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Clozapine, atypical antipsychotic drug, is widely used in patients with schizophrenia, for whom previous therapy was inadequate or not tolerated. Clozapine-induced myocarditis (CIM) is a relatively rare but potentially life-threatening complication of clozapine therapy; however, the underlying mechanism has not been so far well elucidated. Factors predisposing to CIM include a rapid dose titration, advanced age and co-administration of sodium valproate. In this paper, we present a case of a 22-year-old male patient with refractory schizophrenia who developed CIM during low-dose clozapine treatment with co-administration of valproate and risperidone. On the basis of our case and literature review, we point out that during the first weeks of clozapine treatment patients should be actively, daily monitored for the presence of symptoms suggesting CIM. The low dose of clozapine and concurrent use of valproate are unique aspects of the report, adding new information to the discussion on safety of concomitant use of clozapine and valproate. Further investigation is required to better understand the role of co-administration of valproate and risperidone in the pathogenesis of CIM. [ABSTRACT FROM AUTHOR]

The third universal definition for the diagnosis of myocardial infarction necessitates evidence of myocardial necrosis confirmed by the elevation of cardiac biomarkers. Coupled with the following ECG findings: recent ST-segment-T wave changes and/or evolution of the pathological Q wave or recent left bundle branch block. In this article, we strive to present contemporary electrocardiographic criteria defining myocardial infarction. Electrocardiography remains the most basic, simplest, reliable and quickest way to diagnose a myocardial infarction; despite the use of recent diagnostic modalities (including ultra-sensitive markers and imaging methods). Hence proficiency and ability in the interpretation of electrocardiographic criteria of a presenting myocardial infarction is paramount and should be one of the basic abilities of any physicians. [ABSTRACT FROM AUTHOR]

Background: In patients with chronic critical leg ischaemia (CCLI) the lesions of other (except leg arteries) vascular system regions are often observed. Aim of study: The aim of the study was to assess clinical usefulness of troponin I (cTnI) measurement in patients hospitalised due to chronic critical leg ischemia (CCLI). Material and methods: The study included 72 patients at the age of 76.3 ± 9.4 years with CCLI. The level of cTnI and enzymes: creatine kinase (CPK), CK isoenzyme MB (CK-MB) were measured in all patients during the day of admission and on the first and the second day after vascular procedure. On the same days an electrocardiogram was also performed. Patients with symptomatic and unstable coronary heart disease were not included into the study. Results: Increased cTnI values (> 0.014 ng/ml) were found before vascular procedure in 4.2% of patients and in 12.5% of patients after procedure. There was a direct relationship between CPK, CK-MB levels, electrocardiogram result and positive (increased) cTnI before and after surgery. There were no significant differences concerning mortality rate between the group of cTnI positive and negative patients, however, a statistically significant higher myocardial infarction rate occurred in the group with positive cTnI (22.2% v. 0%; p = 0.0067). Other (extracardiac) reasons that influenced on increased cTnI troponin level during postoperative period were: perioperative decrease of the blood cell count that required ransfusion and acute renal failure. Conclusions: Troponin I measurement in patients with CCLI has significant value to identify patients with high risk of cardiologic complications, particularly useful to diagnose silent myocardial ischemia during perioperative period. [ABSTRACT FROM AUTHOR]