We report a case of 37-year-old male, who was admitted to the Vilnius University hospital Santaros Klinikos emergency department suffering from acute chest pain. ECG and elevated troponin level confirmed ST-elevation myocardial infarction, although coronary angiogram had not shown hemodynamically significant changes in coronary arteries. Patient admitted after using cocaine a day ago. To conclude, myocardial infarction is rare, but serious consequence of cocaine use. Clinicians should consider interrogating all young patients presented to the emergency department with acute chest pain for cocaine use.
Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome.
Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found.
Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001).
Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.
Increased awareness of chronic kidney disease stimulates an interest towards early detection and prevention. The true prevalence of kidney injury varies from 10 to 40%, mostly depending on the methodology of the study and the population enrolled. A screening strategy targeting the highest risk groups, those with diabetes or hypertension, family history of diabetes, hypertension, or kidney disease, is likely to be most efficient and cost effective. Quantification for albuminuria should be performed using laboratorymethods or albumin to creatinine ratio and should be monitored at regular intervals. The most correct equations calculating glomerular filtration rate differ in separate populations, and the most accurate equations in patients with high cardiovascular risk are MDRD and CKD-EPI. Markers of early kidney damage have association with other target organs damage, even in subclinical or preclinical mode. Individuals at stage 4 and 5 chronic kidney disease, with higher levels of proteinuria, proteinuria together with haematuria, rapidly declining glomerular filtration rate, or poorly controlled hypertension should be referred to a nephrologist in order to identify the cause, provide recommendations, slow progression, or treat complications.
Objectives. To assess the association between education degree and attitude towards the treatment after myocardial infarction (MI).
Design and Methods. The participants of this cross-sectional study were 191 (140 men and 51 women) outpatients in a period of 3 months – 5 years after acute MI (mean age 59 ± 9.2 years) from Vilnius University Hospital Santaros Klinikos. All patients were asked to complete two questionnaires: “Quality of Life and Treatment after Myocardial Infarction” and “Cholesterol-lowering Drugs Consumption Peculiarities”. The data was analyzed using the SPSS software.
Results. The education degree (a higher (post-secondary education provided by a college or university) vs. a lower (secondary or vocational education) education degree) had similar influence on the patients’ occasional concern (43.2%; n = 35 vs. 52.9%; n = 55, respectively; p = 0.226) and on the frequent concern (25.9%; n =21 vs. 26.9%; n = 28, respectively; p = 0.226) about MI. Patients with a higher education degree were more likely to identify themselves as the main subjects in MI treatment in comparison with patients that had a lower education degree (30.5%; n = 25 vs. 15.2%; n = 16, respectively, p = 0.033). More educated patients found it easier to follow up the doctor’s treatment plan than less educated patients (23.2%; n = 19 vs. 9.5%; n = 10, respectively; p = 0.035).
Conclusions. More educated patients are more likely to follow up the doctor’s treatment plan and see it easier than less educated patients. Thus, more attention should be paid to less educated patients in order to increase their own impact on their post-MI treatment.
Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006.
Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years.
Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities.