The widow maker warning sign or wellens' syndrome: A case report

Wellens' syndrome, also known as LAD (left anterior descending) coronary T-wave syndrome, widow maker or warning sign, is a potentially unrecognized critical proximal LAD stenosis with possible fatal consequences. It can be associated with extensive acute anterior wall myocardial infarction, with left ventricular dysfunction and a lethal outcome within a few days after the onset of symptoms. It usually consists of a typical ECG finding in the precordial leads that represents a significant proximal LAD stenosis in patients with unstable angina pectoris. Although this syndrome is not indicated for PCI (the patient is usually pain-free at the time of electrocardiography registration), it is necessary to recognize the characteristic pattern and perform an emergency coronary angiography and percutaneous or surgical revascularisation of the affected blood vessel. Here we present the case report of a 47 year-old woman without previous anamnesis of coronary disease. On admission to the Coronary Care Unit she was chest pain-free and had all the indicators of Wellens' syndrome

Fractional flow reserve of intermediate lesions on collateral donor coronary arteries after myocardial infarction

Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability

A Toxic Hepatitis Caused the Kombucha Tea – Case Report

Background: Toxic hepatitis may clinically manifest as other diseases of the liver, where it must always be considered in differential diagnoses of unexplained liver damage, such as poisoning with kombucha tea.Case report: 47-year old female patient was hospitalized and has consumed daily ounces of kombucha tea. During hospitalization patient was diagnosed with toxic hepatitis and treated with intravenous solutions of hepatic protective and ursodeoxycholic-acid (effective therapy). Conclusion: Examinations showed that kombucha tea has potential to revert the CCl4-induced hepatic toxicity, but used in overdose can induce toxicity himself

Fractional Flow Reserve Method in Cardiac Catheterization Laboratory without Cardiosurgical Backup: Initial Experiences

Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities.Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions.Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization.Results:  Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005).Conclusion:  Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI

Kounis Syndrome Associated With the Use of Diclofenac

BACKGROUND: Diclofenac is a widely used analgesic, anti-inflammatory, antipyretic drug. In several case reports, its use was associated with the occurrence of Kounis syndrome. The aim of this review was to investigate and summarize published cases of Kounis syndrome suspected to be associated with the use of diclofenac. METHODS: Electronic searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Serbian Citation Index. RESULTS: Twenty publications describing the 20 patients who met inclusion criteria were included in the systematic review. Specified patient ages ranged from 34 to 81 years. Eighteen (90.0%) patients were male. Five patients (25.0%) reported a previous reaction to diclofenac. Reported time from the used dose of diclofenac to onset of the first reaction symptoms ranged from immediately to 5 hours. Diclofenac caused both type I and type II Kounis syndrome, with the presence of various cardiovascular, gastrointestinal, dermatologic, and respiratory signs and symptoms. Most patients experienced hypotension (n = 15 [75.0%]) and chest pain (n = 12 [60.0%]). The most frequently reported finding on electrocardiogram was ST-segment elevations (n = 17 [85.0%]). Coronary angiogram showed normal coronary vessels in 9 patients (45.0%), with some pathologic findings in 8 patients (40.0%). CONCLUSION: Clinicians should be aware that Kounis syndrome may be an adverse effect of diclofenac. Prompt recognition and withdrawal of the drug, with treatment of both allergic and cardiac symptoms simultaneously, is important

Sex and age differences and outcomes in acute coronary syndromes

Background: There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age ( lt = 65 years). Methods: From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality. Results: The study population was constituted by 2876 patients younger than 65 years and 2294 patients older. Women were older than men in both the young (56.2 +/- 6.6 vs. 54.1 +/- 7.4) and old (74.9 +/- 6.4 vs. 73.6 +/- 6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients. Conclusions: In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less

Processing of affective and emotionally neutral tactile stimuli in the insular cortex

The insula is important for the processing of pleasant aspects of touch whereas its role in the processing of emotionally neutral touch has been less explored. Here, we used a network approach to investigate the insular processing of pleasant stroking touch and emotionally neutral vibratory touch, analysing functional magnetic resonance imaging data from 23 healthy adult participants. Vibration and skin stroking activated areas in the posterior, middle and anterior insula. Psychophysiological interaction analyses suggested that skin stroking increased functional connectivity between the posterior and ventral anterior insula. Vibration instead increased functional connectivity between the posterior and dorsal anterior insula, and induced a stronger decrease of the default mode network activity compared to stroking. These results confirmed findings from previous studies showing that the posterior insula processes affective touch information. We suggest that this is accomplished by relaying tactile information from the posterior insula to ventral anterior insula, an area tightly connected to the emotional parts of the brain. However, our results also suggested that the insula processes tactile information with less emotional valence. A central hub in this processing seemed to be the right dorsal anterior insula

Correlation between Timi Risk Score and Clinical Outcome in Patients with Unstable Angina Pectoris

Given Taking that the TIMI score is a major predictor of MACE, this study aimed to determine the value of the TIMI risk score in predicting poor outcomes (death, myocardial infarction, recurrent pain) in patients presenting with unstable angina pectoris in short-term observation. A total of 107 patients with APns were examined at the Clinical Centre Kragujevac and were included in the investigation. The TIMI score was determined on the first day of hospitalization. During hospitalization, the following factors were also observed: troponin, ECG evolution, further therapy (pharmacologic therapy and/or emergency PCI or CABG), age, hypertension and hyperlipidaemia. The low-risk group (TIMI 0 - 2) included 30.8% of patients, whereas 47.6% of patients were in the intermediate-risk group (TIMI 3 - 4), and 21.5% of patients were in the high-risk group (TIMI 5 - 7). Good outcomes (without adverse event) and poor outcomes (death, myocardial infarction, and recurring chest pain) were dependent on the TIMI risk score. The increase in TIMI risk score per one unit increased the risk of a poor outcome by 54%. Troponin and TIMI risk score were positively correlated. Our results suggest that the TIMI risk score may be a reliable predictor of a poor outcome (MACE) during the short-term observation of patients with APns. Moreover, patients identified as high-risk benefit from early invasive PCI, enoxaparin and Gp IIb/IIIa inhibitors. Th us, routine use of the TIMI risk score at admission may reduce the number of patients not recognized as high-risk

Comparative effect of bisoprolol and losartan in the treatment of essential hypertension

Objective: We investigated the effects of bisoprolol and losartan on subjects with essential hypertension, by conducting heart rate variability (HRV) analysis of ECG signals. Our intention was to establish the set of linear and nonlinear heart rate variability parameters, which could be used as a noninvasive markers in the treatment of hypertension. Materials and Methods: Sixty subjects with essential hypertension included in this study were divided in two groups. During the four weeks medical treatment, the first group was administered with daily oral dose of 5 mg of bisoprolol and the second with daily oral dose of 50 mg of losartan. We recorded ECG signals, and performed HRV analysis of consecutive RR time intervals, before and after a month of pharmacological therapy. Results: In the case of bisoprolol, statistically the most significant changes of HRV parameters were: TP (1814.1 +/- 1731.3 ms(2) vs. 761.3 +/- 725.0 ms(2), P LT 0.0001), RR (870.2 +/- 105.7 ms vs. 1027.2 +/- 150.0 ms, P LT 0.0001), HR (70.81 +/- 8.42 bp/min vs. 60.10 +/- 9.52 bp/min, P LT 0.0001). In the case of losartan, the most significant changes were: SDNN (43.16 +/- 17.27 ms vs. 237.98 +/- 118.54 ms, P = 0.002), rmSDD (27.09 +/- 18.27 ms vs. 46.82 +/- 37.71 ms, P = 0.003), SD2 (55.18 +/- 20.6 vs. 70.67 +/- 26.12, P LT 0.019) and DF2 (0.69 +/- 0.21 vs. 0.86 +/- 0.25, P LT 0.014). Conclusion: Effects of bisoprolol and losartan were especially manifested among the set of linear HRV parameters. As a consequence of effect of losartan, we singled out the nonlinear parameters SD2 and DF2

Comparative effect of bisoprolol and losartan in the treatment of essential hypertension

Objective: We investigated the effects of bisoprolol and losartan on subjects with essential hypertension, by conducting heart rate variability (HRV) analysis of ECG signals. Our intention was to establish the set of linear and nonlinear heart rate variability parameters, which could be used as a noninvasive markers in the treatment of hypertension. Materials and Methods: Sixty subjects with essential hypertension included in this study were divided in two groups. During the four weeks medical treatment, the first group was administered with daily oral dose of 5 mg of bisoprolol and the second with daily oral dose of 50 mg of losartan. We recorded ECG signals, and performed HRV analysis of consecutive RR time intervals, before and after a month of pharmacological therapy. Results: In the case of bisoprolol, statistically the most significant changes of HRV parameters were: TP (1814.1 +/- 1731.3 ms(2) vs. 761.3 +/- 725.0 ms(2), P LT 0.0001), RR (870.2 +/- 105.7 ms vs. 1027.2 +/- 150.0 ms, P LT 0.0001), HR (70.81 +/- 8.42 bp/min vs. 60.10 +/- 9.52 bp/min, P LT 0.0001). In the case of losartan, the most significant changes were: SDNN (43.16 +/- 17.27 ms vs. 237.98 +/- 118.54 ms, P = 0.002), rmSDD (27.09 +/- 18.27 ms vs. 46.82 +/- 37.71 ms, P = 0.003), SD2 (55.18 +/- 20.6 vs. 70.67 +/- 26.12, P LT 0.019) and DF2 (0.69 +/- 0.21 vs. 0.86 +/- 0.25, P LT 0.014). Conclusion: Effects of bisoprolol and losartan were especially manifested among the set of linear HRV parameters. As a consequence of effect of losartan, we singled out the nonlinear parameters SD2 and DF2