Faculty of Medicine

Permanent URI for this communityhttps://repository.ukim.mk/handle/20.500.12188/14

Browse

Settings

Subject: search.filters.subject.ACS

Search Results

Now showing 1 - 3 of 3
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    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)
    ;
    ;
    Jovanoski, Mario
    ;
    ;
    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.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    Spontaneous Coronary Artery Dissection
    (Department of Anesthesia and Reanimation, Faculty of Medicine, "Ss Cyril and Methodius" University, Skopje, R. N. Macedonia, 2023-04)
    ;
    ;
    ;
    Bojoski I
    ;
    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.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    Myocardial Perfusion Single Photon Emission–Computed Tomography (MPS) SPECT in Ischaemia detection in suspected Acute Coronary Syndromes (Case report)
    (2018-09-05)
    ;
    ;
    ;
    Introduction: The ischemic cascade as a result of myocardial oxygen supply–demand mismatch starts with metabolic alterations followed by changes of perfusion, diastolic dysfunction, regional systolic wall motion dysfunction, ischaemic ECG changes and finally angina. MPS can detected perfusion changes even in rest and detected ischemia. Case report: 61 years old woman with prolonged typical anginal pain at rest was admitted at our hospital. First symptoms occurred a month ago as stable angina CCS class II and rapidly progressed to III/IV class. Patient had visited hospital several times with normal ECG , high sensitive troponin tests in normal rang, normal echocardiogram and negative exercise test. Because of hypertension and dyslipidemia antihypertensive ACE inhibitor), statin (atorvastatin) and aspirin were prescribed.After admission the resting 12-lead ECG was performed with negative T waves in precordial leads V1-4 High sensitive troponin test was in normal rang, transthoracic echocardiography was normal so the patient was refer to MPS. The ECG-gated MIBI Tc 99 m SPECT rest study with CT correction was performed. We detected severe hypoperfusion in apical segments of anterior, lateral, inferior wall and septum and in midventricular segment of inferior wall (30% of the LV myocardium) with mild hypokinesia and reduced wall thickening suggesting two vessel disease. Patient was referred to coronarography. 99%mLAD,85% pLAD and 90% pRCA stenosis were found and PCI with implantation of Resolute ONYX stent to mLAD and Xience PROx stent to pLAD with TIMI flow 3 was performed. PCI to RCA was suggested in a month. Patient was discharged with optimal medical treatment. Conclusion: MPS rest study could be useful in patients with suggestive symptoms suspected for acute coronary syndromes for detecting ischemia, risk stratification and need of immediate reperfusion.