Impact of cardio-vascular complications on predicting of the thromboembolic events and prognosis of infective endocarditis outcome

Cardiology Department, State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: The infective endocarditis (IE) is a serious immune-inflammatory disease characterized by vegetative damage of cordis and causing serious complications. The average annual sick rate is 3-10 cases for 100 000 of population, and mortality is 16-20%. Aim: To study the cardiovascular complications in patients with infective endocarditis and their impact on the evolution and prognosis of the disease. Materials and methods: The study included 132 patients: 128 — hospitalized in the Cardiology Department Nb. 4 of the Cardiological Institute, and 4 patients from the Municipal Hospital “Holy Trinity”. The average age of enrolled patients was 39.94±2.1 years. The diagnosis was established according to the DUKE diagnostic criteria for IE. Results: The most common complication in patients with IE is cardiovascular insufficiency (Cl), which was reported in 100% of investigated patients. Analyzing the results, we noted that in 48.7% of the patients from the study was developed Cl III NYHA functional class (FC), followed by the Cl II FC degree in 43% of cases. Cl IV and IFC were diagnosed in only 6% and 2.3%, respectively. FC of Cl in patients with IE increasing dependence of endocardial involvement in the disease process and valvular damage, detection of the vegetation cusp and chordae rupture, annular abscess at EcoCG. The most frequently involved in the disease process were aortic and mitral valve in 53.5% and 41.5% of cases, respectively. It was proved echocardiographically the endocardium damage in 72.6% of cases: vegetations (64%), the decompensation of prosthetic valve (25%), breakage of cords (18%), myocardium apostasis (3.79%). The positive hemoculture was found in the 41.5% of cases, mostly staphylococcus (44%) and streptococcus (38%). In 20% of cases there were diagnosed embolisms. Due to predicting of thromboembolic complications using special formulas in our patients the result was 7%. The forecast of the outcome was favorable in 74% patients, relatively favorable and unfavorable was observed in 17% and 9%, respectively. Conclusions: The IE course severity is determined by several criteria: “masked” clinical picture, delayed diagnosis, high frequency of complications and the problems of the early detection of them, as well as the complexity of selection of an efficient treatment. High CD FC by NYNA, embolisms and high percentage of negative hemocultures were the predictors of lethal outcome

The use of intravenous immunoglobulin in the treatment of Hashimoto’s encephalopathy: case based review

BackgroundHashimoto’s encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto’s encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.MethodsThe online databases PubMed and EMBASE were searched.ResultsA total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto’s encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient’s status.ConclusionIn last years, intravenous immunoglobulin therapy proved its utility in Hashimoto’s encephalopathy’s treatment, being a well tolerated therapy associated with remarkable improvement in patient’s status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto’s encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids

Wolf-Parkinson-White syndrome, clinical case

State medical and Pharmaceutical University ’’Nicolae Testemitanu”, Chișinau, Republic of MoldovaIntroduction: Wolf-Parkinson- White syndrome (WPW) is a type of ventricular pre-excitation realized through an abnormal connection between the atria and the ventricles, known as Kent bundle, prior to nodo-hisian depolarization. The disease has a genetic substrate, it develops mainly in men, involving a high risk of ventricular arrhythmias and sudden death. The incidence of WPW syndrome is 4 cases per 100,000 persons, while the prevalence is 1-3 cases per 1000 pers. Male/female ratio is 1.5-2/1. About 50 % of patients with WPW develop tachyarrhythmias; the frequency of supraventricular tachycardia paroxysms increases from 10% at the age of 20-39 to 36% over 60 years. The management of the disease depends on the paroxysms frequency and the types of arrhythmia. We present the clinical case of a man with WPW syndrome who develops recurrent paroxysmal supraventricular tachycardia, treated since 1997. Clinical case: Patient L., 52 years old, admitted to the Cardiology Department nr.3 of PMSI MCH „Holy Trinity”. Diagnose: WPW syndrome. Paroxysmal supraventricular tachycardia. HF I NYHA. The complaints presented on onset: palpitations, inspiratory dyspnea, fatigue. History of the disease: diagnosed in 1997, when he developed a paroxysm of supraventricular tachycardia. Arrhythmia paroxysms were the cause of repeated hospitalizations - 2-3 times/year while being on antiarrhythmic therapy with Amiodarone. On physical examination: The overall condition of medium severity. Clean, normal-colored skin. Vesicular breath sounds, rales missing. Rhythmic heart sounds with HR 170 b/min, BP 120/70 mmHg. ECG conclusion: WPW syndrome. Supraventricular tachycardia with HR 170 b/min. Normal heart electrical axis. LV repolarization disorders. EchoCG: moderate dilatation o f LA and RA. Induration of the aortic walls. LV hypertrophy, left ventricular contractile function is preserved. Laboratory analysis without deviation from the norm. Treatment: Amiodarone 800mg-intravenously in perfusion until paroxysm cessation, with subsequent administration after schema. Conclusions: Patient L., 52 years with WPW syndrome who develops an arrhythmia paroxysm was hospitalized for its cessation and reassessment of treatment strategy. Pharmacological cardioversion had positive effect. The prognosis is favorable for the patient due to rare paroxysms of supraventricular tachycardias with a good response to drug treatment

Management of pacients with single ventricle: classic and contemporary aproaches

Disciplina Cardiologie USMF “Nicolae Testemiţanu”, Departamentul cardiochirurgie IMSP Spitalul Clinic Republican, Dispensarul IMSP Institutul de Cardiologie, Asociaţia Studenţilor Medici AO “AStudMed”This article represents a work of synthesis, based on the literature reviews, and includes the classification principles of congenital cardiac malformation – single ventricle, treatment techniques presented according to international protocols and clinical studies. Our research is dedicated to the problem of finding the most optimal support in order to obtain the lowest risk of complications and the best results possible in the improvement of the life’s quality. Lucrarea dată reprezintă un articol de sinteză bazat pe reviul literaturii, care include principiile după care se clasifică malformaţia congenitală de tip ventricul unic, tehnici de tratament prezentate conform protocoalelor internaţionale, studii clinice. Problema pe care o abordăm în studiul nostru este suportul optim necesar cu scop de a obţine risc de complicaţii minim şi a ameliora calitatea vieţii la maxim posibil

Particularities of the left heart infective endocarditis

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”Left heart endocarditis (IE LH) is an infection of the heart with impaired endovascular isolated mitral and/or aortic valve involvement. The incidence of left heart damage in EI constitutes 85-90% cases, most commonly develops on native valves (72%) and cardiac prostheses (25%) in patients with comorbidities: diabetus miellitus (21%), viral hepatitis (15%), liver cirrhosis (7%), cancer (3.9% -5.2%) [1, 2, 5]. Morbid circumstances characteristic for IE LH patients are infections and tooth extraction (31.8%), poor dental hygiene (17.9%), urogenital inflammation (13.1%) and skin involvement (5.1%). Prevalent microbial trigger in IE LH 40 patients is commonly streptococcal (38%), staphylococcal (34%) and enterococcal (10%) [2, 4]. In this article we present our own findings on the clinical features, predisposing cardiac factors, comorbidities, etiology, endocardial involvement in the pathologic process, and occurred complications in patients with left heart endocarditis. Endocardita infecţioasă de cord stâng (EI de CS) este o infecţie endovasculară a cordului cu afectarea izolată a valvei mitrale sau/şi a valvei aortale. Incidenţa afectării cordului stâng în EI constituie 85-90% cazuri, se dezvoltă mai frecvent pe valve native (72%) şi proteze cardiace (25%), la pacienţi cu comorbidităţi: diabet zaharat (21%), hepatite virale (15%), ciroză hepatică (7%), cancer (3,9%-5,2%). [1, 2, 5]. Circumstanţele morbide caracteristice pentru pacienţii cu EI de CS sunt infecţiile şi extracţiile dentare (31,8%), igiena dentară precară (17,9%), procesele inflamatorii urogenitale (13,1%) şi tegumentare (5,1%). Triger-rul microbian prevalent la bolnavii cu EI de CS este cel streptococic (38%), stafilococic (34%) şi enterococic (10%) [2, 4]. În acest articol prezentăm rezultatele proprii referitor la particularităţile evoluţiei clinice, factorilor cardiaci predispozanţi, comorbidităţile, etiologia, implicarea endocardului în procesul patologic, şi complicaţiile survenite la pacientii cu EI de CS

Cardiovascular complications and prognosis of the outcome of infective endocarditis

Disciplina Cardiologie, Clinica Medicală nr.3 Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”Infective endocarditis (IE) is a severe septic disease in which the microbial graft affects the intact, native or prosthetic heart valves and other cardiac structures, causing structural damage and systemic embolism. The annual incidence ranges from 3 to 10 IE cases per 100000 persons/year, with an increasing tendency in some new clinical variants. High lethality is caused by serious disease complications, cardiovascular being the most dangerous for patients. Heart failure is the most common complication in IE, valvular damage caused by rupture of prosthetic or native valve cusps, infected chordae tendineae rupture, fistulas or prosthetic dehiscence, myocardial absces, myocardial muscle rupture. The high degree of cardiac failure by NYNA, embolisms and high percentage of negative blood cultures were the predictors of lethal outcome. Endocardita infecţioasă (EI) este o maladie septică gravă, cu localizarea grefei microbiene pe valve intacte, native sau protezate şi pe alte structuri cardiace, ce determină deteriorari structurale şi embolii sistemice. Incidenţa anuală a EI variază între 3-10 cazuri la 100000 persoane/an, cu tendinţa de creştere la pacienții cu variante clinice noi ale maladiei. Mortalitatea înaltă a EI este cauzată de complicații grave, îndeosebi cele cardiovasculare. Insuficienţa cardiacă (IC) congestivă este complicaţia cea mai frecventă în EI, cauzată de deteriorările valvulare: perforarea cuspelor valvulare native sau protezate, ruptura cordajelor infectate, fistule sau dehiscenţe protetice, abcese miocardice, miocardită cu ruptura muschilor. Gradul înalt a IC după NYHA, embolismul și rata mare a hemoculturii negative sunt predictorii pronosticului nefavorabil a maladiei

Infective endocarditis complicated by peripheral stigmatus, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP SCM „Sfânta Treime”Infective endocarditis (IE) presents a microbial infection with insidious or sudden onset involving in infectious process endocardium and other heart structures. IE prevalence ranges from 1.9 to 6.2 cases per 100,000 persons / year, and it’s mortality ranges between 20-50%. IE is a characteristic lesion locating frequent vegetation in heart valves - 77-82%, although it may involve horde trends, papillary muscles, ventricular and atrial endocardium, atrial and ventricular septal defects. Approximately 10-25% of patients with cutaneous manifestations present - the peripheral stigmat, that develops more frequently in patients with staphylococcal trigger, or in patients with IE late diagnosed. We report the clinical case of a 61-year-old man with secondary streptococcal etiology endocarditis with comorbidities (viral B hepatitis, gastric haemorrhage) with vascular skin manifestations. Endocardita infecţioasă (EI) prezintă o infecţie microbiană cu debut insidios sau brusc implicând în procesul infecţios endocardul şi alte structuri ale cordului. Incidenţa EI variază între 1,9-6,2 cazuri la 100.000 persoane/an, iar mortalitatea constituie 20-50%. Leziunea caracteristică EI este vegetaţia cu localizarea mai frecventă pe valvele cardiace – 77-82%, cu toate că poate implica hordele tendineie, muşchii papilari, endocardul ventricular şi atrial, defectele septale atriale şi ventriculare. Aproximativ 10-25% din pacienţii cu EI prezintă manifestări cutanate –stigmat-ul periferic, care se dezvoltă mai frecvent la pacienţii cu trigger stafilococic, sau la bolnavii cu EI depistată tardiv. Raportăm cazul clinic a unui bărbat de 61 de ani cu endocardită infecţioasă secundară, etiologie streptococică, cu comorbidităţi (hepatită virală B, hemoragie gastrică) cu manifestări vasculare tegumentare

First hours management of acute myocardial infarction

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicina Internă, USMF „Nicolae Testemiţanu”, IMSP Institutul de Cardiologie, IMSP SCM „Sfânta Treime”Correct management of the first hours of acute myocardial infarction is the most important link in the prevention of mortality, complications, and achieve good results in the further development of patients. Studying the clinical course of 161 patients diagnosed with AMI treated with primary PCI and thrombolysis, allowed comparative analysis of the benefits and deficiencies of each method of treatment. The results of each method is in close relation with the time from symptoms onset until treatment, risk factors and preventive treatment. Managementul corect al primelor ore ale infarctului miocardic acut (IMA) reprezintă cea mai importantă verigă în prevenirea mortalităţii, complicaţiilor şi obţinerea unor rezultate bune în evoluţia ulterioară a pacienţilor. Studierea evoluţiei clinice a celor 161 pacienţi cu diagnosticul de IMA, trataţi prin PCI primar şi tromboliză, a permis analiza comparativă a beneficiilor şi neajunsurilor fiecărei metode de tratament. Rezultatele fiecărei metode este într-o strânsă relaţie cu timpul scurs de la debutul simptomelor până la tratament, pregătirea preventivă şi prezenţa factorilor de risc