Background: Familial hypercholesterolemia (FH) is an inherited disorder characterized by significantly elevated levels of low-density lipoprotein (LDL) cholesterol and is usually diagnosed after the occurrence of major adverse cardiovascular event. Aim: The aim of this study was to evaluate FH existence, increase awareness of this disorder, and highlight the importance of early treatment which leads to a reduction of premature cardiovascular events and death. Methods: The research had a cross-sectional, descriptive, and analytical character, and included 6881 (n = 6881) patients who were hospitalized in the Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina, in the period from January 2019 to January 2021. LDL values were analyzed, and all patients with LDL ≥4 mmol/L were included in the study. The Dutch Lipid Score was calculated for all patients, and the findings of invasive coronary angiography were taken into account in those patients for whom it was performed. Results: From 6881 patients, 74 patients had LDL ≥4 mmol/L. Possible FH (score: 3–5) was found in 25 patients, probable FH (score: 6–8) in 2 patients, while the diagnosis of definite FH was not made in any patient. A ST-elevation myocardial infarction was an indication for hospitalization in 44.60% (n = 33), hypertension in 14.87% (n = 11), and angina pectoris in 14.87% (n = 11) of patients. Patients under the age of 65 had higher Dutch Lipid Score compared to the patients above the age of 65, regardless of male or female. Correlational analysis indicated a significant positive relationship between Dutch Lipid Score and level of cholesterol (r =0.385; P < 0.01) and LDL (r = 0.401; P < 0.001). Statistically significant predictors in the explanation of FH were age (β = −0.45; P < 0.001) and LDL (β = 0.52; P < 0.001). Conclusion: LDL values and age are the main determinants of the FH existence, and the effect on LDL values should be imperative in clinical practice.

Background: Hypertension is the most important risk factor for cardiovascular morbidity and mortality. Blood pressure control rates are as low as 17% to 31% in patients diagnosed with hypertension in high-income countries; control rates are likely poorer in low- to middle- and low-income countries. Blood pressure control rates are as low as 17% to 31% in patients diagnosed with hypertension in high-income countries; control rates are likely poorer in low- to middle- and low- income countries. Overall, 43% to 66% of patients fail to adhere to their prescribed antihypertensive medications, and after 1 year, ≈40% of patients with hypertension may stop their initial drug treatment. Objective: The aim of the study was to evaluate the effects of single pill combination antihypertensive drugs on the adherence to treatment, blood pressure control and cardiovascular events vs. free-combination therapy. Methods: We enrolled 192 adult hypertensive patients not older than 79 years, with untreated or uncontrolled hypertension despite previously receiving free combination antihypertensive therapy, between November 2020 and March 2022. Patients treated with single pill combination (SPC) were compared with an arm of the same size (n = 96) and matched by age and gender who received a standard free combination (FC) antihypertensive therapy. Results: There were significant reductions from baseline to month 6 of follow-up in office SBP in the SPC group vs. reduction in FC group (21.9 vs. 13.1 mmHg; p < 0.0001). There were significant reductions from baseline to month 6 of follow-up in office DBP in the SPC group vs. group with free-combination therapy (13.7 vs. 8.0 mmHg; p < 0.0001). At 6 months, 94 participants (98%) were still prescribed the SPC therapy. At the final 6-month study visit, 84.2% of patients in the SPC therapy group were adherent to the prescribed antihypertensive therapy vs. 52% of patients in the FC group. Target BP values (mean 24h ambulatory systolic/diastolic BP < 130/80 mmHg) were reached by more recipients of SPC than free-combination therapy (78.2% vs. 46.3%, p < 0.05) at month 6 of follow-up. Conclusion: Treatment with single pill combinations (SPC), is the emerging best practice for safe, effective, rapid, and convenient hypertension control. It improves the affordability, adherence and control of arterial hypertension.

Background: The prevalence of chronic heart failure (CHF) is up to 1-2% of the adult population in developed countries, rising to >10% after the age of 70. Heart failure with reduced ejection fraction (HFrEF) remains a prevalent clinical syndrome associated with significant morbidity and mortality. Objective: The aim of this study was to evaluate the clinical efficacy of sacubitril/valsartan in a group of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) and its effect on the hemodynamic, metabolic, renal, and cardiac remodeling parameters. Methods: From January 2018 to May 2021, 106 patients with chronic heart failure with reduced ejection fraction (HFrEF) were prospectively enrolled. Patients treated with sacubitril/valsartan (ARNI) were compared with an arm of the same size (n = 53) and matched by age and gender who were taking a standard optimal medical therapy for HFrEF. Results: The 106 patients completing the study were characterized by age: 69.5 ± 8.0, 64% are male gender. The mean duration of follow-up in the 2 treatment arms was 12 months. In the ARNI arm, we evaluate the hemodynamic, metabolic, renal, and cardiac remodeling parameters upon the initial evaluation and at the end of the follow-up after 12 months treatment with sacubitril/valsartan. The LVEF values increased significantly (p < 0.001) in the ARNI arm compared to the OMT arm, 42.1 % vs. 30.1%. The LVMI decreased from a baseline value of 153.1 g/m2 to 147.8 g/m2 with significant improvement only in the arm treated with ARNI. The eGFR values increased significantly (p < 0.001) in the ARNI arm compared to the OMT arm 70.1 vs. 64.9 mL/min/1.73 m2. Initiation and titration of sacubitril-valsartan was associated with a reduction in NT-pro-BNP concentration, the values of NT-pro-BNP improved significantly only in the arm treated with ARNI 3107.1 vs. 5678.2. Mortality and re-hospitalization due to HF were lower in the arm treated with ARNI compared to the control (20.3 vs. 32.4 % and 25.3 vs. 46.6 %, respectively; p < 0.05). Conclusion: Sacubitril/valsartan is an important advancement in the treatment of HFrEF. Sacubitril/valsartan induce “hemodynamic recovery”. This study provides real-world data demonstrating incremental improvements in functional and echocardiographic outcomes in optimally treated patients with HFrEF switched to sacubitril/valsartan in ambulatory setting.

Background: We could say that traditional healing is a way of healing that has been common since ancient times. It has been passed down from generation to generation for many centuries. Magic medicine, although not approved by any of the monotheistic religions present in Bosnia and Herzegovina, and strictly prohibited by Islam, in the form of various magical acts and spells, exists among the people. Some of these magical practices have their roots in the pre-Christian Slavic period and earlier. Objective: The aim of this article was to provide the review of the traditional medicine during the history and today in Bosnia and Herzegovina. Methods: Review of the available literature, personal contacts and personal experience in contact with the traditional medcine. Discussion: Some of these magical practices have their roots in the pre-Christian Slavic period and earlier. Since the cause of the disease was usually associated with evil beings of supernatural powers, a deity or God’s will or punishment, it is understandable that priests have long been engaged in healing. Especially in the mentally ill, there seemed to be a certain divine or demonic origin of the disease. Muslim folk medicine divides diseases into two groups; in fevers and obsessions with unclean spirits. Folk medicine knows the healing properties of herbs and other substances of animal or mineral origin. The medicinal properties of simple foods that can be found in every home are also widely used, such as: milk, honey, vinegar, oil, onion, and garlic. Prescription books, known as “ljekaruše”, were created by collecting and writing down folk remedies. They were written mostly by Catholic priests. “Witch doctors” or “healers” have been preserved in Orthodox monasteries. Conclusion: Traditional medicine is important for history of medicine, ethnology, anthropology, and abounds in folklore elements. It is an area that leads to knowing, understanding or feeling the very nucleus of a nation.

Background: Arrhythmias are common problems in hypertensive patients. The presence and complexity of both supraventricular and ventricular arrhythmias may influence morbidity, mortality, as well as the quality of life of patients. Objective: The aim of this study was to assess the diagnostic value of combined 24h BP and ECG Holter monitoring in detection of cardiac arrhythmias in patients with arterial hypertension. Methods: We analyzed the simultaneous records of combined 24h BP and ECG Holter monitoring for 356 adult patients with diagnosed arterial hypertension in the period from January 2017 until January 2021 year. The cardiac arrhythmias were classified in three main groups as following: a) Supraventricular arrhythmias; b) Ventricular arrhythmias; c) Bradyarrhythmia’s. Standard transthoracic echocardiograms were performed in order to evaluate signs of hypertensive or structural heart disease with focus on left ventricle hypertrophy and LV function. Results: Patients had a mean age of 64 ± 11years, 62% male. Average clinic BP was 153.4+18/87.5+14 mmHg. More than 46% of patients displayed a very high-risk profile. In all enrolled patients, cardiac arrhythmia was detected in 302 (84%) patients. The total number of patients with supraventricular arrhythmias was 153 (50,7%). Ventricular arrhythmias were detected in 98 (32,5%) patients. Bradyarrhythmia’s were detected in 51 (16,9%) patients. Elevated resting heart rate in sinus rhythm was detected in 87 (31,6%) of 275 patients with sinus rhythm. Conclusion: Most arrhythmias are related to longstanding arterial hypertension. Effective treatment of arterial hypertension plays important role in preventing structural and functional cardiac abnormalities which will contribute to the reduction of cardiac arrhythmias in hypertensive patients.

Background: An estimated 64.3 million people are living with heart failure worldwide. Functional MR in chronic HFrEF reflects primarily the severity of LV dysfunction and is not related to structural alterations of the mitral valvular apparatus. FMR in patients with HFrEF independently of the etiology of HFrEF and its underlying mechanisms, contributes to progression of the symptoms of HF and is independent predictor of worse clinical outcomes. Objective: The purpose of this study was to assess the severity of functional mitral regurgitation (FMR) and its clinical implications in patients with chronic heart failure with reduced ejection fraction (HFrEF). Methods: We enrolled 146 consecutive adult patients with CHF with reduced ejection fraction (HFrEF) who presented to outpatient clinics. All patients underwent clinical and physical examination. Baseline examination included medical history, detailed assessment of current medication, electrocardiogram recording, transthoracic echocardiogram and comorbidities. Heart failure with reduced ejection fraction was defined in line with the new guidelines as history of HF signs and symptoms as well as a LV ejection fraction (LVEF) below 40%. Cardiovascular risk factors were recorded according to the respective guidelines. FMR was defined and graded according to the ESC/EACTS Guidelines for the management of valvular heart disease. The extent of FMR was assessed at baseline and after a median follow-up period of 4 years in 146 consecutive HFrEF patients (left ventricular ejection fraction <40%). All of the patients received the heart failure (HF) medications in agreement with 2016 and 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Major adverse cardiac events were defined as a composite of all-cause death and the need for admission for HF. Results: A total of 146 chronic HFrEF patients (mean age of 63±11 years, 62% male, mean LVEF of 25±11%) of which 19% patients had severe FMR at baseline, with a mean EROA of 31.4±2.7 mm2 and a mean Reg Vol of 45.9±5.3 ml. There was a significant interaction between FMR and NYHA functional class in predicting death or need for hospitalization, (P < 0.0001 for the interaction term FMR NYHA III-IV). During a median follow-up period of 4.2 (IQR) 3.1-5.8) years, the primary endpoint occurred in 52 (36%) patients (21 HF admissions, and 31 deaths). There was a strong graded association between the presence and degree of FMR and risk of death or admission (P <0.0001) at 4 years follow-up period. Regarding HF therapy, 129 patients (88%) received RAAS antagonists, 17 patients (12%) received ARNI, 86 patients (59%) received beta-blockers, 75 patients (51%) were treated with MRA. 31 patients (21%) underwent cardiac resynchronization therapy (CRT) with a response rate of 64%. 24 patients (16%) underwent ICD implantation. Conclusion: Guideline-directed medical therapy is the first-line treatment for chronic HF patients who also have FMR. After this first-line approach, surgical or MitraClip transcatheter therapy can be considered in patients with persistent severe and symptomatic FMR in order to improve symptoms, quality of life and functional status.

Background: A significant number of patients who underwent surgical myocardial revascularization (CABG) have various comorbidities, including left ventricular diastolic dysfunction (LVDD). Objective: The aim of this paper is to show that patients with preoperative LVDD are at an increased risk of postoperative adverse events and have a worse prognosis compared to patients without LVDD. Methods: The study included 116 patients who underwent myocardial revascularization (CABG) performed at Medical Institute Bayer in Tuzla over a period of 1 year. None of the patients had previously undergone CABG or valvular surgery, or undergone stent implantation (PCI). The presence of LV diastolic dysfunction was detected by echocardiography, and the patients were divided into two groups: with and without LVDD, and further classified into three degrees of LVDD. Results: Of the total number of subjects who underwent surgical revascularization of the myocardium without echocardiographically detected LVDD, 24.1% were patients, and 75.9% were patients with LVDD. In the group with LVDD, the range of days spent in the intensive care unit (ICU) is significantly higher compared to patients without LVDD. Also, patients with LVDD had a significantly higher number of hours of inotropic support, a significantly higher number of cases of tachycardia, predominantly atrial fibrillation (POAF). In this group of patients, a greater number of other adverse events were observed, such as myocardial infarction, cardiac or renal failure, TIA or CVI. Of the total number of patients in the study, 107 patients survived surgical myocardial revascularization and had a satisfactory recovery while 9 (7.8%) survived, all from the group with LVDD. Conclusion: Patients with preoperative diastolic dysfunction of the left ventricle, especially with III degree of dysfunction, are exposed to a higher postoperative risk of adverse events such as: atrial fibrillation, prolonged stay in the intensive care unit, the need for longer-term support with inotropes, and the fatal outcome was recorded exclusively in patients with LV diastolic dysfunction.

Background: Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure. Objective: We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder. Methods and Results: The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure. Conclusion: Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.

Background: Cardiac myxoma is the most common benign tumor of the heart. It presents with a variety of clinical signs and symptomatology making diagnosis frequently quite a challenge. Objective: The aim of this article is to present a case report of giant right atrial myxoma with symptoms of right heart failure in adult patient. Case report: We present a case of large right atrial myxoma which is an uncommon location for this type of heart neoplasms, discovered incidentally in a female patient 77-year-old who came to our polyclinic for cardiological exam with hypertension last 11 years and obesity. Results and Discussion: Various clinical signs and symptoms produced by cardiac myxomas have been reported in the literature. Depending on location and morphology, cardiac tumors can produce four types of clinical manifestations: systemic-constitutional, embolic, cardiac, and secondary metastatic manifestation. Echocardiography as non-invasive imaging method and Transesophageal echocardiography has superior role for precise evaluation of cardiac tumors. Transesophageal echocardiography has superior role for accurate diagnostic evaluation of cardiac mass. Surgical excision of cardiac myxoma carries a low-operative risk and gives excellent short- and long-term results. Conclusion: Myxoma is the most prevalent primary heart tumor. It is rare to find a myxoma in the right atrium, occurring only in 15-20% of myxoma cases. Clinical manifestations of myxomas consist in a triad: constitutional symptoms, embolization and intracardiac obstruction. Transesophageal echocardiography has superior role for precise evaluation of cardiac tumors. Currently, there is no effective medical treatment, and surgical excision of the tumor is necessary.

To date, the prevalence of CHD worldwide is ∼9 per 1000 newborns, with substantial geographic variation. The latest knowledge in the world for the last 50 years about their origin, diagnosis and therapy has contributed to their care. Since adult patients with CHD now present increasing numbers at advanced ages, including the elderly, the term grown-up CHD no longer appears appropriate and was therefore replaced with adult CHD (ACHD) according to the ESC guidelines published in 2020 year. Due to medical, surgical, and technological evolutions over the past decades, >90% of individuals who are born with CHD now survive into adulthood. ACHD represent a challenge for clinicians. Despite optimal medical and surgical treatment, many will experience a progressive decline in cardiopulmonary function leading to advanced heart failure. Severe ventricular dysfunction and/or pulmonary hypertension may not be amenable to corrective repair. Their early recognition and follow-up in adolescence will contribute to better care for these patients. Importantly, the care for ACHD patients is a lifelong process and requires advance care planning strategies.

Introduction: COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China’s Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020. Aim: The aim of this study is to search scientific literature in the biomedicine and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection of Cardiovascular diseases (CVD), and other most common chronic diseases which are on the top mortality and morbidity rates in almost all countries in the world. Also, to propose most useful measures how to prevent patients to keep themselves against COVID-19 infection. Methods: We used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVD, and, also, Guidelines proposed by World Health Organization (WHO) and European Society of Cardiology (ESC), and some other international associations which are included in global fighting against COVID-19 infection. Results: After searching current scientific literature we have acknowledged that not any Evidence Based Medicine (EBM) study in the world during last 5 months from the time when first cases of COVID-10 infection was detected. Also, there is no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19. Expectations that vaccine against COVID-19 will be produced optimal during at least 10 months to 2 years, and in all current Guidelines most important proposed preventive measures are the same like which one described in Strategic documents of WHO, in statements of Declaration of Primary Health Care in Alma Ata in 1978. Conclusion: WHO proposed preventive measures can be helpful to everybody. Physicians who work at every level of Health Care Systems, but especially at primary health care level, must follow those recommendations and teach their patients about it. But, the fact is that current focus of COVID-19 epidemic has targeted on protection of physical health of population in global, however, the influence on mental health which will be one of the important consequences of COVID-19 pandemic in the future, and which could be declared as «Post-coronavirus Stress Syndrome„ (PCSS) could be bigger challenge for Global Public Health.

Objective: The aim of this study was to evaluate corelation of serum level of NGAL to severity of hypertension and diastolic disfunction in patients with ST- segment elevation myocardial infarction treated with fibrinolytic therapy. Design and method: We included 54 consecutive ST-segment elevation myocardial infarction patients treated with fibrinolytic therapy (alteplase). The median follow-up time was 6 days (interquartile range, 5 to 7 days). Blood samples were drawn immediately after admission prior to fibrinolytic administration. The endpoints were mean systolic and diastolic pressure (continuously monitored) and mean E/A ratio as a measure of diastolic function. Results: Patients with high NGAL (above 134,05 &mgr;g/l; 75th percentile) had significantly higher mean systolic and mean diastolic blood pressure compared to patients with low NGAL (under 134,05 &mgr;g/l; 75th percentile), p = 0,001 and p = 0,003; respectively. Patients with high NGAL (above 134,05 &mgr;g/l; 75th percentile) had significantly lower E/A ratio compared to patients with low NGAL (under 134,05 &mgr;g/l; 75th percentile), p = 0,004. Conclusions: High NGAL significantly corelates with severity of hypertension and diastolic dysfunction in patients with acute STEMI.