The aim of our study was to determine whether diabetic ST segment elevation myocardial infarction (STEMI) patients arrive in the emergency room (ER) later than non-diabetics, compare the differences in pain quality and quantity between those groups, and measure differences in the outcome after an index hospitalization. A total of 266 patients with first presentation of STEMI were included in our study during a period of two years, 62 with diabetes and 204 without diabetes type 2. Pain intensity and quality at admission were measured using a McGill short form questionnaire. Diabetic patients did not arrive significantly later than non-diabetic (χ2; p = 0.105). Most diabetic patients described their pain as “slight” or “none” (χ2; p < 0.01), while most non-diabetic patients graded their pain as “moderate” or “severe” (χ2; p < 0.01). The quality of pain tended to be more distinct in non-diabetic patients, while diabetic patients reported mainly shortness of breath (χ2; p < 0.01). Diabetic patients were more likely to suffer a multi-vessel disease (χ2; p < 0.01), especially in the late arrival group. Therefore, cautious evaluation of diabetic patients and adequate education of target population could improve overall survival while well-organized care like a primary PCI Network program could significantly reduce CV mortality.

A B S T R A C TThe aim of this paper was to investigate the prevalence of smoking using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N=1,298

SaŽeTaK: Svjedoci smo sve češćih slučajeva akutnih koronarnih sindroma u mlađih bolesnika, odnosno u bolesnika u kojih ne nalazimo prisutne tipične preinačive ili nepreinačive čimbenike rizika. Veći-na studija defi nira mlađe pacijente kao osobe dobi do 45 godina. U takvih se bolesnika obično dijagnosticira akutni infarkt miokarda (AIM) s normalnim koronarnim arterijama, odnosno koronarne arterije ne pokazuju intraluminalne nepravilnosti (stroga defi nicija) ili arterije s manjim stupnjem stenoze, ali hemodinamski bez značenja (u većini slučajeva < 30% stenoza). Nedavno objavljena studija (APPROACH) utvrdila je učestalost akutnog infarkta miokarda s normalnim koronarnim arterijama u iznosu od 2,8% u bolesnika podvrgnutih koronarnoj angiografi ji kod AIM-a. Diferencijalna dijagnoza takvih akutnih koronarnih zbivanja uključuje miokarditis, stres miokardiopatije i sindrom baloniranja vrška lijeve klijetke. Ne postoji jedinstveno objašnjenje nastanka AIM-a s normalnim koronarnim arterijama, ali predloženo je nekoliko mogućih mehanizama: latentna ateroskleroza, vazospazam, tromboza i hiperkoagulabilno stanje, embolizacija i upala. Postoje stečeni i nasljedni sindrom trombofi lije.U ovom ćemo prikazu opisati povezanost između nasljednih oblika trombofl ije u koje ubrajamo mutaciju faktora V Leiden, mutacija gena za protrombin, manjak proteina C i proteina S, manjak antitrombina i mutacija gena za glikoprotein inhibitor plazminogen aktivatora-1 s akutnim oblicima srčanožilnih bolesti. SUMMaRY:We are witnessing increasingly frequent cases of acute coronary syndrome in younger patients, or in patients who did not present the typical risk factors. Most studies defi ne younger patients as persons under 45 years of age. Such patients are typically diagnosed with acute myocardial infarction (AMI) with normal coronary arteries, i.e. the coronary artery does not show intraluminal anomalies (strict defi nition) or with a smaller artery stenosis but hemodynamically insignifi cant (in most cases <30% stenosis). A recently published study (APPROACH) determined the prevalence of AMI with normal coronary arteries was 2.8% in patients who underwent coronary angiography for AMI. Differential diagnosis of such acute coronary events includes myocarditis, stress cardiomyopathy, and Takotsubo syndrome. There is no single explanation for the origin of AMI with normal coronary arteries, but a few possible mechanisms have been suggested: latent atherosclerosis, vasospasm, thrombosis and hypercoagulability, embolization, and infl ammation. We differentiate between acquired and inherited thrombophilia syndrome.In this report, we will describe a link between hereditary forms of trombophilia (a mutation of factor V Leiden, prothrombin gene mutation, defi ciency of protein C and protein S, antithrombin defi ciency, and mutations in the gene for glycoprotein plasminogen activator inhibitor-1) and acute forms of cardiovascular disease.KlJUČNe RIJeČI: trombofi lija, akutni koronarni sindrom, infarkt miokarda s urednim koronarnim arterijama.KeYWORDS:...

Aritmije i uloga medicinske sestre prilikom elektrokardioverzije Arrhythmias and the role of a nurse during electrical cardioversion Aritmije su poremećaji srčanog ritma. Poremećaje srčanog ritma dijelimo prema frekvenciji na bradiaritmije i tahiaritmije, a prema mjestu nastanka na supraventrikularne aritmije (nastaju u pretklijetkama) i na ventrikularne aritmije (nastaju u srčanim klijetkama).Aritmije srca mogu se liječiti lijekovima, elektrokardioverzijom, radiofrekventnom ablacijom i ugradnjom elektrostimulatora ili defibrilatora, a izbor terapije ovisi o vrsti aritmije, simptomima i postojanju drugih bolesti srca, kao i izboru bolesnika. Elektrokardioverzija je postupak kojim se poremećaj srčanog ritma prevodi u sinusni ritam, udarcem istosmjerne struje sinkronizirane s ventrikularnim kompleksom u elektrokardiogramu.Proces zdravstvene njege bolesnika s aritmijama zahtijeva temeljitu provedbu sestrinske anamneze i izdvajanje čim-benika koji su ključni u formiranju sestrinske dijagnoze. Sestrinske dijagnoze su opis problema koje sestra prepoznaje kod pacijenata te se na temelju tih problema pristupa definiranju ciljeva i planiranju intervencija. U skrbi za bolesnika s aaritmijama vodeće su sestrinske dijagnoze Anksioznost u/s neizvjesnošću ishoda elektrokardioverzije te Neupućenost u/s nedostatka znanja o tijeku terapijskog postupka.Planiranje zdravstvene njege za bolesnika u intezivnoj koronarnoj jedinici obuhvaća utvrđivanje prioriteta, definiranje ciljeva, planiranje intervencija te izradu plana zdravstvene njege. Suvremeni terapijski procesi nameću interdisciplinarni pristup i stalnu edukaciju. U svojem radu u intenzivnoj koronarnoj jedinici naišli smo na mnoga pitanja koja su nas potakla na razmišljanje. Uz već poznati problem organizacije rada, nedostatak osoblja i materijala, velikog opsega posla i stresa s kojima se medicinske sestre iz koronarne jedinice svakodnevno susreću, naišli smo na nedostatak protokola po kojima bi radilo i nameće se pitanje specijalizacije medicinskih sestara radi kvalitetnije i sigurnije zbrinjavanja pacijenata. Medicinske sestre su svjesne svoje odgovornosti i standarda rada koji se od njih očekuje.Arrhythmias are heart rhythm disorders. According to the frequency, cardiac arrhythmias can be divided into bradyarrhythmias and tachyarrhythmias, whereas according to the place of origin, cardiac arrhythmias can be divided into supraventricular arrhythmias (occur in the atria) and ventricular arrhythmias (occur in ventricles).Cardiac arrhythmias can be treated with medications, electrical cardioversion, radiofrequency ablation and pacemaker or defibrillator implantation, whereas the choice of a therapy depends on a type of arrhythmia, symptoms and the presence of other heart diseases as well as the selection of patients. Electricial cardioversion is a procedure in which the heart rhythm disorder is reset back to its normal sinus rhythm by causing a directed electric shock synchronized with the ventricular complex in the electrocardiogram.The process of medical care for patients w...

2013;8(5-6):176. Cardiologia CROATICA Constrictive pericarditis classically presents as a progressive and debilitating condition characterized by pericardial fibrosis, with or without calcification 1 . This results in chronic refractory congestive heart failure for which pericardiectomy is often required. Until relatively recently, the development of constrictive physiology was presumed to be irreversible 2 . However, in the past two decades there have been reports describing transient forms of constrictive pericarditis that have been resolved without surgical intervention. The development of constrictive hemodynamics and subsequent resolution with medical therapy (transient constrictive pericarditis) was first described by Sagrista-Sauleda et al 3 in 1987. The authors suggested that mechanism responsible for the findings in these patients was transiently thickened and inelastic pericardium resulting from edema, fibrin deposition or inflammation. We present a case of 42-year-old man with a one-month history of fatigue and exertional dyspnea who came to our ER department complaining of abdominal discomfort accompanied by anasarca. There were no specific changes on initial ECG, the values of troponin T were normal and NT-proBNP slightly increased. On presentation, he was normothermic, tachycardic with normal first and second heart sounds and without audible pericardial rub. Jugular veins were markedly distended with positive Kussmaul's sign and hepatomegaly. A transthoracic echocardiogram revealed abnormal ventricular septal motion -septal bounce, respiratory variation in ventricular size, biatrial enlargement and presence of a dilated inferior vena cava without inspiratory collapse. The Doppler flow velocity measurements revealed exaggerated respiratory variation (more than 25%) in both mitral inflow velocity and tricuspid-mitral inflow difference. LV EF was normal and there weren't any signs of pulmonary hypertension or pulmonary valve stenosis. E/E" was 5. Chest MSCT revealed thickened pericardium (8-16mm) especially surrounding right ventricle without signs of calcification. There was also a moderate-sized right pleural effusion present with associated compressive atelectasis. Patient refused cardiac catheterization. With subsequent diagnostic work-up we excluded restrictive cardiomyopathy, primary liver disease, pulmonary hypertension and lung disease. The etiology of pericardial constriction was not established but idiopathic or postviral cause seemed likely. Patient was treated with diuretics and salt restrictive diet to relief fluid overload and peripheral oedema. Significant clinical improvement was seen following 4 weeks of treatment with regression of edema, ascites, hepatomegaly and pleural effusion. Control echocardiography revealed resolution of constrictive hemodynamics according to flow velocity measurments as well as regresion of vena cava inferior and hepatic vein dilation.