CHALLENGING MANAGEMENT OF SEVERE MYOCARDITIS WITH COMPLETE RECOVERY – a case report

Cardiogenic shock has a high mortality rate (up to 60%). Different respiratory and mechanical circulatory support (MCS) is sometimes needed in treating these critically ill patients. We present a young patient with severe acute myocarditis and cardiogenic shock successfully treated to full recovery which required different extracorporeal membrane oxygenation (ECMO) configurations and a percutaneous left ventricular assist device (LVAD)

COVID-19 and Antihypertensive Therapy

Kardiovaskularne bolesti (KVB) su značajno prevalentne u COVID-19 bolesnika. Prema svim dosad relevantnim izvješćima i radovima, KVB su povezane s lošijim kliničkim tijekom i većom smrtnošću uz COVID-19. Arterijska hipertenzija, kao najučestaliji kardiovaskularni entitet i čimbenik rizika prerane smrtnosti u populaciji, pod posebnim je interesom kao komorbiditet uz COVID-19 zbog nedovoljno razjašnjene povezanosti s COVID-19 ishodima, ali i zbog potencijalnoga nepovoljnog učinka nekih antihipertenzivnih lijekova – konkretno inhibitora renin-angiotenzinskog sustava koji su vrlo često lijek izbora u liječenju hipertenzije. U ovome će članku prikazani podaci biti potkrijepljeni najnovijom relevantnom literaturom i preporukama na ovu temu te će se približiti ova problematika i aktualni pristup liječenju arterijske hipertenzije u COVID-19 pandemiji.Cardiovascular diseases (CVDs) are significantly prevalent in COVID-19 patients. According to all relevant reports and studies to date, CVDs are associated with a worse clinical course and higher mortality when combined with COVID-19. Arterial hypertension, as the most common cardiovascular entity and risk factor for premature mortality in the population, is of particular interest as a COVID-19 comorbidity due to insufficiently clarified association with COVID-19 outcomes, but also due to the potential harm of some antihypertensive drugs – specifically renin-angiotensin inhibitors, which are very often the drug of choice for treating hypertension. The presented data in this article, supported by the latest relevant literature and recommendations on the topic, will bring closer this issue and current approach to the treatment of arterial hypertension during the COVID-19 pandemic

Antithrombotics in heart failure

Heart failure is a common clinical condition associated with high morbidity and mortality rate despite significant improvements in pharmacotherapy and implementation of medical procedures. Patients with heart failure are at an increased risk of developing arterial and venous thrombosis, which contribute to the high rate of adverse events and fatal outcomes. Many heart failure patients routinely receive antithrombotic therapy due to the presence of a specific indication for its use, like ischemic heart disease or atrial fibrillation. However, there is no solid evidence to support the routine use of antithrombotic agents in all heart failure patients. This article reviews the evidence for using antithrombotic therapy in heart failure patients

Post-transplant lymphoproliferative disorder after heart transplantation

Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid neoplasms associated with immunosuppression following solid organ transplantation or allogeneic hematopoietic stem cell transplantation. Mismatch for cytomegalovirus (CMV), such as when a seronegative recipient receives an organ from a seropositive donor, was shown to be associated with a seven-fold increase in PTLD. A 20-year-old male patient was admitted to the hospital due to back and abdominal pain. He had underwent a heart transplant 6 years ago due to postmyocarditic dilated cardiomyopathy and soon after the transplant, he had developed CMV pneumonitis. At examination, abdominal ultrasound showed multiple lesions of the liver, and patohystology of the lesion biopsy revealed PTLD, i.e. Non-Hodgkin’s diffuse large B cell lymphoma, for which the patient received 8 cycles of chemotherapy (R-CHOP protocol). Nine months after the first dose, the patient was admitted to the hospital due to simptoms of heart failure (NYHA IV) and echocardiography revealed significantly reduced cardiac function (LVEF 25%). Graft rejection was excluded with heart biopsy and it was concluded the etiology of heart failure was anthracycline (Doxorubicin) toxicity. Given the severity of the patient’s condition, he was again listed for heart transplant, and ultimately, retransplanted. Eight years after the retransplant, the patient is in excellent overall condition. Heart transplant patients have about a 1- 6% risk to develop the PTLD. The incidence of chronic Doxorubicin cardiotoxicity is about 1.7%. This patient had developed both, but, fortunately, with timely and right therapy the outcome can be successful