Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement.

Extending the indication of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients naturally results in longer life expectancy and survival rates after the intervention. The longer life expectancy of these patients leads to an increased possibility of future acute coronary events, necessitating the development of effective and appropriate treatment strategies. Acute coronary syndromes (ACS) in patients with previous TAVR procedures present with modified clinical characteristics when compared to the non-TAVR population. In populations with prior TAVR procedures, plaque rupture remains the main cause of ACS. However, unlike the non-TAVR population, there is an increased frequency of nonatherotrombotic mechanisms, like emboli and mechanical obstruction of coronary ostia by valve components. The main observation related to the treatment of ACS TAVR patients is the significantly lower percentage of patients undergoing invasive management. Furthermore, ACS in TAVR patients is associated with poor prognosis, higher long-term mortality rates, and higher incidence of MACE. It is surprising that considering this significant and increasingly recognized issue, there are only a few studies that have investigated ACS after TAVR. The scope of the present review is to address available data about ACS following TAVR, focusing on incidence, timing, mechanism, and causes. We also examined current knowledge regarding optimal invasive treatment and analyzed short and long-term clinical outcomes.

[Use of TENS in patients with rheumatoid arthritis]. / Primjena TENS-a kod bolesnika s reumatoidnim artritisom.

The patients with rheumatoid arthritis of the fourth grade have used the whole basic therapy and, of course, antirheumatic therapy with all their positive and negative effects. We have applied and analysed the application of analgetic physical therapy with TENS (Transcutaneous Electrical Nerve Stimulation). TENS appeared to be a perfect substitution for nonsteroid antirheumatics and analgetics. Its easy application, the possibility of using at home and practically non-existent contraindications give him the priority at pain relief for rheumatoid arthritis of the fourth grade.