Ante Matana

Unmasking effect of propafenone on the concealed form of the Brugada phenomenon

A case report of a patient with frequent ventricular premature beats but with an otherwise normal ECG and no structural heart disease. Propafenone in therapeutical doses unmasked the ECG picture of the Brugada phenomenon

Prognostic significance of complete atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement

Data were obtained and analyzed in 243 patients with acute inferior myocardial infarction who were admitted to the coronary care unit during the years 1987 and 1988. One hundred and ninety-eight patients had no signs of right ventricular involvement (group I), whereas 45 patients had inferior myocardial infarction with right ventricular infarction (group II). Patients were divided into groups depending on the presence or absence of complete atrioventricular block during hospital stay (groups Ia and IIa without block and groups Ib and IIb with block). Selected clinical and laboratory variables were compared for each group. We found that patients with inferior myocardial infarction and complete atrioventricular block had significantly higher mortality rates only in the presence of right ventricular infarction: 41% mortality rate in group IIb versus 11% mortality rate in group Ib (p less than 0.05). Patients with right ventricular infarction but without complete atrioventricular block (group IIa) had a mortality rate similar to that found in patients with inferior myocardial infarction and no atrioventricular block (group Ia): 14% versus 11% (p = NS). In patients with inferior myocardial infarction without right ventricular involvement (group I), complete atrioventricular block did not influence survival: 14% mortality rate in group Ib versus 11% mortality rate in group Ia (p = NS). The excessively high mortality rate in patients who have inferior myocardial infarction with right ventricular involvement and complete atrioventricular block could be the consequence of greater infarct size, but the synergistic influence of right ventricular infarction and complete atrioventricular block could be the other factor that influences outcome.

Relationship between QT dispersion and the incidence of early ventricular arrhythmias in patients with acute myocardial infarction

There is controversy about the influence of QT dispersion on the incidence of early ventricular arrhythmias in patients with acute myocardial infarction (AMI). The QT and QTc dispersion (QTd, QTcd) between two groups of patients with AMI were compared: 39 patients with early sustained ventricular tachycardia or ventricular fibrillation (VT/VF) and 40 patients without such arrhythmias. QTd and QTcd were calculated from the admission and predischarge ECG, expressed as the difference between the maximum and minimum QT and QTc interval in 12 leads. The coefficient of variability was also calculated (VQT, VQTc). Groups did not differ significantly in age, incidence of previous infarction, Killip class, electrolyte status, infarct location, expected and final ECG infarct size, enzymatic infarct size, thrombolytic treatment and reperfusion rate, i.e., in variables that could influence the VT/VF occurrence. On admission, patients with VT/VF had significantly greater QTd (77+/-23 vs 53+/-27 ms, P<0.001) and QTcd (90+/-29 vs 62+/-28 ms, P<0.001); VQT and VQTc were also significantly higher. Although similar differences existed on predischarge ECG, they were smaller. The results indicate that QT dispersion varies during the illness, and that measurements of QT dispersion could be helpful in predicting serious ventricular arrhythmias.

Persistent and progressive st segment elevation caused by myocardial metastasis

This is a case of a female patient with collecting duct carcinoma of the right kidney and myocardial metastasis. On electrocardiogram the myocardial metastasis presented with a prolonged and progressive ST elevation and a gradual decrease of the R wave amplitude in leads V3-V6. Echocardiography and autopsy findings confirmed the diagnosis.

Can the difference in serum concentration of urea and cystatin C be used in diagnosis and prognosis of heart failure

Changes in renal function are an important diagnostic and prognostic indicator in patients with heart failure (HF). They are caused by decreased renal perfusion and consequently decreased glomerular filtration rate (GFR), or by the effect of increased neurohormonal activity (sympathetic nervous system [SNS], rennin-angiotensin-aldosterone system [RAAS] and arginine vasopressin [AVP]). However, the increase of serum concentration of urea, creatinine and other metabolites is not specific for HF. Therefore, it is not possible to distinguish HF from renal diseases solely based on the increase of their concentration, since the increase of their concentration caused by the decrease of GFR cannot be differentiated from the increase due to neurohormonal activity. Urea and cystatin C (Cys C) have different mechanisms of renal elimination, so it can be assumed that in HF their concentrations will not be increased proportionally, what can be used for diagnostic and prognostic purposes. After glomerular filtration Cy C undergoes proximal tubular reabsorption and breakdown, without returning to the blood flow. Since it is not secreted, its serum concentration depends only on GFR. In contrast to Cys C, urea is filtered in glomerulus and subsequently reabsorbed in proximal tubules and collecting duct. Reabsorption of urea is modified by effects of SNS, RAAS and AVP. Therefore its serum concentration depends upon GFR and neurohormonal effect on the tubular function. Since the increase of serum concentration of Cys C is caused only by the effect of the decreased renal perfusion on GFR, while the increase of urea is a result from both decreased GFR and tubular effects of increased neurohormonal activity, the paper hypothesis is that in HF the increase of urea will be significantly higher than the increase of serum Cys C, while in the patients with renal diseases their increase would be mostly proportional. It can be assumed that the disproportion between the increase of Cys C and urea would indicate an increased neurohormonal activity in patients with HF and correlate with its activity. If this hypothesis is proved correct, this parameter could be used in HF diagnosis and risk stratification of such patients.

Right-Sided Cardiac Thromboembolism and its Successful Treatment with Streptokinase: Case Report

A sixty-eight-year-old woman with a clinical diagnosis of pulmonary embolism and large right-heart embolus on echocardiography is presented. Because of the critical clinical condition of the patient and the inability to perform surgical intervention, thrombolytic treatment (streptokinase) was administered. The patients condition improved, the right-heart embolus disappeared, and on the perfusion lung scan there was only one small perfusion defect in the right lung. The authors consider thrombolysis to be appropriate treatment for right-heart thromboembolism whenever surgical embolectomy is not possible.

A simple prognostic model for assessing in-hospital mortality risk in patients with acutely decompensated heart failure

Abstract Background An assessing of the in-hospital mortality risk for an emergency hospitalized patient with acutely decompensated heart failure (ADHF) is challenging task. Simple formula can help. Methods On the base of six indicators identified in derivation group, simple formula for assessing the risk for in-hospital mortality of ADHF patients was derived and later tested in validation group. Results The retrospective analysis of a derivation group (533 survivors, 121 deceased) identified six risk indicators: age, heart rate (HR), systolic blood pressure (SBP) and serum concentrations of urea, sodium (Na) and uric acid (UA). The final formula was created ([age/10]2 × HR/SBP)+(Urea-Na/10)+UA/100 and formula result of 53 was established as cut-off result. In the derivation group, at the cut-off point of 53, area under the ROC curve (AUC) was 0.741 (95% CI 0.701–0.776); with sensitivity 54% and specificity 83%. The discriminative capacity of the formula was significantly higher than each of its components. In the validation group of 591 patients (527 survived, 64 died) AUC was also 0.741 (95% CI 0.706–0.774), sensitivity was 66% and specificity 76%. Positive predictive value (PPV) of the developed formula was modest (34%), but negative predictive value (NPV) was 95%. N-terminal pro-B type natriuretic peptide and troponin I were determined, but not included into formula. Conclusions The developed formula enables simple, rapid and inexpensive risk assessment, but its disadvantage is a low PPV. However, a high NPV permits the identification of patients with a low risk of in-hospital mortality, which could lead to a more rational patient treatment.

Permanent left atrial electromechanical dissociation after conversion of atrial fibrillation in a patient with interatrial block

In a 52‐year‐old woman, pharmacological conversion to sinus rhythm was achieved after 31 days of atrial fibrillation. In spite of permanent sinus rhythm, even 7 months after the conversion, no mechanical left atrial activity was restored, although right atrium showed normal contractility.

Primary spontaneous pneumothorax and mitral valve prolapse are not associated

ZusammenfassungEINLEITUNG: Mitralklappenprolaps ist eine häufige Diagnose bei Patienten mit primärem Spontanpneumothorax. Es wird davon ausgegangen, dass der Mitralklappenprolaps und der primäre Spontanpneumothorax eine Manifestation von systemischen Anomalien des Bindegewebes sein könnte. Ziel dieser Studie war es, die Prävalenz von Mitralklappenprolaps bei Patienten kroatischer Herkunft mit primären Spontanpneumothorax zu erheben und ihre mögliche Assoziation mit Bindgewebserkrankungen zu erfassen. Wir untersuchen umgekehrt auch die Prävalenz von primärem Spontanpneumothorax bei Patienten mit primärem Mitralklappenprolaps. METHODEN: Bei 32 Patienten mit primärem Spontanpneumothorax ohne bestehende Lungenerkrankungen oder Bindegewebserkrankungen wurde eine zweidimensionale transthorakale Echokardiografie von einem zertifizierten Kardiologen durchgeführt. Echokardiographische und demografische Merkmale wurden mittels deskriptiver Statistik analysiert. Ebenso haben wir medizinische Aufzeichnungen von 60 Patienten mit Mitralklappenprolaps ausgewertet. ERGEBNISSE: Es wurde bei keinem Patienten mit primärem Spontanpneumothorax ein Mitralklappenprolaps festgestellt. Alter, Geschlecht, Rauchen, Body Mass Index, Seite des Spontanpneumothorax , Häufigkeit des Auftretens und Familienanamnese entsprachen früheren Untersuchungen. Umgekehrt wurde auch bei keinem der 60 Patienten mit primärem Mitralklappenprolaps ein primärer Spontanpneumothorax diagnostiziert. SCHLUSSFOLGERUNG: Unter Anwendung neuer echocardiographischer Kriterien der Definition eines Mitralklappenprolaps, haben wir bei keinem Patienten kroatischer Herkunft mit primärem Spontanpneumothorax einen Mitralklappenprolaps gefunden. Auch haben wir keinen primären Spontanpneumothorax in einer Gruppe von Patienten mit Mitralklappenprolaps feststellen können. Die Herkunft der Patienten könnte einen Einfluss auf die Inzidenz eines Mitralklappenprolapses bei Patienten mit primärem Spontanpneumothorax, sowie auch umgekehrt auf die Inzidenz eines primären Spontanpneumothorax bei Patienten mit primärem Mitralklappenprolaps haben.SummaryBACKGROUND: Mitral valve prolapse (MVP) is a common diagnosis in patients with primary spontaneous pneumothorax (PSP). This description assumes that MVP and PSP might be manifestations of a systemic connective tissue abnormality. The purpose of this study was to determine the prevalence of MVP in PSP patients of Croatian origin and evaluate their relationship with connective tissue disorders. We also examined the prevalence of PSP in patients with primary MVP. METHODS: Thirty-two patients with PSP and without underlying pulmonary disease or connective tissue disease underwent two-dimensional transthoracic echocardiography performed by a certified cardiologist. Echocardiography and demographic features were analyzed using descriptive statistics. We also examined the medical records of 60 patients with primary MVP. RESULTS: MVP was found in none of the 32 patients suffering from PSP. The age, sex, smoking status, body mass index, side, rate, and family history were similar to previous investigations. Likewise, none of the 60 patients with primary MVP ever had PSP. CONCLUSION: By applying an updated definition of MVP, we found no MVP case among PSP patients of Croatian origin. We also found no PSP in the primary MVP group. Ethnicity may influence the occurrence of MVP in PSP patients, and PSP in primary MVP patients.

Rare case of a large aneurysm of Valsalva's sinus rupturing into the right ventricle.

Aneurysm of Valsalvas sinus is a rare, serious condition with potentially adverse consequences. In this paper, an unusually large aneurysm rupturing into the right ventricle is presented.