Cardiologia Croatica. 2015;10(11-12)

Đeiti Prvulović

A well-organized network for primary percutaneous coronary intervention (pPCI) is of paramount importance in providing optimal healthcare for patients with acute coronary syndrome (ACS). Organizing a pPCI network is a lengthy and logistically complex task. The purpose of gathering, analyzing, and sharing data on the functioning of the network is to improve the system. Monitoring everyday work and gathering, analyzing, and sharing data are the key elements of continuous improvement. This article describes the efforts to develop a quality monitoring program for the treatment of patients with ACS in western Slavonia – a region in Croatia. We also explain the diagnostic, treatment, and destination protocols used and the types of data we will monitor as indicators of quality and comprehensiveness of care for patients with ACS.

Zdravko Babić

According to multiple authors, erectile dysfunction manifests in over half of the male population with arterial hypertension, especially in middle-aged or older men. Arterial hypertension, but also some of the medication used to treat it, can lead to erectile dysfunction through a number of pathophysiological mechanisms (atherosclerosis in the blood vessels supplying the tissue responsible for the erection, sympathicotonia and dysregulation of the vascular tonus of the erectile organ, poor remodeling and lowered elasticity of blood vessels in the erectile organ, changes in the structure of the cavernous body, and increased concentration of free radicals and lipid peroxidation in the penile tissue). On the other hand, several studies over the recent 15 years have found a positive influence of valsartan on the improvement of erectile dysfunction, as well as orgasmic function, sex drive, and intercourse satisfaction and frequency in patients with arterial hypertension. The basic mechanism that leads to these effects is inhibiting the local angiotensin converting enzyme, but other indirect mechanisms are at play as well. We can thus conclude that valsartan, in addition to good antihypertensive effectiveness, tolerability, and organoprotective effects, has a pronounced pro-erectile effect and is a good treatment choice in patients with arterial hypertension and erectile dysfunction, especially in patients with obesity and diabetes; confirming this hypothesis, however, will require further studies in a patient model.

Mario Ivanuša, Vedrana Škerk, Marija Heinrich, Nada Hrstić, Goran Krstačić, Ivana Portolan Pajić

The central event of the World Heart Day 2015 in Croatia was an open public-health initiative screening for leading cardiovascular risk factors in the city of Zagreb. Individuals with very high risk factor prevalence were accepted into the “Guardians of the Heart” program that assessed cardiovascular risk and offered advice on health. The goal of this article is to report on these results and demonstrate the significance of detecting specific risk factors in individuals with high cardiovascular risk. After an announcement in the media, participants voluntarily applied for free assessment of cardiovascular risk factors during the public event. For interested citizens, health professionals determined the body-mass index (BMI), measured blood pressure (BP), and determined glucose levels and total cholesterol from capillary blood. The first 100 participants with extremely high prevalence of individual risk factors were invited to further detailed evaluation and cardiovascular risk assessment at the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. The results of both actions are presented here. The open public-health action was attended by 308 participants, of whom 59.7% were women and 40.3% men. The average age was 68.8±13.2 years of age. Elevated BP (92.5%) and BMI (46.5% overweight, 25.7% obese) were the most common risk factors. Highly elevated total cholesterol levels were registered in 11.8% participants, and highly elevated glucose levels in the capillary blood in 4.1%. Of the 100 participants invited to detailed cardiovascular risk assessment, 77% responded, of whom 75.2% were women and 24.7% men. Increased BP levels were found in 90.9% of these respondents; dyslipidemia in 85.7%, increased waist size in 84.4%, and 78.9% had elevated BMI. We performed an additional analysis on the results of 30 participants with existing hypertension and dyslipidemia and found elevated risk factors, including elevated BMI (80.0%), waist size (76.7%), urate levels (23.3%), C-reactive protein (16.7%), creatinine (10.0%), and blood glucose levels (10.0%). The most common risk factors in the participants of this public-health action were arterial hypertension and increased BMI. In participants with existing hypertension and dyslipidemia we noted a dismissive approach to these risk factors, both in the sense of non-treatment

Željko Plazonić, Tanja Batinac, Marija Bukvić

Iodinated contrast agents are used to enhance X-ray procedures and can cause both immediate and non-immediate hypersensitivity reactions. Due to their increased use, related hypersensitivity reactions are also on the rise. Following the introduction of nonionic, low-osmolar contrast media the number of hypersensitivity reactions has decreased, but possible severe reactions, such as anaphylaxis, still represent a major concern. Radiologists and cardiologists should keep in mind that previously non-exposed patients could already be sensitized, and could present with a hypersensitivity reaction following the first administration. In previous reactors, especially in cases of severe reactions, an allergy work-up could provide useful information regarding contrast media selection. In patients with a confirmed allergy to contrast media, a contrast medium that has a negative skin test should be chosen, with additional premedication. However, we must keep in mind that none of these measures offer a complete protection from repeated reaction.

Tanja Batinac, Željko Plazonić, Marija Bukvić

Rennin angiotensin system (RAS) blockers are commonly used drugs with proven benefits for cardiovascular and renal diseases. There are four classes of drugs acting on the angiotensin system, the most commonly used being angiotensin converting enzyme inhibitors (ACEI) followed by angiotensin receptor blockers (ARB). These drugs are generally considered safe and effective in the majority of patients, but in some cases adverse drug reactions may occur (ADRs). Angioedema resulting from RAS blocker treatment is a rare but potentially life-threatening event, and we should keep in mind that in recent years the exponential growth of the use if RAS blockers has been evident worldwide, resulting in increased prevalence of angioedema induced by RAS blockers in these patients.