Faculty of Medicine
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Item type:Publication, Pneumonia as a primary manifestation of infective endocarditis - Case report(Macedonian Association of Anatomists and Morphologists, 2024-10); ; Kartalova Janeku, MarijaThis case report discusses the clinical presentation, diagnostic challenges, and clinical implications of a patient initially hospitalized for pneumonia, later diagnosed with infective endocarditis with negative blood cultures. A 72-year-old female presented with a 3-day history of general infection symptoms and a chest X-ray indicative of right-sided pneumonia. The patient did not respond adequately to standard antimicrobial therapy, prompting further diagnostic investigation. A computed tomography scan of the chest revealed a suspected thrombus in the left atrium. Echocardiography confirmed vegetation on the posterior mitral leaflet. Blood cultures and serological tests were negative. Follow-up echocardiography showed progression of the vegetation with compromised mitral valve function, necessitating surgical intervention, and the patient was transferred to the Cardiac Surgery Clinic. The case emphasizes the importance of timely recognition of infective endocarditis, even when patients initially present with respiratory symptoms. The diagnostic protocol includes echocardiographic methods for detecting valve vegetations. Negative blood cultures do not rule out endocarditis. Rapid diagnosis is crucial, as surgical intervention is often indicated, and failure to diagnose can have fatal consequences. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Myocardial Function after Coronary Artery Bypass Grafting in Patients with Preoperative Preserved Left Ventricular Ejection Fraction-The Role of the Left Ventricular Longitudinal Strain(MDPI AG, 2023-05-12); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia(International Scientific Invention Journals, 2019-02-13); ; ; Introduction: Echocardiography as an imaging method is increasingly being used in obstetrics in the management of hemodynamic changes which occur in normal but also in pregnancies with gestational hypertension/preeclampsia. Aim: The aim of the study is to show that some of the heart changes in pregnancies complicated with gestational hypertension and preeclampsia are abnormal and further follow up of these patients is needed. Methods: A total of 81 patients were enrolled in the study. The patients were further divided in two groups. Pregnant women with gestational hypertension or preeclampsia (51) and a control group of normotensive pregnancies (30). A total of 3 echocardiograph exam were made, the first upon entry in the study (28 -34 g.w), the second 2 weeks after delivery and the last 6 months after delivery. Results and discussion: We found several statistically significant results that involve the IVS, PWLV, LKM, left chamber hypertrophy and diastolic function. Diastolic dysfunction usually shows up before systolic dysfunction in the evolution of ischemic/hypertensive cardiovascular disease and is of prognostic value in predicting long term cardiovascular morbidity. The changes seen 6 months after delivery on our last control mean that those changes are permanent and need further prevention strategies. Conclusion: From the noninvasive methods echocardiography is the most favorable method in identifying structural changes and functional changes in pregnancies with hypertension. Echocardiography allows fast, reproducible information and is both safe for mother and fetus. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Papillary Muscle Rupture as a Complication of Barlow’s Disease(Scientific Foundation SPIROSKI, 2022-11-30); INTRODUCTION: Mitral regurgitation (MR) is the second most common valvulopathy worldwide, which can be divided into primary and secondary. According to Carpentier’s classification, the primary MR is further divided into three types. Type II, which includes Barlow’s disease, is described as excessive mobility of the mitral valve (MV) leaflets. Morbus Barlow is a common form of degenerative disease, with an incidence of 2–3% of the general population. Echocardiography plays an important role in its diagnosis. It is a usually benign condition, with only a few severe complications. CASE REPORT: A 75-year-old male with a history of MR, for more than 10 years. On admission, the patient presented with severe fatigue and dyspnea with signs of heart failure and pleural effusion. On auscultation, a systolic murmur was noted, on all the precordium. The ECG revealed sinus rhythm with HR of 71/min and intermittent ventricular extrasystoles. An immediate transthoracic echocardiography (TTE) was performed showing myxomatous degeneration of both MV leaflets and a prolapse of the posterior leaflet. A severe MR was detected with a presumption of papillary muscle rupture (PMR). It also revealed enlarged left atrium and ventricle (LVEDd - 67 mm and LA - 46 mm), with preserved systolic function (EF~54%) and tricuspid regurgitation accompanied by pulmonary hypertension. The laboratory analyses were within normal ranges. The patient was transferred to a cardiovascular surgery clinic, where an immediate MV repair was performed. CONCLUSION: Barlow’s disease is a common echocardiography finding. Although a benign condition, it can rarely present with serious complications such as PMR, ventricular arrhythmias, and even sudden cardiac death. Echocardiography is the first imaging used for the detection of Barlow’s disease and other MV diseases. Early recognition and confirmation with TTE or transesophageal echocardiography, plays also an appropriate treatment, play a key role in patient survival and overall prognosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, А rare case of left ventricular hypertrophy and non-compaction cardiomyopathy in an adult: diagnostic approach(Macedonian Society of Cardiology, 2021-03); ; Left ventricular non-compaction cardiomyopathy (LVNC) is a rare form of primary genetic cardiomyopathy which is characterized by prominent trabeculations and intertrabecular recesses that communicate with the cavity of the left ventricle. The prevalence is between 0.014%-1.3% in the general population. LVNC is associated with different genetic mutations and may have a genetic overlap with the phenotype of other cardiomyopathies, including hypertrophic cardiomyopathy (HCM). In this case report we present a 26-year-old female patient presenting to emergency room with bradycardia and syncope. The transthoracic echocardiography revealed hypertrophy and trabeculations with prominent recesses of the left ventricle. Cardiovascular magnetic resonance imaging (MRI) was performed to confirm the diagnosis of LVNC. The genetic analysis showed mutation of PRKAG2 gene indicating hypertrophic cardiomyopathy with conduction disturbance. In the last years, LVCN and HCM are diagnosed more frequently due to improvements in imaging methods. Although there are many diagnostic tools including contrast ventriculography, CT and MRI, echocardiography is the main imaging method used for diagnostic evaluation of LVNC and HCM. Key words: left ventricular non-compaction cardiomyopathy, hypertrophic cardiomyopathy, echocardiography, cardiovascular magnetic resonance imaging - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Asymptomatic bicuspid aortic valve with dilated ascending aorta in adult patient(2015); ; Introduction and case report description: Bicuspid aortic valve is a congenital malformation which is result of an abnormal cusp formation during early embryogenesis. The most frequent finding in association with this abnormality is dilation of the proximal ascending aorta. We present a case of 53year old patient who was incidentally diagnosed with bicuspid aortic valve and dilated ascending aorta. Our patient had been well until September 2010, when he had a car accident and a fracture of the hip and contusion of the right shoulder. Since then, he had a several episodes of a dull chest pain and because of this symptoms, he visited his physician who directed him to our hospital for further examination, because he incidentally detected a diastolic heart murmur. The patient had no remarkable medical history,his ECG on admission was normal. Because of the presence of early diastolic murmur heard on the third intercostal space, echocardiography was performed. He was diagnosed with bicuspid aortic valve, and dilated ascending aorta (59mm), with moderate aortic regurgitation. CT scan was also performed to evaluate the diameter and the extent of the dilatation, and the intraluminal diameter of the ascending aorta was 57x56mm, with no signs of dissection. He underwent coronary angiography and carotid ultrasound (he had no significant stenosis of the coronary and carotid arteries) and was further directed in Cardiac Surgery Center, for aortic valve and ascending aorta replacement. According to the latest guidelines on BAV, our patient meets the criteria for surgical treatment of the condition(surgery should be considered for any patient with aortic root diameter >/=55mm). BAV malformations are inherited, particularly in males, so imaging of the first degree relatives is appropriate if the patient has an associated aortopathy or a family history of VHD/aortopathy. TTE is usually the primary imaging technique for diagnosing BAV. Nevertheless, CT or MRI scan is recommended for evaluation of the entire ascending aorta because TTE may not visualize the entire ascending aorta and may fail to calculate the largest diameter. Bicuspid aortic valve is the most common congenital cardiac malformation, which is rather recognized as a syndrome which incorporates aortic wall abnormalities, including aortic dilatation. This condition may also be complicated with aortic valve stenosis and/or regurgitation. Individuals may have a normal functioning BAV and may be not aware of the potential complicatios. Delayed identifying of this abnormality or the complications may have a fatal consequences. In our case, the patient was asymptomatic and was diagnosed incidentally. Regular follow-up becomes mandatory after BAV has been diagnosed, in order to closely observe such patients with regard to progression of the disease itself and its complications, and in order to suggest treatments. For patients who have a severely diseased aortic valve and aorta, aortic valve replacement and ascending aorta replacement is the treatment of choice. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Significance of cardiovascular evaluation in patients with moderate Chronic Obstructive Pulmonary Disease (COPD)(Publi Créations, 2020-01); Introduction Chronic obstructive pulmonary disease (COPD) with prevalence 5-13% is a major cause of morbidity and mortality in the world and fourth leading cause after myocardial infarction, malignant diseases and cerebrovascular incidents. The main cause of morbidity and mortality in COPD patients are cardiovascular diseases. COPD is an independent cardiovascular risk factor even in mild and moderate stage of the disease, due to persistent low-grade systemic inflammation. Early diagnosis and treatment of cardiovascular morbidity in COPD patients is important for improving life quality and prognosis. Aim To evaluate cardiovascular morbidity in patients with moderate COPD. Material and methods Cross-sectional study. Investigated group: 63 patients (40 male, 23 female) with diagnosed moderate COPD (forced expiratory volume in 1st second - FEV1 50-80%) according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria and according to ABCD classification: 60% (B), 40%(A). Control group - 30 subjects with normal spirometry (without COPD) as controls. Inclusion criteria for both groups: age 40-75, cigarette smoking history >=10 pack/years, signed consent for participation and clinically stable condition at least 6 weeks prior enrolment. Exclusion criteria: other chronic or acute pulmonary disease, diabetes mellitus, valvular heart disease, left ventricular hypertrophy, body mass index>35 kg/m^2, liver or renal failure, anaemia, muscle disorders, patients who do not want to participate. All patients underwent pulmonary function tests (spirometry and gas analysis), chest-X ray in two directions (postero-anterior and latero-lateral position), resting electrocardiogram (ECG), 24 hour-ECG-Holter monitoring, two-dimensional (2D)Doppler echocardiography, Doppler-ultrasound of lower limb and carotid arteries. Results The COPD group showed significantly higher prevalence of right ventricular (RV) abnormalities. RV systolic dysfunction was present in 47,61%, pulmonary hypertension (PH) in 23,8%, tricuspid regurgitation as most frequent valvular abnormality in 14,28%, left ventricular (LV) systolic dysfunction in 14,28%. Electrocardiography results obtained premature ventricular (PVCs) contractions in 6,34%, p-pulmonale in 7,93%, right bundle branch block (RBBB) in 4,76%. There was significant difference between normal ECG findings in patients with moderate COPD 8,33% versus 76,67% in control group. 24-hour-ECG-Holter monitoring allowed detection of arrhythmias in asymptomatic patients, and detected abnormalities were significantly higher compared to resting ECG. 24h-ECG-Holter monitoring revealed premature supraventricular (PSCs) contractions in 38,1%, sinus tachycardia in 33,3%, PVCs in 47,6%, PVCs pairs in 14,3%, PVCs couplets in 9,5%, un-sustained ventricular tachycardia in 4,8%. Carotid plaques without stenosis were detected in 33,3%, with stenosis less than 40% of the arterial lumen in 9,5%, with stenosis 40-60% of the lumen in 4,76% and intima-media thickness (IMT) > 0,5mm in 28,6%. According to this, in the control group 10 patients (33,33%) had normal finding, 12 (40%) had thickened IMT and 8 patients (26,67%) non-stenotic atherosclerotic plaques. Frequency of peripheral artery disease in COPD patients based on Doppler ultrasonography of lower limb arteries was significantly higher in COPD 61,93% versus 43.33% in the control group. 7 Conclusion Cardiovascular evaluation in patients with moderate COPD is very important because of the increased risk of cardiovascular incidents in the early stage of the disease. Integrated-care approach for COPD patients is significant for early detection of unrecognized coexisting cardiac disorders. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CORONARY ARTERY BYPASS GRAFTING PORTENDS DECREASED RIGHT VENTRICULAR FUNCTION(Macedonian Association od Anatomists, 2020-07-03); ; ; Lazovski, NDecreased right ventricular (RV) function is a frequently observed phenomenon after coronary artery bypass grafting (CABG) that often implicated poor long term prognosis. The aim of this study was to assess the existence of RV dysfunction 4 to 6 months after CABG using echocardiographic Assessment of tricuspid annular plane systolic motion (TAPSE) and RV free wall longitudinal strain (RVFWS) using speckle tracking. During the period from October 2017 to October 2018, forty-seven consecutive patients undergoing CABG were enrolled in this prospective study. 2D transthoracic echocardiography was performed within one week before CABG as well as 4 to 6 months after surgery. All measurements were made by a single experienced investigator.4-6 months after CABG right atrial (RA)and RV dimensions were significantly increased although the mean value stayed in reference margins. TAPSE was significantly reduced (p=0.0001) as well as RVFWS (p=0.015) which showed fewer negative results implicating decrement in RV function after surgery. Patients with abnormal postoperative RVFWS had insignificantly larger preoperative end-diastolic and end-systolic volume index as well as worse left ventricular (LV)function manifested with lower LV ejection fraction (LVEF), lower systolic volume index (SVI) and more positive LV global longitudinal strain.We could not find any significant difference among preoperative values of RA and RV dimension as well as TAPSE and PAPs between patients with normal vs. abnormal postoperative RVFWS. Our study showed depressed RV function 4-6 months after CABG. We suggest that RV free wall strain could be obtained and should be applied along with other conventional markers in the assessment of RV function after CABG. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry(SAGE JOURNALS, 2020-07-10); Lilit BaghdassarianBackground: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and midcavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Left Atrial Thrombus in Patient with Mitral Valve Disease(Southeast European Medical Forum, 2019, 2019);