Faculty of Medicine

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Author: search.filters.author.Nikolovski, RobertSubject: search.filters.subject.diagnosis

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    D DIMERS - A POWERFUL TOOL IN THE DIAGNOSIS OF AORTIC DISSECTION
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
    Jovanoski, Marko
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    Nikolovski, Robert
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    Petkovski, D.
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    Introduction: Acute aortic syndrome is one of the most life threatening cardivascular conditions besides acute coronary syndrome and pulmonary embolism. Fifty percent of all the patients with aortic dissection do not survive for surgery or other therapeutic procedure to be performed and they experience a lethal end. D dimers although are a marker with a low specificity and sensitivity they can help us and guide us to make the right diagnosis. Aim: Using d dimers to raise the suspicion for acute aortic dissection and using the triple chest pain CT angiography protocol to confirm the right diagnosis. Case report: This series of case reports are about a few patients that presented in the emergency department with either a chest or back pain which was radiating to different body regions (including the lumbal region and the abdominal area). As these symptoms can sometime overlap and manifest as different acute cardiovascular syndromes, which can lead to increased morbidity and mortality, a CT angiography was performed after the regular noninvasive, low cost echocardiography was done to potentially find a possible diagnosis and show us the right diagnostic path. D dimers were also examined in all of the patients and increased level was found in all of the above mentioned. Aortic dissection (Stanford A or B ) was the final diagnosis in all of them, every single patient requiring a different therapeutic approach. Conclusion: D dimers in combination with a good clinical examination can be a perfect tool to raise the suspicion for acute aortic syndrome and after performing a triple chest pain protocol with CT angiography we can confirm and treat the diagnosis which requested a hospital admission.
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    MISDIAGNOSIS OF CERVICOBRACHIAL SYNDROME WITH SUBOCCLUSION OF THE LEFT SUBCLAVIAN ARTERY
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023)
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    Nikolovski, Robert
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    Introduction: Cervical spondylosis (degenerative osteoarthritis) and subclavian occlusion, mostly caused by atherosclerosis, share similar symptoms. Both are diseases of the advanced age. Thus, there are similarities of overlapping or misdiagnosis of both diseases. The aim of this case report was to present diagnosis and treatment of subclavian subocclusion and possibility of misdiagnosis with cervicobrachial syndrome. Case report: We present the case of a 71-year-old woman with noncontrolled hypertension. For many years she complained of occasional pains and tingling in her neck, left shoulder, and hand, coolness in the fingers of the left hand, headache and occasionally dizziness. An x-ray finding of the cervical spine was in favor of spondyloarthrosis on the neck vertebrae, and after consulting an orthopedic specialist, she was diagnosed and treated as cervicobrachial syndrome for many years without success. Cardiology examination detected different high blood pressure readings in both arms and that induced us to perform a computerized angiography (CT). CT showed subocclusion on the left subclavian artery after which our patient underwent angiography and stent implantation. After the procedure, the blood pressure difference decreased and the symptoms disappeared. Conclusion: Due to similar symptoms, whenever cervicobrachial syndrome is diagnosed, the blood pressures in both arms should be measured. In case of their difference, subclavian stenosis should also be considered and appropriate investigations should be made, especially if the difference in pressures is high.
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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.