Faculty of Medicine

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HEART BLOCK AS A COMPLICATION OF ACUTE MYOCARDIAL INFARCTION, CLINICAL ASSESSMENT AND APPROACH. A CASE REPORT
(Faculty of Medical Sciences, University of Tetova, 2023-09-24)
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Murtezani, Besir
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Zhaku, Vegim
Optimal treatment for acute ST-elevation myocardial infarction (STEMI) within 12 hours after symptom onset includes primary percutaneous coronary intervention (PCI) or thrombolytic therapy. For STEMI patients who present later than 12 hours, current guidelines do not recommend PCI except the presence of hemodynamic or electrical instability or continuing ischemic symptoms. Thus, our intention is to show that early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of myocardial infarction (MI), more commonly inferior MI. Patient 49 years old patient (male) presented in our department with weakness, dizziness, short-term instability and nausea. The symptoms started one day before admission. The ECG on admission showed a total AV block with a heart rate approximately 33 b/min and ST segment elevation in the inferior leads. Laboratory tests were normal except for an extreme elevated high sensitive troponin. The echo showed normal finding with the exception of the slightly reduced kinetics of the apex, base and mid segment of the lower-posterior wall of the IVS. Coronary angiography was immediately performed, showing 100% stenosis of the rPDA. A stent is placed on the corresponding coronary artery. The total block was present all the time, and following the recommendations, a temporary pacemaker was placed in the patient due to hemodynamic instability and bradycardia. Despite reperfusion, the block persisted 7 days after the intervention, during which a permanent pacemaker was implanted and the patient was discharged for home treatment. This case highlights the importance and ways of early reperfusion to improve outcomes in patients with STEMI. Early reperfusion may also play a role in the early recovery of AV block that may occur as a complication of MI, more commonly inferior MI.
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A case of myocardial infarction in a young patient with combination of factor V Leiden and MTHFR gene mutation
(National Society of Cardiology of N. Macedonia, 2022-11)
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Zafirovska B
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Dimitrovska B
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Bede I
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Tomeski S
Introduction: Inherited thrombophilia due to a combination of factor V Leiden and MTHFR gene mutation leads to a hypercoagulable state resulting in thromboembolic events and arterial thrombosis. Case report: We present a case of a 35-year-old male patient who presented to the emergency room with intensive chest pain that started 2 hours ago while he was cycling for a distance of 11km. The ECG showed ST segment elevation of 3mm in the inferior leads. An emergent coronary angiography was indicated which showed thrombotic formations in the proximal right coronary artery (RCA), rPDA and RPL without atherosclerotic plaques. Percutaneous coronary intervention with plain old balloon angioplasty (PCI/ POBA) and thromboaspiration was performed, which was followed by tirofiban infusion and continuous infusion of unfractionated heparin for 24 hours. The molecular genetic analysis revealed the patient to be heterozygous for factor V Leiden and homozygous for methylenetetrahydrofolate reductase (MTHFR) C677T gene mutation. After completing the required clinical examinations, the patient was discharged in a good clinical condition with a recommendation for medical treatment including a prophylactic dose of direct oral anticoagulant. After a one-year follow-up, the patient had no symptoms or recurrent cardiovascular events. Conclusion: Inherited thrombophilia is а significant risk factor for coronary artery disease and performing genetic testing in younger patients with a cardiovascular event, plays an important role for adequate treatment and prophylaxis from recurrent complications. Although individual patient consideration is recommended, the use of oral anticoagulation for prophylaxis is shown to be effective in these patients. However, further studies are needed for the indications and duration of prophylactic anticoagulation in patients with inherited thrombophilia after an arterial thrombotic event.
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Incremental Value of Cardiac Biomarkers in Mid-term Prognosis of Patients with Acute Coronary Syndrome
(Scientific Foundation SPIROSKI, 2022-02-14)
Serafimov, A
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Donevski, D
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Karakolevska Ilova, M
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Joveva, E
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Todosieva Serafimova, K
Background: Given the number of prognostic studies, both short- and long-termed, in patients with myocardial infarction (MI), the data on predicting major adverse cardiac events (MACE) following discharge still remains limited. Aim: to identify early predictors of MACE in MI patients, that underwent Primary Percutaneous Coronary Intervention (pPCI), with special emphasis on multiple cardiac biomarkers. Materials and methods: we analysed clinical, LV functional, angiographic variables, as well cardiac troponin, a marker of myocardial necrosis, natriuretic peptide (NT-proBNP), a marker of myocardial stress, and white blood cells (WBC), as a marker of inflammation. The study population were 150 consecutive patients treated for acute myocardial infarction. Results: The average follow-up period was 31 months. In total, 26 patients suffered from at least one MACE. Multivariate logistic regression analysis identified several independent predictors: NT-proBNP (p=0,07), number of diseased vessels (p=0,027), and need for loop diuretic therapy (p=0,050). ROC curve demonstrated excellent discriminatory function for MACE of NT-proBNP and WBC (area under the curve .640, and .658, p=0.025 and 0.011 respectively). Conclusion: The combination of biomarkers for myocardial stress and inflammation improves the prediction of major adverse cardiac events in MI survivors.
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QT prolongation, QT dispersion and ventricular arrhythmias in patients with acute coronary syndrome treated with percutaneous coronary intervention
(2018-03)
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Bekim Pocesta
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Taravari Hajber
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Bojovski Ivica
The QT interval prolongation which happens during acute coronary syndrome is a dynamic parameter which changes at different points-reaches the peak point 24h after PCI and gets back in the normal range after 72h. QT dispersion follows this trend of change as well. Theres no difference of these changes between patients who present with STEMI, and patients with NSTEMI, except for the value of QT dispersion at admission which is shorter in the STEMI group. These patients have increased risk of malignant arrhythmias and should be closely monitored
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Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry
(Elsevier BV, 2021-07-20)
De Luca, Giuseppe
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Debel, Niels
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Cercek, Miha
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Jensen, Lisette Okkels
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Background and aims SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1 until April 30, 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure. Results Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29 % vs 5.5 %, p < 0.001), definite in-stent thrombosis (8.1 % vs 1.6 %, p = 0.004) and heart failure (22.6 % vs 10.6 %, p = 0.001) that was confirmed after adjustment for confounding factors. Conclusions Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.
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Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry
(Springer Science and Business Media LLC, 2020-12-18)
De Luca, Giuseppe
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Cercek, Miha
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Jensen, Lisette Okkels
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Calmac, Lucian
It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.
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Antiphospholipid Syndrome - A Case Report of Pulmonary Thromboembolism, Followed with Acute Myocardial Infarction in Patient with Systemic Sclerosis
(ID Design 2012/DOOEL Skopje, 2015-12-15)
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Chaparoska, Emilija
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Pocesta, Bekim
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We are presenting an uncommon case of pulmonary embolism, followed with an acute myocardial infarction, in a patient with progressive systemic sclerosis.

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