Kostova, Nela

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Kostova, Nela

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Kostova, Nela

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Special Conditions in Venous Thrombembolism - Case Series
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2019-10-01)
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Klincheva, Milka
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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.
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Early Coronary Artery Disease in a Female Patient with Discoid Lupus Erythematosus and Hashimoto’s Thyroiditis
(Scientific Foundation SPIROSKI, 2023-08-15)
Dimitrovska, Biljana
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Jovchevska, Simona
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Bede, I.
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Vraynko, Elif
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BACKGROUND: Atherosclerosis is a chronic inflammatory condition involving the endothelium of the blood vessels, predominant the coronary arteries. Main risk factors are dyslipidemia, hypertension, diabetes, smoking, obesity, and lack of physical activity. Patients with autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis etc., have a twofold increased risk of developing CAD at younger age, compared with the general population. CASE REPORT: A 41-year-old female patient, with history of smoking and dyslipidemia, was admitted to our hospital with acute inferoposterior myocardial infarction. Initially, coronary reperfusion therapy per protocol was administrated and primary percutaneous coronary intervention (PCI) was performed. Multivessel CAD was found, and two stents were implanted on obtuse marginal and circumflex artery. Transthoracic echocardiography (TTE) revealed left ventricle systolic and diastolic dysfunction with segmental hypokinesis. Additionally, the patient was first diagnosed with DLE at the age of 15, but the disease was uncontrolled in the last 7 years. She also has hypothyroidism, regularly treated with hormone replacement therapy. The patient was discharged with medicamentous therapy including dual antiplatelet agents, statin, beta-blocker, angiotensin-receptor blocker, potassium sparing diuretic and proton pump inhibitor. One month later, recoronarography was performed with stenting of left anterior descending artery. TTE showed improvement of the left ventricle systolic function with preserved ejection fraction. The blood test showed elevated levels of antithyroid antibodies. A rheumatologist was consulted, who recommended therapy with hydroxychloroquine and regular follow-ups. CONCLUSION: In younger patients with chronic inflammatory diseases, inflammatory mediators play a significant role in the development of the atherosclerotic plaques, regardless of co-existing risk factors. Therefore, an early cardiovascular assessment is required in these patients for preventing severe or life-threatening cardiovascular events.
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A Case of Tacotsubo Cardiomyopathy - How We Uncovered the Diagnosis
(Sciencedomain International, 2020-08)
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Otljanska, M
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Taravari, H
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Jovkovski, A
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Introduction: Tacotsubo cardiomyopathu (TTC) is a stress-induced condition characterized by transient appical hypokinesia and is usually caused by stress-induced catecholamine release with toxic action that leads to stunning myocardium. Methods and Results: The patient was a 62 year old woman without any history of heart disease and she admitted with chest pain and electrocardiography (ECG) with ST segment elevation in the precordial leads and troponins suggesting acute anterior myocardial infarction (MI). Emergency coronary angiography which is performed showed no significant coronary artery disease. Echocardiography showed reduced LV ejection fraction with left ventricular apical ballooning and (LV) thrombus. Cardiac magnetic resonance imaging showed localized hypokinesia of the mid septal segments and akinesis of all segments of the apex of the left ventricle and T2 hyperintesity consistent with myocardial transmural oedema in the same area with diffuse involvement. During the hospitalizasion patient was treated with single antiplatelet, anticoagulation therapy, diuretics, angiotensin-converting-enzyme inhibitors (ACE inhibitors) and beta blockers for treatment of heart failure reduced Ejection fraction (HFrEF). At 3 months follow up ECG was normal with reversal of symptoms and regression of wall motion abnormalities at echocardiography. According to investigation results, a diagnosis of takotsubo syndrome (TTS) was established. Conclusion: Tako-tsubo cardiomyopathy often presents as an acute coronary syndrome with ST segment changes, as ST-segment elevation and/or T-wave inversion. Clinical presentation is characterized by acute coronary artery disease, in the absence of obstruction, verified by coronarography.Diagnostic methods are very important to make true decision of Tacotsubo cardiomyopathy.
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Nebivolol: A Different Beta-Blocker for Hypertension
(MedCrave, 2016-04)
Otljanska, M
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Otljanski, A
Beta blockers are one of the classes of antihypertensive drugs, but there are controversies of their use as an initial therapy in treatment of arterial hypertension based on different guidelines for treatment of arterial hypertension. Nebivolol is a third generation, highly selective β-adrenoceptor antagonist with antihypertensive efficacy similar to other beta blockers but with unique function of increasing the release of nitric oxide (NO) via activation of β3-adrenergic receptors which improves endothelial function, produces vasodilatation, improves arterial compliance and reduces peripheral vascular resistance. Nebivolol highly selective lipophilic B1-adrenergic receptor antagonist and B3 agonist has different pharmacokinetics and pharmacodynamics profile from other beta blockers with more favourable metabolic and hemodynamic profile, like side effect profile, beta receptors blockade affinity, vasodilating properties, and improvement of endothelial function. Nebivolol has been show to be effective beta blocker for treatment of mild to moderate arterial hypertension as monotherapy or in combination therapy.
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A Curious Case of Acute STEMI in a Young Patient; Things are Not Always What They Seem
(Scientific Foundation SPIROSKI, 2023-06-30)
Vraynko, Elif
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Dimitrovska, Biljana
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Bede, I.
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Tomeski, S.
BACKGROUND: Acute myocardial infarction (MI) is a rare occurrence in patients under 40 years of age without positive family history for coronary artery disease (CAD). Genetic conditions as inherited thrombophilia can lead to a hypercoagulable state, resulting in thromboembolic events and arterial thrombosis. CASE SUMMARY: We present a case of a 35-year-old male patient who presented to the emergency room with an inferior MI after a strenuous cycling exercise. An urgent coronary angiography showed thrombotic formations in the right coronary artery without atherosclerotic plaques. Plain old balloon angioplasty and thrombus aspiration were performed, which was followed by GP IIb/IIIa inhibitor infusion and unfractionated heparin for 24 h. From past medical history, the patient had COVID-19 like symptoms 20 days before the event and had his first dose of anti- COVID vaccine 2 weeks prior. After additional testing, molecular genetic analysis results revealed the patient to be heterozygous for factor V Leiden (FVL) and homozygous for methylenetetrahydrofolate reductase C677T gene mutation. The patient was discharged on direct oral anticoagulant and antiplatelet therapy. After 1-year follow-up, he had no symptoms or recurrent cardiovascular events. CONCLUSION: Inherited thrombophilia is а significant risk factor for CAD and performing genetic testing in younger patients with a cardiovascular event and plays an important role for adequate treatment and prophylaxis from recurrent complications. The use of oral anticoagulation for prophylaxis is shown to be effective in these patients. However, further studies are needed to prove their exact role and duration of treatment.
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Prognostic value of normal myocardial perfusion imaging in asymphtomatic diabetic patients with moderate and high calcium score
(Oxford Academic, 2015-06)
Peovska, I
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Davceva, J
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Pop Gjorceva, D
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Zdravkovska, M
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Background: To evaluate the intermediate prognostic value of normal myocardial perfusion imaging in asymptomatic diabetic patients with high cardiovascular (CV) risk with intermediate and high coronary calcium score (CAC). Methods: 115 asymptomatic patients with high CV risk without known coronary artery disease (CAD), underwent SPECT myocardial perfusion imaging (MPI) after multislice computer tomography with coronary calcium score (CAC) assessment for detection of suspected CAD was. Presence of traditional risk factors, diabetes control and presence of albuminuria were evaluated. 75 patients with normal MPI results were included in the study. 17 segment model for myocardial perfusion and function analysis was used. Patients were devited in to three groups: I gr- 20 patients with diabetes duration between 1-5 years; II gr- 24 patients with diabetes duration 5-10 years; III gr- 31 patients with diabetes duration >10 years. End points (cardiac death, non fatal myocardial infarction, heart failure, new angina, revascularization) at 6 months, 1 and 2 years were followed. Results: All patients have normal rest left ventricular function with EF >50% and normal myocardial perfusion scans. 40 patients had moderate calcification of the coronary arteries with average CAC 290+/-95. 35 patients had severe coronary calcification with average CAC 568+/-67. There was correlation of diabetes duration with CAC severity (r-0,62 for diabetes duration over 10 years). Only 3 cardiac events were registrated at 24 month follow up in the II and III group (new angina with percutaneous coronary (PCI) revascularization). Heard events (cardiac death, nonfatal myocardial infarction STEMI/NSTEMI) were 0% in gr I, 4.2% in gr II and 6.4% in Gr III. Overall rate of CV at 24 month follow up was 4.0%. Conclusions: MPI and CAC are valuable techniques for preclinical assessment of CAD in asymptomatic high risk patients, which help guide optimal treatment decision and prognosis. Diabetic patients even with normal MPI have increased intermediate risk for CV events. Prognostic value of normal myocardial perfusion imaging in asymphtomatic diabetic patients with moderate and high calcium score SCORE.
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Myocardial gated SPECT imaging in asymptomatic diabetic patients: clinical decision and optimal therapeutic approach
(Medical Publishing, d.o.o., 2013-05-14)
Peovska, Irena
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Otljanska, Magdalena
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Arnaudova, Frosina
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Tachycardia – induced cardiomyopathy (TIC): a reversible state
(Hrvatsko kardiološko društvo, 2012-10)
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Arnaudova-Dezhulovikj, F
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Tachycardia-induced cardiomyopathy (TIC) is defined as a condition characterized by atrial or ventricular myocardial dysfunction as a result of prolonged and increased atrial or ventricular rates. There is no underlying structural heart disease, and the condition is reversible upon control of the arrhythmia. The prevalence of the disease can’t be truly estimated as it is mainly described in case reports. During 2011 we established the diagnosis of tachycardia induced cardiomyopathy in 4 patients. All of them were male, at the age of 40–55, with no previous cardiovascular disease. At the time of presentation two patients had atrial fibrillation, and the other two of them atrial flutter, with fast ventricular rate (130–160 bpm. All of them presented with symptoms and signs of congestive heart failure. The duration of the arrhythmias was approximately 4–8 weeks before hospitalization. On admission, echocardiographic parameters were consistent with dilated cardiomyopathy with moderately to severe reduced ejection fraction (25–40%). In all cases there was no structural heart disease, no signs of inflammation or metabolic disturbances. Coronary angiography showed normal coronary arteries. In all cases there was resolution of the ventricular dysfunction following appropriate treatment of the arrhythmias and achieving and maintaining sinus rhythm. During the follow-up period of 12–18 months the patients are in NYHA I functional class, with echocardiographic dimensions and volumes within normal ranges, on beta blockers, ACE inhibitors, ASA or OAT. Two of them had few episodes of AF of short duration. The recognition of tachycardia-induced cardiomyopathy is important as appropriate treatment (rhythm and/or rate control) has a good outcome. It needs to be taken into consideration in the differential diagnosis of idiopathic dilated cardiomyopathy.
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99mTc-MIBI GATED-SPECT Myocardial Perfusion Scintigraphy in Asimptomatic patients with Systemic Lupus Erythematosus.
(Medical Facilty, Ss Cyril and Methodius University, Skopje, R. Macedonia, 2018)
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Tanevska, B
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Sandevski, A
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Myocardial Perfusion Abnormalities in Young and Premenopausal Women with Systemic Lupus Erythematosus, Detected with 99MTC MIBI Myocardial Perfusion Scintigraphy - Prevalence and Correlation with Proatherogenic Factors
(Walter de Gruyter GmbH/Macedonian Academy of Sciences and Arts, 2018-12-01)
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Pop-Gjorcheva, Daniela
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Sandevski, Aleksandar
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Atherosclerosis in young and premenopausal women with systemic lupus erythematosus (SLE) is frequent, premature and progressive. Although asymptomatic or with atypical clinical presentation, the patients are at high risk of cardiac events. Aim of this study is to estimate the risk profile for atherogenesis and the prevalence of myocardial perfusion abnormalities with 99mTc myocardial perfusion scintigraphy (MPS) in young and premenopausal women.

Kostova, Nela

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