FIRST APPLICATION OF AUTOMATED EXTERNAL DEFIBRILATOR IN SERBIA - CASE REPORT.

INTRODUCTION: Sudden cardiac death is an unexpected natural death from cardiac causes. It is the most common and first manifestation of coronary artery disease. It accounts for 50% of mortality from cardiovascular disease in the United States of America and other developed countries, so measures that can reduce it are an important medical task. CASE REPORT: A 55-year old man suddenly lost consciousness at the train station in Novi Sad. An eyewitness provided first aid and ventricular fibrillation was converted to sinus rhythm by means of the automated external defibrillator. Emergency Medical Service Novi Sad soon arrived, continued resuscitation procedure, and transported the patient to the Cardiac Care Unit, who was then diagnosed with acutedmyocardial infarction and primary percutaneous coronary intervention was performed. Resuscitative hypothermia was applied in acute phase to prevent further brain injury. During further hospitalization the patient was stable, woke up from coma and early rehabilitation measures were implemented. After six months the patient had normal physical activities and there was no left ventricular segmental hypokinesia on echo cardiography. CONCLUSION: The application of all four chains of survival is important in increasing the survival rate of patients with sudden cardiac arrest.

[Streptococcus bovis endocarditis as a sign of colon cancer: case report].

INTRODUCTION: Streptococcus bovis is labeled in the literature as a cause of bacteremia and endocarditis, which are often associated with gastrointestinal malignancy. CASE OUTLINE: In our paper we present a patient with endocarditis induced by Streptococcus bovis who was also, after completed cardiologic examination and treatment, diagnosed colon cancer in situ by targeted endoscopy. Owing to the timely diagnosis, and after successful cardiologic surgery with implantation of an artificial aortic valve, patient underwent surgery of the colon, and is now asymptomatic and in good health. CONCLUSION: Complete and detailed endoscopic examination of the colon must be done in patients with endocarditis caused by Streptococcus bovis, even if the patient is asymptomatic. By following these recommendations, it is possible to detect precancerosis or cancer at an early stage and save the patient's life.

Effect of serum lipid level change on 10-year coronary heart risk distribution estimated by means of seven different coronary risk scores during one-year treatment.

INTRODUCTION: This study was done in order to evaluate the effect of serum levels of total cholesterol, triglycerides, low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol on 10-year coronary heart disease risk distribution change. MATERIAL AND METHODS: This study included 110 subjects of both genders (71 female and 39 male), aged 29 to 73, treated at the Outpatient Department of Atherosclerosis Prevention, Centre for Laboratory Medicine, Clinical Centre Vojvodina. The 10-year coronary heart disease risk was estimated on first examination and after one-year treatment by means of Framingham, PROCAM and SCORE coronary risk scores and their modifications (Framingham Adult Treatment Panel III, Framingham Weibul, PROCAM NS and PROCAM Cox Hazards). Age, gender, systolic and diastolic blood pressure, smoking, positive family history and left ventricular hypertrophy are risk factors involved in the estimation of coronary heart disease besides lipid parameters. RESULTS: There were no significant differences in nutritional status, smoking habits, systolic and diastolic pressure, and no development of diabetes mellitus or cardiovascular incidents during one-year follow. However, a significant reduction in cholesterol level (p < 0.001), triglycerides (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and an increase in high-density lipoprotein cholesterol (p < 0.02) was present although therapeutic target values were not achieved. In addition, a significant increase was observed in the category of low 10-year coronary heart disease risk (Framingham- p < 0.001; Framingham ATP III- p < 0.001; Framingham Weibul- p < 0.001; PROCAM- p < 0.05; PROCAM NS- p < 0.05; PROCAM Cox Hazards- p < 0.001: SCORE- p < 0.001) and a reduction in high-risk category (Framingham- p < 0.001; Framingham ATP III- p < 0.005; Framingham Weibul- p < 0.005; PROCAM- p < 0.001; PROCAM NS-p < 0.001; PROCAM Cox Hazards- p < 0.001; SCORE- p < 0.005) in comparison with the risk at the beginning of the study. CONCLUSION: Our results show that the correction of lipid level after one-year treatment leads to a significant redistribution of 10-year coronary heart disease risk estimated by means of seven different coronary risk scores. This should stimulate patients and doctors to persist in prevention measures.

Double heart rupture after acute myocardial infarction: a case report.

INTRODUCTION: Double heart rupture is a rare complication of acute myocardial infarction with high mortality. CASE REPORT: We presented a 67-year-old female patient with symptoms and signs of myocardial infarction, diagnosed with echocardiography, rupture of the septum, the presence of a thrombus and a small pericardial effusion. Soon after admission the patient died. Autopsy revealed tamponade and double myocardial rupture, free wall rupture and ventricular septal rupture, as a cause of death. CONCLUSION: This case highlights the need to evaluate patients with myocardial infarction, recurrent chest pain, echocardiographic signs of effusion and the presence of thrombus in the pericardium in terms of double rupture of the heart.

Myopericarditis--diagnostic dilemmas in relation to acute myocardial infarction.

INTRODUCTION: Myopericarditis with clinical presentation of chest pain, electrocardiographic changes and positive cardio specific enzymes is often a differential diagnostic dilemma in relation to acute myocardial infarction. Literature data are very scarce and only case reports or small series of patients can be found in the literature so each case is a significant contribution to this issue. CASE REPORT: A 19-year-old patient was admitted to the intensive care unit, with chest pain, electrocardiographic signs of suspected myocardial lesion and highly positive cardio specific enzymes. Since echocardiography revealed segmental hypocinesia of the left ventricle, urgent coronary angiography was done, which diagnosed normal luminogram of coronary arteries. Having received the adequate therapy, the patient was subjectively asymptomatic, hemodynamically stable, sub-febrile at the beginning of hospitalization. Two weeks after admission, the patient was discharged in good condition with diagnosis of myopericarditis. CONCLUSION: This case shows that it is sometimes difficult to differentiate acute miopericarditis from acute myocardial infarction only according to anamnesis, clinical, electrocardiographic sings and echocardiography.

Vojvodinascore--local system for cardiac operative risk evaluation.

INTRODUCTION: The aim of the study was to investigate the prognostic value, sensitivity and specificity of both the logistic and additive European System for Cardiac Operative Risk Evaluation (as well as the European System for Cardiac Operative Risk Evaluation II and to assess the necessity for developing a local outcome prediction model in cardiac surgery. MATERIAL AND METHODS: The research included 406 consecutive patients who had undergone cardiac surgical procedures at Institute of Cardiovascular Diseases of Vojvodina from January 2012 to July 2012. The authors compared the predicted mortality according to the additive and logistic European Systems for Cardiac Operative Risk Evaluation, the new European System for Cardiac Operative Risk Evaluation II and the observed mortality (30 days after surgery). RESULTS: The difference between the predicted and observed mortality regarding the whole group of 406 operated cardiac patients was not statistically significant for the additive European System for Cardiac Operative Risk Evaluation (p = 0.081) and the European System for Cardiac Operative Risk Evaluation II (p = 0.164), but it was statistically significant for the logistic European System for Cardiac Operative Risk Evaluation (p = 0.031). The areas under the receiver operating characteristic curves are statistically different from 0.5 for both models (additive and logistic European System for Cardiac Operative Risk Evaluation), as well as for the European System for Cardiac Operative Risk Evaluation II. However, the proper classification of the patients has not been observed since their sensitivity and specificity are not satisfactory. CONCLUSION: The additive and logistic European Systems for Cardiac Operative Risk Evaluation overestimate while the European System for Cardiac Operative Risk Evaluation II underestimates the risk in cardiac surgery. We believe that a locally derived model would be of great use in the everyday clinical practice since it would faithfully illustrate the actual state of patient population of the region where it was developed. At the same time it would provide the accurate prediction of surgical outcome.

Electrocardiographic signs of acute myocardial infarction in left bundle branch block.

INTRODUCTION: Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. LITERATURE REVIEW: Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25. CONCLUSION: The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

[Correlation between acute coronary syndrome, hyperlipoproteinemia and statins].

Atherosclerosis is defined as a chronic, progressive, proliferative and inflammatory process developed as a response of blood vessel endothelium to the numerous noxious factors. The definition, which is only an approximate one, shows that one of the terms to carry definition is progression. In other words, it is a well-known fact today that atherosclerosis is a progressive process. The question about the possibilities of its stagnation and regression arises. The appearance of statins and their introduction into the therapy and the process of prevention give a positive answer to the previous question. The results of many studies have also shown that statins can be used to decrease and even stop the process of atherosclerosis. Using the modern diagnostic procedures, primarily the intravascular and Doppler ultrasound, andfocusing on regression, these studies fillowed the process of atherosclerosis in patients with statin therapy. The conclusions of these studies have indicated a clear degree of regression of atherosclerosis which is not a spectacular one, but implies the significant clinical improvement.

[Statins in aortic stenosis].

Patients with any degree of aortic-valve disease have increased cardiovascular morbidity and mortality. The active inflammatory component of calcific aortic valve disease has been recognized, and similarities with atherosclerotic disease have been identified. Both calcific aortic valve disease and atherosclerosis are characterized by lipid infiltration, inflammation, neoangiogenesis, calcification, and endothelial dysfunction. From these observations, the hypothesis has emerged that statins, which reduce the progression of atherosclerotic disease and significantly improve the clinical outcome in patients with coronary artery disease, might also be beneficial in patients with aortic stenosis. Since aortic stenosis, like atherosclerosis, is an active disease process, it seems plausible that statins might slow its hemodynamic progression. In addition, the use of statins might also lead to a reduction in cardiovascular end points in the group of patients at high risk for vascular complications. Evidence that lipid lowering therapy slowed the progression of aortic stenosis relative to non statin therapy was suggested by several retrospective studies but some prospective studies, such as SALTIRE trial, found that intensive lipid lowering therapy did not halt the progression of calcific aortic stenosis. So, we can not recommend statin therapy for patients with calcific aortic stenosis in the absence of coexisting coronary disease.

[Terminology and diagnostic criteria for non-Q wave myocardial infarct]. / Terminologija i dijagnosticki kriterijumi non-Q infarkta miokarda.

INTRODUCTION: Non-Q myocardial infarction represents a specific entity of infarction. Many studies have shown that non-Q myocardial infarction differs from Q myocardial infarction not only electrocardiographically, but also from pathophysiological, histological, clinical and prognostic points of view. NON-Q MYOCARDIAL INFARCTION-TERMINOLOGY: Until 1980's, anatomical terminology depending on ECG changes was used in the literature. Subendocardial infarction referred to non-Q myocardial infarction, while transmural infarction referred to Q myocardial infarction. Since it was established that presence or absence of Q waves is a non-specific marker of transmural necrosis, in 1982 Spodick proposed the use of terms based on ECG findings. DIAGNOSTIC CRITERIA FOR NON-Q MYOCARDIAL INFARCTION: Elevation of markers of myocardial damage (CK, CK-MB, Troponin) is the most significant criterion for diagnosis of non-Q myocardial infarction. It cannot be made without this criterion because non-Q myocardial infarction may have ECG changes identical to those in unstable angina. Authors do not agree which type of initial ECG changes is the most frequent (ST elevation, ST depression or inverted T waves). CONCLUSION: Non-Q myocardial infarction represents a specific entity of myocardial infarction. Anatomically, based on the extension of necrosis, non-Q myocardial infarction is subendocardial, but it can be transmural as well. ECG changes in non-Q myocardial infarction may be identical to those in unstable angina. Therefore, elevation of cardiac enzymes is the golden standard in diagnosis of non-Q myocardial infarction.

[Mitral valve prolapse]. / Prolaps mitralne valvule.

INTRODUCTION: Mitral valve prolapse (MVP) is a common finding in everyday clinical practice. However, despite simple diagnostics, clinicians remain interested in it due to its undetermined prevalence, various etiology, clinical features and echocardiographic findings. ETIOLOGY AND PREVALENCE: MVP exists as a primary condition and is commonly associated with tissue diseases of familial origin. It is more common in people with asthenic constitution and congenital thoracic abnormalities. Secondary etiology occurs in rheumatic processes on mitral valve, hypertrophic cardiomyopathy and ischemic heart disease. The prevalence varies between 0.33-17%. DIAGNOSIS AND COMPLICATIONS: Clinical manifestations are different and in most patients asymptomatic. The diagnosis is established by anamnesis, physical examination, M-mode and 2-dimen-sional transthoracic and transesophageal echocardiography, left ventriculography and direct histopathologic investigation of mitral apparatus. Although MVP is a benign condition, there are certain complications such as infective endocarditis, severe mitral regurgitation, heart failure, cerebral and coronary embolism events, arrhythmias and sudden death. Complications mostly occur in patients with heart murmurs and mitral insufficiency in contrast to patients with cusps.

[Wall tension or stress in ischemic heart disease]. / Zidna napetost ili stres u ishemijskoj bolesti srca.

INTRODUCTION: Wall stress or wall tension is a conception derived from physics (Laplace's law) and represents the systolic force or work per surface unit. It is the systolic force made by myocardial tissues. Stress increase indicates enlargement of the left ventricle or increase of intracavitary pressure. MATERIAL AND METHODS: This investigation included 170 subjects; control group consisted of 50 patients (pts) with normal coronary angiographic finding without valvular anomalies and the examination group included 120 pts with coronary disease. Transthoracic echocardiography was performed in the left lateral position using computerized Hewlett Packard SONOS 1000 apparatus. Invasive hemodynamic procedure was performed using GENERAL ELETRICS CGR 300. Meridional and equatorial systolic and diastolic stress were calculated according to Grossman formula. RESULTS: The meridional end-diastolic equatorial stress was 18.55 +/- 12.12 dyn/cm2 x 10(3) in the control group, while in coronary patients it was 28.15 +/- 13.42 dyn/cm2 x 10(3). In healthy persons the meridional end-systolic stress established by echocardiography was 190.37 +/- 23.15 dyn/cm2 x 10(3), while in coronary patients 203.82 +/- 17.88 dyn/cm2 x 10(3). End-diastolic equatorial stress was 34.32 +/- 17.18 dyn/cm2 x 10(3) in the control group and 46.13 +/- 17.82 dyn/cm2 x 10(3) in coronary patients. Systolic equatorial stress in the control group was 357.42 +/- 32.15 dyn/cm2 x 10(3) and in coronary patients 385.34 +/- 35.72 dyn/cm2 x 10(3). The same parameters determined by invasive hemodynamic procedure were slightly higher, but without statistical significance in relation to the values determined by echocardiography (P > 0.05). CONCLUSION: Values of equatorial and particularly meridional stress were higher in coronary patients in relations to healthy persons, but without significant difference. The correlation coefficients of all investigated parameters established by noninvasive 2D echocardiography and invasive hemodynamic procedure were in one domain of medium high and high values. Meridional stress increases in coronary patients, equatorial in hypertensive patients or valvular anomalies with severe myocardial hypertrophy. In regard to high correlation between these two techniques, echocardiography may be considered a highly reliable method in evaluation of wall tension.