Objective: A patient, female, 78 years of age, appears with symptoms of rapid fatigue, headache, vertigo which has progressed followed by irregular blood pressure. She has been diagnosed as hypertensive heart disease, chronic obstructive pulmonary disease (COPD), essential hypertension and supraventricular tachycardia paroxysmal in our clinic. Previously, she diagnosed as essential hypertension, coronary artery disease (CAD), COPD and atrial fibrillation paroxysmal. She was taking non selective beta blocker, angiotensin receptor blocker, iso sorbitol mononitrate (ISMN) and an inhibitor of platelet aggregation, but without any special progress. Figure. No caption available. Design and method: ECG and echocardiogram show underway hypertensive heart disease that shows a deep inverted tunnel-shaped T waves in the left precordial leads and concentric hypertrophy of the left ventricle with IVSs 1.45 mm. Ambulatory Blood Pressure Monitoring (ABPM) show unregulated hypertension stage III, JNC VIII. Spirometry confirmed moderate restrictive disease on the basis of COPD. Results: After two months, patient subjectively feels great and it confirms regulated blood pressure. Control ECG findings point to the complete regression of deep invert T waves in the left precordial leads. Control echocardiogram shows improving left ventricular compliance is verified with regression IVS thickness from 1.29 mm to the improvement of diastolic heart function. (ABPM) show regulated hypertension stage I, JNC VIII. Conclusions: In the literature there is not a lot of work in combination therapy with selective beta 1-blocker and calcium channel blocker third generation in the treatment of hypertensive heart disease. Our work shows that in the short time interval combination with these two groups of drugs can significantly contribute to the improvement of the clinical picture and objective parameters ECG and echocardiogram for hypertensive heart disease.

Introduction: This study evaluated the frequency of domination of the coronary arteries types in patients treated by surgical myocardial revascularization. The aim of the study was to determine whether the left coronary circulation dominance is a prognostic factor for poorer outcome in patients undergoing coronary artery bypass surgery. Material and methods: A total sample consisted of 100 patients with coronary artery disease that were treated with coronary artery bypass grafting at the Clinic for Cardiac Surgery, Clinical Center of the University of Sarajevo. To all patients on the basis of preoperative coronary angiography was determined the dominance of the coronary arteries. Patients included in the study were divided into two groups, with the left and right with coronary dominance. Results: Left coronary dominance in a sample of patients was present in 21/100 (21%), right in 69/100 (69%) and balanced in 10/100 (10%) cases. Female gender was significantly more frequent in patients with left coronary dominance and proved to be a stronger predictor of poorer outcome, especially in combination with left main stenosis of the left coronary artery and left coronary dominance. Inability of revascularization of the r. interventricularis posterior (RIVP) was statistically significantly higher in case of left dominance 9/21 (42.9%), compared to the right 16/79 (20.3%), p=0.033. Lethal outcome was more common in case of left dominance in relation to the right (9.4% vs 0.9%). The incidence of surgical complications, respiratory, neurological and renal complications was not significantly different between groups, while the length of hospital stay was significantly higher in the group of patients with left dominance, p = 0.003. Conclusion: Left coronary dominance is an important risk factor for patients undergoing surgical myocardial revascularization.