Faculty of Medicine

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    The Role of Interleukin-1 and Interleukin-6 in the Development of Acute Myocardial Infarction
    (2023-08-26)
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    Elizabeta Srbinovska-Kostovska
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    Slavica Josifovska
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    Certain cytokines as interleukin-1 (IL-1) and interleukin-6 (IL-6) are produced by the neutrophils and macrophages localized in the atheromatous plaques. The levels of circulating inflammatory cytokines IL-1 and IL-6 are found to be significantly increased in patients with ST-Segment Elevation Acute Myocardial Infarction (STEMI). In a group of 38 patients with STEMI, the levels of IL-1ß and IL-6 were determined in the coronary circulation (CC) by analysis of aspirates from the culprit lesions and the levels of these inflammatory markers in the systemic (peripheral) circulation (SC) during STEMI and six months after STEMI. Coronary angiography (CA) and percutaneous coronary intervention (PCI) were performed in all patients and the levels of cytokines were determined by the ELISA method. By examining the levels of IL-1ß and IL-6, the aim of this study was to determine their predictive value in short-term prognosis. In the acute phase (STEMI) there was a statistically significant difference between the mean values of IL-1ß (p=0, 000000) and IL-6 (p=0, 026204) in the samples of CC and SC, respectively. Results from the six months of follow-up showed that there were statistically no significant differences between the mean values of IL-1ß and IL-6 in the CC and SC. Moderate and low-positive correlation between the mean values of IL-1ß (r=0,6816; p=0,000) and IL-6 (r=0,4291; p=0,000) in CC and SC was observed at the sixth month of follow-up. In conclusion, our results confirm that IL-1ß and IL-6 are linked to the progression of Coronary Artery Disease (CAD) and should be considered as predictive markers.
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    Papillary muscle rupture as a complication of acute myocardial infarction
    (2021-02)
    Elena Grueva Nastevska
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    Zivko Petrovski
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    Vladislava Karanfilova Grueva
    Papillary muscle rupture is one of the rarest complications, with incidence of 1-5% 1 in patients with acute myocardial infarction (AMI), and usually happens 5-7 days after the initial event. This complication has a high mortality of 50% in the first 24hours, often leading to decompensation and pulmonary edema. The acute rupture and the severe dysfunction of the mitral leaflet finally result in a severe mitral regurgitation and in most of the cases leads to cardiogenic shock and death. The competence of the mitral valve is maintained by the actions of the anterolateral and posteromedial papillary muscles, but this mechanical complication occurs dominantly on the posteromedial muscle, with greater incidence of more than ten times compared to the anterolateral one. Transthoracic echocardiography (TTE) is a diagnostic tool with 65-85% sensitivity in visualizing structural abnormalities of the heart and is the most available and fast method in diagnostic this mechanical complication. Beside the structural abnormalities that can be detected, echocardiography can provide precise assessment of the regurgitant jet through the color doppler and continuous doppler ultrasound. It is very important to follow the guidelines from both the European and the American heart associations that recommend urgent echocardiography in patients that become hemodynamically unstable during or after acute myocardial infarction. However, the diagnosis of papillary muscle rupture is not always easy because patients are often elderly and frequently diagnosed with a particularly severe clinical presentation, or hemodynamic instability, which are all factors associated with high operative mortality. The only definite treatment for this condition is the cardiosurgical treatment, which in the last 10 years has an improved success and reduced mortality2. Intra-aortic balloon counter-pulsation may be necessary for severely unstable patients, or other mechanical circulatory support devices. Mitral valve repair can be done in patients who have a partial papillary muscle rupture, in case of detachment of the main insertion of a head which still remains fixed to the remnant papillary muscle via muscular bridges, unlike the complete rupture (or rupture of the main head) where mitral valve replacement is the main surgical therapy because complete post-MI papillary muscle rupture generally requires MVR due to the friable infarcted tissue. We describe a clinical case of a patient with severe mitral regurgitation after acute myocardial infarction and discuss the management for such patients in the current era
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    Ventricular Fibrillation and Tachycardia during Acute Myocardial Infarction: incidence, predictors, mortality and treatment
    (EHJ - Oxford University Press, 2007-09-02)
    Lazarov L.
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    Kotevski V.
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    Georgievski A.
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    Lazarova E.
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    Projevska D.