafting (CABG) in 2006-2007 whereas the corresponding proportions in 2016-2017 were 90% and 10%. The proportion of patients who did not achieve target blood pressure (according to ESC guidelines valid at the time of each survey) in 2006-2007, 2011-2013 and 2016-2017 was 53.5%, 52.3%, and 38.9%, respectively, the proportion of those who did not achieve the LDL cholesterol target (according to ESC guidelines valid at the time of each survey) was 36.3%, 64.0%, and 61.7%, respectively, and the proportion of those with high fasting glucose was 12.6%, 14.6%, and 19.7%, respectively. The proportion of smokers was 16.2%, 19.5%, and 16.8%, whereas 30.5%, 28.6% and 40.5% of patients were obese in 2006-2007, 2011-2013 and 2016-2017, respectively. The proportion of patients taking antiplatelets (91.8% vs. 92.0% vs. 96.3%), β-blockers (90.3% vs. 87.5% vs. 92.6%), and lipid-lowering drugs (88.7% vs. 91.0% vs. 93.7%) did not change significantly.Conclusions: The analysis of three multicenter surveys provides evidence of the considerable potential for a further reduction in cardiovascular risk in patients following elective myocardial revascularization in Poland., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Termedia Sp. z o. o.)

We present electrocardiograms of a 70-year-old man with a history of inferior wall myocardial infarction. Since the infarction he had frequent episodes of ventricular tachycardia that was on many occasions misdiagnosed as either supraventricular tachycardia or atrial flutter. We contribute the mistakes to the presence of relatively narrow QRS complexes and QRS alternans that imitated fusion beats. The QRS morphology similar to that seen in idiopathic ventricular tachycardia suggested participation of the Purkinje fibers of the posterior fascicle in the reentrant circuit. The arrhythmia was ablated with single radiofrequency current application in the mid-paraseptal area of the left ventricle.

We describe a case of an otherwise healthy 48-year-old man who survived aborted sudden cardiac death (SCD). His ECG showed ST segment elevation in inferior leads, therefore an acute coronary syndrome was suspected. However, serial troponin T and CPK-MB were negative, echocardiogram was unremarkable and exercise test was negative. On the basis of electrophysiological study, positive ajmaline test, persistent ST segment elevation in inferior leads and other clinical features (PQ interval of 240 ms, family history of SCD) a diagnosis of variant Brugada syndrome was made. Persistent ST segment elevations in inferior leads can be a marker of variant Brugada syndrome.