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This paper aims to find new predictors of poor antihypertensive treatment adherence in the Romanian adult hypertensive population. Six hundred eighty hypertensive subjects identified in the SEPHAR IV survey were evaluated by a study questionnaire, including a 4-item Morisky Medical Adherence Score (MMAS-4), BP and anthropometric measurements, and laboratory workup. BP control was defined as <140/90 mmHg at both study visits (4 days apart). According to the MMAS-4 score, adherence was considered low (3-4p), moderate (1-2p) and high (0p). Statistical analysis was performed with SPSS Statistics 18.0 software at a significance level of p=0.05. Of the total 680 hypertensive subjects, 461 were receiving antihypertensive treatment. According to BP control, treated hypertensives were further divided into two groups - controlled (181 subjects, 39.2%) and uncontrolled HTN (280 subjects, 60.8%). The mean age was 63.25±11.65 years and the female gender was more prevalent (61.1%). Distribution regarding residence was balanced (urban area - 51.5%). Low antihypertensive treatment adherence was recorded in 46 subjects representing 9.9% of the total group, with a significantly higher rate among uncontrolled hypertensive subjects [35 subjects (12.5%) vs. 11 subjects (6.1%); p=0.024]. Total cholesterol (AUC=0.659; CI=95%: 0.557-0.761; p=0.005) and LDL cholesterol (AUC=0.645; CI=95%: 0.537-0754; p=0.011) were statistically significant predictors of low treatment adherence. The MMAS-4 is a readily available tool that can be used in daily clinical practice. The lipid profile can be used to identify less adherent HT patients. Future research should establish a metabolic profile of the nonadherent patient and focus on developing strategies to increase adherence. [ABSTRACT FROM AUTHOR]

We report the case of an 88-year-old male who was admitted for presenting acute onset pain in the right lower limb associated with dyspnea. After clinical exam and Doppler echography, the deep vein thrombosis was confirmed. The thoracic angio computed tomography revealed segmentary pulmonary embolism, but also showed aneurysmal dilated ascending aorta and presence of chronic extensive type B aortic dissection with multiple atheroma plaques. Despite the unfortunate association, the anticoagulant treatment was carefully monitored, with no complications or bleeding events. Taking into consideration the thromboembolic event and high atherosclerotic burden, the patient was discharged with novel oral anticoagulant and statin, abstaining from antiaggregant therapy. The association of pulmonary embolism with aortic dissection represents a rare condition that raises certain anticoagulant and therapeutic dilemma. [ABSTRACT FROM AUTHOR]

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Throughout the world, cardiovascular diseases (CVD) have become a major public health problem and have been recognized as a leading cause of death and disability in most developed and developing countries. Hypertension is the most important risk factor for cardiovascular diseases such as stroke, coronary artery disease, end-stage renal disease and heart failure. It is estimated that about 25% of the world's adult population have hypertension, and it will be likely to increase to 29% by 2025. In Europe, an estimated 37% - 55% of the adult population is affected by hypertension. The primary aim of this cross-sectional study was to estimate the prevalence of arterial hypertension among adults (n = 2659) in a rural community of the North Romanian Region. A secondary aim was to identify the risk factors involved in hypertension. The study gathered information on socio-demographic conditions, history of diseases, habits and anthropometric parameters. The number of inhabitants in the records of the general practitioner (GP) who conducted the collaboration is 2659 people, of whom 1244 males (46.78%) and 1415 females (53.21%). The patients fulfilled defined diagnostic criteria for hypertension: systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg, or have been diagnosed with hypertension or have taken antihypertensive drugs within two weeks. Patients with secondary hypertension were excluded. The mean age of the study group was 65.96 ± 11.93 years, the age varying between 26 and 92 years. Among these, 9.13% had increased blood pressure values, most of them having 1st or 2nd degree arterial hypertension. By diving the persons into 6 age categories, according to decades, normal blood pressure values were more frequently seen in age extremities (< 50 or > 80 years old). A positive relationship was obtained between arterial hypertension and obesity and a direct correlation between arterial hypertension and type 2 diabetes mellitus. Stress was more pronounced in the active population where 38.6% of persons declared that they were stressed compared to only 18.3% in the retired population (p = 0.0001). The findings can contribute to strategies for improving health services to monitor and prevent cardiovascular events. [ABSTRACT FROM AUTHOR]

Copyright of Internal Medicine / Medicină Internă is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Internal Medicine / Medicină Internă is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prevalence of coronary heart disease is higher in men but the prevalence of stroke and the annual number of cardiovascular deaths are higher in women. Despite these findings, the cardiovascular risk in the female population is still underestimated. The present study aimed to identify cardiovascular risk factors and correlations with atherosclerotic cardiovascular disease in 285 patients from a rural community in Romania, aged between 26-92 years, 187 (65,6%) females, 98 (34,4%) males, in order to establish gender differences. Traditional risk factors were assessed. We used descriptive statistic methods to calculate the average and standard deviation of the assessed parameters. Divided by gender, the cardiovascular risk factors presented important differences. Almost all cardiovascular risk factors were more importantly represented in the female group: type 2 diabetes mellitus (73.0%), chronic stress (70.0%), family history of cardiovascular disease (57.0%). Obesity was frequent in females but with no statistical difference. Of all the women, 57.9% had arterial hypertension compared to men (27.7%) the statistical significance being almost insignificant (p = 0.052). Women had 4.3 times greater odds of obesity, 14.2 fold increased odds for abdominal adiposity, 2.8 times greater odds of high waist-hip-ratio and more than three-fold greater odds of having metabolic syndrome (p = 0.001). Among men, BMI and waist circumference were significantly correlated with blood pressure, triglycerides, total, LDL-, and HDL-cholesterol and fasting glucose; in women, only blood pressure was positively associated with BMI and waist circumference. Further studies are needed to establish the correlation between gender and cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Mobile right heart thrombus represents a rare situation that complicates acute pulmonary thromboembolism and is associated with high rates of mortality. In such cases, anticoagulation with heparin, thrombolysis, surgical embolectomy or percutaneous catheter intervention represent possible therapeutic measures, but no certain guideline recommendations have been proposed for this particular setting and the treatment should be conducted by guiding after local possibilities and experience. We present the case of a 69-year old male patient, with stable vital signs, that was admitted for acute pulmonary thromboembolism. Transthoracic echocardiography revealed right heart dilatation, acute pulmonary artery hypertension (PAH) and a serpiginous mobile thrombus located in the right atrium prolapsing into the right ventricle (RV) with maximum length 54 mm. After 24 hours of thrombolysis with streptokinase, the patient evolution was favorable, with disappearance of thrombus, RV function improvement and reduction of PAH. No post-thrombolysis complications were observed and the patient was discharged with indication of oral anticoagulation for long term. [ABSTRACT FROM AUTHOR]

Chronic diseases result in an enormous burden of morbidity and mortality worldwide, projected to continuously increase over the next decades. Cardiovascular diseases, followed by cancers, chronic respiratory diseases and diabetes mellitus, represent the main causes of death caused by chronic conditions. The majority of chronic diseases are multifactor disorders, the main etiological role being played by various behavioral or environmental risk factors. Social factors such as education, employment status, income, familial and social stress have also a major role in determining chronic diseases, both directly and indirectly, by increasing the susceptibility to behavioral risk factors. Chronic pathology results in chronic symptoms which dramatically impairs the patient quality of life and working capacity, also resulting in a significant social and economic burden. Social problems develop with the progressive exercise capacity alteration, resulting in limited mobility, home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma. Chronic diseases prevention focuses on behavioral risk modifying, mainly implying specific social interventions, as long as most behavioral risk factors are represented by socially mediated activities. Considering the magnitude of the problems currently determined by chronic diseases, a coherent strategy for the management of these conditions, should be a high priority at both levels of society and health care systems. This strategy must provide an efficient risk control, the optimal medical care for the patient, by applying a holistic patient-centered approach, and specific social assistance. [ABSTRACT FROM AUTHOR]

Autopsy (necropsy, postmortem examination, autopsy cadaverum) is often marginalized in contemporary medicine, although it remains an important practice with enormous potential to move forwards new medical information and develop clinical practice. Many doctors are not common with autopsy examination and are not sufficiently conscious of the benefits of this procedure not only for the families involved, but also for patients. Standard autopsy should ideally be an critical part of investigating foetal loss, newborn deaths and neonatal deaths without foetal malformations. In many countries where family approval is required, it has been recently recorded a decrease in the number of autopsies. Clinicians and other family doctors requiring family consent for autopsy should consider in advance the options for a full, limited, or step by step post-mortem examination; the problem of tissue sampling and the autopsy value, as well as the possibility that the information obtained has a real benefit for themselves should also be iterated. However, this type of information must be provided in compliance with personal and cultural values of the involved families. Therefore, the role and usefulness of autopsy will be reflected in their public support, and only when the new generation of physicians will realize the importance of the knowledge gained from examining the human body after death, the importance of necropsy for current medicine will be understood. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 76-year-old woman with existing uninvestigated chronic hepatitis B presented with resting dyspnea and bilateral leg swelling. It mentions that laboratory findings highlighted important hepatic cytolysis, moderate anemia, and increased D-dimers; and transthoracic echocardiography revealed a large, well-defined echogenic mass with hypoechoic central areas that occupied the right atrium almost entirely.

The article presents a case study of a 44-year-old man who had a percutaneous transluminal coronary angioplasty (PTCA) on his 2nd marginal artery in 2011 and was admitted for recurring retrosternal chest pain. Among the treatment and examinations that the patient had are intake of medicines, like Bisoprolol, Aspirin, and Simvastatin, electrocardiography (ECG) exercise stress test, and ergonovine maleate provocation test. It mentions that the patient has coronary spasm.

This paper presents the case of an asymptomatic persistent left superior vena cava unmasked by a simple non-invasive cardiac imaging, namely microbubble test by transthoracic echocardiography. A 25 years old man complaining of atypical chest pain at exertion was examined by the cardiologist. The clinical exam was normal. Twelve leads ECG showed sinus rhythm of 55 beats/min, QRS axis of 70 degree and minor right bundle branch block. Transthoracic echocardiography has shown a large coronary sinus of 32 mm, without right cavities dilatation and without any sign of pulmonary hypertension. Transthoracic echocardiogram was repeated during injection of agitated saline solution into the left basilica vein and micro-bubbles unexpectedly filled firstly coronary sinus and then passed through the right atrium. Contrast enhanced computer tomography angiography confirmed the presence of persistent left superior vein cava and the site of drainage into a large coronary sinus. Right superior vein cava was also identified. It is mandatory to consider persistent left superior vena cava draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus shown by transthoracic echocardiography. Even if persistent left superior vena cava could be diagnosed by a simple, non-invasive imaging test, an associated heart disease must always be excluded in these patients by another imaging method like computer tomography. This case underlines also the importance of multimodality imaging in the evaluation of these abnormalities. [ABSTRACT FROM AUTHOR]

Nowadays the new concept in cardiovascular disease namely Heart Team, a multidisciplinary team created in tertiary hospitals to find the best medical care or to decide and assist complex surgical or percutaneous interventional cardiology procedures (e.g. for high risk patients with severe aortic stenosis referred to transcutaneous valve implantation or electrophysiology procedures) in patients with severe or life threating cardiac disease, might be created and function in all tertiary hospitals. Multidisciplinary collaboration between experts for early diagnosis and appropriate/optimal treatment might prevent or reduce long hospitalization, temporary or permanent incapacitation and implicitly social costs in coronary heart disease, valvulopathies, atrial fibrillation, infective endocarditis, heart failure, peripheral artery disease or congenital heart disease. Moreover new multidisciplinary teams like cardiometabolic team will be appearing. However, Heart Team concept, this useful tool for obtaining optimal clinical outcomes, has not been widely implemented. Delayed diagnosis and inappropriate treatment in the absence of a heart team might have medical, social, legal and ethical outcomes. This article underlies the utility and the limits of Heart Team, a multidisciplinary team of experts, created in tertiary hospitals involved in complex medical care of patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflict of interest: None declared.