Single dominant right coronary artery with hypoplastic left coronary branch: a rare congenital anomaly: a case report.

Background: A right single coronary artery (SCA) and hypoplastic coronary disease represent a rare coronary artery anomaly, which is associated with sudden cardiac death. The clinical manifestations of these anomalies depend on the distribution of collateral vessels. Case summary: A 55-year-old female presented with dyspnoea, mild chest pain during physical activity, and palpitations. Selective coronary angiography revealed a prominent SCA originating from the right coronary sinus. Approximately 2 mm from the ostium, this artery branched into two: a dominant right coronary artery (RCA) and a smaller artery for the anterior wall perfusion. The dominant RCA then moved posteriorly, bifurcating into a posterior descending artery and a posterolateral artery. The latter occupied the expected location of the left circumflex artery and supplied the majority of the coronary circulation, including the left ventricle. Notably, there were no significant atherosclerotic calcifications or stenoses observed. Discussion: We describe a unique case of a SCA that doesn't conform to any category within the modified Lipton's classification. Symptoms are speculated to arise from the compression of the SCA between the aorta and pulmonary artery during physical exertion. Additionally, hypoperfusion from the hypoplastic left coronary branch in the anterior wall warrants consideration. It's paramount to meticulously evaluate the risk of sudden cardiac death when treating patients with a SCA. For high-risk patients, coronary artery bypass grafting should be contemplated.For our patient, given the clinical context, pharmacological treatment optimization was chosen.

Association between apelin-12 and creatine kinase-MB, depending on success of reperfusion in STEMI patients.

BACKGROUND: Acute myocardial infarction is characterised by an imbalance in the supply and demand of oxygen in the heart. It requires urgent reperfusion, and poor outcomes are attributed to myocardial ischaemia-reperfusion injury. We aimed to evaluate the association between apelin-12 levels and creatine kinase-MB activity in predicting the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) patients. METHODS: In this study we included 72 patients with the following criteria: chest pain suggestive of myocardial ischaemia for at least 30 minutes, an electrocardiogram with ST-segment elevation (measured at the J-point) ≥ 2 mm in leads V2-V3 and/or ≥ 1 mm in the other leads, rise of specific biomarkers such as cardiac troponin and the MB fraction of creatine kinase (CK-MB), and those who underwent reperfusion therapy. Blood samples for the measurement of apelin-12 and creatine kinase-MB were collected 12 hours after the reperfusion therapy. RESULTS: In patients with thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2, the median of the apelin-12 level was 1.80 ng/ml (0.46-9.20), and with TIMI flow 3, it was 5.76 ng/ml (1.14-15.2). Variability was observed in the apelin values (Mann-Whitney test) based on TIMI flow grade (p < 0.001), while no variability was observed for creatine kinase-MB (p < 0.18). The degree of association between apelin-12 and creatine kinase-MB levels was analysed with Pearson's correlation, enabling us to determine patients with successful reperfusion (determined as TIMI flow 3) (p < 0.004), and those with unsuccessful reperfusion (with TIMI flow ≤ 2) (p = 0.86). CONCLUSION: In STEMI patients undergoing reperfusion therapy, Apelin-12 level was associated with creatine kinase-MB activity according to the success of the reperfusion.

Influence of apelin-12 on troponin levels and the rate of MACE in STEMI patients.

BACKGROUND: During acute myocardial infarction, phosphorylated TnI levels, Ca2+ sensitivity and ATPase activity are decreased in the myocardium, and the subsequent elevation in Ca2+ levels activates protease I (caplain I), leading to the proteolytic degradation of troponins. Concurrently, the levels of apelin and APJ expression are increased by limiting myocardial injury. METHODS: In this prospective observational study, 100 consecutive patients with ST-elevation acute myocardial infarction were included. Patients meeting the following criteria were included in our study: (1) continuous chest pain lasting for >30 min, (2) observation of ST-segment elevation of more than 2 mm in two adjacent leads by electrocardiography (ECG), (3) increased cardiac troponin I levels, and (4) patients who underwent reperfusion therapy. We evaluated the levels of apelin-12 and troponin I on the first and seventh days after reperfusion therapy in all patients. RESULTS: Apelin-12 was inversely correlated with troponin I levels (Spearman's correlation = -0.40) with a p value <0.001. There was variability in the apelin values on the seventh day (Kruskal-Wallis test) based on major adverse cardiac events (MACE) (p = 0.012). Using ROC curve analyses, a cut-off value of >2.2 for the association of apelin with MACE was determined, and the AUC was 0.71 (95% CI, 0.58-0.84). Survival analysis using the Kaplan-Meier method showed a lower rate of MACE among patients with apelin levels >2.2 (p = 0.002), and the ROC curve analysis showed a statistically significant difference in the area under the curve (p = 0.004). CONCLUSION: The influence of apelin levels on troponin levels in the acute phase of STEMI is inversely correlated, whereas in the non-acute phase, low apelin values were associated with a high rate of MACE.

Atrioventricular septal defect with common atrioventricular junction guarded by a common valve consisting of left atrioventricular trifoliate valve.

INTRODUCTION: Atrioventricular septal defect with common atrioventricular junction is a rare adult congenital cardiac syndrome. This occurrence with prolonged survival is exceptionally rare. CASE REPORT: We present the case of a patient who presented with this defect with common atrioventricular junction who survived to the age of 32. We describe a 32-year-old man with atrioventricular septal defect with common atrioventricular junction guarded by a common valve. His history, clinical course, and anatomic findings are discussed along with the factors which may have contributed to his longevity, which is unique in the medical literature. His management reflected the state of medical knowledge at the time when he presented, and although alternate approaches may have been utilized if the patient presented today. We discuss the findings, frequency, classifi cation, and management of congenital defects. Development of embryonic structure is altered by interaction between genetics and environmental factors toward a rare associated of congenital cardiac defects-complex congenital heart disease. CONCLUSION: This case demonstrates that patients with very complex congenital cardiac disease may survive to adulthood, presenting challenges in both medical and surgical treatment.

The impact of acute myocardial infarction on left ventricular systolic function.

BACKGROUND: During acute myocardial infarction left ventricular systolic function is an important prognostic factor whose worsening is still frequent despite the therapeutic approach. We aimed to estimate the incidence of left ventricular systolic dysfunction among patients experiencing acute myocardial infarction. METHODS: The study involved 154 consecutive patients admitted at Coronary Care Unit. The study design was based upon the collection of patient histories, clinical examination and other complementary tests. RESULTS: In overall study population, predominantly with male gender, the incidence of left ventricle systolic dysfunction was 42.3%, which correlated with myocardial damage, electrocardiography changes, myocardial enzymes, and myocardial wall motion. CONCLUSIONS: Transthoracic Echocardiography represents a valuable tool and left ventricular ejection fraction should be evaluated in all patients experiencing acute myocardial infarction since the incidence of left ventricular dysfunction in patients with Acute Myocardial Infarction remains relatively high.

Limitations of CHADS2 scoring system in predicting stroke risk--need to change the age criteria.

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia with a strong association with age. The aim of this study was to evaluate the rate of stroke in relation to age and anticoagulation status based on CHADS2 risk criteria. METHODS: This study included all patients with non-valvular atrial fibrillation admitted to our clinic between 1/11/2007 and 1/11/2009, with minimum one year follow up for patients without stroke. We calculated risk based on CHADS2 (C-cardiac failure, H- hypertension, A-age >75 years, D-diabetes mellitus, S-stroke) point system and evaluated anticoagulation status at the moment of first occurrence of stroke. We observed the rate of stroke in different group age. RESULTS: The average of participants with AF was 67.9 +/- 10.3 years. Amongst 302 patients with non-valvular atrial fibrillation, 32.5% had been anticoagulated while 13.9% of experienced stroke. The stroke were more present in patients who used aspirin in age group 65-74 (22.5%, P = 0.014). The mean age of patients who experienced stroke were 67.2, SD +/- 10.8 vs. 71.6, SD +/- 5.1, P = 0.000. Of the patients with stroke from age group 65-74 years, 23 were in CHADS2 0-1 scoring system. CONCLUSION: The higher rate of stroke was in the 65-74 years age group, with CHADS2 scoring system 0-1, and without anticoagulation therapy. Therefore modification has to be considered for the CHADS2 scoring system to account the age as a risk factor for population in different regions.

Cardiac and pulmonary alterations in patients with rheumatoid arthritis.

INTRODUCTION: cardiac and pulmonary clinical manifestations frequently absent in patients with rheumatoid arthritis (RA). The aim of this study was to evaluate cardiac and pulmonary alterations in RA among patients without clinical manifestations. MATERIALS AND METHODS: The study was conducted in 169 patients (127 female and 42 male, with mean age 51.6, SD +/- 12.7 years, P > 0.05) with RA diagnosed on the basis of ACR criteria. All patients underwent a transthoracal echocardiography (TTE), a chest X ray, an electrocardiogram and laboratory tests. Patients with clinical manifestations of cardiac and pulmonary disease were excluded from the study. RESULTS: Pericarditis was evidenced in 16.6%, mitral regurgitation in 21.9%, aortal regurgitation in 26%, and pulmonary diffuse fibrosis in 16.6% of cases The authors found that 158 (93.5%) of patients were CRP positive. CONCLUSION: Our study demonstrated that cardiac and pulmonary alterations are frequently present and prevalence of elevated CRP levels and positive serologic tests was high in asymptomatic patients with RA among patients without clinical manifestations.

"Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans.

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

Single ventricle, bicuspid aorta and interatrial wall aneurysm as a rare complex adult congenital heart disease: a case report.

BACKGROUND: Single ventricle, bicuspid aortic valve and interatrial wall aneurysm in adulthood are a rare and unique case in medical literature. This presented case with congenital heart disease has never been treated surgically and clinical consequences seriously presented in adulthood. CASE PRESENTATION: A 27 year old man with complex congenital heart disease presented. At the age of six, the single ventricle was ultrasonographly diagnosed, but at age 27 clinical consequences started to be seriously present. We explored his history, clinical course, physical examination, laboratory findings, medical treatments and actual patient condition. CONCLUSION: The possibilities for surgical evaluation are presented.

Poststaphylococcal coagulase negative reactive arthritis: a case report.

We report a case of a 49-year-old patient who developed poststaphylococcal coagulase negative reactive arthritis. The woman presented with constitutional symptoms, arthritis, urinary infection and conjunctivitis. The blood culture was positive for the staphylococcal coagulase negative infection. Erythrocyte sedimentation rate and C-reactive protein were elevated, whereas the rheumatoid factor was negative. Radiographic findings confirmed diagnosis of pleuropneumonia, and one year later of chronic asymmetric sacroileitis. Physicians should be aware of possible reactive arthritis after staphylococcal coagulase negative bacteremia.