Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for approximately 5–15% of acute myocardial infarctions (MI). This infarction type raises a series of questions about the underlying mechanism of myocardial damage, the diagnostic pathway, optimal therapy, and the outcomes of these patients when compared to MI associated with obstructive coronary artery disease. We present the case of a 60-year-old patient with multiple cardiovascular risk factors and comorbidities who is admitted in an emergency setting. The patient is known with a conservatively treated inferior myocardial infarction which occurred 3 months prior, with reduced left ventricular ejection fraction. Emergency coronary angiography revealed normal epicardial coronary arteries, which led to further investigations of the underlying cause. Considering the absence of epicardial and microvascular spasm, CMR (cardiac magnetic resonance) confirmation of two transmural myocardial infarctions in the territories tributary to coronary arteries, and a high index of myocardial resistance in culprit arteries, we concluded the diagnosis of MINOCA due to the microvascular endothelial dysfunction. Although the concept of MINOCA was devised almost a decade ago, and these patients are an important part of MI presentations, it still represents a diagnostic challenge with multiple explorations required to establish the precise etiology.
Cardiovascular disease is one of the leading causes of morbid-mortality, although better outcomes and lower mortality of age-adjusted coronary artery disease were registered since 1980s, especially in high-income populations, sustaining the cost effective of cardiac prevention methods. The aim of this prospective study was to evaluate the role of cardiac rehabilitation in improving psycho-emotional risk scores: the Hamilton Depression (HAM-D) and Anxiety Rating Scale (HAM-A) in coronary artery bypass grafting (CABG) patients, in less than one week after cardiovascular surgery and in 6 months follow-up after the engagement in the cardiac recovery program. Methods – During 01.05.2015 – 01.03.2017, CABG was performed in 100 patients, aged 40-80 years old, who followed rehabilitation in the Cardiovascular Rehabilitation Clinic. The mean age of the patients under study was 65.70 ± 9.91 years old. Results – In the fi rst phase of the cardiovascular rehabilitation program, the mean values were: 16 points for HAM-D, and 25 points on HAM-A scale. By comparing the Phase I and Phase III results, the median HAM-D score improved more than 50%, and HAM-A about 36% (p<0.05). Conclusion – The study highlighted the role of early rehabilitation after CABG surgery and the HAM-D and HAM-A scores improvement, emphasizing the importance of including psycho-emotional status assessment in the management of the patient who benefi ted from cardiac surgery. Apart from clinical data and the cardiovascular risk scores, the psycho-emotional risk stratification can provide important information regarding outcomes and prognosis.
Background: The risk scoring systems used in cardiac surgery (including EuroSCORE II) include only insulin-dependent diabetes. Diabetes mellitus (DM) is a marker of poor prognosis after surgical myocardial revascularization, but its impact in patients with isolated surgical aortic valve replacement (SAVR) has not been well established. Aim: We aimed to analyze differences in outcomes and surgical risk in patients with and without type 2 DM (T2DM), which underwent SAVR. Material and methods: We included retrospectively the patients hospitalized for SAVR between January 2000 and June 2014 in Cardiovascular Surgery Unit of Cardiovascular Diseases Institute. Preoperative parameters and early postoperative outcome in patients with and without T2DM were compared. Results: A number of 1191 patients were included (65.4±13 years; 67.8% men); 144 (12.07%) out of those were with T2DM. Biological prostheses were performed in 22% of patients. Mean age was higher in T2DM group (p=0.005). The mean EuroSCORE II risk score was 5.49±0.63 in T2DM and 4.89±0.17 in non-T2DM patients (p=0.579). In these 2 groups, preoperative left ventricular systolic function was comparable. Mean values of cardiopulmonary bypass time were 137.88±5.71 minutes in T2DM, 149.48±4.8 minutes in non-T2DM patients (p=0.714). The need of inotropic therapy was an important predictor for postoperative evolution (6±2 days in non-T2DM and 15±4 days in T2DM; p=0.008). Conclusions: Patients with T2DM undergoing SAVR have a nonsignificantly higher operative risk score comparing with non-T2DM patients. In spite of this, T2DM seems to be a risk factor that could worsen the postoperative outcome, by requiring prolonged inotropic treatment.
P ostoperative atrial fibrillation (POAF) is a most common complication of cardiac surgery. Its incidence depends on the surgery type and is estimated at 40-50 % in valvular surgery cases [18]. The arrhythmia is associated with high risk of stroke, increased early and late mortality, and considerable costs. Advanced age is consistently reported to be an independent risk factor for arrhythmic complications. Increasing life expectancy caused a growing number of replaced aortic valves [2, 12, 23]. Patients undergoing aortic valve replacement have many comorbidities with cumulative arrhythmic risk; therefore, prophylactic management is needed. Postoperative atrial fibrillation can occur anytime, mostly 2 to 4 days after surgery but possibly
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