Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies. CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis

Coronavirus Disease 2019 and Catheterisation Laboratory Considerations: “Looking for Essentials”

The current coronavirus disease 2019 (COVID-19) outbreak is a significant health crisis that impacts every healthcare system worldwide, and has led to a dramatic change in dealing with different diseases during the pandemic. Interventional cardiologists are frontline workers who deal with many cardiovascular emergencies, either in patients with proven COVID-19 or in suspected cases. Many heart associations worldwide are currently setting appropriate recommendations for the management of emergency cardiac interventions. In this expert opinion, the authors highlight the essential requirements in the cardiac catheterisation laboratory during the COVID-19 pandemic

Diffuse Arterial Thrombosis as a First Manifestation of Occult Malignancy

Aim. To raise the awareness of a hypercoagulability state as it is often associated with the different types of malignancies. Venous thromboembolism is a frequent complication in these patients, and usually it happens after the diagnosis of cancer is confirmed. However, hypercoagulability disorders presenting as the first symptoms or signs in the cancer patients have rarely been reported. Furthermore, arterial thrombosis is extremely rare even in cancer patients. Method. Review of the case characteristics and literature review. Results. We present a case of 39-year-old woman who was admitted to our hospital because of intermittent claudication in the right lower extremity. CT angiography revealed multiple thrombi in the arterial system starting from the left ventricle, followed by a thrombus in the distal part of the descending aorta, in the superior mesenteric artery, and in the right popliteal artery. Further investigation of this young patient with no risk factors for hypercoagulable state and no other comorbidities led to complete work-up including diagnostic evaluation for malignancy. The suspicion was confirmed after performing upper endoscopy with biopsy, which revealed malignant neoplasm of the stomach. Conclusion. Whenever a patient suffers hypercoagulability disorders, even arterial thrombosis, we should always consider the possibility of a cancer

Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis

AIM: We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis. CASE PRESENTATION: A female 40 years of age was admitted with signs of pulmonary embolism, confirmed with CT scan, which also reviled a thrombus in the right ventricle. The patient had medical history of systemic sclerosis since the age of 16 years. She suffered an ischemic stroke 6 years ago, but she was not taking any anticoagulant or antithrombotic medications ever since. She received a treatment with thrombolytic therapy, and subsequent UFH, but, on the second day after receiving fibrinolysis, she felt chest pain accompanied with ECG changes consistent for ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography was undertaken, which reviled cloths causing total occlusion in 4 blood vessels, followed with thromboaspiration, but without successful reperfusion. Several hours later the patient developed rapid deterioration with letal ending. During the very short hospital course, blood sampling reviled presence of antiphospholipid antibodies. CONCLUSION: The acquired antiphospholipid syndrome is common condition in patients with systemic autoimmune diseases, but relatively rare in patients with systemic sclerosis. Never the less, we have to be aware of it when treating the patients with systemic sclerosis

Glicoregulation in diabetic and no diabetic patients and the impact on early clinical outcome in patients with acute coronary syndrome

Aim of the study: The aim of our study was to analyse the impact of glicoregulation before and during the hospital treatment in patients with acute coronary syndrome on early in-hospital clinical outcome (CE). Methods: We included in the analyse ACS patients (STEMI, NSTEMI, APNS) treated with PCI, in whom we analysed: demographics, risk profile, basic biochemical variables (Hgb, BUN, creatinine, Na, K), lipid profile (Tg, HDL, LDL Hol, lpa), HgbA1C, admitting glucose level and levels of glucose during the hospitalisation, and TIMI flow before and after PCI procedure. We divided patients in diabetics and non-diabetics. Than based on the level of HgbA1C measured at admition we subdivided diabetics in good (6.5%) DM, and patients without previously known diabetes in three groups: no diabetics (6.5) HgbA1C. Based on glycaemic levels we divided pts. in groups: good regulation (5-10mmol/L), bed regulation: >10mmol/L epizodes, and <5mmolL aeizodes. We analized influence of glikoregulation on biochemical variables and lipide profile, PCI results (TIMI flow), and cardiac events (heart failure, shock, dysrhythmias, GIT bleeding, CVI and cardiac death). Statistical analyse: descriptive and comparative statistics with t-test, Chi square test, uni and multivariate analyse. Significance determined at 0.05. Results: 80 pts. Were included in the analyse (33.8% females and 66.2% males), at mean age of 60.2±10.8y. Risk profile: 51% had HTA, 6.3% HLP, 36.3% positive family history, 33.8% were diabetics, 61.4% smokers, 5% previous CAD. Mean Hgb 14.6±1.4mg/dl, BUN 5.9±3.2, creatinine 80.5±30.6 micromol/L, Na 137.5±3.4, K 4.2±0.5. No differences in biochemical and lipide profile was found between groups. Among 53 no diabetic patients prior to ACS, we identified 4 (5%) patients with diabetes (>6,5), and 18 (22.5%) with pre-diabetes (5.6-6.5%). Mean TIMI flow was 0.45±0.79 before, and 2.96±0.19 after PCI, r -.221, p 0.000. The single independent predictor in multivariate analyse (included HgbA1C, admitting glycaemic level, glucoregulation and diabetic group) on TIMI flow was admitting glycaemia (beta -.327, p 0.003). 12/80 pts. had CE, and again we included same variables and identified two independent predictors of CE: admitting glycaemic level (beta .386, p 0.007) and HgbA1C (beta .254, p 0.070). Conclusion: Acute coronary syndrome identified patients with previously no diagnosed diabetes. Stress glycaemia (admition glycaemic level) was found to be significant predictor of PCI results, and together with HgbA1C level of CE in ACS patients treated with PCI

Anemia, renal impairment and in-hospital mortality, in acute worsening chronic heart failure patients

Aim of the study: To analyze the impact of anemia and renal impairment on in-hospital mortality(IHD), in patients with acute worsening chronic heart failure. Methods: 232 randomly selected patients with symptoms of HF were retrospectively analyzed. Analyzed variables: gender, age, risk factors and co-morbidities: HTA, HLP, DM, COPD, CAD, PVD, CVD, anemia(defined as Hgb ≤10mg/dl), renal failure. Measured variables: systolic and diastolic BP, Hgb, sodium, BUN, creatinine, length of hospital stay and IHD. Comparative analysis was performed between patients with in-hospital mortality(IHD) and survivors, as a function of anemia and renal impairment. Statistical analysis: descriptive and comparative analysis, t-test, Chi square, univariate (binary logistic and linear regression and multivariate linear regression(stepwise backward). Results: Mean age 69.6±11.4, 102(44%)females and 130(56%) males, with females being significantly older 72.6±12.5 vs. 67.7±10.2(p=0.002), with significantly higher SBP, DBP and sodium level (p=0.003; 0.002 and 0.028 respectively), and males having HTA more often OR 1.3; p=0.017. Mean hospital stay was 6.8±5.8 days, with significant difference between IHD and non IHD group(7.9±4.5 vs. 3.8±7.9; p=0.000), with the highest mortality during the first (37.3%) and second hospital day (44.1%). 44 pts.(19%) had anemia, 31(13.4%) had known Chronic Renal Failure(CRF), and 59(25.4%) had IHD. Anemia was significantly associated with IHD (Chi square 6,36, sig 0.012, Exp B 2.48, sig 0.010), meaning pts. with anemia had 2,5 times greater risk for IHD. CRF per se, was not associated with IHD. Univariate linear regression identified creatinine(R square .032, beta .180, sig 0.006), and BUN(R square .034, beta .184, sig 0.005), as predictors of IHD. Multivariate stepwise regression model(anemia, HRF, Hgb, BUN, creatinine, sodium) at step 3(mean square .799, sig 0.002), identified two independent predictors Hgb(beta -.148, sig 0.028), and BUN(beta .163, sig 0.055). Multivariate model that included other known predictors of IHD(EF%, SBP, DBP, HRF, CAD, anemia, Hgb, BUN, creatinine, sodium) at step 8(mean square 1.537, sig 0.000), identified four independent predictors: EF%(beta -.204, sig 0.002), SBP(beta -.130, sig 0.052) as markers of systolic dysfunction and again anemia(Exp B 2.2.06, sig 0.041), and BUN(beta .200, sig 0.002). Conclusion: Anemia and renal impairment are well known comorbidities associated with HF that have great impact on course of HF. We confirmed that anemia and BUN, are significantly independent predictors of in hospital mortality in acute worsening CHF

Association of biomarkers of oxidative stress, stress glycaemia and glycated haemoglobin with acute coronary syndrome

The aim of our study was to comparatively evaluate association between biomarkers of oxidative stress, stress glycemia and HbA1c in patients with coronary artery disease

Women's perspective on the COVID-19 pandemic: Walking into a post-peak phase

The pandemic of Novel Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has provoked hundreds of thousands of deaths, resulting in catastrophe for humans.Although some insights have been garnered in studies on women, children and young adults infected with COVID-19, these often remain fragmented in literature.Therefore, we discussed the impact of COVID-19 pandemic on women, children and young patients, particularly those with underlying cardiovascular comorbidities or congenital heart disease. Furthermore, we gathered and distilled the existing body of literature that describes their cardiovascular complications and the recommended actions in favour of those patients toward the post-peak pandemic period.Although many questions still require answers, this article is sought to help the practicing clinician in the understanding and management of the threatening disease in special populations

Predictors of in-hospital mortality in patients with acute or acute worsening chronic heart failure

Aim of the study: to identify predictors of in-hospital mortality in acute HF patients. Patients and methods: 355 randomly selected patients admitted to ICCU with symptoms of HF were analyzed for: risk factors and co-morbidities (COPD, CAD, PVD, anemia, renal failure), heart rate, systolic and diastolic BP, Hgb, sodium, BUN, creatinine, ejection fraction (based on which patients were divided in PEF-HF and REF-HF); length of stay and GWTG-HF score (Get with the Guidelines-HF risk score), calculated from the seven clinical variables in that score. Comparative analyze was performed between patients with in-hospital mortality (IHM) and survivors. Statistical analyze: univariate and multivariate binary and linear logistic regression, ROC Curve for testing of discriminate function of GWTG-HF score. Results: 355 patients at mean age 70.1±10.9, 150 (42%) females and 205 (58%) males were included. Females were older 72.9±11.4 vs. 67.9±10.0 (p=0.000), had higher DBP (p 0.007) and EF (%): 43.6±11.6 vs 41.1±9.5 (p 0.029), and sodium level (p 0.018), more often had HTA (OR 1.4; p=0.001), while males had PAD (OR 1.7; p 0.020), and prior MI (OR 2.2; p 0.001). No significant differences in death rate, length of hospital stay and GWTG-HF score was observed. 82 (23.1%) events were registered (IHD group). The highest mortality rate was observed during the first 48 hours (40.4%). Mean hospital stay was 6.3±5.3 days, with no differences between the groups (5.6±3.9 vs. 6.7±5.9; p=0.056). We identified several univariate predictors: prior MI (beta -.490; p 0.041), PVD (beta -1.01; p 0.007); anemia (OR 1,89; p 0.044); REF-HF (OR 2.43; CI 1.7-3.6; p 0,000); EF (beta -.258; p=0.000); SBP (beta -.299; p=0.000), DBP (beta .315; p=0.000); Hgb (beta -.142; p=0.007), sodium (beta -.107; p 0.045); creatinine (beta .184; p=0.000), BUN (beta .199; p=0.000), and GWTG-HF score (beta .279; p 0.000). Multivariate logistic regression identified SBP (beta -.014; p 0.020) and anemia (ExpB 3.668; p 0.019); as positive, while prior MI (ExpB -2.753; p 0.050); PVD (ExpB -1.348; p 0.005) and DBP (beta .034; p 0.003) as negative predictors for in-hospital death. Mean GWTG-HF score was 38.9 ±10.1 (37.3 ±9.3; 44.0 ±11.0; p 0.000, non-IHD vs IHD pts). It had excellent discriminate function (ROC Curve: Area under the Curve .694, p< 0.000 (CI .627-.778), in predicting IHD. Conclusion: Low sodium, high BUN and creatinine are predictors of IHD, but only anemia, reduced EF and low systolic BP were identified as independent predictors of IHD. GWTG-HF score is a powerful tool for prediction of IHD in acute or acute worsening CHF patients

Early rehospitalizations in patients treated for acute coronary syndrome - can we identify predictors?

Purpose: To analyze early rehospitalization rate (defined as 90 days after the acute event) in patients with ACS, and to identify predictors of risk for readmission. Methods:463 randomly selected patients with ACS,were retrospectively analyzed.Analyzed variables:type of ACS(STEMI/NSTEMI/APNS),location of MI,gender,age,risk factors:HTA,HLP,DM,COPD,CAD,PVD,CVD,EF,type of treatment(PCI vs. noninvasive),extensiveness of coronary disease,GRACE and TIMI risk score, type of morbidity,and reason for rehospitalization.Comparative analysis was performed between patients with early rehospitalisation and others.Statistical analysis:t-test,Chi square,univariate and multivariate linear regression. Results:463 patients were enrolled:68.9% males mean age 60.4±10.9, and 31.1% females mean age 64.94±12.0(p 0.000).MI type:STEMI 75.8%,NSTEMI 11.2%,APNS 13%; MI location:40.2% anterior,39,7% inferior,3% lateral and 3.7% multiple locations(p 0.000).Risk profile:15.3% HCAD,27% HF,62% HTA,28.1% DM,5.8% PVD,2.6% COPD.Mean BMI was 27±2.9,mean SBP 138.8±28.5mmHg,mean HR 84.3±24.2,mean EF (in 208 pts.) 50.2±10.4%, mean GRACE score(in 72 pts.) was 148.9±60.6,mean TIMI score(in 263 pts.) was 3.9±2.3. 87.5% were treated with PCI procedure, with mean disease’s CA 1.84(range 1-5), median 1(p 0.000). Hospital morbidity was present in 16% of pts.,6.9% minor, 3% major bleeding complications, 2.4% acute HF, 1.9% pericardial effusion, and 1.1% early stent thrombosis.Early rehospitalization rate was 6.3% (29/463):14 ischemic/trombotic events;9 acute heart failures, 3 malignant arrhythmias, and three fatal events. Univariate predictors of RH: HR(R square 0.014, p 0.014, beta .116, r -.217, p 0.002);EF(%) (R square 0.055, p 0.001, beta -.234, r -.231, p 0.001).HTA was significantly associated with reduced hospitalization risk (Chi square 4.28, p 0.039, exp B .405, p 0.054),diabetes(Chi square 10.04, p 0.002, exp B 3.45, p 0.001), PVD (expB 2.85, p 0.070),early in-hospital morbidity(expB 2.12, p 0.084),and NSTEMI pts. had OR 1.3, and APNS pts. OR 1.16 for rehospitalization(higher but not significantly in comparison to STEMI pts.). Multivariate model with variables that were found significantly associated with HR, identified two strong independent predictors of early rehospitalization(mean square.424, sig 0.000),EF(beta -.220, p 0.001),and diabetes(t 2.52, p 0.012) Conclusions:LV systolic dysfunction was again proven to be a strong predictor of clinical outcome in terms of early hospital readmission in ACS patients no matter how they were treated for ACS, and diabetes was the single strong independent predictor-risk factor for this event