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There was no relationship between BP load and gender, BMI, and duration of hypertension. Diastolic BP load was age-related. Middle-aged patients were characterised by significantly higher values of 24-h and daytime diastolic BP load than the elderly patients.

A b s t r a c tBackground: Clinical evaluation of patients with diabetes or after myocardial infarction (MI) with preserved left ventricular (LV) systolic function is not very precise in isolating patients at particularly high risk of developing manifest cardiac failure and associated cardiovascular incident. Early diagnosis of LV diastolic dysfunction is essential because implementation of the appropriate treatment can positively affect the course of the disease. Aim:To assess the impact of LV diastolic function on B-type natriuretic peptide (BNP) concentration at rest and immediately after exercise test, and to search for the relationship between LV diastolic function and BNP secretion, tolerance, and duration of exercise in the studied groups of patients.Methods: Ninety-nine consecutive patients were qualified for the study: in Group 1 -patients with type 2 diabetes without a history of MI, and in Group 2 -patients after MI with preserved LV systolic function (ejection fraction ≥ 40%), without diabetes. The studied patients had echocardiography with LV systolic and diastolic function evaluation, an electrocardiographic exercise test and blood sampling for BNP determination before and immediately after exercise test. Results:The study included 99 patients aged 40-75 years (60 patients after MI and 39 patients with diabetes). The study group included 62 patients who were diagnosed with diastolic dysfunction. Diastolic dysfunction occurred in 41 (68.4%) patients in the group after MI, and in 21 (53.8%) patients in the group with diabetes, severe disorders in the form of pseudonormal and restrictive mitral valve inflow occurred in 13 (21.7%) and five (12.8%), respectively. The average BNP concentration in patients with severe diastolic dysfunction at rest was 188.3 vs. 25.2 pg/mL in patients with normal diastolic function (p < 0.001). In all patients with severe diastolic dysfunction BNP after exercise was 285.2 vs. 37.5 pg/mL in patients with normal diastolic function, and the increase in BNP during exercise was 96.9 vs. 12.4 pg/mL, respectively. Duration of exercise and exercise tolerance in patients with normal diastolic function was better in comparison with the studied patients with disturbed diastolic function, but did not reach statistical significance. Conclusions:The BNP initial concentration and its value immediately after exercise were significantly higher in subjects with severe diastolic disorders than those in subjects with normal LV diastolic function and in subjects with impaired LV relaxation.

A 73-year-old female patient was referred for coronary artery computed tomography angiography (CTA) due to dyslipidemia, hypertension, and mild ventricular arrhythmia. The study demonstrated a double left anterior descending artery (LAD) Type 1 variant (Fig. 1A) and significant atherosclerotic lesions in the coronary arteries. Conventional coronary angiography confirmed presence of an anomaly and significant atherosclerotic lesions within the second marginal branch (Mg 2) and the right coronary artery (RCA). The patient was treated with percutaneous coronary intervention (PCI) of Mg 2 and RCA with drug-eluting stenting (DES).A 63-year-old female smoker with hypertension, had a positive stress test with low exercise tolerance (5.9 METS) and significant ST depression in leads II, III, aVF, V5 and V6, with chest pain. The 24-h Holter electrocardiography monitoring demonstrated ventricular arrhythmia with nonsustained ventricular tachycardia (nsVT). The CTA revealed multifocal significant atherosclerotic lesions and dual LAD Type 1 (Fig. 1B). The patient did not consent to coronary angiography.Computed tomography angiography is the preferred imaging method in the assessment of coronary arteries anomalies. The main advantages

Dissection is defined either as a split in the intima or the presence of intramural haematoma. The dissection of a coronary artery can, in rare cases, lead to acute coronary syndrome (ACS) or manifest itself as cardiac tamponade or cardiogenic shock. Spontaneous dissection occurs in 0.1-0.28% of patients with ACS undergoing coronary angiography. The diagnosis should be considered in young patients without risk factors of coronary artery disease, as well as in perinatal women or women using hormonal contraceptives. It can also occur in patients with congenital connective tissue disease, e.g. Marfan syndrome or after cocaine ingestion and prolonged physical effort. A patient aged 54 years without atherosclerosis risk factors was admitted to the department due to acute retrosternal pain. The patient had not been treated cardiologically, did not smoke, had a positive family history, and led an active lifestyle. Electrocardiogram test performed after admission revealed ST segment elevation in leads II, III, aVF, and V 5 -V 6 (Fig. 1). The patient received acetylsalicylic acid and clopidogrel, and was immediately qualified to invasive diagnostics of the coronary arteries. Coronary angiography revealed spontaneous dissection with the presence of a blood clot in the proximal segment of the left anterior descending (LAD) artery and another blood clot in the distal segment closing the artery. No abnormalities were demonstrated in the other epicardial arteries (Fig. 2). The patient was qualified to conservative treatment: abciximab was injected intravenously and a control coronary angiography after seven days was scheduled. Laboratory tests showed elevated troponin T max levels (724 ng/mL) without an increase in CPK-MB levels. Echocardiography showed hypokinesis of apical and medial segments of anterior and lateral walls, and ejection fraction of 50%. The control coronary angiography revealed no blood clot in the proximal segment of the LAD artery, with smooth vessel outline and with TIMI-3 flow (Fig. 3). The patient was qualified to conservative treatment, whereas double antiplatelet therapy was continued. Pathogenesis of the coronary artery dissection is not completely determined. Maehara et al. [Am J Cardiol, 2002; 89: 466-468] and Venzetto et al. [Eur J Cardiothorac Surg, 2009; 35: 250-254] reported the presence of two types of coronary artery dissection: the first one is initiated by a breach of neointimal continuity and propagation of medial dissection (recognised both angiographically and in intravascular ultrasound), whereas the latter one results from the pathology of the arterial intima without communication to the vessel lumen (recognised only in intravascular ultrasound). Optimal treatment of spontaneous coronary artery dissection (SCAD) has not been determined and may vary, depending on dissection extension and clinical signs. In the present case study SCAD occurred in a male patient without risk factors of coronary artery disease, after sudden and intense emotional distress. As a result of pharmacological t...