Cardiologia Croatica. 2025;20(3-4)

Faruk Čustović, Sandra Đurkovska, Amer Iglica, Sanko Pandur

We present a case of an asymptomatic, painless, Stanford type A aortic dissection (AD) that was discovered on computed tomography coronary angiography. The patient, a 82-year-old man, who had no previous medical records and no prescribed chronic therapy, presented with clinical and subjective signs of congestive heart failure and was hospitalized for further assessment. He denied any type of chest pain, whether before or during hospital stay. On transthoracic echocardiography, aortic dilatation with moderate aortic regurgitation was found (without the intimal flap on the left parasternal long axis view), left ventricular ejection fraction was preserved, and there were no signs of pericardial effusion. Due to the suspicion of an ischemic incident (the electrocardiogram was dynamic, the patient remained painless), the patient was referred for a computed tomography coronary angiogram, which revealed multivessel coronary artery disease with stenosis up to 60%, but also an intimal flap in the ascending aorta – Stanford type A dissection, which was then further confirmed by computed tomography angiography of the aorta. The patient refused the recommended surgical treatment, left the hospital at his own request, and was recommended drug therapy and follow-up. Because of the deceptiveness of clinical presentation and challenging differential diagnosis, prompt diagnosis of AD as a medical emergency remains a challenge in everyday clinical practice, and its atypical forms in terms of clinical presentation and imaging tests should be taken into account.

Marija Tomac Stojmenović, Ana Petretić

Cardiac asthma is medical condition which occurs as a consequence of heart failure, predominantly left-sided. It is caused by pulmonary congestion resulting from left heart dysfunction. Herein we will describe the case of a patient with dilatative cardiomyopathy, of unknown etiology, with reduced left ventricular systolic function, in whom the first manifestation of heart failure took the form of cardiac asthma. We emphasize the importance of the clinical examination and the patient’s medical history, as every wheezing sound in the lungs is not necessarily caused by asthma or exacerbation of chronic obstructive pulmonary disease.

Irena Mitevska, Irina Kotlar Velkova, Elena Grueva Nastevska, Enes Shehu, Dusan Petkovski, Ana Chelikic, Elma Kandic, Matej Otljanski, Vasil Papestiev

Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-year-old male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.

Matijana Jurišić, Miro Jakovljević

Psychocardiology is an interdisciplinary field that connects psychology and cardiology in order to provide comprehensive care for patients with cardiovascular (CV) diseases. Psychological factors such as stress and depression significantly influence the progression of these diseases, while empathy and resilience play a crucial role in improving treatment outcomes. A systematic literature review was conducted using the PubMed and Google Scholar databases for the period between 2011 and 2023. Studies assessing the impact of empathy and resilience on health outcomes in CV patients were analyzed, as well as studies evaluating interventions aimed at developing these traits. Inclusion criteria encompassed both quantitative and qualitative studies that tracked long-term treatment outcomes in hospitalized patients. An empathetic approach in cardiological care was associated with higher adherence rates to therapeutic recommendations and reduced hospitalizations. Patients who experienced empathy from healthcare professionals had a 25% higher adherence rate to treatment and 40% fewer hospital readmissions within a year. Resilience was linked to better patient adaptation to chronic illness, reducing stress and promoting healthier lifestyle choices. Interventions such as education and support significantly enhanceed these traits, thereby lowering the risk of complications and improving recovery. Empathy and resilience play key roles in the care of CV patients, positively influencing their psychological and physical outcomes. Implementing programs to strengthen the empathy of healthcare professionals and the resilience of patients can improve treatment quality and overall well-being in CV patients.