This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern--concentration in the first measurement is higher than in the second one, and biphasic pattern--concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3 +/- 10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p < 0.001). We found statistically significant real negative correlation (p < 0.05) between BNP concentration and left ventricle ejection fraction (LVEF) with high correlation coefficient (r = -0.684). BNP concentrations were significantly higher among patients in Killip class II and III compared to Killip class I; Killip class I BNP = 226.18 pg/mL vs. Killip class II 622.51 pg/mL vs. Killip class III 1530.28 pg/mL, p < 0.001. BNP concentrations were significantly higher in patients with; (i) myocardial infarction vs. controls; (BNP 835.80 pg/mL vs. 243.03 pg/mL); (ii) in pts with positive major adverse cardiac events (MACE) vs. negative MACE (BNP 779.08 pg/mL vs. 242.28 pg/mL, p < 0.001); (iii) in pts with positive compared to negative left ventricle (LV) remodelling (BNP 840.77 pg/mL vs. 341.41 pg/mL, p < 0.001). Group with biphasic pattern of BNP release had significantly higher BNP concentration compared to monophasic pattern group. In biphasic pattern group we found significant presence of lower LVEF, Killip class II and III, LV remodelling and MACE. We found that BNP is strong marker of adverse cardiac events in patients presenting with a myocardial infarction. In our AMI group we found significant elevation of BNP and it is suspected that second peak secretion is not only due to systolic dysfunction and subsequent remodeling of LV but also due to impact of ischaemia. Patients with biphasic pattern probably have worse prognosis due to severe coronary heart disease. Besides its diagnostic role as a simple blood marker of systolic function, BNP is also important prognostic marker who helps making clinical decision about early invasive vs. conservative management.

The evolution of homocysteine (Hcy) changes after acute myocardial infarction is still not elucidated. Serum Hcy concentration has been shown to increase between acute and convalescent period after myocardial infarction and stroke. Also a decrease in serum Hcy during acute phase was observed. It is still not clear whether the Hcy is a culprit or an innocent bystander in cardiovascular diseases. Addressing the discrepancies in Hcy changes in patients with acute myocardial infarction might give insight in Hcy role in cardiovascular diseases and offer implications both for the clinical interpretation and patients risk stratification. The aim of the study was to evaluate serum Hcy concentration changes during early post myocardial infarction. The study included 55 patients with AMI from the Clinics for Heart Diseases and Rheumatism at University of Sarajevo Clinics Centre. For Hcy analysis blood was collected on day 2 and 5 after the AMI onset. Serum Hcy concentration was determined quantitatively with fluorescent polarisation immunoassay on AxSYM system. Cluster analysis revealed two groups of AMI patients with different trends of serum Hcy changes. Increase in serum Hcy concentration was observed in 33 (60,0%) patients (AMI 1 group), while in 22 (40,0%) patients a decrease was observed (AMI 2 group). On day 2, patients in AMI 2 group had significantly higher mean Hcy concentration compared to AMI 1 group of patients (15,27+/-0,96 and 11,59+/-0,61 micromol/L p<0,05). On day 5, no significant difference in mean Hcy level between AMI 1 and AMI 2 group of patients was observed (14,86+/-1,1 vs. 12,75+/-0,74 micromol/L respectively). Significant differences between AMI 1 and AMI 2 patients were observed in VLDLC levels and CK-MB activity on day 2. Patients in AMI 1 group had significant increase in platelets count from day 2 to day 5 (230,1+/-11,6 vs. 244,2+/-11,0; p<0,05). Our study of serial Hcy changes in patients with AMI revealed two different patterns of Hcy changes in early post infarction period which might reflect two distinct populations of AMI patients. Although further research is necessary, possible explanation for the observed findings could be a different genetic background, vitamin and oxidative status of patients with AMI.

The study was designed with the main intent to assess and explain the differences between athlete's heart syndrome and the heart of healthy non-athletes, and to distinguish between physiological and pathological heart condition. Prolonged athletic training causes changes in heart that are termed "athlete's heart syndrome". Athlete's heart diagnosis and related issues are a great challenge due to complementary morphological, functional and electro-physiological changes that may indicate both physiological and pathological condition. The study included 150 subjects, of those 100 were active athletes and 50 were in control group. The study protocol included one clinical examination, one electrocardiogram and one echocardiograph for each subject. Average age was 20,51+/-8,51 in the athletes and 21,48+/-2,53 in control group. Significantly higher average left ventricle (LV) mass (401,23 g vs. 143,23 g) and LV mass index (196,05 g/m2 vs. 83,98 g/m2) was found in the athletes (p<0,05). The study showed increased mass and wall thickness with usual inner dimensions of athlete's heart. Systolic and diastolic function of athlete's heart is normal. Athlete's heart with these features is a healthy heart.

UNLABELLED The aim of the study is an echocardiographic assessment of the influence of a long-term lisinopril treatment in combination with amlodipine in patients with LV hypertrophy. PATIENTS AND METHODS In a clinical prospective study that lasted for 12 months, there were 20 subjects included whose blood pressure was under control. Prior to and after 12 months, there was an assessment of treatment efficacy through determining the values of blood pressure, cardiac frequency and echocardiographic examination of the heart, while the safety of administration was assessed based on the laboratorial blood and urine analysis and monitoring of undesirable effects. RESULTS Systolic and diastolic blood pressure remained stabile with preserved cardiac frequency. Echocardiographic findings have shown that EF remained intact, and E/A value improved from 0.89 +/- 0.26 to 1.03 +/- 0.61. There were changes in LVMI for 9.3 +/- 1.45 g/m2. CONCLUSION Myocardial function remained preserved even after 2.5 years of treatment with amlodipine and lisinopril, in combination, with good tolerance.

Hypertension is a major risk factor for cardiovascular diseases; drugs that reduce blood pressure and simultaneously improve or reverse endothelian dysfunction, as nebivolol, may be advantageous in terms of cardiovascular protection. The objective of this study is to show the anti-hypertensive efficacy and safety of nebivolol (5 mg once a day) given to patients with arterial hypertension for 3 months. It should also provide information about drug's influence on laboratory tests--fasting blood glucose and serum cholesterol, triglyceride and creatinine concentrations. Six centers--Tuzla, Sarajevo, Mostar, Bihac, Zenica and Banja Luka participated in this prospective study with follow-up period of 3 months that included 3 visits. The study group consisted of 328 hypertensic patients. Results showed a significant decrease in both systolic and diastolic blood pressure and heart rate at the end of the study. Fasting blood glucose level and serum cholesterol, triglyceride and creatinine changed significantly during the study, with lower levels of all the tests. Nebivolol seems to be free from some of the problems that generally accompany not only the classical beta- blockers but sometimes also newer classes of antihypertensive drugs. With its high anti-hypertensive efficiency and safety, and presence of statically significant difference in laboratory tests and beneficial effects, absence of adverse interaction with glucose and lipid metabolism, patients treated with Nebivolol may show an optimal adherence to therapy.

AIM Evaluation of efficacy and safety of long-term (24 weeks) administration of a combined therapy of ACE inhibitors (lisinopril) and calcium-channel antagonists with long-term action (amlodipine) (with or without diuretics). METHOD A total number of 98 patients of both genders were included in the prospective, open trial. Evaluation of efficacy of the trial was carried out by careful monitoring of anamnesis and physical examination, blood-pressure values, pulse, body weight, ECG test and echocardiographic test. Evaluation of safety of the trial was based on the evaluation of a physician, standard laboratory evaluation, adverse effects. RESULT Mean value of blood pressure in the beginning of clinical trial was significantly reduced (from 197.65 +/- 18.05/107.1+/-13.1 mm Hg, to 139.85 +/-10.45/82.6+/-5.47 mmHg) after 24 weeks, without special oscillations in last three months. The pulse remained within physiological limits. In 73.08% patients, echocardiographic test has proven an improvement of ejection fraction. Minor adverse effects have been reported, which were not a reason for interruption of the treatment, with the exception of 3 cases (lower leg oedema, dry cough). CONCLUSION An extremely good effect in patients with moderate hypertension was reported in the trial, as well as in patients with severe hypertension with good tolerance.

In this work we have analyzed 512 coronary angiograms that were done during 2003 year at the Clinic for heart diseases and rheumatism of the University of Sarajevo Clinic Center (UCCS) and we have dissected 20 human hearts at the Institute for Anatomy. We strived to prove frequency of the muscular bridges on branches of the coronary artery, their localization and influence on the arteriosclerotic changes. Using coronary angiography method we consluded that the presence of the muscular bridges in observed population in 4.88% of cases, with the most frequent localization on the anterior interventricular branch (ramus interventricularis anterior). By dissection method the muscular bridges have been found in 55% of cases and the most frequent localization was on the anterior interventricular branch and branches of the right coronary artery. Smaller frequency of the muscular bridges, shown by the angiography method, can be explained by the fact that thick muscular bridges perform weak compression and because of that minimal systolic reduction of the lumen which can not be noticed by the angiography. The muscular bridges are four times frequent on males and they are the most frequent in the age group from 40 to 50 years. In the 88% of patients with the muscular bridges were found arteriosclerotic changes localized proximately from muscular bridge.

CVD are on the first place among death causes in the world. The half of all death at middle age persons is CVD causality, the most often because of ischaemic heart diseases, and there are a few clinic forms: acute coronary syndrome, stabile pectoral angina, variant pectoral angina, syndrome x, and silent myocardial ischemia. Toward definition ACS include clinical manifestation causality of myocardial ischemia due of atherosclerotic plague rupture. ACS include: non-stable pectoral angina non-Q infarction, Q myocardial infarction and sudden cardiac death. Consequence of plague rupture is occlusive thrombus which produces typical ST elevation on ECG after that appearance Q-in ECG with blood markers elevation (Troponin I, T, CK and CK-MB). There are sometimes non-typical ST elevation on ECG with blood markers elevation and chest pain. On that way becomes non-Q infarction. Smaller thrombus make non stable pectoral angina and appearance of ST depression on ECG without blood markers elevation. Sometimes sudden cardiac death is the first sign of coronary disease in the diagnostic management coronary disease due of: clinical symptom of chest pain, ECG (with or without ST elevation) and appearance appsence biochemical blood markers (at myocardial necrosis troponins are present in blood during 14 days, CK-MB is present 3 days). Sometimes echocardiography examination is helpful in estimate of regional kinetic disorders. European society of cardiologists made guidelines for management od ACS without ST elevation and guidelines management of acute myocardial infarction with ST elevation.

Management of hypertension, at the beginning of the new millennium, persists in being a difficult, demanding and responsible task. Beta blockers and diuretics reduce mortality, stroke and coronary disease in patients suffering from arterial hypertension. Newer antihypertensive drugs which block the renin angiotensin system, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), may have additional benefits in high-risk individuals with normal blood pressure. The additional benefit has been confirmed in LIFE and ANBP2 studies. In HOPE study, application of the ACE inhibitors in high-risk patients with "normal" BP values resulted in reduction of major cardiovascular events. Problem of adherence to therapy also continues to be one of the most important problems in management of hypertension. The success of antihypertensive management is directly proportional to the adherence to therapy. The new European guidelines for the management of arterial hypertension and JNC 7 recommendations offer a rational and effective approach to management of hypertension. These two documents contain a series of new attitudes, and reminded of some old and opened some new questions.