Ischemic mitral regurgitation in patients with acute myocardial infarction.

AIM OF THE STUDY: Echocardiographic evaluation of mitral regurgitation (MR) during the evolution of patients with acute myocardial infarction (MI). MATERIAL AND METHODS: The study included 104 patients (73 males and 31 females), aged between 38-85, diagnosed with acute myocardial infarction (based on clinical, ECG and enzymatic evidences), in order to assess the MR (clinically--a new systolic murmur, and by echocardiography--the severity of MR). Echocardiography was performed upon admission and at 10-30 and 180 days after the onset of acute MI. The evaluation of MR was based on the following parameters: jet area, jet area indexed to left atrium, regurgitated volume, left atrial and left ventricular size, the evaluation of mitral valve apparatus in order to eliminate other possible causes of MR. RESULTS AND DISCUSSION: MR was found in 35 patients from 104 diagnosed with acute MI, as follows: severe in 20 patients (jet area > 8 square cm, jet area indexed to left atrium > 40%, regurgitated volume > 30 mL) and mild in 15 patients (jet area < 4 square cm, jet area indexed to left atrium < 20%, regurgitant volume < 30 mL). In 30 patients MR was produced by the dilatation of mitral annulus (because of the evolution to ischemic dilatative cardiomyopathy), 5 patients developed left ventricular aneurysm; in 3 patients, MR was produced by chordae rupture and in 2 patients we diagnosed an ischemic prolapse of posterior mitral leaflet. In evolution all the patients developed symptoms and signs of heart failure, and 2 patients were referred to surgery. CONCLUSIONS: The appearance of MR in the evolution of MI is an important sign of bad prognosis by its contribution to the appearance and/or to the worsening course of heart failure. Mechanisms of this MR are very complex based on the alteration of left ventricular geometry. Echocardiography plays an essential role in the early diagnosis of MR, estimating its severity, the mechanisms and also the prognosis.

Barriers of antiaggregant treatment.

UNLABELLED: In the present study we aimed to evaluate side effects of antiplatelet therapy in order to establish correlations with medication type, doses and association with other therapies. MATERIAL AND METHODS: In the study we prospectively evaluated a cohort of patients who received antiplatelet therapy for different pathologies. We included patients with acute coronary syndromes, valvular disease complicated with supraventricular arrhythmias (especially atrial fibrillation), carotidal critical stenosis, neurologic disease (ischemic or thrombotic), and peripheral artery disease. RESULTS AND DISCUSSIONS: The study included 125 patients (85 males and 40 females), aged between 45 and 85, and admitted in the 1st Cardiology Department, St Spiridon Hospital, between January 2012 and December 2013, who received antiplatelet therapy for different pathologies. All the patients included in the study received platelet antiaggregant therapy with Clopidogrel in association or not with Aspirin or low weight molecular heparin. Side effects reported (possibly correlated with antiplatelet therapy) were: macroscopic hematuria (7 cases), cutaneous ecchymosis (7 cases), purpuric lesions (9 cases), gingival bleeding (12 cases), upper gastrointestinal bleeding (6 cases), and hemoptysis (2 cases). CONCLUSIONS: Hemorrhagic events under the treatment with antiplatelet agents are rare in comparison with the large number of patients treated. Clinical manifestations are very different depending on the drug and also on the drug-associations used. Hemorrhagic accidents may sometimes be very serious, determining the specific therapeutic measures.

The incidence of supraventricular arrhythmias in patients with essential arterial hypertension--clinical and evolutive correlations.

AIM OF THE STUDY: The analysis of supraventricular rhythm disorders encountered in hypertensive patients and the establishment of correlations with other associated risk factors, duration of hypertension, the evolution and prognosis. MATERIAL AND METHODS: The study included a group of 110 patients, 80 men and 30 women, aged between 40 and 85, admitted in the 1st Cardiology Clinic during 2010-2013, diagnosed with essential arterial hypertension second and third degree. For the detection of arrhythmic events surface 12-lead ECG and 24-hour Holter monitoring were used. RESULTS AND DISCUSSION: Supraventricular arrhythmias encountered in the patients of the group were: ESA (mostly isolated, but also doublets, atrial bigeminy), atrial fibrillation, atrial flutter, sinus tachycardia, sinus bradycardia. Some arrhythmias may be an expression of the excessive activation of the sympathetic nervous system or on the contrary, vagal predominance, (ex. sinus bradycardia). Part of the arrhythmias occurring in hypertensive patients are hypertensive heart disease expressions, others are due to associated risk factors (smoking, alcohol) and even medication administered. In some cases, rhythm disturbances disappear with the normalization of the blood pressure; however, most of the times, the specific combination of anti-arrhythmic medication with antihypertensive medication is required. CONCLUSIONS: Supraventricular arrhythmias are frequently found in hypertensive patients, especially in those with long-term, uncontrolled hypertension, with impact on the evolution, prognosis and therapeutic management.

Acute cardiogenic pulmonary edema--etiological spectrum and precipitating factors.

AIM: The analysis of the predisposing and precipitating factors encountered in the anamnesis of the patients hospitalized with acute pulmonary oedema, in order to establish some correlations with the evolution and prognosis. MATERIAL AND METHODS: The study included 50 patients, 32 males and 18 females, admitted to the Cardiology I Clinic between 2009 and 2013, diagnosed with acute pulmonary oedema upon admission. The following aspects were investigated: cardiovascular antecedents, prodromal elements of the current episode of acute pulmonary oedema (APE), risk factors and associated co morbidities, previous treatments followed at home as well as the triggering factors of the acute episode. RESULTS: The main pathology on which the acute pulmonary oedema (APE) episode occurred was represented by: arterial high blood pressure (HBP), dilated cardiomyopathy, ischemic heart disease, valvular heart disease, pre-existing atrial rhythm disorders. The analysis of the factors that precipitated the acute pulmonary oedema episode revealed the following possible triggering conditions: inadequate physical effort on the background of treatment discontinuation, high sodium diet, a prolonged ischemic episode due to inadequate physical effort, rhythm disorder with rapid ventricular response (atrial fibrillation, atrial flutter). In some cases, the risk factors were cumulated. CONCLUSIONS: Acute pulmonary oedema represents a major emergency that requires immediate admission to hospital and rapid treatment in the emergency department concurrent with the identification of the triggering and precipitating factors.

Cardiac tumors.

Cardiac tumors are a group of rare disorders with a frequency that varies in population studies between 0.0017% and 0.33%. There are primary cardiac tumors with an incidence of 5% of all cardiac tumors and secondary tumors (metastases of the heart) in 95% of cases. Symptoms are nonspecific and can mimic many other heart diseases. This fact makes the diagnosis of cardiac tumors very difficult. Approximately 75% of the primary cardiac tumors are benign; the most frequent histological type encountered is myxoma in 50% of cases, followed by cardiac fibromas, lipomas, rhabdomyomas, hemangiomas, teratomas, papillary fibroelastomas, pericardial cysts or cystic tumor of the atrioventricular node region. Secondary cardiac tumors (metastases) are 20 times more common than primary cardiac tumors. Paraclinical methods (especially imaging evaluation) are always necessary for the complete diagnosis: transthoracic and transesophageal echocardiograms are the gold standard investigations in the diagnosis of the cardiac tumors; CT scans together with MRIs are complementary diagnostic methods that are useful when the diagnosis is uncertain. In the majority of cases surgical treatment is recommended.

Hyponatremia--risk factor in patients with chronic heart failure--clinical, evolutive and therapeutic implications.

UNLABELLED: Patients with heart failure are, by definition, hemodynamically unstable. This condition may be accentuated by medication (digitalis, diuretics, antiarrhythmics), so that they become more sensitive to electrolyte disturbances. Hyponatremia is the most common electrolyte disorder, particularly common in the intensive care unit. AIM: The evaluation of the incidence of hyponatremia in patients diagnosed with chronic heart failure in order to establish a correlation with the evolution, prognosis and therapeutic implications. MATERIAL AND METHODS: We analyzed retrospectively 120 patients diagnosed with chronic heart failure NYHA II-IV classes, admitted in the Cardiology Clinic between 2009 and 2013. We analyzed electrolytic disturbances which occurred during different strategies of therapy. RESULTS: 120 patients with heart failure were admitted in the Cardiology Clinic between 2009 and 2013, 92 males and 28 females. Diagnosis was established by classical criteria. Evaluation was very complex and included: complete clinical examination, electrocardiogram, echocardiography, chest ray examination and biochemical analyses especially hepatic, renal function and electrolyte status. CONCLUSIONS: The data obtained showed that electrolyte disturbances are frequent in patients with chronic heart failure, irrespective of NYHA class. Hyponatremia is usually associated with diuretic therapy and may play a very important role in the subsequent development of life-threatening complications. Patients with heart failure who develop hyponatremia during their evolution had a worse prognosis.

Is there a cardiovascular risk in inflammatory bowel diseases?

Inflammatory bowel diseases (IBD) are characterized by an increased thrombembolic risk, given the powerful relation between inflammation and thrombosis. Multiple studies showed that patients with IBD have an up to 3-fold higher risk for developing venous thrombembolic (VTE) complications compared to general population, this risk being more increased in the hospitalized IBD flares. Thus, latest consensus recommendations indicate prophylaxis for VTE in hospitalized patients with active IBD but with no clear indications for the management of IBD outpatients. Regarding atherothrombotic risk (myocardial infarction or stroke), up-to-date data are inconclusive. IBD is associated with subclinical atherosclerosis in patients without clinical manifestations of cardiovascular diseases (CVD). However, the results of major studies assessing the hypothesis that IBD is strongly associated with atherosclerotic macrovascular events prove to be divergent even if they show positive correlations with CVD especially on different subgroup analysis. These facts should lead in the future to more prospective studies with control groups that have the same cardiovascular risk profile as in IBD populations in order to admit definitively that patients with IBD are exposed to an increased cardiovascular risk.