Úvodník

Pavel Gregor

Vnitr Lek 2019, 65(10):603  

Interdisciplinary cooperation for a maximum acceleration of availability of modern therapy for ischemic stroke for all patients in need of endovascular thrombectomy

Petr Widimský, Ivana Štětkářová, Hana Malíková

Vnitr Lek 2019, 65(10):606-609 | DOI: 10.36290/vnl.2019.106  

Catheter-based (endovascular) thrombectomy is class I.A indication for the treatment of acute ischemic stroke. However, its availability in most countries is extremely low due to the lack of trained staff. Even the countries with best stroke services (e.g. Czech Republic) currently treat only one third of patients, who would be indicated to such therapy and in many countries the treatment simply is not available. It is estimated, that on the European level only 10% of the suitable patients are currently treated. This review manuscript is written by representatives of the three main specializations dealing with acute ischemic stroke treatment and prevention:...

Innovations in pharmacological treatment of heart failure

Jiří Vítovec, Jindřich Špinar, Lenka Špinarová

Vnitr Lek 2019, 65(10):611-619 | DOI: 10.36290/vnl.2019.107  

The main goal of the heart failure treatment is the decrease of mortality and morbidity, especially improvement of quality of life and decrease of hospitalisations. ACE inhibitors are the cornerstone of the treatment, MRA should be added to ACEI. Angiotensin receptor blockers (ARB) are indicated in the case of ACE inhibitors intolerance. Betablockers in maximal tolerated doses should be added to the renin angiotensin blockade. Diuretics are given to the symptoms relieve - dyspnoe or oedema. Digoxin is indicated in selected patients. There are 3 new promising groups of drugs: (1) Angiotensin Receptor-Neprilysin Inhibitor - ARNI - Sacubitril/Valsartan...

New european guidelines for the diagnosis and treatment of hypertension, issued in 2018 - brief comments

Jiří Widimský jr

Vnitr Lek 2019, 65(10):621-623 | DOI: 10.36290/vnl.2019.108  

Short commentary focuses on the new European guidelines on Hypertension produced by European society of cardiology and European society of Hypertension. More detailed analysis is given to target blood pressure levels as well as basic therapeutic approaches. New European guidelines are similar to recent national Czech recommendations.

Acute and recurrent pericarditis

Tomáš Paleček

Vnitr Lek 2019, 65(10):624-629 | DOI: 10.36290/vnl.2019.109  

Pericardial diseases have been until recently relatively neglected entity; however, there has been a markedly increased interest in these disorders in the last decade due to new diagnostic as well as therapeutic options. Various clinical manifestations of pericardial diseases may be generally grouped into pericardial syndromes including pericarditis, pericardial effusion, cardiac tamponade and constrictive pericarditis. In this review, the comprehensive analysis of acute and recurrent pericarditis is presented. Acute and recurrent pericarditis represent the most common pericardial disorders in clinical practice, in which major changes in therapeutic...

Prophylaxis for infective endocarditis - an endless story with a colorful past, an uncertain presence and unclear future

Pavel Gregor

Vnitr Lek 2019, 65(10):630-635 | DOI: 10.36290/vnl.2019.110  

Opinions on the prevention of infective endocarditis (IE) have significantly changed in recent years. A gradual departure from antibiotic prophylaxis can be observed, both in terms of the spectrum of procedures and the profile of individuals in whom it is indicated. The extreme case is the rejection of all antibiotic prophylaxis in all patients and for all procedures in some countries. Concise conclusions are primarily provided by European recommendations. Patients at the highest risk are currently recommended for prophylaxis; this in particular concerns valvular prostheses, some complex congenital heart defects, sewn palliative shunts, conduits or...

Inflammatory myocardial disease

Jan Krejčí, Hana Poloczková

Vnitr Lek 2019, 65(10):636-642 | DOI: 10.36290/vnl.2019.111  

Inflammatory diseases of the heart muscle include myocarditis and inflammatory cardiomyopathy, which is myocarditis associated with a heart muscle dysfunction. The causes of myocardial inflammatory disorders may be infectious, most commonly viral, as well as non-infectious. Diagnosing is difficult, the clinical suspicion of this diagnosis can be established based on clinical picture and non-invasive diagnostic methods, the most important of which is cardiac magnetic resonance imaging. The definitive diagnosis is based on histological and immunohistochemical evidence of inflammation directly from heart muscle samples. These can be obtained by endomyocardial...

Current and future trends in the treatment of dyslipidemias

Michal Vrablík

Vnitr Lek 2019, 65(10):643-650 | DOI: 10.36290/vnl.2019.112  

Lipid-lowering treatment is a part of prevention and treatment of vascular diseases caused by atherosclerosis. We need new strategies for modifying plasma lipoprotein levels in the light of new findings that reduce target lipid levels further lower, as well as the growing population of patients for whom existing treatments cannot be offered. The spectrum of existing drugs (new statins) is widening, pharmacological treatments (recombinant lipoproteins-bound statins), improved forms of established drugs (selective PPARα receptor modulators) are coming. The new procedures include fixed combinations of established drugs improving adherence and intensifying...

Genetic testing in patients with hypertrophic cardiomyopathy

Jiří Bonaventura, Josef Veselka

Vnitr Lek 2019, 65(10):652-658 | DOI: 10.36290/vnl.2019.113  

Hypertrophic cardiomyopathy (HCM) is a frequent inherited heart disease with an estimated prevalence of up to 1 in 200 individuals. In the majority of cases, HCM is inherited as an autosomal dominant genetic trait with pathogenic variants detected in sarcomeric proteins. Nevertheless, the genetic basis of HCM is more complex. More than 2 000 mutations in 27 genes have been described in association with HCM. The genetic and allelic heterogeneity makes molecular analysis by conventional methods time-consuming and expensive. Next Generation Sequencing (NGS) based genomic testing allows rapid analysis of a large number of genes or even a whole genome at...

Takotsubo syndrome

Karolína Poledníková, Petr Toušek

Vnitr Lek 2019, 65(10):659-662 | DOI: 10.36290/vnl.2019.114  

Takotsubo syndrome (TTS) is currently regarded as a special type of acute coronary syndrome. The syndrome can be trigerred by emotional stress factors and more often by some severe non-cardiac conditions. The long-term outcome of TTS patients is similar to those with myocardial infarction. The exact pathophysiological mechanism is not yet fully explained. Excessive amount of catecholamines released into bloodstream after stress attack plays a crucial role. The transient left ventricle dysfunction is probably caused by combination of several pathophysiological mechanism. There is little data concerning the treatment of TTS. It is important to focus...

Jan Pirk a kolektiv. Kardiochirurgie

Petr Němec

Vnitr Lek 2019, 65(10):665  

Odešel profesor Marek, velký internista, endokrinolog, ale především velký člověk

Richard Češka

Vnitr Lek 2019, 65(10):663-664