Heart-type fatty acid-binding protein (H-FABP) is a non-invasive bio-marker, with high sensitivity and specificity, being capable to point out the myocardial injury and to predict major adverse cardiovascular events (MACE). Cardiac rehabilitation program, through a complex and sustained post-interventional management plays an important role in reducing the plasma levels of H-FABP. In the study, which included 120 post-coronary artery bypass (CABG) patients, we analyzed the link between low levels of general post-surgical health status and the presence of cardiovascular risk factors, common biochemical markers, and especially the role played by diabetic status in lowering the plasma H-FABP levels. From the group, 65 patients had been diagnosed with type 2 Diabetes Mellitus (T2DM). The H-FABP values decreased both in diabetics and in non-diabetics between the two phases of CR, 6 months away from CABG. More than half of the patients had important reduction of H-FABP, at 6 months after the onset of CR program. Half of the group registered a smaller reduction of H-FABP, but more noticeable in diabetics. Ischemic lesion during open heart surgery is linked to high levels of H-FABP and with an occurence risk of postoperative atrial fibrillation, that can be also triggered and sustained by multiple endocrine conditions related to aging. Thus, metabolic control should always remain a target of the complex management in cardiac rehabilitation.

Treatment of patients with immune thrombocytopenic purpura (ITP) associated with recurrent venous and arterial thrombosis can represent a major challenge. We present the rare case of a 56-year-old female who was first diagnosed with severe ITP at the age of 36. She required corticosteroid therapy and splenectomy in evolution. However, in the last three years she had several episodes of recurrent venous thromboembolism for which she required different anticoagulant therapies despite severe thrombocythemia. The patient also developed acute myocardial infarction treated by primary percutaneous coronary intervention that was complicated with acute intrastent thrombosis. Thus, maximal antiplatelet therapy was mandatory. For ITP, the patient received intravenous steroids, platelet transfusion as well as eltrombopag. Moreover, the patient also suffered from a haemorrhagic uterine fibroma that required surgery. Thus, a close multidisciplinary approach was needed for the successful treatment of this patient.

Guidelines for primary prevention suggested using any risk score, among those QRISK2, identifying the high-risk populations. The purpose of this study was to determine whether the QRISK2 Score would register changes in patients with coronary artery disease demanding acute or postponed CABG intervention. The QRISK2 Score was performed the day of admission after the clinical examination and blood test results, and immediately after CABG surgery (in the first week post-CABG, in an interval of 24 hours to 7 days) having another blood test evaluation. The 120 patients admitted in the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Disease met the inclusion criteria: CABG patients (less than 1 week), aged 40-85 years old, BMI ] 25 kg/m�, and mixed dyslipidemia. In both phases, for every patient, it was performed a clinical examination, a set of hematological, biochemical, lipid, coagulation and inflammatory profile, and ECG and echocardiography. Our research on hospitalized patients undergoing CABG, by comparing the Phase I and Phase III results, revealed that the median 10-year QRISK2 cardiovascular risk score was approximately 47.88 % lower (p=0.000) in the first week after cardiac surgery. QRISK2 score gives a more appropriate risk estimation based on the social component, thus identifying high risk patients associating social deprivation. Comparative to Framingham risk score, QRISK2 score, by including additional variables, proves the efficacy of lifestyle changes and management decisions, and sustaines the treatment directed towards modifying variables or risk factors.