Pregnant patient with an artificial heart valve

Do zadań należących do zespołu interdyscyplinarnego, w którego skład wchodzą kardiolog, ginekolog położnik oraz zespół pielęgniarski, należy poinformowanie planującej ciążę kobiety o zagrożeniach, z jakimi może się spotkać w czasie ciąży, przekazanie zasad stosowania terapii przeciwkrzepliwej z określeniem najbezpieczniejszej metody zapobiegania zakrzepicy wszczepionej protezy zastawkowej, leczenie zakrzepicy protezy w przypadku jej rozpoznania, wybór sposobu rozwiązania ciąży, a także profilaktyka infekcyjnego zapalenia wsierdzia w wybranych przypadkach. Niniejsza praca stanowi przegląd współczesnych zaleceń dotyczących powyższych zagadnień.It is crucial for the multidisciplinary team consisting of cardiologist, obstetrician as well as nursing staff to inform the patient with artificial valve who is planning pregnancy about the possible threats related to the pregnancy, the necessity of anticoagulation therapy with pointing the safest and the most effective one, the management of prosthesis thrombosis in case of its diagnosis, the choice of delivery type and prophylaxis of endocarditis, where appropriate. This paper is a systematic review of comprehensive approach to abovementioned issues

Iron status and myocardial injury while recovering from acute myocarditis

Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p &lt; 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation.Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p < 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation

Vascular stiffness: pathophysiology, clinical implications, assessment methods

The concept of vascular age was created to reflect the real condition of one’s arterial tree, independent of the calendar age. The term of “early vascular aging” describes accelerated degenerative process within the arterial wall, while “healthy vascular aging” relates to slower than expected for a given age progression of arterial degeneration. Vascular age can be estimated by the measurement of: arterial stiffness (AS) parameters, carotid intima- media thickness (CIMT) or calcium score. CIMT reflects structural changes within the arterial wall and is regarded as the marker of subclinical atherosclerosis, while AS demonstrates functional alterations of arterial wall. Some parameters of the AS, including carotid- femoral pulse wave velocity (cf-PWV), were proven to be independent predictors of cardiovascular events, impaired cognitive function, kidney dysfunction and retinal diseases. Increased AS of aorta has important implications for the development of hypertension and for unfavorable arterial-ventricular coupling. Elevated AS leads to increased afterload of the left ventricle, which results in the ventricular negative remodeling with fibrosis and ischemia and ultimately in heart failure. There are various methods of assessment of local, regional or systemic arterial stiffness. The gold standard for the estimation of AS (regional) is the cf-PWV. However, ultrasonographic (including echotracking) methods offer a bed-side tool of the measurement of local AS parameters of the superficial arteries. Increased AS promotes the development of hypertension and other cardiovascular events, therefore its prevention should be a target of the therapy.The concept of vascular age was created to reflect the real condition of one’s arterial tree, independent of the calendar age. The term of “early vascular aging” describes accelerated degenerative process within the arterial wall, while “healthy vascular aging” relates to slower than expected for a given age progression of arterial degeneration. Vascular age can be estimated by the measurement of: arterial stiffness (AS) parameters, carotid intima- media thickness (CIMT) or calcium score. CIMT reflects structural changes within the arterial wall and is regarded as the marker of subclinical atherosclerosis, while AS demonstrates functional alterations of arterial wall. Some parameters of the AS, including carotid- femoral pulse wave velocity (cf-PWV), were proven to be independent predictors of cardiovascular events, impaired cognitive function, kidney dysfunction and retinal diseases. Increased AS of aorta has important implications for the development of hypertension and for unfavorable arterial-ventricular coupling. Elevated AS leads to increased afterload of the left ventricle, which results in the ventricular negative remodeling with fibrosis and ischemia and ultimately in heart failure. There are various methods of assessment of local, regional or systemic arterial stiffness. The gold standard for the estimation of AS (regional) is the cf-PWV. However, ultrasonographic (including echotracking) methods offer a bed-side tool of the measurement of local AS parameters of the superficial arteries. Increased AS promotes the development of hypertension and other cardiovascular events, therefore its prevention should be a target of the therapy

A 64-year-old man suffering from ST-elevation myocardial infarction and severe thrombocytopenia: Procedures in the case of a patient not fitting the guidelines

The objective of this case report is to present how the chronic condition significantly complicates life-saving procedures and influences further treatment decisions. A 64-year-old man suffering from arterial hypertension and immune thrombocytopenic purpura presented to the Emergency Department with anterior ST-elevation myocardial infarction. An immediate coronary angiography was performed where critical stenosis of the proximal left anterior descending was found. It was followed by primary percutaneous intervention with bare metal stent. In first laboratory results, extremely low platelet count was found (13 × 10 9 /L). Consulting haematologist advised the use of single antiplatelet therapy and from the second day of hospitalisation only clopidogrel was prescribed. On the sixth day of hospital stay, patient presented acute chest pain with ST elevation in anterior leads. Emergency coronary angiography confirmed acute stent thrombosis and aspiration thrombectomy was performed. It was therefore agreed to continue dual antiplatelet therapy for 4 weeks. As there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. Both the risk of haemorrhagic complications and increased risk of thrombosis must be taken into consideration when deciding on patient’s treatment

Plasma Levels of Apelinergic System Components in Patients with Chronic and Acute Coronary Syndromes—A Pilot Study

The effects of the apelinergic system components apelin (AP) and elabela (ELA) in the regulation of human cardiovascular homeostasis, and data concerning the relationship between ELA and AP and coronary artery disease (CAD) are yet unknown. The aim of the study was the evaluation of AP, ELA and APJ-receptor levels in the plasma of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS). The study group consisted of 114 patients with CAD and 33 healthy controls. Patients were divided into two groups: with CCS (n = 30) and ACS (n = 84). Routine laboratory tests and plasma ELA, AP-17, AP-13 and APJ receptor levels were measured. Echocardiographic data were analyzed in all patients. Levels of AP-17 and ELA were significantly lower in CCS than in healthy controls and ACS patients. We demonstrated significant increase of levels of plasma apelinergic system peptides, especially ELA and AP-17 in ACS patients compared with healthy controls and CCS, suggestive of compensating up-regulation mechanisms. There is a relationship between circulating ELA and AP-17 levels and classical, biochemical markers of ischemia and left ventricular ejection faction as well