Medicinski pregled
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Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. ⋯ The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.
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Atrial fibrillation increases the risk of ischemic stroke five fold, while the application of long-term anticoagulant therapy is associated with the occurrence of hemorrhagic complications. The aim of our study was to evaluate the incidence of thrombotic and hemorrhagic complications in patients with atrial fibrillation during antithrombotic treatment. ⋯ The overall incidence of complications in the study group was 0.08 patient per a year. The combined antithrombotic treatment increases the risk of hemorrhagic complications and affects the severity of bleeding. Oral anticoagulant therapy is more efficient in the prevention of ischemic stroke and thromboembolic complications in patients with atrial fibrillation.
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Dislocation of the proximal tibiofibular joint is a rare injury. It occurs during a sports activity that includes rough twisting movements of the bent knee. The role of the proximal tibiofibular joint is to reduce torsional loads to the ankle, to distribute the bending moment of the outer side of tibia, and transfer the vertical load while standing. In the literature there is no larger series; only several cases of the proximal tibiofibular joint dislocation treated by different methods have been published so far. ⋯ The proximal tibiofibular joint dislocation may be the cause of the chronic pain of the knee so it has to be taken into account when making differential diagnosis in case of the pain at the lateral side of the knee. The key for making the accurate diagnosis is the technically correct X-ray of the injured knee compared with the opposite one, showing the displacement of fibular head. If manual reposition fails, open reduction internal fixation and screw transfixation of the proximal tibiofibular joint allow good results and fast return to sport activities.
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Venous thromboembolism is one of the leading cause of maternal mortality worldwide. The incidence of venous thromboembolism is estimated at 0.76 to 1.72 per 100.000 pregnancies which is four times as great as the risk in nonpregnant women. The purpose of this article is to raise awareness of this frequent problem in pregnancy and provide a practical approach for the diagnosis, management, and prevention of venous thromboembolism during pregnancy and delivery. ⋯ Unfractionated heparin or low-molecular-weight heparin has a central place in the prevention and treatment of venous thromboembolism in pregnancy because they do not pass through the placenta, thus avoiding the risks likely to be induced by warfarin. The prevention of venous thromboembolism must focus on the patients known to be at high risk bearing in mind that the recommendations for prophylaxis, even in high-risk patients, are based on the limited data.
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The use of electrocardiogram in athletes as a routine screening method for diagnosing potentially dangerous cardiovascular diseases is still an issue of debate. According to the guidelines of the European Society of Cardiology, the recording of electrocardiogram is necessary in all athletes as a screening method, whereas the guidelines of the American Heart Association do not necessitate an electrocardiogram as a screening method and they insist on detailed personal and family history and clinical examination. CLASSIFICATION OF ELECTROCARDIOGRAM CHANGES IN ATHLETES: According to the classification of the European Society of Cardiology, electrocardiogram changes in athletes are divided into two groups: a) usual (physiological) that are connected with training; b) unusual (potentially clinically relevant) that are not connected with training. SUDDEN CARDIAC DEATH IN ATHLETES: The most frequent causes include hypertrophic cardiomyopathy and congenital coronary artery anomalies, while others may be found only sporadically at autopsy. Physiological electrocardiogram changes are frequent in asymptomatic athletes and they do not require further assessment. They include sinus bradycardia, atrioventricular blocks of I and II degree--Wenkebach, isolated increased QRS voltage, incomplete right bundle branch block and early repolarization. Potentially pathological electrocardiogram changes in athletes are not frequent but they are alarming and they urge further assessment to diagnose the underlying cardiovascular disease as well as the prevention of sudden cardiac death. They include: T wave inversion, ST segment depression, complete right or left bundle branch block, atrial pre-excitation syndrome-WPW, long QT interval, short QT interval, Brugada like electrocardiogram finding. ⋯ Introduction of electrocardiogram recording into the screening protocol in athletes increases the sensitivity of evaluation and may help to discover asymptomatic cardiovascular diseases that may cause sudden cardiac death. Special attention and further assessment are required when the above potentially pathological electrocardiogram changes are found in athletes.