[Can pharmacotherapy in heart failure affect mortality?].

J Widimský, R Cihák

Vnitr Lek 1992, 38(3):209-219

The prognosis of patients with advanced chronic cardiac failure is very poor. Only investigations made in recent years provided evidence that this adverse prognosis can be influenced by conservative pharmacological treatment. Among many tested vasodilating substances positive data were obtained only with high doses of nitrates with hydralazine and in particular with inhibitors of the angiotensin converting enzyme which are the greatest advance in the treatment of chronic cardiac failure. Preparations of this group mitigate the symptomatology, increase load tolerance and improve the prognosis. So far they are indicated above all in severe forms of cardiac...

[Computer-assisted electrocardiographic mapping and left ventricular function in patients with acute myocardial infarct].

J Sochman, M Janota, V Staněk

Vnitr Lek 1992, 38(3):220-227

In 22 patients with a first myocardial infarction the authors assessed the relationship between morphological changes of the QRS complex and systolic left ventricular function. Using a 56-lead computer-assisted electrocardiogram from the precordium in the form of a map (apparatus Cardiomap-1), the authors prepared a record during the first days after initiating treatment with a thrombolytic agent and again after a period of three weeks. They found only one correlation between the decrement of Q waves and the increase of the left ventricular ejection fraction (p less than 0.05). This correlation, however, is of no practical importance due to the low...

[Echocardiographic evaluation of the left ventricle in mild hypertension treated with physical exercise].

H Nĕmcová, J Spác, M Blaha, I Dvorák

Vnitr Lek 1992, 38(3):228-233

The authors submit findings of haemodynamic changes during long-term treatment of mild hypertension by physical training. Using this method, blood pressure was normalized in all subjects. The authors conclude that physical activity has a similar impact on the haemodynamics of mild hypertension as drugs which reduce the tension of the sympathetic nerve. A surprising finding was the diminution or complete disappearance of cardiac hypertrophy in this treatment.

[Permanent variable frequency cardiac pacing: which patients with chronic complete atrioventricular block profit most?].

J Lukl, V Doupal, P Heinc, A Hyzák

Vnitr Lek 1992, 38(3):234-239

The authors examined 27 patients with chronic complete atrioventricular block (AVIII) and an implanted pacemaker with rate responsive pacing (RRP), controlled by atrial frequency (DDD stimulation--19 patients) or the length of the QT interval (VVIR pacing--8 patients). The loading test in AVIII ventricular stimulation 70/min (VVI 70) and RRP proved a more than double asset of MKP in RRP, as compared with VVI 70 (55.5 +/- 43.3% vs. 24.3 +/- 34.1%, p less than 0.001). The difference was greater in acquired than in congenital AVIII (27.7 +/- 18.5% vs. 8.4 +/- 4.1%, p less than 0.002) and in patients where the maximum heart rate on VVI did not exceed 70/min,...

[Esophageal stimulation in WPW syndrome].

J Vainer, R Ometto, M Bottero, M Vincenzi, G M Mosele

Vnitr Lek 1992, 38(3):240-245

Transoesophageal stimulation of the atria combined with bicycle ergometry provides a satisfactory reproducibility of a number of basic electrophysiological parameters at rest and during a load. Due to the good sensitivity and low specificity this test can be recommended in WPW syndrome as a screening examination in particular in active sportsmen and junior subjects. To assess the risk of sudden death in subjects with this syndrome it is, however, necessary to evaluate the complex of all assembled data, as the shortest R-R interval in induced atrial fibrillation is not sufficiently specific.

[Serial testing of antiarrhythmic agents using programmed stimulation in recurrent ventricular tachycardia].

J Lukl, C Cíhalík, P Heinc

Vnitr Lek 1992, 38(3):246-251

Serial testing of drugs (STL) by means of programmed electric stimulation (PES) was implemented in 41 patients with relapsing monomorphic persisting ventricular tachycardia (S-KT) of varying aetiology and severity. To reduce underrating of the action of antiarrhythmics, milder criteria were used for evaluation of the short-term and long-term effectiveness of therapy. By STL a total of 137 drugs and their combinations were tested. S-KT was not induced by 60 of them (44%) and in 35 patients (85%). In the remaining 6 patients STL could not be completed because of non-adherence of the patients to the method or because of serious proarrhythmic action of...

[Ebstein's anomaly (a group of 47 patients)].

K Zeman, B Vítek, V Chaloupka, A Necasová, S Masková

Vnitr Lek 1992, 38(3):252-257

In a group of 47 patients with Ebstein's anomaly followed up on a long-term basis the authors describe the natural course of the disease as well as contemporary diagnostic and therapeutic possibilities. The authors draw attention to typical symptoms of Ebstein's anomaly and emphasize the importance of early diagnosis by two-dimensional echocardiographic and Doppler examination and the introduction of individual conservative or surgical treatment.

[ECG Holter monitoring in patients with chronic renal failure in a long-term dialysis program].

J Gonsorcík, S Palko, M Takác, M Mydlík, J Vancík, K Derzsiová, I Tkác

Vnitr Lek 1992, 38(3):258-264

Using the Holter method, the authors monitored for 24-hours 30 patients included in a long-term dialyzation programme during and after haemodialysis. A group of 15 patients who had during examination frequent or complex supraventricular or ventricular ectopia was compared with a group of 15 patients with sporadic ectopia. In the arrhythmic group paroxysmal supraventricular tachycardia was recorded in 33% and paroxysmal atrial fibrillation in 13%, polytopic or repetitive ventricular extrasystoles in 14%, couplets in 20% and volleys of ventricular extrasystoles or non-persisting ventricular tachycardia in 20%. Comparison of clinical laboratory and echocardiographic...

[Complete recovery of left ventricular function after myocardial infarct].

J Sochman, J Peregrin, J Vrbská, H Skalická

Vnitr Lek 1992, 38(3):265-269

In a 27-year-old patient with an infarction of the anterior myocardial wall, significant from the haemodynamic aspect, a complex procedure is described by which in the course of four hours after the beginning of complaints normalization of the lumen and blood flow of the coronary artery supplying the infarction focus was achieved. The authors used thrombolytic intravenous treatment which involved infusion of 1.5 million u. of streptokinase (Streptase, Boehringer, Ingelheim) in the course of 45 mins., N-acetylcysteine 2.0 g i.v. (Broncholysin, Spofa) and percutaneous transluminal coronary angioplasty. In the course of 16 days the left ventricular function...

[Cardiac pacing therapy of late intermittent AV block after surgery for tetralogy of Fallot].

B Vítek, J Nicovský, P Kamarýt, E Cizmárová

Vnitr Lek 1992, 38(3):270-275

Postoperative atrioventricular block may be the cause of early or late death unless diagnosed and treated in time. The authors describe the development of late intermittent complete intraventricular block in an 11-year-old girl with syncope nine years after radical correction of the tetralogy of Fallot. Incomplete trifascicular block was diagnosed by electrophysiological examination of the conduction system four years before the development of complete trifascicular block. With regard to the serious character of an intermittent block cardiac pacing therapy was used.

[Wilson's disease and pregnancy].

V Stvrtinová, I Balazovjech, S Hlinstáková, K Hlinsták, A Sasko

Vnitr Lek 1992, 38(3):276-280

The authors describe the case of a 27-year-old female patient with Wilson's disease who during penicillinamine treatment became pregnant and was delivered of a healthy infant. The diagnosis of Wilson's disease was confirmed by the finding of a Kayser-Fleischer ring in the cornea and a concurrent serum ceruloplasmin concentration lower than 0.20 g/l. Unrecognized and untreated, the disease is associated with the development of organ complications which in the end prove fatal. On the other hand, early diagnosis and effective treatment throughout life can prevent liver and brain damage and thus enable the patient to live a normal life and women can have...

[Manifestations and early course of type I diabetes mellitus--a decisive period from the viewpoint of controlling the further development of the disease].

K Vondra, T Merhaut, M Voborská, V Zamrazil

Vnitr Lek 1992, 38(3):281-288

The autoimmune process focused on B-cells of the islets of Langerhans and leading gradually to their destruction is latent before the manifestation of diabetic symptoms. The detection of this preclinical stage in particular in sporadic cases is in common clinical practice, due to the low prevalence of the disease in the population and pretentious character as regards applied methods, unreal. Therefore attention is focused on the period of clinical manifestation of the diabetic syndrome and its early stages when by early diagnosis and intensive insulin or immunosuppressive treatment it is still possible to preserve a substantial proportion of functional...

[Primary hyperaldosteronism, problems in diagnosis and therapy in clinical practice].

A Kreze, J Hrnciar, M Dobáková, S Kompis

Vnitr Lek 1992, 38(3):289-294

The paper summarizes data from the recent literature on pathogenetic variants of primary hyperaldosteronism, screening, diagnosis and therapy of this secondary form of arterial hypertension. On examples from their own practice the authors draw attention to the that the diagnosis and treatment of this disease is not always as straightforward as might appear from the literature. The solution is simple, effective screening in every hypertensive patient by examination of the kalaemia before treatment of arterial hypertension is started. In case of hypokalaemia the subsequent procedure should be the concern of specialized departments.

[Lambliasis or giardiasis?].

Z Churý

Vnitr Lek 1992, 38(3):298