[Clinical aspects and haemodynamic parameters for monitoring patients with acute myocardial infarct (AIM)]. / Uporedni znacaj klinickih i hemodinamskih parametara za pracenje oboljelih od akutnog infarkta miokarda (AIM-a).

In acute myocardial infarct (AIM) incomes to a local disturbances in contractility: hypokinesia, akinesia, diskinesia, asynchronia. With repeated AIM esspecially in high oclussive coronary disease incomes to diffuse disturbance in contractility of myocard, with disorder in systolic and diasystolic function of heart. The aim is to point on significance of clinical and haemodynamic parameters in revealing heart weakness in AIM. By retrograded analysis in our study was embraced 86 patients deseased from AIM, average age of 58.42 years. Front wall infarct had 60,46%, backwall infarct had 39.54% of deseased patients. Patients were monitored clinically, electrocardiographically and haemodynamically with microcatetherisation of the right heart by Schwan-Ganz threeluminal thermodilutional catether with regulation of heart minute volumen. By haemodynamic values they were splitted in four groups. In clinical study, silent heart tones had 33%, systolic murmurs on ictus 19%, gallop rhythm 26% and lung failure 22% of patients. The most reliable clinical sign for heart weakness were low heart tones and gallop rhythm as well as lung failure. By haemodynamic values aquired by microcatetherisation of right heart with regulation of minute heart volumen, deseased with AIM were 15% in first group, 28% in second group, 3% in third group and 54% in fourth group of patients.

[Atrial fibrillation after surgical myocardial revascularisation]. / Fibrilacija atrija nakon hirurske revaskularizacije miokarda.

Atrial fibrillation characterized by uncoordinated atrial activation. On the electrocardiogram is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size and shape. The incidence of atrial fibrillation in patients under 22 years old is 2%, whereas for patients under 60 years old, the incidence is 8.8%. The most common cause of death in patient with atrial fibrillation is stroke, and occurs in 1% to 5% patients in the age group 50 to 59 years, whereas 30% patients in the age group 80 to 89 years. The incidence of atrial fibrillation after coronary artery bypass surgery occurs in 20% to 40% patients. We examined the incidence atrial fibrillation in patients after coronary artery bypass surgery, most common risk factors for occurs atrial fibrillation. Prospective study was conducted on 100 patients, who were divided in two groups, which had similar age structure, gender and they had disease coronary artery which required coronary artery bypass surgery. We established that incidence atrial fibrillation after coronary artery bypass surgery was 24%. Age was one of main risk factors that is responsible for appearance of atrial fibrillation. Gender like risk factor at 60 year old persons does not have statistical significance, while at persons which are younger then 60 years male has greater statistical significance like risk factor. Patients with triple vessel disease after coronary artery bypass surgery had most common atrial fibrillation.

[Coronary disease and left branch block]. / Koronarna bolest i blok lijeve grane.

In the LBBB (the block of the left branch) control group there were 2 examinees Hi (6.45%). LAH and LHP were not found. The block of the left branch often creates problems in electrocardiographic diagnosis of coronary disease. It can be registered as complete LBBB, anterior-left hemiblock (LAH) and posterior-left hemiblock (LPH). The combinations are possible with the block of the right branch (RBBB) and A-V blocks. The most frequent cause is coronary disease, and next is sclerodegenerative changes in heart intrinsic-conduction system. Our study involves 98 of examinees with coronary disease, and 78 of that number are males and 24 are females, all average-aged 60.83+/-12.6. Control group (examinees who do not suffer from coronary disease) is made of 31 subjects, and 24 of that number are males, and 7 are females, all average-aged 57.16+/-10.4. Those diagnosed with coronary disease, as the examinees from control group, had the indications for the coronagraphy. The coronagraphy was performed and electrocardiographic findings were analyzed. The average degree of coronary arteries stenosis of the ill examinees was 77.5+/-14.9%, and in the examined group 23.5+/-12.5%. Of the examinees with the block of the left branch, 4 Hi examinees had one-artery illness (4.08%), 3 Hi had two-artery illness (3.06%) and 1 Hi had three-artery illness (1.02%). In one-artery coronary disease LAD stenosis was most frequent. Disruptions in conduction LBBB+LAH was found in 17.34% ill examinees, and 8.16% of those from LBBB and 9.8% from LHH. Of examinees with LAH, one-vessel coronary disease was found in 5.1% and two-vessel coronary disease in 4.08%. The most frequent was LAD stenosis, rarely combined with CX stenosis, and in one case LAD combined with RCA stenosis. In group with coronary disease LPH was not found.

[Intracoronary radiotherapy]. / Intrakoronarna radioterapija.

Intervenient cardiology is significantly more represented in attempts to solve problems of heart coronary artery disease in comparison to aortocoronary bypass procedures. Resthenoses of coronary artery blood vessel after PTCA, or PTCA and stent placement are frequent. The main causes are: neointimal hyperplasia, late contraction, and remodelling. The application of brachitherapy offers the possibility to prevent resthenosis especially stent resthenosis. Our report encompasses eight patients diseased from coronary artery occlusionn. Half of there patients had a stent resthenosis. The average degree of blood vessel occlusionn before the intervenient manipulation was 78%, and after treatment 25%-30%. Early results after recanalisation of coronary blood vessel are thus fat satisfactory, but results are to be followed carefully.

Insertion/deletion polymorphism of angiotensin-converting enzyme gene--risk factor for coronary artery disease in the Tuzla region population (Bosnia and Herzegovina).

Angiotensin II is the major effector molecule of renin-angiotensin system; its production can be conveniently interrupted by angiotensin-converting enzyme (ACE). Typical plasma levels of ACE accompany the I/D polymorphism; however, a controversy exists as to whether the DD genotype of the ACE polymorphism affects the risk for the development of coronary artery disease (CAD) and to what extent the ACE polymorphism is associated with CAD in different populations. We compared the I/D polymorphism in 212 CAD patients younger than 50 years with 165 healthy control individuals. They were all from the Tuzla region in Bosnia and Herzegovina. Patients with CAD had a higher prevalence of the DD genotype (36.3%) than controls (25.6%). The odds ratio for the ACE DD genotype in CAD patients was 1.7 (95% confidence interval 1.0-2.7; p < 0.05). We may conclude that the D/D genotype of the ACE gene polymorphism is associated with an increased risk for CAD in the Bosnian population.