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  • Author: Liviu Macovei x
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Assessment of microalbuminuria in hypertensive patients with established coronary artery disease

Abstract

Objectives. Cardiovascular risk assessment is continuously improving due to a better understanding of the atherosclerotic pathomechanism by investigating new risk factors. Microalbuminuria is known as a predictor of renal, as well as cardiovascular morbidity and mortality in patients with hypertension. The aim of this study was to determine the clinical relevance of microalbuminuria and its relationship with traditional cardiovascular risk factors in hypertensive high-risk patients with established coronary artery disease. Methods. We have collected clinical and laboratory data from 94 hypertensive patients (currently treated or newly diagnosed) with known coronary artery disease (angiographically documented) admitted in the Institute of Cardiovascular Diseases. From January 2012 to April 2013 they were screened for microalbuminuria. For the diagnosis of microalbuminuria, a first-morning urine sample was analyzed by immunoturbidimetry (MAU range: 20-200 mg/l, the microalbuminuric group). Patients with urinary albumin excretion >200 mg/l were excluded. Patients with values <20 mg/l were considered the normoalbuminuric group. Results. A large percentage (53.2%) of the study group was found with microalbuminuria. Patients with microalbuminuria were older, mostly male, with a longer duration of hypertension, and with a higher prevalence of left ventricular hypertrophy (LVH). None of the traditional cardiovascular risk factors - age, male gender, obesity, smoking, diabetes mellitus, dyslipidemia - indicated a statistical significance in relation with MAU. Although left ventricular ejection fraction (LVEF) didn't influence the level of microalbuminuria, a strong correlation was achieved with the presence of LVH (p=0.005) and duration of hypertension (p=0.046). Conclusion. Hypertensive high-risk patients should be routinely screened for microalbuminuria and when confirmed they may need a more aggressive medical therapy to lower the cardiovascular risk.

Open access
Particularities of Acute Myocardial Infarction in Young Adults

Abstract

Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.

Open access
A Rare Cause of Ventricular Fibrillation Confirmed by Speckle-Tracking Imaging

Abstract

Introduction: Cardiac arrhythmias caused by electrical injuries are rare among emergency service admittances. We present a case of ventricular fibrillation (VF) with a rare etiology, confirmed by speckle-tracking imaging.

Case presentation: A 38-year-old man was addressed to our hospital to evaluate the etiology of an episode of VF, promptly resuscitated in a territorial hospital. On admission, his 12-lead electrocardiogram revealed a sinus rhythm, without any ST-T changes or atrioventricular conduction disorders. Transthoracic echocardiography and coronary angiography were normal, and the electrophysiological study did not induce VF. Anamnesis showed that the arrhythmia occurred after an electrical injury, resulting from the contact with a domestic low-voltage source. Speckle-tracking imaging revealed closure of the electric arc within the heart, which could explain the absence of skin-burn injuries in this case. The patient was discharged after seven days of hospitalization, without any complication.

Conclusions: VF can occur after an unexpected electrical shock during a household accident. This case report underlines the need for a complex interdisciplinary approach in such difficult cases, when the absence of any electrical injuries on the skin makes it difficult to recognize the electrical shock that triggered the ventricular fibrillation.

Open access