Andrej Dukat, Professor of Internal medicine at the Comenius University has his expertise in epidemiology, prevention and treatment of cardiovascular diseases in Slovakia. His clinical practice included noninvasive cardiac diagnosis, research in the field of hypertension, lipids and diabetes. After years of his experiences in preventive cardiology, he wrote articles in the peer-reviewed papers and in the textbooks. He is teaching internal medicine at the university both for pregradual, postgradual, and also for foreign medical students. He is the past-president of the Slovak Society of Internal Medicine, was member of the boards, and is the fellow and honorary fellow of several scientific societies. Conducted and is still conducting several clinical trials as the national coordinator. He is responsible for the accreditation of the Universities and teaching schools in the field of medicine and pharmacy in Slovakia.

Statement of the Problem: N-terminal pro brain natriuretic peptide (NT-proBNP) levels are useful biomarkers for the diagnosis and prognosis of heart failure (HF) patients. However, the data on association of uric acid (UA) concentrations and NT-pro BNP are still lacking. Methodology & Theoretical Orientation: The relationships of UA, NT-proBNP, clearance of creatinine and NYHA function class and echocardiographic variables in primary care patients with HF were investigated. Results: 848 patients (402 men, 446 women) with the mean age of 70.1 ± 7.5 SD were included in the study. NT-proBNP concentrations correlated with UA levels in both men and women after adjusting for age, body mass index (BMI) and glomerular filtration rate (r=0.096, p<0.0001; r=0.123 p<0.0001). UA concentrations rose with the severity of NYHA class and was significantly higher in patients with moderate and severe both systolic and diastolic dysfunction in a multivariate analysis. Conclusion & Significance: A positive correlation between the concentrations of UA and NT-pro BNP in patients with HF has been observed. UA levels were associated with the severity of the disease. It is suggested that the level of UA, analogically to NT-proBN may be another important biochemical biomarker of severity and prognosis among patients with HF.

Background: Vascular calcification is common in chronic kidney disease (CKD), and recognized as surrogate marker for cardiovascular disease (CVD). Indoxyl sulfate (IS) is a protein bound uremic toxin to exacerbate vascular calcification in CKD patients, and its therapeutic target has been searched for. We hypothesized that Notch signal pathway alterations caused by IS is involved in vascular calcification because Notch signal activation increase cell survival of vascular cells in developmental and pathological status. Methods: IS (200 mg/kg/day in drinking water) or vehicle was administered to Dahl salt-resistant normotensive rats (DN) and Dahl salt-sensitive hypertensive rats (DS) to evaluate vascular calcification and the expression of Notch-1 and 3 with immunohistochemistry. Human arterial smooth muscle cells (HASMCs) was culture under various concentration of IS, and the expression of Notch 1 and 3, and apoptosis were assessed with RT-PCR, caspase activity assay, and TUNEL staining. Inorganic phosphate-induced calcification in HASMCs was also evaluated with or without IS and pharmacological inhibition of Notch and apoptosis signaling (gamma-secretase inhibitor, DAPT; 20 μM; caspase inhibitor, ZVAD 100 μM). Results: Aortic calcification was observed solely in IS-administered DS rats. The expression of Notch-1 and 3 was slightly increased in aortic SMCs from vehicle-treated DS rats compared to vehicle treated DN mice. IS induced the expression of Notch-1 and 3 in aorta from both DN and DS rats, and strong signal was especially observed in IS-administered DS rats. Notably the expression of Notch-1 and 3 was fainted in vascular calcification in IS-treated DS rats. In cultured HASMCs, the expression of Notch1 and 3 was peaked at 24 h after administration of IS (1000 μM), and fainted within 72 h. The expression of Notch-1 and 3 was also peaked at the concentration of 500 μM of IS and fainted less than 1000 μM. Exposure to IS increased TUNEL -positive cells and caspase 3/7 activity in a dose- and time- dependent manner. IS accelerated inorganic phosphate-induced calcification in HASMCs, and the effect was canceled by pharmacological inhibition of Notch and apoptotic signal. Conclusion: IS transiently activates Notch signal in vascular smooth muscle cells, but the effect was fainted in accordance to higher concentration and longer duration of exposure to IS. The decreased Notch activity induced formation of apoptotic body and calcified lesions. Thus, Notch signal would be a novel therapeutic target for vascular calcification in CKD patients.

Andrey V Kuznetsov has worked on the problems of delicate mechanisms of energy metabolism in the heart and their changes under pathophysiological conditions. He has studied mitochondrial function and regulation in normal cells and in various pathological states, in particular in the field of mitochondrial cardiac system, mitochondrial interactions with other intracellular structures and systems, performing analysis of mitochondria in situ and in vivo. Also, he studied the roles of mitochondrial damage in ischemia reperfusion injury, apoptosis, calcium homeostasis, oxidative stress, mitochondrial ROS production, cardiac and muscle diseases with imaging of mitochondria and mitochondrial function, mitochondrial dynamics (fission, fusion, motility) in various living cells. He has extensive knowledge in cardiac bioenergetics and mitochondrial physiology and experience in optical imaging (fluorescent, two-photon) of single cell and single mitochondria, imaging of mitochondrial Ca2+, ROS, membrane potential, mitochondrial dynamics for basic science and in clinically oriented studies.

In the heart, mitochondrial alterations play a major role in cell injury, including ischemia-reperfusion (IR), heart failure, oxidative stress, etc. Severe impairment of mitochondrial oxidative phosphorylation during IR dramatically decreases cardiac energy status (ATP and phosphocreatine) leading to cellular energy stress. Cardiac IR is associated with specific damage to mitochondria. This was confirmed also in in vitro studies in cultured cardiac cells showing severe changes in energy metabolism and mitochondria under conditions of hypoxia or simulated ischemia. Also, function of mitochondrial creatine kinase (CKmit) in the heart can be used as sensitive biomarker for evaluation of the efficiency of cardiac repair, regeneration, remodeling. In various pathologies like cardiomyopathy, heart failure, ischemia-reperfusion injury, CKmit functional coupling correlates well with the parameters of cardiac function, such as left ventricular ejection fraction and end-diastolic pressure. Thus, multiple mitochondrial damages are considered for determining factor causing loss of cardiomyocytes function and viability through apoptosis and necrosis. Based on these findings, an assessment of mitochondrial properties and function can be suggested for the evaluation of organ recovery and efficiency of various therapies of the heart, including post-ischemic shock wave therapy (SWT). Models and methods used were: Cardiac tissue; Permeabilized myocardial fibers (from left ventricle); Cell cultures; simulated ischemia-reperfusion; HL-1 and H9c2 cardiomyocytes. In vitro and in situ methods are: Fluorescent confocal in vivo imaging; High-resolution respirometry of myocardial fibers and cardiac cells; FACS analysis; and luminescent determination of cellular ATP levels. To better understand the mechanisms of SWT, various IR models are frequently used. In our studies, the correlation of cardiac performance and mitochondrial function in animal IR models indicates the potential of mitochondrial analysis for quantitative assessment of the recovery of myocardial energy metabolism and organ function upon SWT. Also, in vitro models using cardiomyocytes we show that after IR cell viability correlates with the loss of mitochondrial respiratory capacity, membrane potential and cellular ATP. SWT significantly improves mitochondrial function in H9c2 cardiomyocytes upon IR. Therefore, detailed mitochondrial analysis can offer a sensitive tool to evaluate efficiency of SWT and tissue regeneration. Furthermore, mitochondria are major source for ROS, which in turn may directly or indirectly stimulate angiogenesis. Mitochondrially generated ROS thus can be considered as potential targets for promoting myocardial angiogenesis in cardiac SWT. Summarizing, the advances of modern approaches in mitochondrial research and applications of these methods to recently established experimental in vivo and in vitro models can provide sensitive estimation of SWT efficiency, as well as new insights into shock wave associated mechanisms.

Sherif A S A Mansour is a Consultant of Cardiothoracic Surgery in Ministry of Health Hospitals, in addition to working as a Surgeon in Royal Stoke Hospital, Stoke-on-Trent, UK. He works at the Ain Shams University in Cairo, Egypt as a Senior Lecturer. He is subspecialized in Off Pump CABG, minimal invasive cardiac surgery with fantastic results and many contributions to various cardiac surgery centers in the Middle East, Asia and Africa. He has publications in the peer reviewed journals and contributions in some published cardiothoracic books with many contributions at international conferences across Europe and Asia. Recently, he started to explore the field of Robotic Heart Surgery with strong steps toward achieving his goal of mastering it.

Objective: Experimental evidence correlates oxidative stress with atrial electrical remodeling which turned to be one of the most important factors in developing postoperative atrial fibrillation (AF). Some evidences have shown the role of antioxidant vitamins in preventing postoperative AF. We designed this study to evaluate the effect of orally administered vitamin C on the incidence of postoperative AF in patients undergoing coronary artery bypass grafting (CABG) +/- valve surgery. Methods: 380 patients undergoing CABG +/- valve surgery were equally divided into group A in which patients received (1 gm/12 hours) of vitamin C orally one day preoperatively and all through their postoperative hospital stay and group B in which patients received a placebo as a control group. All patients were continuously monitored after surgery in the intensive therapy unit and afterwards with 12 lead ECG daily done until their discharge. Results: The mean age of patients was 57.16±8.84 years in Group (A) and 56.91±8.09 years in group B, (p>0.05). Postoperative AF developed in 7 (3.6%) and 42 (22.1%) patients in groups A and B, respectively (p<0.001). The intensive therapy unit stay was 1.81±0.41 and 2.12±0.52 days for groups A and B, respectively (p<0.001). The hospital stay was 5.67±0.62 versus 6.10±1.12 days for groups A and B, respectively (p<0.001). Conclusions: Oral vitamin C is a safe and cheap supplementation that can be used to decrease incidence of postoperative AF in patients undergoing CABG +/- valve surgery.

Elizabeth Thong is a medical student at Imperial College London with a keen interest in cardiology. She has published articles in journals on women’s heart health and quality of life after mitral valve replacement, and has worked on projects on diffuse large B-cell lymphoma, outpatient hysteroscopy services and improving patient consent procedures. She has written chapters in a book answering patient questions regarding surgical procedures, and has presented posters at multiple national conferences. She hopes to continue exploring her interests in medicine whilst familiarizing herself with different types of research, with a particular focus on cardiology.

Clopidogrel, ticagrelor and prasugrel, in combination with indefinite aspirin, are indicated as part of a dual anti-platelet therapy (DAPT) regimen for management of patients with acute coronary syndrome and/or undergoing percutaneous coronary intervention. Dual treatment with clopidogrel/prasugrel/ticagrelor is only recommended for up to 12 months: extended treatment beyond these risks has adverse effects without additional clinical benefit. The audit aims to ensure ticagrelor; prasugrel and clopidogrel are prescribed in line with local and NICE guidance. Results from 10 patients on ticagrelor and/or prasugrel and 15 patients on clopidogrel and low dose aspirin (75 mg) were used. We analyzed and discussed whether ticagrelor, prasugrel and clopidogrel were prescribed in line with guidance and investigated reasons behind the lack thereof. 100% of patients on ticagrelor or prasugrel were co-prescribed aspirin. 92% had their DAPT initiated by a hospital consultant, 100% had the indication for their DAPT documented, 100% had a review or stop date documented, and 93% prescribed DAPT for more than 12 months had the on-going need documented. Upon investigation, the reasons behind a GP initiated therapy was clearly documented and explained with the subsequent specialist consultation supporting this. For the patient who was continued on ticagrelor after 12 months, no reason was given and this should be addressed through medication reviews. The results of this audit suggest that the practice has good regulations regarding medication review and adherence to guidelines. However, though 100% of patients had recent medication reviews, there was often no specific review date for their DAPT and general medication reviews were conducted. While medication reviews can be specific to DAPT and include more details for DAPT, no patient has their medication unchecked for prolonged periods of time and hence, the practice closely follows local and NICE guidelines.

Abdalazeem Ibrahem, has completed his graduation from university of Kassala 2009, He is working as specialty cardiology registrar in United Kingdom, at BCHUB, Ysbyty Gwynedd Hospital. he has completed his core medical training in UK, full membership of MRCP UK. His academic interest, writing papers and literature review. He has participated in 16th world cardiology congress 2016, Dubai, Hertfordshire journal of medicine December 2016, Global Journal of Infectious Diseases and Clinical Research October 2016. Membership with British society of echocardiography (BSE) British cardiovascular interventional society (BCIS) UK. He attended several a cadmic meetings, regionally and nationally, He has participated in various national work-shops, congress.

Introduction: Takotsubo cardiomyopathy (TCM) is a rare form of acute cardiomyopathy characterized by left ventricular apical ballooning. It was first described in Japan in 1990 by Sato et al. Patients are often present with chest pain, ST-segment elevation on electrocardiography (ECG) with elevated cardiac enzyme levels in consistency with myocardial infarction (MI). We report here five cases of Takosubo cardiomyopathy presented to a general district hospital during the period of eight weeks. The epidemiological features of TCM have changed significantly, previously the main risk factor was physical and emotional distress however recently unknown precipitating factors have been reported, TCM were considered extremely rare until the past 20 years. It is esti-mated that patients with TCM accounted for approximately 2% of all the patients with sus-pected acute coronary syndrome1.According to a case report, the majority of the patients were women (93.5%). Asians were the largest group (57.2%) followed by Caucasians (40%). The presentations mimic an acute myocardial infarction. The most frequent presenting symptom was chest pain (65.9%) followed by dyspnoea (16.2%). ST elevation was the most common ECG abnormality (87.5%). Contrary to most reports, this is not a benign disease with compli-cations occurring in 18.9% and death in 3.2%. The most common complication was shock followed by left ventricular thrombus formation and congestive heart failure

Ewelina Janczewska completed his Bachelor’s Degree in Medical Emergency. After that, she obtained Master's Degree in Public Health. She is pursuing PhD in Department of Emergency Medicine - Medical University of Warsaw since 2013. She teaches students the directions of medical and health sciences. She teaches first aid and treatment in sudden cardiac arrest (BLS, ALS). She is the Author of scientific publications; and is actively involved in many international conferences and congresses.

A sense of security is an overarching and principal value that must be guaranteed so that people could develop themselves properly in every aspect of life. Safety in the field of health is very important, especially in situation when health or even human life suddenly deteriorates. Hospital Emergency Departments (which belong to the National Medical Rescue System) are ready 24 hours a day and seven days a week to provide healthcare in emergency states. They are the major link of the whole health care system in Poland. In the years 2010-2013 functioned from 208 to 222 Hospital Emergency Departments (EDs) in Poland. One of them was the ED in Infant Jesus Clinical Hospital, located in the center of the country's capital–Warsaw. For four years medical assistance in this ED obtained 85926 patients (in 2010-17899 patients, in 2011-19766, in 2012-23516 and in 2013-24745). Significant and serious reasons of admission were diseases and ailments from the circulatory system (cardiovascular diseases). In 2010, they amounted to 6.5% of all admissions to the ED, in 2011- 7.1%, in 2012-6.5%, in 2013-6.4%. More often admitted women (54.8%) than men. Most often people were registered to ED because of chest pain (27.0% of all patients with ailments and cardiovascular diseases - within four years). Another reason for the admission to the ED was hypertension (in 2010-278, in 2012 grew to 347), inflammation and thrombophlebitis (2010-147, in 2013-228), atrial fibrillation and atrial flutter (in 2010-103, in 2013-152). Hospital emergency departments are the destination for patients whose health suddenly deteriorated and require specialized/highly specialized health aid. Cardiovascular diseases always pose a major health problem in emergency departments but the phenomenon of the growing number of people with these symptoms indicates new challenges that await the health care system.