Faculty of Medicine

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Access type: UnknownAuthor: search.filters.author.Grueva Nastevska, Elena

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    Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
    (Medicinska Naklada d.o.o., 2025-04)
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    Grueva Nastevska, Elena
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    Shehu, Enes
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    Petkovski, Dushan
    Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
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    Evaluation of echocardiographic parameters for right heart function and pulmonary hypertension in the progression of Chronic Obstructive Pulmonary Disease
    (2022)
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    Grueva Nastevska, Elena
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    Risteski, Dejan
    INTRODUCTION Chronic opstructive pulmonary disease (COPD) is one of the diseases with highest mortality rate, high morbidity and early mortality. Right ventricular hypertrophy with preserved systolic function is most common finding in patients with COPD.COPD patients not so rarely have increased pulmonary vascular resistance (PVR), moderate to severe form of pulmonary hypertension, ‘’cor pulmonale” and right heart failure. Our study investigated the echocardiographic parameters used to assess right ventricular function and pulmonary hypertension in patients with chronic obstructive pulmonary disease (COPD) according to their specificity and sensitivity and disease progression. MATERIAL AND METHODS We have analysed 94 patients with COPD (Gold class I-IV). The 13 echo-cardiography parameters important for assessment of right ventricular function and pulmonary hypertension due to their sensitivity and specificity and progression of the disease were evaluated: basal dimension of the right ventricle(DV bazal), right atrium(DA), right atrial area(DA area), S‘wave of the right ventricle of TDI, TAPSE, functional area change (FAC %), (SPAP), Vmax of tricuspid regurgitation , acceleration time of pulmonary artery (AT), pulmonary vascular resistance (PVR), myocardial performance index of the right venricle (MPI), global strain of the right ventricle(GL strain), collаpsibility of vena.cava inferior >/<50 %. RESULTS AND DISCUSSION Predictors of disease progression with high specifity ans sensitivity are the parameters: MPI DV TDI, Global strain of DV and collabsibility of v.cava inferior less then 50%. Predictors of disease progression with high specifity and low sensitivity are : DV bazal, DA, DA area, S TDI, TAPSE, FAC, SPAP, V max TR. Predictors of disease progression with low specifity and high sensistivity are parameters: shortened acceleration time of the pulse Dopler of the pulmonary valve and the development of pulmonary vascular resistаnce. CONCLUSION Echocardiography is a non invasive and useful method for evaluation and follow up the patients with COPD. All this indicates that the values of certain echocardiographic parameters can help us detect disease progression, with high sensitivity, high specificity or both.