Rationale:Angiotensin-converting enzyme (ACE) inhibitors are one of the most used medication among patients with arterial hypertension. In most cases, ACE inhibitors caused side effects are mild; however, from 0.1% to 0.7% of patients can develop life threatening adverse effect, angioedema. Unlike histamine mediated, ACE inhibitor-related angioedema can develop at any time during the treatment course.Patient concerns:An 89-year-old woman with a medical history for arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation developed ACE inhibitor-induced angioedema after 5 years of daily ramipril administration.Diagnoses:Arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation and late onset ACE inhibitor-induced angioedema.Interventions:The ACE inhibitor was used for arterial hypertension on a daily basis for the past 5 years. Patient developed airway obstruction requiring intubation. Standard therapy with epinephrine, methylprednisolone and clemastine was administered. Treatment was ineffective, considering that angioedema persisted.Outcomes:Angioedema resolved after 13 days from the discontinuation of ramipril. Death due to cardiopulmonary insufficiency occurred 24 days after the admission to intensive care unit, despite full clinical resolution of ACE inhibitor-induced angioedema.Lessons:Our case highlight the importance of educating clinicians about ACE inhibitor-induced angioedema, as potentially fatal adverse drug reaction. Considering the fact, that no laboratory or confirmatory test exist to diagnose ACE inhibitor-induced angioedema, clinicians’ knowledge is the key element in recognition of ACE inhibitor-related angioedema.

Multidisciplinary outpatient rehabilitation can be considered as effective treatment. However, it is necessary to implement specific, well-adapted consuming assessment instruments in order to evaluate the outcomes of daily multidisciplinary outpatient rehabilitative treatment.

The aim of this work was to assess the quality of pharmacological treatment in patients within one year after acute myocardial infarction. Material and methods. We performed a prospective survey of 985 consecutive patients with acute myocardial infarction who were treated in the Clinic of Cardiology of Kaunas University of Medicine Hospital in 2004. About half of patients were hospitalized from different regions of Lithuania. According to the follow-up protocol, an information on 514 patients and their used treatment within 13.8±3.2 months after myocardial infarction were collected by letter with questionnaire. Results. Beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotic drugs were the most drug used (76%, 74%, and 76%, respectively) in patients following myocardial infarction. Most of the patients used a three-drug combination (36.8%), more rarely – two-drug (24.1%) or four-drug complex (19.8%). One drug was used only in 12.1% of cases; 7.2% of patients did not use any cardiac drugs. Betaadrenoblocker with angiotensin-converting enzyme inhibitor was the most common (40.3%) used drug combination in patients on two drug complex. The combination of beta-adrenoblocker, angiotensin-converting enzyme inhibitor, and antithrombotics was more frequently used in patients on three drug complex. The combination of two or three cardiac drugs with statin was used in several cases (1.6–10.3%). Conclusions. These findings underscore that the use of beta-adrenoblockers, angiotensin-converting enzyme inhibitors, and antithrombotics was high (about 75%) in patients during the first year after myocardial infarction, and the combination of these three drugs was used more commonly. The discordance between existing guidelines for statin use after myocardial infarction and current practice was determined in patients following myocardial infarction.

The aim of this study was to identify associations of the parameters of heart rate variability (HRV) with the variations in geomagnetic activity (GMA), solar wind, and cosmic ray intensity (CRI) in patients after coronary artery bypass grafting or valve surgery in Kaunas, Lithuania, during 2008–2012. The data from 5-minute electrocardiograms (ECGs) in 220 patients were used. ECGs were carried out at 1.5 months, 1 year, and 2 years after the surgery (N = 495). A lower (higher) very-low-frequency-band (VLF) and a higher (lower) high-frequency band (HF) in normalised units (n.u.) were associated with a low maximal daily 3-hourly ap (the DST index > 1). A lower mean standard deviation of beat-to-beat intervals (SDNN) and VLF, LF, and HF powers were lower in patients when Ap < 8 occurred two days after the surgery, and a low solar wind speed (SWS) occurred two days before the ECG. The effect of CRI was non-significant if the linear trend was included in the model. Low GMA and a low SWS may effect some HRV variables in patients after open-heart surgery. The GMA during the surgery may affect the SDNN in short-term ECG during the longer period.