CHelichich, Ana

Preferred name

CHelichich, Ana

Official Name

CHelichich, Ana

Main Affiliation

ana.chelikic@medf.ukim.edu.mk

Now showing 1 - 9 of 9

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QT PROLONGATION AND VENTRICULAR ARRHYTHMIA IN METHADONE USER PRESENTING WITH SEVERE HYPOKALEMIA
(Institute of Knowledge Management, 2022-12-16)
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Mario Jovanoski
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Elena Grueva Nastevska
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Hajber Taravari
Introduction: Severe hypokalemia is a serious, life-threatening condition that can lead to muscle weakness, paralysis, fatigue and different types of cardiac rhythm disturbances including QT prolongation and furthermore lethal arrhythmias. On the other hand, prolongation of the QT interval can be exacerbated in methadone users who receive high doses of the drug. Methadone is a drug that is mostly used as a replacement therapy for opiates, and it is known that it can interfere in the cardiac action potential cycle. Case report: We present a case of 39y/old male who visited our clinic brought by an ambulance due to palpitations, fatigue and muscle weakness in the arms and legs. The patients’ symptoms aggravated in the past 2 weeks when he lost the ability to do the everyday activities and finally to walk, because of extreme weakness of the extremities. On the day of the admission, he experienced a syncope for the first time in his life. His initial ECG revealed sinus rhythm with prolonged QT interval and polymorphic ventricular extrasystoles, which evolved in nonsustained ventricular tachycardia. His initial laboratory finding showed severe hypokalemia, and his previous medical history revealed use of methadone replacement therapy for approximately 20 years. The patient was closely monitored in the intensive care unit, and potassium replacement therapy was immediately initiated by the use of intravenous potassium infusion. Toxicologist and nephrologist were also included in the treatment in order to reduce the methadone dose and to exclude a secondary cause of severe hypokalemia. The patient’s condition improved after 9 days, when the potassium level was in normal range and the rhythm disturbances completely resolved. Conclusion: This case highlights the importance of timely recognition of severe electrolytic abnormalities that can lead to dangerous arrhythmias. Careful replacement with 24h monitoring and frequent laboratory analysis is required until the potassium level reaches the target range and until the heart rhythm stabilizes. This case also reveals the importance of the significance of the follow up of every drug addict that receives methadone replacement therapy on a primary level, in order to exclude QT prolongation. In these cases, the dose of methadone should be reduced or replaced with another medication, in order to prevent potentially lethal arrhythmias.
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Acute Arterial Thrombosis in Anticoagulated Patient for Acute Pulmonary Thromboembolism
(Nizameddin KOCA, 2023-04-29)
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Elena Grueva
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Elma Kandic
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Oliver Bushljetikj
Acute limb ischemia is a rare condition in patients with venous thromboembolism (VTE), who already receive anticoagulation treatment. Inflammation is a risk factor for thrombus formation. Patients with active ulcerative colitis, especially at time of exacerbation, are more prone to thromboembolism, both venous and arterial. Risk for thrombosis is 18% higher risk, with also higher risk of bleeding. Up to date, there is no contraindication to any anticoagulant drug in patients with ulcerative colitis. We represent a case of a 73 year - old woman with ulcerative colitis (UC) exacerbation, hospitalized initially for pulmonary thromboembolism, that developed acute arterial thrombosis when switched on novel oral anticoagulant (NOAC).
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Учество во GHATI(Globalhear Atack Threatment iniatiative), Регистерот како евалуација на третманот на миокарден инфаркт
(Македонско здружение по Кардиологија, 2021-10)
Igor Zdravkovski
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Elma Kandikj
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Oliver Bushletikj
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Left Ventricular Aneurysm with Recurrent Ventricular Tachycardia
(2021-12)
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D. Risteski
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B. Pocesta
BACKGROUND: Ventricular tachyarrhythmias as complication of LV aneurysm are not unusual complication and can lead to sudden cardiac death. The accepted consensus for treatment of LV aneurism is medical therapy unless other indication for surgery exists, or existing treatment cannot control the symptoms. CASE REPORT: A 29-year-old man with no prior cardiac history was admitted to the hospital, after an episode of chest pain accompanied with fatigue and dizziness, for the last 2 h. His electrocardiogram on admission showed ventricular tachycardia with heart rate 260/min. Selective coronarography was performed and no significant stenosis of coronary artery was found. On transthoracic echocardiography, the left ventricle was mildly dilated (ejection fraction 50%), but whole apex was akinetic with giant aneurism. CONCLUSION: Aneurysms of the LV, sometimes associated with malignant ventricular arrhythmias, are very late complication of myocardial infarction. Resection of the aneurysm, although has no high-class recommendation (2), can cure the ventricular arrhythmias, as in presented case.
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Fulminant myocarditis in COVID-19 - Case report
(Macedonian Pharmaceutical Association = Македонско фармацевтско друштво, 2021-01)
Elena Grueva Nastevska
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Elma Kandic
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Vladislav Gruev
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Acute Myocarditis after Pfizer-BioNTech COVID-19 m-RNA Vaccination
(Scientific Foundation SPIROSKI, 2022-11-30)
Elena Grueva-Nastevska
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Planinka Zafirovska
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Elma Kandic
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BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. CASE PRESENTATION: We are presenting a patient with heart failure symptoms caused by PVE after Pfizer-BioNTech coronavirus disease-2019 (COVID-19) m-RNA vaccination. CONCLUSION: The exact mechanism of myocarditis in young men who received the second dose of mRNA COVID-19 vaccine is not yet known. However, this is a rare complication and most people generally recover quickly requiring only supportive treatment. In contrast, the risk of developing myocarditis from the viral infection is much higher.
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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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Papillary Muscle Rupture as a Complication of Barlow’s Disease
(Scientific Foundation SPIROSKI, 2022-11-30)
Ile Kuzmanoski
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Aleksandra Georgieva
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INTRODUCTION: Mitral regurgitation (MR) is the second most common valvulopathy worldwide, which can be divided into primary and secondary. According to Carpentier’s classification, the primary MR is further divided into three types. Type II, which includes Barlow’s disease, is described as excessive mobility of the mitral valve (MV) leaflets. Morbus Barlow is a common form of degenerative disease, with an incidence of 2–3% of the general population. Echocardiography plays an important role in its diagnosis. It is a usually benign condition, with only a few severe complications. CASE REPORT: A 75-year-old male with a history of MR, for more than 10 years. On admission, the patient presented with severe fatigue and dyspnea with signs of heart failure and pleural effusion. On auscultation, a systolic murmur was noted, on all the precordium. The ECG revealed sinus rhythm with HR of 71/min and intermittent ventricular extrasystoles. An immediate transthoracic echocardiography (TTE) was performed showing myxomatous degeneration of both MV leaflets and a prolapse of the posterior leaflet. A severe MR was detected with a presumption of papillary muscle rupture (PMR). It also revealed enlarged left atrium and ventricle (LVEDd - 67 mm and LA - 46 mm), with preserved systolic function (EF~54%) and tricuspid regurgitation accompanied by pulmonary hypertension. The laboratory analyses were within normal ranges. The patient was transferred to a cardiovascular surgery clinic, where an immediate MV repair was performed. CONCLUSION: Barlow’s disease is a common echocardiography finding. Although a benign condition, it can rarely present with serious complications such as PMR, ventricular arrhythmias, and even sudden cardiac death. Echocardiography is the first imaging used for the detection of Barlow’s disease and other MV diseases. Early recognition and confirmation with TTE or transesophageal echocardiography, plays also an appropriate treatment, play a key role in patient survival and overall prognosis.
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VACCINE-INDUCTED THROMBOTIC THROMBOCYTOPENIA AND COVID-19 VACCINES: CASE SERIES
(Macedonian Academy of Sciences and Arts, 2022-01)
Lazarova Trajkovska E
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Grueva Nastevska E
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Vaccine-induced thrombotic thrombocytopenia (VITT) is a condition similar to heparin-induced throm- bocytopenia (HIT), but it is associated with prior administration of COVID-19 vaccines without prior exposure to heparin. The incidence of VITT is not certain, but it appears to be extremely rare. Reports of unusual and severe thrombotic events, including cerebral and splanchnic venous thrombosis and other autoimmune adverse reactions, such as immune thrombocytopenia or thrombotic microangiopathies in connection with some of the SARS-CoV-2 vaccines, have caused a great deal of concern within the pop- ulation and the medical community. We would like to present 4 clinical cases of VITT, hospitalized and treated in intensive care unit (ICU) of University clinic of cardiology in Skopje.

CHelichich, Ana

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