Cimbenici rizika i srcanožilne bolesti u obiteljima poginulih u ratu u Hrvatskoj i Bosni i Hercegovini

This article writes about a 37-year-old patient with Eissemanger's syndrome. The catheterization was done when he when he was 7 years old and was diagnosed as follows: VSD, ASD and pulmonary hypertension. After repeated catheterization when patient was 23 years old the final diagnosis was established: Fenestra aortico pulmonalis, VSD, ASD, aortic stenosis gr II and pulmonary hypertension. The patient has been treating conservatively

Low HDL cholesterol (HDL-C) level and smoking are known risk factors for coronary heart disease. The effect of cigarette smoking on HDL-C level was analysed in this study, with aim to determine whether smoking causes lowering its level. Study included 105 participants, aged 30-70 years, from Family Medicine Teaching Center of Dom zdravlja Tuzla. Smoking status was analysed and HDL-C level was measured after fasting for at least 12 hours in all participants. The greater number of smokers had HDL-C level < 1.03 mmol/L than non-smokers (P = 0.04). The greater number of non-smokers had HDL-C level > or = 1.54 mmol/L comparing with smokers (P = 0.001). Smokers had significantly lower mean HDL-C level than non-smokers (P = 0.003). Results suggest that cigarette smoking adversely affects HDL-C by lowering its level, which further increases the risk for developing coronary heart disease.

UNLABELLED: Prolonged forms of HAV infection are atypical forms of diseases which occur in up to 24% cases. In clinical mean those forms of disease are described as relapses (recidivisms) and recrudescence. During the three-year multi-centric study we have explored prolonged forms of HAV infection, on two geographically separated and epidemiologically different regions, from every aspect. The purpose of this study, in clinical biochemical sense, was to explore all clinical forms of this disease and determine its biochemical characteristics. This research involved 60 patients with prolonged HAV infection (PTHA) and 30 patients with conventional hepatitis A. During conventional HAV-infection the disease ends in 4 to 8 weeks. Markers of HAV, HBV and HCV infection were determined using ELISA method. Antigen HAV in stool was determined using method of reversed immuno-electro-osmopforesis. Circulating immune complexes was determined photometrical in the sediment poliethylenglicole on rollers length of 450 nm. Research has shown that the PTHA manifests in three clinical forms: recrudescence, relapse and "prolonged hepatitis A from the beginning". All forms of PTHA were often significantly icteric with a clearly shown clinical pictures (p<0.05). Every new disease episode (relapse and/or recrudescence) is in average of smaller intensity than the initial infection. CONCLUSIONS: Clinically clear PTHA infection manifests through recrudescence in 66,8 % of cases, through relapse in 26,6 % of cases and "prolonged hepatitis A from the beginning" in 6,6 % of cases. Recrudescence appears significantly often one time rather than two or more times (p<0.001). Relapse never appeared:after recrudescence, and it was not noted more than once. "Prolonged forms of disease from the beginning" could represent relapse/recrudescence whose initial disease phase remained sub clinic. Average duration of PTHA is five times longer than in the control group. Men tend to fall ill from PTHA twice as much as woman.

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.

UNLABELLED Precondition to prevention and control of morbidity and mortality of myocardial ischemia--coronary disease, is its good diagnostic. Goal of this study is to asses diagnostic significance of positive trademill stress test in diagnosis of coronary disease. MATERIAL AND METHODS we analyzed 120 patients with markedly positive classic trademill stress test using Bruce protocol in the year 2003. In all cases, positive stress test was followed by selective angiography, using standard technique with multiple sections. Blood vessel narrowing of more than 50% was chosen as the criteria for positive angiographie finding. With the help of coronary angiography, it was found that 62 (51.7%) of patients has stenosis of less than 50% or normal angiographic finding. 58 (48.3%) of patients had stenosis of more than 50%. Of that number, 24 (41.4%) had one-vessel coronary disease, 12 (20.7%) two-vessel coronary disease, and 10 (34.5%) three-vessel coronary disease. 2 patients (3.4%) had stenosis of the trunk of left coronary artery. Results of this study show that the sensitivity of trademill stress-test is less than optimal, and should be supplemented by other non-invasive techniques (such as myocardial perfusion scintigraphy, radionuclide ventriculography and stress echocardiography) in diagnostics of coronary disease.

There are three major modifiable risk factors for coronary hearth disease: smoking, hyperlipidemia and hypertension. Smoking acts synergistically with other risk factors increasing the risk for cardiovascular morbidity and mortality. Many epidemiological studies consist hard and consistent relationship between smoking and coronary hearth disease, which is related with duration and number of smoking cigarettes. On the other side. high risk for coronary hearth disease in ex smokers decreases substantially in the first 2 to 3 years, and after that degree of lowering risk decreases in such way that after 10 years former smokers have the same risk level as never smokers. Because the cardiovascular diseases are leading cause of death in world today, smoking cessation is one of the most important intervention of primary care physician for reduction morbidity and mortality from coronary hearth disease and improvement overall community health.

Atrial fibrillation characterized by uncoordinated atrial activation. On the electrocardiogram is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size and shape. The incidence of atrial fibrillation in patients under 22 years old is 2%, whereas for patients under 60 years old, the incidence is 8.8%. The most common cause of death in patient with atrial fibrillation is stroke, and occurs in 1% to 5% patients in the age group 50 to 59 years, whereas 30% patients in the age group 80 to 89 years. The incidence of atrial fibrillation after coronary artery bypass surgery occurs in 20% to 40% patients. We examined the incidence atrial fibrillation in patients after coronary artery bypass surgery, most common risk factors for occurs atrial fibrillation. Prospective study was conducted on 100 patients, who were divided in two groups, which had similar age structure, gender and they had disease coronary artery which required coronary artery bypass surgery. We established that incidence atrial fibrillation after coronary artery bypass surgery was 24%. Age was one of main risk factors that is responsible for appearance of atrial fibrillation. Gender like risk factor at 60 year old persons does not have statistical significance, while at persons which are younger then 60 years male has greater statistical significance like risk factor. Patients with triple vessel disease after coronary artery bypass surgery had most common atrial fibrillation.

INTRODUCTION The occurrence of U-wave in electrocardiogram appears after T-wave. It is period of the greatest excitability of the myocardium in heart electrical activity usually of the some direction as its own T-wave. AIM OF THE WORK ANALYSE: U-wave with ischaemia and dysfunction of the myocardium in exercise test. MATERIAL AND METHODS The prospective study has been done for 51 patients. Electrocardiogram, exercise test vas made for all patients and immediately after test, echocardiography with Doppler and colour-Doppler. In the analysis of dysfunction of the left chamber these important parameters were followed: METS; decrease of blood pressure, devaluation of ST-segment, U-wave, heart rate, dyspnea, sweating and paleness. RESULTS Positive U-wave was noticed in 51%, negative in 24% examinees. Sensitivity of U-wave on the base of the breakdown of segmental vall motion in echocardiography (ischaemia) is 66.67% with false negative resists of 33.33%. Systolic dysfunction with influential parameters correlates in the best way with decrease of blood pressure and regressive coefficient is 66.93, but the weabest correlation is with U-wave (0.53). Correlative coefficient for U-wave in systolic function is 0.263. Regressive coefficient with influential parameters in diastolic dysfunction is 3.34, correlative coefficient is 0.108. CONCLUSIONS U-wave in registered at rest after exercise test when heart rate is equal or below 95 in a minute. Registration of U-wave is an additional parameter in diagnostics of ischaemia and dysfunction of the myocardium of the left chamber (small influence).

Long time ago lipids increased in blood have been known as risk factor for atherosclerosis that causes coronary heart disease among which myocardial infarction is the most complicated. Aim were to present the lipids status structure in patients with acute myocardial infarction and on the basis of that to suggest corresponding statin in treatment. Our research involved 202 patients with acute myocardial infarction, patients were both gender and from 37 to 89 year. Out of total number of patients, 100 of them were with anterior myocardial infarction (group I) and 102 with inferior myocardial infarction (group II). Whole cholesterol, low density lipoproteins, high density lipoproteins and triglycerides were followed. Hi square test and variance analysis were used to prove statistically significant difference. In the sample of group I increased LDL was found in 92 patients and increased TGL in 46 patients while decreased HDL was found in 61 patients. In the sample of group II increased LDL was found in 64 patients, increased TGL in 44 patients, while decreased HDL was found in 51 patients. We analysed the next combinations in both groups: LDL > with HDL <; LDL > with TGL >; HDL < with TGL >; LDL >, TGL > with HDL <. Combination decreased HDL with increased TGL was found in group I in 5 patients, and in group II in 12 patients. Other combinations in both groups were similarly values. On the basis of the obtained results we found statistically significant difference between the two groups of patients. Patients in group I have more frequently increased values of LDL in comparison to patients in group II (p < 0.00005). In patients in group II who had decreased HDL and increased TGL statistically significant difference was found in comparison to the patients in group I (p < 0.02). On the basis of the obtained results and up to now studies on statins effects we suggest Atorvastatin for treatment the patients with anterior myocardial infarction, increased LDL with normal values of HDL and Simvastatin for treatment the patients with inferior myocardial infarction, decreased HDL.

Dysfunction of the left chamber of the heart happens when the function is not sufficient to supply all organs with needed quantity of blood, oxygen and nourishing materials. Consequence is an exhaustion of the heart compensatory and peripheral mechanisms. The research is based on the results of the analysis of residual changes that remained since acute myocardium infarct got over (scar, contracture changes, conductivity) and analysis of the remained functional part of the left chamber myocardium. Electrocardiogram, echocardiography and exercise test were used. 60 patients were examined. 6 varieties of chronic myocardium infarcts were found: anteroseptal, inferior, anterolateral and anterior-broaden, high-lateral and posterior localisation. Wagner's method QRS-scoring system and scores for wall motion by the American of ehocardiography were found the damage size of the myocardium mass. Correlative coefficient is full (r = 1.0). In chi2-test there is no significant difference (Wagner, echocardiography) in dimensions of old infarct (p < 0.05). Dyastolic dysfunction was set by echocardiographic method for 75%, systolic 41.11% examinees, remodelling in 80%, extended isovolumetric relaxation time and time of deceleration in 100% cases, speed ratio E-wave and A-wave below 1.0 in 82.66% cases. Exercise test was made for 85% examinees. Dysfunction was registered in 84.37%, diastolic in 80.39%, systolic in 43.17% cases. On the base of coronarographie results (23.33% examinees) the sensitivity was set for: exercise test in systolic dysfunction is 42.86%, in dyastolic is 71.43% and echocardiography in systolic disfunction is 57.14%, in dyastolic 100%. According to echocardiographic analysis of parameters the greatest influence has reduction of ejection fraction with 36.67% in systolic and extension of the period of deceleration with 38.79% in diastolic dysfunction. There is a good complement of the tested methods (p < 0.05). There is possibility, with these methods to appraise dysfunction of the left chamber in old myocardium infarct with conclusion that echocardiography is more sensitive since gives more data and direct visualization of changes.

Occurrences of arrhythmias during the acute myocardial infarction is explained with local ischaemia, but mechanism of later occurrences is unclear. Our study had for the aim to examine relationship between postinfarction left ventricle dilatation and appearance of arrhythhmias, and to show drug effects on remodelling. Patients who developed progressive left ventricle dilatation had higher mortality then patients without changes of left ventricle volume, and mortality is due of sudden cardiac death. Drugs who had preventive effects or reverse remodelling can help in prevention of malignant arrhythhmias and sudden cardiac death. It is showed that ACE inhibitors, beta-blockers and aldosterone antagonists had preventive effects on left ventricle remodelling. The combined therapy with ACE inhibitors, beta-blockers and aldosterone antagonists is showed as the most-effective in prevention of remodelling, appearaance of arrhythhmias and sudden cardiac death.

AIM OF THE STUDY To establish the presence of pericarditis and exudative pleuritis in patients with systemic lupus erythematosus (SLE) prior to and after glicocorticoid and cytotoxic therapy. PATIENTS AND METHODS In 43 patients, 39 women and 4 men, with SLE (disease was diagnosed according to revised American College of Rheumatology ACR criterias, 1997), aged between 20 and 61 and averaged disease duration of 5.54 +/- 5.74 years, heart/lung radiology and heart echosonography were performed in order to discover possible serositis (pericarditis and exudative pleuritis) prior to and after cytotoxic and glucocorticoid therapy. RESULTS The presence of pericarditis and exudative pleuritis was established in 20 patients (47%) before the therapy. After the therapy pericarditis was present in 2 patients, average volume of 150 ml, and exudative pleuritis was also present in phrenicocostal sinus, but its volume was minimal. This table is showing the results of our study on patients with SLE and serositis. The results were compared with the results of European and Belgrade group in year 2000. [table: see text] CONCLUSION Higher frequency of serositis (pericarditis and exudative pleuritis) in our study is probably a result of more active disease, and the effects of cytotoxic and glucocorticoid therapy were satisfing exept in two patients who were resistant on therapy. That is the reason why we had to consider plasmapheresis.