Spontaneous coronary artery dissection (SCAD) accounts for 1%-4% of cases of acute coronary syndrome (ACS). SCAD is caused by separation occurring within or between any of the three tunics of the ...coronary artery wall. This leads to intramural hematoma and/or formation of false lumen in the artery, which leads to ischemic changes or infarction of the myocardium. The incidence of SCAD is higher in women than in men, with a ratio of approximately 9:1. It is estimated that SCAD is responsible for 35% of ACS cases in women under the age of 60. The high frequency is particularly observed during pregnancy and in the peripartum period (first week). Traditional risk factors are rare in patients with SCAD, except for hypertension. Patients diagnosed with SCAD have different combinations of risk factors compared with patients who have atherosclerotic changes in their coronary arteries. We presented the most common so-called "non-traditional" risk factors associated with SCAD patients.
In the literature, there are few diseases frequently associated with SCAD, and they are identified as predisposing factors. The predominant cause is fibromuscular dysplasia, followed by inherited connective tissue disorders, systemic inflammatory diseases, pregnancy, use of sex hormones or steroids, use of cocaine or amphetamines, thyroid disorders, migraine, and tinnitus. In recent years, the genetic predisposition for SCAD is also recognized as a predisposing factor. The precipitating factors are also different in women (emotional stress) compared with those in men (physical stress). Women experiencing SCAD frequently describe symptoms of anxiety and depression. These conditions could increase shear stress on the arterial wall and dissection of the coronary artery wall. Despite the advancement of SCAD, we can find significant differences in the clinical presentation between women and men.
When evaluating patients with chest pain or other ACS symptoms who have a low cardiovascular risk, particularly female patients, it is important to consider the possibility of ACS due to SCAD, particularly in conditions often associated with SCAD. This will increase the recognition of SCAD and the timely treatment of affected patients.
The study was aimed at assessing the difference between the right ventricle apex versus the right ventricular outflow tract lead position in functional capacity in the patients with the preserved ...left ventricular ejection fraction after 12 months of pacemaker stimulation.
This was a prospective, randomized, follow-up study, which lasted for 12 months. The study sample included 132 consecutive patients who were implanted with permanent anti-bradicardiac pacemaker. Regarding the right ventricular lead position the patients were divided into two groups: the right ventricle apex group consisting of 61 patients with right ventricular apex lead position. The right ventricular outflow tract group included 71 patients with right ventricular outflow tract lead position. Functional capacity was assessed by Minnesota Living With Heart Failure score, New York Heart Association class and Six Minute Walk Test. Left ventricular ejection fraction was assessed by echocardiography.
Minnesota Living With Heart Failure score and New York Heart Association class had a statistically significant improvement in both study groups. The patients from right ventricle apex group walked 20.95% (p=O.03) more in comparison to starting values. The patients from right ventricular outflow tract group walked only 13.63% (p=0.09) longer distance than the startingoneConclusion. Analysis of tests of functional status New York Heart Association class and Minnesota Living With Heart Failure questionnaire showed an even improvement in the right ventricle apex and right ventricular outflow tract groups. Analysis of 6 minute walk test showed that only the patients with the preserved left ventricular ejection fraction from the right ventricle apex group had a significant improvement after 12 months of pacemaker stimulation..
Bacgraund/Aim. Sudden cardiac death (SCD) is one of the biggest problems of the contemporary medicine. Large studies showed that anti-arrhythmics, including amiodarone, are not effective in ...prevention of SCD in the patients with cardiac diseases who were on drug treatment. Those patients who received implantable cardioverter defibrillators (ICD) had better survival. The aim of this paper was to determine whether the patients receiving the ICD in the primary and secondary SCD prevention have longer survival than the patients treated exclusively with drug therapy. Methods. We included 1,260 patients with cardiac insufficiency and reduced left ventricular ejection fraction (LVEF < 35%) who were at high risk for malignant ventricular arrhythmias and SCD. Five hundred forty patients received ICD therapy. The cardiac resynchronization therapy ? CRT/ICD group (n = 270) comprised the patients with cardiac insufficiency and CRT/ICD pacemaker at an optimal medical therapy. In the control group (n = 450), there were the patients with cardiac insufficiency (NYHA functional class 3?4, LVEF ? 35%, QRS duration ? 130 ms), at optimum drug therapy. Results. In the ICD group, there was a statistically significant increase in end-systolic volume (ESV) from 92.68 mL to 99.05 mL. In the group of patients with cardiac insufficiency who were on drug therapy, there was a significant decrease in LVEF (33.15% vs. 30.2%; p = 0.017), 6-minute walk distance (6 MWT distance) (216.55 m vs. 203.27 m, p = 0.003). In the same group, there was an increase in the values of ESV (90.19 mL vs. 95.41 mL; p = 0.011). An increase in the mortality rate in the group of patients with drug therapy compared to the CRT/ICD and ICD groups was statistically significant (p < 0.05). Conclusions. An ICD pacemaker implantation significantly reduces mortality compared to medical therapy only. In addition, the patients who have CRT in addition to ICD pacemaker, have a significantly better quality of life and increase in LVEF.
nema
Aim. Patients with heart failure have poor prognosis and mortality rate is between 15–60% per year. Implantable cardioverter-defibrillators and cardiac resynchronization therapy have been shown to ...improve survival, decrease hospital readmissions and mortality, and improve functional status and quality of life in patients with heart failure and left ventricular systolic dysfunction. Aim of the study was to examine the effects of different CRT devices in carefully selected heart failure patients during 1 year.Material and methods. We included 98 heart failure patients. First group (n=60) received CRT-P, while in second group (n=38) were patients with CRT-D pacemaker (with an additional cardioverter-defibrillator option).Results. Data gathered in our the study showed that both CRT-P and CRT-D in adequately selected heart failure patients improve different clinical parameters: symptoms, echocardiographic parameters, decrease QRS duration, increase 6 min walk test distance, decrease mortality rate.Conclusion. Patients with both CRT-P and CRT-D showed improvement in heart failure symptoms and CRT had significant influence on disease prognosis during 1 year of follow up. Nevertheless we do not have the perfect criteria for selection of patients and their follow up after the device implantation. In patients with the rhythm disturbances CRT-D option is the right choice only if the patient has the indications for resynchronization therapy as well. This choice however depends on clinical judgment of the operator more than on strict protocols and guidelines which are necessary but we need more clinical trials to support current hypothesis.
In our work we describe the case of a patient with a Brugada syndrome. It is a rare syndrome which carries a potential risk of sudden cardiac death which occurs usually at an early age. Unfortunately ...it is most frequently the first clinical manifestation of this genetic disease. Sometimes, as in our patient it could co-exist with other cardiovascular abnormalities which give us an opportunity to establish the right diagnosis and apply adequate preventive measures. It is of paramount importance to explore the possibility of the existence of this syndrome in the patient’s family members. The first diagnostic procedure is an ECG which is an inexpensive and readily available diagnostic tool.
Technology development in the recent years has enabled that both prevention and treatment of life-threatening heart rhythm disorders are managed by implantable cardioverter-defibrillators. Clinical ...studies have confirmed the advantage of this type of therapy in the prevention of sudden cardiac death in the recent years, so the use of ICDs has became a clinical routine. Rarely functional disturbances of those devices could be seen as undetected malignant arrhythmias (undersensing) or false detection of a normal heart rhythm (oversensing). Patient N.S. aged 67 years was admitted to Cardiology Clinic, Clinical Center Niš because of inappropriate sequential therapy of implantable cardioverter-defibrillator (ICD) (12 shocks were delivered within 48 hours before admission). ICD pacemaker was implanted four years before the admission due to dilated cardiomyopathy (LVEF 25%). Based on a detailed analysis of the device’s parameters the rapid increase in ventricular lead impedance was established (it was > 3000Ω; and the normal range is 250-2000 Ω). It was found that oversensing was the cause of sequential shocks delivery with energy of 35 J. The damaged lead of the ICD detected false signals as VF (ventricular fibrillation) and applied therapy. On the third day of hospitalization, the patient received an ICD Medtronic Maximo II device with the active electrode Medtronic Sprint Quattro 6947 but the left atrial electrode was not displaced. Prophylactic antibiotic therapy was given and patient was discharged 5 days after implantation. After one month at the control visit device parameters were satisfactory, the sensing function was appropriate with good impedance of the lead. Special feature of these devices is the need for individual programming, tailored to each patient, so it is necessary for a center that performs the implantation to have a medical team that has experience in the application of this type of therapy.
Persistent left superior vena cava represents a congenital vascular defect of the venous system, and is usually discovered accidentally. Temporary pacemaker lead placement should be performed under ...the fluoroscopy control, but also by using the ECG QRS morphology. Echocardiography also represents a reliable noninvasive diagnostic tool for the assessment of temporary pacemaker lead position.
Prognosis in heart failure (HF) is poor and mortality widely ranges - 15-60% per year. Cardiac resynchronization therapy (CRT) is a therapeutic concept for patients who have NYHA III or IV class, ...LVEF ≤ 35%, left bundle branch block with wide QRS ≥ 120ms and ventricular dyssynchrony on optimal medical therapy. The aim of the study was to determine the effects of resynchronization therapy in patients with moderate to severe HF. In our study, 140 patients with HF were treated with different modalities of therapy in the Clinical Centre Niš. The first group of patients received CRT, and the second, control group were HF patients without echo criteria for CRT. In the control group, 36 patients received an implantable cardioverter-defibrillator (ICD). Results of the study showed that resynchronization therapy in patients with HF improves different parameters: clinical symptoms, echocardiographic parameters, decreases QRS duration, increases 6-minute walk test distance and decreases mortality rate. The benefit of cardiac resynchronization therapy in combination with optimal medical therapy is proven to be beneficial in patients with HF and asynchrony. CRT improved clinical symptoms of heart failure and had influence on disease progression.
Persistent left superior vena cava represents a congenital vascular defect of the venous system, which often makes standard 58 cm endocardial lead placement impossible.
A right chamber approach by ...the left cephalic vein was tried. This was impossible because standard endocardial lead (SJM Isoflex 5 1646T, bipolar lead, 58 cm in length, body diameter 7 French) was too short for this patient. A unipolar lead for coronary sinus (Medtronic ATTEIN 4193-88), 88 cm in length, body diameter 4 French, was placed in the posterior branch of the coronary sinus. With such positioning of the lead, a VVI pacemaker pacing was enabled. The operation lasted for 48 minutes, and the time of total X-ray exposure was 9.6 minutes. The values that were achieved were: threshold 0.3 V, pulse width 0.37 ms, maximum R 22.55 mV. Ten months after the implantation, the values were: threshold 0.3 V, maximum R 28.8 mV.
Persistent left superior vena cava in some cases makes standard 58 cm endocardial lead placement impossible due to its joining to the right atrium over the dilated coronary sinus. Coronary sinus lead placement in the posterior or lateral coronary sinus branch represents an acceptable alternative approach for pacemaker lead placement in these patients.
PDF
