The survival of patients with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia is influenced positively in some instances by revascularization of the heart muscle and implantation of a cardioverter-defibrillator. The objective of the submitted work was to evaluate by perspective follow-up of subjects with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia: a) the effect of revascularization of the heart muscle on the prognosis, making use of programmed stimulation of the ventricles and testing the effectiveness of antiarrhythmic treatment; b) the importance of implantation of a cardioverter-defibrillator in revascularized and non-revascularized subjects for the prevention of sudden "arrhythmic" deaths.The authors examined 37 patients (32 men and 5 women), age bracket 34 to 78 years (mean age 61 +/- 11) with IHD and spontaneous ventricular tachyarrhythmia after ruling out acute myocardial infarction. The group was divided into sub-groups without revascularization (21 subjects) and with revascularization (16 subjects). In both sub-groups programmed stimulation of the ventricles was implemented. During the diagnostic finding of programmed stimulation they tested antiarrhythmic drugs, most frequently amiodarone administered orally. A cardioverter-defibrillator was implanted to 10 patients. All patients were followed-up to death, the longest period being 24 months. They evaluated the frequency of cardiac deaths (death on cardiac grounds incl. sudden "arrhythmic" death) and sudden "arrhythmic" deaths (death within on hour after onset of symptoms or first recorded malignant ventricular tachyarrhythmia). In the sub-group without revascularization with diagnostic inducibility of the heart muscle in 85.7% of patients the authors described 9 cardiac deaths (42.9%) and 8 sden "arrhythmic" deaths (38.1%). Conversely in the sub-group with revascularization and with diagnostic programmed stimulation of the ventricles in half the subjects 5 clinical deaths were found (31.3%) and 3 sudden "arrhythmic" deaths (18.8%). Analysis of 11 sudden "arrhythmic" deaths revealed that no subjects with an implanted cardioverter-defibrillator (5) died (documented malignant ventricular tachyarrhythmia). Five of the six patients who died (all without a cardioverter-defibrillator) were not revascularized.Revascularization of the heart muscle in patients with ischaemic heart disease (after elimination of acute cardiac infarction) and malignant ventricular tachyarrhythmia reduces the risk of relapse of this arrhythmia. The benefit of implantation of a cardioverter-defibrillator was recorded in all subjects regardless of the revascularization of the heart muscle.
In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive only in complete obstruction of the left coronary, in case of multiarterial affection almost in all cases. Coronarography revealed only in 4 patients (9%) isolated stenosis of the trunk of the left coronary, most frequently the finding was also on two other (36.4%) or 3 (34.1%) arteries. Complete occlusion of the trunk of the left coronary was recorded in 6.8%. An ejection fraction of 50% or more was recorded in 75% of the patients. Surgical revascularization was performed in 35 patients. Twenty-nine patients are followed up after operation on a long-term basis (on average for 7.8 months), 23 of the patients report improvement of their complaints (65.7%). The investigation provided evidence that stenosis of the trunk of the left coronary is a relatively frequent finding in the patient population with ischaemic heart disease and that it is most frequently associated with affection of two and three arteries.(ABSTRACT TRUNCATED AT 250 WORDS)
Rescue angioplasty is an operation performed in the acute stage of myocardial infarction where systemic thrombolysis did not lead to opening of the artery. Investigations made in recent years indicate the benefit of rescue angioplasty only in those patients where the infarcted artery is patent several hours after evidence that thrombolysis failed. At the same time they provide evidence of the increasing safety and technical success of the operation. The authors present a brief review of the literature pertaining to the development of views, and emphasize the need of early and correct indication.
The authors present an integrated view on the role of stents in different indications in patients with IHD from the aspect of recently published or presented randomized trials.
The purpose of our pilot study was to find out if total body water (TBW) changes could objectively modify the course of adaptation during training for elite runners at different altitudes. The aim of this pilot study is to summarize the indication of the progress of acclimatization at high altitudes (1000–2700 meters above sea level) during alpine conditioning. In three training camps at various altitudes the TBW of elite runners (F = 3, M = 1; n = 4; age 23 } 0.9) was monitored, in order to check the progress of acclimatization. We used BIA measurement methods (Bodystat 1500) at different high altitude running camps at the Czech Republic, Morocco and Ethiopia. Changes in TBW were used to check the progress of acclimatization. We discovered that the retention peaks of TBW corresponded with critical days (p ≤ 0.04; Cohen’s d). The highest measured increases of TBW at an altitude of 1000 m were for runner 1, 1.7 litres and for runner 2, 2.1 litres with retention peaks for both occurring on the 5th day. At an altitude of 1770 m runner 1 reached an increase of TBW of 6.3 litres, with a retention peak on the 11th day, and runner 3 had an increase of 5.1 litres with a peak on the 8th day. In the acclimatization phase we found two critical periods, from the 4th–6th day, and after the 10th–12th day. For runner 4 in altitude 2700m who completed the camp at a higher altitude, the situation is more complicated because there were fluctuations of the content of TBW in the range of 1.25 litres, with the highest depression on the 5th and then again an unsettled rise and reaching a maximum on the 12th, when she nearly returned to the initial value. Detected retention peaks reflected different levels of altitude (5th–12th days).We can conclude that the measuring of changes in TBW during camps at higher altitudes may be one of the biomarkers during acclimatization to altitude.
Úvod: Aortální stenóza je nejčastější chlopenní vadou v dospělosti a katetrizační implantace aortální chlopně (TAVI) je novou, rozvíjející se alternativou ke standardní chirurgické náhradě aortální chlopně (AVR), vhodnou pro pacienty s vysokým operačním rizikem. Shrnujeme první zkušenosti s touto metodou na našem pracovišti.Metodika: Autoexpandibilní chlopeň CoreValve Revalving 18 F 3. generace je tvořena nitinolovým rámem a bioprotézou z prasečího perikardu. Přehledně popisujeme průběh výkonu. V období od dubna 2009 do ledna 2010 jsme TAVI provedli u 17 nemocných se symptomatickou významnou aortální stenózou. Stručná charakteristika souboru (průměrné hodnoty): věk 81 let, logistické EuroSCORE 21 %, plocha aortálního ústí 0,42 cm2/m2, ejekční frakce LK 52 %. Technická úspěšnost výkonu byla 100%. Mortalita do 30 dnů byla 0% a byl jasně patrný příznivý vliv TAVI na symptomatologii nemocných - dušnost se zlepšila alespoň o jeden stupeň NYHA klasifikace u všech nemocných.Závěr: Naše první zkušenosti s TAVI jsou velmi povzbudivé. Úspěch TAVI je podmíněn týmovým přístupem při předoperačním hodnocení, technicky precizním výkonem a pečlivou pooperační péčí. Domníváme se, že opatrný přístup k indikaci TAVI je nutný do potvrzení role této metody v delším sledování, v budoucnosti lze očekávat méně selektovanou aplikaci této metody.
Prace shrnuje klinicke sledovani pacientů v sekundarni prevenci ICHS po nasazeni kombinovane hypolipidemicke lecby nebo v nejvyssim kardiovaskularnim riziku. Dle poslednich doporuceni by hladina LDL-cholesterolu u těchto pacientů měla dosahovat hodnoty pod 2,0 mmol/l. Vzhledem k tomu, že v oblasti doporuceni pro lecbu hyperlipoproteinemii existuje rozpor mezi doporucenimi na jedne straně a realitou použivani hypolipidemik v praxi a tim dosahovani cilových hladin lipidů na druhe straně, zaměřili jsme se na skutecný stav efektu hypolipidemicke lecby kombinaci statinu a ezetimibu. Výsledky nasi prace poukazuji na ucinnost přidani ezetimibu ke stavajici lecbě statinem s dosaženim dalsiho poklesu LDL-cholesterolu. Kombinovanou lecbou statinem a ezetimibem v praxi kardiologicke ambulance lze dosahnout cilove hladiny LDL-cholesterolu pod 2,0 mmol/l.
To assess the occurrence of late clinical events after the discontinuation of dual antiplatelet treatment in patients with drug-eluting stent implantation, complex coronary artery disease and high clinical risk profile.Between January 2004 and December 2005, 2080 patients underwent percutaneous coronary intervention, including 276 patients (13%) who were treated with drug-eluting stents. At the 6-month follow-up, 273 patients remained event-free and of these, 171 completed the 12-month and 18-month follow-ups and have been enrolled in the analysis. Dual antiplatelet treatment was administered for 6 months in all patients.At the 18-month follow-up, stent thrombosis had occurred in 10 patients (5.8%), resulting in five sudden deaths and five target-vessel nonfatal myocardial infarctions. The majority (80%) of the events had developed within 7-12 months. The larger stent area and left main interventions were significantly associated with stent thrombosis (P=0.031 and P=0.001, respectively).Our study confirmed worrisome results concerning drug-eluting stent thrombosis after the discontinuation of dual antiplatelet treatment. The rate of stent thrombosis-related events in our high-risk cohort of patients reached almost 6% with a 50% mortality. The majority (80%) of the events occurred within the months 7-12.
Akutni infarkt myokardu se vyskytuje u těhotných žen poměrně vzacně a je spojen s vysokou mortalitou matky i plodu. Riziko je nejvyssi ve třetim trimestru, u žen mladsich 35 let a u žen rodicich pomoci cisařskeho řezu.
Autoři popisuji připad 32lete nemocne romske narodnosti s rizikovým chovanim a velmi malou „compliance“ k lecbě.
Pacientka byla poprve hospitalizovana ve 32. týdnu gravidity pro akutni infarkt myokardu spodni stěny. Třeti den hospitalizace podepsala negativni reverz a odesla domů. Druhý den po porodu doslo ke vzniku recidivy akutniho infarktu myokardu v teže oblasti. Pro casnou poinfarktovou anginu byla (po znacnem nalehani na nemocnou i rodinne přislusniky) u nemocne provedena selektivni koronarografie s perkutanni koronarni intervenci na prave věncite tepně.
V zavěru prace autoři diskutuji problematiku akutniho infarktu myokardu u těhotných žen, vcetně možných způsobů lecby.
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