[Ebstein's anomaly with patent foramen ovale and supraventricular paroxysmal tachycardia]

A case of asymptomatic 36 years old men with Ebstein anomaly of tricuspid valve, patent foramen ovale and paroxismal supraventricular tachycardia is presented in this paper. A routine physical examination revealed a heart systolic murmur along left and right side of sternum, with right bundle branch block on ECG. It led to the detailed non-invasive cardiologic examination (transthoracic, transeophageal and stress echocardiography, ambulatory ECG), what disclosed above mentioned Ebstein anomaly. Also he was operated on upon superior lip fissure at the first year of life. Regarding his very mild symptoms (NYHA g. 1), he was treated only medicamentosly.

[Converting enzyme inhibitors in acute myocardial infarct and heart failure]

Inhibitors of angiotensin converting enzyme (ACE inhibitors) have been introduced more than fifteen years ago into the treatment of hypertension, congestive heart failure, myocardial infarction and diabetic nephropathy. The therapeutic success is related to their action in reduction of plasma and tissue angiotensin II concentrations and potentiation of endogenous kinins. They are able to improve myocardium metabolic status, prevent cardiac hypertrophy, limit myocardial infarct size, and thus prevent heart failure. Since 1987 ACE inhibitors are introduced in the clinical practice in our clinic. We introduced the therapy with lisinopril (Lopril), in 70% of patients among 2855 patients that were admitted in Coronary Care Unit in 1997 and 1998. Lisinopril was introduced as soon as the patient was admitted, together with fibrinolitic, Heparin and Aspirin therapy. Since that time we noticed decrease in postinfarction heart failure in comparison to previous years. We recommend permanent therapy with a small doses of ACE inhibitors in patients with heart infarction.

[ECG in patients with hemorrhagic fever]

We analyzed 128 electrocardiograms (ECG) of 43 patients with haemorrhagic fever associated with kidney syndrome (HFKS) during an epidemic in 1989, region around Sarajevo. The greatest number of alternations was noticed in toxic phase, and the smallest number in invasive phase of disease. All alternations were transient. Extended QT interval was dominant, and was found in 19 patients (45%). Tall and peaked T wave in the case of 17 patients or in 40%, during toxic and recovering phase, was the second by its frequency. As the third by its frequency, there was U wave manifestation. We found this kind of alternation in the case of 13 patients or in 31%. Incomplete right bundle branch block was the most frequent find during invasive phase of HTKS and it was found in 3/7 of all patients. The same thing was found in 6 patients more, during toxic phase, so in total it was 21%. First degree AV block was presented in 8 patients or 19%. Other finds, ischemia, P-pulmo, arrhythmia etc. had frequency less than 10%.