[Current management of patients with ventricular tachycardia]. / Suvremeni pristup bolesnicima s ventrikulskom tahikardijom.

Ventricular arrhythmia has for decades been considered as a premonitory sign and risk marker of sudden death. Novel theories about arrhythmogenesis and conditions for the occurrence of sudden death, as well as evidence about proarrhythmic effect of antiarrhythmic drugs, have changed the views on the treatment of ventricular arrhythmia. Ventricular tachycardia (VT) is most often associated with structural heart disease: ischemic heart disease and previous myocardial infarction, cardiomyopathy (dilated and hypertrophic), arrhythmogenic right ventricular dysplasia, valvular heart disease (mitral valve prolapse), heart failure, condition after surgical correction of a congenital heart disease. Sometimes VT occurs without structural heart disease (congenital LQTS, Brugada syndrome, idiopathic VT). Today's standpoint is to treat only symptomatic and/or prognostically significant arrhythmias. Prognostic significance of VT mostly depends on the type and degree of structural heart disease and on global cardiac function. In patients with asymptomatic non-sustained VT and low risk for sudden death no treatment is needed or antiarrhythmics are administered. Conversely, in high risk patients implantation of automatic cardioverter-defibrillator is indicated. In the treatment of acute attack of VT the following can be used: electroconversion, cardiac pacing (overdrive), lidocaine, amiodarone, beta-blockers, and occasionally magnesium or verapamil. In the prevention of recurrent arrhythmia and sudden death we can use: amiodarone, sotalol, mexiletin, phenytoin, beta-blockers, radiofrequency ablation, implantable cardioverter-defibrillator, and in specific patients verapamil, pacemaker or left ganglion stellatum denervation.

[Atrio-biventricular electrostimulation in the treatment of congestive heart failure. Case report]. / Atrio-biventrikulska elektrostimulacija u lijecenju kongestivnog zatajivanja srca. Prikaz bolesnika.

Over the past few years, indications for permanent cardiac pacing have been broadened. Accordingly, American Heart Association and American College of Cardiology included dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy and pacing for prevention of atrial fibrillation into indications for permanent cardiac pacing. Studies have described favourable effect of dual chamber cardiac pacing in congestive heart failure in dilated cardiomyopathy, regardless of etiology. In the past two years, even more beneficial effect was associated with multisite, biventricular cardiac pacing. On the basis of the reported results, a multisite pacemaker InSync was implanted to a patient with dilated cardiomyopathy (NYHA class IV), who was also on the list for heart transplantation, and who fulfilled other criteria for implantation of multisite pacemaker. During the eleven-month follow-up, functional improvement, better 6-minute walking test and enhanced quality of life of the patient were observed, which is in accordance with the literature data.

Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study).

In order to study left ventricular hypertrophy patterns in obese hypertensives, we examined 132 patients with essential hypertension by 2D, M-mode and Doppler echocardiography. The patients were classified in four comparable groups, corresponding to the values of Quetelet's body mass index (BMI) and grades of obesity. More obese hypertensives had on average larger left ventricles with thicker walls and larger left atria than less obese, or lean ones. Left ventricular mass increased significantly and progressively with advancing grades of obesity, but relative wall thickness (wall thickness/cavity size ratio) did not diminish. Doppler echocardiography revealed significantly higher prevalence of left ventricular diastolic dysfunction among obese than among lean hypertensives. In the second part of our study, we analyzed the subgroups defined by the severity of hypertension and the age of the patients. The correlation of the indices of left ventricular and left atrial hypertrophy with the BMI values was considerably better in the group of moderate than in the group of mild hypertension. The r values were 0.62 vs. 0.22 for left ventricular mass and 0.64 vs. 0.26 for left atrial dimension. The group of patients with severe hypertension was characterized by left ventricular cavity enlargement in correlation with increasing BMI values, but without corresponding left ventricular wall thickening. So called left ventricular "eccentricity index", as the reverse value of relative wall thickness, correlated well (r = 0.76) with the BMI values. The indices of left ventricular hypertrophy correlated with the BMI values slightly better in middle age groups than in the groups of the youngest (< or = 30 years) or the eldest (> or = 61 years) hypertensives. In conclusion, eccentric left ventricular hypertrophy does not seem to be a distinctive feature of hypertensive heart disease in obesity. There is only some tendency toward the "eccentricity" of left ventricular geometry which becomes more apparent in more severe forms of hypertension, especially in very obese persons.

Clinical value of biochemical markers in the diagnosis of acute myocardial infarction.

Current strategy for the use of biochemical markers in the diagnosis of acute myocardial infarction is not yet uniform. New markers of myocardial damage have significantly altered the former viewpoints. The study included 41 patients with confirmed acute myocardial infarction (25 males and 16 females, age range 42-85 years). Control group comprised of 25 patients with chronic renal failure without signs of acute coronary event (n = 11) and patients with confirmed coronary artery disease (n = 14). The level and activity of CKMB (microgram/L and U/L), and the level of myoglobin and cTnl were determined. The results showed the sensitivity of CKMB (microgram/L) in the first six hours from the onset of pain to be statistically significantly higher than the sensitivity of cTnl, while myoglobin was confirmed to be the earliest marker. Determination of CKMB (U/L) activity should be abandoned since it was found to have the lowest sensitivity and specificity. Also, a combination of myoglobin and CKMB (microgram/L) showed a statistically significantly higher sensitivity and diagnostic efficacy but lower diagnostic specificity compared to the combination of myoglobin and cTnl.

[Risk factors for the onset of ventricular tachycardia in patients with mitral valve prolapse]. / Cimbenici rizika za nastanak ventrikulske tahikardije u pacijenata s prolapsom mitralne valvule.

Non-invasive diagnostic methods (history, ECG, phonocardiography, exercise testing, Holter monitoring and Doppler echocardiography) were done in 48 persons with mitral valve prolapse (MVP). The aim was to establish possible risk factors for occurrence of ventricular tachycardia (VT) in persons with MVP and to find a possible difference between these risk factors. The possible risk factors for VT are: syncope, negative T wave in the inferolateral ECG leads, longer duration of QT interval, ST devalvation and duration of the ST devalvation, reduction of oxygen consumption evaluated by exercise testing, left ventricular function impairment, polymorphic premature ventricular contractions (PVC's), paired PVC's, larger dimensions of left cardiac chambers, larger surface and thickness of anterior mitral leaflet, extent of mitral regurgitation and higher mitral valve prolapse score. In patients with sustained VT we found higher age, more frequent syncopal attacks, longer QTc interval, more frequent negative T wave in inferolateral ECG leads, deeper ST devalvations, lower oxygen consumption, more prominent left ventricular function impairment, more frequent polimorphic PVC's (more than 10/1000 ventricular complexes), paired PVC's and thicker anterior mitral leaflet than in patients with non-sustained VT. (For all these risk factors is p < 0.01). Non-invasive diagnostic methods could help to identify the patients with mitral valve prolapse at elevated risk for VT.

[Detection of changes in the microvasculature in systemic connective tissue diseases--report on methods]. / Detekcija promjena na mikrovaskulaturi kod sistemskih bolesti vezivnog tkiva--prikaz metoda.

The aim of the paper is to draw attention to the possibility of an early detection of microvascular changes in systemic connective tissue diseases by the serial application of capillaroscopy, dermothermometry and digital photophlethysmography. A detailed review of diagnostic methods as well as the description of own protocol of their application is presented.