Cardiologia Croatica. 2023;18(7-8)

Adna Sijerčić

The main objective of this review was to investigate whether educational attainment has an impact on the occurrence of atrial fibrillation (AF) as well as the implementation of smart technology to detect this condition. Data on the relationship between education level and the occurrence of AF were collected, as well as data on smart devices for detecting AF. A lower level of education has been linked to an increased risk of AF. With this in mind, it is easy to explain the clear correlation between education level and AF, as well as the adoption of smart device detection and how it may improve illness prognosis. People with a higher level of education understand and embrace the notion of employing smart devices to detect and prevent AF; they also have decreased AF prevalence compared with those with a lower level of education.

Ana Antonić, Koraljka Benko, Kristina Uglešić, Tin Nadarević, Vjekoslav Tomulić

We report the case of a younger, physically active patient who presented at the emergency department with swelling, pain, and bluish discoloration of the left arm, with clinical examination identifying effort-induced deep vein thrombosis of the arm (Paget-Schroetter syndrome). After unsuccessful medication treatment with a therapy dose of low-molecular-weight heparin, the patient was treated with an endovascular procedure – percutaneous aspiration thrombectomy. The procedure was successful, with the establishment of peripheral flow through the subclavian, axillary, and cephalic vein despite some thrombotic masses remaining. Before discharge, the patient was placed on peroral anticoagulation treatment with rivaroxaban. Additional imaging was performed during treatment of the superior thoracic aperture, confirming the diagnosis. Expanded laboratory testing showed values within normal limits. Follow-up showed regression of the symptoms. Color Doppler ultrasound and clinical examination verified maintenance of peripheral flow through the affected veins, with residual small thrombi and the development of collaterals. The patient was subsequently considered for decompression therapy by removing the first rib as a permanent solution for the symptoms.

Điđi Delalić, Anđela Simić, Višnja Nesek Adam, Ingrid Prkačin

Arterial hypertension is the most common cause of cardiovascular diseases and mortality. It significantly contributes to the incidence of other chronic diseases, the most frequent being myocardial infarction and stroke. Arterial hypertension, whether chronically uncontrolled or especially in case of hypertensive emergency, represents a complex state that must be adequately assessed and managed. Hypertensive emergencies are not common in the general population, but represent a serious health emergency that can rapidly lead to irreversible damage and loss of function of target organs if not treated adequately. Prompt and effective treatment in prehospital emergency care significantly contributes to the overall quality of the healthcare system.

Matko Spicijarić, Ana Antonić

As a syndrome accompanied by numerous symptoms and with various manifestations, heart failure (HF) has been the topic of many scientific studies as well as guidelines of cardiological societies across the world. The prevalence of HF in people above 70 years of age is higher than 10%. The seriousness of the disease is clear from its mortality, which is approximately 20% in a one-year period and as high as 53% in a five-year period. These data raise the question whether patients are diagnosed in a timely manner and what treatment modalities are available given the very high mortality. Herein we describe the treatment of a 67-year-old patient hospitalized with a clinical picture of anasarca. Laboratory findings and echocardiography allowed rapid establishment of the diagnosis of acute heart failure with reduced left ventricular ejection fraction (LVEF). As circumstances allowed, medications were gradually introduced into the treatment based on the Guidelines from the European Society of Cardiology (ESC). Despite several days of application of very high doses of diuretic therapy, good diuresis was established, but pitting edema in the lower and upper legs were still clinically present, as was ascites. Due to the above, treatment was started using intermittent slow ultrafiltration (SUF), which is also mentioned in the ESC Guidelines, but with no clearly defined recommendations on how it is to be employed. The patient underwent intermittent SUF using a dialysis catheter on nine separate occasions. These procedures successfully eliminated almost 25 liters of fluid, clinically resulting in decongestion. We further describe the subsequent rehospitalizations and follow-up examinations which included adjustments to the patient’s pharmacological therapy and the implantation of a cardiac resynchronization device. All of the above lead to improved patient quality of life, but also to improved LVEF. Recent studies have examined ultrafiltration as a supplemental treatment for HF. Despite the differences in the study populations and SUF modalities, the studies indicate that ultrafiltration leads to decongestion and hemodynamic stabilization, and most authors also report reduced need for rehospitalization. As patient mortality was not reduced, further studies are required on the application of ultrafiltration and other forms of treatment for patients with advanced HF.