Cardiologia Croatica. 2021;16(11-12)

Boris Blažinić

How can we increase our gratitude and happiness? How can you avoid disappointing yourself and others? How often have you been let down by someone or something? How many times have you become frustrated, angry, or sad as a result of it? It is critical to understand how to manage your expectations in order to avoid it, and it refers to the conscious strategies, techniques, and approaches they use to effectively direct their activities and behaviors. One of the most valuable skills you can have is the ability to self-manage and take personal responsibility for your own future. You should be able to set and strive for realistic goals. When we realize that our expectations are nothing more than our best guesses carved in theory. (1) These best guesses are, at their core, our deeply ingrained beliefs mixed with a glimmer of hope. The purpose of the lecture is to raise awareness of unconscious strategies and mental patterns that can lead to disappointment and disrupt relationships with ourselves and others. The goal of the lecture is to adopt strategies to increase our freedom of choice and to choose strategies to help us manage our own and other people’s expectations.

Ivica Matić

Progress in education, research and practice in recent years has become more present and makes a significant contribution to professional nursing development. (1) Evidence-based practice is an important aspect of setting work standards and the overall professionalization of nursing. In addition, it is important to understand scientific research methodology in the field of cardiovascular nursing with the aim of collecting best evidence and their implementation in practice. Such an approach enables keeping up to date with the latest trends and changes in modern cardiology, better application of new technologies and the provision of better overall care. Nurses should also meet employers’ expectation in the field of scientific research competencies. (2) Understanding the fundamental values ​​of science is crucial in the implementation of research according to the rules of scientific methodology. Planning research, searching bibliographic database and data processing are crucial steps in writing a scientific paper. Knowing the structure of a scientific article and accepting all the basic principles when writing a paper will increase the quality of the work and the possibility of publishing. It is essential to get familiar with the tools that help in the evaluation of the best journal, follow the instructions on preparing the manuscript and the rules of successful communication with editors in order for the publishing process to be successful. The aim of the lecture is to present the basics of the methodology of scientific work in the process of planning and conducting research, writing and publishing. It should also perform an efficient search of bibliographic databases through the workshop, as well as prepare a manuscript in accordance with the scientific journal.

Emily Živčić, Ema Kojić, Ivana Šego

**Introduction:** According to the guidelines of the European Council for Resuscitation from 2010, hypothermia is recommended in adult comatose patients after cardiopulmonary arrest. The use of invasive and non-invasive methods of systemic hypothermia is prescribed, and during hypothermia other therapeutic procedures such as percutaneous coronary intervention can be approached in order to maximize the optimal therapeutic effect for the patient. (1, 2) According to the guidelines of the European Council for Resuscitation from 2015, targeted temperature control is still recommended, now striving to reach 36°C, as opposed to the previously recommended 32–34°C. (3) Recent research from 2021 has shown that therapeutic hypothermia does not reduce mortality, and there is no significant difference between hypothermia and normothermy. (4) **Case report:** 40-year-old patient lost consciousness and was arrested at work. Lay resuscitation was started, and the Emergency Medical Service was called. The initial rhythm in the ECG was ventricular fibrillation, and he was defibrillated on one occasion, followed by pulseless electrical activity. The resuscitation procedure was continued with the use of three ampoules of adrenaline, to which return of spontaneous circulation was achieved. Upon arrival at the Coronary Care Unit, the patient was intubated, mechanically ventilated, sedated, and muscle relaxed. Hemodynamically and rhythmically stable. Therapeutic hypothermia was performed, after which he recovered consciousness and was successfully extubated and separated from mechanical ventilation. The patient was indicated for the installation of an implantable cardioverter defibrillator for the purpose of secondary prevention of sudden cardiac death. **Conclusion:** Timely and successful resuscitation after cardiopulmonary arrest is a prerequisite for the patient’s recovery and his return to independent living. Given the frequency of cardiopulmonary arrests, they most often occur in outpatient settings, so the outcome of further treatment and recovery depends on timely finding the victim, recognizing the condition, proper performance of lay resuscitation, use of publicly available automated external defibrillators and pace of hospitalization (2).

Biljana Šego, Mirjana Slanc, Mirela Adamović, Zoran Marić, Ivana Jelinek, Matija Vrbanić, Kristijana Radić, Ivica Benko, Ljiljana Švađumović, Vlatka Funduk

The COVID-19 pandemic has posed new challenges in the treatment of acute coronary syndrome for several reasons. COVID-19 primarily affects the respiratory system, but in patients with risk factors (arterial hypertension, diabetes, obesity, underlying cardiovascular disease) it can cause severe respiratory failure, thrombotic events, and worsening of cardiovascular status. Diagnosis and treatment of patients with acute myocardial infarction during a pandemic can be hampered by anti-epidemic measures taken to prevent transmission to patients and medical staff, patients’ fear of disease, health system burden, and staff occupancy, all of which can slow timely medical response. (1, 2) The first experiences and recommendations with patients with ST-elevation myocardial infarction (STEMI) and COVID-19 were unclear, but since November 2020, the recommendations of the European Society of Cardiology emphasize adherence to all previous guidelines for the treatment of STEMI patients with the aim of early and successful reperfusion, but with mandatory use of personal protection equipment and masks for both patients and staff. We present our experiences with the treatment of patients with acute myocardial infarction who were positive for SARS-CoV-2 or had already developed moderate or severe symptoms. Since the 3rd wave of the epidemic, University Hospital Dubrava was organized as a COVID-19 dedicated hospital for patients with severe symptoms with or without serious comorbidities in the City of Zagreb and 6 surrounding counties. The clinical characteristics and outcomes of patients with STEMI and specifics in the treatment management of these patients and medical staff are presented.

Marina Stanković, Željka Stojkov, Blaženka Miškić, Barica Stanić

The COVID-19 pandemic posed a major challenge in all areas of life, both for healthcare professionals and all patients treated in hospitals at the time, and especially COVID-positive patients who developed acute respiratory syndrome or pneumonia. These patients were respiratory dependent in intensive care units and during treatment they developed symptoms of acute coronary heart disease and acute myocardial infarction (AMI). (1) The major challenges posed to nurses during a pandemic are numerous from psychological support to patients, patient’s families who did not have access to their loved ones, protective equipment, placing the patient in a pronation position, monitoring hemodynamic changes and that are just some of the tasks that nurses needed to respond to. We will attempt to demonstrate some of the challenges in health care that we face by presenting the case of patients with AMI during treatment in the intensive COVID unit.

Renata Nakić, Antonia Zrinjski, Božica Leško, Martina Đuzel, Dijana Šereg Semenić

**Introduction**: The fact is that we are in a period when women decide to become pregnant and give birth later in life, but such a trend carries with it its own risks. According to a Mayo Clinic study that analyzed more than 55 million births in the U.S. between 2002 and 2014, women aged 35 to 39 are five times more likely to experience acute myocardial infarction, compared to women in their 20s. (1) The aim of the case report is to determine whether there is a reasonable suspicion that pregnancy and childbirth in middle or later life contributes to the more frequent occurrence of acute myocardial infarction in this vulnerable group. **Case report**: Patient N.N. at the age of 39 he comes to the Emergency Department due to severe retrosternal pain characterized by constriction, with propagation in both shoulders. The patient has been treated with low-molecular-weight heparin since the established conception throughout the pregnancy, because after the birth of the stillborn in April 2020, the tendency to thrombosis was hematological determined. The second pregnancy went smoothly and on June 20, 2021. gave birth to a healthy child. In the Emergency Department, an anteroseptal acute myocardial infarction with ST-segment elevation and she was admitted to the Clinic for Cardiovascular Diseases for invasive cardiac treatment. As part of the treatment, the patient was transferred to the University Hospital “Sveti Duh” for optical coherence tomography (OCT) and then re-admitted at the University Hospital Centre “Sestre milosrdnice”. In addition to OCT and coronary angiography, hematology was performed, abdomen ultrasound and echocardiography. The patient continued to be cardiopulmonary compensated, hemodynamically stable and in sinus rhythm.

Ana Marinić, Vjera Pisačić, Valentina Jezl, Danijela Gregurević

The connection between mental states and heart disease is not accidental. There is strong epidemiological evidence that these are bidirectionally related conditions, which pose a risk to each other, but often coexist. The prevalence of anxiety and depression is higher in cardiac patients compared to the general population. Studies show that 20% of patients with congestive heart failure suffer from depression, while 50% of patients with acute coronary heart disease in intensive care units show some of the symptoms of anxiety disorder. (1, 2) Depressed patients have less motivation and energy for self-care activities, participate less in the treatment and rehabilitation program, which prolongs the disease, worsens symptoms, and increases mortality. Typical symptoms of cardiovascular diseases such as fatigue, malaise and insomnia are very similar to the symptoms of depression, so they can often remain unrecognized in clinical practice and consequently insufficiently treated. Therefore, considering all the knowledge in the field of psychocardiology, early detection and successful treatment of psychological disorders (especially anxiety and depression) would improve the clinical outcome, facilitate the care of such patients, and ensure a better quality of life.

Valentina Gal, Valentina Pandža, Ivana Pecak, Nikolina Šoštarić, Tihana Dabić, Josipa Prskalo, Marija Vujčić, Ana Vlašiček

**Introduction**: Management of a patient with acute myocardial infarction (AMI) is complex and requires a good cooperation between physicians and nurses/technicians. At the time of the SARS-CoV-2 pandemic the care of such patients is even more complex. (1) The virus posed new challenges in the treatment and care of patients with AMI. Some people may feel the symptoms of heart disease but because of the risk of a pandemic they will not go to general practitioner or to the emergency department. Despite that, one should always keep in mind that early treatment saves lives. The aim of this paper was to show how at the time of the SARS-CoV-2 pandemic there is a complex care and treatment of patients with AMI, and how nursing interventions were carried out in such situations. **Case report:** 63-year-old patient was admitted to the Department of Intensive Cardiac Care with an AMI. Chest pain witch spreads to the left arm all the way to the elbow, that occurred after walking on a straight line of 100 metres was the reason that this patient came to the Emergency Department. The patient also states that he has a positive epidemiological history for COVID-19 infection. During the treatment in the Emergency Department, an electrocardiogram was performed, which showed myocardial infarction with ST-segment elevation. Along with the ECG, the patient’s blood was drawn, and a nasal swab for the SARS-CoV-2 virus was routinely taken. After the arrival of cardioselective enzymes the patient was prepared for urgent coronary angiography. At the Catheterization Lab coronary angiography and percutaneous coronary intervention was performed. Right coronary artery was occluded. After predilatation two drug eluting stents (Ultimaster 3.5/28 mm and Angiolite 4.0/16 mm) were placed in the right coronary artery. In the final coronary angiogram, there were no residual stenoses with TIMI III flow. The nurses and technicians were adequately prepared according to the instructions of the Croatian Institute of Public Health since the patient had a positive epidemiological history. After the coronary angiography patient was transferred to the Department of Intensive Care where all epidemiological measures were taken by the staff. After initial acute treatment the test for SARS-CoV-2 arrived positive. The patient was transported to University Hospital Dubrava which was a respiratory intensive care center.

Saška Bojanić, Biljana Hržić

**Introduction**: A left ventricular aneurysm is an outburst of the heart wall and is one of the late complications of myocardial infarction. The main factors for the development of an aneurysm are complete anterior incoming artery occlusion and failure to achieve coronary artery permeability at the area of infarction. (1) **Case report**: We present a 55-year-old female patient whose symptoms of pneumonia due to COVID-19 infection had „masked“ the clinical state of acute myocardial infarction. The treatment was initiated in Primary respiratory – intensivist center in University Hospital Dubrava. She was a patient with long-standing hypertension and diabetes. Based on medical history and examination, ECG, coronary angiography, and dynamics of cardioselective enzymes, subacute myocardial infarction was diagnosed, and the patient was treated conservatively. After discharge from the hospital, the patient underwent echocardiography showing the formation of a postinfarction aneurysm at the left ventricle with thrombus formation. The patient was further monitored through a cardiac daily hospital unit for titration of anticoagulant therapy with warfarin. At the last follow-up, the significant progression of the left ventricular aneurysm was verified by echocardiography. The patient was urgently admitted to the Coronary Care Unit where detailed diagnostics was performed, including MSCT of the heart according to the TAVI protocol and cardiac MRI natively and in the delayed phase. The findings showed progression and growth of the pseudoaneurysm to the pre-existing aneurysm extension in the left ventricle. This case report provides an overview of nursing care expectations at the intensive cardiac care unit with a focus on teamwork, professional communication, and patient preparation for diagnostic procedures. Furthermore, it is important to emphasize that the demands for medical care during pandemics are not common and show a constant lack of highly trained cardiologists and cardiac nurses.

Matija Vrbanić, Kristijana Radić, Ivica Benko, Ljiljana Švađumović, Vlatka Funduk, Biljana Šego, Mirjana Slanc, Mirela Adamović, Zoran Marić, Ivana Jelinek

Severe aortic stenosis is becoming an increasingly common disease in an increasing number of patients older than 75 years. In addition to patients with severe comorbidities and high or prohibited surgical risk for treatment of severe aortic stenosis, these patients could be candidates for TAVI (transcatheter aortic valve implantation). (1, 2) With the increase in the number of candidates for TAVI in Croatia in the last 2 years, we can see a trend of a significant increase in the number of procedures, and during 2020 for the first time in Croatia, more than 200 procedures were performed in one year, reaching the minimum European average. In recent years, emphasis has been placed on minimally invasive, “accelerated” procedures for the treatment of these patients, with the least need for treatment in the intensive care unit and the shortest possible hospital stay. The COVID-19 pandemic has further increased the need for as few hospitalizations as possible and as short hospital stays as possible, so an increase in the number of TAVI candidates is expected in the future. Here we show the role of the staff at the day hospital and the cardiology department in the fastest and most accurate selection and treatment of patients for TAVI, to short hospital treatment, with as few complications and a short stay at intensive care units. This report shows the role of the day hospital in rapid processing and selection of treatment strategy as also a vascular approach, to reduce the possibility of complications during the stay at the ward, as well as in the invasive cardiology laboratory, and subsequent monitoring of treatment outcomes and long-term success.

Đurđa Vlajković, Cecilija Leporić, Božica Leško

Poorly regulated blood pressure values or poor therapeutic response to antihypertensive therapy are required in the case of proven anatomical or pathological changes in the renal arteries during therapeutic interventional procedures such as dilation or, if necessary, implantation of the stent. (1) The care of such a patient includes mental and physical preparation, carrying out diagnostic procedures such as laboratory blood tests, imaging methods (MSCT angiography of renal arteries and abdominal aorta), continuous measurement of blood pressure and preparation for intervention and continuous nursing care after the interventional procedure of renal artery dilation. Angiography is considered a safe procedure, but there are rare complications: hematoma and pain at the puncture site, allergic reaction to the contrast agent, infection at the puncture site, kidney damage by contrast agent, heart attack or stroke, damage to the artery. After completing the procedure, angiography, rest, control of the vital functions and fluid balance sheets with a view to preventing any complications and monitoring the patient’s health status. It is recommended that you drink a larger amount of liquid to expel the contrast agent from the organism by urination. After completing hospital treatment, it is possible to return to daily activities, although it is good to avoid more severe strain (e.g., lifting severe subjects) for the first week. Existing cardiovascular diseases, hyperlipidemia, diabetes, age of the patient, and body weight require an individualized approach to the patient in the diagnosis of diagnostics and therapeutic intervention procedure.

Monika Tuzla, Nada Hrstić

**Introduction**: Emotional intelligence is defined as the ability to recognize feelings, identify them clearly, comprehend them, control and use them to express thoughts. In everyday situations, such as communicating with others or making decisions, feelings play a significant role. Emotional support is essential in a profession such as nursing, which requires not only technical knowledge but also psychological support. It is important to highlight that the more complicated the job, the more important emotional intelligence is. That is why understanding one’s own emotions and developing emotional intelligence are critical to the advancement of a profession (1). The purpose of this paper is to demonstrate nurses’ and technicians’ attitudes toward emotional intelligence in relation to work experience, stress, and their own emotions. **Methods**: A survey was carried out among nurses and technicians at the Institute for Cardiovascular Prevention and Rehabilitation in Zagreb. Demographic data and questions implying the relationship between their emotions in everyday work, communication skills, and their attitude toward the working environment’s relationship to the development of emotional intelligence were analyzed. **Results**: Analysis of a survey of 24 nurses and 1 technician, with 76 percent having higher expertise, 12 percent having medium expertise, and 12 percent having high expertise. 68 percent of participants have working experience for more than 16 years, and 92 percent are familiar with emotional intelligence. More than half of those polled believe that their own good mood helps them solve problems, and 44 percent believe that length of service contributes to better emotional control. Almost half of the employees, 48 percent, believe they can generally assess emotions by observing another person, and 44 percent believe communication skills help them do so. Although 60% of employees learn from negative experiences, the working environment influences the development of emotional intelligence in 52% of them depending on the situation. **Conclusion**: Developing emotional intelligence contributes to greater self-control, which is required in nursing work, as well as problem solving and adequate treatment in stressful situations, which are unfortunately an unavoidable part of a nurse/daily technician’s work. By analyzing the survey, we can argue that employees and other people have a tendency to control and recognize their own emotions, but creating a better working environment also stimulates more positive emotions in employees, resulting in better problem solving and stress reduction.

Damir Strapajević, Dubravka Kučko, Ana Marija Sukalić

Venous thrombosis is a multifactorial disease that causes clots to form in the deep veins of the extremities. (1) A thrombus in a vein obstructs venous flow, causing damage to surrounding tissue due to increased venous pressure in the affected area. This raises the risk of pulmonary embolism, which occurs because of thrombotic contents migrating into the pulmonary circulation. Adults are afflicted with a high rate of vein disease. There is information on etiopathogenesis, diagnosis, therapy, and nursing care. Trauma, infection, surgery, immobilization, pregnancy, hormone replacement therapy, contraception, antiphospholipid syndrome, cardiovascular disease and heart failure, malignancies, inflammatory bowel disease, severe systemic disease, and iatrogenic vascular disease are all known causes of deep vein thrombosis. Furthermore, many patients with thrombophlebitis (an inflammatory thrombotic process of the superficial veins) have an undiagnosed risk of deep vein thrombosis and pulmonary embolism, both of which have a high mortality rate.

Renee Mixich, Senka Pejković

The cardiology day hospital (CDH) is an alternative for scheduled cardiac and in most cases diagnostic procedures. In the University Hospital Dubrava at the Department for Cardiovascular Medicine, the CDH allows many of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. The aim of this short overview and experience at the University Hospital Dubrava was to perform a descriptive analysis of the activity carried out and to evaluate the quality of the provided care. In a public-funded health system, it is essential to make the most of available resources. Clinical management encourages cost containment by avoiding unnecessary hospitalizations without decreasing the quality of the medical care provided. One approach to achieve this objective is to perform lower-risk, elective, diagnostic and therapeutic invasive procedures. A daily hospitalization refers to a hospital stay lasting for several hours for various purposes: non-invasive diagnostic procedures, clinical and other examinations, and treatments that cannot be performed in the outpatient clinic but do not justify hospital admittance. It is a medical care unit where certain interventions are performed and post-procedure medical or nursing attention is provided under the supervision of a specialized medical team. In the field of cardiovascular diseases, several diagnostic and therapeutic activities can be carried out during a short stay. A very common procedure that can be performed in this way is cardiac catheterization via radial artery access, as it reduces the incidence of complications and simplifies puncture site care in both diagnostic and interventional procedures. Heart failure is one of the most prevalent cardiovascular syndromes, whose treatment makes the most of CDH resources. (1) CDH units have proven effective in the treatment of these patients and have reduced the number of emergency room visits and rehospitalizations. Day hospitals are excellent support, as they facilitate close follow-up after hospital discharge and offer patients fast access to care in situations of clinical worsening. This benefit could be extended to other patients with a prompt hospital discharge or patients seen in the emergency department (e.g., pericardial syndromes, atrial fibrillation, following heart surgery), who might need preferential access to reassessment, diagnostic tests, or therapeutic interventions that cannot be covered in the outpatient setting. The cardiology day is conceived as an area designed to provide complex or sophisticated medical care with little delay and avoiding hospitalization in patients with cardiovascular conditions that can be treated in an ambulatory setting.

Bernarda Markov, Snježana Jušić

Lemierre´s syndrome is a rare but serious infection caused by bacteria attacking the lymph nodes of the neck and causing blood clots to form in the large veins of the neck, whereas mediastinistis is an acute inflammation of the mediastinum. (1, 2) The presence of enlarged lymph nodes in the mediastinum on an X-ray of the lungs or a CT of the thorax leads to the diagnosis. In this case report we describe the case of 40-year-old patient who was admitted to the Cardiology Department of the Šibenik General Hospital due to swelling and pain in the left side of the neck, as well as fever. The course of the patient’s stay in Šibenik General Hospital, as well as the transfer and course of the patient’s stay in University Hospital Centre Split, where the patient was transferred due to disturbed general condition, hemodynamic instability, and worsening of inflammatory parameters, is shown. All diagnostic procedures for determining the cause of the patient’s condition, as well as all therapeutic procedures, are also discussed. Deep vein thrombosis of the cephalic vein, pericardium effusion, and bilateral pleural effusion were all confirmed by diagnostic tests. Can we say with certainty that the resulting clinical picture is post-COVID-19 because the patient overcame a moderate clinical picture of SARS-CoV-2 virus infection a month before the onset of these symptoms?

Mateja Kovačević, Nina Krpan, Katarina Vađić, Renata Čosić, Mihaela Ipša, Božica Leško, Tomislav Kučina

**Introduction:** Pulmonary embolism is a disorder caused by the sudden obstruction in the pulmonary artery with consequent obstruction of blood flow to the lung tissue. A thrombus that most often comes from the deep veins of the legs or pelvis is the most common cause. Shortness of breath is the most common symptom of pulmonary embolism. Patients may experience panic attacks due to tachypnea, anxiety, and restlessness, and sharp pain may be present in the chest, especially if the person is breathing deeply (pleuritic pain). Headaches, fainting, and cramps may occur due to the reduced ability of the heart to deliver a sufficient amount of oxygenated blood to the brain and other organs. Also, irregular heart rhythm and cyanosis can occur. Symptoms of pulmonary embolism occur abruptly. Fever, pleuritic chest pain, cough, and bloody sputum are symptoms of a lung infarction. A pulmonary embolism is seen as a filling defect at pulmonary angiography. Treatment of pulmonary embolism is performed with anticoagulant and/or fibrinolytic therapy, oxygen, analgesics, and sedatives. Mortality depends on the size of the embolus, the size and number of obstructed pulmonary arteries, and the patient’s previous cardiopulmonary status. (1) The aim of this paper is to present the treatment and acute care of a patient with massive pulmonary embolism and the interventions of a nurse. **Case report:** 52-year-old patient was admitted to the Department of Intensive Cardiac Care due to a massive pulmonary embolism confirmed by CT angiography. Before a hospitalization, on several occasions at home, she felt dyspnea accompanied by chest discomfort, which first stopped spontaneously, and later after taking therapy for asthma, which she has been suffering from for 2-3 years. Due to the worsening of dyspnea, the patient decided to call an ambulance, which measured 70% oxygen saturation, 105 bpm heart rate, and systolic pressure 200 mmHg. The patient’s family history was positive for cardiovascular disease. Upon admission, the patient was still mildly dyspneic, with 91% oxygen saturation on oxygen therapy with 2L on a nasal catheter, blood pressure 160/110, 107 bpm heart rate, and required an elevated position. Due to the high-risk acute pulmonary embolism, the patient received fibrinolytic therapy with alteplase, which went without complications, and a complete treatment was performed. During hospitalization, the patient was continuously monitored, vital parameters were measured and recorded, laboratory findings were monitored, therapy was applied according to the doctor’s prescription, and health care was provided.

Antonela Barišić, Dominik Tvorek

Atrial fibrillation (AF) is the most common persistent arrhythmia in the general population, with a prevalence of 2–4% in adulthood and a tendency to increase 2- to 3-fold in terms of life expectancy. (1) AF is the cause of numerous vascular complications, including cerebrovascular stroke (20-30% ischemic stroke or 10% cryptogenic stroke), heart failure due to increased ventricular rate (in 20-30% of FA patients), vascular dementia, and other general disorders such as depression or frequent hospitalizations. (2) The generally accepted treatment for vascular complications is warfarin, and more recently, new oral anticoagulants, which can cause hemorrhage. (3) The decision on the type of treatment approach is made on the basis of symptoms, type of cardiac treatment (ECG, the holter ECG, echocardiography, blood tests), the physician’s decision and the patient’s consent to the proposed treatment. Catheter atrial fibrillation ablation is an invasive procedure during which controlled local heating or cooling of the tissue is performed to target the source of the arrhythmia. This procedure contributes greatly to the improvement of symptomatology in patients and supports further progress in the treatment of AF. Before performing ablation treatment, it is important to mentally and physically prepare the patient for the procedure. The physical preparation of the patient includes, among other things, TEE (the issue of thrombus in the auricle) and the application of therapy (anticoagulants). It is very important when acquiring a medical history, to acquire information on which anticoagulant drug is used and how long the patient has been using it. (2) Postprocedural care involves monitoring the cognitive status, the presence of neurological outbursts, monitoring the puncture site, the presence of chest pain, throat, back, blood pressure control, ECG, patient mobilization, and monitoring of complications. When caring for a patient, it is important to mention the holistic approach and the principle of individual approach to each patient. The aim of this lecture is to present the measures implemented in nursing care before and after ablation treatment. It is important to be aware of the connection between anticoagulant therapy and ablation therapy. The nurse as part of a multidisciplinary team has an important role in the prevention of complications, but also in their early detection, which greatly affects the quality of life of patients.

Ivana Babić, Ana Ljubas, Danijela Grgurević, Vesna Grubić

The outbreak of the COVID-19 pandemic has led to a change in the organization of health care delivery. There is a paradigm shift that has affected changes in the way hospital and outpatient care is provided in all levels of a health system. The new organization of work has led to reduced access to health services, which mostly affected patients suffering from cardiovascular diseases. For example, in the first wave of pandemic only acute patients were admitted to hospitals, and all preventive examinations and elective examinations and diagnostic procedures of chronic patients were postponed. According to available data, comparing the first half of 2020 to the same period in 2019, approximately 30% less patients were treated for myocardial infarction in Croatian hospitals. The aim of this article is to show that through well organized and coordinated work of a multidisciplinary team, health system resources can be accessed with minimal risk of COVID-19 threat to cardiovascular patients. Since the beginning of the pandemic, University Hospital Centre Zagreb has been following epidemiological recommendations and guidelines of the national and world professional societies and organizations and acting in accordance with the same. We also monitored the results of our own clinical practice on the daily basis. The first response to the new care paradigm was to educate staff and to monitor the implementation of measures aimed at reducing the possibility of the SARS-CoV-2 virus entering our clinic. Our second response to the new paradigm was to establish contact with all patients whose health services were postponed or who were postponed by patients for the fear of infection and to plan new appointments. Nurses and medical technicians play a key role in planning and implementing all measures. The role of a nurse is divided into three levels. The first level is technical and its goal is cooperation and coordination with other team members. The second level consists of educating, counseling patients and family members and providing support in desirable steps aimed to achieve the best quality of life. The third level is monitoring of implementation of measures and evaluation objectives. With good organization and providing of measures, all planed diagnostic and treatment procedures at Clinic for Cardiovascular Diseases of University Hospital Centre Zagreb are carried out according to plan. Transmission of SARS-CoV-2 virus to the staff and patients was minimal (1). With good organization, the health system resources can be coordinated and available for every cardiovascular patient. In order to reduce the consequences of COVID-19 and ensure safe and effective care, it is important to monitor and adhere to all recommended epidemiological measures.

Katarina Matković, Saša Bura, Marina Klasan, Boris Barac, Ivana Hodanić

Cardiac arrhythmias are one of the leading causes of sudden cardiac death and impaired quality of life in patients. (1) Therefore, treatment approach and timely detection of these diseases is extremely important in order to reduce mortality rates. In modern times, thanks to the constant progress of medicine and numerous educations of medical staff, the quality of life of patients with cardiac arrhythmias has improved. Imaging methods provide relevant representations of heart function, precise insight into the structure and function of the heart, and ultimately can reveal the exact location of the arrhythmia as well as its cause. Continuous development and improvement of imaging methods leads to more successful diagnosis and treatment of cardiac arrhythmias. The scope of work of nurses and technicians on work sites where imaging methods are performed includes work on highly technologically advanced medical devices, knowledge of complex imaging techniques and therapeutic procedures, protection against ionizing radiation, work in various multidisciplinary health care teams and preparation and adequate patient care during radiological and other imaging methods.

Krešimir Librenjak, Ana Martinović, Zoran Bakotić

Pacemaker implants have always posed a continuing challenge to cardiac nurses in learning and handling new equipment and electronic devices. Working with temporary pacemakers, permanent single-chamber, through two-chamber then to multi-chamber devices and implantable cardioverter-defibrillators does not allow us to relax, but dedicated work and progress from all of us. His stimulation as a somewhat newer method of electrostimulation treatment, in addition to all the current technical aspects of the usual implantation of pacemakers, also provides us with some new, specific challenges. (1) As this is an electrode implantation in a very narrow region of interest, knowledge of the anatomy and physiology of the conduction system of the heart is at most importance. Knowledge of the signal of His potential is also extremely important. And in order to successfully implant such a system, we also need specific materials for the delivery of an adequate (special) electrode to the His region. Due to the location of the His and its participation in the electrical impulse conduction system, it is necessary to be extremely accurate in order to prevent the development of the Exit block, either due to electrode dislocation or insufficient output current. In order to carry out a successful procedure with the operator, the whole team must adequately prepare the room, patient, devices (programmer, ECG, electrophysiology station, materials). Necessary materials in these procedures are adequate His electrodes without lumens, preformed His introducer for easier placement of the electrode in the region of interest, modification of the electrophysiology system for simultaneous recording of unipolar, bipolar His signals and measurement of stimulation parameters. Our goal is to show the challenges in the implantation of the His cardiac pacing system, and how we have developed procedure for the implantation of that specific system.

Ivana Kuserbanj, Sandra Benković, Jadranka Daskijević

The coronary lithotripsy system is indicated when there is a need to improve the lumen of calcified and stenotic coronary arteries with a balloon catheter under low ATM before a stent is implanted. (1) The coronary intravascular lithotripsy catheter is routed through coronary arteries until it reaches a difficult to approach spot of a calcified stenosis, including also the calcified stenosis that we assume are going to provide resistance when being inflated by a PTCA balloon or when a coronary artery is being prepared for a stent implantation and evenly expand an implanted coronary stent. The lithotripsy catheter emits intermittent sound waves at the aimed spot, breaking the calcium clusters in the lesion therefore enabling a larger lumen with the help of a low ATM inflated balloon. In this paper we will present a case report of a patient before and after intravascular lithotripsy, including the preparation of the patient and the catheter itself.

Martina Kralj, Mirela Šarić

Invasive procedures in cardiology have a diagnostic and therapeutic function. The elective number of procedures is becoming more common in inpatient wards, therefore preparing and monitoring patients should be organized so that the patient is informed and adequately prepared, and the nurse fast and skillful. It is imperative that the nurse as a part of a multidisciplinary team has skills and knowledge in accordance with recent guidelines, which contributes to quality of care and satisfaction in the team. Invasive procedures that are prepared and monitored are coronary angiography, electrophysiological examination, radiofrequency ablation, cryoablation, occluders, pacing. The preparation of the patient health care team should be agreed prior to patient preparation. Increased workplace demands, which are very often the result of poor time management, can very easily lead to burnout. (1) Multitasking or the ability to perform multiple jobs or tasks at the same time is a skill that a nurse/technician they need to master. It is important to realize that time thieves exist. Kounter, Stein and Jick (2008) talking about organizational changes state how they can be divided into three groups. This is the so-called big three which includes changes in the environment, in the organization and in the individual. (2) Psychological preparation begins by entering the ward, making the patient familiar with the ward, the ward rules, the procedure which will be done, and the multidisciplinary team. Physical preparation also begins with the arrival to the ward and lasts until going to the surgery. It differs for each of the above-mentioned procedures, so it is advised to have a flowchart to use when preparing a patient. The procedure is followed by monitoring the patient, which requires expertise in cardiology from the nurse in order to be able to recognize the complications that follow the above-mentioned procedures in time. This is important to us because by timely recognition of the objective and subjective parameters, we can prevent undesirable consequences as a multidisciplinary team. Upon discharge the patient should also be educated about further lifestyle and check-ups.

Marina Klasan, Saša Bura, Katarina Matković, Ivana Hodanić, Boris Barac

The electrode extraction procedure, although successful in most patients, is one of the most complex and risky procedures in the field of cardiology. (1, 2) Complications can be more or less serious. More serious complications include: death, myocardial rupture with consequent tamponade, rupture of large veins, pulmonary embolism that requires surgery, and other. Mild complications that can occur are: pericardial effusion that does not require pericardiocentesis or surgery, hemothorax that does not require thoracic drain, swelling of the upper extremity or vein thrombosis through which the electrode was inserted, air embolism, pneumothorax, and other. We will present the case of a patient in whom, during electrode extraction, a large blood vessel ruptured, a condition that requires urgent surgical intervention by opening the chest.

Nikola Jutriša

Anomalies are common in medicine and are encountered daily. (1) Some anomalies are congenital and are discovered at a young age (especially if they are symptomatic), while others are discovered by chance as an accidental finding. Congenital heart and large blood vessel anomalies occur in 1 in 120 live births and occur during the first 10 weeks of embryonic development. The precise cause is frequently unknown, and it is worthwhile to consider chromosome abnormalities, various genetic syndromes, maternal diseases, external factors, or a combination of these. Acquired anomalies are frequently unpleasant surprises that occur as a side effect of treating or overcoming various diseases. Acquired anomalies occur as a side effect of treating or overcoming various diseases and are frequently an unwelcome surprise during the healing process. The lecture’s goal is to present anomalies in the invasive treatment process that are rarely seen.

Mario Josipović, Matea Podvorec

Ionizing radiation and radioactive substances are a natural and constant phenomenon in the environment and in many human activities. It is extremely important to know the correct application of ionizing radiation, not only for timely and accurate diagnosis and successful treatment, but also for knowing undesirable consequences that can occur with improper use of the same. The purpose of invasive cardiology with the use of X-rays is to simplify and to improve procedures previously performed surgically; to eliminate the need for general anesthesia and to minimize time spent in hospital. In the operating room for invasive and interventional cardiology, it is important that the medical staff who work there, and are not the radiology profession, are educated on radiation protection and the use of protective equipment in the area of ionizing radiation. (1) In the presentation, we will give a review of protective equipment that is visibly improving both in protection and making it easier for the staff to use it. Personal protection is extremely important, it is legally regulated, and it must be strictly controlled.

Ivana Hodanić, Marina Klasan, Saša Bura, Katarina Matković, Boris Barac

The most common valve disease is aortic stenosis, its prevalence increases with increasing age of the population. The prevalence averages 2 to 4% in patients over 65 years of age. (1) Almost a third of patients do not have cardiac surgery for aortic stenosis due to high operative risk and comorbidity. Therefore, transcatheter aortic valve implantation (TAVI) is being performed more and more often. With this method, an artificial biological valve is inserted into the place of the degenerated native valve on the “beating” heart, with the help of a catheter. If the patient has not previously been implanted with a permanent pacemaker, a temporary pacemaker should be installed. Electrostimulation of the heart during aortic valve placement serves to briefly induce ventricular tachycardia during balloon dilatation and release of the valve from the catheter. Due to the anatomical correlation between the structure of the aortic valve and the conduction system of the heart, one of the most common complications after TAVI are disorders of the conduction system involving branch bundle block, complete heart block, and the need for permanent pacemaker implantation. Although these disorders are not usually fatal, they can have a major impact on patients ’condition and long-term consequences. There are several risk factors for conduction disturbances, including age, heart anatomy, periprocedural factors, type of valve implanted, pre-existing abnormalities, and comorbidities. As this technique becomes increasingly familiar to physicians, patients need to be prepared in order to minimize the development of cardiac conduction disorders after TAVI.

Miroslav Geček, Tomislav Pijetlović, Gordana Hursa, Sanja Keleković

Traditional right ventricular pacing as well as cardiac resynchronization therapy are both successful and well established methods of stimulation in patients with heart conduction system disorders. Although classical stimulation methods perform the primary function well, the detrimental effects of long-term apical stimulation are well known. For this reason, a new method of stimulation, his bundle pacing (HBP) was introduced (1, 2). In this case report, we will briefly describe the anatomy and physiology of the cardiac conduction system. We will look at patient preparation and nurse tasks during and after the procedure. And lastly say something about the benefits of his bundle stimulation method.

Lucija Dizdarević, Saša Dizdarević

Transcatheter aortic valve implantation (TAVI) is one of the procedures that changes the view of performing interventional procedures in cardiology. (1, 2) A procedure is similar to cardiac catheterization or percutaneous coronary intervention. Patient preparation requires some diagnostic tests and collection of relevant clinical data. From the beginning of process, nurses are involves as a member of the health team. Important is an open communication in which the patient has the opportunity to discuss his fears and concerns related to implantation, ask questions about the planned procedure, ask for explanation about follow up in the intensive care unit, verbalize the feeling of concern for family members and ask questions about the quality of life after the procedure. TAVI is now a widely known and widespread method of treating severe aortic stenosis in patients who have a high risk for surgery or contraindication. The patient should be explained in a clear and understandable way the importance of the procedure, hospitalization, possible treatment outcomes, as well as possible risks and complications. Team cooperation and care reduce the risk of failure during preparation for the procedure, the occurrence of complications during execution and their minimization in recovery. The patients with TAVI requires continuous care before, during and after the procedure in order to achieve the highest possible subjective quality of life.

Kristina Pavlović, Milka Grubišić, Dragana Jurčić

Mechanical Circulatory Support (MCS) is an increasingly common form of heart failure (HF) treatment as the number of people with HF growing, and the fact that the number of heart donors is limited and unpredictable. (1) Also, a large number of patients with HF do not meet the strictly defined criteria for transplantation. The goal of mechanical circulatory support is to relieve the heart volume in failure and achieve satisfactory blood flow to peripheral organ systems. Here, we will present the most common postoperative complications of patients with implanted mechanical circulatory support. Some of the most common complications include the thrombosis of the supporting circulatory device, stroke, bleeding, and infection of the driveline of the device. Mechanical support devices carry certain risks and complications. Complications are unavoidable in patients with implanted mechanical circulatory support, and although they cannot be completely removed, they can be significantly reduced through continuous education. The prevalence of complications increases as the use of the devices themselves expands, from short-term support to increasingly destination therapy or bridge to transplantation. Nurses play an important role within the multidisciplinary team, especially in preparing patients for mechanical pump implantation, postoperative health care, prevention of possible complications, and patient education. Quality health care can prevent the occurrence of complications of treatment, and in the case of their development contribute to reducing the consequences.

Ružica Lovrić, Dora Aldžić, Mario Udovičić, Goranka Oremović, Ivica Benko

Heart transplantation is a therapy of choice for patients with advanced terminal heart failure. A particular problem in these patients represents the titration of immunosuppressive therapy during infection, which is especially true in COVID-19. We present a case of a heart transplant recipient, who was successfully treated for a severe COVID-19 pneumonia. The patient underwent the orthotopic heart transplantation in 2018 at the age of 52 due to ischemic cardiomyopathy. Early posttransplantation phase was uneventful, and his immunosuppressive regimen consisted of tacrolimus and mycophenolate mofetil. Following the recommendations he was fully vaccinated for COVID-19. Despite this, one month after the last vaccine, he presented to our emergency department with dyspnea, prostration, fatigue and respiratory insufficiency. A bilateral pneumonia caused by SARS-CoV-2 was verified, and he was hospitalized in the COVID-19 primary intensive respiratory center where high flow oxygen therapy was immediately initiated. The treatment was further complicated by secondary pneumonias, extending the duration of his hospital stay. Finally, after two months of hospital treatment the patient was discharged home. The treatment of immunosuppressed heart transplant recipients for COVID-19 is an extraordinary clinical challenge, requiring an uneasy act of balance between a deadly infection and a potentially equally fatal heart transplant rejection. (1)

Dragana Jurčić, Milka Grubišić, Kristina Pavlović

Every cardiosurgical patient’s health problem necessitates adequate and timely diagnosis, treatment, health care, and postoperative education. As medicine advances, more emphasis is placed on adequate patient education, resulting in better collaboration between healthcare professionals and patients. This has been shown to improve treatment outcomes. During education, nursing attention is focused on the patient and his needs. As a team member, the nurse approaches each patient holistically. The case will present the most common cardiac surgery procedures as well as the associated postoperative nursing education for cardiac surgery patients. Previous research has shown that adequate preoperative and postoperative patient education plays a significant role in the postoperative period of recovery. (1) The most common procedures in cardiac surgery are aortic and mitral valve replacement and coronary artery bypass grafting. Heart transplants and the implantation of a mechanical support device are also becoming more common. Given the specificity and complexity of individual procedures, an individual approach to each patient is required. The educational goals of cardiac surgery patients are to maintain and improve health, prevent complications, care for wounds, adhere to specific measures, and improve quality of life (independence and faster return to family and work environment). Patients who have undergone cardiac surgery are chronic patients who frequently require lifelong health care. Given the unique characteristics of cardiac surgery patients, it is necessary to include family members in the education process. Support is also important, not only from family but also from the workplace, and patients who have received a heart transplant should be encouraged to participate as a member of the Association of Transplant Patients. Postoperative education is provided daily, with the goal of recognizing the problem and accepting the treatment method by both the patient and his family. Discharge from home care is an exciting time for the patient; they are plagued by many issues that make them feel insecure, so a well-executed postoperative education will provide a calmer and safer discharge. Furthermore, nursing care and education do not end when the patient is discharged; however, if in doubt, the patient can call for assistance at any time.

Renata Habeković, Danijela Žigrović, Mirjana Dubravec, Dubravka Crnković, Maja Kokalović, Sanjica Kurtanjek-Gorupec

Heart transplantation (HT) in children is a method of treating severe heart diseases when all other treatment options are exhausted. Although HT in adults is now considered a routine operation, in children it is a much more complex and demanding procedure. (1) In the complex process of preparing a child for transplantation and postoperative care, the flawless cooperation of team members is crucial. Heart transplantation aims to prolong the life of a child, enable normal growth and return to an active life. Heart transplantation is intended primarily for children with cardiomyopathies, less frequently with severe arrhythmias or congenital heart defects. In order to perform a HT, it is first of all necessary to achieve the theoretical and practical conditions prescribed by the Eurotransplant system: selection criteria, examination protocol during processing for HT and readiness of the cardiac surgery team. After the criteria are met, it is necessary to plan adequate postoperative care and health care for the child. The paper will present the HT program in children at the University Hospital Centre Zagreb. Heart transplantation has been performed since 2011. According to the Register of the International Society for HT, 300 to 400 HT in children are made worldwide every year, or 10% of all HT. Longer survival has been achieved with complex guidelines for screening donors and organ recipients, remarkable advances in immunosuppressive therapy, performing endomyocardial biopsies, and thus patient care in the period before and after transplantation. Raising awareness about HT in children is very important for raising awareness about organ donation as it is the biggest limiting factor of this method. The stay of the child after the transplant at Clinic is aimed at bringing the child closer to the parents, monitoring the rejection of the transplant, monitoring postoperative infections and parents’ education led by the physician and nurse. The success of a HT in a child depends on the timely diagnosis and recognition of the terminal stage of the disease, the ability of the cardiac surgery team and the ability to adequately care for the child after a HT. Treatment requires multidisciplinary cooperation and support from parents and the environment in which the child lives.

Milka Grubišić, Dragana Jurčić, Kristina Pavlović

**Introduction**: Infectious endocarditis (IE) is a potentially life-threatening condition that requires urgent diagnosis and treatment (1). Heart valve endocarditis associated with COVID infection presents a challenge, not only for physicians but for nurses as well. Considering the situation and implementation of new epidemiological measures, challenging nursing care in changed and difficult working conditions presented an important factor in the treatment of the patient. In this paper we will present a case of 36-year-old patient who was hospitalized in December 2020 in University Hospital Dubrava for infectious endocarditis complicated by COVID-19. **Case report**: Patient was initially hospitalized in October 2020 at the University Hospital for Infectious Diseases for pneumococcal pneumonia and meningitis. Mechanical ventilation begins due to the development of respiratory insufficiency. Vancomycin antibiotic therapy consequently results in acute renal injury. Renal function recovers after a short period of hemodialysis. During the stay, cardiorespiratory arrest developed and resuscitation was successfully performed. Transthoracic echocardiography finds a perivalvular abscess of the aortic valve without a visible vegetation. After a month of hospitalization, there is a further deterioration of the clinical condition. Testing for coronavirus (SARS-CoV-2) was performed and a positive finding was confirmed, with the development of bilateral COVID-19 pneumonia with respiratory failure requiring oxygen therapy and further mechanical ventilation. Due to the need for further diagnosis, transesophageal ultrasound of the heart, which could be performed only by trained staff, and implementation of measures to prevent the spread of the virus, the patient was transferred to University Hospital Dubrava which became the central COVID hospital for the Republic of Croatia. Transesophageal ultrasound, in compliance with all safety measures, found an aortic root abscess with pseudoaneurysm with large mobile vegetation on the aortic valve and massive aortic regurgitation, which confirmed the diagnosis of infectious endocarditis. Massive bilateral pleural effusion with signs of acute respiratory distress syndrome (ARDS) was verified. Emergency cardiac surgery was indicated for treatment of aortic valve endocarditis. A biological aortic valve was successfully implanted, the aortic root abscess was repaired and the remaining defect was closed with a pericardial patch. Postoperative recovery proceeded without complications. Control echocardiography records normal hemodynamic parameters over the aortic valve. With adequate nursing care and intensive physical therapy, the patient successfully recovered and was discharged home on the twelfth postoperative day. Conclusion: A positive finding for coronavirus led to a prolongation of the diagnosis and treatment of infective endocarditis. Despite all treatment measures taken, COVID infection accelerated the progression of IE symptoms leading to cardiac arrest. The patient’s condition required urgent cardiac surgery which could be performed only by trained medical staff (physicians, nurses, perfusionists, technicians) and with adherence to epidemiological measures in pre-planned COVID hospitals that could meet the demanding conditions.

Matea Dumančić

Numerous patients with congenital heart diseases have a dysfunctional pulmonary valve and require cardiac surgery at an early age. Until the last decade, the replacement of a dysfunctional pulmonary valve or conduit could only be performed by open heart surgery. The introduction of percutaneous Melody pulmonary valve (1) implantation into our therapeutic protocol today, offers an attractive alternative to the surgical procedure of pulmonary valve replacement in carefully selected patients. The nursing staff who cares 24 hours for these patients, plays the key role in the preoperative patient preparation and in the post-procedural course and education. The main advantage of this procedure is the avoidance of open heart surgery in patients who already had several previous surgeries and may need future ones. The findings of many studies are encouraging and most patients with corrected tetralogy of Fallot and related anomalies will require multiple lifelong interventions, and it is impossible to predict what technology and alternatives will be available in the future. Ultimately, appropriate sequencing of surgical replacement and percutaneous pulmonary valve implantation will depend on individual patients’ needs. Despite this, PPVI (Percutaneous Pulmonary Valve Implantation) is now recognized as an important part of therapy to prolong the lifespan of an existing bioprosthetic valve.

Marina Deucht, Andreja Lebar Bašić

In March 2020, University Hospital (UH) Dubrava will become the dedicated hospital for COVID-19 patients. Patients with pulmonary damage were admitted to UH Dubrava via the emergency department and assigned to different wards based on disease severity and comorbidity. Acute respiratory failure patients were admitted to the Intensive Care Unit. Many patients developed an addiction to some form of oxygen therapy. Patients in the acute phase of the disease’s functional capacity are affected by the COVID-19 systemic pattern (1). The purpose of this paper was to describe the experience and work of a physiotherapist at UH Dubrava during the pandemic in treating COVID-19 patients in the acute phase of the disease. We wanted to show what clinical challenges the physiotherapists faced in a sample of 210 patients (97 women, 113 men), with an average age of 70 years. The information was obtained from the Department of Physical and Rehabilitation Medicine with Rheumatology’s database. The severity of the disease’s symptoms with comorbidities present, cognitive status, and the final treatment outcome are all presented in percentages, as are the developed symptoms of ARDS, pulmonary embolism, pneumonia, and the associated form of oxygen therapy. Eighty-two percent of the total number of patients were discharged for home care. We believe that respiratory physical therapy has aided these patients’ recovery and quicker reintegration into normal life. Unfortunately, 18% of patients died as a result of the disease. Based on the physiotherapist’s experience at the UH Dubrava in conducting early inquiry and physiotherapy intervention in the clinical care of patients, good teamwork and daily monitoring of parameters from the hospital information system database were extremely beneficial. As a result, we developed an early rehabilitation strategy that we thought was best for patients at the time.

Alen Baćar, Jelena Petrović

Heart failure (HF) is a clinical syndrome resulting from functional and structural abnormality of the heart which disrupts filling its tissue with blood and fails to meet the organism’s metabolic needs. It is one of the main issues in public health and leads to an increasing prevalence in the population. (1) Management of the HF includes conservative treatment, heart transplantation and mechanical circulatory support. One of such mechanical circulatory supports is the intracardiac left ventricular assist pump - Impella. Intracardiac pump is a surgically implanted miniaturized axial pump that extracts blood from the left ventricle and sends it to the aorta delivering oxygen filled blood to the rest of the body. Common indications for implanting an intracardiac pump are acute myocardial infarction with cardiogenic shock and in implanting a high risk coronary angioplasty. Nursing a patient with an intracardiac pump is a complicated area in nursing that demands continuous education, recent data monitoring, a more holistic approach and professional cooperation with other members of the team. Main tasks for a nurse taking care of a patient with an implanted intracardiac pump are regular assessments, supervising, monitoring and recording vital signs, recognizing early signs of complications and working using the aseptic technique. Education and teamwork of all health personnel are directed towards recognizing the problem, methods of treating the patient and educating their families. The role of the nurse is to offer support, recognize and react to a problem, teach the patient all the skills and to adapt to a new situation.

Tanja Mikulandra, Nevenka Vila

**Introduction:** Heart failure (HF) occurs as a result of any structural or functional heart disorder. HF is global health problem with prevalence of 1-2% in the general population and occurring in more than 1% to 2% of people over the age of 70. HF significantly affects the quality of life of patients, frequent hospitalizations and the adverse outcome of the disease. The aim of this study was to examine the impact of the COVID-19 pandemic on hospitalization of patients with heart failure. **Patients and Methods:** The study involved 59 patients, 28 (47.5%) women and 31 (52.5%) men, who were treated at The Department of Heart and Blood Vessel Diseases, University Hospital Osijek from March 20 to June 1, 2020. The average age of the subjects was 60.9 years. For the research, we created a questionnaire witch contain 7 questions about demographic data, hospitalizations and knowledge about the heart failure. **Results:** According to the obtained results, 32 (54.2%) of subjects come from the city, 41 (69.5%) of subjects have a secondary qualification, and 50 (84.7%) live in a common household. Analysis of the data showed that at the time of the onset of the COVID-19 pandemic, there were significantly more patients who were hospitalized for the first time due to HF 40 (67.8%) compared to the number of patients with HF who were hospitalized 3 or more times, 19 (32.2%). **Conclusion:** Educating patients about self-care and symptom control (1) during repeated hospitalizations can result in a decrease in the number of hospitalizations and an improvement in quality of life.

Helena Lovrenčić, Ivana Tomašić, Vesna Slonjšak, Ivana Škalec, Karolina Keleković

Chronic heart failure is a complex, usually progressive clinical syndrome that, regardless of structural or functional heart disease, is characterized by the inability of the heart to receive or displace blood and thus meet the metabolic needs of the organism (1). Heart failure (HF) most often occurs as a result of a previous and late treatment of myocardial infarction, uncontrolled hypertension, heart valve disease, or myocardial disease. Patient education is an important component of HF care and should be provided through effective and well-assessed strategies. Numerous studies in patients with HF have shown a need for education (2). Almost all nursing diagnoses involve educating a patient or family member in a health care plan through nursing interventions (3). The nurse spends the most time with the patient and educates him about the importance of taking therapy, lifestyle changes - weight loss, limiting fluid intake, reducing salt in the diet, regulating blood pressure and blood glucose, and managing stress. Relapses are common due to a frivolous understanding of the disease and non-compliance with health instructions. Education about the disease helps to raise self-confidence, encouraging patients to become aware of their disease, to do everything to slow down the course of HF and thus reduce the number of hospitalizations, and to improve the quality of life.

Valentina Jezl, Vjera Pisačić, Ana Marinić, Danijela Grgurević

**Introduction:** In 2020, several authors reported on the onset of multisystem inflammatory syndrome in children (MIS-C) (1-3), but the constant progression of the pandemic increases the number of reported cases in adults. It´s a life-threatening condition that occurs a few weeks after primary infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which often involves severe acute heart failure. We report about two cases of multisystem inflammatory syndrome in male adult (MIS-A) admitted to the Department of Intensive Cardiac Care, Arrhythmia and Transplantation Cardiology, University Hospital Centre Zagreb. **Case report:** They are both younger males, ages 26 and 40, who recovered from SARS-CoV-2 infection in February and March 2021. Both had a mild clinical presentation that did not necessitate hospitalization or oxygen therapy. The younger patient’s medical history was marked by adiposity and arterial hypertension, whereas the other patient had no significant medical history. Both patients are admitted to the emergency department due to persistent fever, and preliminary blood tests reveal elevated inflammatory markers, ferritin, cardio selective enzymes, and the heart failure marker NT-proBNP. The 26-year-old patient’s condition rapidly deteriorated on the third day of hospitalization, with the development of chest pain, tachydyspnea, and hypotension. He was transferred to the tertiary center’s coronary intensive unit due to the development of cardiogenic shock, which was supported by vasopressors and inotrope (4), while the 40-year-old patient was moved due to suspected MIS-A. Both patients reported febrility (up to 39.5°C), dyspnea, reduced exercise tolerance, dry cough and diarrhea. The young patient reported chills and shivering, headache and nose secretions, while the other patient reported rashes on the forearms and distal part of the thighs without itching. Both patients had severely reduced global systolic function, with an left ventricular ejection fraction (LVEF) of about 20% and 30%, respectively. Following consultation with an infectious disease specialist, the protocol for the treatment of MIS-A was approached, and we began with two cycles of intravenous immunoglobulin, corticosteroids, and antibiotic therapy. Chronic heart failure therapy was gradually introduced into patients. Following the administration of this therapy, patients’ clinical and subjective conditions improve, with regression of inflammatory markers and cardio selective enzymes. Control echocardiography and magnetic resonance imaging were also performed, revealing that the young patient had fully recovered left ventricular function, with LVEF of 63% and the other patient having LVEF 53%. Patients were discharged home in good general condition on the 16th and 21st days of their hospitalization. **Conclusion:** Multisystem Inflammatory syndrome in adult is rare but life-threatening complication of COVID-19 and it requires rapid diagnosis, hemodynamic support and specific treatment. The COVID-19 pandemic has highlighted the importance of nurses, but also the need for continuous education. The COVID-19 pandemic has highlighted the value of nurses, as well as the need for ongoing education. The nursing profession is rapidly evolving and does not solely focus on patient care; but even so, nurses are required to have knowledge about highly sophisticated treatments for patients, as well as the use of various technological achievements and innovations.

Željka Mijolović, Snežana Golubović, Irena Kužet Mioković, Marica Komosar-Cvetković

The Center for Diabetes, Endocrinology and Cardiometabolism was established on February 1, 2020. It is organized in a way to provide superior care to endocrinological patients with diabetes, thyroid, pituitary, adrenal glands and other associated cardiometabolic diseases. On June 15, 2020, we launched the first diabetology day hospital, which aims at group education of patients about the nature and self-control of diabetes and about possible complications. The intention is to train patients to independently control the disease and coexist with it through education. In this new normal COVID era, our education is conducted exclusively individually, up to 15 minutes with the use of protective equipment and distance. If reeducation is required, the patient is ordered for re-examination. Patients who are hospitalized are also included in our project Early Detection of Diabetes to identify these patients at an early stage of the disease, which would prevent possible complications of the disease and consequently reduce treatment costs. The first in a series is the installation of the first continuous glucose monitoring (CGM) and Holter ECG at the Cardiac Rehabilitation Department on May 28, 2020, which would detect a possible correlation of glucovariability and changes in heart rhythm in patients with diabetes. At Thalassotherapy Opatija we have the privilege to approach each patient individually in collaboration with our multidisciplinary team consisting of a Master of Nursing, nutritionist, psychologist, neurologist, cardiologist, dermatologist, physiatrists, and physiotherapists. Patients will receive a structured insight into the condition of the disease, potential complications, planned treatment and recommended physical activity, all with the aim of ensuring the highest possible quality of life for the patient. For outpatients and patients in cardiac rehabilitation, education is facilitated by Passport for Life and Life with Diabetes, designed, and written in Thalassotherapy Opatija. Nurses are perhaps the most important members of a multidisciplinary team, so continuous education in any segment of the system is crucial for quality care to increase and ensure expertise and competence, so in diabetology it is important to always be up to date with the latest guidelines on nutrition, self-control. CGM devices), insulin pumps, GLP-1 drugs, insulins, etc., so that this knowledge can be transferred to patients through individual and group therapies. (1-3)

Irena Kužet Mioković, Marica Komosar-Cvetković, Romina Mrakovčić, Ivona Brajković

Cardiovascular diseases continue to be the leading cause of death and disability in most European Union countries. Secondary prevention has become the foundation of treatment, but most patients do not meet the standards of guidelines that predispose them to disease progression, recurrent events, and repeated hospitalizations. Our society is changing rapidly, new trends are coming, and digitalization is emerging that enters all aspects of our lives. The increasingly complex and demanding needs of patients are leading to changes that require nurses to acquire a higher level of knowledge, skills and competencies. The education of cardiac nurses in developed countries has followed the development trends of modern cardiac practice. In cooperation with the health care system and professional societies, and in accordance with the requirements of clinical practice, programs and methods of implementing specialist programs for education and certification are created. In this way, nurses, in addition to the combination of skills, knowledge and attitudes they have acquired through their previous training, acquire and develop additional clinical competencies. By implementing specialist programs in the educational system of nurses in accordance with the acquired competencies, and examples of cardiac nursing practice in developed countries speak in favor of this. Nurses, as the most numerous health professionals, must get a leading role in modern preventive cardiology and rehabilitation programs because they can give a great deal in reducing the burden of cardiovascular diseases. (1-5)

Marina Jelinić, Marina Hrvatin

Cardiovascular care implies cardiovascular rehabilitation as a team procedure that includes an interdisciplinary and transdisciplinary approach of health professionals. Cardiovascular rehabilitation includes a series of activities aimed at achieving the best possible physical, mental and social condition, where patients after the acute phase of the disease should re-occupy a place in the community and continue to live an active life (1). Numerous scientific articles suggest that measures and procedures during cardiac rehabilitation led to a significant reduction in risk factors and mortality in cardiac patients (2). Cardiac rehabilitation programs began to be developed and implemented in the middle of the last century. Today’s modern programs include all available educational and motivational approaches to reduce cardiovascular risk factors, promote healthy behavior, and lead an active lifestyle. This paper will present the development of rehabilitation of cardiac patients in Istria. The very beginning as well as the special development and progress through networking are shown. Special progress has been made since 2012 through the LOVE YOUR HEART Adriatic Cardiovascular Disease Prevention Network project, which was implemented in three countries: Albania, Croatia and Italy. Funds were provided from EU, and the project objectives were related to creating the preconditions for effective prevention through exchange of experiences with partners, preparation of educational materials and establishment of a center for cardiovascular disease prevention in terms of improving the process of early detection of risk factors. Today, our cardiac patients have the opportunity to start rehabilitation in a very short period of time after they have been diagnosed. In addition to rehabilitation, patients are also offered help with lifestyle changes. Family physicians, psychologists, nurses, physiotherapists, and nutritionists work with patients.

Urška Hvala

**Introduction:** Cardiovascular diseases (CVD) are still the leading cause of mortality in the world. Peripheral arterial disease occurs because of the narrowing of the peripheral artery, most commonly of the lower extremities. Peripheral arterial disease (PAD) is one of the most common consequences of atherosclerosis, followed by CAD. (1) The aim of the study we wanted to find out level of knowledge about the risk factors for the development of CVD among patients with CAD and PAD, as they share the same basic cause of atherosclerosis, the same treatment approaches and the same risk factors. In patients with PAD, we wanted to find out how they obtain information about the disease, since they do not have the same opportunities of getting information or planned health education as do patients with CAD. **Methods**: We used a descriptive method of work with a cross-sectional study and collected the data with a questionnaire. The questionnaire was developed based on the Coronary artery Disease Education Questionnaire (CADE -Q) and questionnaire about Heart Failure patients Knowledge of Their Disease. The final version of the tool had 31 questions, divided into 4 content sets, on nutrition, methods of treatment, physical exercise and on the risk factors for the onset of atherosclerosis. In the fifth part, patients with a PAD were asked questions about the source of information on the disease. The internal consistency of the questionnaire was analyzed by calculating the Kuder-Richardson- 20 (KR-20) was 0.85. The required power of statistics is set to 0.8. For our sample size calculation, we consider 0.15 (normalized to the interval 0 to 1), which corresponds to the value of 4.65 on the knowledge scale of this research. **Results:** The population was represented by 37 patients with PAD who came to elective treatment in the hospital and 46 patients with CAD. Knowledge of patients with PAD is higher than the knowledge of patients with CAD, both in considering all the questions and in the set of questions about the risk factors for the onset of atherosclerosis. Information on their illness is obtained from health care staff n = 45–77% of patients with PAD. **Discussion and Conclusion:** In the study, we demonstrated better knowledge of patients with PAD and poorer knowledge of patients with CAD on atherosclerosis and risk factors for atherosclerosis. The work of the nurse for the health education of patients with PAD and CAD was shown through research as the need and key to the empowerment of patients. This tool can be applicable in clinical settings for measuring the effectiveness of the health education for patients with PAD and CAD.

Ana Radan, Romana Ivelić

The role of family, relatives and friends is vital to maintaining the quality of life of hospitalized patients. During hospitalization, constant interaction between family and nurses is necessary to achieve comprehensive care. (1) The family greatly helps to reduce the stress caused by disease and hospitalization. (2) The closest ones guide the patient to effectively cope with all complications of the disease and participate in self-help activities. (3) Some of the activities that a family can carry out during hospitalization are communication, psychological and emotional support, encouragement, patient representation and information on topics related to it, participation in planning, cooperation during the therapeutic process and participation in providing care such as meal assistance, body massage, individual hygiene, etc. (4) One of the major problems that significantly affects psychological status during a coronavirus pandemic is the ban on visiting hospitalized patients. While there is no doubt that such restrictions are designed to reduce the spread of the virus, they pose a threat to the family community. The family cares more and more for their loved ones, there is a fear of loneliness, sadness, and the possibility of losing motivation. (5) Family involvement in the care of hospitalized patients is of great importance. The presence of families and regular communication of health professionals with patients and their families should become part of regular care. Family participation in the hospital will be effective if the family is informed of the patient’s condition and adequately educated by the medical staff to provide effective psychological support to loved ones.

Mirjana Barišić, Vesna Babić

Atrial fibrillation (AF) is the most common arrhythmia after extrasystoles, which significantly affects quality of life and increased mortality. Quality of life is a subjective feeling and individual experience. It implies inner peace, joy and satisfaction with life, life without special burden, fear and uncertainty. The most common causes of AF are age, hypertension, coronary heart disease, heart failure, obesity, diseases of mitral valve, diabetes mellitus, hyperthyroidism. Symptoms include palpitations, shortness of breath, headache, fatigue, and chest pain. In maintaining sinus rhythm and reducing symptoms, AF ablation is a more effective method than antiarrhythmic therapy. (1) A retrospective clinical study was conducted at the Department of Arrhythmias of the University Hospital Centre Rijeka in patients with AF who underwent ablation treatment between 1st January 2019 and 31st January 2019. Out of a total of 106 patients undergoing ablation treatment for AF (33 cryoablations and 73 radiofrequency ablations), 88 patients who gave their written consent approached the study. For testing quality of life, was used an AFEQT questionnaire, which is specific and sensitive specific to patients with AF. The goals of the study were to analyze the values of the AFEQT questionnaire before and after the ablation of atrial fibrillation, and to compare the obtained values before and after the ablation performed depending on sex, age, presence of arterial hypertension, the type of ablation and body mass index. The overall result of the AFEQT questionnaire is statistically significantly better after ablation. Patients under the age of 65 achieved a statistically significantly better overall score on the AFEQT questionnaire. Male subjects report higher levels of quality of life. Subjects with a higher body mass index achieved statistically significantly lower results in the overall AFEQT questionnaire result after ablation was performed. There was no statistically significant difference in quality of life between patients who underwent cryoablation and those who underwent radiofrequency ablation. Ablation treatment of FA largely helps decreased symptoms and improve quality of life. Comparing the results of this study with literature (1), we can conclude that atrial ablation is a justified method of treatment of AF, which significantly improves patients quality of life.

Ana Ljubas, Ivica Benko, Ivica Matić

Dear Colleagues, it is our great honor and pleasure to welcome you at the 8th congress of the Croatian Association of Cardiology Nurses (CACN) with international participation. Over the course of the next three days of the congress, we have tried to cover all current topics and challenges in cardiovascular nursing practice. The congress program consists of thematic sessions and symposia of the Croatian Association of Cardiology Nurses working groups. As in previous congresses, part of the program will include oral presentations and interesting case reports from everyday clinical practice that will guide us through the professional work of congress participants. Since our lives and provision of healthcare services have been taking place under significantly changed conditions over the past 18 months due to the COVID-19 pandemic, part of the program is dedicated to caring for cardiac patients during the pandemic. We would like to thank our sponsors, who have enabled to acquire new knowledge on cardiovascular nursing through the congress symposia. We would also like to thank the Spektar Agency for providing technical assistance. We are sure that the time after the presentations will be filled with constructive discussions that will encourage critical thinking and contribute to building professional excellence! Predsjednici kongresa: / *Congress Presidents:* **Ana Ljubas**, mag. med. techn., FESC **Ivica Benko**, dipl. med. techn., ECDSAP dr. sc. **Ivica Matić**, mag. med. techn.