Myocardial infarction, in the diagnostic and therapeutic aspects, is of one of the great social and medical problems. Clinical diagnosis requires the presence of clinical symptoms in combination with indirect indicators of cardiac necrosis, such as biochemical markers- enzymes, electrocardiographic (ECG) and echocardiography findings. Assessment of heart failure by determining markers of myocardial damage is very significant challenge in the process of clinical assessment of patients with myocardial infarction, for further diagnosis, treatment and prognosis. Heart failure occurs in all patients with myocardial infarction, to a lesser or greater extent. Bearing in mind that, a myocardial infarction involving the anterior wall of the heart has worse prognosis, the subject of interest of this study is whether the markers of myocardial damage will be higher in patients with this localization of myocardial infarction. It was interested too, in whether it is possible to find elevated markers of myocardial damage- failure indicators, brain natriuretic peptide, in corelation with clinical signs of cardiac insuficiency.

Introduction: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice and its prevalence increases with age. Patients who develop AF also have cardiovascular risk factors, structural heart disease, and comorbidities, all of which can increase mortality. AF causes a significant economic burden with the increasing trend in AF prevalence and hospitalizations. Research Objectives: The objective of our study is to evaluate the impact of the most common known risk factors on the incidence of atrial fibrillation as an important precursor of cardiac and cerebrovascular morbidity and mortality among our patients in Bosnia and Herzegovina during median follow up period (September 2006 - September 2016). The other objective is to estimate the CHA2DS2-VASc score among our patients based on clinical parameters. Patients and methods: This study includes 2352 ambulant and hospitalized patients with atrial fibrillation. All patients underwent clinical evaluation which includes thorough assessment for potential risk factors and concomitant conditions in order to determine which of them represent the most common among examinees with atrial fibrillation. Results: The results show that male gender has slightly more incidence of AF. Obesity and overweight with BMI ≥ 27, cigarettes smoking and sedentary life style are almost present in patients with AF. Arterial hypertension, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal dysfunction, structural and valvular heart disease and peripheral vascular disease are the most common comorbidities among our patients. The mean CHA2DS2-VASc score was 3.2±1.4 and the mean HAS-BLED score was 2.1±1.2. Conclusion: Atrial fibrillation is the most common sustained cardiac rhythm disorder. The study shows that obesity, alcohol consumption, smoking cigarettes and dyslipidemia can be considered as triggers and predisposing factors for appearance of AF. Arterial hypertension, coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, Peripheral vascular disease and chronic kidney disease are playing important role in developing of AF.

Introduction: Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2030, 14–17 million AF patients are anticipated in the European Union. Atrial fibrillation remains one of the major causes of stroke, heart failure, sudden death all over the world. Research Objectives: The objective of our study is to determine the cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence during 11 years follow up period. Patients and methods: This study includes 2352 ambulant and hospitalized patients with atrial fibrillation (AF) who were enrolled during the follow up period. All patients underwent clinical evaluation in order to determine cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence. Results: The results of cumulative incidence for sudden cardiac death was 1.71%, for stroke 2.56%, for myocardial infarction 1.20% and for heart failure was 5.73%. In our study the age-adjusted incidence and prevalence of AF are slightly lower in women. The study shows that the risk of death is higher in females than in males with AF. Conclusion: Despite good progress in the management of patients with atrial fibrillation (AF), this arrhythmia remains one of the major causes of stroke, heart failure, sudden death. Effective treatment of patients with atrial fibrillation includes not only rate control, rhythm control, and prevention of stroke, but also management of cardiovascular risk factors and concomitant diseases.

Objective: Cardiovascular diseases are considered to be the leading cause of mortality and are usually caused by atherosclerosis. Accelerated atherosclerosis is confirmed in several rheumatic diseases including Rheumatoid arthritis. Impact of traditional risk factors for atherosclerosis is well known. Results of numerous studies point out the importance of inflammation in the development of atherosclerosis and maintaining the stability of atherosclerotic plaque. In patients with rheumatoid arthritis existence of chronic inflammation is an independent risk factor for accelerated atherosclerosis. Design and method: To determine the frequency of traditional and non-traditional risk factors for development of cardiovascular diseases in patients with rheumatoid arthritis. In 50 patients with rheumatoid arthritis ESR(an erythrocyte sedimentation rate), C-reactive protein CRP, fibrinogen, cholesterol, triglycerides, blood pressure RR, rheumatoid factor RF, blood glucose level, gender distribution, age, disease activity DAS 28 score were determined. Results: In the study group the mean age was 63.4 years, the percentage of females was 80%, ESR in the first hour was 60.1 mm, CRP 31.2 mg/l; cholesterol 5.41 mmol/l; triglycerides 2.76 mmol/l; RF 276; fibrinogen 5.12 g/l; Blood sugar 6.8 mmol/l, RR 140/90 mmHg; DAS 28 score of 6.4. Conclusions: The presence of traditional and non-traditional risk factors for cardiovascular diseases in patients with Rheumatoid arthritis leads to the development of accelerated atherosclerosis and increased incidence of cardiovascular diseases in these patients.

Syncope is a sudden and brief loss of consciousness followed by spontaneous recovery. Syncope develops because of temporary reduction in blood flow to the brain with consecutive cerebral oxygen deprivation. Therefore, syncope is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. Various causes are well described in the literature and include cardiac, vascular, neurological, metabolic and miscellaneous origins [1]. Sometimes it is difficult to determine the real cause of syncope, so numerous analyses need to be performed. Sick sinus syndrome (SSS) refers to a combination of symptoms such as dizziness, confusion etc. (symptoms and signs of end-organ hypoperfusion) caused by sinus node dysfunction (SND). SND is a frequent cause of syncope, and in this case it was a result of cerebral hypoperfusion. We report here the case of a patient with history of syncope and dizziness. Three years before admission the patient underwent surgical repair of atrial septal defect (ASD) by pericardial patch closure of ASD. Recurrent syncope was a result of SSS and this syndrome rarely occurs after surgical patch closure of ASD.

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.

Introduction: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Research Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE echocardiography for detection and assessment of ischaemic mitral regurgitation (IMR) with baseline age (62 ± 9), ejection fraction (EF 41±12%), the regurgitant volume (RV) were 42±21 mL/beat, and effective regurgitant orifice area (EROA) 20±16 mm2, the regurgitant fraction (RF) were 48±10%, Jet/LA area 47±12%. Also we measured the of vena contracta width (VC width cm) 0,4±0,6 for assessment of IMR severity. During 5 years follow up, total mortality for patients with moderate/severe IMR–grade II-IV (54.2±1.8%) were higher than for those with mild IMR–grade I (30.4±2.9%) (P<0.05), the total mortality for patients with EROA ≥20 mm2(54±1.9%) were higher than for those with EROA <20 mm2(27.2±2.7%) (P<0.05), and the total mortality for patients with RVol ≥30 mL (56.8±1.7%) were higher than for those with RVol<30ml (29.4±2.9%) (P<0.05). After assessment of IMR and during follow up period 64 patients (46%) underwent CABG alone or combined CABG with mitral valve repair or replacement. In this study, the procedure of concomitant down-sized ring annuloplasty at the time if CABG surgery has a failure rate around 24% in terms of high late recurrence rate of IMR during the follow period especially after 18–42 months. Conclusion: The presence of ischaemic MR is associated with increased morbidity and mortality. Chronic IMR, an independent predictor of mortality with a reported survival of 40–60% at 5 years. Ischaemic mitral regurgitation has important prognosis implications in patients with coronary heart disease. Recognizing the mechanism of valve incompetence is an essential point for the surgical planning and for a good result of the mitral repair. It is important that echocardiographers understand the complex nature of the condition. Despite remarkable progress in reparative surgery, further investigation is still necessary to find the best approach to treat ischaemic mitral regurgitation.

IntroductIon: Cardiac tumors can be primary (benign or malignant), with incidence from 0.002 to 0.3% according to autopsy reports, and secondary which are more common, found in about 5-10%. The most common primary tumor of the heart is the myxoma. About 75% of all myxomas are located in the left atrium. They occur in all age groups, usually from the third to the sixth decade. They are more common in women, usually solitary, round tumors with a diameter of 10 cm, uneven surfaces.