Faculty of Medicine

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    EVALUATING A TRANSITORY RIGHT BUNDLE BRANCH BLOCK IN FOOTBALL PLAYER
    (Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2022)
    Janushevski, Filip
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    Background: Athletic heart is a non-pathological condition. The occurrence of arrhythmias or branch block in athletes should be taken seriously. Cardiac examinations performed by an experienced cardiologist are crucial for defining the true condition of the athlete's heart and the eventual prevention of sudden cardiac death. Case report A professional football player at the age of 22 years with no personal or familial history of cardiovascular disease is referred to a cardiologist for abnormal treadmill test results. The treadmill test was impressive for the RBBB pattern on the electrocardiogram (ECG) that was not revealed on his basic and native ECG. As mentioned before he had no history of cardiovascular disease and he had been playing football skillfully for 10 years. This case report represents the importance of the electrocardiogram as a diagnostic tool in the evaluation of the athlete’s heart. Conclusion Despite consensus documents, recommendations and guidelines for electrocardiogram interpretation in athletes this method lacks specificity and sensitivity and sometimes further evaluation is needed for proper diagnosis and treatment.
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    Dilated cardiomyopathy in acromegaly - Case report
    (2014-10)
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    Todorova, Biljana
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    Introduction: Patients diagnosed with acromegaly develop many cardiovascular complications such as hypertension, arrhythmia, systolic and diastolic dysfunction, valvular dysfunction and heart failure. Dilated cardiomyopathy (DCM) with systolic and diastolic dysfunction is relatively rare but is associated with high mortality to 60%. In MCC the heart muscle gradually dilate and the dysfunction that develops is irreversible. It is therefore necessary early diagnosis and treatment of acromegaly by removal of the tumor and drug treatment with drugs that prevent the heart failure. Material and methods: We present a case of acromegaly diagnosed at the patient at the age of 27 with pituitary macroadenom, hipopituitarizam, diabetes,insipiden diabetes and atrophy of the optic nerve. The patient was subjected to endoscopic surgery but the disease remained active and she was treated with radiotherapy. Our patient has ignored the underlying disease and didn’t call in to the review and controls. The patient was hospitalized with difficult situation of heart failure with anasarca, hypertension, fatigue and severe left ventricular dysfunction with global hypocinesia in the Clinic for Cardiology. She was treated with diuretics, cardiotonics, vasodilators and hormone replacement therapy. Conclusion: Early diagnosis and prompt treatment of acromegaly can prevent irreversible cardiomyopathy. The problem is greater, if it is associated with other morbidities such as hypertension and diabetes.
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    VENTRICULAR ENLARGEMENT OR BENIGN FORM OF ECG IN ATHLETES.
    (“Ss. Cyril and Methodius” University, Skopje, R.N. Macedonia, Department of Anaesthesia and Reanimation Faculty of Medicine, 2022-06)
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    Janushevski, F
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    Abnormalities of electrocardiogram (ECG) in athletes are challenging and often misdiagnosed. Despite consensus documents recommendations and guidelines for electrocardiogram interpretation in athletes, this method has a lack in specificity and sensitivity and the most of the time further evaluation is needed for proper diagnostic and treatment. This report, through case report, has a goal to rise the knowledge of novel ways of ECG interpretation in athletes. Although it is not as specific or sensitive as a diagnostic method, knowing the basics and some of ECG irregularities can help clinicians to proper evaluate some cardiovascular disorders in athletes that can lead to erroneous consequences, such as malignant electrical disorders and sudden cardiac death (SCD).
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    Rhabdomyolysis and Cardiomyopathy in a 20-Year-Old Patient with CPT II Deficiency
    (Hindawi Limited, 2014-01-20)
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    Zafirovska, P
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    Caparovska, E
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    Pocesta, B
    Aim. To raise the awareness of adult-onset carnitite palmitoyltransferase II deficiency (CPT II) by describing clinical, biochemical, and genetic features of the disease occurring in early adulthood. Method. Review of the case characteristics and literature review. Results. We report on a 20-year-old man presenting with dyspnea, fatigue, fever, and myoglobinuria. This was the second episode with such symptoms (the previous one being three years earlier). The symptoms occurred after intense physical work, followed by a viral infection resulting in fever treated with NSAIDs. Massive rhabdomyolysis was diagnosed, resulting in acute renal failure necessitating plasmapheresis and hemodialysis, acute hepatic lesion, and respiratory insufficiency. Additionally, our patient had cardiomyopathy with volume overload. After a detailed workup, CPT II deficiency was suspected. We did a sequencing analysis for exons 1, 3, and 4 of the CPT II gene and found that the patient was homozygote for Ser 113 Leu mutation in exon 3 of the CPT II gene. The patient recovery was complete except for the cardiomiopathy with mildly impaired systolic function. Conclusion. Whenever a patient suffers recurrent episodes of myalgia, followed by myoglobinuria due to rhabdomyolysis, we should always consider the possibility of this rare condition. The definitive diagnose of this condition is achieved by genetic testing.
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    Arrhythmias induced cardiomyopathy - reversible dilated cardiomyopathy in patients with atrial fibrillation/flutter with fast ventricular rate
    (Macedonian Society of Cardiology, 2014)
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    Arnaudova-Dezhulovikj F.
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    Kamcevska-Dobrkovic L.
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    Otljanska M
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    In-hospital outcome of patients with peripartum cardiomyopathy – a single center study
    (Medical Publishing, d.o.o., 2014-10-29)
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    Arnaudova-Dezulovic, Frosina
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    Palasheva, Lidija
    Peripartum cardiomyopathy (PPCMP) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure (HF) occur between the last month of pregnancy and the first 5 months postpartum. The causes and pathogenesis are poorly understood and PPCMP remains a diagnosis of exclusion. Clinical presentation includes usual signs and symptoms of heart failure, and unusual presentations relating to thromboembolism. Effective HF treatment reduces mortality rates and increases the number of women who fully recover left ventricular (LV) systolic function. PPCMP is common in some countries and rare in others. During 6 years period (2008-2014) 22 patents (pts) were admitted to our hospital with diagnosis of PPCMP. 16(73%) pts were admitted to our hospital immediately post-partum, because of acute HF which needed immediate and aggressive HF treatment. Six (27%) pts presented congestive HF symptoms during the first three months after delivery. At the admission all the pts had documented LV systolic dysfunction with echocardiography (EF <45%). Five of them (23%) had severely impaired LV systolic function (EF=25-30%), seven (32%) pts had EF of 30-40%, and 10 (45%) pts had mild LV systolic dysfunction. During the hospitalization, clinical and functional improvement and stabilization was achieved in all patients. Complete recovery of LV systolic function was observed in 12 (55%) pts with PPCMP. In 10 pts (45%) there was persistence of LV systolic dysfunction determined with echocardiography. Peripartum cardiomyopathy is rare, but a serious disease associated with significant cardiac functional deterioration. Early diagnosis and appropriate medical treatment allows good functional recovery in majority of these patients and favorable prognosis. Reliable population-based information about incidence and prevalence of PPCMP is essential to the development of health policies for prevention and control of this condition.