Kostova, Nela

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Kostova, Nela

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Kostova, Nela

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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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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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Arterial hypertension in patients with coronary artery disease treated with surgical myocardial revascularization
(AEP Press, 2007-07)
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Borozanov, V
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Taneva, B
Objectives: To evaluate the incidence and prognostic power of arterial hypertension in patients with coronary artery disease treated with surgical myocardial revascularisation, before and after the operation. Background: Arterial hypertension is one of the leading modifiable risk factors in CAD patients who underwent CABG surgery with the major impact on clinical outcome in these patients. Methods: 749 patients with mean age of 55 +/- 8 years, (639 male/119 female) were analyzed for their preoperative: demographic, clinical, left ventricular morphologic and functional and angiographic, perioperative: type of operation, type and number of applied conduits, in-hospital morbidity and mortality, and post-operative: demographic, clinical, left ventricular morphologic and functional and angiographic characteristics. Mean postoperative follow-up period was 5.97 +/- 4.27 years. Results: Hypertension was found in 52.7% of patients before the operation, and it was the most frequent risk factor, without any differences between different age groups, but significantly more often in females (p = 0.0001), diabetics (p = 0.0001), and patients with preserved LV function (p = 0.011). Although significantly correlated with in-hospital morbidity (r = 0.085 and p = 0.023), HTA was not identified as independent predictor. The most predictable was the occurrence of early neurological complications. HTA was also found to be a predictor of long life prognosis in CABG patients, but not as independent prognostic factor. Significant reduction in incidence was found in post-CABG patients (30.1%), which is most likely a result of applied pharmacologic treatment. ACE-inhibitors, Ca-antagonists and B-blockers were applied in 39.44%, 30.1% and 33.6% of patients respectively, with significant positive correlations found for all of them as follows: r = 0.221, p = 0.0001, r = 0.316, p = 000.1 and r = 0.093, p = 0.031. Conclusion: Hypertension is the most powerful risk factor in CAD patients who undergo CABG surgery in our country, and a powerful prognostic factor of early and late clinical outcome. There is a trend toward decreasing the incidence of HTA in post-CABG patients, as a result of improved pharmacologic treatment after the operation (Tab. 5, Fig. 1, Ref. 13). Full Text (Free, PDF) www.bmj.sk.
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Relationship between myocardial viability and improvement in left ventricular function and heart failure symptoms after coronary artery bypass surgery
(Macedonian Academy of Science and Art (MANU), 2007-07-28)
Peovska, I
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Maksimovic, J
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Davceva, J
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Background: The evaluation of myocardial viability is an important preoperative parameter, predictive of improvement in regional and global left ventricular (LV) function after coronary artery bypass surgery (CABG). However, whether the presence of viability is also associated with relief of heart failure symptoms after revascularization is not always certain. The aims of the study were to define the relationship between extent of viable myocardium and improvement in LV function after CABG and to determine whether preoperative viability testing can predict improvement in heart failure symptoms. Methods: Eighty-five consecutive patients with ischemic cardiomyopathy (mean LVEF 35%) undergoing surgical revascularization were studied with a Tc-99m sestamibi one-day rest/nitrate enhanced myocardial perfusion SPECT imaging (MPI) to assess viability. Regional and global function were measured before and 16 -/+ 6 months after revascularization. We have used the Bull's eye quantitative analysis of MPI scans and 17 segment model of LV function and perfusion evaluation. Heart failure symptoms were graded according to the New York Heart Association (NYHA) criteria, before and 16 -/+ 6 months after revascularization. Results: The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r 0.79, P < 0.01). Patients with > 4 viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79% respectively for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms after revascularization, with positive and negative predictive values of 79% and 74%, respectively. Conclusion: The presence of substantial viability (four or more viable segments, 24% of the left ventricle) on myocardial perfusion gated SPECT imaging in patients with ischemic heart failure before CABG surgery has significant correlation with the improvement in LVEF and heart failure symptoms postoperatively.
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Special Conditions in Venous Thrombembolism – Case Series
(Macedonian Academy of Sciences and Arts, 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.

Kostova, Nela

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