rss_2.0Seminars in Cardiovascular Medicine FeedSciendo RSS Feed for Seminars in Cardiovascular Medicine in Cardiovascular Medicine Feed presentation of pulmonary embolism and pericardial effusion as complications of cancer: a case report<abstract> <title style='display:none'>Summary</title> <p>We report the case of a 62-year-old woman who was admitted to Vilnius University Hospital Santaros klinikos suffering from week-long shortness of breath during minimal physical activity. Computed tomography angiography and echocardiogram findings led to a diagnosis of pulmonary embolism and large pericardial effusion. The patient was previously diagnosed with a base of tongue cancer with lung metastasis. The patient received low-molecular-weight-heparin, and pericardiocentesis was performed. As a result, the patient’s general condition improved, and she was discharged from the hospital. In this case, pulmonary embolism and pericardial effusion coincided as complications of malignancy. The concurrent presentation of these conditions is rare and poses a clinical dilemma regarding the treatment, including anticoagulant therapy.</p> </abstract>ARTICLEtrue closure using negative pressure wound therapy after heart transplantation<abstract> <title style='display:none'>Summary</title> <sec><title style='display:none'>Background</title><p>Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT).</p></sec> <sec><title style='display:none'>Case presentation</title><p>This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient.</p></sec> <sec><title style='display:none'>Conclusion</title><p>Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI.</p></sec> </abstract>ARTICLEtrue closure using negative pressure wound therapy after heart transplantation<abstract> <title style='display:none'>Summary</title> <sec><title style='display:none'>Background</title><p>Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT).</p></sec> <sec><title style='display:none'>Case presentation</title><p>This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient.</p></sec> <sec><title style='display:none'>Conclusion</title><p>Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI.</p></sec> </abstract>ARTICLEtrue resonance diagnostic criteria of non-compaction cardiomyopathy: new diagnostic criteria still needed?<abstract> <title style='display:none'>Summary</title> <p>Non-compaction cardiomyopathy (NCC) is a rare pathology, but the exact rates of its prevalence are not known due to the lack of a diagnostic gold standard. The purpose of this article is to analyse the available cardiovascular magnetic resonance (CMR) diagnostic criteria of non-compaction described in the literature and to compare their sensitivity and specificity in the diagnosis of NCC. A search of available literature related to the CMR diagnostic criteria of myocardial non-compaction was conducted in the medical database PubMed in February of 2022. The period of publication of scientific articles covered the years from 1996 to 2022. A total of 7 full-text scientific articles were included in the final literature review. The main diagnostic criteria were used: the maximum non-compact (NCM) to compact myocardial layers (CM) ratio (NCM:CM), the percentage of trabeculated left ventricular (LV) myocardial mass, the percentage of trabeculated LV myocardial volume, the non-compact myocardial mass index of the total LV, and the determination of the total LV and the maximal fractal dimension (FD) of the apex with the use of fractal analysis. The lack of accurate diagnostic criteria results in an overdiagnosis of NCC. The highest sensitivity and specificity are associated with the maximum FD &gt; 1.30 of the apex established by applying the fractal analysis method. Fractal analysis requires dedicated software, and this method is difficult to apply in routine clinical practice. Thus, the diagnostic criteria for the NCC using magnetic resonance imaging with higher diagnostic value remain to be sought.</p> </abstract>ARTICLEtrue arrest due to systemic lupus erythematosus relapse: case report<abstract> <title style='display:none'>Summary</title> <p>We report a case of a 36-year-old man who was admitted to the Vilnius University Hospital Santaros clinics emergency department suffering from acute chest pain and experienced cardiac arrest. Changes in the electrocardiogram, elevated troponin level, and clinical symptoms lead to ST-elevation myocardial infarction (MI) diagnosis. The patient was diagnosed with systemic lupus erythematosus (SLE). He was in a remission state of SLE and was not taking drugs for one year before MI happened. SLE may be associated with antiphospholipid syndrome, which can cause cardiovascular complications such as MI. Although it is a usual practice to stop treatment in remission, in some cases, clinicians should consider continuing SLE treatment to avoid cardiovascular complications. In this case, the exacerbation of SLE and myocardial infarction occurred almost simultaneously with no previous thrombotic or cardiovascular events.</p> </abstract>ARTICLEtrue atrial blood cyst of a patient with hypertrophic cardiomyopathy<abstract> <title style='display:none'>Summary</title> <p>Intracardiac blood cysts are generally observed in infants and regress spontaneously with time. Blood cysts are mainly located on the left side of the heart and atrioventricular valves. These findings are extremely rare in older children and adults. We report a rare case of a 45-year-old female patient with a cardiac blood cyst in the right atrium and hypertrophic obstructive cardiomyopathy. To the best of our knowledge, this is the first-ever case report in the literature of blood cyst and hypertrophic cardiomyopathy.</p> </abstract>ARTICLEtrue the P-wave model of a single electrocardiogram lead<abstract><title style='display:none'>Summary</title><p>We describe a parametric model for the P-wave of a single electrocardiogram (ECG) lead trajectory. Though previously met in the bioengineering literature, the model was not treated in a complete parametric fashion. The paper fills the gap by making use of both frequentist and Bayesian approaches. Supporting real data example is provided. Further potential applications are also discussed.</p></abstract>ARTICLEtrue of high sensitivity C-reactive protein and metabolic syndrome components in middle-aged subjects without overt cardiovascular disease in LitHiR primary prevention programme<abstract><title style='display:none'>Summary</title><p><bold>Objectives</bold>: Circulating levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been reported to be associated with increased risk of cardiovascular disease (CVD), as well as with metabolic syndrome (MetS). Therefore, our objectives were to investigate the associations between hs-CRP levels and individual MetS components as well as to analyse if hs-CRP levels are linked with the number of MetS components present in middle-aged subjects.</p><p><bold>Design and methods</bold>: A cross-sectional study included 4628 middle-aged MetS subjects from the Lithuanian High Cardiovascular Risk primary prevention programme (LitHiR) from 2011 to 2020. MetS was diagnosed according to the National Cholesterol Education Program ATP III modified criteria. CRP was measured by a validated high-sensitivity assay. A hs-CRP cutpoint of 5 mg/l was used to differentiate high and low hs-CRP groups.</p><p><bold>Results</bold>: The mean value of hs-CRP was 3.23 ± 4.04 mg/l, and significantly increased as the number of components of MetS increased (<italic>p</italic> &lt; 0.001). The concentration of serum hs-CRP was significantly associated with waist circumference, systolic and diastolic blood pressure, and fasting blood glucose (all <italic>p</italic> &lt; 0.001). However, no statistically significant associations were found between hs-CRP and serum triglycerides (<italic>p</italic> = 0.340) or serum high-density lipoprotein cholesterol (<italic>p</italic> = 0.148).</p><p><bold>Conclusions</bold>: Serum hs-CRP increased progressively with increased waist circumference, blood pressure, fasting blood glucose in middle-aged subjects with MetS. The higher values of hs-CRP were more often present in obese subjects and women. The incremental rise in mean serum hs-CRP level was found with an increasing number of MetS components.</p></abstract>ARTICLEtrue education degree affect the patient’s attitude towards the treatment after myocardial infarction?<abstract><title style='display:none'>Summary</title><p><bold><italic>Objectives</italic></bold>. To assess the association between education degree and attitude towards the treatment after myocardial infarction (MI).</p><p><bold><italic>Design and Methods</italic></bold>. The participants of this cross-sectional study were 191 (140 men and 51 women) outpatients in a period of 3 months – 5 years after acute MI (mean age 59 ± 9.2 years) from Vilnius University Hospital Santaros Klinikos. All patients were asked to complete two questionnaires: “Quality of Life and Treatment after Myocardial Infarction” and “Cholesterol-lowering Drugs Consumption Peculiarities”. The data was analyzed using the SPSS software.</p><p><bold><italic>Results</italic></bold>. The education degree (a higher (post-secondary education provided by a college or university) vs. a lower (secondary or vocational education) education degree) had similar influence on the patients’ occasional concern (43.2%; <italic>n</italic> = 35 vs. 52.9%; <italic>n</italic> = 55, respectively; <italic>p</italic> = 0.226) and on the frequent concern (25.9%; <italic>n</italic> =21 vs. 26.9%; <italic>n</italic> = 28, respectively; <italic>p</italic> = 0.226) about MI. Patients with a higher education degree were more likely to identify themselves as the main subjects in MI treatment in comparison with patients that had a lower education degree (30.5%; <italic>n</italic> = 25 vs. 15.2%; <italic>n</italic> = 16, respectively, <italic>p</italic> = 0.033). More educated patients found it easier to follow up the doctor’s treatment plan than less educated patients (23.2%; <italic>n</italic> = 19 vs. 9.5%; <italic>n</italic> = 10, respectively; <italic>p</italic> = 0.035).</p><p><bold><italic>Conclusions</italic></bold>. More educated patients are more likely to follow up the doctor’s treatment plan and see it easier than less educated patients. Thus, more attention should be paid to less educated patients in order to increase their own impact on their post-MI treatment.</p></abstract>ARTICLEtrue the increase of uric acid associated with the components of the metabolic syndrome?<abstract><title style='display:none'>Summary</title><p><bold>Objectives:</bold> There is increasing evidence that metabolic syndrome (MetS) may be associated with increased uric acid levels. Previous studies indicate that hyperuricaemia is an independent risk factor for cardiovascular disorders. We sought to determine the association of serum uric acid (SUA) with MetS components and other cardiovascular risk factors among middle aged Lithuanians with MetS.</p><p><bold>Design and methods:</bold> A cross-sectional study was conducted in 2018. A total of 705 subjects aged 40 to 65 years with MetS diagnosed using NCEP ATP III criteria were included. None of the participants had previously diagnosed cardiovascular, cerebrovascular, peripheral artery or end-stage oncological disease. Blood tests and all anthropometric measurements were obtained using standard methods. Subjects were divided into 2 groups: with hyperuricaemia and without hyperuricaemia.</p><p><bold>Results:</bold> Hyperuricaemia was found in 33.3% of subjects. Mean serum uric acid level increased as the number of metabolic factors increased. Participants with hyperuricaemia had abnormal waist circumference (p &lt; 0.001), higher systolic (p = 0.001) and diastolic blood pressure (p = 0.003), higher levels of triglycerides and, lower levels of high-density lipoprotein cholesterol (p &lt; 0.001). Subjects in hyperuricaemia group were more likely to be alcohol users (p = 0.034), to have diabetes (p = 0.02) and higher body mass index (p &lt; 0.001). Their creatinine levels were statistically significantly higher (p &lt; 0.001).</p><p><bold>Conclusions:</bold> Our analysis showed that serum uric acid is associated with MetS and other cardiovascular risk factors. The study found a statistically significant association with the four out of five components of the MetS (excluding plasma glucose) as well as with alcohol consumption, and renal function indicators (creatinine, eGFR).</p></abstract>ARTICLEtrue regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome<abstract><title style='display:none'>Summary</title><p>We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin.</p><p><bold>Conclusion</bold></p><p>Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.</p></abstract>ARTICLEtrue analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction<abstract><title style='display:none'>Summary</title><p>Right ventricular myocardial infarction (RVMI) accompanies about 30–50% of inferior wall myocardial infarction. RVMI is associated with higher rates of cardiogenic shock, atrioventricular block, atrial fibrillation, increased mortality rates. The topic requires a scientific update, as only a few studies have been made on RVMI during the past decade. We aimed to analyse the impact of RVMI on inferior myocardial infarction.</p><p><bold>Design and methods</bold>: Retrospective study included 310 patients with documented inferior myocardial infarction (with and without RVMI) between January 2013 and January 2014. Data on baseline characteristics, mortality, in-hospital complications: cardiogenic shock and rhythm and conduction disorders was collected.</p><p><bold>Results</bold>: In 102 (32.9%) patients with inferior myocardial infarction, RVMI was present and 208 (67.1%) cases were without RVMI involvement. RVMI patients had higher rate of rhythm and conduction disturbances than patients without RVMI involvement: atrioventricular block (OR 3.8, 95% CI 2.0–7.1, <italic>p</italic> &lt; 0.001), atrial fibrillation (OR 1.6, 95% CI 0.9–2.9, <italic>p</italic> = 0.001), also higher incidence of cardiogenic shock (OR 2.6, 95% CI 1.7–3.9, <italic>p</italic> &lt; 0.001). Mortality rates after 24 months were higher in RVMI group (OR 1.8, 95% CI 1.2–3.8, <italic>p</italic> = 0.034). No significant difference was found on in-hospital mortality.</p><p><bold>Conclusions</bold>: Right ventricular involvement complicates the long-term mortality and outcomes after inferior myocardial infarction. It is related to a higher incidence of in-hospital complications, especially I–III degree AV block and atrial fibrillation. However, influence on long-term mortality needs further investigation.</p></abstract>ARTICLEtrue tachycardia in a patient with cardiac haemochromatosis and normal left-ventricular ejection fraction<abstract><title style='display:none'>Summary</title><p>We describe a rare case of ventricular arrhythmia in a patient with cardiac haemochromatosis related to iron overload in the myocardium and without evidence of systolic dysfunction or heart failure. This case stresses the utility of cardiac magnetic resonance imaging for the early identification of iron overload in the heart and starting appropriate treatment.</p></abstract>ARTICLEtrue prevention strategy for cardiovascular disease in Lithuania<abstract><title style='display:none'>Summary</title><p>Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006.</p><p>Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years.</p><p>Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities.</p></abstract>ARTICLEtrue myocardial injury<abstract><title style='display:none'>Summary</title><p>We report a case of 37-year-old male, who was admitted to the Vilnius University hospital Santaros Klinikos emergency department suffering from acute chest pain. ECG and elevated troponin level confirmed ST-elevation myocardial infarction, although coronary angiogram had not shown hemodynamically significant changes in coronary arteries. Patient admitted after using cocaine a day ago. To conclude, myocardial infarction is rare, but serious consequence of cocaine use. Clinicians should consider interrogating all young patients presented to the emergency department with acute chest pain for cocaine use.</p></abstract>ARTICLEtrue stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review<abstract><title style='display:none'>Summary</title><p>Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required.</p></abstract>ARTICLEtrue paper: A new type of polyphenols-containing dietary supplement for correction of lipids and inflammatory markers in patients with coronary artery disease<abstract><title style='display:none'>Abstract</title><p>Objective: To evaluate the impact of two original compositions of polyphenols-containing dietary supplement on lipid profile and level of C-reactive protein (CRP) in patients with angiographycally verified coronary artery disease (CAD). Design and methods: 167 patients were selected during their scheduled post-event elective bicycle stress-test examination. All patients received standard CAD therapy and permanent statin therapy and had elevated total cholesterol (TC &gt; 5.0 mmol/L) and/or CRP (&gt;3.5 mg/L) levels. The study consisted of 2 days of polyphenol depletion followed by a 12-week supplementation period in a randomized, blinded, placebo-uncontrolled parallel design. Two different compositions SILVA 1 (Quercetine, linseed oil and Resveratrol), and SILVA 2 (Quercetine, linseed oil and Pycnogenol) were tested. Results: All parameters changed compared baseline and 1 and 3 months in both groups. CRP decreased from 2.48 ± 1.62 mg/L at baseline to 1.97 ± 1.15 mg/L, high density cholesterol (HDL-C) increased from 1.18 ± 0.31 to 1.38 ± 0.34 mmol/L, also decrease of triglycerides (TG) from 1.5 to 1.29 mmol/L after 3 months treatment in SILVA I group was statistically significant (p &lt; 0.001). Changes of parameters between baseline and 1 or 3 months in SILVA II group were not statistically significant. Hovewer, decrease of CRP (from 2.6 ± 1.28 to 2.41 ± 1.68), decrease of low density cholesterol (LDL-C from 2.95 ± 1.2 to 2.88 ± 1.21), increase of HDL-C (from 1.25 ± 0.22 to 1.34 ± 0.23), decrease of TC (from 5.2 ± 1.3 to 5.1 ± 1.28) and decrease of TG (from 1.4 ± 0.41 to 1.3 ± 0.38) can be counted as tendency of changes. Conclusion: This study reveals the superiority of treatment with statins in combination with composition containing Resveratrol for correction of lipid profile and inflamation marker CRP of patients with CAD</p></abstract>ARTICLEtrue report: Life-saving pulmonary endarterectomy for a young female with primary antiphospholipid syndrome complicated by severe chronic thromboembolic pulmonary hypertension<abstract><title style='display:none'>Abstract</title><p> Background: Prothrombotic state and impaired clot dissolution can contribute to the occurrence of chronic thromboembolic pulmonary hypertension in primary antiphospholipid syndrome. Pulmonary endarterectomy - the surgical removal of the organized thromboembolic material from the proximal pulmonary arteries - is the procedure of choice and potentially a curative option for patients with chronic thromboembolic pulmonary hypertension, including patients with antiphospholipid syndrome. We report an exceptionally severe and complicated case with favourable outcome. Case presentation: We present a case of a successful high risk pulmonary endarterectomy in a 29-year-old female with primary antiphospholipid syndrome and end-stage chronic thromboembolic pulmonary hypertension. Despite highly complicated perioperative course an impressive improvement in symptoms and functional status was achieved. Conclusion: We hope that this complicated but successfully managed case of a combination of two rare diseases will arouse earlier suspicion and timely diagnosis for such patients and will encourage physicians to promptly refer the suitable patients to a pulmonary endarterectomy team. It is important to remember that severe thrombocytopenia may occur in patients with antiphospholipid syndrome</p></abstract>ARTICLEtrue The choice and cardiovascular safety of particular nonsteroidal anti-inflammatory drugs<abstract><title style='display:none'>Abstract</title><p> Nonsteroidal anti-inflammatory drugs (NSAIDs) are authorized for the relief of pain and inflammation in a wide range of conditions including the discomfort associated with headaches, osteoarthritis, rheumatoid arthritis, and menstrual pain and are available by prescription or over-the-counter (OTC). We reviewed common adverse effects of NSAIDs (especially those related to cardiovascular [CV] system) along with NICE (National Institute for Health and Care Excellence), EMA (European Medicines Agency), and the FDA (U.S. Food and Drug Administration) guidelines for safe and effective use of particular NSAIDs. Furthermore, we examined the NSAIDs market in Lithuania in a period between June 2016 and May 2017 and discussed how well recommendations mentioned above were followed. We emphasized that there was a high percentage of diclofenac prescribed in Lithuania while international guidelines encourage prescribing ibuprofen or naproxen for their relatively lower CV risk. Reviewing past trials, we observed that despite existing guidelines no single NSAID could be considered to be the safest one due to a lack of superiority trials</p></abstract>ARTICLEtrue failure awareness: a cross-sectional study on misconceptions and educational opportunities<abstract><title style='display:none'>Abstract</title><p> Heart failure (HF) is an increasing cause of cardiovascular morbidity and mortality. However, the lay public awareness about HF is shown to be inferior to the knowledge of myocardial infarction or stroke. The vast majority of HF patients lack basic comprehension of HF and self-care, which translates into suboptimal treatment outcomes. Therefore this study aimed to establish the present level of knowledge about HF of the lay public and to evaluate the effects of a single public lecture for the consideration of implementing further steps to raise public awareness. Design and methods: We performed a cross sectional survey study using an anonymous questionnaire designed by the German Competence Network Heart Failure (CNHF). Respondents were selected randomly and fulfilled the questionnaire free-willingly prior to and after a standardized lecture on HF. The CNHF questionnaire consisted of two sets of questions focusing on individual characteristics of the respondent and HF-related knowledge. The gathered data were verified by a standardized procedure in Wurzburg, Germany. Results: Among 1025 respondents 60% were females: 15% of the participants had occupational experience in the medical field. The majority (79%) of the study population had heard about HF previously. Typical complaints and symptoms of HF were correctly identified as ‘shortness of breath’ by 69%, ‘swelling of feet’ by 56%, ‘fatigue’ by 56%, and ‘weakness’ by 54% survey participants. The lecture resulted in 22% (from 26% to 48%) increase of correct identification of the combination all three HF symptoms (shortness of breath, swelling of feet and tiredness). The lecture significantly increased the proportion of correct answers for most of the questions. Particularly notable gains were observed in respondents without prior medical experience. Conclusion: The study population’s initial awareness of HF was insufficient. Standardized lecture improved the short-term knowledge about HF symptoms and nature of the disease. Regular educational activities increasing the HF awareness of general population and HF patients can increase the overall HF treatment success.</p></abstract>ARTICLEtrue