The impact of earthquakes on the frequency and prognosis of the most common emergency cardiac conditions.

AIM: To assess whether the number of patients with a cardiac chief complaint and their characteristics differed between before and after two major earthquakes that struck Croatia in 2020. METHODS: We collected data on all visits of patients with a cardiac chief complaint examined in the emergency departments of six hospitals nearest to the epicenters. Patients seen during the 7 days before the earthquake were compared with those seen on the day and during the 6 days after the earthquake. RESULTS: Patients seen after the earthquake were younger (68 [59-79] vs 72.5 [65-80]; P<0.001) and less frequently had cardiovascular disease (32.9% vs 42.8%; P<0.001). This group less frequently had the primary diagnosis of acute myocardial infarction (AMI) (15.6% vs 21.9%; P=0.005), heart failure (9.3% vs 19.4%; P<0.001), dysregulated hypertension (13.9% vs 19.4%; P=0.01), but more frequently had non-anginal chest discomfort (28.8% vs 18.0%; P<0.001). In a subgroup analysis of patients seen in hospitals located within 20 km from the epicenter, significantly more patients seen after the earthquake compared with those seen before the earthquake presented with AMI (14.5% vs 22.8%; P=0.028), acute elevation of blood pressure (10% vs 21.8%, P=0.001), and paroxysmal arrhythmias treated with electrocardioversion (0.9% vs 4.5%, P=0.022). CONCLUSION: After two moderately strong earthquakes, hospitals within 20 km from the epicenter saw a significant increase in acute cardiac conditions such as elevated blood pressure, AMI, and cardioverted arrhythmias. Eventually, these earthquakes had no impact on the outcomes of the studied population.

Impact of reperfusion therapy and infarct localization on frequency of premature ventricular beats in acute myocardial infarction.

AIM: To determine the impact of infarct localization and types of reperfusion therapy on the frequency of ventricular premature beats (VPBs) in patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF). METHODS: A total of 705 patients with acute ST elevation myocardial infarction (STEMI) were divided according to the infarct localization (anteroseptal, anterolateral, inferior and posterior) and reperfusion therapy (fibrinolysis or percutaneous coronary intervention with stenting) into two groups: LVEF<45% was an experimental group and LVEF>45% was a control group. The occurrence of VPBs<10 per hour was defined as a non-significant, and the occurrence of VPBs>10 per hour defined as a significant. RESULTS: In patients with fibrinolysis therapy and LVEF<45% significant number of VPBs were in anteroseptal (p=0.017), anterolateral (p<0.001) and posterior AMI (p<0.001), but in patients with percutaneous coronary intervention (PCI) and LVEF<45% significant number of VPBs were only in anteroseptal AMI (p=0.001) localization. CONCLUSION: In patients with reduced ejection fraction in AMI, treatment with PCI method has a better antiarrhythmic effect compared to fibrinolysis treatment.

[The influence of fibrinolytic and heparin therapy in acute myocardial infarction upon gastrointestinal bleeding in patients with asymptomatic ulcerous disease]. / Utjecaj fibrinoliticke i heparinske terapije u akutnom infarktu miokarda na gastrointestinalno krvarenje kod asimptomatskih ulkusnih bolesnika.

AIM: To determine in patients with asymptomatic ulcerous disease frequency of hemathemesis and melena (H/M) as complications of fibrinolytic and heparin therapy in acute ST-elevation myocardial infarction (STEMI). METHODS: According to heparin and streptokinase therapy, STEMI patients were divided into two groups. Each group consisted of case study subgroup with patients who had asymptomatic ulcerous disease and a control study subgroup with patients who did not have ulcerous disease. RESULTS: In heparin therapy there was no significant increase of H/M in patients with and without ulcerous disease (3.4% vs 2.8%, n.s.) as well as in fibrinolytic therapy (5.9% vs 6.8%, n.s.). Fibrinolytic therapy causes more H/M in relation to heparin therapy in patients with ulcerous disease (5.9 vs 3.4%; chi2=6.389; p=0.011) as well as in patients without ulcerous disease (6.8 vs 2.8%; chi2=616; p=0.013). In patients with H/M there were insignificantly more women than men (42.4% vs 57.6%, n.s.). CONCLUSION: Patients with asymptomatic ulcerous disease can be exposed to fibrinolytic and heparin therapy when treating STEMI without a significant risk to H/M occurrence in relation to patients without ulcerous disease.

[The region of Karlovac in the urgent PCI network]. / Karlovacka regija u mrezi hitne perkutane koronarne intervencije.

AIM: The aim of the study was to determine circumstances of referring patients with ST-elevation myocardial infarction (STEMI) for urgent percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Different forms of acute coronary syndrome (ACS) and circumstances of referring STEMI patients to Karlovac PCI from October 2005 to February 2008 were analyzed. RESULTS: During the period of observation, 366 ACS patients were hospitalized. There were 37% of patients with unstable angina pectoris, 15% with myocardial infarction without ST-elevation (NSTEMI) and 48% with STEMI. Out of 176 STEMI patients, 52% had subacute infarction, 22% were referred for urgent PCI, 17% received fibrinolytic treatment, whereas in 9% of patients PCI and fibrinolysis were contradictory. Out of 30 patients with fibrinolysis, PCI was not carried out in 14 patients that arrived in hospital within 2-3 hours, 2 patients arrived after 6 hours, 3 patients were older than 75 and 11 patients refused invasive approach to treatment or it was personal estimate of the physician. CONCLUSION: Accordingly, too many patients with subacute STEMI arrived in hospital. The success of PCI project would be even better if it was used in patients with unstable angina pectoris and NSTEMI.

Frequency of ventricular premature beats and ventricular tachycardia in STEMI treated with fibrinolytics.

To determine in acute myocardial infarction with an ST elevation (STEMI) treated with fibrinolytics frequency of ventricular premature beats (VPBs) and ventricular tachycardia (VT) according to the damaged area and residual cardiac function. With anterolateral infarction with ejection fraction (EF) < 45%, incidence of VPBs < 10/h was statistically significantly reduced (p < 0.001) while incidence of VPBs > or = 10/h as well as VPBs in a pair and VT was increased (p < 0.001). With anteroseptal infarction with EF < 45%, incidence of VPBs < 10/h was statistically reduced (p = 0.06) and incidence of VPBs > 10/h, VPBs in a pair and VT was increased (p = 0.06). With inferior and inferoposterior infarction with EF < 45%, incidence of VPBs < 10/h was reduced and incidence of VPBs > or = 10/h, VPBs in a pair and VT was increased. However, such difference was not statistically significant. Along with reduced residual cardiac function, one can also expect increase in frequency of VPBs and VT in all forms of STEMI regardless the area of damage. Such frequency is significant with all forms of anterior infarction, that is to say, slightly more with anterolateral infarction in relation to anteroseptal one. However, with inferior and inferoposterior infarction this frequency of VPBs i VT is not significant.

The first seven years of implantation of permanent cardiac pacemakers in a small urban community in central Croatia.

The aim of the study was to assess the situation with implantation of cardiac pacemakers and to critically evaluate the possibility of this method of treatment. The study was conducted from 2001 to 2007. Data on a total of 211 operations were included in the study. There were 121 (57.3%) male patients, mean age 69.7 years, and 90 (42.7%) female patients, mean age 74.5 years. Total number of operations increased from 18 in 2001 to 24 in 2002, 28 in 2003, 38 in 2004, 38 in 2005, 30 in 2006 and 35 in 2007. Primo implantation was carried out in 196 (92.9%) cases. The following types of pacemakers were used: VVI in 79 (40.3%), VVIR in 73 (37.2%), DDD in 7 (3.6%), DDDR in 18 (9.2%), VDD in 17 (8.7%) and AAIR in 2 (1.0%) cases. ECG indication was second degree heart block in 40, third degree heart block in 86, chronic atrial fibrillation with bradyarrhythmia in 57, sick sinus syndrome in 27 cases and trifascicular block in one case. The symptoms included dizziness in 126, syncope in 52, dyspnea in 45, bradycardia in 12, chest pain in 3 and cerebral dysfunction in 2 cases. In conclusion, our patients now receive appropriate treatment within a shorter time, thus reducing pressure upon large cardiac surgery centers. However, efforts should be continuously invested in approaching European standards of artificial pacemaker implantation.

[Neuromusculoskeletal chest pain]. / Neuromisicnokostana prsna bol.

To determine frequency of neuromusculoskeletal etiology of chest pain is performed. By means of a retrospective analysis and on the basis of the history of the patients' disease, data were collected after chest pain had been medically worked out. The causes to chest pain were in 82% of cardial etiology, in 9% of neuromusculoskeletal etiology, in 6% of gastrointestinal etiology and 3% others. All the patients suffering from neuromusculoskeletal causes to chest pain were, besides anti-rheumatic therapy, also treated by certain form of cardiac therapy. The task of a doctor is to accurately recognize serious disorders as possible causes to chest pain. However, the doctor must not make wrong diagnosis of potentially dangerous conditions thus causing unwanted psychological and economical consequences. In order to realize this, adequate diagnostic possibilities are necessary besides the knowledge about all possible causes to chest pain.

Cardiovascular risk factors in a small urban community in central Croatia.

The aim of this study was to determine in Karlovac (southern part of central Croatia) the most important risk factors for coronary heart diseases in men and women according to age < or = 59 and > or = 60 on the basis of their prevalence in 558 non-coronary patients and 442 symptomatic coronary patients. In younger male coronary patients (< or = 59 years of age) in relation to the control study, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001), smoking (p < 0.01) and diabetes (p < 0.01). In older male patients (> or = 60 years of age) there was no statistically significant difference in a single risk factor. In younger female coronary patients, the statistically significant more frequent risk factors were hypercholesterolemia (p < 0.001) and diabetes (p < 0.001) and in older female patients diabetes (p < 0.05). This population sample showed higher prevalence of cardiovascular risk factors in younger coronary patients. The most frequent risk factors were diabetes, hypercholesterolemia and smoking. The difference is slighter in older coronary patients where it is diabetes, which is the most important for women.