Faculty of Medicine

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Author: search.filters.author.Hajber TaravariHas files: Yes

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    QT PROLONGATION AND VENTRICULAR ARRHYTHMIA IN METHADONE USER PRESENTING WITH SEVERE HYPOKALEMIA
    (Institute of Knowledge Management, 2022-12-16)
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    Mario Jovanoski
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    Elena Grueva Nastevska
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    Hajber Taravari
    Introduction: Severe hypokalemia is a serious, life-threatening condition that can lead to muscle weakness, paralysis, fatigue and different types of cardiac rhythm disturbances including QT prolongation and furthermore lethal arrhythmias. On the other hand, prolongation of the QT interval can be exacerbated in methadone users who receive high doses of the drug. Methadone is a drug that is mostly used as a replacement therapy for opiates, and it is known that it can interfere in the cardiac action potential cycle. Case report: We present a case of 39y/old male who visited our clinic brought by an ambulance due to palpitations, fatigue and muscle weakness in the arms and legs. The patients’ symptoms aggravated in the past 2 weeks when he lost the ability to do the everyday activities and finally to walk, because of extreme weakness of the extremities. On the day of the admission, he experienced a syncope for the first time in his life. His initial ECG revealed sinus rhythm with prolonged QT interval and polymorphic ventricular extrasystoles, which evolved in nonsustained ventricular tachycardia. His initial laboratory finding showed severe hypokalemia, and his previous medical history revealed use of methadone replacement therapy for approximately 20 years. The patient was closely monitored in the intensive care unit, and potassium replacement therapy was immediately initiated by the use of intravenous potassium infusion. Toxicologist and nephrologist were also included in the treatment in order to reduce the methadone dose and to exclude a secondary cause of severe hypokalemia. The patient’s condition improved after 9 days, when the potassium level was in normal range and the rhythm disturbances completely resolved. Conclusion: This case highlights the importance of timely recognition of severe electrolytic abnormalities that can lead to dangerous arrhythmias. Careful replacement with 24h monitoring and frequent laboratory analysis is required until the potassium level reaches the target range and until the heart rhythm stabilizes. This case also reveals the importance of the significance of the follow up of every drug addict that receives methadone replacement therapy on a primary level, in order to exclude QT prolongation. In these cases, the dose of methadone should be reduced or replaced with another medication, in order to prevent potentially lethal arrhythmias.
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    Prognosticators of heart failure in patients after treatment because of acute coronary syndrome
    (2016-05)
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    Bekim Pocesta
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    Gorjan Krstevski
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    Hajber Taravari
    Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.