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

The stable angina pectoris complicated with a myocardic old infarction, unidentified in time, clinical case

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP SCM ”Sfânta Treime”Stable angina pectoris (AP) is the most common form of ischemic heart disease, which is characterized by constrictive retrosternal pain of short duration, dependent on exercise, with radiation to the jaw, shoulders, back, or arms, typically occurs with exertion or emotional stress and improved by rest or nitroglycerin administration. Atypical discomfort may occur in the epigastric region. The incidence of angina pectoris in most European countries is between 20,000 and 40000-1000000 inhabitants suffer where a higher frequency occurs in able-bodied men. [3] Patients with stable angina, who do not follow a treatment, can further develop atherosclerotic plaque instability with the installation of myocardial infarction. We present a clinical case of a man of 76 years with stable angina pectoris, who neglected antihypertensive and antianginal treatment, suffered a myocardial infarction with inapparent clinical, occasionally diagnosed in worsening of angina pectoris. Angina pectorală (AP) stabilă este cea mai frecventă formă a cardiopatiei ischemice, care se caracterizează prin dureri retrosternale constrictive de scurtă durată, dependente de efort fizic, cu iradiere în mandibulă, umeri, spate, sau braţe, apărut tipic la efort sau stres emoţional şi ameliorat in repaus sau la administrarea de nitroglicerină. Atipic, disconfortul poate să apară in regiunea epigastrică. Incidența anginei pectorale, în majoritatea ţărilor europene, oscilează între 20.000 şi 40.000 la 1.000.000 locuitori suferă, cu o frecvență mai înaltă de instalare la bărbați apți de muncă [3]. Pacienții cu angină stabilă, care nu respectă tratamentul, pot dezvolta ulterior instabilitatea plăcii aterosclerotice, cu instalarea infarctului miocardic. Prezentăm un caz clinic a unui bărbat, de 76 de ani cu angină pectorală stabilă, care a neglijat tratamentul hipotensiv și antianginal, a suportat un infarct miocardic cu clinică nemanifestă, ocazional diagnosticat la agravarea anginei pectorale

Contemporary aspects of intravascular ultrasound in everyday practice

State Medical and Pharmaceutical University “Nicolae Testemiţanu”, Chişinău, Republic of MoldovaIntroduction: IVUS utility is to quantify the severity of atherosclerotic stenoses that appear angiographically moderate and often significantly reduce the minimum luminal surface. Detailed images of the arteries can be visualized using IVUS catheter that provides cross sections, bidimensional concentric stacked vessels. This catheter possesses rotational transducers able to visualize the vascular wall layers in three positions: longitudinal, rotational and ultrasonographical. In literature, the information about IVUS investigation is modest. The smaller is the distance to the catheter, the better is image clarity. We performed the literature synthesis on IVUS investigation to highlight its priorities in comparison with angiography. Purpose and Objectives: Taking into account the incontestable medical progresses of the last decades, that had repercussions over the investigations applied in medical practice, there exists a necessity of referring to the recent practical methods, in consequence, a true paradigm shift and replacement of the old methods with modern practice are expected. Materials and methods: Contemporary bibliographic and scientific data were selected and the recent recommendations on the problem of diagnosing the severity of atherosclerotic vascular stenoses, rarely diagnosed angiographically (-50% ) were revised, the morphology and atherosclerotic plaque diameter were studied, parietal calcifications were assessed by intravascular ultrasonography with the electronic study of these complications. Results: The analysis of literary domain sources reveals that the IVUS method is used mainly in the USA, is currently in a slow phase of growth, with an average of 5-8% of the coronary interventions performed. IVUS utilization in Europe is lower, in Japan it reaches 14-20%, reflecting the reimbursement rates and medical practice patterns. The increasing application of this technique is due to the practical simplicity of use, image quality and precise information about the structure of the vessel. Conclusion: Identification of unstable plaques in medical practice is one of the main challenges of modern cardiology, because of the prevalence of atherothrombotic phenomena and its consequences on cardiovascular mortality and morbidity. IVUS is a method that quantifies the severity of atherosclerotic stenoses and provides important details of all vascular layers. The detection of unstable plaques by IVUS has a major value, particularly in patients with acute coronary syndrome for the prevention of subsequent atherothrombotic events and administration of the appropriate treatment

Intravascular ultrasound classical and contemporary aspects and vision

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicina Internă, USMF “Nicolae Testemiţanu”IVUS-utility is to quantify the severity of atherosclerotic stenoses that appear angiographically moderate and often turn significantly reducing the minimum luminal surface. Detailed images of the arteries can be visualized using IVUS catheter that provides cross sections, bidimensional concentric stacked vessel. This catheter possess rotational transducers able to visualize the vascular wall layers in three positions: longitudinal, rotational and ultrasonographical. In the literature the information about the investigation IVUS is modest. Techniques for determining IVUS resolution in 3-dimensions are described by Boston 20 MHz catheter and by IVUS scanner Diasonics. Image obtained outside the plan is measured by determining the thickness of the beam, and the axial and lateral plan – measured by the minimum distance between two points. As the distance to catheter is less, the image clarity is better. We performed the synthesis of literature on IVUS investigation to highlight it’s priorities compared with angiography. Utilitatea IVUS-ului este de a cuantifica severitatea stenozelor aterosclerotice care apar angiografic moderat şi se dovedesc adesea semnificativ prin reducerea suprafeţei luminale minime. Imagini detaliate ale arterelor se pot vizualiza, utilizând cateterul IVUS care oferă secţiuni transversale, bidimensionale concentrice suprapuse vasului. Acest cateter posedă transductori rotaţionali, capabili de a vizualiza straturile peretelui vascular în trei poziţii:longitudinală, rotaţională şi ultrasonografică. În literatura de specialitate există informaţie modestă despre investigaţia IVUS. Tehnicile pentru determinarea rezoluţiei IVUS în 3 dimensiuni sunt descrise pentru cateterul Boston de 20 MHz şi un scaner IVUS Diasonics. Imaginea obţinută în afara planului este măsurată prin determinarea grosimii fascicolului, iar cea axială şi laterală – evaluată prin distanţa minimă dintre 2 puncte. Cu cât distanţa până la cateter este mai mică cu atât claritatea imaginii este mai bună. Am efectuat sinteza literaturii referitor la investigaţia IVUS, pentru a evidenţia priorităţile ei în comparaţie cu angiografia

Clinical case: inferior myocardial infarction of the left ventricle, extended to the right ventricle

State Medical and Pharmaceutical University „Nicolae Testemițanu”, Chișinău, Republic of MoldovaIntroduction: Acute myocardial infarction of the right ventricle (AMI RV) is rarely met, it being associated with an inferior AMI of the left ventricle (AMI LV) in 33-50% of the cases, determining the increase of early morbidity and mortality. The symptoms of hypotension, clear pulmonary areas and turgid jugular veins are considered a marker of the RV lesion in patients with inferior AMI. Approximately 25-50% of AMI RV present with hemodynamic disturbances. Female gender, age over 70 years, arterial hypertension, smoking, atrio-ventricular block and bundle branch block are predictive factors for the RV implication in patients with inferior AMI. The patient R., 72 years old, was admitted to the Cardiology Department nr. 1 of the PMSI Institute of Cardiology with the diagnosis: Ischaemic cardiopathy. Inferior acute myocardial infarction. Cardiac asthma accesses. Acute cardiac failure II Killip. Complaints: Constrictive pain in the right parasternal and in the epigastric areas, inspiratory dyspnea at light physical effort, cardiac asthma accesses, calf swelling, fatigue. History of the disease: The general state has been worsening for 2 weeks with epigastric pain, dyspnea progression, and apparition of cardiac asthma accesses. Ambulatory Echo-CG determined RV cardiomegaly, ejection fraction decrease (35%) and presence of akinetic areas. He was immediately hospitalized in the Cardiology Department of PMSI Institute of Cardiology. Clinical examination: General state severe, pale skin, acrocyanosis. Hoarse vesicular murmur in the lungs. Rhythmic, diminished heart sounds, with HR=74 beats/minute, BP=140/90 mm Hg. Liver +4 cm. Paraclinical investigations: ECG at admission: Sinus rhythm, HR=95/minute, LV myocardium hypertrophy, repolarization changes on the inferior wall of the LV. Repeated ECG: comparatively, with no visible changes. Echo-CG: M oderate aortic stenosis. Regurgitation of the AoV of the Ilnd degree. Moderate dilation of the LA, RA, RV. Akinesia of the inferior wall of the LV, of the basal and medium segments in the lateral and posterior walls of the LV. Akinesia of the RV wall. Regurgitation of the TV of the Illrd degree, MV of the Ilnd degree. Severe pulmonary hypertension. Markers of myocardial necrosis: negative. Treatment: Beta-blockers, nitrates, diuretics, ACE inhibitors, anticoagulants, antiplatelets. Conclusion: The patient R., 72 years old, presenting with an extended AMI, involving the LV and RV, which determined intensive therapy. According to literature data, patients with an inferior AMI of the LV, involving the RV, have a worst prognosis