Effective prevention of thromboembolism is essential for patients with mechanical prosthetic heart valves. For this group of patients, vitamin K antagonists (VKAs) remain the drug group of choice despite the widespread use of new anticoagulants in other diseases. As a consequence, warfarin resistance remains a serious challenge for physicians. The current report describes a 65-year-old male patient that had a mechanical prosthetic aortic valve implanted due to severe aortic insufficiency after infective endocarditis. Despite consistent increases in his warfarin dose, the level of international normalized ratio (INR) remained very low. The patient was considered to have warfarin resistance. Warfarin was successfully replaced by another VKA, acenocoumarol, which resulted in a stable INR observed over 1 year of follow-up. Achieving the target INR in patients with mechanical prosthetic heart valves using VKAs is the main goal of thromboprophylaxis. Although the genetic changes that cause warfarin resistance are understood, the options to overcome these pharmacogenetic issues remain limited. Based on the success with this current patient, physicians with similar patients with warfarin resistance might wish to consider replacing warfarin with acenocoumarol.
The clinical manifestations of cocaine-induced cardiovascular diseases are variable: from vessel to tissue problems. Often different pathologies can have similar clinical picture. In the present case a young man experienced intensive chest pain and had ST-segment elevation on ECG in area of inferior wall of the left ventricle. Typical changes on cardiac magnetic resonance imaging and normal coronary arteries on coronary angiography helped to put the diagnosis of acute myocarditis and ruled out acute myocardial infarction.
Coronary artery disease (CAD) remains a top cause of morbidity and mortality nowadays. Current guidelines are used to deϐine timely diagnostic and management strategies for a patient with new angina symptom. According to the guidelines, the main purpose is assessment of the pretest probability of obstructive CAD. Exercise electrocardiography is the most accessible methodwith 85-90% speciϐicity and 45-50% sensitivity. Cardiopulmonary exercise testing (CPET) with concomitant monitoring of electrocardiogram, heart rate and blood pressure, expired gas analysis has become widespread among different exercise tests. CPET is an important clinical tool to estimate exercise capacity. In most cases it allowsto determine the causes of limited physical activity, evaluate both the blood supply (pulmonary, cardiovascular, haematopoietic systems) and tissue oxygen metabolism (skeletal muscle system) in response to physical exercise.The indications for invasive coronary angiography include: high clinical risk of CAD, symptoms which are refractory to medical therapy, low tolerance to exercise or if revascularization is considered for improvement of prognosis. The aim. To highlight the need for a combination of non-invasive stresstesting (CPET, stress echocardiography) and invasive testing (such as coronary angiography) to develop proper tactics of treating patients with established CAD. Conclusion. Described clinical case demonstrates preferences of combined different functional non-invasive tests (CPET, stress echocardiography) in a patient with confirmed CAD, who received prognosis modifying therapy and had high exercise tolerance due to regular cardio training. This gave the reason for postponing the repeated ICA to determine the dynamics of the progression of coronary atherosclerosis. However, when an anginal attack occurred and repeated urgent ICA was performed, it became necessary to perform coronary artery bypass grafting and, later, due to the continuation of anginal attacks and the presence of areas of ischemia, stenting of the trunk of the left coronary artery.
The aim – assessment of gender differences in the frequency of comorbidities, structural and functional state of the heart, arterial stiffness, pulse load and ventricular-arterial interaction in patients with hypertension and heart failure with preserved left ventricular ejection fraction.Material and methods. 115 patients were diagnosed with HFpEF II A or II B stage, II or III NYHA FC, with LV EF ≥ 50 % and signs of LV diastolic dysfunction by TTE, and were divided into 2 groups by gender (group 1 – women with AH and HFpEF, and group 2 – men with hypertension and HFpEF). The control group consisted of 58 patients matched for age, gender composition, with AH 1–2 degrees, without heart failure; they were also divided into 2 groups (groups 3 and 4, respectively). Results. The examined groups of patients did not statistically differ regarding age and, among patients with HF, men and women did not differ in frequency of II or III FC (NYHA); among men, earlier MI was noted more frequently than in women – 23 (37.1 %) vs 4 (7.5 %) (P<0.001). BMI among women with or without HF was higher (30.3±5.4 vs. 29.8±4.6 and 32.0±4.5 vs. 30.0±3.2, P<0.05), without differences in the frequency of obesity. In women, the average GFR was lower – 61.2±13.5 vs. 74.4±15.2 and 70.6±1.3 vs. 86.1±17.9 (by 13.3 % and 18 %, respectively, P<0.001) Among patients with HFpEF, the prevalence of anemia was higher in women (16 (30.2 %) vs. 7 (11.3 %), P<0.05). The distance of the 6-minute walk test was significantly less in the group of patients with HF of both genders compared with the control group (353.4±91.6 vs. 553.2±56.6 and 384.3±83.5 vs. 569.8±33.7, P<0.01), with a slightly worse result among women (by 8 %, P<0.01). In women with HF, compared with men, there were elevated rates of both arterial elastance Ea — 2.3±0.6 vs.1.9±0.4, P<0.05 (by 17.4 %), and end-systolic stiffness Ees – 3.3±1.3 vs. 3.0±1.1, P<0.05 (by 9.1 %). Despite similar values of brachial BP and central BP in women with HF, compared to men, larger PWWc-f was noted by 9.5 % (12.8±1.5 vs. 12.2±1.4, P<0.05) and AIx75 by 9.2 % (37.7±12 1 vs. 34.7±8.9, P<0.05).Conclusions. In the population of the examined patients with AH and HFpEF there is a tendency towards more pronounced diastolic LV dysfunction, severity of clinical manifestations of heart failure in women, in comparison with men, in the absence of gender differences. Women with HFpEF have a higher resistive and pulsative load on LV. Thus, in women with hypertension, there is an increased tendency to develop HFpEF compared to men.
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