Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

The main causes of death in patients with chronic kidney disease (CKD) are of cardiovascular nature. The interaction between traditional cardiovascular risk factors (CVRF) and non-traditional risk factors (RF) triggers various complex pathophysiological mechanisms that will lead to accelerated atherosclerosis in the context of decreased renal function. In terms of mortality, CKD should be considered equivalent to ischemic coronary artery disease (CAD) and properly monitored. Vascular calcification, endothelial dysfunction, oxidative stress, anemia, and inflammatory syndrome represents the main uremic RF triggered by accumulation of the uremic toxins in CKD subjects. Proteinuria that appears due to kidney function decline may initiate an inflammatory status and alteration of the coagulation – fibrinolysis systems, favorizing acute coronary syndromes (ACS) occurrence. All these factors represent potential targets for future therapy that may improve CKD patient’s survival and prevention of CV events. Once installed, the CAD in CKD population is associated with negative outcome and increased mortality rate, that is the reason why discovering the complex pathophysiological connections between the two conditions and a proper control of the uremic RF are crucial and may represent the solutions for influencing the prognostic. Exclusion of CKD subjects from the important trials dealing with ACS and improper use of the therapeutical options because of the declined kidney functioned are issues that need to be surpassed. New ongoing trials with CKD subjects and platelets reactivity studies offers new perspectives for a better clinical approach and the expected results will clarify many aspects.

Therapeutic Value of miRNAs in Coronary Artery Disease

Atherosclerotic ischemic coronary artery disease (CAD) is a significant community health challenge and the principal cause of morbidity and mortality in both developed and developing countries for all ethnic groups. The progressive chronic coronary atherosclerosis is the main underlying cause of CAD. Although enormous progress occurred in the last three decades in the management of cardiovascular diseases, the prevalence of CAD continues to increase worldwide, indicating the need for discovery of deeper molecular insights of CAD mechanisms, biomarkers, and innovative therapeutic targets. Recently, several research groups established that microRNAs essentially regulate various cardiovascular development and functions, and a deregulated cardiac enriched microRNA profile plays a vital role in the pathogenesis of CAD and its biological aging. Numerous studies established that over- or downregulation of a single miRNA gene by ago-miRNA or anti-miRNA is enough to modify the CAD disease process, significantly prevent age-dependent cardiac cell death, and markedly improve cardiac function. In the light of more recent experimental and clinical evidences, we briefly reviewed and discussed the involvement of miRNAs in CAD and their possible diagnostic/therapeutic values. Moreover, we also focused on the role of miRNAs in the initiation and progression of the atherosclerosis plaque as the strongest risk factor for CAD.

Statistical Study on Obesity Correlation - Inflammatory Status - Cardiovascular Pathology

The mediators of inflammation are involved in the pathophysiological processes by which obesity, especially the abdominal, causes an increased cardiovascular risk. The role of inflammation is increasingly accepted in the pathogenesis of diabetes and metabolic syndrome. In type 1 DZ autoimmune lesions from the pancreatic islets play a causal role in the development of the disease. In type 2 DZ, the mediators of inflammation released at adipocyte level play a key role in the development of the cardiovascular complications of this condition. Primary obesity is conditioned by excessive dietary intake and the functional status of anabolic systems. In the last decades, the prevalence of obesity has increased dramatically worldwide but also in our country, due to the increasing adoption of a sedentary lifestyle and excessive caloric intake by the population. Keywords: obesity, abdominal circumference (CFA), C-reactive protein, ischemic coronary artery disease.

Mechanical Circulatory Support in Management of Cardiogenic Shock and Myxedema Coma

The cardiovascular system is a major target of thyroid hormone action and the two systems are closely interlinked. It can be greatly impacted even with subtle alterations in thyroid function. Caution is needed when implementing thyroid hormone replacement in patients with severe hypothyroidism, especially in the setting of ischemic coronary artery disease. If not properly treated, myxedema may ensue. Given the high mortality of myxedema coma, supportive care may not always suffice and patients may require more invasive interventions. We present a challenging case of a patient with overt hypothyroidism with concurrent acute coronary syndrome which subsequently lead to myxedema coma and cardiogenic shock. A transcaval approach for the delivery of an Impella 5.0 (Abiomed Inc., Danvers, MA) was utilized in supporting this patient. To our knowledge, this is the first reported case that describes the use of a mechanical circulatory support in treating myxedema-induced cardiovascular collapse.

Acute Coronary Syndromes in the Elderly: Impact of Age on Diagnosis and Terapeutic Management

Cardiovascular pathology in the elderly is a topic of particular interest because it is themain cause of morbidity and mortality in this segment of the population, but also because in the last century the population over 60 years (this is the arbitrary limit from which a person is considered to be elderly) has doubled and is estimated to increase 2-3 times during the first century of this millennium. With the aging of the population, the number of associated diseases increases, but also the complexity of treatment for these diseases and the cost of hospitalization. Ischemic coronary artery disease has an increased incidence in the elderly population.Acute myocardial infarction (AMI) with ST segment elevation is manifested relatively frequently with atypical symptoms at onset - dyspnea, diaphoresis, nausea, confusion, epigastric pain, syncope. The influence of age on diagnosis and therapeutic management. There are no electrical changes in 40% of the elderly with acute myocardial infarction. Statistics show that 50% of patients addmited for AMI are elderly and 80% of acute myocardial infarction deaths occur in the elderly, due to both greater risk of post-treatment complications (eg left ventricular rupture after fibrinolysis) and general suboptimal treatment in the eldery, either due to age, comorbidities and atypical presentation delaying the diagnosis. Generally, outcomes of patients undergoing percutaneous coronary intervention are better compared to patients treated with fibrinolysis, the invasive strategy being thus preferred in these patients.

The current profile of the patient with atrial fibrillation

Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by an irregular and extremely rapid atrial electrical activation that causes loss of atrial mechanical function and important hemodynamic consequences. AF classification is important in both the therapeutic approach and the prognosis. Several classifications based on the ECG patch, epicardial or endocavitary records have been performed over time, but no classification can take into account all the characteristics of AF and especially associated diseases, which may be both the cause and consequence of arrhythmia. Aim: The aim of the study is to establish the current profile of the patient with atrial fibrillation in the new era of oral anticoagulant therapy and sinus rhythm restoration. Material and methods: The trial was conducted on patients with atrial fibrillation hospitalized between 01.10.2014-31.03.2015 at Institute of Cardiovascular Diseases ”Prof. Dr. G. Georgescu”, Iasi. Patients included in the study were analyzed according to age and sex, criteria for the clinical and paraclinic definition for atrial fibrillation. Results: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our clinic. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, and valvulopathy are common in patients with AF. Patients with AF are usually elderly patients with many associated diseases in whom sinus rhythm restoration treatment and anticoagulant therapy are difficult to establish. AF is one of the most common arrhythmias that complicates the evolution of acute myocardial infarction, association between dual antiplatelet therapy and anticoagulation treatment, increasing the risk of bleeding complications. Conclusions: Atrial fibrillation is an extremely common cardiovascular pathology and is present in about one-third of patients admitted to our hospital. The data obtained revealed that this arrhythmia occurs in a small number of cases as the only pathology of the patient, usually associated with numerous comorbidities. Cardiovascular diseases such as hypertension, ischemic coronary artery disease, valvulopathy are common in our practice. Patient with AF is a patient who requires long-term anticoagulant therapy and in whom sinus rhythm recovery therapy is dependent on the precocity of presentation to the physician, as well as on the therapeutic resources of current medicine.