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Papers by Lovel Giunio
Časopis. Autori: Nikolić Heitzler, Vjeran; Babić, Zdravko; Miličić, Davor; Bergovec, Mijo; Ragu,... more Časopis. Autori: Nikolić Heitzler, Vjeran; Babić, Zdravko; Miličić, Davor; Bergovec, Mijo; Ragu, Miroslav; Mirat, Jure; Strozzi, Maja; Plazonić, eljko; Giunio, Lovel; Steiner, Robert. Naslov: Croatian Primary PCI Network-two years results. ...
Annals of Saudi Medicine
The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction ... more The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG. Data was obtained from a chart review of 2958 patients with first AMI: 770 (26%) patients with non-Q-wave AMI and 2188 (74%) patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria (anterior Q-wave, anterior non-Q-wave, inferior Q-wave, inferior non-Q-wave). A logistic regression was performed to assess independent predictors of AMI type and site. Key findings were: 1) inferior non-Q-wave AMI was more frequent in young women (P<0.001); 2) inferior Q-wave AMI was more common in young men (P<0.001); 3) anterior non-Q-wave AMI was more common in older men (P<0.0...
Collegium Antropologicum, 2005
In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atria... more In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atrial thrombus attached to a permanent pacemaker lead was incidentally identified by transesophageal echocardiography. Surgical treatment, recommended because of the large dimensions of the mass, was refused by the patient, and thrombus was successfully dissolved by anticoagulant treatment. Pathogenesis of pacemaker lead thrombosis, clinical implications, diagnostic and therapeutic options are discussed.
A circadian pattern with a morning peak and the triggering role of emotional stress have been sug... more A circadian pattern with a morning peak and the triggering role of emotional stress have been suggested for ventricular arrhythmias. After controlling for participant baseline characteristics and medication used, the authors studied the association of emotional upset, physical activity, and meteorologic parameters with occurrence of ventricular tachycardia (VT) in 457 Croatian participants aged 11–88 years consecutively assigned to undergo continuous 24-hour Holter monitoring. In 2001, multivariate analysis of possible VT precipitators was performed separately for men, women, those aged <65 years, and those aged>64 years. A U-shaped pattern of wind speed (either very weak or very strong), rising relative air moisture, falling atmospheric pressure, and emotional upset were independent predictors of VT episodes in all participant subgroups. Positive association of VT with higher atmospheric temperature or pressure was observed in women and elderly. After adjustment for external ...
Cilj rada je bio utvrditi ucestalost hospitalizacija bolesnika zbog infarkta miokarda, te bolnick... more Cilj rada je bio utvrditi ucestalost hospitalizacija bolesnika zbog infarkta miokarda, te bolnicki mortalitet u tih bolesnika tijekom razdoblja od 1. sijecnja 1981. g. do 31. prosinca 2005. godine u KB Split. Podaci su prikupljeni iz povijesti bolesti, a promatrani su u odnosu na spol i dob. Analizom podataka utvrdili smo da godisnji broj hospitaliziranih bolesnika u navedenom razdoblju neprestano raste, od 196 u 1981. godini, do 522 u 2005. godini. Prosjecan godisnji bolnicki mortalitet od infarkta miokarda neprestano pada od 20% u 1981. godini do 10% u 2005. godini. Pri tome je mortalitet žena u odnosu na muskarce stalno dvostruko veci od 30% prema 15% u 1981. godini do 16% prema 8% u 2005. godini. Prosjecna životna dob hospitaliziranih žena se smanjila sa 69 u 1981. godini na 66 u 2005. godini, dok se prosjecna životna dob muskaraca povecala od 59 u 1981. godini na 62 godine u 2005. godini. Prosjecna dob svih zajedno ostala je ista, 61 godina. Iz dobivenih rezultata može se zaklj...
Cardiologia Croatica, 2016
![Research paper thumbnail of [Characteristics of patients with acute myocardial infarct treated in Split from 1982 to 1992]](https://attachments.academia-assets.com/81769622/thumbnails/1.jpg)
](Lijec̆nic̆ki vjesnik
Background: The characteristics of patients with ongoing myocardial infarction (MI) contacting th... more Background: The characteristics of patients with ongoing myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods: This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results: A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions: Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
Annals of Saudi …, 2005
BACKGROUND : The importance of pathophysiological mechanisms involved in onset of acute myocardia... more BACKGROUND : The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. ...
Liječnički vjesnik, 2012
The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surge... more The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our "real-world" results to current guidelines and historical controls. Data of all STEMI patients treated by PCI were prospectively recorded. From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital time delays should be managed aggressi...
We present the case of a 50-year-old woman with abdominal pain, nausea, loss of appetite, and fre... more We present the case of a 50-year-old woman with abdominal pain, nausea, loss of appetite, and frequent stools in whom the routine ultrasonographic examination demonstrated a double-reflective, ribbon-like structure in the lumen of the initial segment of the ascending colon, which suggested colon taeniasis. Because the initial parasitologic analysis yielded negative results and application of albendazol did not have any therapeutic effect, the diagnosis was confirmed by barium enema and subsequently by parasitologic examination of proglottids passed in the stool after application of niclosamide. The double-reflective, ribbon-like structure in the lumen of the intestine seems to be specific to the ultrasonograph
![Research paper thumbnail of [Primary percutaneous coronary intervention (pPCI) in hospital without regional cardiac surgery support, data from Split region]](https://attachments.academia-assets.com/78407154/thumbnails/1.jpg)
](Lijecnicki vjesnik, 2012
OBJECTIVES The aim of our study was to investigate the feasibility of pPCI in hospital without ca... more OBJECTIVES The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our "real-world" results to current guidelines and historical controls. METHODS Data of all STEMI patients treated by PCI were prospectively recorded. RESULTS From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. CONCLUSIONS Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital...
Cardiologia Croatica
VIII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VII. sa... more VIII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VII. sastanak intervencijskih kardioloških medicinskih sestara i tehničara
Journal of Pain Research, 2017
Background: The degree of pain caused by the implantation of cardiac electronic devices (CEDs) an... more Background: The degree of pain caused by the implantation of cardiac electronic devices (CEDs) and the type of anesthesia or perioperative pain management used with the procedure have been insufficiently studied. The aim of this study was to analyze perioperative pain management, as well as intensity and location of pain among patients undergoing implantation of CED, and to compare the practice with published guidelines. Patients and methods: This was a combined retrospective and prospective study conducted at the tertiary hospital, University Hospital Split, Croatia. The sample included 372 patients who underwent CED implantation. Perioperative pain management was analyzed retrospectively in 321 patients who underwent CED implantation during 2014. In a prospective study, intensity and location of pain before, during, and after the procedure were measured by using a numerical rating scale (NRS) ranging from 0 to 10 in 51 patients at the same institution from November 2014 to August 2015. Results: A quarter of patients received analgesia or sedation before surgery. All the patients received local lidocaine anesthesia. After surgery, 31% of patients received pain medication or sedation. The highest pain intensity was observed during CED implantation with the highest NRS pain score being 8. Some patients reported severe pain (NRS >5) also at 1, 3, 6, 8, and 24 hours after surgery. The most common pain locations were surgical site, shoulder, and chest. Adherence to guidelines for acute perioperative pain management was insufficient. Conclusion: Patients may experience severe pain during and after CED implantation. Perioperative pain management was suboptimal, and higher doses of sedation and intensive analgesia are required. Guidelines for acute perioperative pain management and anesthesia during CED implantation should be developed.
Cardiologia Croatica, 2016
Collegium Antropologicum, Jul 1, 2005
In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atria... more In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atrial thrombus attached to a permanent pacemaker lead was incidentally identified by transesophageal echocardiography. Surgical treatment, recommended because of the large dimensions of the mass, was refused by the patient, and thrombus was successfully dissolved by anticoagulant treatment. Pathogenesis of pacemaker lead thrombosis, clinical implications, diagnostic and therapeutic options are discussed.
International Journal of Angiology, 2016
A 69-year-old man was admitted after syncope followed with chest pain and signs of cardiac tampon... more A 69-year-old man was admitted after syncope followed with chest pain and signs of cardiac tamponade. He had undergone permanent dual-chamber pacemaker implantation 3 weeks earlier. Transthoracic echocardiography (TTE) confirmed a pericardial effusion, and urgent pericardial drainage was performed. Right ventricular perforation caused by active-fixation (screw-in) lead was verified by multislice computed tomography. The lead was extracted under fluoroscopy and bedside TTE monitoring in the operating room with cardiothoracic surgery backup. In the same act, the new ventricular passive-fixation lead was implanted.
Cardiologia Croatica, 2016
VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sast... more VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničara Goal: Despite the guidelines, more than two-thirds of patients with massive/high risk pulmonary embolism (PE) do not receive thrombolytic therapy 1,2. Submassive/intermediate risk PE, as defined by right ventricular failure and/or NT-proBNP/troponin elevation, which can result in life-threatening deterioration/sequel is treated with thrombolytic therapy even less frequently. The main reason, that thrombolytics are used infrequently despite the potential clinical benefit of rapid clot lysis, is respect for significant bleeding complications, since nonpathologic thrombi are also lysed. The reluctance of majority of treating physicians to actually use thrombolytic therapy in everyday praxis persist and is matched only by zeal to publish successfully treated cases by minority of interventional colleagues. "Radial"-transcubital approach to high risk pulmonary embolism and subsequent catheter directed intervention (CDI) is proposed as a realistic alternative to both routinely used heparin therapy and surgical embolectomy, that can with modifications even be used in the case of contraindications for thrombolytic therapy. The goal of this presentation is to present a real-life center experience of the feasibility and safety of CDI including protocol for transcubital CDI as a first-line therapy in patients with clinically massive/high risk and submassive/intermediate risk PE. Patients and Methods: From March 2011 throughout December 2015, 29 patients with massive or submassive PE underwent a CDI at the University Hospital Centre Split, Croatia. CDI involved mechanical catheter fragmentation and the application of adjuvant thrombolytic therapy through a pigtail catheter positioned in the pulmonary artery (PA) or rheolytic thrombectomy (RT). Results: A total of 29 patients were enrolled in the study (15 men, 51.7%; 14 women, 48.3%). Clinical success was achieved in 26 of 29 cases (89.6%). There were no major procedural complications (0%). The 90-day survival rate was 89.6%. Conclusion: "Radial"-transcubital CDI in patients with clinically massive or submassive PE is feasible and safe. In experienced centers it should be considered as a first line treatment.
Texas Heart Institute …, 2000
Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disabilit... more Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage.We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lower-limb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. Early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.
Časopis. Autori: Nikolić Heitzler, Vjeran; Babić, Zdravko; Miličić, Davor; Bergovec, Mijo; Ragu,... more Časopis. Autori: Nikolić Heitzler, Vjeran; Babić, Zdravko; Miličić, Davor; Bergovec, Mijo; Ragu, Miroslav; Mirat, Jure; Strozzi, Maja; Plazonić, eljko; Giunio, Lovel; Steiner, Robert. Naslov: Croatian Primary PCI Network-two years results. ...
Annals of Saudi Medicine
The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction ... more The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG. Data was obtained from a chart review of 2958 patients with first AMI: 770 (26%) patients with non-Q-wave AMI and 2188 (74%) patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria (anterior Q-wave, anterior non-Q-wave, inferior Q-wave, inferior non-Q-wave). A logistic regression was performed to assess independent predictors of AMI type and site. Key findings were: 1) inferior non-Q-wave AMI was more frequent in young women (P<0.001); 2) inferior Q-wave AMI was more common in young men (P<0.001); 3) anterior non-Q-wave AMI was more common in older men (P<0.0...
Collegium Antropologicum, 2005
In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atria... more In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atrial thrombus attached to a permanent pacemaker lead was incidentally identified by transesophageal echocardiography. Surgical treatment, recommended because of the large dimensions of the mass, was refused by the patient, and thrombus was successfully dissolved by anticoagulant treatment. Pathogenesis of pacemaker lead thrombosis, clinical implications, diagnostic and therapeutic options are discussed.
A circadian pattern with a morning peak and the triggering role of emotional stress have been sug... more A circadian pattern with a morning peak and the triggering role of emotional stress have been suggested for ventricular arrhythmias. After controlling for participant baseline characteristics and medication used, the authors studied the association of emotional upset, physical activity, and meteorologic parameters with occurrence of ventricular tachycardia (VT) in 457 Croatian participants aged 11–88 years consecutively assigned to undergo continuous 24-hour Holter monitoring. In 2001, multivariate analysis of possible VT precipitators was performed separately for men, women, those aged <65 years, and those aged>64 years. A U-shaped pattern of wind speed (either very weak or very strong), rising relative air moisture, falling atmospheric pressure, and emotional upset were independent predictors of VT episodes in all participant subgroups. Positive association of VT with higher atmospheric temperature or pressure was observed in women and elderly. After adjustment for external ...
Cilj rada je bio utvrditi ucestalost hospitalizacija bolesnika zbog infarkta miokarda, te bolnick... more Cilj rada je bio utvrditi ucestalost hospitalizacija bolesnika zbog infarkta miokarda, te bolnicki mortalitet u tih bolesnika tijekom razdoblja od 1. sijecnja 1981. g. do 31. prosinca 2005. godine u KB Split. Podaci su prikupljeni iz povijesti bolesti, a promatrani su u odnosu na spol i dob. Analizom podataka utvrdili smo da godisnji broj hospitaliziranih bolesnika u navedenom razdoblju neprestano raste, od 196 u 1981. godini, do 522 u 2005. godini. Prosjecan godisnji bolnicki mortalitet od infarkta miokarda neprestano pada od 20% u 1981. godini do 10% u 2005. godini. Pri tome je mortalitet žena u odnosu na muskarce stalno dvostruko veci od 30% prema 15% u 1981. godini do 16% prema 8% u 2005. godini. Prosjecna životna dob hospitaliziranih žena se smanjila sa 69 u 1981. godini na 66 u 2005. godini, dok se prosjecna životna dob muskaraca povecala od 59 u 1981. godini na 62 godine u 2005. godini. Prosjecna dob svih zajedno ostala je ista, 61 godina. Iz dobivenih rezultata može se zaklj...
Cardiologia Croatica, 2016
Lijec̆nic̆ki vjesnik
Background: The characteristics of patients with ongoing myocardial infarction (MI) contacting th... more Background: The characteristics of patients with ongoing myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods: This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results: A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions: Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
Annals of Saudi …, 2005
BACKGROUND : The importance of pathophysiological mechanisms involved in onset of acute myocardia... more BACKGROUND : The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular events has been observed, particularly between men and women. ...
Liječnički vjesnik, 2012
The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surge... more The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our "real-world" results to current guidelines and historical controls. Data of all STEMI patients treated by PCI were prospectively recorded. From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital time delays should be managed aggressi...
We present the case of a 50-year-old woman with abdominal pain, nausea, loss of appetite, and fre... more We present the case of a 50-year-old woman with abdominal pain, nausea, loss of appetite, and frequent stools in whom the routine ultrasonographic examination demonstrated a double-reflective, ribbon-like structure in the lumen of the initial segment of the ascending colon, which suggested colon taeniasis. Because the initial parasitologic analysis yielded negative results and application of albendazol did not have any therapeutic effect, the diagnosis was confirmed by barium enema and subsequently by parasitologic examination of proglottids passed in the stool after application of niclosamide. The double-reflective, ribbon-like structure in the lumen of the intestine seems to be specific to the ultrasonograph
Lijecnicki vjesnik, 2012
OBJECTIVES The aim of our study was to investigate the feasibility of pPCI in hospital without ca... more OBJECTIVES The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our "real-world" results to current guidelines and historical controls. METHODS Data of all STEMI patients treated by PCI were prospectively recorded. RESULTS From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. CONCLUSIONS Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital...
Cardiologia Croatica
VIII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VII. sa... more VIII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VII. sastanak intervencijskih kardioloških medicinskih sestara i tehničara
Journal of Pain Research, 2017
Background: The degree of pain caused by the implantation of cardiac electronic devices (CEDs) an... more Background: The degree of pain caused by the implantation of cardiac electronic devices (CEDs) and the type of anesthesia or perioperative pain management used with the procedure have been insufficiently studied. The aim of this study was to analyze perioperative pain management, as well as intensity and location of pain among patients undergoing implantation of CED, and to compare the practice with published guidelines. Patients and methods: This was a combined retrospective and prospective study conducted at the tertiary hospital, University Hospital Split, Croatia. The sample included 372 patients who underwent CED implantation. Perioperative pain management was analyzed retrospectively in 321 patients who underwent CED implantation during 2014. In a prospective study, intensity and location of pain before, during, and after the procedure were measured by using a numerical rating scale (NRS) ranging from 0 to 10 in 51 patients at the same institution from November 2014 to August 2015. Results: A quarter of patients received analgesia or sedation before surgery. All the patients received local lidocaine anesthesia. After surgery, 31% of patients received pain medication or sedation. The highest pain intensity was observed during CED implantation with the highest NRS pain score being 8. Some patients reported severe pain (NRS >5) also at 1, 3, 6, 8, and 24 hours after surgery. The most common pain locations were surgical site, shoulder, and chest. Adherence to guidelines for acute perioperative pain management was insufficient. Conclusion: Patients may experience severe pain during and after CED implantation. Perioperative pain management was suboptimal, and higher doses of sedation and intensive analgesia are required. Guidelines for acute perioperative pain management and anesthesia during CED implantation should be developed.
Cardiologia Croatica, 2016
Collegium Antropologicum, Jul 1, 2005
In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atria... more In a 62-year-old man with permanent atrial fibrillation and recurrent stroke, a large right atrial thrombus attached to a permanent pacemaker lead was incidentally identified by transesophageal echocardiography. Surgical treatment, recommended because of the large dimensions of the mass, was refused by the patient, and thrombus was successfully dissolved by anticoagulant treatment. Pathogenesis of pacemaker lead thrombosis, clinical implications, diagnostic and therapeutic options are discussed.
International Journal of Angiology, 2016
A 69-year-old man was admitted after syncope followed with chest pain and signs of cardiac tampon... more A 69-year-old man was admitted after syncope followed with chest pain and signs of cardiac tamponade. He had undergone permanent dual-chamber pacemaker implantation 3 weeks earlier. Transthoracic echocardiography (TTE) confirmed a pericardial effusion, and urgent pericardial drainage was performed. Right ventricular perforation caused by active-fixation (screw-in) lead was verified by multislice computed tomography. The lead was extracted under fluoroscopy and bedside TTE monitoring in the operating room with cardiothoracic surgery backup. In the same act, the new ventricular passive-fixation lead was implanted.
Cardiologia Croatica, 2016
VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sast... more VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničara Goal: Despite the guidelines, more than two-thirds of patients with massive/high risk pulmonary embolism (PE) do not receive thrombolytic therapy 1,2. Submassive/intermediate risk PE, as defined by right ventricular failure and/or NT-proBNP/troponin elevation, which can result in life-threatening deterioration/sequel is treated with thrombolytic therapy even less frequently. The main reason, that thrombolytics are used infrequently despite the potential clinical benefit of rapid clot lysis, is respect for significant bleeding complications, since nonpathologic thrombi are also lysed. The reluctance of majority of treating physicians to actually use thrombolytic therapy in everyday praxis persist and is matched only by zeal to publish successfully treated cases by minority of interventional colleagues. "Radial"-transcubital approach to high risk pulmonary embolism and subsequent catheter directed intervention (CDI) is proposed as a realistic alternative to both routinely used heparin therapy and surgical embolectomy, that can with modifications even be used in the case of contraindications for thrombolytic therapy. The goal of this presentation is to present a real-life center experience of the feasibility and safety of CDI including protocol for transcubital CDI as a first-line therapy in patients with clinically massive/high risk and submassive/intermediate risk PE. Patients and Methods: From March 2011 throughout December 2015, 29 patients with massive or submassive PE underwent a CDI at the University Hospital Centre Split, Croatia. CDI involved mechanical catheter fragmentation and the application of adjuvant thrombolytic therapy through a pigtail catheter positioned in the pulmonary artery (PA) or rheolytic thrombectomy (RT). Results: A total of 29 patients were enrolled in the study (15 men, 51.7%; 14 women, 48.3%). Clinical success was achieved in 26 of 29 cases (89.6%). There were no major procedural complications (0%). The 90-day survival rate was 89.6%. Conclusion: "Radial"-transcubital CDI in patients with clinically massive or submassive PE is feasible and safe. In experienced centers it should be considered as a first line treatment.
Texas Heart Institute …, 2000
Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disabilit... more Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage.We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lower-limb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. Early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.