Faculty of Medicine

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    Spontaneous Coronary Artery Dissection
    (Department of Anesthesia and Reanimation, Faculty of Medicine, "Ss Cyril and Methodius" University, Skopje, R. N. Macedonia, 2023-04)
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    Bojoski I
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    Jovanoski M
    Spontaneous coronary artery dissection (SCAD) is non-iatrogenic, non-traumatic and nonatherosclerotic separation of the coronary artery wall caused by intramural hematoma development with or without simultaneous co-existence of coronary wall tear. The net effect is compression of the true coronary artery lumen with development of ischemia. SCAD typically occurs in relatively young population, dominantly females (around 90%), often in peripartum, in which there are absent or very rare classical risk-factors for coronary artery disease (CAD). The most frequent clinical manifestation of SCAD is acute coronary syndrome (ACS – STEMI or NSTEMI), rarely cardiogenic shock or life-threatening arrhythmias (VT or VF), and sometimes sudden cardiac death. Diagnosis (which sometimes can be challenging) is dominantly established by coronary angiography, and sometimes modalities of intravascular visualization may be useful (IVUS, OCT). The most of the patients with SCAD are treated conservatively and small proportion of them requires revascularization (PCI or CABG). In addition, we present several cases with SCAD. Conclusion: Timely and accurate diagnosis and treatment is extremely important in SCAD, which is a potentially life-threatening condition.
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    Pulmonary embolism in a patient with COVID-19 pneumonia despite satisfying anticoagulation status
    (Department of Anesthesia and Reanimation, Faculty of Medicine, "Ss Cyril and Methodius" University, Skopje, R. N. Macedonia, 2022-12)
    Jovanoski M
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    Introduction: COVID-19 disease is a disease related to many complications, some of them are life threatening. Venous thromboembolism is one of the cardiovascular causes (the third in mortality in the group of cardiovascular diseases), which can lead to serious morbidity and even mortality. Aim: To present the fact that a quality anticoagulation therapy is not always a 100 percent safe mechanism of dealing with VTE. Case Report: This case report is about a patient which was presented with a clinical condition related to COVID-19 bilateral bronchopneumonia. As such, she was treated with all the necessary medications, but after a VTE occurred as one of the complications, we had to upgrade the doses of anticoagulation to a therapeutic status. The CT angiography showing lobar and subsegmental pulmonary embolism was the gold standard to confirm the diagnosis. The effect of the LWMH which was used for the VTE was controlled by measuring the anti-Xa blood level. A further correction of the doses and types of antibiotics had to be done because of medications related thrombocytopenia which made the condition even more difficult to fight with. Conclusion: Using the antiXa as a tool to control the anticoagulation status in VTE patients can be a valuable thing to do. However, we must be always thorough in observing the clinical condition of the patient and be aware of the complications which can happen.