Background: Myocardial surgical revascularization in patients with low left ventricular ejection fraction (LVEF) is accompanied by a high rate of morbidity and mortality. Objective: The aim of this study was to investigate and eliminate the reasons for the most common perioperative and postoperative complications. Methods: A total of 64 were analyzed. of patients during 2019 who underwent coronary artery bypass grafting (CABG), average age 61.29±9.12 years. Results: Out of the total number of operated patients, there were 16 women and 48 men. Patients were divided into two groups. The first group consisted of patients who underwent surgery with the use of cardiopulmonary bypass (cCABG-CPB) and the second group those who underwent surgery without the use of cardiopulmonary bypass (OPCAB). In 41 patients, myocardial infarction was previously recorded. Critical stenosis of the main trunk of the left coronary artery was present in 14 patients. The incidence of postoperative complications was higher in the cCABG-CPB 16/10 group (p0.030). Conclusion: In our study, we confirmed that myocardial revascularization is justified, especially in the case of multivessel coronary disease. In the long term, it significantly improves the systolic function of the left ventricle, and thus and quality and length of life.

Background: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. Blood pressure control rates are as low as 17% to 31% in patients diagnosed with hypertension in high-income countries; control rates are likely poorer in low- to middle- and low-income countries. Blood pressure control rates are as low as 17% to 31% in patients diagnosed with hypertension in high-income countries; control rates are likely poorer in low- to middle- and low- income countries. Overall, 43% to 66% of patients fail to adhere to their prescribed antihypertensive medications, and after 1 year, ≈40% of patients with hypertension may stop their initial drug treatment. Objective: The aim of the study was to evaluate the effects of single pill combination antihypertensive drugs on the adherence to treatment, blood pressure control and cardiovascular events vs. free-combination therapy. Methods: We enrolled 192 adult hypertensive patients not older than 79 years, with untreated or uncontrolled hypertension despite previously receiving free combination antihypertensive therapy, between November 2020 and March 2022. Patients treated with single pill combination (SPC) were compared with an arm of the same size (n = 96) and matched by age and gender who received a standard free combination (FC) antihypertensive therapy. Results: There were significant reductions from baseline to month 6 of follow-up in office SBP in the SPC group vs. reduction in FC group (21.9 vs. 13.1 mmHg; p < 0.0001). There were significant reductions from baseline to month 6 of follow-up in office DBP in the SPC group vs. group with free-combination therapy (13.7 vs. 8.0 mmHg; p < 0.0001). At 6 months, 94 participants (98%) were still prescribed the SPC therapy. At the final 6-month study visit, 84.2% of patients in the SPC therapy group were adherent to the prescribed antihypertensive therapy vs. 52% of patients in the FC group. Target BP values (mean 24h ambulatory systolic/diastolic BP < 130/80 mmHg) were reached by more recipients of SPC than free-combination therapy (78.2% vs. 46.3%, p < 0.05) at month 6 of follow-up. Conclusion: Treatment with single pill combinations (SPC), is the emerging best practice for safe, effective, rapid, and convenient hypertension control. It improves the affordability, adherence and control of arterial hypertension.

Background: Arrhythmias are common problems in hypertensive patients. The presence and complexity of both supraventricular and ventricular arrhythmias may influence morbidity, mortality, as well as the quality of life of patients. Objective: The aim of this study was to assess the diagnostic value of combined 24h BP and ECG Holter monitoring in detection of cardiac arrhythmias in patients with arterial hypertension. Methods: We analyzed the simultaneous records of combined 24h BP and ECG Holter monitoring for 356 adult patients with diagnosed arterial hypertension in the period from January 2017 until January 2021 year. The cardiac arrhythmias were classified in three main groups as following: a) Supraventricular arrhythmias; b) Ventricular arrhythmias; c) Bradyarrhythmia’s. Standard transthoracic echocardiograms were performed in order to evaluate signs of hypertensive or structural heart disease with focus on left ventricle hypertrophy and LV function. Results: Patients had a mean age of 64 ± 11years, 62% male. Average clinic BP was 153.4+18/87.5+14 mmHg. More than 46% of patients displayed a very high-risk profile. In all enrolled patients, cardiac arrhythmia was detected in 302 (84%) patients. The total number of patients with supraventricular arrhythmias was 153 (50,7%). Ventricular arrhythmias were detected in 98 (32,5%) patients. Bradyarrhythmia’s were detected in 51 (16,9%) patients. Elevated resting heart rate in sinus rhythm was detected in 87 (31,6%) of 275 patients with sinus rhythm. Conclusion: Most arrhythmias are related to longstanding arterial hypertension. Effective treatment of arterial hypertension plays important role in preventing structural and functional cardiac abnormalities which will contribute to the reduction of cardiac arrhythmias in hypertensive patients.

Background: A significant number of patients who underwent surgical myocardial revascularization (CABG) have various comorbidities, including left ventricular diastolic dysfunction (LVDD). Objective: The aim of this paper is to show that patients with preoperative LVDD are at an increased risk of postoperative adverse events and have a worse prognosis compared to patients without LVDD. Methods: The study included 116 patients who underwent myocardial revascularization (CABG) performed at Medical Institute Bayer in Tuzla over a period of 1 year. None of the patients had previously undergone CABG or valvular surgery, or undergone stent implantation (PCI). The presence of LV diastolic dysfunction was detected by echocardiography, and the patients were divided into two groups: with and without LVDD, and further classified into three degrees of LVDD. Results: Of the total number of subjects who underwent surgical revascularization of the myocardium without echocardiographically detected LVDD, 24.1% were patients, and 75.9% were patients with LVDD. In the group with LVDD, the range of days spent in the intensive care unit (ICU) is significantly higher compared to patients without LVDD. Also, patients with LVDD had a significantly higher number of hours of inotropic support, a significantly higher number of cases of tachycardia, predominantly atrial fibrillation (POAF). In this group of patients, a greater number of other adverse events were observed, such as myocardial infarction, cardiac or renal failure, TIA or CVI. Of the total number of patients in the study, 107 patients survived surgical myocardial revascularization and had a satisfactory recovery while 9 (7.8%) survived, all from the group with LVDD. Conclusion: Patients with preoperative diastolic dysfunction of the left ventricle, especially with III degree of dysfunction, are exposed to a higher postoperative risk of adverse events such as: atrial fibrillation, prolonged stay in the intensive care unit, the need for longer-term support with inotropes, and the fatal outcome was recorded exclusively in patients with LV diastolic dysfunction.

Background: Left atrial dilatation, according to recent studies is important in the onset of atrial fibrillation, stroke and death. The most reliable echocardiographic parameter of left atrial dilatation is the left atrial volume index (LAVi). Aim: The objective of this study is to evaluate the impact of LAVi on the occurrence of atrial fibrillation after surgical myocardial revascularization (CABG). Methods: A prospective study included 116 patients undergoing surgical myocardial revascularization followed from admission to discharge. The examination was conducted at the Special Hospital “BH Centre for Heart” Tuzla. Preoperative ultrasound examination determined the parameters of left ventricular diastolic function and LAVi in all patients and postoperatively determined the onset of AF, the day of onset, duration in hours, number of episodes. Logistic regression was used to evaluate whether an event occurred or not, and the effect of time on the event of interest was analysed by Cox's parallel hazard regression. Results: 75.9% of patients had diastolic left ventricular dysfunction (LVDD). Preoperative values of LAVi are significantly higher when the LVDD grade is higher. In patients with LVDD and higher LAVi values, the risk of AF occurrence is greater, the longer the duration of AF, and the significantly greater number of AF episodes. As a result of the analysis, the most significant predictors of AF are: LVDD and LAVi. Conclusion: LAVi has the best hazard function in explaining the occurrence of atrial fibrillation after surgical myocardial revascularization.

Background: Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure. Objective: We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder. Methods and Results: The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure. Conclusion: Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.

Introduction: The most common cause of myocardial ischemia is atherosclerotic epicardial coronary artery disease, present in 90% of patients. Risk factors positively correlate with the onset, development and subsequent complications of atherosclerotic disease. Aim: Determine the percentage frequency of classic risk factors for coronary disease in patients with non-ST segment elevation myocardial infarction (NSTEMI), with regard to gender. Methods: A retrospective study was conducted on 600 respondents, treated for NSTEMI at the Clinic for Internal Medicine of the University Clinical Center (UKC) Tuzla, in the period from June 2016 to December 2019. Results: Overall, smoking was the leading risk factor (65%), followed by hypertension (58%), hyperlipoproteinemia (39%), overweight (33%), positive family burden (30%) and diabetes mellitus (19%). In male patients, the leading risk factor was smoking, rating at 74%, while in female patients – it was hypertension at 67%. In younger groups of patients leading risk factors were smoking and a positive family burden. Conclusion: With adequate prevention and treatment measures, a significant reduction in the prevalence of the cardiovascular disease can be achieved, since the risk factors for its development have long been known. Quitting smoking is one of the most effective secondary prevention measure since it reduces the reinfarction risk rate by 50%. Knowledge of coronary risks, as well as success in reducing them, can greatly contribute to patients’ overall sense of contentment and significantly raise their self-confidence.

Introduction: Postoperative Atrial Fibrillation (POAF) is associated with a higher rate of postoperative complications and mortality, as well as with longer hospitalization and increased treatment costs. We have designed and performed a randomized, trial of pharmacological prophylaxis in which the event of interest is POAF. Aim: The aim of this study is to reduce the risk of postoperative, complications associated with this arrhythmia. Methods: We included 240 stable patients with a coronary heart disease, who were referred to elective surgical revascularization of the myocardium. The patients were assigned into three groups of 80 patients each: group A (BB, beta blocker, comparator), group B (BB+ Amiodarone) and group C (BB + Rosuvastatin). The goal was to establish whether intervention by combination therapy was more useful than a comparator. Results: An event of interest (POAF) has occurred in 66 of the total 240 patients. Number of new POAF cases is the lowest in Group B, 14 (17.5%) compared to 25 (31.25%) new cases in the comparator group, and 27 new cases (33.75%) in group C. Absolute risk reduction was 13.75%, ≈14% less POAF in group B compared to comparator. Relative risk reduction was 56% (RR 0.56, p = 0.04). Number Needed to Treat was 7.27. In group C, 33.75% of patients developed POAF. Absolute risk was insignificantly higher in group C (2.5%, NS) compared to the comparator .The number needed to harm was high, 40. Conclusion: The results of our research show that prophylaxis of POAF with combined therapy BB + Amiodarone was the most efficient one.

Aim: The aim of this case report is to show the significance of the cardiac tamponade, it’s timely diagnosis and to present the unusual approach of the treatment. That was conducted with corticosteroids when the surgical procedure gave no results in rare cases like this. Case Report: This paper presents the case of a man aged 72 years with a verified tamponade of pericardium. A large pericardial effusion with tamponade signs was verified by ultrasound and computerized tomography (CT) of the chest in a hemodynamically stable patient, and in the inability to evacuate the same, with pericardial fenestration, was successfully treated with corticosteroids. Conclusion: A large pericardial effusion with the signs of tamponade verified by echocardiography and computerized tomography, in hemodynamically stable patient, and in the inability to evacuate the same by fenestration, was treated successfully with corticosteroids.

Introduction: Dilatation of the left atrium and left ventricular diastolic dysfunction (DDLV) according to recent studies has significance in the occurrence of postoperative atrial fibrillation (AF), stroke and death. Authors of some studies found no relationship between these parameters and atrial fibrillation. Objective: this study is to determine the time of occurrence and duration of atrial fibrillation in patients after surgical revascularization (CABG) due to the presence of left ventricular diastolic dysfunction and left atrium dilatation and identify the most significant predictors of incident AF. Methods: Prospective study included 116 patients undergoing surgical myocardial revascularization followed from admission to discharge. The study was conducted at the Special Hospital “Heart Center BH” Tuzla for a period of one year (March 2011/2012 g.). For all patients was performed preoperative ultrasound examination, especially parameters of diastolic function of the left ventricle and left atrium volume index (LAVi), as the best parameter sized left atrium, and the postoperative occurrence of certain AF and day occurrence, duration in hours, the number of attacks. To assess whether an event occurred or not was used logistic regression, and the effect of time on the event of interest is analyzed by Cox ‘s regression hazard parallel. Results: 75.9 % of patients had DDLV, and 91.4 % were hypertensives, 12.9 % from the previous stroke (ICV) and 42.2 % diabetics (DM), 14 % with COPD. The average age of patients was 61.41 ± 4.69 years. In both groups was 32.8 % women and 67.2 % men. LAVi preoperative values were significantly higher as DDLV greater degree. In patients with DDLV and higher values LAVi risk of AF is higher, the greater the length of AF and significantly higher number of attacks FA. Early occurrence of atrial fibrillation and its longer duration in function with increasing LAVi a marked increase in the value LAVi have the greatest hazard for the early appearance of atrial fibrillation. As a result of analysis of the most significant predictors of AF are DDLV and LAVi. Conclusion: Postoperative atrial fibrillation occurs earlier and lasts longer in patients with DDLV and elevated left atrial volume index especially LAV > 36ml/m2. LAVi has the best explanation of the function of hazard occurrence of atrial fibrillation after CABG.