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Case Report
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Sarcocystosis is a critical parasitic zoonosis caused by Sarcocystis species, an intracellular protozoan parasite of the Apicomplexa phylum and one of the most prevalent parasitic diseases among wild and domestic animals all around the world. Infection in the definitive host is mainly characterized by the formation of cysts in muscle tissue. In intermediate host skeletal muscles, the diaphragm and heart are the favored locations for Sarcocystis spp. While we were examining the heart of a three-month-old dead lamb, we incidentally observed striking, white, and discrete spots, measuring 2–3 mm, that were diffusely distributed in the endocardium. Microscopically, numerous Sarcocystis were seen within cardiomyocytes and Purkinje fibers. No different pathological modifications had been found in inflamed muscle fibers or the surrounding interstitium. To the best of our knowledge, there is no case report about diffuse involvement of endocardium by Sarcocystis spp., and this unique form of sarcocystosis prompted us to place the current case on record.
Case Report
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Introduction: Systemic amyloidosis AL is an unusual disease characterized by a heterogeneous presentation.
Clinical Case: We present a case of systemic amyloidosis AL with unusual cardiac, mesenteric, renal, peritoneal, and gastrointestinal involvement, in which the diagnostic hypothesis was formulated on the basis of problem-solving and ultrasound technique (abdomen, lung, heart ultrasound).
Conclusion: This case shows that multi-organ ultrasound, associated with problem-solving, may be very helpful in the diagnosis of systemic diseases, even unusual ones, avoiding a long diagnostic interval length.
Clinical Case Report
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The most common cause of cardiogenic shock (CS) is acute myocardial infarction (AMI), which is diagnosed in approximately 5–8% of patients hospitalized for AMI and is more common in patients with acute ST-segment elevation myocardial infarction (STEMI). CS is caused by severe myocardial dysfunction, which leads to a decrease in cardiac output, hypoperfusion of the end organs, and hypoxia. Mortality in diabetic patients with AMI is high. Besides the fact that type 2 diabetes mellitus (DM2) contributes to the progression of coronary atherosclerosis, coronary pathology in this category of patients occurs against the background of a specific diabetic myocardial lesion - diabetic cardiomyopathy. Against the background of cardiomyopathy, acute heart failure is more often developed with a decrease in global myocardial contractility up to CS, which increases hospital-acquired mortality in MI by more than 15 times. The increased risk of death observed in patients with DM2 in the acute period of myocardial infarction (MI) persists for several years, and therefore, at present, in patients with the acute coronary syndrome (ACS) and diabetes, an early invasive strategy is preferable to a conservative strategy. The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial demonstrated that in patients with CS complicating AMI, emergency revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) improved long-term survival when compared with initial intensive medical therapy. However, in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) study, stenting of non-infarct-dependent coronary arteries in CS increases the risks of major cardiac events, as well as the number of repeated revascularizations within 30 days and 1 year. Patients with multivessel lesions, in most cases, are elderly patients (75–90 years old) who have age restrictions on taking the loading dose at the prehospital stage. Such a loading dose of clopidogrel may not be sufficient to saturate the patient in fact, despite optimal epicardial recanalization, a large proportion of patients still experience impaired reperfusion and in-stent thrombosis. A large body of evidence has been accumulated on the benefits of glycoprotein (GP) IIb-IIIa inhibitors in terms of prevention of stent thrombosis, and benefits in mortality, especially among high-risk patients, and as an upstream strategy.
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Introduction: Approximate entropy (ApEn) is a widely imposed metric to evaluate a chaotic response and irregularities of RR-intervals from an electrocardiogram. Yet, the technique is problematic due to the accurate choice of the tolerance (r) and embedding dimension (M). We prescribed the metric to evaluate these responses in subjects exhibiting symptoms of chronic obstructive pulmonary disease (COPD) and we strived to overcome this disadvantage by applying different groupings to detect the optimal.
Methods: We examined 38 subjects split equally: COPD and control. To evaluate autonomic modulation the heart rate was measured beat-by-beat for 30 min in a supine position without any physical, sensory, or pharmacological stimuli. In the time-series obtained the ApEn was then applied with set values for tolerance, r and embedding dimension, M. Then, the differences between the two groups and their effect size by two measures (Cohen’s ds and Hedges’s gs) were computed.
Results: The highest value of statistical significance accomplished for any effect size statistical combinations undertaken was -1.13 for Cohen’s ds, and -1.10 for Hedges’s gs with embedding dimension, M = 2 and tolerance, r = 0.1.
Conclusion: ApEn was capable of optimally identifying the decrease in chaotic response in COPD. The optimal combination of r and M for this were 0.1 and 2, respectively. Despite this, ApEn is a relatively unpredictable mathematical marker and the use of other techniques to evaluate a healthy or pathological condition is encouraged.
Editorial
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) called COVID-19 is often associated with thrombotic complications, especially in severe cases. We report a case of COVID-19 revealed by a right intraatrial thrombus to emphasize the risk of thromboembolic diseases linked to this pathology. He was a young subject, 41 years old, with no notable history. He complained of asthenia and precordialgia. Echocardiography showed the presence of a right intraatrial thrombus and laboratory tests confirmed COVID-19. Under medical treatment combining antithrombotics, chloroquine and azithromycin, the thrombus regressed, and the markers of inflammation were normalized after 12 days. One month later, the patient remained clinically stable with normal echocardiography.
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In today's world, the growth of technical progress has increased the number of people with obesity, which is one of the main risk factors for the development of acute myocardial infarction (MI).
Objective: To evaluate the effect of obesity on some clinical and anthropometric characteristics in patients with acute MI.
Material and Methods: A special questionnaire - a “registry card” was developed for monitoring patients with acute MI and collecting the necessary and complete information from employees of the Cardiovascular Diseases (CVD) Prevention Department. The presented article describes the data of a preliminary analysis of patients with acute MI treated in the clinic. Of the 202 people, 191 (94.6%) had a body mass index (BMI) calculated. Depending on the level of BMI, three groups were selected: 1 g (BMI < 25 kg/m2) - 36 (18.8% of 191) patients with acute MI with normal weight (control group); 2 g (BMI = 25–30 kg/m2) - 84 (44.0% of 191) overweight people; 3 g (BMI > 30 kg/m2) - 71 (37.2% of 191) people with obesity. Differences were considered significant at p < 0.05.
Results: Despite the fact that acute MI developed in women 2.6 times less frequently and 8.7 years later in age than in men, nevertheless, obesity in women was recorded more often, while in men overweight prevailed. In acute MI between the age of the respondents and the presence of increased weight, an inverse relationship was revealed (p > 0.05), i.e., as the weight category increased, the age of the patients decreased. In patients with MI, as the weight increased, there was an increase in comorbid pathology, especially associated with impaired carbohydrate metabolism (p < 0.0001). A more severe form of MI (STEMI) was more often recorded in persons with a BMI > 25 kg/m2, while the front wall was the most vulnerable to the development of acute MI, regardless of the weight category of patients. The back wall was involved in the pathological process both in individuals with overweight and in patients with obesity. The apical segment in the largest number of cases was only affected in people with obesity.
Conclusion: Obesity is a kind of epidemic of modern society. Its effects on the quality of life, prognosis, and effectiveness of conservative or minimally invasive treatment methods in patients with acute cardiovascular catastrophes, such as acute MI, are still a very controversial issue that requires furthermore in-depth study and analysis.
Original Research
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Introduction: Non-ST-elevation (NSTE) acute coronary syndrome (ACS) is a common and polymorphic condition. Predicting significant coronary artery disease (CAD) is sometimes difficult. The objective of this study was to identify predictors of CAD severity in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).
Patients and Methods: We prospectively evaluated 296 patients with NSTE-ACS who underwent a coronary angiography. Significant CAD was defined as ≥70% stenosis in at least one major coronary artery. Clinical characteristics in the hospital for 30 days and one-year outcomes were prospectively noted and a multivariate analysis was performed.
Results: The study included 296 NSTE-ACS patients. The mean age of the patients was 62.1 ± 12.6 years old while 58.1% of the patients were males. A multivariable analysis for the significant CAD predictors is shown (Figure 1), representing current smoking (ORa = 4.4; 95% confidence interval [CI] = 1.5–13.0, p = 0.007), a diabetic under insulin (Ora = 6.4; 95% [CI] = 2.4–17.4, p < 10-3), typical angina (ORa = 5.4; 95% [CI] = 1.7–16.8, p = 0.003), persistent angina (ORa = 5.3; 95% [CI] = 1.3–21.8, p = 0.019), recurrence of angina (ORa = 8.9; 95% [CI] = 1.5–51.4; p = 0.015), down sloping ST depression (ORa = 6.1; 95% [CI] = 2.4–15.3, p < 10-3), positive troponin (ORa = 4.2; 95% [CI] = 1.9–9.2, p < 10-3), kinetic disorder > 2 segments (ORa = 2.5; 95% [CI] = 1.1–6.0, p = 0.049), intima-media thickness (IMT) > 0.8 mm (ORa = 5.2; 95% [CI] = 2.3–12.1, p < 10-3).
Conclusion: In this study, the severity of CAD was predicted by parameters such as typical or recurrent angina pectoris, current smoking, diabetic on insulin, down sloping ST depression, elevation of troponin, kinetic anomaly in more than two segments and the IMT greater than 0.8 mm.
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