Faculty of Medicine

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    MARIJUANA-INDUCED ACUTE CORONARY SYNDROME IN A YOUNG PATIENT
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023)
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    Jovanoski, Mario
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    Andov, Mishel
    Introduction: Acute coronary syndrome (ACS) is generally a natural consequence of the progression of coronary atherosclerosis. But in minority of cases, it might be developed due to non-atherosclerotic reasons including recreational marijuana use. Possible pathophysiological mechanisms include inflammation, procoagulant state and vasoconstriction (vasospasm) of the coronary arteries. Marijuana adverse effects on cardiovascular system are various and well documented. Case report: We present a 29-years old male who was referred to our Clinic due to chest pain and morphologic ECG changes. The patient has been previously hospitalized in local hospital due to hematochezia. Because of the chest pain, ECG was performed, and blood sample was taken there to determine the troponin level (hs-Tn I). ST-segment elevation and high level of hsTn I were indication for urgent transfer of the patient to our clinic. After admission, the patient underwent coronary angiography and PCI. Thoroughly taken history revealed that the patient was occasionally smoking marijuana in recreational purposes. He was a cigarette smoker, but he had no additional known risk factors for CAD. Conclusion: Recreational marijuana use may be a trigger factor for an acute coronary syndrome. We should always think and suspect marijuana and other recreational drugs as a potential risk factor for adverse cardiovascular events in young patients.
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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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    Acute Myocardial Infarction with St-Segment Elevation: To Aspirate or Not?
    (MedCrave, 2017-03-17)
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    Paljoshkovska-Jordanova S
    Acute myocardial infarction with ST-segment elevation (STEMI) is the most serious clinical manifestation of acute coronary syndrome (ACS). Golden therapeutic approach for patients with STEMI is primary percutaneous coronary intervention (PCI) and its aim is to restore normal coronary flow and provide myocardial tissue reperfusion as soon as possible leading to myocardial salvage. Thrombus aspiration is an adjunctive therapeutic modality to conventional PCI which can be especially powerful and helpful in some clinical subsets of STEMI with large thrombus burden. Here we discuss about advantages and disadvantages of the thrombus aspiration technique in regard to the most important clinical trials.