Browsing by Author "Gudelj, Ognjen (54420054500)"

Background: Microvascular dysfunction (MVD) is associated with adverse prognosis and may account for abnormal stress tests and angina symptoms in women with cardiac syndrome X (CSX). The aim of our study was to assess MVD by coronary flow velocity reserve (CFVR) and left ventricular (LV) contractile function by LV global longitudinal strain (LVGLS) in CSX patients with respect to presence of slow coronary flow (SCF). It was of additional importance to evaluate clinical status of CSX patients using Seattle Angina Questionnaire. Methods and results: Study population included 70 women with CSX (mean age 61 ± 7 years) and 34 age-matched controls. CSX group was stratified into two subgroups depending on SCF presence: CSX-Thrombolysis In Myocardial Infarction (TIMI) 3- normal flow subgroup (n = 38) and CSX-TIMI 2- SCF subgroup (n = 32) as defined by coronary angiography. LVGLS measurements and CFVR of left anterior descending (LAD) and posterior descending (PD) artery were performed. CFVR-LAD and PD were markedly impaired in CSX group compared to controls (2.34 ± 0.25 vs 3.05 ± 0.21, p < 0.001; 2.32 ± 0.24 vs 3.01 ± 0.13, p < 0.001), and furthermore decreased in CSX-TIMI 2 patients. Resting, peak, and ΔLVGLS were all significantly impaired in CSX group compared to controls (for all p < 0.001), and furthermore reduced in CSX-TIMI 2 subgroup. Strongest correlation was found between peak LVGLS and CFVR LAD (r = −0.784, p < 0.001) and PD (r = −0.772, p < 0.001). CSX-TIMI 2 subgroup had more frequent angina symptoms and more impaired quality of life. Conclusions: MVD in CSX patients is demonstrated by reduction in CFVR and LVGLS values. SCF implies more profound impairment of microvascular and LV systolic function along with worse clinical presentation. © 2020 Japanese College of Cardiology

Introduction. Pulmonary vein isolation (PVI) by antral circumferential ablation is the standard procedure for patients with symptomatic and drug-refractory paroxysmal atrial fibrillation (AF). In some patients addition of ganglionated plexi (GP) modification in anatomic locations to PVI confers significantly better outcomes than PVI alone. Case report. We reported a patient with paroxysmal, symptomatic AF and severe bradycardia a month prior to ablation. The patient was treated with antiarrhythmic drugs without success. Because of severe bradicardia the patient was implanted with a temporary pace maker two days before PVI. During PVI the decision was made to also do a modification of the left GP. Three months after the procedure the patients was in stable sinus rhythm without any symptoms. Conclusion. In selected patients with paroxysmal AF and pronounced vagal response PVI by circumferential antral ablation combined with GP modification during single ablation procedure can produce higher success rates than PVI or GP ablation alone. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Currently, arterial hypertension is the most massive chronic non-infectious disease of mankind. It may remain undiagnosed for years, provoking later complications, such as acute heart failure, cerebrovascular stroke, myocardial infarction, renal failure, hypertensive retinopathy, or sudden death. Primary arterial hypertension is more common, while secondary occurs in about 5–20% of cases. The recent studies have shown that stress may be a core factor in the development of essential hypertension in some patients. For the patients suffering from post-traumatic stress disorder, stress is the dominant etiological factor that leads to the disease. It has been proven that chronic stress can affect blood pressure regulation and endocrine-metabolic functions through the limbic-hypothalamic centers; therefore, it can affect the arterial hypertension development. The strong association between stress and arterial hypertension has also been confirmed in preclinical and animal studies. For the pharmacotherapy approach, the most important are beta-adrenergic blockers, angiotensin-converting enzyme (ACE) inhibitors and AT1-receptor blockers (sartans). As a second line treatment, calcium channel blockers, diuretics, alpha-adrenergic blockers, and central antihypertensive agents may be required. The anxiolytics, such as benzodiazepines, should be considered if chronic anxiety and psychosomatic disorders are present. © 2021, Serbia Medical Society. All rights reserved.