The effect of adding phytosterol to hypolipidemic therapy with statins on the size of lipoprotein particles in patients with very high cardiovascular risk

Andrej Dukát, Ján Gajdošík, Peter Sabaka, Dávid Baláž, Lucia Mistríková, Stanislav Oravec, Peter Gavorník, Ľudovít Gašpar

Vnitr Lek 2015, 61(5):398-400  

Despite significant improvement in the diagnosis and therapy of cardiovascular diseases their global risk and proportion of their clinical forms remains very high. Still the large part of the patients cannot reach the estimated target lipid levels despite statin therapy. Low adherence to preventive programmes with physical training and diet leads to progression of the pathological process of atherothrombosis. One possible therapeutic approach could be the combined hypolipidemic treatment. In this context we followed-up the size of lipoprotein particles among very high risk patients on statin monotherapy, where phytosterole was added. Lipoprotein profile...

Personalized pharmacotherapy of digoxin

Milan Grundmann, Ivana Kacířová

Vnitr Lek 2015, 61(5):406-409  

Introduction:Therapeutic and toxic effects of digoxin are related to its serum concentrations, recent evidence suggests that a lower therapeutic range 0.5-0.9 ng/ml is associated with reduced mortality. Aim:To show the advantages of therapeutic drug monitoring for dosing of digoxin. Method:Trough serum levels of digoxin were estimated by immunoassay MEIA (AxSym Abbott). The long term serum concentration - time profile of digoxin has been predicted by the Bayesian analysis computer program MW-Pharm 3.30 MediWare. Results:Sex case reports of the patients between 71 to 92 years are presented to show...

In what extend we can reach the current LDL-cholesterol treatment goals in secondary prevention

Otto Mayer jr, Jan Bruthans

Vnitr Lek 2015, 61(5):439-446  

Background:A number of clinical trials have shown that patients with overt atherovascular disease may benefit from more aggressive dosage of statins. We aimed to determined the usual dosage of statin in clinical practice and the adherence to recommended target concentration of LDL-cholesterol. Methods and results :We analyzed 948 patients with mean age 64.5 years (SD ± 9.0) after acute coronary syndrome and/or coronary revascularization (Czech samples of EUROASPIRE III and IV). In spite that more than 93 % of patients were in 2012/2013 treated with statin, only 2.4 % with the highest dose (atorvastatin 80 mg or equivalent)....

New version of classification of pulmonary hypertension

Michael Aschermann

Vnitr Lek 2015, 61(5):387-391  

Pulmonary hypertension has multifactorial pathophysiology with endothelial dysfunction, vasoconstriction, pulmonary vessel wall remodeling and plexiform lesions contributing to increased pulmonary vascular resistance. Recent studies showed the importance of several mediators in PH pathophysiology, including prostacyclin, nitric oxide, serotonine, endothelin 1, several cytokines, chemokines, as well as members of the transforming growth factor β family (TGF-β). Current article summarizes new classification version of pulmonary hypertension, which was presented at World pulmonary hypertension symposium in 2013. This classification has five...

Hypertension in females

Renata Cífková

Vnitr Lek 2015, 61(5):392-397  

Hypertension is the most common cardiovascular disorder affecting more males in younger age groups; in the age group of 45-64, it is equally frequent in both genders, it is more common in elderly females. Blood pressure increases more in females around the menopause. Use of hormonal replacement therapy is not associated with an BP increase but, because of increased risk of coronary events, stroke, and thromboembolic events, HRT is not recommended in CVD prevention. There is a similar decrease in BP by antihypertensive drugs in both genders as well as benefit from antihypertensive treatment. Women report about a double rate of adverse events of antihypertensive...

White-coat hypertension and masked hypertension

Jan Filipovský

Vnitr Lek 2015, 61(5):401-405  

White-coat hypertension (WCH) is very common: it is present in about one third of subjects with high office blood pressure (BP). A typical patient is a non-smoking female at higher age. Prognostic data are not very reliable because most patients are treated on the basis of elevated office BP; some long-term studies have shown that cardiovascular (CV) risk is increased compared to normotensives. The opposite disorder is masked hypertension (MH). Its prevalence in population-based studies is 13 %. MH is common in males, typically aged between 30 and 50 years, smokers with unfavorable risk profile, and it is also frequent in diabetics. The risk of future...

Controversies accumulated around betablockers

Jaromír Hradec

Vnitr Lek 2015, 61(5):410-416  

Betablockers are one of the most successful drug classes in cardiology. They have many indications - starting with treatment of arterial hypertension, continuing with secondary prevention post myocardial infarction up to the treatment of heart failure with reduced ejection fraction. Recently, many analysis and information were published which are questioning yet unshakable role of betablockers in some cardiovascular diagnosis. This review article summarizes the controversies, which have accumulated around betablockers in the treatment of hypertension, secondary prevention of coronary artery disease, perioperative administration in patients undegoing...

Is there a need to treat atrial fibrillation aggressively?

Josef Kautzner

Vnitr Lek 2015, 61(5):417-420  

Atrial fibrillation (AF) is the most frequent sustained arrhythmia in human. Earlier studies comparing strategy of rhythm control versus rate control did not show any difference in outcomes. This resulted in conservative approach when managing less symptomatic AF. This situation is changing in last years. One of the reasons is emerging data on higher risk of AF for human health, especially on consequences of asymptomatic brain embolisations and AF-related brain hypoperfusion. These may explain association of AF with dementia. The other reason reflects more encouraging results of catheter ablation of AF. These factors provide new insight into indications...

The role of uric acid and allopurinol therapy in cardiovascular disease

Aleš Linhart, Daniel Rob

Vnitr Lek 2015, 61(5):421-430  

Uric acid elevation is very common among patients with cardiovascular, renal and metabolic diseases. The role of uric acid in the pathogenesis of these diseases has been subject of intensive research and scientific discussions for decades. Allopurinol, which has been used in clinical practice for almost 50 years, is the drug of first choice for long-term control of gout. Due to its efficiency, low price and well-known risk profile, it is a widely prescribed drug. However allopurinol treatment in patients with asymptomatic hyperuricemia and cardiovascular diseases is still controversial. This review summarizes the increasing evidence of experimental...

Outpatient treatment of venous thromboembolic disease

Radovan Malý, Jaroslav Malý

Vnitr Lek 2015, 61(5):431-438  

Venous thromboembolic disease which includes both venous thrombosis and pulmonary embolism, is a frequent and potentially fatal disease. Based on the introduction of low-molecular-weight heparins (LMWH) into practice it has been proved that outpatient treatment of venous thrombosis is effective and safe for a large number of patients with VTE. The growing volume of data on LMWH outpatient treatment in recent years shows that up to 50 % of patients with clinically stable pulmonary embolism can be treated at home. In spite of these facts home treatment of pulmonary embolism has not been established as part of common practice as yet. If we were to summarize...

Hyperosmolar hyperglycemic state

Jaroslav Rybka, Jerguš Mistrík

Vnitr Lek 2015, 61(5):451-457  

The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of diabetes decompensation, especially in type 2 diabetes (T2DM), and with critical prognosis. Primary characteristics of HHS include extreme hyperglycemia, severe dehydration (with prerenal hyperazotaemia), plasma hyperosmolarity, frequent disorders of consciousness, absent or minimum ketoacidosis (with higher values, only found in combined forms). Both DKA and HHS have a common pathogenetic mechanism, but both states are opposite extreme deviations, and the boundaries between them are not entirely clear. Significant hyperglycemia is at the forefront of HHS, while ketoacidosis...

Combination treatment of hypertension in 2015

Jindřich Špinar, Jiří Vítovec, Lenka Špinarová, Miroslava Bendová

Vnitr Lek 2015, 61(5):458-465  

We present an overview of the present views on combination treatment and on fixed combinations in the treatment of hypertension according to guidelines of ESH/ESC and ČSH from 2013. The most frequently recommended dual combinations include a blocker of the renin-angiotensin system (ACEI or sartan) and a calcium channel blocker, and further a blocker of the renin-angiotensin system and a diuretic and a calcium channel blocker and a diuretic. In 2014 a fixed-dose combination of an ACE inhibitor (perindopril), a calcium channel blocker (amlodipine) and an diuretic (indapamide) appeared on the Czech market. Within the PIANIST study including 4 731 insufficiently...

The current state and future of care of patients with congenital heart defects

Miloš Táborský, Jana Popelová, Anna Nečasová, Jan Janoušek, Štěpán Černý, Petr Němec, Jan Pirk, Milan Šamánek

Vnitr Lek 2015, 61(5):466-469  

Care of patients with congenital heart diseases in Czech Republic does not have only important history, falling to the prewar period, but especially systematic and long-term work with excellent results in pediatric patients. With improvements in the care of these patients also improves their survival with the need for continuous care in adulthood including reoperation, catheter ablations incisional tachycardias and other specialized procedures in difficult heart morphology. The article is a reflection and an appeal to all responsible professionals, organizers and payers of health care, how to proceed and provide specialized training, continuity of...

Inhibition of renin-angiotensin-aldosterone system in heart failure, or from CONSENSUS to PARADIGM-HF

Jiří Vítovec, Jindřich Špinar, Lenka Špinarová

Vnitr Lek 2015, 61(5):470-474  

An historical survey is presented of mortality trials on angiotensin-aldosteron system inhibition in patients with chronic heart failure. From the CONSENSUS trial up to the PARADIGM-HF trial, ACE inhibitors/angiotensin II receptor antagonists (AT₁-blockers, ARBs, sartans), along with mineralocorticoid receptor blockers, have been the gold standard of treatment. Both direct renin blocker aliskiren and dual blocker enalapril + neprilysin proved ineffective; on the other hand, the new dual inhibitor valsartan + neprilysin LCZ 696 is a new and promising therapeutic agent for future treatment of chronic heart failure.

Hemocoagulation - New views on the old cascade

Jan F. Vojáček

Vnitr Lek 2015, 61(5):475-479  

The process of hemocoagulation can be generally divided into the following stages: initiation, amplification, propagation and stabilization of thrombus. The most important changes of the hemocoagulation scheme accepted so far concern the position and generally the existence of the coagulation system external and internal branches, the central role of a tissue factor in initiation of hemocoagulation and the newly understood roles of factors XI and XII. Newly an active role of monocytes, leukocytes, erythrocytes and endothelial cells and their receptors in hemocoagulation has been identified, as well as the role of circulating microparticles which transfer...

Primary hyperaldosteronism: problems of diagnostic approaches

Jiří Widimský jr

Vnitr Lek 2015, 61(5):480-483  

Primary hyperaldosteronism (PH) is common cause of endocrine/secondary hypertension with autonomous aldosterone overproduction by adrenal cortex. PH is typically characterized by hypertension, hypokalemia, high plasma aldosterone/renin ratio, high aldosterone, suppressed renin and nonsupressibilty of aldosterone during confirmatory tests. Diagnosis of PH can be difficult since hypokalemia is found only in 50 % of cases and measurement of the parameters of renin-angiotensin-aldosterone system can be influenced by several factors. Morphological diagnosis requires in majority of cases adrenal venous sampling. Early diagnostic and therapeutic measures...

Neuro-cardiology or cardio-neurology - a new specialization of the future?

Petr Widimský, Ivana Štětkářová

Vnitr Lek 2015, 61(5):484-486  

Acute ischemic stroke is a catastrophic cardiovascular disease with frequent cardiac causes and cerebral consequences, thus the close cooperation between neurologists and cardiologists is necessary for the optimal patient management. Furthermore, recent randomized trials demonstrated, that catheter-based thrombectomy (CBT) is the most effective treatment for properly selected patients. Interventional cardiology with its widespread non-stop services for acute myocardial infarction can fill the existing gaps in coverage of population needs with neurointerventional services. Thus, a new future medical subspecialization may emerge: neurocardiology or cardioneuro...

Pheochromocytoma - why is its early diagnosis so important for patient?

Tomáš Zelinka, Jiří Widimský jr

Vnitr Lek 2015, 61(5):487-491  

Pheochromocytoma may present with various clinical signs, symptoms due to continuous and/or paroxysmal release of catecholamines. Arterial hypertension may be sustained and/or paroxysmal and palpitations are mainly due to sinus tachycardia. In some cases, even as the first manifestation of pheochromocytoma, may occur severe cardiovascular complications such as hypertensive emergency, myocardial ischemia, cardiomyopathy and heart failure, multisystem crisis or shock. Catecholamine release may be also associated with arrhythmias - tachycardias (supraventricular or ventricular) or less frequently bradycardias (AV blocks and junctional). The effect of...

What may cause diabetes

Miroslav Pernický, Juraj Papinčák, Adriana Reptová, Soňa Kiňová, Ján Murín

Vnitr Lek 2015, 61(5):447-450  

The case study describes a case of 49-year-old man with morbid obesity since childhood (BMI 40 kg/m²), arterial hypertension (approx. since aged 15, treated since 2004), dyslipidemia (since 2006), type 2 diabetes mellitus (since 2006, on insulin therapy since 2008) and smoking (until 2011, 20 cigarettes a day). Treatment: 16 types of medication, 8 for hypertension, statin, therapy for diabetes, aspirin, allopurinol. In 2010 (when aged 45) hospitalized in our clinic with dyspnoea and chest pain with a high pressure reading of 180/110 mm Hg (identified symptoms of heart failure with LV ejection fraction of 33 %, in NYHA II functional class,...

Kardiologie ve FN Královské Vinohrady v Praze má 80 let a Kardiocentrum FNKV a 3. LF UK 20 let

Pavel Gregor

Vnitr Lek 2015, 61(5):492-495  

Cholesterol - mýtus nebo největší zabiják?

-red-

Vnitr Lek 2015, 61(5):496  

Významné životní jubileum prof. MUDr. Jiřího Widimského, DrSc., FESC, FAHA

Václav Monhart

Vnitr Lek 2015, 61(5):381  

Brňáci přejí profesoru Jiřímu Widimskému k životnímu jubileu a vzpomínají na společné chvíle

Miroslav Souček, Lenka Špinarová, Jindřich Špinar, Jiří Vítovec

Vnitr Lek 2015, 61(5):382-385  

Několik vzpomínek až příliš osobních

Miloš Štejfa

Vnitr Lek 2015, 61(5):386  

Effect of spironolactone in patients with heart failure and preserved left ventricular function - TOPCAT study

Jiří Widimský sr

Vnitr Lek 2015, 61(5):376-380  

The TOPCAT study followed the effect of spironolactone on a chronic heart failure with a preserved left ventricular ejection fraction. The study did not find any impact on the primary goal of the study, i.e. a combination of cardiovascular mortality, managed cardiac arrest or hospitalization rate for heart failure treatment. The only finding of the study was the decrease in hospitalization rates for a heart failure. A post hoc analysis, however, identified a significant difference between patients from the Americas (USA, Canada, Argentina, Brazil) on the one hand and those from Russia/Georgia on the other. The differences were rather striking. Whereas...