Maciej Janiszewski

Is atrial fibrillation a risk factor for normal-tension glaucoma?

Abstract Glaucoma (GL) and atrial fibrillation (AF) are diseases of significant social importance. Cardiovascular disorders such as systemic hypertension, hypotension, increased blood viscosity, vasospasm, and diabetes are potential risk factors of GL, especially when intraocular pressure is not elevated. Only a few studies have reported a possible connection between cardiac arrhythmias and GL. The purpose of this study was to evaluate the risk of GL in patients with AF. A total of 117 patients were included in the study, 79 with AF (AF group) and 38 with sinus rhythm (Control group), matched for age and sex. The mean ± standard deviation age was 73.6 ± 7.2 and 71.6 ± 4.7 years for the AF and control groups, respectively. There were no statistically significant differences in the percentage of systemic hypertension, congestive heart failure, diabetes mellitus type 2, or vascular disease between the groups. Patients were examined for the presence of normal-tension glaucoma (NTG) by an ophthalmologist. NTG was confirmed in 40 patients (34.2%) in the entire group, with 35 (44.3%) in the AF group and 5 (13.15%) in the Control group. The incidence of NTG was significantly higher in the AF group (P = .0221). Women represented 60% of GL patients in the AF group and 80% in the control group. There were no significant differences in intraocular pressure between the groups (mean ± standard deviation, 14.3 ± 2.3 vs. 14.2 ± 2.8 mmHg, P = .4202). Approximately three-fourths of patients with AF and NTG had early visual field damage based on the Hodapp classification. AF, independent of other known cardiovascular risk factors, increases the risk of developing NTG. Many AF patients do not have conspicuous symptoms of GL, so understanding the possible risk of its development is critical because early detection might help to prevent later visual impairment and even irreversible blindness.

CXCL12 in Patients with Chronic Kidney Disease and Healthy Controls: Relationships to Ambulatory 24-Hour Blood Pressure and Echocardiographic Measures

Background/Aims: Chronic kidney disease is a pro-inflammatory condition where the interplay between different regulatory pathways and immune cells mediates an unfavorable remodeling of the vascular wall and myocardial hypertrophy. These mechanisms include the action of CXCL12. The aim of this study is to evaluate the association between serum CXCL12 with left ventricular hypertrophy (LVH) and blood pressure control in chronic kidney disease (CKD) patients. Methods: This single-center observational study involved 90 stable CKD stage 1–5 patients (including 33 renal transplant recipients) and 25 healthy age- and sex-matched control subjects. CXCL12 was quantified by ELISA. 24-h ambulatory blood pressure monitoring was performed in 90 patients and 25 healthy controls. Left ventricular mass index (LVMI) was calculated based on the transthoracic echocardiography measurements in 27 patients out of the CKD population and in the whole control group. Results: CXCL12 correlated significantly with LVMI by multivariate regression analysis (coefficient B = 0.33, p = 0.02) together with age (B = 0.30, p = 0.03) and gender (B = 0.41, p = 0.003). A positive correlation was observed between CXCL12 and average 24-h systolic blood pressure (SBP) (rho = 0.35, p = 0.001), daytime SBP (rho = 0.35, p = 0.001), and nocturnal SBP (rho = 0.30, p = 0.002). Nocturnal hypertension was frequent (46% of CKD patients). Conclusions: The results of our study point towards a link between CXCL12 and LVH as well as blood pressure control among patients with CKD, supporting the thesis that CXCL12 may be regarded as a new potential uremic toxin.

The influence of systemic cryotherapy on selected hemodynamic parameters and the assessment of the safety of its use in patients with successfully treated hypertension

Whole body cryotherapy (WBC) is one of the newer fields of physiotherapy, which consists of the application of temperatures below 110 C for the purpose of activating the stimulation mechanisms of the organism. The cardiovascular system plays an important role in the response of the organism to cryogenic temperatures [1,2]. Included among the main therapeutic effects of whole body cryotherapy are the reduction of pain, the lowering of muscle tension, anti-inflammatory activity, and an improvement of tissue blood supply. From this point of view, it is applied in orthopedics, rheumatology, neurology and also biological regeneration of sportspersons. Cryotherapy supports basic care and facilitates treatment by physical exercise [3e7]. WBC treatment causes a stress reaction in the organism. This manifests itself mainly as superficial skin vasospasm, increased vascular resistance and increased venous return, resulting in an increase in blood pressure (BP) [8e10]. Additionally, changes in blood distribution associated with secondary congestion can be potential causes of myocardial and large vessel dysfunction, which is particularly important in patients with cardiovascular diseases including hypertension [2,6,8].

STEMI in a 26-year-old man after the use of mephedrone

In recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admissionIn recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admission

ST elevation myocardial infarction in a 26-year-old man after the use of mephedrone.

In recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admissionIn recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admission

26-letni mężczyzna z ostrym zespołem wieńcowym (STEMI) po zastosowaniu mefedronu

In recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admissionIn recent years there has been an increase in the number of acute coronary syndromes (ACS) as a direct consequence of the use of psychoactive drugs. While knowledge of cardiovascular complications after the use of ‘classic narcotics’ is quite extensive, knowledge about the harmful effects of new psychostimulants, so-called ‘bath salts’, is little. ‘Bath salts’ is a colloquial name for different kinds of products that contain psychoactive substances that are consumed in order to give effects characteristic of narcotics. A 26-year-old man with a medical history of hypertension and smoking was transferred to our Department from a District Hospital, presenting with severe retrosternal chest pain. The pain had begun at night immediately after drinking alcohol and insufflating mephedrone. His blood pressure (BP) was 190/120 mm Hg and his heart rate was 90 bpm. The electrocardiogram revealed sinus rhythm with 2 to 3-mm ST-segment elevations in leads V2–V5 (Fig. 1). In the emergency room he received aspirin, clopidogrel and 5,000 U of heparin IV. The patient was taken for an emergent cardiac angiography, which revealed total occlusion of the midsegment of the left anterior descending (LAD) artery. Circumflex and right coronary artery were patent (Fig. 2). Primary percutaneous coronary intervention was performed. The initial restoration of patency of the artery revealed a small atherosclerotic plague with thrombus in the place of the previous occlusion (Fig. 3). The patient was given abciximab, and a drug-eluting stent was deployed in the midsegment of the LAD. The result of the procedure was good and TIMI 3 grade flow was restored (Fig. 4). The rest of his hospital course was unremarkable. Echocardiography revealed hypokinesis of the anterior wall and left ventricular ejection fraction of 55%. The patient was discharged after 6 days. Mephedrone is an organic derivative of cathinone used as a stimulant and empathogen. It has been illegal in the European Union since 2010 but is still available on the black market in the form of crystals, powder, tablets, or capsules. The typical side effect of mephedrone is activation of the sympathetic nervous system, characterised by increased BP and tachycardia. Case reports exist of cerebrovascular accident, aortic aneurysm rupture, and sudden deaths in association with mephedrone use. So far there have been no publications proven by coronary angiography of ACS being the immediate consequence of the use of mephedrone. Our case highlights the potential health hazards associated with mephedrone. Taking into account the growing popularity of psychoactive substances, in the coming years we can expect more cardiovascular complications in people who use “bath salts”. People with asymptomatic atherosclerosis are in a particularly high-risk group. Figure 1. Electrocardiogram on admission