Predrag Milicevic

Primary PCI for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura. A case report and review of the literature.

Background and Purpose:The occurrence of acute myocardial infarction (AMI) in patients with idiopathic thrombocytopenic purpura (ITP) is rare, especially when the platelet count is low. Since only few case reports have been published, there are no recommendations for the management of thrombocytopenic patients with AMI. The aim of the present study is to discuss different aspects of this challenging issue and to review limited data available in the literature.Case Study:An 80-year-old patient with ITP (platelet count 5 . 109/l) is presented who developed an AMI (ST segment elevation myocardial infarction) and was successfully treated by primary percutaneous coronary intervention (PCI).Conclusion:Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.ZusammenfassungHintergrund und Fragestellung:Akute Myokardinfarkte (AMI) bei Patienten mit idiopathischer thrombozytopenischer Purpura (ITP, Morbus Werlhof) sind seltene Ereignisse. Da in der Literatur nur einige wenige Fälle beschrieben sind, existieren auch keine Therapieempfehlungen für diese Konstellation. In der vorliegenden Studie sollen unterschiedliche Aspekte dieser herausfordernden Situation diskutiert und die verfügbaren Daten aus der Literatur zusammenfassend beschrieben werden.Fallbericht:Geschildert wird der Fall eines 80-jährigen Patienten mit ITP (Thrombozytenzahl 5 . 109/l), der einen AMI (ST-Strecken-Hebungsinfarkt) erlitten hatte und mit primärer perkutaner Koronarintervention (PCI) erfolgreich behandelt wurde.Schlussfolgerung:Das hohe Blutungsrisiko bei Patienten mit ITP und AMI erfordert eine sorgfältige Balance zwischen Antikoagulation bzw. Plättchenhemmung einerseits und Anhebung der Thrombozytenzahl andererseits.

Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura

Background and Purpose:The occurrence of acute myocardial infarction (AMI) in patients with idiopathic thrombocytopenic purpura (ITP) is rare, especially when the platelet count is low. Since only few case reports have been published, there are no recommendations for the management of thrombocytopenic patients with AMI. The aim of the present study is to discuss different aspects of this challenging issue and to review limited data available in the literature.Case Study:An 80-year-old patient with ITP (platelet count 5 . 109/l) is presented who developed an AMI (ST segment elevation myocardial infarction) and was successfully treated by primary percutaneous coronary intervention (PCI).Conclusion:Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.ZusammenfassungHintergrund und Fragestellung:Akute Myokardinfarkte (AMI) bei Patienten mit idiopathischer thrombozytopenischer Purpura (ITP, Morbus Werlhof) sind seltene Ereignisse. Da in der Literatur nur einige wenige Fälle beschrieben sind, existieren auch keine Therapieempfehlungen für diese Konstellation. In der vorliegenden Studie sollen unterschiedliche Aspekte dieser herausfordernden Situation diskutiert und die verfügbaren Daten aus der Literatur zusammenfassend beschrieben werden.Fallbericht:Geschildert wird der Fall eines 80-jährigen Patienten mit ITP (Thrombozytenzahl 5 . 109/l), der einen AMI (ST-Strecken-Hebungsinfarkt) erlitten hatte und mit primärer perkutaner Koronarintervention (PCI) erfolgreich behandelt wurde.Schlussfolgerung:Das hohe Blutungsrisiko bei Patienten mit ITP und AMI erfordert eine sorgfältige Balance zwischen Antikoagulation bzw. Plättchenhemmung einerseits und Anhebung der Thrombozytenzahl andererseits.

Visual assessment vs. strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction

AIMS We sought to determine the prevalence of overt and subclinical LV dysfunction in patients with critical left anterior descending coronary artery (LAD) stenosis but without a history of myocardial infarction and to compare diagnostic value of routine echocardiographic parameters with myocardial strain analysis for detection of critical LAD stenosis. METHODS AND RESULTS We retrospectively studied 269 patients with suspected coronary artery disease (CAD)-209 consecutive patients with critical LAD stenosis and 60 consecutive patients with atypical chest pain and without CAD. Conventional visual assessment of LV asynergy in the LAD territory was compared with global, regional, and segmental peak systolic longitudinal strain (PSLS) parameters derived by two-dimensional speckle tracking echocardiography (2D STE). Wall motion abnormalities in the LAD territory were found in 41% of patients with critical LAD stenosis, whereas, depending on the cut-off value, global longitudinal strain (GLS) was impaired in 42-69% of patients. GLS with an area under the receiver operating characteristic curve (AUC) of 0.85 showed better discriminative power for detecting critical LAD stenosis than conventional wall motion score index (AUC 0.73, P < 0.05, for the difference between the AUCs). PSLS values were significantly lower in basal and midventricular segments supplied by critically narrowed LAD, particularly if they also appeared dysfunctional on visual assessment. CONCLUSIONS Detection of subclinical LV dysfunction by 2D STE might improve identification of patients with critical LAD stenosis, although visually apparent regional LV dysfunction in the LAD territory is not uncommon finding in this subset of patients.

Myocardial mechanical and QTc dispersion for the detection of significant coronary artery disease

AIMS Ischaemic but viable myocardium may exhibit prolongation of contraction and QT interval duration, but it is largely unknown whether non-invasive assessment of regional heterogeneities of myocardial deformation and QT interval duration could identify patients with significant coronary artery disease (CAD). METHODS AND RESULTS We retrospectively studied 205 patients with suspected CAD who underwent coronary angiography. QTc dispersion was assessed from a 12-lead electrocardiogram (ECG) as the difference between the longest and shortest QTc intervals. Contraction duration was assessed as time from the ECG R-(Q-)wave to peak longitudinal strain in each of 18 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of 18 time intervals (dispersionSD18) or as the difference between the longest and shortest time intervals (dispersiondelta). Longitudinal strain was measured by speckle tracking echocardiography. Mean contraction duration was longer in patients with significant CAD compared with control subjects (428 ± 51 vs. 410 ± 40 ms; P = 0.032), and it was correlated to QTc interval duration (r = 0.47; P < 0.001). In contrast to QTc interval duration and dispersion, both parameters of mechanical dispersion were independently associated with CAD (P < 0.001) and had incremental value over traditional risk factors, wall motion abnormalities, and global longitudinal strain (GLS) for the detection of significant CAD. CONCLUSION The QTc interval and myocardial contraction duration are related to the presence of significant CAD in patients without a history of previous myocardial infarction. Myocardial mechanical dispersion has an incremental value to GLS for identifying patients with significant CAD.

[Takotsubo cardiomyopathy: report of the first case series in Serbia and review of the literature].

INTRODUCTION Takotsubo cardiomyopathy is a relatively novel cardiac syndrome that is characterized by transient left ventricular asynergy involving apical and mid-ventricular segments. EPIDEMIOLOGY AND PATHOPHYSIOLOGY It occurs predominantly in elderly women in the absence of obstructive coronary artery disease and is usually associated with severe emotional or physical stress. This syndrome is manifested with chest pain, electrocardiographic changes that mimic acute myocardial infarction, and minimal myocardial enzymatic release. Several different mechanisms have been proposed: coronary artery spasm, dynamic left ventricular outflow/ intracavitary obstruction, coronary microvascular dysfunction and direct catecholamine-mediated cardiomyocite injury. THERAPY AND PROGNOSIS Complete recovery usually occurs after dramatic presentation, frequently complicated with acute heart failure. Therapy is empiric and directed towards supportive measures against cardiogenic shock, acute heart failure, dysrhythmias. In-hospital mortality rate is less than 1%, but long-term prognosis is still unknown. In addition to the review of the literature on takotsubo cardiomyopathy, we present the first series of patients with this syndrome detected in Clinical Hospital Center Zemun.

Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura@@@Primäre PCI wegen akuten Myokardinfarkts bei einem Patienten mit idiopathischer thrombozytopenischer Purpura. Fallbericht und Literaturübersicht: A Case Report and Review of the Literature

Background and Purpose:The occurrence of acute myocardial infarction (AMI) in patients with idiopathic thrombocytopenic purpura (ITP) is rare, especially when the platelet count is low. Since only few case reports have been published, there are no recommendations for the management of thrombocytopenic patients with AMI. The aim of the present study is to discuss different aspects of this challenging issue and to review limited data available in the literature.Case Study:An 80-year-old patient with ITP (platelet count 5 . 109/l) is presented who developed an AMI (ST segment elevation myocardial infarction) and was successfully treated by primary percutaneous coronary intervention (PCI).Conclusion:Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.ZusammenfassungHintergrund und Fragestellung:Akute Myokardinfarkte (AMI) bei Patienten mit idiopathischer thrombozytopenischer Purpura (ITP, Morbus Werlhof) sind seltene Ereignisse. Da in der Literatur nur einige wenige Fälle beschrieben sind, existieren auch keine Therapieempfehlungen für diese Konstellation. In der vorliegenden Studie sollen unterschiedliche Aspekte dieser herausfordernden Situation diskutiert und die verfügbaren Daten aus der Literatur zusammenfassend beschrieben werden.Fallbericht:Geschildert wird der Fall eines 80-jährigen Patienten mit ITP (Thrombozytenzahl 5 . 109/l), der einen AMI (ST-Strecken-Hebungsinfarkt) erlitten hatte und mit primärer perkutaner Koronarintervention (PCI) erfolgreich behandelt wurde.Schlussfolgerung:Das hohe Blutungsrisiko bei Patienten mit ITP und AMI erfordert eine sorgfältige Balance zwischen Antikoagulation bzw. Plättchenhemmung einerseits und Anhebung der Thrombozytenzahl andererseits.