Impact of cardio-vascular complications on predicting of the thromboembolic events and prognosis of infective endocarditis outcome

Cardiology Department, State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: The infective endocarditis (IE) is a serious immune-inflammatory disease characterized by vegetative damage of cordis and causing serious complications. The average annual sick rate is 3-10 cases for 100 000 of population, and mortality is 16-20%. Aim: To study the cardiovascular complications in patients with infective endocarditis and their impact on the evolution and prognosis of the disease. Materials and methods: The study included 132 patients: 128 — hospitalized in the Cardiology Department Nb. 4 of the Cardiological Institute, and 4 patients from the Municipal Hospital “Holy Trinity”. The average age of enrolled patients was 39.94±2.1 years. The diagnosis was established according to the DUKE diagnostic criteria for IE. Results: The most common complication in patients with IE is cardiovascular insufficiency (Cl), which was reported in 100% of investigated patients. Analyzing the results, we noted that in 48.7% of the patients from the study was developed Cl III NYHA functional class (FC), followed by the Cl II FC degree in 43% of cases. Cl IV and IFC were diagnosed in only 6% and 2.3%, respectively. FC of Cl in patients with IE increasing dependence of endocardial involvement in the disease process and valvular damage, detection of the vegetation cusp and chordae rupture, annular abscess at EcoCG. The most frequently involved in the disease process were aortic and mitral valve in 53.5% and 41.5% of cases, respectively. It was proved echocardiographically the endocardium damage in 72.6% of cases: vegetations (64%), the decompensation of prosthetic valve (25%), breakage of cords (18%), myocardium apostasis (3.79%). The positive hemoculture was found in the 41.5% of cases, mostly staphylococcus (44%) and streptococcus (38%). In 20% of cases there were diagnosed embolisms. Due to predicting of thromboembolic complications using special formulas in our patients the result was 7%. The forecast of the outcome was favorable in 74% patients, relatively favorable and unfavorable was observed in 17% and 9%, respectively. Conclusions: The IE course severity is determined by several criteria: “masked” clinical picture, delayed diagnosis, high frequency of complications and the problems of the early detection of them, as well as the complexity of selection of an efficient treatment. High CD FC by NYNA, embolisms and high percentage of negative hemocultures were the predictors of lethal outcome

The correlation between coronary stents length and in-stent restenosis

Cardiology Department, State University of Medicine and Farmacy “Nicolae Testemitanu”, Chisinau, Republic of MoldovaActuality: In-stent restenosis (ISR) is considered most important complication of the percutaneous transluminal coronary angioplasty (PTCA). For a period of six months, the prognosis of PTCA varies in dependence of what method is used: it occurs in over 45-50% of cases after balloon angioplasty, in 10-15% after the use of bare metal stents (BMS) the result being better and below 10% after the use of drug eluting stents (DES). The aim: To elucidate the impact of coronary stent's length in ISR occurrence in patients with various forms of IHD, after a 6 months follow-up. Material and Methods: In this study were involved 150 patients. According to the stent's length, the group was divided into 2 subgroups: group I - subgroup I - that of “long” stents (>20mm) - 64 patients and subgroup II - that of “short” stents (<20mm) - 86 patients. Patients underwent clinical supervision for a period of 6 months. Results: In order to solve these lesions in the patient's groups were used several models of BMS. In both groups the model “Driver/Integrity” was used more often - 44.2% in group I and 39.1% in group II. On the second stage were placed “Vision” stents model which were used in 33.7% cases of the “short stents” group and in 35.9% cases of the “long stents” group. “Liberte” were used in the treatment of 22.1% patients from the Ist group and of 25% patients from the IInd group. After a 6 month follow-up IRS confirmed angiographically had 10.5% patients in whose treatment were used “short” BMS and 20.3% patients in whom were implanted “long” BMS, while in 8.1% patients the Ist group and 15.6%in the IInd group were diagnosed new injuries, due to this fact they suffered repeated angioplasty procedures, the obvious differences being statistically relevant one - p <0.05. The lumen loss index was more important for long stents - 2.54 vs. 2.33mm (p <0.05). Conclusions: 1. Bare metal stents whose length is <20mm have a favourable prognosis at a 6 month distance compared to those >20mm, in-stent restenosis rate in this period was 10.5% for short stents and 20.3% for those long. 2. It is necessary to choose an optimal length by using bare metal stents - so that the stent's borders not to exceed long away the coronary lesion, but for cases that require the use of stents >20mm is more beneficial to use drug eluting stents. 3. It is advisable to avoid the use of bare metal stents in the treatment of coronary lesions with those lengths more than 20mm, in these cases drug eluting stents are of choice, while in the cororarian lesions with their length <20mm treatment, bare metal stents can be used widely

Clinical case: inferior myocardial infarction of the left ventricle, extended to the right ventricle

State Medical and Pharmaceutical University „Nicolae Testemițanu”, Chișinău, Republic of MoldovaIntroduction: Acute myocardial infarction of the right ventricle (AMI RV) is rarely met, it being associated with an inferior AMI of the left ventricle (AMI LV) in 33-50% of the cases, determining the increase of early morbidity and mortality. The symptoms of hypotension, clear pulmonary areas and turgid jugular veins are considered a marker of the RV lesion in patients with inferior AMI. Approximately 25-50% of AMI RV present with hemodynamic disturbances. Female gender, age over 70 years, arterial hypertension, smoking, atrio-ventricular block and bundle branch block are predictive factors for the RV implication in patients with inferior AMI. The patient R., 72 years old, was admitted to the Cardiology Department nr. 1 of the PMSI Institute of Cardiology with the diagnosis: Ischaemic cardiopathy. Inferior acute myocardial infarction. Cardiac asthma accesses. Acute cardiac failure II Killip. Complaints: Constrictive pain in the right parasternal and in the epigastric areas, inspiratory dyspnea at light physical effort, cardiac asthma accesses, calf swelling, fatigue. History of the disease: The general state has been worsening for 2 weeks with epigastric pain, dyspnea progression, and apparition of cardiac asthma accesses. Ambulatory Echo-CG determined RV cardiomegaly, ejection fraction decrease (35%) and presence of akinetic areas. He was immediately hospitalized in the Cardiology Department of PMSI Institute of Cardiology. Clinical examination: General state severe, pale skin, acrocyanosis. Hoarse vesicular murmur in the lungs. Rhythmic, diminished heart sounds, with HR=74 beats/minute, BP=140/90 mm Hg. Liver +4 cm. Paraclinical investigations: ECG at admission: Sinus rhythm, HR=95/minute, LV myocardium hypertrophy, repolarization changes on the inferior wall of the LV. Repeated ECG: comparatively, with no visible changes. Echo-CG: M oderate aortic stenosis. Regurgitation of the AoV of the Ilnd degree. Moderate dilation of the LA, RA, RV. Akinesia of the inferior wall of the LV, of the basal and medium segments in the lateral and posterior walls of the LV. Akinesia of the RV wall. Regurgitation of the TV of the Illrd degree, MV of the Ilnd degree. Severe pulmonary hypertension. Markers of myocardial necrosis: negative. Treatment: Beta-blockers, nitrates, diuretics, ACE inhibitors, anticoagulants, antiplatelets. Conclusion: The patient R., 72 years old, presenting with an extended AMI, involving the LV and RV, which determined intensive therapy. According to literature data, patients with an inferior AMI of the LV, involving the RV, have a worst prognosis