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Gender Related Differences in the Risk Profile, Comorbidities and Prognostic Indicators of Patients with Acute Coronary Syndrome


Nia Emilova1, S. Denchev2, M. Gospodinova2, S. Dimitrov3, Т. Kundurdjiev4

1 Clinic of Cardiology, University Hospital „Аlexandrovska”, Sofia

2 Clinic of Cardiology, Medical Institute of the Ministry of Internal Affairs, Sofia

3 Department of Invasive Cardiology, MHAT Hristo Botev”, Vratza

4 Faculty of Public Health, Medical University, Sofia



Purpose: We aimed to investigate the significance of gender-related contrasts concerning the risk profile, comorbidities and prognostic indicators of patients with acute coronary syndrome.

Material and methods: The study group included 259 patients (144 men, 55,6% and 115 women, 44,4%) with diаgnosed acute coronary syndrome (ACS), admitted to University Hospital Alexandrovska”, Sofia. Data about risk factors for atherosclerosis, noncardiac chronic disease, type of presenting symptoms were collected through clinical exam. The echocardiographic indices of left ventricular systolic function (ejection fraction and end-systolic volume) were obtained with 2D - mode echocardiography. The coronary disease severity was assessed by calculating SYNTAX scores in those patients with performed selective coronary angiography. The frequency of adverse events for a period of one year was registered.

Results: Women were significantly older (69,5±10,9 vs 62±13,2 years, p<0,0001), had more frequently аrterial hypertension (96,5% vs 84%, p=0,001) and comorbidities (55% vs 33,3%, p=0,001). Smoking was more prevalent among male patients (66,2% vs 20,9%, p<0,0001). Atypical angina was encountered with similar frequency among female and male patients (22,2% vs 32,2%, p=0,089). The incidence of obstructive coronary disease (90,1% vs 76,6%, p=0,005) and acute myocardial infarction with persistent ST elevation were higher in the examined male group (65% vs 35%, p=0,008). In contrast to women, more subsequent percutaneous interventions (32,4% (n=35) vs 19,1% (n=17), p=0,037) and rehospitalisations (57% (n=61) vs 40% (n=36), p=0,022) were observed in the male group during follow-up.

Conclusion: Specific for male gender association with more extensive obstructive coronary atherosclerosis is observed in our study despite the lower coronary risk factor burden and fewer baseline comorbidities. The sex-based difference regarding risk for adverse cardiovascular outcome is dependent on the higher frequency of obstructive coronary atherosclerosis and left ventricular systolic dysfunction among male patients.

Кеy words: аcute coronary syndromes, prognostic indicators, sex

Address for correspondence: Nia Emilova, University Hospital „Аlexandrovska”, 1 Georgi Sofiiski” Str, 1421, Sofia; e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it


Narrow QRS-complex extrasystoles inducing a varying degree of AV block – what is the mechanism?


Iskra Bayraktarova, Milko Stoyanov, Tchavdar Shalganov

Cardiology Department

National Heart Hospital – Sofia


Address for correspondence:

Assoc. prof. Tchavdar Shalganov, MD, PhD

Cardiology Department

National Heart Hospital

65, Koniovitsa Str

1309 Sofia

Tel: +359-2-9211-411

Fax: +359-2-9211-402

This e-mail address is being protected from spambots. You need JavaScript enabled to view it


Extrasystolic arrhythmia is a common clinical finding. Treatment is indicated in case of limiting symptoms and/or large proportion of the ectopy. The possible treatment options as well as the long-term prognosis depend on the precise type of the extrasystoles. Standard surface electrocardiogram does not always provide sufficient information for a differential diagnosis. We present a case of rare extrasystolic arrhythmia with ECG features typical of both supraventricular and ventricular ectopy. The precise diagnosis was established through an electrophysiological study.

Key words: extrasystoles; atrioventricular block; electrocardiogram; electrophysiological study; radiofrequency ablation.


Supraventricular premature beats are commonly identified in clinical practice. Despite the possibility of sometimes identifying a precipitating factor for their occurrence (inflammation, ischaemia, hormonal imbalance, emotional or physical stress, alcohol usage, caffeine and nicotine-product consumption or other types of stimulants), it is not uncommon for extrasystoles to appear completely unprovoked. Their incidence rises with age, and the prognosis is in general favourable, except in cases where they trigger another type of supraventricular arrhythmia, for instance atrial flutter or atrial fibrillation. [3, 5] Therapy is indicated in cases of arrhythmia of a different type induced by the ectopic beats, or in the presence of disabling symptoms.


Acute double vessel myocardial infarction from the territory of te Left Anterior Descending artery (LAD) and the Right Coronary Artery (RCA), complicated by dissection of Left Main Coronary Artery (LMCA). A Case report.


Borislav Atzev, Yordan Dzhumean, Georgi Lyutov, Dima Vasenska
Clinic of Cardiology, MHAT “Puls”, 62 Slavyanska Str., Blagoevgrad 2700, Bulgaria
Tel. +359-88-8755-370
e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Summary: Acute myocardial infarction of two vascular territories is known as double or combined myocardial infarction. In this case report we have represented a fourty year old man with anterior and inferior myocardial infarction. Emergency coronary angiography showed thrombotic occlusion in the Left Anterior Descending artery (LAD) mid segment as well as subtotal thrombotic occlusion in the Right Coronary Artery (RCA) mid segment. Emergency coronary angiography was performed to the infarct related arteries. Due to iatrogenic dissection of the Left Main Coronary Artery (LMCA) we undertook percutaneous coronary intervention (PCI) of LMCA with good angiographic result. After one month, control coronary angiography showed no significant stenosis of the LAD, RCA and LM.

Key words: double vessel myocardial infarction, coronary artery disease, PCI.

Acute myocardial infarction (AMI) involving acute transmural ischemia of two vascular territories at the same time, is known as double or combined infarction [1]. It has been reported rarely in most series of patients admitted for AMI due to its poor clinical outcomes. The iatrogenic dissection of LMCA is uncommon, but potentially serious complication that requires prompt management using angioplasty.

We report a case of a 40-year old man who presented in the emergency department with constricting chest pain with onset at rest and of around two hours.


Treatment Strategies Of Atrial Fibrillation In Patients With Heart Failure

R.Pancheva, D.Vassilev

Cardiology Clinic, “Alexandrovska” University Hospital, Sofia Bulgaria



Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Its prevalence is estimated to at least double in the next 50 years as the population ages. Approximately the same is frequency of heart failure. Typical of these is the presence of common risk factors and mutual potentiation. Rhythm control in patients with heart failure and atrial fibrillation leads to improved left ventricular ejection fraction, quality of life and its longevity. Because many antiarrhythmic drugs are contraindicated in patients with structural heart disease, their suboptimal efficacy and significant adverse effects, we focus on non-pharmaceutical interventions as an opportunity to change the risks and benefits associated with the maintenance of sinus rhythm.

Keywords: atrial fibrillation, heart failure, rhythm control, rate control, catheter ablation



Tchavdar Shalganov, Milko Stoyanov, Nikolai Bonev, Joro Nichev
Cardiology Department
National Heart Hospital – Sofia

Address for correspondence:
Assoc. prof. T. Shalganov, MD, PhD
Cardiology Department, National Heart Hospital
65 Koniovitsa Street, 1309 Sofia, Bulgaria
Tel: +359-2-9211-411
Fax: +359-2-9211-402

Summary: We present a patient with congenital long QT syndrome and normal baseline left ventricular function in which several years after the implantation of an automatic cardioverter-defibrillator severe left ventricular dysfunction was found together with a peculiar ECG during antibradycardia pacing. The mechanism for the appearance of the unusual ECG and of the left ventricular dysfunction is discussed.

Key words: antibradycardia pacing; left ventricular dysfunction; LQTS; implantable cardioverter-defibrillator.


The implantation of a cardioverter-defibrillator (ICD) is a method of choice for preventing sudden cardiac death in patients with long QT syndrome (LQTS) which have syncope, cardiac arrest and/or documented polymorphic ventricular tachycardia (VT) or ventricular fibrillation (VF) while treated with beta-blockers. [9, 11] It is presumed that in primary electric cardiac disorders such as LQTS the effective termination of sustained life-threatening ventricular arrhythmias in the absence of structural heart disease or left ventricular (LV) dysfunction may result in normal or near-normal lifespan provided there are not device-related complications.


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