Antiplatelet therapy is an integral part of optimal medicamentous therapy in patients with coronary artery disease. The strategy of antiplatelet/anticoagulant therapy is adjusted (combination of ...drugs, dosing and duration of therapy) depending on the stage of the disease (acute coronary syndrome with percutaneous coronary intervention, chronic coronary syndrome, or coronary surgical revascularization) and comorbidity of each patient (e.g., atrial fibrillation, left ventricular thrombus, etc.). Guidelines and clinical practice in particular are not uniform and specific regarding dual antiplatelet therapy in patients undergoing coronary artery bypass grafting, especially in the setting of chronic coronary syndrome.
One of the drugs that are widely used in the treatment of atrial fibrillation is amiodarone. Despite considerable prolongation of the corrected QT interval and a substantial degree of bradycardia, ...amiodarone exhibits a remarkably low frequency of pro-arrhythmic events and <1.0% incidence of torsades de pointes, mostly after long-term usage. We present a case of an 80-year-old female with paroxysmal atrial fibrillation accompanied by acute heart failure treated by short-term parenteral amiodarone therapy and development of torsades de pointes.
Background. It is known that after coronary artery bypass graft surgery (CABG) heart rate variability (HRV) becomes significantly decreased with a gradual recovery in a few months after surgery. ...However, literature data about the impact of the off-pump CABG on postoperative HRV are not complete. Therefore, the aim of this study was to analyze postoperative value of HRV in CABG patients operated on with off-pump versus on-pump coronary surgery. Methods. This study included 206 consecutive patients who underwent CABG. Sixty six patients (32%) were operated on off-pump while 140 patients (68%) were operated on using the machine for extracorporal circulation. HRV was analyzed from 24-hours Holter electrocardiogram recordings. Results. No significant differences in postoperative values of HRV variables were found between off-pump versus on-pump CABG patients (Mean RR interval 885 ± 106 versus 879 ± 125 ms, standard deviation of all normal R-R intervals 107 ± 30 versus 105 ± 34 ms, NS, total power 2298 ± 2472 versus 2156 ± 1913 ms2, NS). Conclusions. The results of the study showed that there are no differences in HRV few months after surgery between patients operated on with off-pump versus on-pump CABG.
Introduction: The aim is to evaluate the effect of robot-assisted training on the most important aspects of functioning and disability in patients with upper extremity neurologic impairment.
...Materials and Methods: A prospective six-week pilot study included robot-assisted training of the upper extremity and conventional neurorehabilitation in 12 participants after a stroke or traumatic brain injury. Outcome measurements were range of motion (ROM), the International Classification of Functioning, Disability and Health (ICF) Core Set for Hand and the Visual Analog Scale (VAS) for pain sensation. A Wilcoxon test was used for the analysis of pre- and post-test differences and Spearman’s correlation was used for connecting the data collected.
Results: A statistically significant difference was found for ROM (shoulder abduction/adduction, shoulder flexion/extension, shoulder internal/external rotation and forearm pronation/supination) and a number of ICF categories (Body Function: b280, b710, b715, b730, b760; Activities and Participation: d230, d430, d440, d445, d5). A significant positive correlation of medium intensity (r=0.589) was found between the duration of movement coordination training and the ICF category b760. We did not find a statistically significant difference in pain sensation (VAS) with regard to the direct use of the device. For all analyses, p<0.05 and CI was 95%.
Conclusion: Robot-assisted training and conventional neurorehabilitation improved motor and functional recovery. There was a correlation between training a specific goal on the device and one of the ICF Body Function categories.
Antiplatelet therapy is an integral part of optimal medicamentous therapy in patients with coronary artery disease. The strategy of antiplatelet/anticoagulant therapy is adjusted (combination of ...drugs, dosing and duration of therapy) depending on the stage of the disease (acute coronary syndrome with percutaneous coronary intervention, chronic coronary syndrome, or coronary surgical revascularization) and comorbidity of each patient (e.g., atrial fibrillation, left ventricular thrombus, etc.). Guidelines and clinical practice in particular are not uniform and specific regarding dual antiplatelet therapy in patients undergoing coronary artery bypass grafting, especially in the setting of chronic coronary syndrome. Key words: Antiplatelet therapy; Coronary artery disease; Coronary artery bypass grafting Sastavni dio optimalne medikamentne terapije u bolesnika s koronarnom bolescu je antitrombocitna terapija. Terapija antitrombocitnim te antikoagulantnim lijekovima (kombinacija lijekova, doziranje i trajanje terapije) prilagodava se ovisno o stadiju bolesti (akutni koronarni sindrom s perkutanom koronarnom intervencijom, kronicni koronarni sindrom ili kirurska revaskularizacija) i komorbiditetu pojedinog bolesnika (npr. atrijska fibrilacija, tromb lijeve klijetke itd.). Smjernice, a oso bito klinicka praksa, nisu jedinstvene u pogledu dvojne antitrombocitne terapije u bolesnika koji su podvrgnuti operaciji aortokoronarnog premostenja, narocito u postavkama kronicnog koronarnog sindroma. Kljucne rijeci: Antitrombocitna terapija; Koronarna bolest; Aortokoronarno premostenje
Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial ...infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.
The aim of this study was to investigate the effect of 3-weeks stationary cardiac rehabilitation on plasma lipids level in patients with CHD. The study included 444 consecutive patients (364 male and ...80 female, mean age 58 +/- 9 year) with CHD who underwent 3-weeks stationary cardiac rehabilitation. Patients were divided into groups depending on their baseline levels of cholesterol and medication therapy: patients with normal (< 5 mmol/L, group I, 129 patients) and elevate plasma level of Total cholesterol (> 5 mmol/L, group II, 315 patients) and subgroups Ia and IIa (with statin in therapy), Ib and IIb (without statin in therapy). After 3-weeks cardiac rehabilitation, the levels of Total cholesterol 5.75 +/- 1.34 vs. 5.17 +/- 1.08 mmol/l; p < 0.001, triglycerides 2.04 +/- 1.33 vs. 1.81 +/- 1.06 mmol/L; p = 0.004, LDL-cholesterol 3.77 +/- 1.14 vs. 3.21 +/- 0.96 mmol/L; p < 0.001 were significantly lower while the level of HDL-cholesterol 0.94 +/- 0.28 vs. 0.99 +/- 0.27 mmol/L; p = 0.008 were significantly higher in comparison with the baseline values. Furthermore, we found significant changes in lipid profile at the end of rehabilitation in each group of patients compared with the baseline values. There were no significant differences in plasma lipids level between group of patients with or without statin in therapy at the end of rehabilitation. The results of this study suggest that moderate regular physical activity and diet alone or in combination with hypolipidemic drugs already after 3 weeks have a favourable effect on plasma lipids level and should be propagate in the prevention of CHD.
Abstract Stress cardiomyopathy or Tako-Tsubo Syndrome (TTS) clinically manifests with sudden chest pain and/or dyspnea, and is generally triggered by emotional or physical stress. ...Electrocardiographic (ECG) changes are similar to acute myocardial infarction with ST-elevation, but coronarography shows no significant pathomorphological changes of coronary arteries. Ventriculography and echocardiography show reversible akinesis and ballooning of the left ventricle apex with reduced ejection fraction. Like as it is with TTS, similar ECG changes are extensively reported in patients with intracerebral bleeding. We reported the case of a 52-year-old female patient who was clinically presented with stress cardiomyopathy with ST-segment elevation of the anterolateral location complicated by a secondary massive intracranial bleeding. Many cases of TTS or ECG changes in intracranial bleeding were described separately, but to our knowledge, this is the first report where both events developed in the same patient with the fatal outcome.
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