The influence of acide-base status disturbances on the course and prognosis of acute myocardial infarction with ST segment elevation

Uvod: Akutni infarkt miokarda sa ST elevacijom (STEMI) praćen je relativno visokim mortalitetom, mnogobrojnim i kompleksnim ranim i kasnim komplikacijama. U savremenoj literaturi malo je podataka o acidobaznom (AB) statusu kao prediktoru intrahospitalnih komplikacija, veličine infarkta miokarda, remodelovanja leve komore i mortaliteta. Ciljevi: Cilj istraživanja je da se utvrdi prediktivna vrednost parametara AB statusa na pojavu intrahospitalnih komplikacija (edem pluća i ventrikularne aritmije), remodelovanja leve komore, jednogodišenjeg neželjenog kardijalnog događaja (MACE), kao i povezanost parametara AB statusa sa veličinom infarkta. Metode: Istraživanje je koncipirano kao unicentrična studija praćenja u trajanju od godinu dana za svakog uključenog pacijenta. U istraživanje su uključeni pacijenti sa STEMI lečeni putem primarne PCI (pPCI). Svim pacijentima su se pored uobičajene laboratorijske dijagnostike, elektrokardiograma i pPCI radile gasne analize arterijske krvi pre i nakon završene pPCI. Određivane su vrednosti parametara AB statusa, a pod metaboličkom acidozom definisane su vrednosti pH 12 i Cl-/Na+ 2 (OR 4,514; 95% CI (1,807-11,276); p=0,001) pre pPCI, kao i BE2 (OR 3,003; 95% CI (1,274-7,081); p=0,012) nakon pPCI. Najjači statistički značajan prediktor nastanka EP/KŠ u multivarijantnoj analizi svih laboratorijskih parametara na prijemu je laktat sa OR=1,808 (95% CI 1,178-1,777). U posmatranom uzorku, 54 (17,9%) pacijenta je tokom hospitalizacije imalo neki oblik ventrikularne aritmije, 50 (16,6%) pacijenata je imalo VT, a 4 (1,3%) pacijenta je imalo VF. Multivarijantnom regresionom analizom parametara AB, kao nezavisni prediktori nastanka VT/VF izdvojili su AG>12 (OR 3,975; 95% CI (1,53-10,297); p=0,004) pre pPCI i BE12 (OR 4,137; 95% CI (1,224-13,983); p=0,022) nakon pPCI. U posmatranom uzorku, 36 (12%) pacijenata je imalo neki od velikih neželjenih kardijalnih događaja (MACE). Od svih laboratorijskih parametara na prijemu, kao nezavisni prediktori pojave jednogodišnjeg MACE izdvojili su se AG (OR 1,055; 95% CI 1,016-1,158; p=0,015), broj leukocita (OR 1,135; 95% CI 1,016-1,158; p=0,036) i NT-proBNP na prijemu (OR 1,0; 95% CI 1,0-1,0; p=0,041). Jedinstveni statistički značajan doprinos predikciji veličine infarkta posmatrano preko AUC za CK-MB daju laboratorijski prediktori Le 24h od pPCI, maksimalna vrednost CRP i BE nakon PCI. Statistički najjači prediktor je BE nakon pPCI sa koeficijent beta -0,250. U posmatranom uzorku, 48 (16,4%) pacijenata je na kontrolnom pregledu imalo ehokardiografske znake remodelovanja leve komore. Multivarijantnom regresionom analizom AB statusa, kao nezavisni prediktori remodelovanja leve komore izdvojili su se laktat>2 (OR 2,9; 95% CI (1,552-5,509); p=0,001) pre pPCI, kao i laktat>2 (OR 2,193; 95% CI (1,103-4,360); p=0,025) i AG>12 (OR 2,929; 95% CI (1,057-8,113); p=0,039) nakon pPCI. U multivarijantnoj analizi svih poznatih faktora, kao najjači prediktori remodelovanja leve komore izdvojili su se: MBG 0-2 (OR 17,079; 95% CI (3,776-77,255); p12 i Cl-/Na+ 2 (OR 4.514; 95% CI (1.807-11.276); p=0.001) before pPCI, and BE2 (OR 3.003; 95% CI (1.274-7.081); p=0.012) after pPCI. The most independent labortory predictor of PE/CS was lactate with OR=1.808 (95% CI 1.178-1.777). During hospitalization, 54 (17.9%) patients had ventricular arrhythmias (VA), 50 (16.6%) patients had VT, and 4 (1.3%) patients had VF. In multivariate analysis the following variables were independent predictors of VT/VF:AG>12 (OR 3.975; 95% CI (1.53-10.297); p=0.004) before pPCI and BE12 (OR 4.137; 95% CI (1.224-13.983); p=0.022) after pPCI. 36 of included patients, 36 (12%) had MACE. In multivariate analysis the following variables were independent predictors of 1-year MACE: AG (OR 1.055; 95% CI 1.016-1.158; p=0.015), leucocytes (OR 1.135; 95% CI 1.016-1.158; p=0.036) and NT-proBNP at admission (OR 1.0; 95% CI 1.0-1.0; p=0.041). Leucocytes 24h after pPCI, peak CRP and BE after pPCI were significantly associated with infarct size, defined as AUC for CK-MB. The strongest predictor is BE after pPCI with coefficient beta -0,250. At control echocardiography, six months after pPCI, 48 (16.4%) patients had signs of left ventricular remodeling. By multivariate regression analysis, independent predictors of remodeling were lactate>2 (OR 2.9; 95% CI (1.552-5.509); p=0.001) before pPCI, lactate>2 (OR 2.193; 95% CI (1.103-4.360); p=0.025) and AG>12 (OR 2.929; 95% CI (1.057-8.113); p=0.039) after pPCI. The most powerful predictor for left ventricular remodeling of all known predictors were: MBG 0-2 (OR 17.079; 95% CI (3.776-77.255); p<0.0001) and lactate 24h (OR 8.2; 95% CI (2.55-26.37); p<0.0001). Conclusion: In STEMI patients, treated with pPCI, lactate is proved as an independent predictor of acute heart failure and left ventricular remodeling. BE and AG are represented as independent predictors for development of VA. The most significant predictor of infarct size is BE, whereas AG is proved as an independent predictor of one year MACE

The influence of acide-base status disturbances on the course and prognosis of acute myocardial infarction with ST segment elevation

Uvod: Akutni infarkt miokarda sa ST elevacijom (STEMI) praćen je relativno visokim mortalitetom, mnogobrojnim i kompleksnim ranim i kasnim komplikacijama. U savremenoj literaturi malo je podataka o acidobaznom (AB) statusu kao prediktoru intrahospitalnih komplikacija, veličine infarkta miokarda, remodelovanja leve komore i mortaliteta. Ciljevi: Cilj istraživanja je da se utvrdi prediktivna vrednost parametara AB statusa na pojavu intrahospitalnih komplikacija (edem pluća i ventrikularne aritmije), remodelovanja leve komore, jednogodišenjeg neželjenog kardijalnog događaja (MACE), kao i povezanost parametara AB statusa sa veličinom infarkta. Metode: Istraživanje je koncipirano kao unicentrična studija praćenja u trajanju od godinu dana za svakog uključenog pacijenta. U istraživanje su uključeni pacijenti sa STEMI lečeni putem primarne PCI (pPCI). Svim pacijentima su se pored uobičajene laboratorijske dijagnostike, elektrokardiograma i pPCI radile gasne analize arterijske krvi pre i nakon završene pPCI. Određivane su vrednosti parametara AB statusa, a pod metaboličkom acidozom definisane su vrednosti pH 12 i Cl-/Na+ 2 (OR 4,514; 95% CI (1,807-11,276); p=0,001) pre pPCI, kao i BE2 (OR 3,003; 95% CI (1,274-7,081); p=0,012) nakon pPCI. Najjači statistički značajan prediktor nastanka EP/KŠ u multivarijantnoj analizi svih laboratorijskih parametara na prijemu je laktat sa OR=1,808 (95% CI 1,178-1,777). U posmatranom uzorku, 54 (17,9%) pacijenta je tokom hospitalizacije imalo neki oblik ventrikularne aritmije, 50 (16,6%) pacijenata je imalo VT, a 4 (1,3%) pacijenta je imalo VF. Multivarijantnom regresionom analizom parametara AB, kao nezavisni prediktori nastanka VT/VF izdvojili su AG>12 (OR 3,975; 95% CI (1,53-10,297); p=0,004) pre pPCI i BE12 (OR 4,137; 95% CI (1,224-13,983); p=0,022) nakon pPCI. U posmatranom uzorku, 36 (12%) pacijenata je imalo neki od velikih neželjenih kardijalnih događaja (MACE). Od svih laboratorijskih parametara na prijemu, kao nezavisni prediktori pojave jednogodišnjeg MACE izdvojili su se AG (OR 1,055; 95% CI 1,016-1,158; p=0,015), broj leukocita (OR 1,135; 95% CI 1,016-1,158; p=0,036) i NT-proBNP na prijemu (OR 1,0; 95% CI 1,0-1,0; p=0,041). Jedinstveni statistički značajan doprinos predikciji veličine infarkta posmatrano preko AUC za CK-MB daju laboratorijski prediktori Le 24h od pPCI, maksimalna vrednost CRP i BE nakon PCI. Statistički najjači prediktor je BE nakon pPCI sa koeficijent beta -0,250. U posmatranom uzorku, 48 (16,4%) pacijenata je na kontrolnom pregledu imalo ehokardiografske znake remodelovanja leve komore. Multivarijantnom regresionom analizom AB statusa, kao nezavisni prediktori remodelovanja leve komore izdvojili su se laktat>2 (OR 2,9; 95% CI (1,552-5,509); p=0,001) pre pPCI, kao i laktat>2 (OR 2,193; 95% CI (1,103-4,360); p=0,025) i AG>12 (OR 2,929; 95% CI (1,057-8,113); p=0,039) nakon pPCI. U multivarijantnoj analizi svih poznatih faktora, kao najjači prediktori remodelovanja leve komore izdvojili su se: MBG 0-2 (OR 17,079; 95% CI (3,776-77,255); p12 i Cl-/Na+ 2 (OR 4.514; 95% CI (1.807-11.276); p=0.001) before pPCI, and BE2 (OR 3.003; 95% CI (1.274-7.081); p=0.012) after pPCI. The most independent labortory predictor of PE/CS was lactate with OR=1.808 (95% CI 1.178-1.777). During hospitalization, 54 (17.9%) patients had ventricular arrhythmias (VA), 50 (16.6%) patients had VT, and 4 (1.3%) patients had VF. In multivariate analysis the following variables were independent predictors of VT/VF:AG>12 (OR 3.975; 95% CI (1.53-10.297); p=0.004) before pPCI and BE12 (OR 4.137; 95% CI (1.224-13.983); p=0.022) after pPCI. 36 of included patients, 36 (12%) had MACE. In multivariate analysis the following variables were independent predictors of 1-year MACE: AG (OR 1.055; 95% CI 1.016-1.158; p=0.015), leucocytes (OR 1.135; 95% CI 1.016-1.158; p=0.036) and NT-proBNP at admission (OR 1.0; 95% CI 1.0-1.0; p=0.041). Leucocytes 24h after pPCI, peak CRP and BE after pPCI were significantly associated with infarct size, defined as AUC for CK-MB. The strongest predictor is BE after pPCI with coefficient beta -0,250. At control echocardiography, six months after pPCI, 48 (16.4%) patients had signs of left ventricular remodeling. By multivariate regression analysis, independent predictors of remodeling were lactate>2 (OR 2.9; 95% CI (1.552-5.509); p=0.001) before pPCI, lactate>2 (OR 2.193; 95% CI (1.103-4.360); p=0.025) and AG>12 (OR 2.929; 95% CI (1.057-8.113); p=0.039) after pPCI. The most powerful predictor for left ventricular remodeling of all known predictors were: MBG 0-2 (OR 17.079; 95% CI (3.776-77.255); p<0.0001) and lactate 24h (OR 8.2; 95% CI (2.55-26.37); p<0.0001). Conclusion: In STEMI patients, treated with pPCI, lactate is proved as an independent predictor of acute heart failure and left ventricular remodeling. BE and AG are represented as independent predictors for development of VA. The most significant predictor of infarct size is BE, whereas AG is proved as an independent predictor of one year MACE

Istorijski pejzaž nepokretnih kulturnih dobara u Brankovini i mere zaštite od poplava

The attitude towards the values of cultural heritage is one of the important factors in shaping the character of a place and the character of a cultural and historical ambience. Cultural heritage plays an important role in strengthening the regional and local cultures and tradition with respect to economic and social issues, as well as with respect to the environmental protection regulation. The Brankovina cultural and historical complex - the immovable property of exceptional importance, is an important cultural centre of Serbia which implies an integrated protection of all structures together with the surrounding area. The illegal construction, inappropriate reconstructions and interventions in this area have resulted from a lack of urban planning regulation over a long period of time. Insufficiently developed awareness about the importance of cultural heritage for the development of this area, as well as a lack of clearly defined programmes and measures that would ensure a continuous process of protection, presents a constant threat to the survival of this important heritage. The flood risk problem is much more prominent in this area than in other parts of Serbia due to complexity in the protection of historical heritage and particular ambience qualities. The work on the area development programme which would provide spatial, environmental, economic and functional conditions for future development and protection of this area has started after the adoption of the Decision on General Regulation Plan. The achievement of objectives is moving towards the affirmation, protection and improvement of the Brankovina cultural and historical complex as a traditional cultural heritage, along with planning the new facilities that would be appropriate to the importance of the area, and without environmental consequences.Odnos prema vrednostima kulturnog nasleđa je jedan od važnih faktora u oblikovanju karaktera mesta i karaktera kulturno-istorijskog ambijenta. Kulturno nasleđe igra važnu ulogu u jačanju regionalne i lokalne kulture i tradicije u odnosu na ekonomska i socijalna pitanja, kao i u pogledu regulisanja zaštite životne sredine. Kulturno-istorijski kompleks Brankovina - nepokretna imovina od izuzetnog značaja, je važan kulturni centar Srbije, koji podrazumeva integrisanu zaštitu svih struktura zajedno sa okolnim područjem. Bespravne gradnje, neodgovarajuće rekonstrukcije i intervencije u ovoj oblasti rezultat su nedostatka propisa urbanističkog planiranja tokom dugog vremenskog perioda. Nedovoljno razvijena svest o značaju kulturnog nasleđa za razvoj ove oblasti, kao i nedostatak jasno definisanih programa i mera koje bi obezbedile kontinuirani proces zaštite, predstavlja stalnu pretnja opstanku ovog važnog nasleđa. Problem rizika od poplava je mnogo izraženiji u ovoj oblasti nego u drugim delovima Srbije zbog složenosti zaštite istorijskog nasleđa i posebnih ambijentalnih kvaliteta. Rad na programu razvoja u oblasti koja bi omogućila prostorne, ekološke, ekonomske i funkcionalne uslove za dalji razvoj i zaštitu ovog područja je počela nakon usvajanja odluke o planu generalne regulacije. Ostvarivanjem ciljeva kreće se ka afirmaciji, zaštiti i unapređenju kulturnog i istorijskog kompleksa Brankovina, kao tradicionalne kulturne baštine, uz planiranje novih objekata koji će biti prikladni za značaj područja, a bez posledica po životnu sredinu.

Protection and restoration of cultural properties in spatial and urban planning in Serbia; Case study: immoveable cultural properties in Brankovina

Serbia contains a large amount of immovable cultural properties which protection is regulated by law, strategic documents and rules pertaining to this field. The exact situation in the field is often specific and has to be solved from case to case. For example, an urban plan for the cultural and historical complex of Brankovina – the immovable cultural property of exceptional importance, has never been developed. Considering the importance of the locality, any construction activities in a wider area have been forbidden by a special document. This has brought many problems in the use of space and has also led to illegal construction and stagnation in the development of the settlement, as well as made the construction of public and utility facilities impossible. After the decision to develop a plan of general regulation was made, the next step was to create a program for the development of this area and provide spatial, economic and functional conditions that would enable future development and protection of this area and normal subsistence of local population, along with solutions for necessary infrastructure. The paper presents investigations of the current situation and gives guidelines for future development, which implies local economic recovery, protection and restoration of buildings, possibility to develop tourism of small economies and cultural tourism offer. The Plan especially deals with the reconstruction of protected cultural properties based on bioclimatic principles and principles of energy efficiency and ecologically sustainable development.Editors: A. Liakopoulos, A. Kungolos, C. Christodoulatos, A. Koutsopsyro

Мodel for the development of the cultural- historical memorial complex Brankovina and a proposal of measures for the protection against climate change

Kulturno nasleđe ima važnu ulogu u promovisanju lokalne kulture i tradicije i njegova zaštita predstavlja jedan od osnovnih kriterijuma pri planiranju daljeg razvoja područja. U tom kontekstu, kulturno nasleđe postaje ključni pokretač razvoja, turistički atraktor, koji utiče na ekonomsko i socijalno poboljšanje nekog područja, uz istovremenu brigu o ekološkoj zaštiti okruženja. Usaglašavanje dva pravca ‒ zaštite i razvoja ‒ predstavlja osnovu planiranja prilikom daljeg oblikovanja karaktera mesta istaknutih predela i ambijenata. Zaštita kulturnog predela Brankovine, kao jednog od najznačajnijih kulturno-istorijskih spomen-kompleksa na teritoriji Srbije, podrazumeva integralnu zaštitu svih objekata sa okruženjem. Nedovoljno razvijena svest o značaju kulturnog nasleđa Brankovine kao pokretača razvoja ogleda se u izostanku planskih dokumenta i jasno definisanih programa i mera kojima bi se osigurali uslovi za dalji razvoj i zaštitu, što predstavlja stalnu pretnju opstanku ovog značajnog nasleđa. Sa porastom svesti o klimatskim promenama i njihovim vidljivim posledicama, primena mera zaštite je veoma značajna, pogotovo kod kulturnog nasleđa, zbog složenosti zaštite istorijskog kompleksa i posebnih ambijentalnih kvaliteta. Plan generalne regulacije za deo naseljenog mesta Brankovina usvojen 2015. godine, pored programa razvoja ovog područja i planiranja novih sadržaja primerenih značaju prostora, posebnu pažnju je posvetio problemu ugroženosti od posledica klimatskih promena.Cultural heritage plays an important role in promoting the local culture, while the tradition and its protection are among the main criteria in planning further development of an area. In this context, cultural heritage becomes a key driver of development as tourism attractor, affecting the economic and social enhancement of the area and at the same time playing an important role in the environmental protection. Harmonizing and putting together the two directions – the protection and development, provides a basis for building a unique character of these areas. The protection of the cultural landscape of Brankovina, one of the most important cultural-historical memorial complexes in the territory of Serbia, requires an integrated and comprehensive protection of all its structures along with the environmental protection. Insufficiently developed awareness of the importance of the cultural heritage of Brankovina as a driver of development is reflected in the deficiency of the relevant planning documents, clearly defined programs and measures that are needed for its further development and protection. With an increase of awareness about climate change and its visible consequences, the development and implementation of these protection measures become even more important, especially in the cultural heritage, due to the complexity of interventions related to the protection of the historical complex and due to specific environmental quality. The General Regulation Plan for the Inhabited Part of Brankovina was adopted in 2015. In addition to the general development program for the area and planning of a new development in accordance with the area-specific features, a special attention was also given to the potential threats and vulnerability to the effects of climate change.Urednici: Mila Pucar, Marina Nenković-Rizni

SPONTANA REKANALIZACIJA TROMBA: NEOČEKIVANI NALAZ NA KORONARNOJ ANGIOGRAFIJI

Introduction: Spontaneous recanalized coronary thrombi (SRCT) are a rare condition characterized by multiple channels divided by thin septa, communicating with each other, proximally and distally, with the normal coronary lumen. Highresolution intracoronary imaging techniques such as intravascular ultrasound or optical coherence tomography (OCT) enable routine study of the coronary artery lumen and wall. Case report: A 73-year-old male presented to the intensive care unit due to the loss of consciousness and transient extreme bradycardia recorded on electrocardiogram. Coronary angiogram revealed contrast defect on the right coronary artery (RCA). For better assessment of the angiographic fi nding, OCT was performed and confi rmed a honeycomb-like structure starting from medial RCA and propagating up to the distal part. As a result of the data acquired, the diagnosis of SRCT in the RCA was established. It was decided not to treat the RCA with stent implantation, and it was proceeded with optimal medicament therapy and pacemaker implantation. At three-month follow up, the patient reported no subjective symptoms and SPECT showed no signs of ischemia. Conclusion: While there are no appropriate recommendations for the treatment of SRCT yet, decision on treatment is based on imaging techniques fi ndings and physician’s experience. Adequate follow up of these patients can provide important data needed for future guiding of the SRCT treatment.Uvod: Spontana rekanalizacija koronarnih tromba (SRKT) rijetko je stanje i karakteriziraju ga višestruki kanali podijeljeni tankim pregradama, koji međusobno komuniciraju, proksimalno i distalno, s normalnim lumenom koronarne krvne žile. Intrakoronarne slikovne tehnike visoke rezolucije poput intravaskularnog ultrazvuka ili optičke koherentne tomografi je (OCT) omogućavaju rutinsko proučavanje lumena i zida koronarne arterije. Prikaz bolesnika: 73-godišnji muškarac primljen je u jedinicu intenzivne njege zbog gubitka svijesti i prolazne ekstremne bradikardije registririrane na elektrokardiogramu. Koronarni angiogram otkrio je kontrastni defekt na desnoj koronarnoj arteriji (RCA). Radi bolje procjene angiografskog nalaza provedena je OCT i potvrđena struktura nalik na saće, počevši od medijalnog segmenta RCA i šireći se do distalnog dijela. Kao rezultat prikupljenih podataka postavljena je dijagnoza SRKT u RCA. Odlučeno je da se RCA ne liječi implantacijom stenta, nego se nastavilo s optimalnom terapijom lijekovima i implantacijom elektrostimulatora srca. Nakon tri mjeseca praćenja bolesnik nije prijavio nikakve subjektivne simptome, a SPECT nije pokazivao znakove ishemije. Zaključak: Iako još uvijek ne postoje odgovarajuće preporuke za liječenje SRKT-a, odluka o liječenju temelji se na nalazima slikovnih tehnika i iskustvu liječnika. Odgovarajuće praćenje ovih bolesnika može pružiti važne podatke potrebne za buduće smjernice u liječenju SRKT-a

ODGOĐENA MANIFESTACIJA MIOKARDITISA NAKON COVID-A

: Myocardial involvement of coronavirus disease 2019 (COVID-19) varies and is considered to be more serious in patients with severe COVID-19 clinical presentation. Although myocarditis is usually recognized in the setting of acute SARS-CoV-2 infection, delayed manifestations are recognized as well. Case report. A 51-year-old male patient was admitted due to the clinical signs of congestive heart failure, two months after moderate clinical expression of COVID-19 pneumonia, treated as an outpatient. Transthoracic echocardiography (TTE) revealed dilated cardiomyopathy with the presence of diffuse left ventricular (LV) hypokinesia, severely reduced ejection fraction (EF 18%) and diastolic dysfunction with increased left atrial filling pressure. Baseline laboratory tests revealed elevated hs-troponin I, NT-proBN. Diagnostic workout excluded coronary artery disease. Cardiac magnetic resonance imaging strongly pointed in the direction of unrecognized post-COVID myocarditis. The patient was treated according to current guidelines for heart failure with reduced EF. Eight months after discharge, the patient had no limitations of physical activity and TTE showed significant improvement in the systolic function of the left ventricle, EF was 47%, with normal LV filling pressure. Conclusion: Myocarditis is not an infrequent manifestation of COVID-19 infection, especially in hospitalized patients with severe clinical presentation, and commonly manifests within the first week after initial symptoms. Our case report represents an example that also patients with mild form of COVID-19 treated as outpatients can have delayed onset of heart failure as a consequence of COVID-19-induced myocarditis. Therefore, COVID-19 patients deserve a comprehensive approach with systematic clinical and echocardiographic follow-up in order to establish a timely diagnosis, provide appropriate treatment, and prevent serious complications.Zahvaćenost miokarda koronavirusnom bolešću 2019 (COVID-19) varira i smatra se ozbiljnijom u bolesnika s teškom kliničkom slikom COVID-19. Iako se miokarditis obično prepoznaje u okruženju akutne infekcije SARS-CoV-2, prepoznaju se i odgođene manifestacije. Prikaz slučaja: Bolesnik u dobi od 51 godine primljen je zbog kliničkih znakova kongestivnog zatajenja srca dva mjeseca nakon umjerene kliničke manifestacije pneumonije COVID-19, liječen ambulantno. Transtorakalna ehokardiografija (TTE) otkrila je dilatiranu kardiomiopatiju s prisutnošću difuzne hipokinezije lijevog ventrikla (LV), ozbiljno smanjenu ejekcijsku frakciju (18%) i dijastoličku disfunkciju s povećanim osjećajem tlaka u lijevom atriju. Osnovni laboratorijski testovi otkrili su povišen hs-troponin I, NT-proBN. Dijagnostička vježba isključila je koronarnu bolest. Magnetska rezonancija srca snažno je pokazala u smjeru neprepoznatog miokarditisa nakon COVID-a. Bolesnik je liječen prema važećim smjernicama za zatajenje srca sa smanjenom ejekcijskom frakcijom. Osam mjeseci nakon otpusta bolesnik nije imao ograničenja tjelesne aktivnosti, a TTE je pokazao značajno poboljšanje sistoličke funkcije lijeve klijetke, ejekcijska frakcija je iznosila 47%, uz normalan tlak punjenja LV. Zaključak. Miokarditis nije rijetka manifestacija infekcije COVID-19, osobito u hospitaliziranih pacijenata s teškom kliničkom slikom, i obično se manifestira unutar prvog tjedna nakon početnih simptoma. Naš prikaz bolesnika je primjer da i pacijenti s blagim oblikom COVID-19 koji se liječe ambulantno mogu imati odgođeni početak zatajenja srca kao posljedicu miokarditisa izazvanog COVID-19. Stoga bolesnici s COVID-19 zaslužuju cjelovit pristup uz sustavno kliničko i ehokardiografsko praćenje kako bi se pravodobno postavila dijagnoza, omogućilo odgovarajuće liječenje i spriječile ozbiljne komplikacije