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Pneumonia as a primary manifestation of infective endocarditis - Case report
(Macedonian Association of Anatomists and Morphologists, 2024-10)
Milosavljevikj, Ane
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Kartalova Janeku, Marija
This 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.
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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)
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Risteski, Petar
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Popov, Aron Frederik
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Shokarovski, Marjan
Background and Objectives: The role of coronary artery bypass grafting (CABG) on postoperative left ventricular (LV) function in patients with preoperatively preserved left ventricular ejection fraction (LVEF) is still being discussed and only a few studies address this question. This study aimed to assess LV function after CABG in patients with preoperatively preserved LVEF using left ventricular longitudinal strain assessed by 2D speckle tracking imaging (STI). Materials and Methods: Fifty-nine consecutive adult patients with coronary artery disease (CAD) referred for a first-time elective CABG surgery were enrolled in the final analysis of this prospective single-center clinical study. Transthoracic echocardiography (TTE), with conventional measures and STI measures, was performed within 1 week before CABG as well as 4 months after surgery. Patients were divided into groups based on their preoperative global longitudinal strain (GLS) value. Differences in systolic and diastolic parameters between groups were analyzed. Results: Preoperative GLS was reduced (GLS < -17%) in 39% of the patients. Parameters of systolic LV function were significantly reduced in this group of patients compared to the patient group with GLS% ≥ -17%. In both groups, 4 months after CABG there was a decline in LVEF but statistically significant only in the group with GLS% ≥ -17% (p = 0.035). In patients with reduced GLS, there was a statistically significant postoperative improvement (p = 0.004). In patients with preoperative normal GLS, there was not a significant change in any strain parameters after CABG. There was an improvement in diastolic function parameters measured by Tissue Doppler Imaging (TDI) in both groups. Conclusions: There is improvement in LV systolic and diastolic function after CABG in patients with preserved preoperative LVEF measured by STI and TDI. GLS might be more sensitive and effective than LVEF for monitoring improvements in myocardial function after CABG surgery in patients with preserved LVEF.
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Echocardiographic Heart Changes in Pregnancies Complicated with Gestation Hypertension and Preeclampsia
(International Scientific Invention Journals, 2019-02-13)
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Milkovski, Daniel
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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.

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