Hlavní téma – kardiologie

prof. MUDr. Jan Václavík, Ph.D., FESC, FEFIM, MHA

Vnitr Lek 2025, 71(2):67  

Diagnosis and treatment of infective endocarditis

Ondřej Ludka, Miroslava Bendová

Vnitr Lek 2025, 71(2):72-85 | DOI: 10.36290/vnl.2025.015  

The European Society of Cardiology published an updated guideline for the diagnosis and treatment of infective endocarditis in 2023 (1), which was subsequently adopted by the Czech Society of Cardiology (2). Unfortunately, the recommendations in the areas of antibiotic prophylaxis and treatment contain many shortcomings and errors (3), which is why three Czech professional societies have developed their own recommendations (4). The following text is a compilation of these documents, primarily intended for internists.

What do the new ESC 2024 guidelines for the treatment of hypertension offer and how do they differ from ESH 2023?

Libor Jelínek, Zdeněk Ramík, Radek Adámek, Jan Václavík

Vnitr Lek 2025, 71(2):86-92 | DOI: 10.36290/vnl.2025.016  

Although the prevalence of arterial hypertension is increasing worldwide, the percentage of patients with controlled hypertension is also increasing. In diagnosing and treating arterial hypertension, doctors can rely on the European Society of Cardiology (ESC) 2024 and European Society of Hypertension (ESH) 2023 guidelines. Both sets of guidelines emphasize existing and add new recommendations. Values in the range of 120-139/70-89 mm Hg are now considered elevated blood pressure by ESC. In the diagnosis of hypertension, there is consensus on the emphasis on out-of-hospital blood pressure measurement. Initiation of pharmacotherapy is indicated in all...

New trends in the diagnosis and treatment of hypertrophic cardiomyopathy

Mária Bakošová, Hana Poloczková, Tomáš Honek, Anna Chaloupka, Jan Krejčí

Vnitr Lek 2025, 71(2):93-102 | DOI: 10.36290/vnl.2025.017  

Hypertrophic cardiomyopathy (HCMP) is an inherited heart disease characterized by thickening of the left ventricular musculature that cannot be explained by hemodynamic load. The prevalence of HCMP is estimated to be 1:500, the disease has a good prognosis in general, but can lead to serious complications from dyspnea, arrhythmias, syncope to heart failure and sudden cardiac death. Today's progress in imaging techniques allows the identification of individual phenocopies of HCMP to target therapy properly. This paper mainly focuses on sarcomeric HCMP, where a recent breakthrough in treatment is the inclusion of the cardiac myosin inhibitor mavacamten...

Diabetes mellitus and chronic renal insufficiency

Peter Girman

Vnitr Lek 2025, 71(2):103-106 | DOI: 10.36290/vnl.2025.018  

With the increasing number of diabetics in the population, there is also a rise in both microvascular and macrovascular complications. Kidney damage represents one of the leading causes of mortality in patients with diabetes. The classification of diabetic nephropathy is based on the glomerular filtration rate and the degree of albuminuria, categorizing patients into risk groups according to their mortality risk. The treatment of these patients is based on data from large multicenter studies, which have demonstrated cardiovascular benefits, particularly with the use of gliflozins. Therefore, gliflozins and statins, together with metformin, are among...

Vitamin D and its clinical applications

Michal Kršek

Vnitr Lek 2025, 71(2):108-114 | DOI: 10.36290/vnl.2025.019  

The article reviews current knowledge about vitamin D from the clinical point of view. The basic facts about its forms, physiological effects and metabolism are summarized. From clinical point of view the article deals with the state of supply of vitamin D, vitamin D deficiency and its clinical signs, symptoms and therapy. In paragraphs devoted to the treatment the current knowledge about forms of vitamin D, their indication, doses and dosage regimens are summarized.

Possible clinical interactions beteween the exocrine and endocrine pankreas functions

David Solil, Petr Dítě, Marie Přecechtělová, Arnošt Martínek, Magda Uvírová, Bohuslav Kianička

Vnitr Lek 2025, 71(2):E1-E5 | DOI: 10.36290/vnl.2025.022  

Pancreas is a vital organ fulfilling both exocrine and endocrine functions. The exocrine part is responsible for the production of digestive enzymes that are released into duodenum, while the endocrine part includes islets of Langerhans cells that produce hormones such as insulin, glucagon and somatostatin. Although these two parts are functionally distinct, there is a constant interaction between them. Disruption of this pathway can lead to a development of various diseases. Tumors or inflammation of the pancreas, trauma and surgery can lead to a secondary diabetes. If the insult simultaneously damages the acini and pancreatic islets, both exocrine...

Secondary diabetes mellitus in acromegaly

Ivana Ságová, Tomáš Bolek, Matej Samoš, Daniela Kantárová, Jakub Benko, Martin Jozef Péč, Jakub Jurica, Ingrid Tonhajzerová, Marián Mokáň

Vnitr Lek 2025, 71(2):E6-E12 | DOI: 10.36290/vnl.2025.023  

Acromegaly is a rare endocrine disorder characterized by the overproduction of growth hormone (GH), most commonly due to a pituitary adenoma, leading to increased production of insulin-like growth factor 1 (IGF-1) in the liver. The effects of GH and IGF-1 on glucose metabolism are antagonistic; GH induces insulin resistance, while IGF-1 enhances insulin sensitivity. However, the insulin-antagonizing effect of GH outweighs the insulin-sensitizing effect of IGF-1 in target tissues, leading to the development of diabetes mellitus (DM) in acromegaly.Secondary DM is a frequent complication in patients with acromegaly. In fact, DM may be the first manifestation...

The rate of progression of diabetic kidney disease in patients with type 1 diabetes mellitus

Lucia Bučková, Miroslava Horáčková, Petr Hoffmann, Michala Lustigová, Monika Tothová, Marika Koželuhová, Ondřej Pátek, Jan Brož

Vnitr Lek 2025, 71(2):E13-E18 | DOI: 10.36290/vnl.2025.024  

The risk of developing diabetic nephropathy is directly proportional to the duration of type 1 diabetes, with metabolic control of the disease playing a crucial role. The peak incidence of diabetic nephropathy occurs between 10 and 20 years after the diagnosis of the underlying disease. The annual incidence of albuminuria development in patients with type 1 diabetes mellitus is 2-3%. The annual incidence of a decline in estimated glomerular filtration rate below 60 ml/min/1.73 m² is 2-4 %, regardless of the type of diabetes. According to older studies from the late 1980s, an individual with type 1 diabetes mellitus (DMT1) has a 40% chance...

Malnutrition in Whipple’s Disease: A Case Report

Veronika Janošcová

Vnitr Lek 2025, 71(2):E19-E24 | DOI: 10.36290/vnl.2025.025  

Whipple‘s Disease (WD) is a rare multisystem disorder caused by the actinomycete Tropheryma whipplei, characterized by a diverse clinical presentation. The prodromal stage is often characterized by arthralgia, while the symptomatic stage predominantly manifests with gastrointestinal symptoms such as chronic diarrhea, abdominal pain, and weight loss. Duodenal biopsy remains the cornerstone of diagnosis, with PCR analysis providing a definitive confirmation. Treatment involves long-term antibiotic therapy. This case report describes a 65-year-old woman newly diagnosed with WD, presenting with severe malnutrition and notable rheumatological and...

Blood pressure variability in hypertension and options for its pharmacological management

Jan Filipovský

Vnitr Lek 2025, 71(2):124-129 | DOI: 10.36290/vnl.2025.021  

Blood pressure (BP) displays a large variability. It can be studied by ambulatory BP monitoring, standardized home BP self measurement or by evaluation of BP measured during repeated office visits. All types of measurement predict future cardiovascular events; variability measured by ambulatory BP monitoring has the strongest predictive power in subjects below 50 years of age. Variability of office BP can be expressed as percentage of visits with achieved target BP; it is ideal to have at least 75%. Antihypertensive drugs have different impact on BP variability; it is decreased by calcium channel blockers, thiazide and thiazide-like diuretics. Therefore,...

Bempedoic acid - a practical review

Barbora Nussbaumerová

Vnitr Lek 2025, 71(2):119-123 | DOI: 10.36290/vnl.2025.020  

Atherosclerotic cardiovascular diseases (ASCVD) remain the most common cause of morbidity and mortality in developed countries, despite the availability of cardiovascular (CV) prevention strategies and efforts to implement them. Dyslipidemia, particularly hypercholesterolemia, along with arterial hypertension, diabetes, and nicotine dependence, are among the main modifiable risk factors in both primary and secondary prevention of ASCVD. Despite significant progress in the pharmacotherapy of these conditions, including hypercholesterolemia, the recommended target serum lipid levels are not achieved in up to two-thirds of patients. A relatively new addition...

Hyponatremie a její úskalí v ko(č/st)ce

MUDr. Ondřej Černocký, MUDr. Adéla Osuchowská

Vnitr Lek 2025, 71(2):130-132