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Left atrial size in patients with arterial hypertension
Milutinovi? Suzana,ApostoloviSvetlana,Tasi? Ivan
Srpski Arhiv za Celokupno Lekarstvo , 2006, DOI: 10.2298/sarh0604100m
Abstract: INTRODUCTION Left atrial size is increased in patients with arterial hypertension. Left atrial enlargement represents a risk factor of atrial fibrillation and stroke. Left atrial size depends on the effect of many other etiological factors, predominantly by body mass and the left ventricular mass. OBJECTIVE The objective of the study was to investigate the frequency of the left atrial enlargement in patients with arterial hypertension, in obese patients with arterial hypertension and in patients with arterial hypertension and left ventricular hypertrophy. In addition, the aim was to investigate the influence of diastolic function parameters on the left atrial dimension. METHOD The study included 93 patients with arterial hypertension (mean age of 46.9 ± 9.7 years, 50.5% of males) and 33 healthy subjects (mean age 45.6 ±10.6 yrs., 40% of males) who consisted the control group. There was no statistical difference of the age and sex between patients and healthy persons. All patients were examined by the echocardiographic ultrasound device HP Sonos 2500 by three echosonographers. RESULTS The patients with arterial hypertension compared to the control group had significantly higher: body mass index (27.8 ± 4.1 versus 24.3 ± 3.0) (p<0.001), the left ventricular mass (249.7 ± 79.1 versus 174.6 ± 47.7) (p<0,001), the left ventricular mass index (122.2 ± 34.3 versus 96.7 + 20.9)(p<0.001) and the left atrium (3.8 ± 0.7 versus 3.3 ± 0.5) (p<0.001). The frequency of the left atrial enlargement in patients with arterial hypertension was 44.1%. The frequency of the left atrial enlargement In patients with arterial hypertension and the left ventricular hypertrophy was 53.3%, and in obese patients with arterial hypertension was 58.3%. Left ventricular diastolic function parameters in patients with arterial hypertension in relation to control exhibited statistically significant differences: isovolumetric relaxation time (IVRT) was longer (193.2 ± 37.8 versus 175,8 ± 23,6) (p<0.001), deceleration time (DT) was longer (193.2 ±37,8 versus 175.8 ±23.6) (p<0.01) and peak early diastolic filling wave velocity /peak atrial diastolic filling wave velocity ratio (E/A ratio) was lower (1.0 ± 0.3 versus 1.2 ± 0.3) (p<0.01). The quotient of linear correlation of the left ventricular diastolic function parameters in patients with arterial hypertension with left atrial volume did not show any significant correlation. CONCLUSION The left atrial size was statistically bigger in patients with arterial hypertension in relation to healthy subjects. The biggest left atrial enlargement was
Late thrombosis of coronary bare-metal stent: Case report
ApostoloviSvetlana,Peri?i? Zoran,Toma?evi? Miloje,Stankovi? Goran
Srpski Arhiv za Celokupno Lekarstvo , 2006, DOI: 10.2298/sarh0604155a
Abstract: Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI). Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS). Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months) thrombosis of coronary bare-metal stent (BMS) is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU) was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.
Comparative effect of streptokinase and alteplase on electrocardiogram and angiogram signs of myocardial reperfusion in ST segment elevation acute myocardial infarction
Toma?evi? Miloje,Kosti? Tomislav,ApostoloviSvetlana,Peri?i? Zoran
Srpski Arhiv za Celokupno Lekarstvo , 2008, DOI: 10.2298/sarh0810481t
Abstract: INTRODUCTION Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. OBJECTIVE The aim of the paper is to compare the effects of streptokinase and alteplase, together with the standard modern adjuvant antiplatelets and anticoagulation therapy (aspirin, clopidogrel, enoxaparin) in patients with ST segment elevation acute myocardial infarction, on electrocardiographic and angiographic signs of the achieved myocardial reperfusion. METHOD The prospective study included 127 patients with the first ST segment elevation acute myocardial infarction who were treated with a fibrinolytic agent in the first 6 hours from the chest pain onset. The examined group included 40 patients on the alteplase reperfusion therapy, while the control 87 patients were on the streptokinase therapy. All the patients received the same adjuvant therapy and all were examined by coronary angiography on the 3rd to 10th day of hospitalization. Reperfusion effects were estimated on the basis of the following: ST segment resolution at 60, 90 and 120 minutes, the appearance of reperfusion arrhythmias at the electrocardiogram, percentage of residual stenosis at the 'culprit' artery, TIMI coronary flow at the 'culprit' artery and the appearance of new major adverse coronary events in the 6-month-follow-up period. RESULTS By analysing the resolution of the sum of ST segment elevation in infarction leading 60 minutes after the beginning of the medication application, we received a statistically significantly higher resolution of ST segment in the group of patients who received alteplase (p<0.05). 60 minutes after the application of thrombolytics, 64% of patients at streptokinase showed the absence of ST segment resolution (<30%), and 32% of patients at alteplase (p<0.0001). Reperfusion arrhythmias as the sign of successful myocardial reperfusion were present in 62.5% of patients at alteplase and in 57.4% of patients at streptokinase, but the difference is not statistically significant. There was no statistically significant difference in the degree of residual stenosis at the 'culprit' artery in the compared groups of p
Miloje Toma?evi?,Branko Beleslin,Svetlana Apostolovi,Milan Pavlovi?
Acta Facultatis Medicae Naissensis , 2005,
Abstract: The shortcomings of coronary arteriography to assess the physiological significance of coronary stenosis have been recognised for decades. Noninvasive test can be inconclusive in some patients. In patients with moderate coronary stenosis, fractional flow reserve (FFR) provide important information and appears to be a useful index of the functional severity of the stenosis and need for coronary revascularization. FFR is invasive index of stenosis severity that is a substitute for noninvasive stress testing. A patient with long stenosis of the mid and distal right coronary artery and inconclusive noninvasive test was presented. FFR was significantly improved, from 0,45 to 0,92, after the coronary intervention. It predicts low restenosis rate.
Routine Coronary Angiography and Revascularization after Thrombolysis-Impact on One-Year Prognosis
Danijela ?or?evi?-Radojkovi?,Zoran Peri?i?,Svetlana Apostolovi,Miodrag Damjanovi?
Acta Facultatis Medicae Naissensis , 2010,
Abstract: The most often used reperfusion strategy for patients with STEMI is still thrombolysis, but it is not the end of treatment. The aim of this paper was to show whether routine in-hospital coronary angiography and subsequent revascularization (percutane-ous or surgery) after thrombolysis improve an one-year prognosis in patients with STEMI. The study involved 155 patients, 29-79 years old, with first STEMI. They were treated with fibrinolytic, aspirin, and enoxaparin. Group I (102 patients) underwent coronary angiography on approximately the 5th day of hospitalization, then percutaneously or surgically revascularized if considered appropriate. In group II (53 patients), in-hospital angiography was not done. Mortality, reinfarction, angina and left ventricular systolic function were analyzed during one-year period. Patients in group II were older, they received clopidogrel and statin less frequently and ACE inhibitors more frequently. The groups were significantly different regarding the in-hospital (3% vs. 15%, p=0.008) and one-year mortality (2% vs. 11.1%, p=0.03). There was a numeric trend for higher frequency of reinfarction in group II (3% vs. 11.1%, p=0.06). After one year, more patients in group II had angina (2.9% vs. 13.2%, p=0.03). In hospital, the groups had similar EF (54% vs. 51.2%, ns), but after one year EF in group I was higher (55.2% vs. 47.6%, p=0.02). Multivariable analysis adjusted for age and differences in drug therapy showed that the lack of routine elective coronary angiography and revascularization is an independent predictor of one-year mortality (RR 4.7, p=0.019) and independent predictor of combined mortality, reinfarction and angina (RR 3.2, p=0.028). Routine coronary angiography and revascularization after thrombolysis improve in-hospital and one-year survival, decrease the frequency of reinfarction and angina, and improve the left ventricular function.
Ru?ica Jankovi?,Milan Pavlovi?,Svetlana Apostolovi,Danijela Djordjevi?-Radojkovi?
Acta Medica Medianae , 2004,
Abstract: Although after the AHA/ACC recommendations there should be no sex differences regarding the diagnostic and therapeutic procedures in acute coronary syndrome and secondary prevention of coronary disease (CD), they still persist not only in our country but also in other, much more developed and equipped hospitals of the West. It has been demonstrated that the discrepancy is primarily conditioned by the advanced age of women and consequently advanced cardiac status at CD presentation, as well as a greater burden of comorbidity in this patient population. Aim of this paper was to assess the sex differences in therapeutic approach in our patients with their first acute myocardial infarction.The investigation enrolled 320 patients (94 women and 226 men) treated in the Coronary Unit, Clinic for Cardiovascular diseases, Clinical Center Nis in the acute phase of the first myocardial infarction. In the experimental sample women were significantly older than men (62,95 ± 8,16 vs 57,73 ± 10,24; p<0,0001). Based on the stratification of both sexes into the age groups, it was demonstrated that there were significantly less women with acute myocardial infarction (AIM) below 55 years of age, and significantly more in more advanced age groups (between 65 and 74 years of life). Compared to men, it was observed that women with AIM significantly less often received fibrinolytic therapy (40% vs 58%; p<0,05). Average age of women receiving fibrinolytic agents was 65,67±8,69 years and men 56,09±10,7, which was of statistical significance (p<0,05). There were no significant differences regarding other groups of drugs. Medicamentous treatment of AIM in our country follows the up-to-date recommendations of European and worldwide associations of cardiologists. The only difference observed was infrequent use of fibrinolytic therapy in women due to sex-conditioned reasons, including different AIM presentation, patient age and complication proneness.
Tomislav Kosti?,Zoran Peri?i?,Dragan Mili?,Svetlana Apostolovi
Acta Medica Medianae , 2010,
Abstract: Ventricular perforation is a rare complication of permanent pacemaker implantation. We report a case of 61-year-old woman with sick sinus syndrome who had the dual chamber pacemaker implanted. Five days after the implantation, the perforation of right ventricle by active ventricular fixation lead was detected. 12-lead surface electrocardiography and multislice chest scan are necessary for detection of rare complications after the pacemaker implantation.
Tomislav Kosti?,Zoran Peri?i?,Sonja ?alinger Martinovi?,Svetlana Apostolovi
Acta Medica Medianae , 2009,
Abstract: Sudden cardiac death poses an immense problem in the middle and highly developed countries because its first expression is at the same time the last one. Ventricle tachycardia, the monomorphous and the polymorphous ones, and ventricular fibrillation are rhythm disorders that are most frequently associated with the phenomenon of sudden cardiac death. Ventricular fibrillation is the most common cause of sudden cardiac death within the first hours of the acute myocardial infarction. A 60-year-old man was admitted to our Clinic from a local hospital due to acute onset of chest pain and ECG signs of anterior ST segment elevation myocardial infarction. He had severe rhythm disturbances, about 70 epizodes of ventricular fibrilation (VF). Due to rhytmical instability of the patient, we decided that along with PCI it was necessary to implant ICD twenty-two days after the first acute coronary event.The ICD implantation ensures the best prevention against sudden cardiac death (secondary and primary) in selected high-risk patients and has no alternative for any medicine known so far. It is significant that, lately, the field of application has extended to indication areas of primary prevention of sudden cardiac death, and especially to development of resynchronization implantable cardioverter defibrillator in the heart failure therapy.
Milan ?ivkovi?,Svetlana Apostolovi,Milan Pavlovi?,Sonja ?alinger Martinovi?
Acta Medica Medianae , 2012,
Abstract: No-reflow has been defined as “inadequate myocardial perfusion through a given segment of coronary circulation without angiographic evidence of a mechanical obstruction”. Important components of the process are thought to include endothelial ischemic injury producing “blebs” of tissue that directly obstruct the microvasculature, leukocyte plugging of capillaries, and the vascular effects of reactive oxygen species. No-reflow can complicate any percutaneous intervention (PCI), though it is more common following acute myocardial infarctions (MI), particularly with prolonged occlusion times. A 59-year-old woman presented to the hospital after two hours of continuous chest pain. Because of acute myocardial infarction of the inferior and lateral wall, she underwent direct stenting to an occlusion in the right coronary artery. Despite successful implantation of stents revascularization failed. In absence of aspiration devices and other pharmacological agent we decide to apply 30 mg (6000 IU) tenecteplase intracoronary. Three min after administration TIMI flow grade improved from TIMI 0 to TIMI 3. Managing no-reflow can be approached in a number of different ways and needs to be tailored to the type of intervention being performed. As confirmed in practice, prevention is better than cure and both mechanical and pharmacological approaches can be employed in high risk cases. In the setting of acute myocardial infarction the most effective preventative measure is the rapid opening of the vessel and as such the development of a robust and efficient primary PCI service is integral to the avoidance of this complication. Managing no-reflow will become increasingly important with the wider development of primary PCI. Within the setting of acute myocardial infarctions with no reflow as primary percutaneous intervention complication, there are potential important future pharmacological regimens that may become established and one of them can be tenecteplase.
Suzana Milutinovi?,Milan Pavlovi?,Miloje Toma?evi?,Svetlana Apostolovi
Acta Medica Medianae , 2005,
Abstract: The aim of this research was to investigate the potential relationship between the longterm exposure to air pollution, as a risk factor, and the development of allergic reactions in the population. The observed sample consisted of Nis citizens of different age groups who lived in areas with high concentrations of air pollutants (investigated group) such as the Square of the October Revolution and Sindjelic’s Square (investigated group), as well as the citizens of Niska Banja (control group) which is the zone with the lowest concentration of air pollution. The investigation was carried out in the Public Health Institute in the period between 1996 and 2000. A significance test was performed using a Mantel-Haenszel chi square test. This test was used to check for a statistically significant difference between the incidence of the obstructive lung disease between the investigated group and the control group across all age groups. The cross-risk and relative risk were determined. The highest value of the chi square test was determined in the age group 26-50 (RR=3.50), in the group up to 25, RR=2.25, and in the group above 51, RR=1.89. The obtained results prove that the incidence of the obstructive lung disease is significantly higher in the exposed population than in the non-exposed.
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