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AORTIC DISSECTION: OFTEN NEGLECTED DIFFERENTIAL DIAGNOSIS IN EMERGENCY AMBULANCE SERVICES
(MIT University Skopje, 2024-03)
Furnadjiski, Atanas
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Antova, I
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Abazi, A
Introduction: Aortic dissection is a rupture of the aortal medial layer produced by intramural hemorrhage that leads in a separation of the aortic wall layers, forming a false and true lumen with or without communication and is highly lethal. It causes a variety of symptoms, which can be discrete and subacute, or chronic, and is frequently misdiagnosed. Aim: This case report aims to present a case of a rare, subtle manifestation of transient ischemic attack caused by an aortic dissection. Case report: A 76-year-old man came to the Emergency Medical Service complaining of recent back and left shoulder pain accompanied by discomfort, as well as left-sided tingling of the face, arm, and leg, along with left hand weakness, that had occurred multiple times in the previous five days and lasted three to four minutes. On admission, he was clinically stable and had normal vital signs, without any neurological deficit. The ECG examination revealed RBBB without ST segment abnormalities. The anamnestic and hetero-anamnestic data were completely consistent with a cerebrovascular transient ischemic attack that occurred three days prior. After reevaluating the patient clinical status that was unchanged, he experienced temporary weakness, sweating, and dizziness revealed by shifting from supine to straight position, which was instantly relieved by kneeling down on the floor. The patient was immediately referred to secondary care. While a CT of the brain revealed normal findings, the CT angiography of the aorta showed an infrarenal aneurismatic dilatation with a 4cm wide flap indicative of impending aortal dissection. The patient was promptly referred to a tertiary care for further examination and medical care. Conclusion: Aortal dissection can easily go undetected in the Emergency Medical Services due to its pleomorphic clinical presentation, which oscillates between acute hemodynamic shocks to subtle, often undetectable symptomatology. Awareness of aortic dissection as differential diagnosis should be promptly lifted to a higher order thinking.
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PREMATURE VENTRICULAR CONTRACTIONS IN ATHLETES
(Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2022)
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Furnadjiski, Atanas
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Nastevska Grueva, Elena
Premature ventricular contractions (PVC) are one of the most common heart rhythmdisturbances in the overall population. Most of them are benign and do not harm the usual life and everyday activities in the population. The individual feeling and the perception of the sensation they occur is different in every person and varies between no sensation to fluttering, pounding or jumping, skipped beats or missed beats, all of which can increase awareness of the heartbeat. The importance of these premature ventricular beats rises especially among the athlete population and sportsmen because some of them may be the result of underlying heart disease which can be life threatening. Conclusion: Prompt diagnosis and adequate evaluation of these extra heart beats has a pivotal role and is the most important determinant in further sport involvement for the athletes with PVCs.
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WOLFF-PARKINSON-WHITE SYNDROME IN ATHLETES
(Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2023)
Furnadjiski, Atanas
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A clinical syndrome named after the cardiologists Louis Wolff, Sir John Parkinson, and Paul Dudley White in 1930, when this heart rhythm disorder was first described, became an important condition in the athlete population because of its possible fatal and unexpected consequences. In the very essence of this pathological condition is an anatomic substrate called an aberrant pathway of Kent- an interposed connective tissue bond between the normal conductive system of the heart. This accessory pathway in circumstances of fast heart rhythm can and will become a fast gate for normal impulse conduction which will result in arrhythmia such as “reentrant” supraventricular tachycardia (AVRT) or atrial flutter (AF) which might degenerate in lethal ventricular fibrillation leading to a sudden cardiac death (SCD) in the athletes. This occurs when the normal impulse of the sinoatrial node travels down the AV node add Hiss Purkinje system and returns in a retrograde manner to the atrium via the accessory pathway. AVRT can be orthodromic, following the normal physiological route, or antidromic when the depolarization wave follows the opposite route of physiologic conduction.
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Hypertension in athletes
(MIT University, 2023-03)
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Furnadjiski, Atanas
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Mitevski, Goran
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Nikolovski, Robert
Hypertension is the most common cardiovascular disease in athletes. Prompt diagnosis and management is crucial for ensuring safe sport participation and prevention of long term complications in athletes. Many diagnostic tools are involved in the management algorithm of the hypertension starting from good anamnesis especially the family history, as well as other simple and sophisticated paramedical imaging techniques, as ECG, Echocardiography, 24 Hours ambulatory ECG monitoring, cardiac MRI and many others. Distinguishing an athlete heart from pathological heart muscle hypertrophy is the key step for the differential diagnosis. Conclusion: Proper pharmacological and non pharmacological measures will facilitate satisfying long term prognosis for the athletes.

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