Chronické srdeční selhání - důležité téma pro internisty

Hana Rosolová

Vnitr Lek 2018, 64(9):829-830 | DOI: 10.36290/vnl.2018.113  

Pathophysiology, causes and epidemiology of chronic heart failure

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2018, 64(9):834-838 | DOI: 10.36290/vnl.2018.114  

The prevalence of heart failure in developed countries is about 1-2 % in general and in patients above 70 years over 10 %. HFpEF is the cause of heart failure from 22 to 73 %, exact data are not available. If compared with HFrEF, patients with HFpEF are older, more frequent women with hypertension and atrial fibrillation, but less myocardial infarction in their history. Heart failure is a hemodynamic disorder and the pathophysiologic basis is cardiac output, cardiac contractility, filling pressures, wall stress during systolic and diastolic function and heart rate. The neurohumoral activation is very important for the diagnosis as well as prognosis...

What we know about epidemiology of heart failure in Slovakia and globally

Eva Gonçalvesová, Marcela Danková

Vnitr Lek 2018, 64(9):839-846 | DOI: 10.36290/vnl.2018.115  

Heart failure (HF) is nowadays some of the most significant causes of mortality and morbidity, as well as one of the leading causes of hospitalization. Increasing number of patients with HF is becoming one of the most burning problems not only for health care, but also for the social welfare system. The knowledge of the epidemiology is crucial for rational planning and management of curative and preventive health care and allocation of research capacities. The sources of data for description of basic epidemiological characteristic of HF in Slovakia come from cross sectional surveys of outpatient care and hospitalization records of patients with heart...

Diagnosis of heart failure: the new classification of heart failure

Barbora Nussbaumerová, Hana Rosolová

Vnitr Lek 2018, 64(9):847-851 | DOI: 10.36290/vnl.2018.116  

Heart failure (HF) is a clinical syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and periphe-ral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Natriuretic peptides have a significant negative predictive value for excluding of heart failure. Echocardiography is the most important imaging method in heart failure. The new classification distinguishes HF by left ventricule ejection fraction (LV...

Pharmacological therapy for chronic heart failure

Jaromír Hradec

Vnitr Lek 2018, 64(9):853-859 | DOI: 10.36290/vnl.2018.117  

Pharmacotherapy of chronic heart failure with reduced ejection fraction (HFrEF) is based on convincing evidence of both, the efficacy and the safety of drugs we are using. This evidence was obtained in big and carefully controlled randomised morbidity/mortality trials; therefore we are talking about evidence-based medicine. The basis for the pharmacological treatment is inhibition of pathologically long-term activated neurohumoral systems, mainly of the sympatoadrenal one by betablockers as well as of the renin-angiotensin-aldosterone one by ACE inhibitors/sartans and by mineralocorticoid receptor antagonists. The new dual inhibitor sacubitril/valsartan...

The heart transplantation

Lenka Špinarová, Jindřich Špinar, Jiří Vítovec

Vnitr Lek 2018, 64(9):860-866 | DOI: 10.36290/vnl.2018.118  

The article reviews history, indication and follow-up after heart transplantation, including the mechanical assist devices. Various complications of posttransplant follow-up are mentioned, e.g. rejection, infection, vasculopathy, meta-bolic disorders, hypertension or malignities. Pharmacotherapy used for immunosuppression is discussed. Heart transplantation improves the prognosis of patients with previous heart failure and also their quality of life.

Comorbidities in heart failure

Jiří Vítovec, Lenka Špinarová, Jindřich Špinar

Vnitr Lek 2018, 64(9):867-873 | DOI: 10.36290/vnl.2018.119  

Comorbidities are important parts of care in patients with heart failure. Comorbidities, as well as their treatments, directly influence the course of heart failure. We present the most comorbidities a their therapy with regard to left ventricular dysfunction.

Arrhythmias and conductance disturbances and heart failure

Jiří Vítovec, Jindřich Špinar, Lenka Špinarová

Vnitr Lek 2018, 64(9):874-877 | DOI: 10.36290/vnl.2018.120  

Arrhythmias and conductance disturbances and heart failure have a close relation. Arrhythmias are serious complication, but also etiology of heart failure. So it is not clear, what is the cause and what is a consequence. Atrial fibrillation is a frequent cause, ventricular arrhythmias a frequent consequence and ventricular fibrillation a frequent cause of death in patients with heart failure. Overview are about frequent arrhythmias as well as their therapy with regard to left ventricular dysfunction.

Outpatient treatment of proximal deep vein thrombosis

Dalibor Musil

Vnitr Lek 2018, 64(9):887-892 | DOI: 10.36290/vnl.2018.122  

The treatment of deep vein thrombosis (DVT) is based on anticoagulation with heparin, warfarin and direct oral anti-coagulants. According to the 9^th ACCP Recommendation, for patients with DVT of the lower limbs, where the clinical state and home conditions permit, preference is given to home treatment over hospitalization. Despite that, the majority of patients with acute DVT still tend to be hospitalized, in particular when proximal thrombosis from the popliteal vein upward is involved. Furthermore, the recommendations do not describe proximal (iliofemoral) DVT as exceptional and more serious. Randomized and observation studies have shown...

Otto Kahler and his family (on the 125th anniversary of his death): I. Ancestors

Pavel Čech

Vnitr Lek 2018, 64(9):879-885 | DOI: 10.36290/vnl.2018.121  

The 125th death anniversary of the famous internist Otto Kahler (1849-1893) offers an occasion to remind that, in the 19th and 20th centuries, his family with all roots of ancestors deeply taken in Bohemia enriched history of medicine with a line of five remarkable physicians in four consecutive generations. The first generation is represented by Otto's father Josef Kahler (1810-1870), the fourth of fifteen children of a farmer in Großdorf near Braunau in northeast Bohemia. He graduated from Charles-Ferdinand University in Prague (1838), worked as a surgical intern and an assistant at Prague Maternity Hospital, as a docent (1844) he announced lectures...