Praxis Medica

30.06.2025.

Professional paper

SRČANA SLABOST I GOJAZNOST

Kao posledica nepravilne ishrane i sedentarnog načina života broj gojaznih osoba dobija epidemijske razmere. Brojne studije pokazuju da je povišen
indeks telesne mase (BMI) nezavistan faktor rizika za nastanak kardiovaskularnih bolesti, uključujući i srčanu insuficijenciju.
Povećanje indeksa telesne mase je udruženo sa povećanim rizikom od pojave srčane slabosti (sistolne i dijastolne) kod osoba oba pola. Naime,
gojaznost je povezana sa češćom hipertrofijom leve komore i njenom dilatacijom, što su prekursori srčanog popuštanja. Usled prisutnog metaboličkog
sindroma kod gojaznih je češća pojava koronarne bolesti. Prevalencija diabetesa, arterijske hipertenzije i hiperlipoproteinemija raste sa porastom
indeksa telesne mase, a oni su faktori rizika za pojavu koronarne bolesti, koja je najčešći uzrok pojave srčane insuficijencije. Pored toga, dijabetes i
arterijska hipertenzija nezavisno povećavaju rizik od nastanka srčane insuficijencije. Povišen BMI udružen je sa izmenjenim remodelovanjem i
hipertrofijom leve komore (verovatno zbog povećanog hemodinamskog opterećenja), neurohormonalnom aktivacijom (povećana simpatička aktivnost,
aktivnost renin-angiotenzin sistema i dr.) i povećanim oksidatvnim stresom. Poslednjih godina ističe se značaj masnog tkiva kao endokrinog organa
koji oslobađa širok spektar biološki aktivnih materija koje mogu imati kardiotoksično dejstvo. Postoji više mogućih mehanizama kojima gojaznost
direktno može dovesti do pojave srčane insuficijencije: gojaznost uzrokuje akumulaciju lipida u ili oko miocita, a oni produkuju lipotoksine sa
direktnim toksičnim efektom na miocite; gojaznost indirektno uzrokuje insuficijenciju desne komore, zbog restriktivne bolesti pluća i poremećaja
disanja tokom sna (sleep apnea); gojaznost je hronično inflamatorno stanje, a inflamatorni citokini mogu narušiti kardijalnu funkciju i/ili izazvati
fibrozu (metaflamacija). Simptomi i znaci SI se naročito teško utvrđuju kod gojaznih, pa se dijagnoza srčane insuficijencije često ne postavlja na
vreme. Gojaznost i terapija srčane slabosti mogu uticati na niže nivoe natriuretskog peptida. Redukcija telesne težine, promena načina života i
ishrane, kao i prevencija dijabetesa kod gojaznih osoba, može značajno redukovati rizik od nastanka srčane insuficijencije. Redukcija telesne težine
dijetom, barijatrijskom hirurgijom ili lekovima (inkretinski hormoni) kod izrazito gojaznih osoba može sprečiti pojavu i poboljšati tok SI. S druge
strane, gojazni, suprotno prvobitnim očekivanjima, često imaju bolju prognozu srčane insuficijencije od negojaznih (obesity paradox). Terapija
srčane insuficijencije kod gojaznih se sastoji iz opštih mera lečenja, medikamentne terapije, invazivnih kardioloških terapijskih mera, kao i hirurškog
lečenja. Primena SGLT2 inhibitora, sakubitril/valsartana i spironolactona imaju posebno povoljan efekat u terapiji srčane insuficijencije kod
gojaznih. Određeni lekovi za terapiju hipertenzije ili dijabetesa, kao što su ACE inhibitori i metformin posebno su efikasni za lečenje i sprečavanje
nekih od posledica ovih bolesti kod gojaznih, a time mogu smanjiti rizik od nastanka srčane insuficijencije. Druga terapija kao što je antiagregaciona
terapija, statini ostvaruju terapijski cilj sprečavanjem nastanka i progresije koronarne bolesti srca,
S obzirom na veliki broj nepoznanica koji prati ovu temu, očekuje se da će buduća istraživanja potpuno razjasniti sve do sada nedovoljno poznate
karakteristike srčane insuficijencije kod gojaznih osoba i da će otvoriti nove terapijske mogućnosti u tretmanu ovih osoba.
Ključne reči: Srčana insuficijencija, gojaznost, rizik, prognoza

Vladan Perić, Marija Stević, Kristina Bulatović

15.02.2025.

Case Reports

IDIOPATHIC PULMONARY HYPERTENSION – CASE PRESENTATION

Pulmonary hypertension (PH) is a hemodynamic condition characterized by a mean pulmonary artery pressure (mPAP) ≥ 25 mmHg at rest, pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 240 dyn·s·cm⁻⁵. The annual incidence of pulmonary arterial hypertension (PAH) is approximately 3–10 new cases per million adults. It is estimated that the prevalence of pulmonary hypertension in individuals over 65 years of age is around 10%.The aim of this study is to present the case of a female patient with progressive dyspnea in whom PAH remained undiagnosed for a prolonged period.A 74-year-old female patient, M.P., was hospitalized in the Coronary Care Unit of the Clinical Center in Kosovska Mitrovica due to symptoms of shortness of breath, choking, fatigue, leg swelling, and weakness. The admission ECG revealed: sinus rhythm, normal axis, high R wave in V2, ST depression, and negative T waves in leads II, III, aVF, and V4–V5. Echocardiography findings showed right ventricular enlargement (2.9 cm), pulmonary artery dilation (3.3 cm), 1–2+ pulmonary regurgitation, and 3+ tricuspid regurgitation, with a systolic pulmonary artery pressure (SPAP) of up to 126 mmHg. The right ventricle measured 5.3 cm in the 4Ch view, with a TAPSE of 1.8 cm. Right heart catheterization revealed the following pressures: PA 78/34/57 mmHg, RV 74/8/10 mmHg, RA 6/6/7 mmHg, CO 4.3 l/min, and LV 99/10/8 mmHg. Although primary pulmonary hypertension is predominantly a disease of younger individuals, it should also be considered in older patients presenting with progressive dyspnea in the absence of structural heart disease.

Kristina Bulatović, Vladan Perić, Maja Šipić, Jovana Milošević, Erdin Mehmedi, Sanja Jovanović

01.12.2020.

Professional paper

Dijabetesna ketoacidoza kod bolesnika sa cerebrovaskularnim insultom - uzroci, mehanizmi, dijagnostika i naše smernice za terapiju

Although cerebrovascular disease may be a well recognised trigger for diabetic ketoacidosis (DKA), literature data on the precise mechanisms, characteristics, or treatment guidelines are rare. The risk of developing an ischemic stroke is doubled in adults with diabetes compared to people with normal glucose metabolism. It is important to point out that even children with DKA have a significantly increased risk of cerebrovascular insult and that they can have a stroke with a frequency of about 10%. Given the significant overlap of symptoms between these two diseases, it can be assumed that attributing DKA symptoms as a manifestation of stroke is not uncommon, especially in elderly and less communicative patients. In addition, pH, bicarbonate concentration, and anion gap are not routinely measured in all diabetics suffering from stroke, at least not in secondary health institutions.Children who develop cerebrovascular stroke during DKA often at the beginning have a preserved consciousness or only mild confusion or lethargy. After a few hours, with the institution of therapy, however, loss of consciousness may occur accompanied by signs of increased intracranial pressure. It was previously thought that the cause was too fast fluid replacement. Recent data suggest that reperfusion injury may be a more likely mechanism. Although most of these studies relate to younger individuals with ketoacidosis, it is clear that at least some of them may be operative in adult DKA. Literature therapeutic guidelines for adult diabetics with stroke-related diabetic ketoacidosis are almost lacking, although it is clear that they could not be the same as those utilised in population with normal glucose metabolism. In this paper, we have tried to define our treatment guidelines for these particular patients.

Aleksandar Jovanović, Vladan Perić, Snežana Marković-Jovanović, Tatjana Novaković, Slavica Pajović, Saša Sovtić, Srbislava Milinić

01.12.2019.

Professional paper

Ebstejn's anomaly in patients perioperative period during a non-cardiac surgery operation

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.

Ljubiša Mirić, Tijana Smiljković, Vladan Perić, Slađana Mirić, Tjaša Ivošević

01.12.2017.

Professional paper

Hiperinsulinemia and ketotic hypoglycemia as the most common forms of hypoglycemic states in childhood

Snežana Marković-Jovanović, Aleksandar Jovanović, Dragica Odalović, Jadranka Mitić, Vanja Nikčević, Perić Vladan

Current issue

Volume 53, Issue 4, 2025

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Contents

SRČANA SLABOST I GOJAZNOST

IDIOPATHIC PULMONARY HYPERTENSION – CASE PRESENTATION

Dijabetesna ketoacidoza kod bolesnika sa cerebrovaskularnim insultom - uzroci, mehanizmi, dijagnostika i naše smernice za terapiju

Ebstejn's anomaly in patients perioperative period during a non-cardiac surgery operation

Hiperinsulinemia and ketotic hypoglycemia as the most common forms of hypoglycemic states in childhood