Zoran Stajic

United in Prevention–Electrocardiographic Screening for Chronic Obstructive Pulmonary Disease

CONFLICT OF INTEREST: NONE DECLARED Introduction P-wave abnormalities on the resting electrocardiogram have been associated with cardiovascular or pulmonary disease. So far, “Gothic” P wave and verticalization of the frontal plane axis is related to lung disease, particularly obstructive lung disease. Aim We tested if inverted P wave in AVl as a lone criteria of P wave axis >70° could be screening tool for emphysema. Material and method 1095 routine electrocardiograms (ECGs) were reviewed which yielded 478 (82,1%) ECGs with vertical P-axis in sinus rhythm. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history and pulmonary function tests. Conclusion Electrocardiogram is very effective screening tool not only in cardiovascular field but in chronic obstructive pulmonary disease. The verticality of the P axis is usually immediately apparent, making electrocardiogram rapid screening test for emphysema.

Preeclampsia and level of oxidative stress in the first trimester of pregnancy

Background/Aim. Introduction: Preeclampsia (PE) is a multisistemic syndrome that complicates 5-8% of all pregnancies. The aim of this study was to evaluate the biochemical parameters of oxidative stress in the first trimester of pregnancy in patients with preeclampsia, with the purpose of comparing the level of oxidative stress with normal pregnancy. Materials and methods. The study was conducted as a prospective study. The study included total of 107 pregnant women divided into two groups. In the study group (n=33) there were women who developed preeclampsia in the current pregnancy. The control group (n=74) were healthy pregnant women. Blood samples were taken between 11. and 14. weeks of gestation, and the values of Superoxide dismutase (SOD), Glutathione peroxidase (GSH-Px) and Total antioxidant status (TAS) were determined in serum by enzymatic colorimetric methods. Results. The values of SOD and GHS-Px were statistically higher in the study group, while the values of TAS were statistically higher in the control group. The level of TAS correlated with GSH-Px and SOD correlated with TAS, but there is no statistical significant correlation between GSH-Px and SOD in the study group. Conclusion. The results of this study suggest a higher level of oxidative stress in the first trimester of pregnancy with preeclampsia, which may indicate that the initiation and development of pathophysiological processes underlying preeclampsia start much earlier than the clinical syndrome exhibit. [Projekat Ministarstva nauke Republike Srbije, br. 174019]

History of sports medicine in east European countries

The purpose of this article is to provide a historical background of medicine, science and sports with the focus on the development of modern sports medicine in European countries, with an accent on Eastern European countries that have a long sports medicine tradition. The development of modern sports medicine began at the end of 19th and the beginning of 20th century, and it has been associated with social and cultural changes in the world of medicine, science and sports. Advanced medical knowledge, skills and practices, and the progress of scientific achievements enabled sports people to improve their performance level. Increased popularisation and commercialisation of sports have resulted from urbanization and city lifestyle, leading to the lack of physical activity and increased psychological pressure. In addition, the growing need and interest in sports and successes in professional sports have become a symbol of international recognition and

Unusual occurrence of ventricular tachycardia induced by single bee sting.

Sir, A 35-year-old female patient was admitted to our emergency room with palpitations, 1 h after a single bee sting in the left hand. She was previously in good health, not on any medications and did not have any past allergic reactions. Local inspection of the left hand revealed only mild erythema and swelling. Hemoglobin, thyroid-stimulating hormone, and serum electrolyte levels were within the normal range. Initial 12-lead electrocardiogram (ECG) showed short runs of the nonsustained ventricular tachycardia (VT) [Figure 1]. Only a few seconds later, she suddenly complained of chest discomfort, dizziness, and intensive palpitations. Repeat ECG showed wide QRS-complex tachycardia at a rate of 160 b.p.m. without detectable P-waves [Figure 2]. A bolus of 150 mg amiodarone i.v. was administered, which rapidly terminated VT and restored normal sinus rhythm [Figure 3]. The treatment was continued with bisoprolol 2.5 mg twice daily. Figure 1 Electrocardiogram showing standard Leads I, II, and III: Frequent ectopic ventricular beats with short runs of the nonsustained ventricular tachycardia Figure 2 Electrocardiogram showing standard Leads I, II, and III: Sustained ventricular tachycardia with the right bundle branch block pattern Figure 3 Electrocardiogram showing standard Leads I, II, and III: Regular sinus rhythm just after conversion with amiodarone Transthoracic echocardiography revealed only a mild mitral valve prolapse with mild mitral regurgitation. The patient refused to undergo further invasive investigations (namely coronary angiography and electrophysiological study) so we performed computed tomography-coronary angiography, which showed the normal anatomy of the coronary arteries and the absence of stenosis. The patient was discharged after 48 h and remained asymptomatic during the next 6 months follow-up. A 24-h-holter-ECG was performed after 1–6 months and was normal. Bee stings have been associated with a wide variety of local and systemic reactions including rarely, tachyarrhythmias, commonly occurring in individuals with preexisting heart disease such as left atrial enlargement and left ventricular failure.[1] Although the arrhythmogenic mechanism of the bee venom is still unknown, many pharmacologically active constituents of the bee venom have been isolated including histamine, serotonin, dopamine and noradrenaline, melittin, hyaluronidase, apamin, and phospholipase A2 which may induce tachyarrhythmias in the absence of anaphylaxis.[2] However, in the presence of anaphylaxis tachyarrhythmias are more common, and possible mechanisms include a direct antigen-antibody myocardial reaction, a pharmacological effect of mediators released during anaphylaxis, the effects of agents such as adrenaline used for treatment, hypoxia, hypotension, preexisting heart disease or a combination of several factors.[3] In this patient only mild mitral valve prolapse was demonstrated by transthoracic echocardiography; and to the best of our knowledge, this is the first reported case of VT in a patient with mild mitral valve prolapse-induced by single bee sting in the absence of anaphylaxis. Bee venom as a metabolic insult and resultant autonomic overactivity probably induced tachyarrhythmia in this case. Cardiac magnetic resonance imaging to look for myocardial scarring and electrophysiologic study to look for inducibility of idiopathic outflow tract VT would be indicated in the setting of purely monomorphic VT. Finally, this case implies the necessity of meticulous ECG monitoring in patients presenting with palpitations and ventricular ectopic beats after bee sting, because malignant tachyarrhythmias may occur even in the absence of anaphylaxis in the setting of only mild structural heart abnormalities, as reported here. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Extremely rare variant of the single coronary artery.

A 58-year-old male patient was admitted for coronary angiography two months after he suffered non-ST elevation myocardial infarction (NSTEMI) of the lateral wall. A coronary angiography (Fig. 1A) showed presence of a single coronary artery arising from the right sinus of Valsalva, comprising three clustered, separated coronary artery ostia (“triple-barrel”), and absence of significant stenosis. A 64-slice multidetector cardiac computer tomography confirmed this rare variant of the single coronary artery (Fig. 1B–C), as well as the benign anterior course of aberrant LAD to the pulmonary artery (Fig. 1D). Echocardiography demonstrated absence of other cardiac abnormalities. The patient was discharged with optimal medical therapy. Figure 1 Single coronary artery arising from the right sinus of Valsalva, demonstrated by coronary angiography (A) and confirmed by multidetector cardiac computer tomography (B). “Tripple-barrel” pattern of ostium of the single coronary artery ... Single coronary artery (SCA) is a very rare congenital coronary artery anomaly with the estimated incidence of 0.02% in adult patients, usually associated with other cardiac anomalies such as Fallot tetralogy, transposition of great arteries, persistent truncus arteriosus and pulmonary atresia [1]. The current classification system of SCA was proposed by Lipton et al. [2] and the variant of SCA found in our patient is the rarest. Isolated single coronary artery is usually asymptomatic and the prevailing opinion is that it is not prone to the development of atherosclerosis [3]. Possible myocardial ischemia and sudden cardiac death are thought to be associated with interarterial course of aberrant LAD between aorta and the pulmonary artery with subsequent compression [4]. In our patient, isolated SCA was associated with anterior course of LAD and absence of significant atherosclerotic plaques, although the patient had previously suffered NSTEMI.

Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia

INTRODUCTION Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. CASE REPORT A 47-year-old woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2 degrees C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patients symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. CONCLUSION The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.

Forearm Approach for Percutaneous Coronary Procedures

This article gives contemporary review on the forearm approach for percutaneous diagnostic and interventional coronary procedures. Advantages and disadvantages as well as practical issues and current controversies regarding both radial and ulnar artery approach are discussed throughout the paper. Having in mind advantages of forearm approach in terms of safety and comfort over the traditional femoral approach, as well as the rapid development of invasive technology in the past years, it will probably become the default vascular approach for all percutaneous coronary procedures in the near future.