Implantation of a Occlutech Figulla® PFO occluder in a patient with patent foramen ovale and history of embolic stroke

The most common interventions in structural heart diseases for various age groups are percutaneous occlusions of septal defects. We present the case of a woman with patent foramen ovale (PFO) periodically causing a right-to-left shunt, after an incident of stroke, with migraine attacks, treated by percutaneous closure of PFO with use of a novel occluder device - an Occlutech Figulla®. The procedure was performed under X-ray and transesophageal echocardiographic monitoring. The novel Occlutech device described above features easy manipulation, good safety and some constructional innovations that enable the time of antiplatelet prophylaxis to be shortened, thus potentially minimizing procedure related risk

Zapalenie mięśnia sercowego związane z zakażeniem Salmonella parathypi C

Myocarditis related to bacterial gastroenteritis is rare, especially in immunocompetent persons. The clinical course of the disease is characterised by non-specific, sparse symptoms, which greatly impedes diagnosis. This paper presents a case of myocarditis in a 39 year-old man with a Salmonella paratyphi C infection. Salmonella infections rarely cause myocarditis, but they should always be considered in cases where myocarditis is suspected and there is no evidence of a viral aetiology.Zapalenie mięśnia sercowego związane z bakteryjnym zapaleniem jelita występuje rzadko, zwłaszcza u osób immunokompetentnych. Przebieg kliniczny choroby charakteryzuje się niespecyficznymi, skąpymi objawami, co znacznie utrudnia diagnozę. W pracy przedstawiono przypadek zapalenia mięśnia sercowego u 39-letniego mężczyzny z zakażeniem Salmonella parathypi C. Zakażenia salmonellą są rzadką przyczyną zapalenia mięśnia sercowego, ale zawsze powinny być brane pod uwagę w przypadkach z podejrzeniem myocarditis w przypadku braku dowodów na etiologię wirusową

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established. OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment. MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) \u3e140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients\u27 suitability for RDN. RESULTS: A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), β-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), β-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). CONCLUSIONS: Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients

Krytyczne ostialne zwężenie pnia lewej tętnicy wieńcowej u 39-letniej kobiety leczonej przezskórną angioplastyką

Isolated critical stenosis of left main coronary artery (LMCA) due to atherosclerosis is very rare and affects about 0.2% ofpatients. We present the case of a 39-year-old, non-smoker women with risk factors for diseases of the cardiovascular systemin the form of hypercholesterolaemia and hypertension, in addition to positive family history and chronic oral contraception.Sick from occurring since atypical angina masked depressive symptoms, with a critical stenosis of LMCA and little suggestivesymptoms of ischaemia because of the existing collateral circulation

Relationship of serum angiogenin, adiponectin and resistin levels with biochemical risk factors and the angiographic severity of three-vessel coronary disease

Background: Patients with advanced coronary artery disease (CAD) have an unfavorable prognosis. Therefore, early identification of this high-risk group is important. The aim of this study was to assess the usefulness of clinical, electrocardiographic and echocardiographic parameters supported by novel atherogenesis and angiogenesis markers in identifying patients with stable, three-vessel coronary artery disease. Methods: The study group comprised 107 patients suffering from three-vessel CAD and a control group of 15 patients presenting with typical angina, a positive exercise stress test and abnormal segmental contractility, but no hemodynamically significant coronary stenosis in their angiograms. In each patient, we characterized a biochemistry test panel including novel markers: angiogenin, resistin, adiponectin, IL-8 and a TNF-a. The angiographic severity of CAD was expressed as a Gensini score. Results: There were significant differences between three-vessel CAD patients and control groups with respect to the serum levels of: hsCRP (2.8 vs 1.4 mg/L, p = 0.01), HDL-cholesterol (45 vs 54 mg/dL, p = 0.04), LDL-cholesterol (102 vs 95 mg/dL, p = 0.04), NT-proBNP (392 vs 151 pg/mL, p = 0.008) and a marker of angiogenetic activity, angiogenin (414 vs 275 ng/mL, p = 0.02), However, no significant differences were found between three-vessel CAD and the control group with respect to the serum level of adiponectin (8.08 vs 7.82 μg/mL), resistin (17.5 vs 21 ng/mL), IL-8 (20.7 vs 26.8 pg/mL) and TNF-a (4.1 vs 4.3 pg/mL). Angiogenin tended to be higher in patients with higher Gensini scores (p = 0.06) but no influence of ejection fraction was noted. Conclusions: Angiogenin is a novel marker of three-vessel coronary disease showing a relationship with the angiographic severity of the disease. (Cardiol J 2010; 17, 6: 599-606

Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention

Background: Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated with primary PCI in acute MI.Methods: This prospective study enrolled 538 patients who underwent primary PCI in acute MI. Admission blood samples were measured for MPV, PDW, and P-LCR. The patients were followed-up a mean period of 26 ± 11 months with regard to cardiac death, non-fatal reinfarction, re-PCI or coronary artery bypass grafting.Results: Kaplan-Meier survival analysis showed a significantly higher 26-month mortalityrate in patients with high MPV (≥ 11.7 fL) than in those with low MPV (< 11.7 fL) (14.6% vs. 5.5%, p = 0.0008). Similar findings were related to high P-LCR (≥ 38.1%) vs. low P-LCR (< 38.1%) — mortality 13.8% vs. 5.8%, p = 0.0025. Higher PDW values (≥ 16 fL) correlated with higher mortality rate as compared to PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint.Conclusions: Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI