[Therapeutic procedures in patients with acute coronary syndrome and life-threatening arrhythmias in prehospital stage]. / Terapijski postupci u bolesnika s akutnim koronarnim sindromom i zivotno ugrozavajucim aritmijama u prehospitalnoj fazi.

The prehospital phase of acute coronary syndrome can be divided into two parts: in the first part laypersons (or nobody), and later on professional medical staff are in contact with the patient. This part is especially important since it is well-known that the mortality rate arising from acute myocardial infarction is highest in the first hour of the disease onset, mostly due to malignant arrhythmias. Apart from calling the doctor, laypersons' help practically comes to resuscitation in case of cardiac arrest. In different regions of the world, there are different programs of interventions that have led to a decline in the mortality rate in this stage of the disease, which is nevertheless higher than in the overall later period (in Zagreb in 2003, 59% : 41%). One of the main reasons for this is late arrival in the hospital where proper help can be given (based on the Registry of Acute Coronary Syndrome of the City of Zagreb in 2003, in the first three hours 26% of women and 33% of men were admitted to the hospital, while figures change to 39% for women and 45% for men in the first six hours). Unfortunately, in Croatia there is no systematic program of prehospital care of patients before the arrival of medical staff although it has been proposed for years. The treatment of certain life-threatening arrhythmias in this phase of the disease depends on the type and level of arrhythmia, hemodynamic status and transportation time. The article provides a summary of different procedures in particular arrhythmias in comparison with the same arrhythmias in other situations and/or other etiologies.

[Arrhythmia in acute coronary syndrome]. / Aritmije u akutnom koronarnom sindromu.

Specific features of most common arrhythmias and cardiac conduction disorders found in patients with acute coronary syndrome are described. The review is intended for physicians properly informed on the general principles of the diagnosis and treatment of cardiac arrhythmias, as a differentiated concise guideline on approaching these patients.

[Present status of cardiac pacing in Croatia]. / Sadasnje stanje elektrostimulacije srca u Republici Hrvatskoj.

The number of implanted cardiac pacemakers in Croatia has considerably increased in the recent years. However, we still have not reached the level of the developed European countries. This particularly applies to the number of implanted cardioverter-defibrillators, and less so to the proportion of simple and sophisticated cardiac pacemakers. Despite this, when indication is established our patients receive top quality and most modern devices, because in Croatia the products of the most renowned world manufacturers are implanted.

[Endocarditis associated with atrial and ventricular cardiac pacing leads. Case report]. / Endokarditis na atrijskoj i ventrikulskoj elektrodi trajnog elektrostimulatora srca. Prikaz bolesnika.

The infection of a transvenous lead implanted for cardiac stimulation is a rare, but serious complication. We report observation of a 25-year old man whose Staphylococcus epidermidis sepsis linked to endocarditis was related to atrial and ventricular pacing leads, and was diagnosed after two months of medical treatment. The most important role during the diagnostic process was played by the echocardiographic examination, especially transoesophageal, which revealed the large vegetations on atrial as well as ventricular pacing lead. The diagnosed condition was treated by complete removal of pacing system using open chest surgery and cardiopulmonary pump. After four weeks of vigorous antibiotic treatment, a new DDDR pacing system was implanted, but with epicardial leads.