Cardiologia Croatica. 2015;10(7-8)

Hrvoje Vrazic, Sanda Sokol Tomic, Ante Lisicic, Diana Rudan, Boris Starcevic, Carsten Lennerz, Christof Kolb

In our daily life it has become almost impossible not to interact, either actively or passively, with various devices that are sources of electromagnetic fields and thereby a potential cause of electromagnetic interference (EMI). Patients with cardiovascular implantable electronic devices (CIED) for treatment of arrhythmias represent a specific risk group that can be adversely affected by these signals. The scope of this problem (EMI in CIED recipients) is relatively small – but relevant, and when issues occur, in most cases they are of a transitory nature and can easily be avoided. However, it is of outmost importance to discuss the issue with patients that have a CIED, bearing in mind their specific situations and needs. Physicians should be aware of and familiarized with the most common interactions between EMI and CIED.

Sonja Francula-Zaninovic

Since cardiovascular diseases (CVD) are still the leading cause of mortality and morbidity, we have been attempting to increase our efforts to reduce their incidence. In everyday practice we implement cardiovascular (CV) prevention guidelines and educate patients on changing bad lifestyle habits and controling CV risk factors. However, all of that is insufficient without the support of the whole society and public policies. So the question must be asked: what else can we do and how should we act? The example of the Netherlands is used to point out activities, initiatives, associations, and also reforms that have been successful in reducing CV mortality and morbidity.

David Zidan, Sandro Brusich, Marina Klasan, Koraljka Benko, Daniela Malic Zahirovic, Ivana Grgic, Zlatko Cubranic

During recent years there has been a significant increase in pacemaker implantation. Consequently, the number of possible complications and the need for pacemaker lead extraction has grown as well. The most common indication for pacemaker lead extraction is localized or systemic infection. Since lead extraction is among the most complex and dangerous cardiologic procedures, new techniques and tools are being developed on a yearly basis that significantly facilitate extraction and reduce the risk of possible, often very severe, complications. Considering the above, it is necessary to organize enough appropriate centers with specialized multidisciplinary teams trained for the performance of these procedures. Since early 2013, a pacemaker lead extraction program was started at the Department for Arrhythmia and Electrical Stimulation at the University Hospital Centre Rijeka. Over a period of two and a half years, a total of 27 procedures have been performed and 51 pacemaker leads were extracted, of which two were defibrillator leads. The main cause of lead extraction was localized infection/pocket decubitus, while the incidence of systemic infection was much lower. Extraction techniques used were predominantly traction and locking stylet extractions. The most significant complication was the development of symptomatic pericardial effusion. There were no fatal outcomes.

Verica Kralj, Ivana Brkic Bilos, Tanja Coric, Maja Silobrcic Radic, Mario Sekerija

Today, the world faces an epidemic of chronic noncommunicable diseases. They are the main cause of death in almost all countries of the world, endangering both the life and health of the people and economic development in general. They are characterized by shared risk factors, shared determinant causes, and shared prevention strategies. Particularly dangerous are cardiovascular and malignant diseases, diabetes, and chronic respiratory diseases associated with the four main shared risk factors – smoking, improper diet, lack of physical activity, and harmful alcohol consumption. However, it is important to also emphasize the association between noncommunicable diseases and shared risk factors with mental disorders and injuries, which requires special attention when discussing chronic diseases. All of this places a significant strain on the health care system, causes a large financial burden, and consequently influences the social and economic development of a country.

Mario Ivanusa

The Hypertension pocketbook, edited by Nadar and Lip, is a new pocket edition by Oxford University Press. It is comprised of four parts with 26 chapters, characterized by a concise but comprehensive presentation of the significance and risks of arterial hypertension. Nearly half of the book is dedicated to the epidemiology and pathogenesis of primary and secondary hypertension, as well as diagnostics and complications associated with the disease. The rest of the book describes the methods of treating arterial hypertension in detail, as well as the specifics of various patient groups. At the very start of the book, the authors remind us that arterial hypertension is the leading chronic noncommunicable disease with a high prevalence and simultaneously the leading cause of death throughout the world. These facts are followed by an interesting presentation of the influence of life styles on arterial pressure. The concluding chapters of the first quarter of the book deal with comprehensive diagnostic management of patients with arterial hypertension, with an emphasis on appropriate risk assessment and stratification for each individual patient. The second quarter of the book reminds readers that arterial hypertension is the main independent risk factor for cardiovascular diseases and that we should always check for complications in everyday clinical practice. These chapters open with a detailed presentation of arterial hypertension as a cardiovascular risk factor, followed by a list of the most significant types of damage to target organs (hypertensive retinopathy, cognitive damage/dementia, hypertensive renal disease). The authors also provide a comprehensive description of the most significant long-term complications of arterial hypertension – left ventricular hypertrophy and atrial fibrillation. The second half of the book discusses non-pharmacological, pharmacological, and invasive treatment of arterial hypertension. After a description of the importance of lifestyle changes, different groups of antihypertensives are discussed in detail – diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and other groups of antihypertensives. This is followed by a description of a novel invasive treatment method – renal denervation, and a chapter on the application of antithrombotic therapy in patients with arterial hypertension. The final part of the book defines cardiovascular risk and describes the overall importance of risk factor management. The treatment algorithms of the British Hypertension Society (BHS-IV) and the National Institute for Health and Clinical Excellence (NICE) are described, and target arterial pressure values and initial antihypertensive treatment choices are compared with European (European Society of Hypertension / European Society of Cardiology; ESH/ESC) and US (Eighth Joint National Committee; JNC-8) guidelines for arterial hypertension. This is followed by chapters on treatment of arterial hypertension in diabetics, the elderly, and in pregnant women, as well as the management of patients with malignant and resistant hypertension. In conclusion, this pocket edition is a new reminder that arterial hypertension is a chronic and often asymptomatic disease and that reducing cardiovascular risk is of primary importance in its treatment.