Magdalena Jachymek, M. Lewandowski, M. Braksator, M. Peregud-Pogorzelska
The article presents the case of a 36-year-old woman referred to the Clinic of Cardiology at the Pomeranian Medical University with exertional dyspnoea that had been increasing for 2 years. Upon examination, the patient was diagnosed with an atrial septal defect type II (ASD II) with a left-to-right shunt and pulmonary hypertension. Echocardiography revealed a defect of 4.3 cm in diameter, right ventricular systolic pressure (RSVP) 80 mm Hg, tricuspid regurgitation. Right heart catheterization (RHC) revealed: mean pulmonary arterial pressure (mPAP) 59 mm Hg, pulmonary vascular resistance 10.22 Wood units (WU) and a negative vasoreactivity test. Following a cardiosurgical consultation, the patient was qualified for preliminary pharmacological treatment and re-examination. Sildenafil was included in the treatment, followed by macitentan. Improvement in exercise tolerance was observed [in the 6-minute walk test — from 440 to 526 m; clinically from New York Heart Association (NYHA) III to NYHA I/II] as well as a decrease in N-terminal pro-B-type natriuretic peptide concentration (from 250 to 170 pg/mL). Echocardiography showed a decrease in RVSP to 60 mm Hg. In RHC performed after one year of treatment, mPAP decreased to 40 mm Hg, PVR decreased to 3.25 WU, and cardiac output increased from 5.57 to 10.44 L/min. Mixed venous oxygen saturation increased from 64.5% to 72.5%. After another cardiosurgical consultation, the patient was qualified for surgery. Closure of ASD II was performed with a pericardial patch and completed with tricuspid valve plasty. The peri-and postoperative period was uneventful, and the clinical and echocardiographic follow-up confirmed the positive effects of the treatment.
{"title":"Preoperative pharmacological management of a patient with ASD II and pulmonary hypertension forcardiac surgery","authors":"Magdalena Jachymek, M. Lewandowski, M. Braksator, M. Peregud-Pogorzelska","doi":"10.5603/FC.2021.0047","DOIUrl":"https://doi.org/10.5603/FC.2021.0047","url":null,"abstract":"The article presents the case of a 36-year-old woman referred to the Clinic of Cardiology at the Pomeranian Medical University with exertional dyspnoea that had been increasing for 2 years. Upon examination, the patient was diagnosed with an atrial septal defect type II (ASD II) with a left-to-right shunt and pulmonary hypertension. Echocardiography revealed a defect of 4.3 cm in diameter, right ventricular systolic pressure (RSVP) 80 mm Hg, tricuspid regurgitation. Right heart catheterization (RHC) revealed: mean pulmonary arterial pressure (mPAP) 59 mm Hg, pulmonary vascular resistance 10.22 Wood units (WU) and a negative vasoreactivity test. Following a cardiosurgical consultation, the patient was qualified for preliminary pharmacological treatment and re-examination. Sildenafil was included in the treatment, followed by macitentan. Improvement in exercise tolerance was observed [in the 6-minute walk test — from 440 to 526 m; clinically from New York Heart Association (NYHA) III to NYHA I/II] as well as a decrease in N-terminal pro-B-type natriuretic peptide concentration (from 250 to 170 pg/mL). Echocardiography showed a decrease in RVSP to 60 mm Hg. In RHC performed after one year of treatment, mPAP decreased to 40 mm Hg, PVR decreased to 3.25 WU, and cardiac output increased from 5.57 to 10.44 L/min. Mixed venous oxygen saturation increased from 64.5% to 72.5%. After another cardiosurgical consultation, the patient was qualified for surgery. Closure of ASD II was performed with a pericardial patch and completed with tricuspid valve plasty. The peri-and postoperative period was uneventful, and the clinical and echocardiographic follow-up confirmed the positive effects of the treatment.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43876590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in heart failure pharmacotherapy and cardio-vascular prevention: reports from The Congress of European Society of Cardiology 2020","authors":"P. Hamala, J. Kasprzak","doi":"10.5603/FC.2021.0050","DOIUrl":"https://doi.org/10.5603/FC.2021.0050","url":null,"abstract":"","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41414253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kaczor, Antonina Doroszewska, B. Górnicka, Dagmara Mirowska-Guzel
Introduction. An important element of general medical skills is the ability to deliver bad news in an effective and emotionally burdensome manner for medical personnel as doctors usually are. Preparing graduates for such a challenge is to familiarize them with the elements of the SPIKES protocol, referring to the 6 elements of the interview that should be included during the giving information. Material and methods. The study has been conducted among the last-year students of the Faculty of Medicine, Medical University of Warsaw, participating in classes at the Medical Simulation Centre (MSC) as part of the “Specialty chosen by the student” block. As a part of that course was the participation of students in a scenario assuming the need to deliver bad news to the family of a patient who has died due to cardiac arrest. Students worked in four-person therapeutic teams, in which 1 student acted as the head of the therapeutic team, 3 other students acted as team member. A previously trained person played the role of a family member. The students’ behaviour was assessed by an independent observer based on audiovisual recordings. Results. Out of 369 students participating in the simulation classes described above at the MSC, 148 people making up 37 Emergency Medical Team (EMT) agreed to an audiovisual recording enabling the study to be carried out. 86% of those speaking with the simulated patient playing the role of the patient’s family ensured a sufficiently long conversation time related to the needs of the family. About 2/3 of the respondents (68.5%) reflected the emotions of the interlocutor and was able to name them and reacted on an ongoing basis to the patient’s reactions in terms of the bad news delivered (63%). Less than half of the respondents (48.5%) took care to maintain intimacy during the conversation. 20% of students provided preliminary information about the incident to introduce them to the interview, and less than 10% of the respondents summed up the interview and suggested further proceedings. Conclusions. The analysis of last year Faculty of Medicine students behaviour showed that practically all elements of the SPIKES protocol require a lot of attention and thorough discussion in the education of subsequent years of students of the medical faculty. Teaching the ability to communicate unfavourable information should take place both at the stage of undergraduate education and its completion in postgraduate education.
{"title":"Ocena umiejętności komunikacyjnych studentów ostatniego roku kierunku lekarskiego Warszawskiego Uniwersytetu Medycznego w zakresie przekazywania niepomyślnych informacji","authors":"M. Kaczor, Antonina Doroszewska, B. Górnicka, Dagmara Mirowska-Guzel","doi":"10.5603/FC.2021.0044","DOIUrl":"https://doi.org/10.5603/FC.2021.0044","url":null,"abstract":"Introduction. An important element of general medical skills is the ability to deliver bad news in an effective and emotionally burdensome manner for medical personnel as doctors usually are. Preparing graduates for such a challenge is to familiarize them with the elements of the SPIKES protocol, referring to the 6 elements of the interview that should be included during the giving information. Material and methods. The study has been conducted among the last-year students of the Faculty of Medicine, Medical University of Warsaw, participating in classes at the Medical Simulation Centre (MSC) as part of the “Specialty chosen by the student” block. As a part of that course was the participation of students in a scenario assuming the need to deliver bad news to the family of a patient who has died due to cardiac arrest. Students worked in four-person therapeutic teams, in which 1 student acted as the head of the therapeutic team, 3 other students acted as team member. A previously trained person played the role of a family member. The students’ behaviour was assessed by an independent observer based on audiovisual recordings. Results. Out of 369 students participating in the simulation classes described above at the MSC, 148 people making up 37 Emergency Medical Team (EMT) agreed to an audiovisual recording enabling the study to be carried out. 86% of those speaking with the simulated patient playing the role of the patient’s family ensured a sufficiently long conversation time related to the needs of the family. About 2/3 of the respondents (68.5%) reflected the emotions of the interlocutor and was able to name them and reacted on an ongoing basis to the patient’s reactions in terms of the bad news delivered (63%). Less than half of the respondents (48.5%) took care to maintain intimacy during the conversation. 20% of students provided preliminary information about the incident to introduce them to the interview, and less than 10% of the respondents summed up the interview and suggested further proceedings. Conclusions. The analysis of last year Faculty of Medicine students behaviour showed that practically all elements of the SPIKES protocol require a lot of attention and thorough discussion in the education of subsequent years of students of the medical faculty. Teaching the ability to communicate unfavourable information should take place both at the stage of undergraduate education and its completion in postgraduate education.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48845232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We described a case of patient with life-threatening hyperkalemia, cardiovascular and chronic kidney disease, in which hyperkalemia instead of typical electrocardiographic changes occurred as pseudonormalization of the electrocardiogram.
{"title":"Pseudonormalisation of the ECG in a patient with life-threatening hyperkalemia","authors":"Paweł Wróbel, A. Jaroszyński","doi":"10.5603/FC.2021.0048","DOIUrl":"https://doi.org/10.5603/FC.2021.0048","url":null,"abstract":"We described a case of patient with life-threatening hyperkalemia, cardiovascular and chronic kidney disease, in which hyperkalemia instead of typical electrocardiographic changes occurred as pseudonormalization of the electrocardiogram.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43743504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Wilk, W. Król, Marcin Konopka, Anna K Żarek-Starzewska, Wojciech Braksator
Takotsubo syndrome (TTS) is an acute condition characterized by transient decrease of regional contractility most often involving apical segments of left ventricle. We present the case report of 87-year old woman diagnosed with intermediate-high risk acute pulmonary embolism, previously discharged in a stable condition, who was presented again to the Emergency Department because of a syncope and increasing levels of troponin. After differential diagnostics including coronaroangiography and transthoracic echocardiography complemented by the longitudinal strain assessment with the use of speckle tracking echocardiography a diagnosis of takotsubo cardiomyopathy was made. This case shows the significance of strain echocardiography in diagnostics of TTS.
{"title":"Późna postać zespołu takotsubo w przebiegu zatorowości płucnej","authors":"A. Wilk, W. Król, Marcin Konopka, Anna K Żarek-Starzewska, Wojciech Braksator","doi":"10.5603/fc.a2021.0034","DOIUrl":"https://doi.org/10.5603/fc.a2021.0034","url":null,"abstract":"Takotsubo syndrome (TTS) is an acute condition characterized by transient decrease of regional contractility most often involving apical segments of left ventricle. We present the case report of 87-year old woman diagnosed with intermediate-high risk acute pulmonary embolism, previously discharged in a stable condition, who was presented again to the Emergency Department because of a syncope and increasing levels of troponin. After differential diagnostics including coronaroangiography and transthoracic echocardiography complemented by the longitudinal strain assessment with the use of speckle tracking echocardiography a diagnosis of takotsubo cardiomyopathy was made. This case shows the significance of strain echocardiography in diagnostics of TTS.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47800784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Wojciechowska, K. Rybak, M. Zarębiński, Łukasz Pastwa, Agnieszka Cudnoch-Jędrzejewska
This is a case of 52-year-old male after episode of syncope and with atypical chest pain referred to hospital with acute anterior ST elevation myocardial infarction. Urgent coronary angiography showed normal coronary arteries and only ECG made the next day made us to suspect Brugada syndrome. The patient had ICD implanted and because of high defibrillation threshold, subcutaneous electrode implantation was decided. Our case highlights, that ECG changes in Brugada syndrome can mimic ST elevation in the course of acute coronary syndrome and that subcutaneous electrode implantation may be useful method of lowering defibrillation treshold.
{"title":"Omdlenie i elektrokardiograficzne podejrzenie zawału serca z uniesieniem odcinka ST nad ścianą przednią – pomyśl o zespole Brugadów!","authors":"M. Wojciechowska, K. Rybak, M. Zarębiński, Łukasz Pastwa, Agnieszka Cudnoch-Jędrzejewska","doi":"10.5603/fc.2021.0039","DOIUrl":"https://doi.org/10.5603/fc.2021.0039","url":null,"abstract":"This is a case of 52-year-old male after episode of syncope and with atypical chest pain referred to hospital with acute anterior ST elevation myocardial infarction. Urgent coronary angiography showed normal coronary arteries and only ECG made the next day made us to suspect Brugada syndrome. The patient had ICD implanted and because of high defibrillation threshold, subcutaneous electrode implantation was decided. Our case highlights, that ECG changes in Brugada syndrome can mimic ST elevation in the course of acute coronary syndrome and that subcutaneous electrode implantation may be useful method of lowering defibrillation treshold.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43709150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antara Banerji, Pradyot Tiwari, Mehul Shah, Munish Dev, Sunil Gurumukhani, Tejas Patel, Sanjay Shah
{"title":"Duży tętniak w pozaczaszkowym odcinku tętnicy szyjnej wyczuwalny jako pulsująca masa w obrębie szyi","authors":"Antara Banerji, Pradyot Tiwari, Mehul Shah, Munish Dev, Sunil Gurumukhani, Tejas Patel, Sanjay Shah","doi":"10.5603/fc.2021.0037","DOIUrl":"https://doi.org/10.5603/fc.2021.0037","url":null,"abstract":"","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42897404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persistent therapy is the continuation of treatment despite having assessed the patient’s clinical condition as showing no prospect of improvement, having exhausted all available treatment options and having found that continued therapy would extend the patient’s suffering with no chance of improvement. Persistent therapy is an exception from the physician’s obligation to provide medical assistance in each case when delay could result in the threat of loss of life, serious bodily injury or serious health disorder. Provisions of Polish law do not provide for any special procedure for consent by an authorized body (e.g. court) for discontinuation of treatment as the result of a finding of no medical indications for its continuation. Accordingly, it rests upon the medical staff to make and implement the decision in this regard. This includes first and foremost making a collective decision, reflecting all circumstances relating to the patient’s clinical condition in the medical records, and giving effect in practice to the patient’s rights — including the right to be informed about the condition of one’s health, to give informed consent to the provision of a medical service, and to die peacefully and with dignity — as appropriate given the patient’s state of consciousness.
{"title":"Uporczywa terapia w świetle orzecznictwa i doktryny w aspekcie praw pacjenta i skorelowanych z nimi obowiązków lekarza","authors":"K. Kocańda, A. Zwierzchowska, M. Bączek","doi":"10.5603/fc.2021.0040","DOIUrl":"https://doi.org/10.5603/fc.2021.0040","url":null,"abstract":"Persistent therapy is the continuation of treatment despite having assessed the patient’s clinical condition as showing no prospect of improvement, having exhausted all available treatment options and having found that continued therapy would extend the patient’s suffering with no chance of improvement. Persistent therapy is an exception from the physician’s obligation to provide medical assistance in each case when delay could result in the threat of loss of life, serious bodily injury or serious health disorder. \u0000Provisions of Polish law do not provide for any special procedure for consent by an authorized body (e.g. court) for discontinuation of treatment as the result of a finding of no medical indications for its continuation. Accordingly, it rests upon the medical staff to make and implement the decision in this regard. This includes first and foremost making a collective decision, reflecting all circumstances relating to the patient’s clinical condition in the medical records, and giving effect in practice to the patient’s rights — including the right to be informed about the condition of one’s health, to give informed consent to the provision of a medical service, and to die peacefully and with dignity — as appropriate given the patient’s state of consciousness.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44541628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Piotr Koprowicz, J. Włodarczyk, M. Kurpesa, J. Kasprzak, T. Rechciński
We present the case of including sacubitril/valsartan in an octogenarian patient with congestive heart failure as a part of the outpatient cardiac rehabilitation program. The case shows that apart from hospital use, it is worth considering including this drug during an outpatient cardiac rehabilitation program, because in such conditions the patient is in frequent contact with the treatment center, so his health status may be assessed almost every day.
{"title":"Initiation of treatment with sacubitril/valsartan during outpatient cardiac rehabilitation program in an octogenarian with heart failure","authors":"Piotr Koprowicz, J. Włodarczyk, M. Kurpesa, J. Kasprzak, T. Rechciński","doi":"10.5603/fc.a2021.0044","DOIUrl":"https://doi.org/10.5603/fc.a2021.0044","url":null,"abstract":"We present the case of including sacubitril/valsartan in an octogenarian patient with congestive heart failure as a part of the outpatient cardiac rehabilitation program. The case shows that apart from hospital use, it is worth considering including this drug during an outpatient cardiac rehabilitation program, because in such conditions the patient is in frequent contact with the treatment center, so his health status may be assessed almost every day.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46098769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Osiecki, Sebastian Przychodzeń, W. Kochman, Dariusz Michałkiewicz
In this case report authors describe 39 years old female with persistent numerous monomorphic ventricular extrasystole and unusual long asystole during ablation in the right ventricular outflow tract which was probably provoked by pain.
{"title":"Przedłużona asystolia w trakcie ablacji w drodze odpływu prawej komory","authors":"A. Osiecki, Sebastian Przychodzeń, W. Kochman, Dariusz Michałkiewicz","doi":"10.5603/fc.2021.0038","DOIUrl":"https://doi.org/10.5603/fc.2021.0038","url":null,"abstract":"In this case report authors describe 39 years old female with persistent numerous monomorphic ventricular extrasystole and unusual long asystole during ablation in the right ventricular outflow tract which was probably provoked by pain.","PeriodicalId":12308,"journal":{"name":"Folia Cardiologica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48847823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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