Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

Koronarne perforacije su retke ali izuzetno neugodne komlikacije perkutanih intervencija. Perforacije koronarnh arterija trećeg stepena po Elisu predstvaljaju najozbiljniju formu perforacija i zahtevaju hitno zbrinjavanje. Često je neophodno uraditi perikardiocentezu i primeniti brojne interventne tehnike kako bismo rešili perforaciju. Stentovi prekriveni politetrafluoroetilenom(PTFE) postali su jedno od najčešće korišćenih perkutanih rešenja, ali su njihove mane visoki profil i slaba fleksibilnost. U našem slučaju, pokušali smo da poboljšamo plasiranje PTFE stenta montiranjem na metalni stent, koji smo iskoristili kao nosač

Approach to the wide QRS-complex tachycardia

© 2018, Serbia Medical Society. All rights reserved. Introduction Patients presenting with tachycardia most often complain of palpitation and dizziness, but can also report episodes of chest pain due to increased myocardial oxygen demand. The aim of this case article was to emphasize the importance of differential diagnosis between different types of supraventricular (SVT) or ventricular tachycardia (VT) according to ECG findings, and highlight the treatment algorithm for wide QRS-complex tachycardia. Case Outline We present a 34-years old female patient which was admitted to our hospital due to palpitations and chest pain that occurred at rest about two hours before hospital admission. Cardiac auscultation showed the presence of irregular heartbeats with tachycardia, whereas arterial blood pressure was 100/60 mmHg. Initial ECG recording demonstrated wide complex tachycardia (WCT) with irregular heart rate of approximately 180 beats per minute with right bundle branch block-like morphology of QRS complexes. After administration of intravenous amiodarone, patient was converted to sinus rhythm, with short PR interval (< 120 ms) and narrow QRS complexes (< 120 ms) with visible delta waves, indicating the presence of Wolff–Parkinson–White syndrome type A as the underlying cause of atrial fibrillation with right bundle branch block-like morphology of QRS complexes. Conclusion The ability to differentiate between VT and SVT with a wide QRS complex due to aberrant intraventricular conduction or preexcitation is critical because the treatment of each is different, and inadequate therapy may potentially have lethal consequences

Cardiorenal Syndrome Type 1: Definition, Etiopathogenesis, Diagnostics and Treatment

Cardiorenal Syndrome Type 1 (CRS-1) is defined as an acute worsening of heart function leading to acute kidney injury and/or dysfunction. It is an important cause of hospitalization which affects the diagnosis as well as the prognosis and treatment of patients. The purpose of this paper is to analyze causes that lead to the development of cardiorenal syndrome type 1 and its clinical consequences, as well as to emphasize the clinical importance of its early detection. The clinical studies and professional papers dealing with etiopathogenesis, diagnosis and treatment of cardiorenal syndrome type 1, have been analyzed. The most important role in the occurrence of cardio renal syndrome type 1 is played by hemodynamic mechanisms, activation of neurohumoral systems, inflammation and imbalance between the production of reactive oxygen species (ROS) and nitric oxide (NO). Diagnosis of cardiorenal syndrome type 1 involves biomarkers of acute renal injury among which the most important are: neutrophil gelatinaseassociated lipocalin (NGAL), cystatin C, kidney injury molecule 1 (KIM-1), liver-type fatty acid binding protein (L-FABP), IL-18 and the values of nitrogen compounds in serum. In addition to a pharmacological therapy, various modalities of extracorporeal ultrafiltration are applied in treatment of CRS-1, particularly if there is resistance to the use of diuretic therapy. As opposed to the experimental models, in clinical practice acute renal injury is often diagnosed late so that the measures taken do not give the expected results and the protective role shown in experimental conditions do not give the same results. For all these reasons, it is necessary to analyze the pathophysiology of renal impairment in cardiorenal syndrome as well as detect early indicators of kidney injury that could have clinical benefit and positive impact on reducing the cost of treatment

Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment

Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd) and aortic pressure (Pa) less than 0.9 (Pd/Pa 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2) and negative captopril scintigraphy (lack of lateralization)

Association of coronary ischemia estimated by fractional flow reserve and Psychological characteristics of patients

Introduction: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). Material and methods: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. Results: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values

Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients

Introduction : Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). Material and methods : From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. Results : Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions : Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values