Department of Cardiology
The roots of the Department of Cardiology reach the year 1957, when the first hospital unit of cardiology in Lithuania, containing 40 beds, was opened in Kaunas Republican Clinical Hospital on the initiative of the late rector of Kaunas Medical Institute Professor Z.Januškevičius (the first chief of the cardiology unit was Professor A.Lukoševičiūtė). In 1977, the cardiac health care service was transferred to a new building, the project and construction of which were highly contributed by Professor J.Blužas. The Department of Cardiology at Kaunas Medical Academy was established after joining the First Department of Internal Medicine in 1989 (previous heads of the Department were Professors Z.Januškevičius and A.Baubinienė) with the Second Department of Internal Medicine (Head of the Department was Professor P.Šnipas). From 1991 to 2000, the Department of Cardiology was headed by Professor P.Zabiela. Since 2001, the Department has been headed by Professor R.Žaliūnas.
The Department of Cardiology mainly consists of an admission division, 2 inpatient cardiological divisions, including 6 subdivisions with 130 beds, a cardiac diagnostic division (with an echocardiographic subdivision), a cardiac intensive care unit (CICU), a cardiac intervention unit and an ischaemic heart disease prevention unit. Yearly, over 3,000 patients are hospitalized in the Cardiac Intensive Care Unit (with 18 inpatient beds). In this unit, critically ill patients with acute coronary syndromes and their complications, life threatening cardiac arrhythmias, acute heart failure, acute pulmonary embolism, aortic dissection, etc. are treated using up-to-date methods of management, combining the most modern interventions with appropriate pharmacological therapy. The unit is equipped with modern monitoring system including invasive haemodynamic monitoring using the most advanced techniques as well as the equipment for advanced haemodynamic support consisting of an intraaortic balloon counterpulsation, left ventricular percutaneous assist device and continuous veno-venous haemofiltration system.
The First Division of Cardiology. Over 3,000 patients with acute and chronic coronary syndromes are treated in the First Division of Cardiology every year. There they receive medical treatment, and different invasive procedures, such as coronary angiography, percutaneous transluminal coronary angioplasty and stenting, are performed. There is a multidisciplinary collaboration among the First Division of Cardiology, the Emergency Department and the Cardiac Intensive Care Unit. Patients with acute coronary syndromes without ST segment elevation are immediately admitted to the First Division and prepared for cardiac catheterisation within 24 hours. Patients with acute myocardial infarction with ST segment elevation after the treatment in the Cardiac Intensive Care Unit are taken to the First Division. Patients with acute coronary syndromes or high-risk stable angina undergo preoperative preparation for surgical treatment of ischaemic heart disease (coronary artery bypass grafting). The services provided include continuous cardiac telemetry monitoring, care of post-cardiac-catheterisation patients with intervention or care for the scheduled coronary artery bypass grafting patients. Different radiology and nuclear medicine methods are used to evaluate the patients’ condition: ultrasound imaging, CT, SPECT, MR. Multidisciplinary teams, including attending cardiologists, interventional cardiologists, vascular and cardiac surgeons, work together to ensure the best possible treatment options.
In the Second Division of Cardiology, every year around 3,300 patients undergo preoperative investigation and treatment prior to coronary bypass grafting and/or valve replacement surgery, or they are hospitalised for pacemaker implantation or radiofrequency ablation. Every year about 200 patients with acquired and congenital valve diseases are investigated and treated before surgical or interventional treatment according to the European guidelines on management of valvular heart disease. We have a 10-year “heart team” work experience in the management of valvular heart disease. TAVI procedures for severe aortic stenosis were started in 2011. More than 10 percutaneous atrial septal closure procedures are done per year. Modern diagnostic tools are used to verify valvular heart and aortic diseases by TEE and 3D echocardiography, magnetic resonance, 320-slide multiplanecomputer tomography. We have a 12-year experience of treating more than 300 patients with infective endocarditis. Also, patients with inflammatory heart disorders, cardiomyopathies, severe heart failure, resistant arterial hypertension and different cardiac arrhythmias are managed there. A heart transplantation programme has been introduced since year 2001, and each year several patients are selected for heart, heart & lung transplantation or implantation of the mechanical circulatory support devices. The Division of Cardiac Arrhythmias provides specialist medical care for patients with most complicated cardiac rhythm disturbances. Together with the routine cardiological investigation, 24–72-hour ECG (Holter) monitoring, transoesophagealelectrophysiologic investigation and orthostatic tests can be performed. The team performing intracardiacelectrophysiologic procedures (EP Laboratory) is a part of the Division of Cardiac Arrhythmias. Every year, in the EP Laboratory of our hospital, 440–460 catheter ablation procedures for various cardiac arrhythmias are performed, including SVTs, ventricular arrhythmias, atrial flutter and cryoablation of atrial fibrillation. During the procedures, together with conventional mapping techniques, we use 3D mapping system (CARTO3), intracardiac echocardiography (ICE), etc. A wide spectrum of CRM (cardiac rhythm management) devices are implanted in our EP laboratory, including conventional pacemakers, ICDs, cardiac resynchronisation devices with and without defibrillator function (CRT-Ds and CRT-Ps), implantable loop recorders, etc. There are about 950 devices implanted every year. In this division, a round-the-clock on duty cardiologist is available, so that any consulting cardiac health caregiver in the city of Kaunas or Kaunas district may get prompt cardiac advice in emergency and urgent cases.
Diagnostic studies of the cardiovascular system are performed in the Cardiac Diagnostic Division not only for patients from the Department of Cardiology, but also for patients with cardiac disorders from other departments of the Hospital of the Lithuanian University of Health Sciences.The Subdivision of Echocardiography (headed by Professor R. Jurkevičius, PhD habil.) was established in 2003. In the Subdivision, echocardiographic studies are performed by 35 experienced echocardiography specialists such as Professor J. Vaškelytė PhD habil.; Professor E. Ereminienė, PhD; Associate Professor N. Stoškutė, PhD; J. Janėnaitė, MD; V. Mizarienė, MD; Associate Professor V. Medzevičienė, PhD et al. Besides clinical work, the Subdivision of Echocardiography is engaged in teaching and scientific research. The staff of the Subdivision perform about 23,000 diagnostic studies a year, including transthoracic transoesophageal, contrast, 3D and stress echocardiographies. The studies are also done by resident doctors under the supervision of experienced specialists. In the Subdivision, cardiology and internal medicine resident doctors are taught according to a specially prepared residentship programme as well as cardiologists, internists, cardiac surgeons, anaesthesiologists, paediatricians, family doctors, sports medicine physicians, et al. Six post-graduate instruction courses have been prepared and taught here: a 4-month “Introductory course to studying echocardiography”, two-week courses “For beginners in Echocardiography”, “Clinical echocardiography”, ”Echocardiographic diagnosis of ischaemic myocardium and atherosclerotic changes in the carotid arteries”, Echocardiographic diagnosis of valvular pathology” and a one-week course “Transoesophageal ultrasound diagnosis of heart disorders”.
The physicians working in the Subdivision are engaged in accomplishing scientific projects together with researchers of the LSMU, the Institute of Cardiology at the LSMU, and Kaunas Clinics (Hospital of the LSMU)
At present, seven doctoral students are preparing their dissertations in the field of echocardiography.
In the Division of Interventional Cardiology, cardiovascular angiographic and angioplasty procedures are performed. Their yearly amount exceeds 4,800 coronary angiographies and more than 2,000 percutaneous coronary interventions performed by experienced internists. Special attention is paid to acute coronary syndrome patients, and interventional cardiologists are available round the clock for emergent procedures. Angioplasty procedures are performed in more than 40 percent of all patients and stent penetration in more than 95 percent of them, with 1.7 stent being implanted per patient. Other modalities for evaluation of atherosclerosis like fractional flow reserve and intravascular ultrasound are also available for structural heart disease patients.
The Ischaemic Heart Disease Prevention Unit performs follow-up of high-risk patients with acute coronary syndromes treated in the Department of Cardiology, patients after myocardial revascularisation, etc. Correction of complex risk factors for coronary artery disease is implemented in the Cardiac Outpatient Division of the Hospital. A very important field in the activity of the Unit is counseling physicians in the city of Kaunas and Kaunas district on prevention of ischaemic heart disease.
Consulting patients from the city of Kaunas, Kaunas District and other places of Lithuania are advised and treated by the cardiologists of the Cardiac Outpatient Division.
Every year, the number of counsels and consulting visits increases (in 2012, there were more than 41,000 counsels given and 76,000 counseling visits made). In the Cardiac Outpatient Division, six professors and two assistant professors permanently perform counseling. In the Division, the performed up-to-date noninvasive echoscopic, electrophysiologic and radiologic studies by high-competence physicians, investigators and counseling specialists allow diagnosing and managing severe clinical cases. One of the most important tasks to be performed by the staff members is to select patients for the third-level interventional diagnostic and treatment procedures, i.e. cardiac coronary artery vascular angiographies, coronary artery angioplasties, aortaland coronary artery bypass surgeries, radiofrequency ablations, cryotherapy and implantation of electrocardiostimulators and cardioverters. At present, new high-resolving-capacity computed tomography, magnetic resonance and positron emission tomography equipment help to better assess the character and degree of cardiac valvular myocardial and coronary artery lesions and more accurately select patients for interventional diagnostic and treatment procedures. Patients with chronic noninfectious diseases (ischaemic heart disease, arterial hypertension, dyslipidaemia, diabetes mellitus) are purposefully investigated by utilising complex investigations of atrial structures and finding out biochemical markers aiding to assess the risk of developing cardiovascular diseases and to choose optimal correction of the risk factors. In the Division, new methods of body composition analysis and assessment of specific body metabolites are being introduced. Also, a programme of financing the selection of persons attributable to the high risk for the cardiovascular diseases group and the prevention measures are being realised in the Division. The Division contains specialised consulting rooms: an ischaemic disease prevention room, in which very high cardiovascular risk patients are observed, and cases of severe arterial hypertension and dyslipidaemia are treated, and a heart failure consulting room, in which physicians observe selectively chosen patients for heart transplantation and patients after this surgery. On the base of the Division, an arterial hypertension centre, nominated on the initiative of the European Hypertension Society, is functioning, at which extended studies of arterial hypertension patients are carried out, the causes of secondary hypertension are diagnosed, selection of arterial hypertension patients resistant to treatment for denervation of kidneys has commenced. In the Outpatient Cardiac Division, scheduled counsels are given for patients who are signed in for a cardiologist after arrival at the Division or by phone or over Internet. On arrival for counseling, patients have to present a referral from a 2nd-level cardiologist or family doctor valid for 30 days, in which already performed tests and studies as well as prescribed treatment are to be indicated, or an identity document; drug compensation passport is also advisable. In case of arrival without a referral, advising (counseling) is to be paid for. The office hours are from 7:30-19:00 on weekdays. In urgent need of medical attention, urgent cardiological aid is rendered in the Cardiac Patient Admission Subdivision, which is open round the clock.
In the Department of Cardiology, problem-based teaching has been started since 2010. A 400-hour module Cardiovascular Diseases and Adrenal Glandular Diseases lasts for 15 weeks. Fourth-year students gain knowledge of incidence, causes, pathogenesis, diagnosis, principles and methods of treatment, and prevention of commonly occurring heart disorders and adrenal glandular diseases, acquire practical skills in self-sufficient patient investigation; they can practice in the following fields: cardiology, cardiac surgery, clinical laboratory diagnostics, clinical biochemistry, radiology, rehabilitation and endocrinology. They have the possibility of extending their knowledge in Cardiology by choosing a 2-week elective course in the 4th and 6th academic years (2 credits). Students also obtain experience in research work by participating in the activities of the Section of Cardiology in the Student Scientific Association. Internal medicine residents have a 4-month training in the Department of Cardiology. Their theoretical knowledge is improved during 18 seminars. Their practical and academic skills are evaluated during a course credit test and later during a complex final examination in internal medicine. The training of residents in cardiology lasting 4 years has been provided in the Department since 1993. The cardiology fellowship programme is conducted according to U.E.M.S. and Core Curriculum in Cardiology, as it has been recommended by the European Society of Cardiology. Every year, 3-5 cardiologists accomplish the training and pursue further career at the University Hospital or tertiary health care centres in the Republic of Lithuania. The Department collaborates with the researchers from the Institute of Cardiology working in the Laboratories of Clinical Cardiology, Invasive Cardiology, Clinical Biochemistry and Automation of Cardiac Investigations, as well as with the professionals from the Department of Rehabilitation, and other departments at the Lithuanian University of Health Sciences. The Department of Cardiology takes part in all the stages of different clinical studies.
Internists have the possibility of continuing medical education in the Department of Cardiology since the autumn semester of 1993, whereas the cardiologists have obtained this possibility since the spring semester. Every year beginning from 1994, about 150 internists and cardiologists get certificates stating that they have completed a course of study in cardiology. Theoretical and practical aspects of cardiology are discussed at monthly conferences of the Kaunas Region Lithuanian Society of Cardiology and during the seminars organised 4 times a year by the Lithuanian Heart Association; professors and researchers of the Department take an active part in preparing educational programmes for these meetings.
Scientific activities of the Department of Cardiology are directed towards introducing new diagnostic methods, management problems of coronary artery disease, arrhythmias and infective endocardites. Much attention is paid to the evaluation of the efficacy of new antiarrhythmic, anti-ischaemic and thrombolytic drugs. The most significant oral presentations have been made at international symposia in Kaunas and Vilnius as well as abroad in Estonia, Italy, Sweden, France, Germany etc. Clinical trial studies of amlodipine, azimilide, dofetilide, d-sotalol, carvedilol, lanoteplase, peghirudin, losartan, lotrafiban, perindopril, simvastatine, tedisamile, telmisartan, etc. were performed according to the Good Clinical Practice Standards of the European Community.
The Department cooperates with the Department of Cardiology of Vilnius University Hospital. Joint articles are published in the issues of seminars organised by the Lithuanian Heart Association and in the Lithuanian medical journal Medicina. The specialists of the Department improve their knowledge and clinical skills in Austria, Switzerland, Sweden, Germany, France and the USA.
The main subject of the scientific research carried out in the Department of Cardiology is “Assessment of the clinical value of risk factors, clinical and biochemical markers, changes in functional parameter of the heart, morphological (molecular and cellular) alterations of the myocardium, and correction between variants of genes, in prognostication of the course and outcomes of ischaemic heart disease in patients with acute ischaemic syndrome". In the Department of Cardiology, teachers and scientific researchers take an active part in the realisation of the following joint scientific research projects together with researchers working in the Institute of Cardiology at the Lithuanian University of Health Sciences, the Department of Thoracic, Cardiac and Vascular Surgery, and researchers in the other departments.
A three-year (2004–2006) project “Development and implementation of the up-to-date teaching aids for cardiac ultrasound research studies” realised in accordance with a 2.5 measure of the single programming document (SPD) priority 2 (of the agreement No ESF/ 2004/2.5.0-03-412), in which the following developed teaching aids have been prepared on the base of digital technologies: a study book “Essentials of Echocardiography”, a textbook “Echocardiography in Clinical Practice” and compact discs - an atlas of echocardiographic images, a teaching digital database of echocardiographic images.
A four-year (2002 – 2005) project financed by the State and Studies Foundation (SSSF) ”Myocardial Remodelling Determinant“
A one-year (2007) project financed by the State and Studies Foundation (SSSF) “Studies of Vascular Stiffness for Diagnosis of Early Pathology”
A one-year (2009) project financedby the State and Studies Foundation (SSSF)“Morphogenesis of Thoracic Aorta Dilative Pathology: investigation of the expression of the renin-angiotensin system, and the transforming growth factor(TGF)-beta“.
A two-year (2009–2010) project financed by Kaunas University of Medical Science Foundation “Evaluation of the Rotation Movement of the Heart and Strain of the Walls in Children after Radiofrequency Ablation”
A two-year (09.2010-2011) project financed by the Research Council of Lithuania “Search for New Markers of Myocardial Dysfunction Diagnosis and Prognosis: the Value of the Indicators of Deformation”
A three-year (2012-2014) project financed by the Research Council of Lithuania “Pathology of the Ascending Aorta: Search for Molecular and Biomechanical Markers of Dilatation”
A three-year (2013-06.2015) project financed by the Research Council of Lithuania “Diagnostic Value of the Myocardial Deformation in the Assessment of Haemodynamic Value of the Coronary Artery Stenosis”
Every year, 1-2 doctoral students begin their studies in the Department of Cardiology. Besides, this clinical base is used for doctoral studies by researchers of the Institute of Behavioural Medicine in Palanga and the Department of Thoracic, Cardiac and Vascular Surgery. Also, clinical resident doctors and students take part in the scientific research work performed by doctoral students. Every year, obligatory scientific research is being performed by 10-12 students in their fifth and sixth year.
Scientific collaboration of the Department of Cardiology
1. A joint Lithuanian, Latvian and Polish project in investigating rare heart diseases ”European Network for Orphan Heart Diseases”, financed by the Regional Operational Programme for Malopolska 2007-2013, Priority 8. Interregional cooperation
2. The registry of the European pregnant women with heart diseases ”EUROobservational Research Programme Registry Pregnancy in Patients with Structural Heart Disease", financed by the European Cardiological Society, realised from April 2011.
3. ”Heart failure Registry of the EUROobservation Research Programme“, financed by the European Cardiological Society, realised from May 2011.
4. International Survey on Acute Coronary Syndromes in Transitional Countries (ISACS-TC), 2010.