Dejan Petrović, Marina Deljanin Ilić, Bojan Ilić, Sanja Stojanović, Milovan Stojanović and Dejan Simonović
Asystole is a rare primary manifestation in the development of sudden cardiac death (SCD), and survival during cardiac arrest as the consequence of asystole is extremely low. The aim of our paper is to illustrate successful cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) and rare and severe form of cardiac arrest - asystole. A very short time between cardiac arrest in acute myocardial infarction, which was manifested by asystole, and the adequate CPR measures that have been taken are of great importance for the survival of our patient.
After successful reanimation, the diagnosis of anterior wall AMI with ST segment elevation was established. The right therapeutic strategy is certainly the early primary percutaneous coronary intervention (PPCI). In less than two hours, after recording the “flatline” and successful reanimation, the patient was in the catheterization laboratory, where a successful PPCI of LAD was performed, after emergency coronary angiography. In the further treatment course of the patient, the majority of risk factors were corrected, except for smoking, which may be the reason for newly discovered lung tumor disease. Early recognition and properly applied treatment of CPR can produce higher rates of survival.
The study case is a foetus with a diagnosed heart tumor in week 23 of pregnancy. The tumor was found in the right ventricle with a concomitant local change of echogenicity of the right atrial wall; it did not cause any haemodynamic disturbances, impair systolic function or disturb inflow into the right ventricle. Foetal check-up in week 30 has shown a complete regression of the lesion in the right ventricular lumen. Because of no foetal movements felt, in week 36 the pregnant patient reported to the hospital where foetal heart asystole was diagnosed and the pregnancy was terminated by labour induction. Foetal autopsy has shown no nodose lesions in the heart or any other lesions which could have been the cause of an abrupt foetal death in utero.
Christopher William Maxwell, Joshua Carson, Michael R. Kaufmann and Brenda G. Fahy
Annual implants of cardiovascular implantable devices (CIEDs) are increasing, thus increasing the risk of device exposure. This case presents CIED management issues following traumatic thermal injury. A 59-year-old female presented to intensive care with 42% total body surface area burn involving tissue over her pacemaker generator. Electrophysiologists interrogated and reprogrammed the pacer and observed the patient over 72 hours without pacing. Serratia bacteremia developed and cardiology recommended device removal. The pacemaker generator and leads were removed by cardiothoracic and burn surgery. Postoperatively, asystole required emergency transvenous pacing wire placement. During bacteremia treatment, cardiology planned to pace with an active-fixation screw-in lead with long-term plans to place a single right ventricular chamber leadless pacemaker because of the extensive burns. The patient developed fungemia and the family opted for comfort care. This case report discusses the management of a CIED exposed after a traumatic thermal burn, including device extraction.
Predrag Cvetković, Zoran Perisić, Tomislav Kostić, Aleksandar Stojković, Miroslav Krstić, Nenad Bozinović, Bratislav Kirćanski and Mima Keković
Implantable loop recorder (ILR) is a method in cardiology, which is used for the diagnosis of unexplained syncope in patients who were not treated successfully using standard methods. Implantable loop recorder is a diagnostic device that is surgically implanted under the skin of the chest area. This device does not have the endovenous implantation of electrodes; instead, electrodes are attached to the machine housing. The device records the heart rhythm continuously, up to 14 months, and stores data outside the activator whenever symptoms appear, or by the automatic activation of the predefined program for bradycardia, asystole, and tachycardia. The aim of this paper was to describe the method for the detection of cardiac syncope with the use of implantable loop recorder.
Jānis Jušinskis, Diāna Amerika and Aleksandrs Maļcevs
Delayed renal graft function (DGF) is a frequent complication with negative impact on the course of early post-transplantation period. The data concerning the impact on the late results are contradictory. This study describes results of 5-year follow-up of 248 recipients after deceased donor renal transplantation. All patients were divided into two groups: with delayed graft function (DGF, n = 53) and immediate graft function, considered as the control group (IGF, n = 195). We evaluated factors that were associated with development of DGF and its impact on the survival of graft and recipient, and frequency of acute rejections and chronic dysfunctions. The rate of observed DGF was 21.4%. Its development was associated with the following factors: age of recipient and their weight, age of donor and their body mass index, high frequency of asystole/hypotension in donors prior to organ explantation (P < 0.05 for all), and longer time of cold ischemia (P = 0.058). The DGF group had higher rate of acute rejections (P < 0.001), and also lower 1.5 and 5-year graft survival and 1.5-year patient survival (P < 0.05 for all). The conclusion is that DGF has negative impact on the survival of renal grafts and patients, especially during the first 1.5 years after transplantation.
Raluca M. Tat, Adela Golea, Ştefan C. Vesa and Daniela Ionescu
in Group A were asystole [n = 23 (57.5%)] and pulseless electrical activity [n = 3 (12.5%)].
In Group A, 15 (37.5%) died in the first three days, six of these in the first 24 hours, six within 48 hours, and three between 48 hours and seventy-two hours. Thirteen more (32.5%) died between 72 hours and thirty days.
Cardiovascular disease was the primary cause of CA in 31 (77.5%) patients. Of all the patients with CA included in the study, 29 (72.5%) developed post-CA shock immediately after resuscitation. Of them, only 4 (13.79%) survived up to 30 days.
syncope and documented asystole: third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation 2012;125:2566-71.
 Deharo JC, Mechulan A, Giorgi R, et al. Adenosine plasma level and A2A adenosine receptor expression: correlation with laboratory tests in patients with neurally mediated syncope. Heart 2012;98:855-9.
 Flammang D, Church TR, De Roy L, et al. Treatment of unexplained syncope: a multicenter, randomized trial of cardiac pacing guided by adenosine 5-triphosphate testing. Circulation
Sokol Myftiu, Enxhela Sulo, Genc Burazeri, Bledar Daka, Ilir Sharka, Artan Shkoza and Gerhard Sulo
previous publication from Albania comparing incident and recurrent cases regarding their clinical profile or in-hospital treatment. International studies have suggested that recurrent cases presented more often with pulmonary oedema, cardiogenic shock and asystole ( 27 ), and have a higher incidence of HF ( 28 ), compared to incident cases.
The results of the analyses comparing in-hospital treatment between incident and recurrent cases have been less consistent. In the Netherlands, utilisation rates of aspirin, beta-blockers, and statins among 4718 STEMI patients were