Chronic inflammation as a new cardiovascular disease factor

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Cardiovascular disease (CVD) is a major public health problem, in most areas of the world. While traditional risk factors for the development of CVD have been researched, the science community has recently identified chronic Inflammation as an additional risk factor. Inflammation is the result of the body's immune system activity recognizing and removing harmful stimuli to start the healing process. Chronic inflammation is referred to as a long-term disorder. Chronic inflammatory disorders include diseases such as rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) etc., which play a crucial role in the process of atherogenesis. Aim of the study. This research was on studying cardiovascular patients, that previously have been diagnosed with a form of chronic inflammation, to show that patients with chronic inflammatory diseases are likely at high risk of developing CVD. Materials and methods. The aim of the research consisted in studying cardiovascular patients, that have been previously diagnosed with a form of chronic inflammation, to show that patients with chronic inflammatory diseases are likely to be at a high risk of developing CVD. Results. By studying the significant inflammatory indicators like C-reactive protein, fibrinogen, Cytokines interleukin, the helper T cells, LDL cholesterol, triglycerides, etc. and their effects on atherosclerosis we can underline the pathophysiology of atherogenesis. When the pro-inflammatory activity starts, it also commences the alteration of lipoprotein concentrations, oxidative stress, and macrophage accumulation, the injury of the endothelial and the activation of the immune system. All these factors and many others are increasing the risk of the atherosclerosis/arteriosclerosis and supported by the traditional factors they create the best conditions for the development of CVD. Patients with rheumatoid arthritis are in the group of an increased risk of CVD; the EULAR recommendations in 2017, updated in 2019, announced that the estimated risks are multiplied by 1.5- 2 for all patients with RA. The same data was found on systemic lupus erythematosus, in which the risks increase by 2-3 times. A similarity was suggested also on psoriatic arthritis and systemic sclerosis. Conclusions. Chronic inflammatory disorders, influenced by their pro-inflammatory effects are relevant as the new risk factors of Cardiovascular disease such as atherosclerosis, arteriosclerosis, acute coronary syndrome, etc

Unstable angina pectoris after PCI revascularization with thrombus aspiration

Cardiology Department, State Medical and Pharmaceutical University “Nicolae Testemifanu”, Chisinau, Republic of MoldovaIntroduction: Percutaneous coronary intervention (PCI) is a non-surgical procedure used in the treatment of coronary artery stenosis. Repeated stenoses of the coronary arteries may develop 6 months later in 40-50% cases of PCI, this resulting in clinical manifestations of cardiac ischemia. Early postinfarction angina pectoris is a form of unstable angina, developing in up to 2 weeks after a myocardial infarction. The present clinical case describes a patient L., male, 50 years old, hospitalized on 26.03.14 in the Cardiology Recovery Department of MCF1 “Holy Trinity”. Complaints: constrictive retrosternal chest pain with irradiation in the left shoulder, general weakness. History of the disease: The patient had an anterior extended myocardial infarction 2 weeks ago, he was hospitalized in Medpark clinics and angiocoronarography was performed, as a result three coronary atherosclerotic lesions were determined with moderately severe stenoses on RCA III and unimportant stenoses on LAD and CX (OM I). In consequence, he was submitted to PCI revascularization with thrombus aspiration. He was discharged for treatment at home with Tab. Aspirini 75 mg daily, Tab. Clopidogrel 75 mg daily for 2 months and was recommended a future stent implantation. Clinical examination: General state o f medium severity. Clear conscience, skin of pale colour. Heart sounds were rhythmic, diminished, with HR=80 beats/minute, Ps=80 beats/minute, BP=110/80 mmHg. Other organ systems had no pathological changes. Paraclinical investigations: ECG: Sinus rhythm, HR=75/minute, EHA - intermediate, pathologic Q wave in III, signs of LV hypertrophy, repolarization disturbances. Echo-CG: Induration of ascending aortic walls, aortic and mitral valves, EF=64%, contraction function of the LV is sufficient. General and biochemical blood analysis: within normal ranges. Markers of myocardial necrosis: negative. Treatment: Beta-blockers, nitrates, antiplatelets, ACE inhibitors, anticoagulants, metabolic drugs and diuretics. Clinical diagnosis: Ischemic heart disease. Unstable angina pectoris. State after PCI revascularization (09.03.14). Congestive heart failure II (NYHA). Conclusion: The patient L., 50 years old, develops an early postinfarction angina pectoris after being submitted to PCI revascularization with thrombus aspiration, as a result of a myocardial infarction experienced 2 weeks ago. The antiischemic treatment received during hospitalization had a positive effect, leading to symptoms’ resolution and the patient is recommended a future stent implantation

Atrial fibrilation in Brugada syndrom

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Atrial fibrilation is the most common cardiac arrhythmia with the worldwide prevalence of more than 33.5 million people and is a subject with increased interest in clinical trials. The reason is the awareness of the high risk of embolic events that in 75 % are complicated by cerebrovascular accidents. It is estimated that the number of patients with AF in 2030 in Europe will be 14–17 million and the number of new cases of AF per year at 120,000–215,000. In approximately 80% of patients, atrial fibrillation is associated with organic heart disease including valvular heart disease (mostly mitral valve disease), coronary artery disease, hypertension, hypertrophic or dilated cardiomyopathy. In 20% of cases, atrial fibrillation occurs in the absence of organic heart disease. Besides the danger of embolic events, atrial fibrillation is the most common atrial arrhythmia found in Brugada syndrome which is associated with malignant ventricular arrhythmias and sudden cardiac death. Aim of the study. The purpose of this study was to review data about characteristics and management of atrial fibrillation in Brugade syndrome. Materials and methods. The source of information was represented by articles published in the online databases: PubMed, HINARI, SCOPUS, EMBASE Results. Current evidence revealed that the prevalence of AF in patients in BrS vastly differs among publish studies, ranged from 6% to 39%. The only genetic mechanism of arrhythmias is related to the mutation of the SCN5A gene that encodes cardiac sodium channels. However, as this sodium channel is found not only in the ventricular tissue, but also in the atria, this could lead to reentrant tachyarrhythmias in the atrium. Nevertheless, management of BrS with AF remains a difficult task, as medication for AF, such as sodium channel blockers, confers their risk owing to their proarrhythmic effects in patients with BrS. In addition, other than quinidine and disopyramide cannot be used because they block sodium channels and cause ventricular arrhythmias. Recent evidence suggested that catheter ablation could be utilized as a first‐line therapy for paroxysmal AF in BrS patients. For the last 2 decades, ICD therapy has been considered as the cornerstone therapy of patients with documented ventricular tachyarrhythmia, but recent studies has been associated ICD therapy with a significant rate of complications, and should be avoided in asymptomatic patients. The most common of these complications are inappropriate shocks, which cause pain, and can produce psychological trauma. Pulmonary vein isolation (PVI) is an effective method for controlling paroxysmal AF. The literature indicates that the success rate of PVI is 79.8% in the long term in patients with brugada syndrome. Conclusions. According to studies, PVI has been shown to have minimal risk of complications and is considered one of the most effective long-term methods in the control of atrial fibrillation and brugade syndrome. This treatment method could be considered the first line of treatment for atrial fibrillation and in brugade syndrome

Thyrotoxic cardiomyopathy: a case report

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Heart failure (HF) is the final common pathway of many cardiovascular diseases. It imposes significant socio-economic and health care burden to both patients and healthcare systems. Although the most common cause of HF is ischemic heart diseases, other less common causes such as hyperthyroidism (thyrotoxicosis), severe anemia, arrhythmia should also be considered during diagnosis to improve overall clinical management of HF. Case report. The 42-year-old man was admitted to cardiology department with mixed (inspiratory and expiratory) dyspnea at moderate effort, palpitations, fatigue, the loss in weight of about 15 kg during 9-10 months. Anamnesis: general condition worsened the last 2 months when appeared generalized edema and mixed dyspnea. During this time did not address to doctor, any treatment has not received. Physical examination revealed swelling in the legs, ankles, ascites, an irregular pulse, at a rate of 130 beats/min, BP- 110/70mmHg. On ECG - atrial fibrillation with rate - 120-57 b/min, electric axis of heart is normal. Signs of left ventricular hypertrophy. The chest X-ray -pulmonary congestion, bilateral pleural effusion. The abdominal X-ray – fluid levels with air on the left. On TTE- thickening of the walls of the aorta and valve apparatus. Dilatation of all heart chambers, significant dilatation of the right atrium and right ventricle, and moderate dilatation of the left atrium and the left ventricle. Contractile function of the left ventricular myocardium is moderately reduced. Ejection fraction = 42%. The second degree mitral regurgitation and third-fourth -degree tricuspid regurgitation. Moderate pulmonary arterial hypertension (PASP= 52mmHg). Sheets of the pericardium are thickened. Fluid in the pleural cavity up to 11 millimeters in the region of the right atrium. Bilateral pleurisy - inhomogeneous fluid with floating elements on the left - about 1,000 milliliters, to the right - about 800 milliliters. Сytological analysis of fluid from pleural cavity pointed to the inflammatory etiology of the effusion. On the ultrasound examination of the thyroid gland – fourth –degree hyperplasia, multiple diffuse changes.On the ultrasound examination of abdominal cavity - ascites, bilateral pleuritic, diffuse changes in the parenchyma of the liver. The glycemic profile -7-00: 4.7 mmol/l, 13-00: 6.3 mmol/l, 17-00: 10.6 mmol/l, glycated hemoglobin - 5,6%. Analysis of thyroid hormones- free Triiodothyronine – 17,22 Pmol/l, free Thyroxine – 79,52 Pmol/l. TSH – ‹ 0, 05 uIU/ml; anti TPO- 144 IU/ml. Tumor marker CA 19-9 - <3.0 U/ml. During hospitalization was consulted by endocrinologist, surgeon. After 11 days of complex treatment with diuretics, anticoagulants, beta-adrenoblockers, antithyroid drugs, cardiac glycosides, corticosteroids, histamine-2- receptor blockers - the general condition improved: dyspnea and general swelling disappeared, general weakness was reduced.Conclusions. The incidence and prevalence of thyrotoxic heart failure (THF) provide a wide variation from 12% to 68% in hyperthyroid patients. Up to 90% of patients with thyrotoxicosis may develop Atrial Fibrillation, 47% Left Ventricle systolic dysfunction and 1% dilated THF and a third of these cases are reversible. Mortality in THF patients is 1.2 higher than in patients with hypertension, valvular heart disease or coronary artery disease, and 1.4 higher than in the general population. Hyperthyroidism is a potentially reversible and curable cause of THF, so it should be excluded in every new patient with HF, especially in young patients and in the absence of coronary artery disease and other structural heart diseases

The importance of myocardial revascularization for later post-infarction survival

Departamentul Medicină Internă, USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Al III-lea Congres al medicilor interniști din Republica Moldova cu participare internațională 24–25 octombrie 2017 Chișinău, Republica MoldovaThe treatment tactics in patients with myocardial infarction in subacute period has rarely presented in international guides and protocols dealing with acute myocardial infarction. This article presents clinical case that demonstrates how the restoration of coronary fl ow even in the late period leads to reperfusion of the ischemia site and inhibits necrosis and apoptosis of cardiomyocytes. This can slow or even prevent remodilation of the left ventricle, which can improve the long-term prognosis and reduce the risk of recurrent heart attack

Particularities of the tricoronarian atherosclerotic lesions occlusion by acute thrombosis at the Cx I in diabetic patient

Departament of Internal Medicine, SMPhU Nicolae Testemitanu, SMPI MCH Holy Trinity, Hepato-Surgical Laboratory, SMPhU N. Testemitanu, Al III-lea Congres al medicilor interniști din Republica Moldova cu participare internațională 24–25 octombrie 2017 Chișinău, Republica MoldovaIntroduction Numerous studies have been conducted on the link between atherosclerosis and atherothrombotic events. The role of endothelium is to maintain vascular health. The endothelium modulates vascular flow by controlling vasodilator tonus, inhibiting platelet aggregation and clotting factors, forming a barrier over the procoagulant subendothelial layer. Endothelium also acts as a barrier against infamy and has the ability to self-repair in case of injury. Studies show that endothelial dysfunction is a predictor of the progression of atherosclerosis and acute coronary events in patients with or without known coronary disease. Patients with diabetes have disorders in the coagulation system, which causes a hypercoagulable status [5]. About 70% of cases of acute coronary thrombosis involve the dislocation of an atherosclerotic plaque and 30% involve superficial lesions of the intima at the site of thrombus formation. Superficial endothelial lesions, which cause coronary thrombosis, most commonly occur in women and diabetic patients with hypercholesterolemia. It is assumed that the cause of lesions would be the action of metalloproteinases in the subendothelial layer, which dislocates the endothelial cells from the basal lamina, causing desquamation. Up to 25% of endothelial erosions occur asymmetrically [4]. The systemic origin of endothelial dysfunction aggravates the process of atherosclerosis and consequently occurs with acute coronary syndrome or chronic ischemic coronary heart disease. PCI in the first hours of STEMI can be divided into primary PCI, PCI combined with reperfusion pharmacological therapy (PCI) and rescue PCI after failure of pharmacological reperfusion. Primary PCI (balloon inflation) should be performed in all cases within the first two hours of first medical contact. Diabetic patients with angina pectoris symptoms should be screened by early coronary angiography, and primary PCI will be the preferred therapy in these patients. Clinical case Patient D., aged 58 years, was urgently hospitalized in the Cardiology Recovery Section on 07.03.2017. Accusation at admission. Retrosternal pain of constrictive character, irradiation in the shoulder and the left hand, present at rest, moderate intensity dyspnea, headache, dizziness, general weakness. The history of the disease. He is considered ill for many years with HTA. It’s under the family doctor’s record. Outpatient treatment is irregularly administered. In the last 3-4 days the state gradually worsens, presenting the above-mentioned accusations. On March 7, 2017, he requested the AMU service. He was urgently transported and hospitalized in the IMSP SCM Holy Trinity Hospital for the diagnosis and treatment tactics. Objective data: overall status of mean severity. Pink-pale skin. Rash is missing. Peripheral edema absent. Auscultatively throughout the lung area there is a vesicular murmur, missing rallies, FR = 18/ min. Apexian shock is determined in the intercostal space V with 1.5 cm lateral to the left medioclavicular line, 1.5 cm wide. Power and moderate resistance. Rhythmic, attenuated cardiac noises, FCC – 68 beats/minute, TA – 140/80 mmHg. The abdomen is enlarged because of mass of adipose tissue and have soft palpation. No change in liver and spleen. Current intestinal transit. No pain during micturition. Negative Giordano sign bilateral. Paraclinic examination: hemoleucogram: hemoglobin – 166 g/l, erythrocyte – 5,1x1012/l, color index – 0,83, hematocrit – 43,4%, leukocyte – 10,2x109/l, unshed – 8% – 3%, lymphocyte – 15%, monocyte – 8%, VSH – 24 mm/h. Biochemical analisys: prothrombin – 119%, fibrinogen – 4.4 g/l, urea – 5.2 mmol/l, creatinine – 0.09 mmol/l, glucose – 7.2 mmol/l, ALT – 139, AST – 116 u/l, total cholesterol – 6.2 mmol/l, triglyceride – 2.30 mmol/l, potassium – 4.9 mmol/l, natrium – 147 mmol/l. Echocardiographic examination: 13.03.2017 – Induction of ascending Aortic Wall, VAo, VM. The cavities of the heart are not dilated. Concentric hypertrophy of the VS myocardium. The apical segment hypokinesia of the PPVS myocardium, the apical and middle segment of the PLVS myocardium. The pump function of the VS myocardium is sufficient. FE Simpson – 56%. Echo-CS Doppler: V max – N. Insufficient VM gr. I-II, VT gr. I-II, VAP gr. I. Impairment of relaxation of the VS myocardium. Coronary angioplasty: tricoronaric atherosclerotic lesions; occlusion through acute thrombosis on Cx I. Moderate stenosis on LAD II, RCA II. Angioplasty Protocol. Acute thrombosis occlusion of Cx I is attempted. The common left artery coronary artery is intubated with a 3.5-6F XB catheter. The lesion was traversed by a PILOT 50, 0.014 to the distal portion of the vessel. Pre-treatment with a 2.5- 20 mm SC swollen flask of 8 atm – 15 sec is practiced. Then implant the stent DES PROMUS 2.75-20 mm, inflated at 8 atm – 15 sec. The proximal segment of the stent was postdiluted with a balloon NC3.0 – 15 mm, swollen at 14 atm 15 sec. There is a reduction in lesion score from 100% to 0 with TIMI III flow and good myocardial blash. Residual stenosis and dissections are not determined. Was’t compilation during the intervention. Clinical diagnosis Tricoronaric atherosclerotic lesions. Occlusion through acute thrombosis on aCx I. Moderate stenosis on LAD II, RCA II. Condition after PCI on aCx I (07.03.2017). Extremely high risk of high blood pressure. ICC II (NYHA), stage B ACC/AHA. Type II subcompensated diabetes mellitus. Dyslipidemia. Stationary treatment Tab. Cardiomagnyl – 75 mg, Tab. Plavix – 75 mg, Sol. Cardimac, Sol. Pyracetam, Tab. Mildronat – 500 mg 2 daily. Conclusions Patient D., aged 58 years, accusing retrosternal pain of constrictive character, irradiation in the shoulder and the left hand, present and rest, moderate intensity dyspnea, headache, dizziness, general weakness following a coronar angiography Established diagnosis: Tricoronary atherosclerotic lesions. Occlusion through acute thrombosis on aCx I. Moderate stenosis on LAD II, RCA II. A stent was applied with revascularization of the respective region. The risk factors to which the patient is subjected, namely the presence of diabetes mellitus, HTA, irregular treatment of ambulatory treatment, and dyslipidemia with 6.2 mmol/l cholesterol were determined from the biochemical analysis. SCORE score of 6%, which indicates a high risk of cardiovascular death over the next 10 years. The patient is recommended to be registered with the family doctor, cardiologist, with dynamic monitoring of TA, glucose, lipid profile. Respecting the proper diet and a healthy lifestyle

The implantable defibrillator - cardioverter, an urgent measure, while waiting for heart transplantation, clinical case

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Insuficiența cardiacă (IC) cu fracție de ejecție scăzută, cauzată de aritmii ventriculare maligne prezintă o rată înaltă de mortalitate 7,37-14,4% anual la tinerii adulți. Defibrilatoarele cardiace implantabile (DCI) au devenit verigă componentă în tratamentul acestor pacienți. Scopul. Prezentarea cazului clinic al pacientului diagnosticat tardiv cu infarct miocardic acut care a dezvoltat insuficiență cardiacă progresivă, spitalizări frecvente, implantare de DCI și studierea acestui caz prin prisma ghidului american din 2022. Material și metode. Bărbat, 62 de ani, inclus în programul de transplant cardiac, internat în secția recuperare cardiacă, SCM „Sfânta Treime”. Datele din anamnestic și rezultatele paraclinice au fost colectate din fișa de observare și cartela de ambulatoriu. Investigații efectuate: ECG, ECHOCG, radiografia cutiei toracice, USG analize de laborator. Rezultate. Clinic: dispnee în repaus, durere parasternală pe stânga, acrocianoză, edeme gambiene, FCC 100 b/min; TA-160/96mmHg. Radiografia toracelui: Cord dilatat. Modificări pseudofibrotice bilateral. Obliterarea sinusului costodiafragmal bilateral. DIC pe stânga. ECG: Ritm sinusal cu FCC 90b/min. Sechele postinfarct în regiunea anteroapicală. Dereglări de repolarizare în regiunea laterală a VS. EcoCG: În cavitățile drepte se vizualizează firele DIC. Achinezie în regiunea apicală a VS. FE-30%. Hipertrofie VS, regurgitarea VM gr. II; CFK-MB (14%), LDH (228U/l), troponine (0,18), glucoza (5,5mmol/l), D-dimerii (3,5mg/l), IP (50%). Tratament cu: ARNI, β-blocatori, nitrați, diuretici, antiagregante, statine. Concluzii. Pacient grav cu FE (30%) și spitalizări multiple a avut indicații vitale pentru implantarea DIC, ca măsură intermediară până la transplant cardiac, cu înrolarea în rândul de așteptare, ceea ce, în conformitate cu ghidul din 2022, prezintă beneficii pentru bolnavii cu risc de moarte cardiacă subită.Introduction. Heart failure (HF) with reduced ejection fraction may cause malignant ventricular arrhythmias has a high mortality rate of 7.37-14.4% annually in young adults. Implantable cardiac defibrillators (ICD) have become a key component in the treatment of these patients. The purpose of the work. Presenting the clinical case of the late diagnosed patient with acute myocardial infarction who developed progressive HF, frequent hospitalizations, ICD implantation and studying this case through the lens of the 2022 American guideline. Material and methods. Man, 62 years old, included in the heart transplant program, hospitalized in the cardiac recovery ward, MCH „Holy Trinity”. The anamnestic data and paraclinical results were collected from the observation sheet and the outpatient card. Investigations performed: ECG, ECHOCG chest x-ray, USG, clinical and biochemical analyses. Results. Clinical: dyspnea at rest, parasternal pain on the left, acrocyanosis, pedal edema. Arrhythmic heart sounds with HB 100b/min; BP 160/96mmHg. Chest X-ray: Dilated cord. Bilateral pseudofibrotic changes. Bilateral costodiaphragmatic sinus obliteration. ICD on the left. ECG: Sinus rhythm with HB 90b/min. Postinfarction sequelae in the anteroapical region. Repolarization disorders in the lateral region of the LV. EcoCG: ICD wires are visualized in the right cavities. Akinesia in the apical region of the LV. EF 30%. LV hypertrophy, regurgitation of MV II deg.; CFK-MB (14%), LDH (228U/l), troponins (0.18), glucose (5.5mmol/l), D-dimers (3.5mg/l), prothrombin (50%). Treatment with: ARNI, β-blockers, nitrates, diuretics, antiplatelet agents, statins. Conclusions. A patient with EF (30%) and multiple hospitalizations had vital indications for ICD implantation as a measure until cardiac transplantation with waitlist enrollment, which according to the 2022 guideline has benefits for patients at risk of SCD

Particularities of intima-media determination in patients with different variants of ischemic heart disease (Literature review)

Departamentul Medicină Internă, USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Laboratorul hepato-chirurgical, USMF Nicolae TestemiţanuAtherosclerosis and its consequences are more common meet in ischemic heart disease and stroke, are and will continue to be present and in the next 20 years, the main cause of mortality of the population around the globe. Incidentally, the latter’s share in the structure of morbidity and general mortality has reached major odds and in the Republic of Moldova

Particularities of management in men’s stable angina

Departament of Internal Medicine, SMPhU N. Testemitanu, SMPI MCH Sfanta Treime, Hepato-Surgical Laboratory, SMPhU Nicolae TestemitanuIntroduction In the US the AP has a prevalence of 3.3%, for men – 3.4%, and for women – 3.2%. In the European countries, according to the data of European Society of Cardiology (ESC), the prevalence of AP raises increases with age for both sexes: from 4-7% for men aged between 45 and 64, and from 5-7% from the women of the same age, from 12-14% for the men aged between 65 and 84 and 10-12% for women of the same age [1, 2]. The most common AP complication is the acute myocardial infarction (AMI). In the United States the prevalence of the myocardial infarction among adults aged ≥20 is 2.8%, 4.0% for men and 1.8 for women. The scientists, who studied this field, have calculated that every 43 seconds an American citizen may develop AMI [1]. According to population studies of Olmsted County and Framingham, the patients with AP develop AMI in 3.-3.5 % per year, so in 30 patients with AP, the AMI progresses in one person [2, 5]. In the United States, IHD causes 146.5 deaths per 100000 of population among men and 80.1 per 100000 of population among women. IHD is responsible for 25.3% of deaths [4, 5]. In Europe, IHD is responsible for 1.8 million of deaths per year, which corresponds to 20% of men and 21% of women. In the Republic of Moldova the death rate because of IHD per 100.000 of population is 138 per men and 51 per women, simultaneously, Romania presents a death rate approximately 2 times smaller: 75 per 100.000 of population – men and 21 per 100.000 – women, and the highest death rate because of IHD is in Russia: 186 per 100.000 of population – men and 44 per 100.000 of population – at women [6]. Various observational studies have proved the existence of sex differences both in clinical and paraclinical presentation, and in therapeutic options which are not effective and safe in equal measures for men and women. At the same time, it has been proved that the men are involved to a lesser extent in the population studies pointing the cardiovascular diseases, so from 62 randomized studies in Europe only 33.5% of participants were women [3, 5]. It was found that men with AP who seek medical attention have a superficial approach, involving more frequently the noninvasive methods versus the invasive methods, and they have a lesser possibility than men of revascularization treatment. So, among the men with AP, 4.2% of them dispose of revascularization, meanwhile only in 2.4% of women with AP dispose of this option of treatment [2, 5]. Taking into consideration the growing of the incidence of AP in women, the determination of a late diagnosis because of clinical atypical manifestations and the reduced involvement of women with AP in population studies, we intend to study the AP peculiarities of women from the Republic of Moldova, which means an actual health and social problem. The aim of the study: to study the etiological, clinical and paraclinical peculiarities and the treatment of stable angina in men. Objectives of the study. To study the cardiac predisposing factors and comorbidities in men with stable angina. To analyze the peculiarities of clinical evolution of stable angina in men. To evaluate the paraclinical results in patients that was included in the study. To evaluate the treatment of stable angina in men. The study included 116 patients with AP, admitted to the Municipal Hospital Sfanta Treime and the Cardiological Institute during September 2015 – November 2016. Diagnostic of Stable Angina was determined by clinical criteria: anamnesis, clinical manifestations, objective data; instrumental examination: electrocardiography in all patients, effort test and coronary angiography in patients selected for revascularization by coronary artery bypass grafting, Holter monitor ECG, stress test medication in a group of patients for technical reasons; Laboratory tests: lipidogram, coagulation, blood glucose, blood counts in all patients, and markers of myocyte injury in some patients with UAP for financial reasons. Results and discussions According to the study goals and objectives, we analyzed in detail AP patients with predisposing factors to determine, comorbidities, clinical manifestations and complications, results paraclince specific treatment and preventive measures in these patients. Starting from the paper’s purpose patients were divided into 2 groups according to sex. In our study group were predominantly men, numbering 67, which constituted 57,8%, compared to women – 49 which corresponds to 42,2%. AP increased prevalence among men is explained by the fact that women have a protective role of ovarian hormones in premenopausal period. We aimed to evaluate patients in the study depending on age and sex, the data is illustrated in the following graphic. In patients aged up to 64 years, AP predominates in men than women: ≤44 years (2,8% vs 0%), 45-54 years (16,5% vs 9,2%); 55-64 years old (46,5% vs 29,4%) and after age 65, AP prevalence is higher in women compared to men: 65-74 years old (32% vs 22,8%); 75-84 years old (26,8% vs 11%); ≥85 years (2,6% vs 0,4%). This phenomenon can be explained by the combination of a new risk factor in women and certain post-menopausal and longer life expectancy of women than men [1, 4]. Analyzing the results, we note that the initial diagnosis of AP was established more frequently in men (62.6%) compared to women (51.6%). Acute Coronary Syndrome was suspected equally to men (22.4%) and women (23.72%). At the same time, women were hospitalized more frequently with other diagnoses (24.2%) vs men (12.2%). According to the pain location, we can observe that in men typical retrosternal pain and precordial pain is determined 82,4% vs 88,5% in biggest proportion compared to women‘s. At the same time, for women’s prevailed pain in the atypical locations in 5.2% and missing of the pain in 12.4%. This results is explaining by a big prevalence of atypical clinical picture of AP. Analyzing this obtained results, we can observe, that men’s pain radiates predominantly on a left shoulder – 67.2 % vs 48.4 %, during the time that extension of the pain in other regions is present more frequently for women’s. In the left shoulder and hand – 17.8% vs 9.8%, interscapulo – vertebral 17.8% vs 14.8%, throat – 8% vs 6.6%, mandible – 3.2% and other locations – 4.8% vs 1.6%. Studying the data obtained, we note that in most of the patients, the AP gives the administration of nitroglycerin, a rate less prevalent in men (59.1%) than in women (62.3%). Anginal pain at rest was determined that yield more often in men (21.5%) than in women (17.1%), and improving crisis management nitroglycerin angina both at rest and was in an amount almost equal to both sexes 19.4% vs 20.6%. Various observational studies have proved the existence of sex differences both in clinical and paraclinical presentation, and in therapeutic options which are not effective and safe in equal measures for men and women. At the same time, it has been proved that the men are involved to a lesser extent in the population studies pointing the cardiovascular diseases, so from 62 randomized studies in Europe only 33.5% of participants were women [Stramba-Badiale M., 2009]. It was found that men with AP who seek medical attention have a superficial approach, involving more frequently the noninvasive methods versus the invasive methods, and they have a lesser possibility than men of revascularization treatment. So, among the men with AP, 4.2% of them dispose of revascularization, meanwhile only in 2.4% of women with AP dispose of this option of treatment. In the study group gr II IC prevailed in almost equal proportion in both sexes, women (57.8%) vs men (59.1%), followed by IC gr. III (36.2%) vs. (35.6%). Gr. IV IC and IC gr. I was in the minority. We should notice that the anti-ischemic therapy, most commonly administered beta-AB, slightly more prevalent in men (73.2%) vs (68.6%), BCC, commonly administered to women (56.2%) vs ( 44.5%) and less nitrates: 14.9% for women vs 12.2% men. The cytoprotective benefited equally to men (41.3%) and women (39.2%). For prophylactic antiplatelet prevailed slightly more prevalent in men (71.2%) vs women (70.3%). Statins and anticoagulants were given less frequently in women. Conclusions Angina pectoris is higher in men than in women (57,8% vs 42,2%). The rate of pathology is changing with age, up to 64 years, angina is more frequent is meat in men (65,8%) vs 38,6 in women, and after the age of 65 years, women prevail (61,4% vs 34,2%). In patients with angina clinical picture was more often represented by the retrosternal pain in 52,7% and dependent in physical exertion in 68,5% of medium intensity, with a duration of 5-10 minutes at those with stable angina (15,9%) and 20 minutes from those with unstable angina (14,7%), that were ameliorated after nitroglycerin intaking. Men representing the angina pectoris have administrated the pharmacological treatment mostly with: notice that the anti-ischemic therapy, most commonly administered beta-AB, slightly more prevalent in men (73.2%) vs (68.6%), BCC, commonly administered to women (56.2%) vs (44.5%) and less nitrates: 14.9% for women vs 12.2% men

Management of stable angina in men (Literature review)

Departament of Internal Medicine, SMPhU Nicolae Testemitanu, SMPI MCH Sfanta Treime, Hepato-Surgical Laboratory, SMPhU N. TestemitanuThe classical description of Stable Angina, which is valid and today, has been made for the first time by William Beberdeb in 1772. His article about almost 20 patients called “Some considerations about chest diseases”. He made a very detailed and excellent description, since the Stable Angina is called up today Heberden’s angina [1, 5]. He described very clear its precipitation to the effort and emotions. Hunter died suddenly, in 1793, at the age of 65, and at the autopsy made by his disciple Edward Jenner it was found the intense coronary artery ossification. These findings allowed the determination of a relation between Stable Angina and coronary disease [8, 9]. Then, in 1799, the scientist Parry linked the Stable Angina problem with the poor blood flow with the obstruction of the coronary arteries, and in 1809 the well-known scientist Bums said that Stable Angina develops because “offer of energy and exhaustion are not balanced”. This important conception remains valid up today [5]. In 1933, the famous Britain cardiologist Sir Thomas Lewis launched the concept that ischemia includes not only changes in the structure of coronary arteries, but and in and their tonicity, therefore a supply deficit may be caused by inadequate coronary tone and the deficit can cup by vasodilation [7, 9]. These methods remain today of major importance in the diagnosis of Stable Angina, very informative, accessible and safe at the same time [6, 7]. An important step in the diagnosis of the Stable Angina was innovation in technique viewing of coronary arteries. Selective coronary angiography was introduced by MasonSones in 1959 in the United States. He relied on the works of German doctor Werner Forssmann, who in 1929 tried this method by himself by inserting a catheter through the cubital vein to the right atrium. Later he and is honored with the Nobel Prize for developing the method of the human body probing