Dissertations / Theses on the topic 'Infarkt myokardu / myocardial infarction'

Ishemijska bolest srca najče&scaron;će nastaje kao posledica razvoja aterosklerotskih promena na koronarnim krvnim sudovima koji dovode do suženja lumena i posledičnog pada protoka arterijske krvi u području vaskularizacije. Akutni oblik koronarne bolesti koji zahteva hitnu primenu reperfuzione terapije je ST elevirani infarkt miokarda. EKG ima veliki značaj u postavljanju dijagnoze ali i u proceni uspe&scaron;nosti same reperfuzije. &Scaron;irina QRS kompleksa jedan je od EKG parametara čija dinamika promena može ukazati na uspe&scaron;nost pPKI i veličinu infarktne zone. Evaluacija &scaron;irine QRS kompleksa kao prediktora veličine infarkta miokarda i reperfuzije nakon pPKI kod pacijenata sa STEMI. Ispitivanje je sprovedeno kao prospektivna, opservaciona klinička studija na Klinici za kardiologiju, Instituta za kardiovaskularne bolesti Vojvodine u periodu od januara 2016. do decembra 2018. godine. U isptivanje je uključeno 200 pacijenata sa STEMI kod kojih je urađena pPKI. Na osnovu dužine trajanja tegoba formirane su dve grupe od po 100 pacijenata. Grupa A kod kojih je totalno ishemijsko vreme bilo &lt;6h i grupa B kod kojih je totalno ishemijsko vreme između 6 i 12h. . Sprovedeno je EKG praćenje radi procene &scaron;irine QRS kompleksa intrahospitalno (pre procedure, odmah nakon pPKI kao i posle 1h i 72h) i na dve vizite ambulantno tokom &scaron;estomesečnog praćenja (nakon mesec dana i &scaron;est meseci). Ehokardiografija je urađena kod svih pacijenata intrahospitalno i na &scaron;estomesečnom ambulantnom pregledu. &Scaron;irine QRS kompleksa su korelirane sa rezultatima interventne procedure procenjene TIMI protokom i TMPG, dinamikom kardiospecifičnih enzima i ehokardiografskim nalazima. U istraživanje je uključeno 71% mu&scaron;karaca i 29% žena, prosečna starost uzorka iznosila je 60.6&plusmn;11.39. Dužina trajanja tegoba značajno se razlikovala između grupa. U grupi A tegobe su trajale prosečno 120 minuta (90-180), dok su u grupi B trajale 420 minuta (360-600) (p&lt;0.0005). DTB nije se značajno razlikovao, 42 minuta (31-54.5) u odnosu na 40.5 minuta (34.5-55) (p=0.818). Prosečna &scaron;irina QRS kompeksa na EKG-u pre pPKI nije se značajno razlikovala između grupa, 100 msec (90-110) u odnosu na 100 msec (93-110) (p=0.308). Nakon reperfuzije uočena je značajna razlika u &scaron;irini QRS kompleksa između grupa na svim intrahospitalnim kao i EKG-ima načinjenim tokom perioda praćenja. QRS kompleks je &scaron;iri kod pacijenata iz grupe B (p&lt;0.0005). Pacijenti iz grupe A koji su imali prohodnu infarktnu arteriju sa TIMI 3 protokom pre implantacije stenta imali su značajno uži QRS kompleks na incijilanom EKG-u u odnosu na pacijente kod kojih je IRA bila sub/okludirana sa TIMI protokom &le;2 (p=0.001). U grupi B prohodna infarktna arterija sa TIMI 3 protokom nije značajno uticala na &scaron;irinu QRS kompleksa na inicijalnom EKG-u (p=0.144). Na EKG-ima nakon procedure QRS kompleks bio je značajno &scaron;iri kod pacijenata kod kojih je TIMI protok &le;2, ali samo za grupu pacijenata koja se javila unutar 6h od početka tegoba (p=0.001). QRS kompleks kod pacijenata koji su se javili nakon 6h od početka tegoba jeste bio uži, ali bez statistički značajne razlike (p=0.336). Pearsonovim testom registrovano je postojanje negativne korelacije &scaron;irine QRS kompleksa i istisne frakcije leve komore, ali i pozitivne korelacije sa WMSI i indeksiranim end sistolnim i end dijastolnim volumenom. ROC analizom pokazano je da ukoliko je QRS kompleks &scaron;iri od 89 msec nakon mesec dana, 8.5 puta je veći rizik od snižene EF na &scaron;estomesečnoj kontroli (p&lt;0.0005, AUC=0.808, cut-off=89msec.). ROC analiza pokazala je i da ukoliko je QRS kompleks &scaron;iri od 99msec 1h nakon procedure, 5 puta je veći rizik od pojave MACE (p&lt;0.0005, AUC=0.744, cut-off=99msec). Izvedena su dva matematička modela zasnovana na &scaron;irini QRS kompleksa koja vr&scaron;e predikciju snižene EF i pojave MACE tokom perioda praćenja. &Scaron;irina QRS kompleksa je pokazatelj reperfuzije kod pacijenata sa STEMI kod kojih se načini revaskularizacija unutar 6h od nastanka tegoba. &Scaron;irina QRS kompleksa mesec dana nakon STEMI predstavlja nezavisni prediktor snižene EF. Pro&scaron;irenje preko 89msec 8.5 povećava rizik od snižene EF. &Scaron;irina QRS kompleksa jedan sat nakon pPKI predstavlja nezavisni prediktor za MACE. Pro&scaron;irenje preko 99msec 5 puta povećava rizik od neželjenog kardiolo&scaron;kog događaja. Izvedena su dva matematička modela koja koriste &scaron;irinu QRS kompleksa i sa visokom precizno&scaron;ću vr&scaron;e predikciju MACE-a, odnosno snižene EF nakon &scaron;est meseci.&nbsp;<br>Ischemic heart disease most commonly occurs as a result of the atherosclerotic changes in the coronary vessels that lead to the narrowing of the lumen and consequent fall in arterial blood flow in the vascularization area. An acute form of coronary artery disease requiring immediate reperfusion therapy is ST-elevation myocardial infarction. The ECG is of great importance not only in making the diagnosis but also in evaluating the success of the reperfusion itself. The duration of the QRS complex is one of the ECG parameters whose change in dynamics can indicate the success of pPCI as well as the size of the infarct zone. Evaluation of the width of the QRS complex as a predictor of myocardial infarction size and reperfusion after pPCI in patients with STEMI. The study was conducted as a prospective, observational clinical study at the Cardiology Clinic of the Institute of Cardiovascular Diseases of Vojvodina between January 2016 and December 2018. The study included 200 patients with STEMI in whom pPCI was performed. Based on the length of discomforts two groups with 100 patients were formed. Group A had a total ischemic time &lt;6h and the total ischemic time in group B was between 6-12h. To assess the duration of the QRS complex, the ECG monitoring was performed intrahospital (before the procedure, immediately after pPCI as well as 1h and 72h after the procedure) and on two outpatient visits during the six-month follow-up period (after one month and six months). Echocardiography was performed in all patients intrahospital and at a six-month outpatient visit. The duration of the QRS complex correlated with the results of the interventional procedure that was evaluated by the TIMI flow and TMPG, the dynamics of cardiospecific enzymes and echocardiography findings. The survey included 71% of men and 29% of women with an average age of 60.6 &plusmn; 11.39. The duration of the discomforts varied significantly between the groups. In group A the discomforts lasted 120 minutes in an average (90-180), while they lasted 420 minutes in group B (360-600) (p &lt;0.0005). DTB did not differ significantly, 42 minutes (31-54.5) versus 40.5 minutes (34.5-55) (p = 0.818). The average duration of the QRS complex on the ECG before pPCI did not differ significantly between the groups, 100 msec (90-110) versus 100 msec (93-110) (p = 0.308). After the reperfusion, a significant difference in the duration of the QRS complex was observed between the groups at all intrahospital ECGs and the ECGs performed during the follow-up period. The QRS complex was broader in group B patients (p &lt;0.0005). Group A patients who had a patent infarct artery with TIMI 3 flow before the stent implantation had a significantly narrower QRS complex on the initial ECG compared to the patients whose IRA was sub / occluded with TIMI flow &le;2 (p = 0.001). In group B, the patent infarct artery with TIMI 3 flow did not significantly affect the duration of the QRS complex at the initial ECG. (p = 0.144). At the post-procedural ECGs the QRS complex was significantly broader in patients with TIMI flow &le;2, but only in the group of patients who arrived within 6 h from the onset of discomforts (p = 0.001). The QRS complex in patients who arrived 6 h after the onset of discomforts was narrower but without statistically significant difference (p = 0.336). The Pearson test registered the existence of a negative correlation of the QRS complex width and the left ventricular ejection fraction, but also a positive correlation with the WMSI and index end-systolic and end-diastolic volumes. The ROC analysis showed that if the QRS complex was wider than 89 msec after one month, there was an 8.5 times higher risk of decreased EF at the six-month control examination (p &lt;0.0005, AUC = 0.808, cut-off = 89msec.). The ROC analysis also showed that if the QRS complex was wider than 99msec 1h after the procedure, there was a 5 times higher risk of MACE (p &lt;0.0005, AUC = 0.744, cut-off = 99msec). Two mathematical models based on the width of the QRS complex were derived that predicted the lowered EF and the occurrence of MACE during the monitored period. The width of the QRS complex is an indicator of reperfusion in patients with STEMI who undergo revascularization within 6 hours from the onset of discomforts. The width of the QRS complex one month after STEMI is an independent predictor of decreased EF. Broadening over 89msec increases the risk of lowered EF for 8.5 times. The width of the QRS complex one hour after pPCI represents an independent predictor of MACE. Broadening over 99msec increases the risk of an adverse cardiac event 5 times. Two mathematical models have derived that use the width of the QRS complex and predict MACE with high precision as well as reduced EF after six months.

Uvod: Pacijenti sa akutnim infarktom miokarda sa ST elevacijom treba da budu podvrgnuti reperfuzionoj terapiji, pre svega pPCI, bez obzira na životnu dob, ali zbog&nbsp; veće učestalosti komorbiditeta, faktora rizika za koronarnu bolest i vi&scaron;esudovne koronarne bolesti, kod pacijenata starije životne dobi, odluka o reperfuzionoj terapiji treba da se donese sa dobrom procenom odnosa rizik &ndash; benefit. Cilj: Utvrđene su razlike u kliničkoj slici, angiografskom nalazu, terapijskom pristupu, toku i ishodu akutnog infarkta miokarda sa ST elevacijom u starih osoba u odnosu na mlađu životnu dob (mlađi od 75 godina). Materijal i metode: U studiju je uključeno 240 pacijenata sa akutnim infarktom miokarda sa ST elevacijom, podeljeni u dve komparabilne grupe (120 bolesnika starijih i kontrolna grupa 120 mlađih od 75 godina), koji su izabrani metodom slučajnog izbora, po redosledu prijema u bolnicu. Za pacijente iz obe grupe popunjavan je upitnik, a tretirani su po jedinstvenom protokolu lečenja. Rezultati: U ispitivanom uzorku, u grupi bolesnika starijih od 75 godina reperfuziona terapija je bila primenjena u 85% slučajeva. Intrahospitalni mortalitet za ceo uzorak je 11,7% i u skladu je sa drugim istraživanjima [27]. Mortalitet u grupi pacijenata preko 75 godina je bio 12,5%, a u grupi pacijenata sa manje od 75 godina 10,8% (p=ns). Zaključak: Klinička slika bolesti kod bolesnika starije životne dobi je če&scaron;će atipična &scaron;to korelira sa drugim studijama [31, 35], a tok bolesti komplikovaniji i ishod lo&scaron;iji. Kod bolesnika starijih od 75 godina če&scaron;ća je vi&scaron;esudovna koronarna bolest. Primarna perkutana koronarna intervencija u akutnom infarktu miokarda sa ST elevacijom u pacijenata starije životne dobi potvrđuje benefit u lečenju, toku i ishodu bolesti.<br>Introduction: Patients with ST segment acute myocardial infarction should undergo reperfusion therapy, PCI in the first place, no matter their life age. However, due to high frequency of comorbidities, risk factors for coronary disease and multi-vessel coronary disease, the decision of reperfusion therapy in elderly patients should be made according to the good evaluation or risk benefit ratio. Aim: The differences have been determined in the clinical picture, angiographic finding, therapeutic approach, course and outcome of ST segment acute myocardial infarction in elderly patients in relation to younger life age (less than 75 years). Material and methods: The study included 240 patients with ST segment acute myocardial infarction. They were randomly divided into two comparable groups according to the date of their hospitalization (120 patients older than 75 and control group of 120 patients younger than 75 years). Both groups of patients filled out the survey and were treated according to the same protocol. Results: In the examined sample of the group of patients older than 75 the reperfusion therapy was performed in 85% of cases. Intrahospital mortality for the entire sample was 11.7% and is in coherence with other researches [27]. Mortality in the group of patients older than 75 years was 12.5%, and it was 10.8% (p=ns) in the group of patients younger than 75.&nbsp; Conclusion: Clinical picture of disease in elderly patients is atypical thus correlating with other studies [31, 35], and course of illness more complicated and with a worse outcome. Multi-vessel disease is more common in patients older than 75 years. Primary percutaneous coronary intervention in STEMI in elderly patients confirms benefits in treatment, course and outcome of disease.

Cilj: Kod trećine bolesnika sa akutnim ST-eleviranim infarktom (STEMI) nakon primarne angioplastike (pPCI) razvije se postinfarktno remodelovanje leve komore (LK). Cilj istraživanja je nalaženje ranih prediktora post-infarktnog remodelovanja leve komore nakon akutnog STEMI i pPCI. Metodologija: Uključeno je 210 ispitanika sa prvim akutnim STEMI prednjeg zida, lečenih pPCI. Urađena je ehokardiografija u prva 24h, a zatim nakon 6 meseci, kada su ispitanici podeljeni u 2 grupe: ispitivanu sa remodelovanjem (n=55; 26%) i kontrolnu bez remodelovanja (n=155; 74%). Ispitanici su klinički praćeni godinu dana. Rezultati i dikusija: Multivarijantnom regresionom analizom, kao najsnažniji rani prediktori post-infarktnog remodelovanja izdvojili su se: postojanje &quot;no reflow&quot; fenomena nakon pPCI (OR=30.0 95% CI, p&lt;0.0001), pojava dijastolne disfunkcije u prva 24h (OR=27.7 95% CI, p&lt;0.0001), povećan dijametar leve pretkomore - LA (OR=5.0 95% CI, p=0,044) i srčana slabost na prijemu - Killip klasa 2-4 (OR=3.4 95% CI, p=0.003.). Univarijantnom regresionom analizom, snažni prediktori su neadekvatna rezolucija ST segmenta - STR (OR 2.0 95% CI, p=0.024) i zbirni indeks zidne pokretljivosti &ndash; WMSI &gt;2 (OR 21.6 95% CI, p&lt;0.0001). Totalno ishemijsko vreme nije imalo uticaja na post-infarktno remodelovanje (p=0.546). Tokom jednogodi&scaron;njeg praćenja ispitanici sa post-infarktnim remodelovanjem su imali značajno veću incidencu glavnih neželjenih kardiolo&scaron;kih događaja: rehospitalizacija (61.8% vs 22.6%; p&lt;0.0001) / najvi&scaron;e rehospitalizacija zbog srčane slabosti (40% vs 2.6%; p&lt;0.0001), sa mortalitetom 5.5%/; reinfarkta (20% vs 7.1%; p=0.007); rekoronarografija (45.5% vs 18.1%; p&lt;0.0001); revaskularizacija (30.9% vs 11%; p=0.001). Zaključak: Kod pacijenata sa akutnim STEMI prednjeg zida lečenih pPCI, pojava &quot;no reflow&quot; fenomena, dijastolne disfunkcije, povećana LA i srčana slabosti na prijemu su najjači rani nezavisni prediktivni faktori za nastanak post-infarktnog remodelovanja. Značajni prediktori su i neadekvatna STR i WMSI&gt;2. Pacijenti sa post-infarktnim remodelovanjem imaju veću incidencu glavnih neželjenih kardiolo&scaron;kih događaja i mortaliteta.<br>Objective: Patients with ST-elevated myocardial infarction (STEMI) treated by primary angioplasty (pPCI) will develop left ventricular (LV) remodeling in one third of the cases. The purpose of this study is to determine early predictors of LV remodeling after acute STEMI and pPCI. Methods: 210 patients with a first acute anterior STEMI treated by pPCI were included. All participants underwent echocardiography in the first 24hrs and again after 6 months, after which they were divided into two groups: remodeling (n=55; 26%) and nonremodeling (n=155; 74%). Results and discussion: The most powerful independent early predictors were: &quot;no reflow&quot; after pPCI (OR=30.0 95% CI, p&lt;0.0001), diastolic dysfunction in the first 24hrs (OR=27.7 95% CI, p&lt;0.0001), increased diameter of the left atrium - LA (OR=5.0 95% CI, p=0.044) and at admission Killip class 2-4 (OR=3.4 95% CI, p=0.003), by multivariant regression analysis. Also, strong predictors were incomplete ST-resolution - STR (OR 2.0 95% CI, p=0.024) and Wall motion score index - WMSI &gt;2 (OR 21.6 95% CI, p&lt;0.0001), by univariant regression analysis. Total ischaemic time had no influence on LV remodeling. The group with remodeling had more frequent major adverse cardiac events (MACE) during one year follow-up: re-hospitalisation (61.8% vs 22.6%; p&lt;0.0001) / mostly re-hospitalisation due to heart failure (40% vs 2.6%; p&lt;0.0001) and mortality 5.5%; reinfarction (20% vs 7.1%; p=0.007); recoronagraphy (45.5% vs 18.1%; p&lt;0.0001); revascularisation (30.9% vs 11%; p=0.001). Conclusion: For the patients with a first acute anterior STEMI, treated by pPCI, development of &quot;no reflow&quot; after pPCI, diastolic dysfunction, increased LA and heart failure on admission are the most powerful early independent predictors for LV remodeling. Incomplete STR and WMSI&gt;2 are strong predictors too. Remodeling patients will have a more frequent incidence of MACE and mortality.

Uvod: Stratifikacija rizika je postala integralna komponenta savremenog pristupa tretmanu u kliničkoj praksi. Danas se u dijagnostici i lečenju akutnog infarkta miokarda (AIM) koriste različiti skorovi rizika kao prognostički instrumenti za kratkoročan i dugoročan ishod bolesti. Nužni proceduralni procesi, u toku primarne perkutane koronarne intervencije (pPKI), kao i saznanja o distribuciji i vrstama lezija koronarnih arterija su od velikog značaja, te se preporučuje finalna evaluacija rizika neposredno nakon izvr&scaron;ene pPKI. Metode istraživanja podataka omogućavaju pronalaženje skrivenih obrazaca u podacima, otkrivanje njihovih uzročno-posledičnih veza I odnosa, te razvoj savremenih prediktivnih modela. Cilj: Kreiranje i testiranje jednostavnog, praktičnog i u svakodnevnoj praksi upotrebljivog prediktivnog modela za procenu intra-hospitalnog ishoda lečenja pacijenata obolelih od AIM sa ST-elevacijom (STEMI) lečenih pPKI. Metode: Istraživanje je unicentrična, retrospektivna, ali I prospektivna studija. U retrospektivnu studiju je uključeno 1495 pacijenta sa STEMI koji su lečeni na Klinici za kardiologiju Instituta za kardiovaskularne bolesti Vojvodine (IKVBV) kod kojih je u cilju rekanalizacije infarktne arterije izvr&scaron;ena pPKI, u periodu od decembra 2008. godine do decembra 2011. godine. Svaki pacijent je inicijalno predstavljen sa 629 obeležja sadržanih u postojećem IKVBV informacionom sistemu, koja čine demografske karakteristike, podaci iz anamneze i kliničkog nalaza, parametri biohemijskih analiza krvi priprijemu, parametri ehokardiografskog pregleda, angiografski i proceduralni detalji i &scaron;ifre prijemnih dijagnoza. U svrhu istraživanja podataka kori&scaron;ćeno je programsko re&scaron;enje otvorenog koda Weka. Tokom evaluacije različitih algoritama izabran je algoritam koji daje najbolje rezultate po tačnosti predikcije i ROC parametru. U sklopu retrospektivnog dela izvr&scaron;ena je validacija prediktivnog modela&nbsp; desetostrukom unakrsnom validacijom na celom skupu podataka. Prospektivnom studijom je na uzorku od 400 pacijenata sa STEMI lečenih pPKI u toku 2015. godine izvr&scaron;ena dodatna validacija razvijenog prediktivnog modela. Za iste pacijente je izračunavat i GRACE skor rizika, te je upoređena njegova, i prediktivna moć razvijenog modela. Rezultati: Alternativno stablo odluke (ADTree) izdvojen je kao algoritam sa najboljim performansama u odnosu na ostale evaluirane algoritme. Cost sensitive klasifikacija je kori&scaron;ćena kao dodatna metodologija da bi se pojačala tačnost. ADTree stablo odluke izdvojilo je osam ključnih parametara koji najvi&scaron;e utiču na ishod intra-hospitalnog lečenja: sistolni krvni pritisak pri prijemu, ejekciona frakcija leve komore, udarni volumen leve komore, troponin, kreatinin fosfokinaza, ukupni bilirubin, T talas irezultat intervencije. Performanse razvijenog modela su: tačnost predikcije je 93.17%, ROC 0.94. Razvijeni model je na prospektivnoj validaciji zadržao performanse: tačnost predikcije 90.75%, ROC 0.93. &Scaron;iroko kori&scaron;ćeni GRACE skor je na prospektivnom skupu postigao ROC=0.86, &scaron;to pokazuje da je razvijeni prediktivni model superiorniji u odnosu na njega. Zaključak: Razvijeni prediktivni model je jednostavan i pouzdan. Njegova implementacija u svakodnevnu kliničku praksu, omogućila bi kliničarima da izdvoje visokorizične pacijente, nakon reperfuzionog tretmana, a potom kod njih intenziviraju tretman i kliničko praćenje, a sa ciljem smanjenja incidence intra-hospitalnih komplikacija i povećanja njihovog preživljavanja.<br>Introduction: Risk stratification has become an integral component of modern treatment in clinical practice. Today, the diagnosis and treatment of acute myocardial infarction (AMI) use different risk scores as a prognostic instruments for short-term and long-term outcome of the disease. The necessary procedural processes during primary percutaneous coronary intervention (pPCI) as well as knowledge about the distribution and types of lesions in coronary arteries are of great importance, and a final risk evaluation is recommended directly after the pPCI. Methods of data mining allow finding hidden patterns in data, disclosure of their causal connections and relationships, and the development of modern predictive models. Aim: To create and test a simple, practical and usable predictive model in daily practice for the&nbsp; assessment of intrahospital treatment outcome of patients with AMI with STsegment elevation (STEMI) treated with pPCI. Methods: Presented research is unicentric, retrospective but also prospective study. Retrospective study included 1495 patients with STEMI who were admitted to the Clinics of cardiology of the Institute of Cardiovascular Diseases Vojvodina (IKVBV). For the purpose of recanalization of the infarct artery, pPCI has been performed to these patients during the period from December 2008 to December 2011. Each patient was initially described with 629 attributes from the existing information system of IKVBV. Those attributes consist of demographic characteristics, data from history and clinical findings, biochemical parameters of blood tests on admission, the echocardiographic parameters, angiographic and procedural details and admission diagnosis codes. For model development, an open source software solution Weka was used. During the evaluation of different algorithms, algorithm that gives the best results in terms of accuracy and ROC parameter was chosen. As part of the retrospective study, in order to assess the models performance, ten-fold cross-validation on the entire data set was used. A prospective study, on a sample of 400 patients with STEMI, treated with pPCI in 2015, performed additional validation of the developed predictive model. GRACE risk score was calculated for the prospective study patients and comparison with the developed model has been performed. Results: Alternative decision tree (ADTree) was isolated as an algorithm with the best performance in relation to other algorithms evaluated. Cost sensitive classification was used as an additional methodology to enhance accuracy. ADTree selected eight key parameters that most influence the outcome of intra-hospital treatment: systolic blood pressure on admission, left ventricular ejection fraction, stroke volume of the left ventricle, troponin, creatine phosphokinase, total bilirubin, T wave and the result of the intervention. The performance of the developed model are: the accuracy of the prediction is 93.17%, ROC 0.94. The developed model kept its performance in prospective validation: accuracy of prediction 90.75%, ROC 0.93. Widely used GRACE score achieved ROC = 0.86 in the prospective study patients, indicating that developed predictive model is superior to him. Conclusion: Developed predictive model is simple and reliable. Its implementation in everyday clinical practice, would allow clinicians to distinguish high-risk patients after reperfusion treatment, and then for them to intensify treatment and clinical follow-up, with an aim of reducing the incidence of intra-hospital complications and increase their survival.

Ciljevi: Cilj ove studije je da ispita bezbednost rane karotidne endarterektomije (CEA) u odnosu na odložene CEA nakon akutnog ishemijskog neurolo&scaron;kog deficita (TIA/CVI). Drugi cilj je da istražimo da li postoji razlika u brzini neurolo&scaron;kog oporavka između navedenih grupa. Metode: Ukupno 157 ispitanika u prospektivnoj studiji je praćeno 30 dana postoperativno. Grupa I ili rana CEA, je imala 50 ispitanika operisanih od 3. do 14. dana po TIA/CVI događaju. Grupa II ili odložena CEA, je imala 107 ispitanika operisanih od 15. do 180. dana nakon TIA/CVI. Praćen je proceduralni op&scaron;ti i specifični morbiditet i mortalitet u 30-dnevnom postoperativnom periodu. Rankin skor (mRS) smo koristili za procenu neurolo&scaron;kog invaliditeta. U odnosu na vrednost mRS skora smo formirali dve podgrupe mRS&lt;3 i mRS3. U statističkoj analizi koristili smo Pirsonov hi test, Studentov test, ANOVU analizu varijanse, Boniferonijev test i multiplu analizu varijanse za ponovljena merenja (GLM- general line model), kao i parametarsku i neparametarsku korelaciju i regresiju. Nivo značajnosti je bio 0,05. Rezultati: Prosečna starost ispitanika je bila 66,72 godine uz 66,2% osoba mu&scaron;kog pola. U grupi I je prosečno vreme do intervencije bilo 9,5 dana, a u grupi II 72,22 dana. Grupe su homogene u odnosu na faktore rizika i komorbiditet. Grupa I je imala 54% nestabilnih aterosklerotskih plakova u poređenju sa grupom II gde ih je bilo 31,8% (&chi;2 = 7.084; p &lt; 0.01). U grupi I TIA je imalo 50% ispitanika, a u grupi II CVI nalaza je bilo 68,2% (&chi;2 =4.825; p &lt;0.05). CVI do 1 cm veličine je statistički značajno vi&scaron;e zastupljen u grupi I , a CVI do 2 cm u grupi II (&chi;2 = 6.913; p &lt;0.05). Stopa CVI je u grupi I bila 2.0% a u grupi II je 2.8% (F = 0.083; p &gt; 0.05). Stopa postoperativnog infarkta miokarda (IM) je u grupi I je 2.0% a u grupi II je 1.9%. Stopa specifičnog hirur&scaron;kog morbiditeta je u grupi I 4.0% a u grupi II 3.7%. U grupi I ukupni morbiditet bio 6.0% a u grupi II 7.5%, razlika nije bila statistički značajna (F =0.921; p &gt; 0.05). Mortaliteta u obe grupe nije bilo. CVI/IM/smrt stopa je u grupi I bio 4.0% a u grupi II je bio 4.7% (F = 0.122; p &gt;0.05). Hiperlipidemija je signifikantan faktor rizika za CVI/IM/smrt (&chi;2 = 4.083; p &lt; 0.05). Pobolj&scaron;anje mRS je u grupi I imalo 52%, a u grupi II 31,8% pacijenata (&chi;2 = 5.903; p &lt;0.01). Relativni rizik je 2,4 odnosno toliko puta je veća &scaron;ansa da kod bolesnika dođe do promene mRS ako je bolesnik u grupi I. Pad mRS koji nastupa između trećeg i desetog dana nakon CEA je statistički visoko značajno izraženiji u grupi ranih CEA ( F 3,701 df 1 p=0,029). Kod bolesnika sa TIA u preko 60% slučajeva do&scaron;lo je do pada mRS, a kod onih koji su imali CVI u oko 25.5% (&chi;2 = 18.050; p &lt; 0.01). Kod Rankin skora podgrupe mRS&lt;3 i mRS3 je pad bio značajan i po vremenu (F 18,774; df 6; p=0,000) i po podgrupi ali je daleko brži pad zapažen u podgrupi mRS&lt;3(F 6,010; df 1; p=0,003). Zaključak: Rana CEA je jednako bezbedna kao i odložena CEA u pogledu incidence perioperativnog morbiditeta i mortaliteta. Ranom CEA se postiže znatno brži neurolo&scaron;ki oporavak pacijenata, naročito onih sa TIA i mRS&lt;3 skorom.<br>Objectives: The aim of this study was to investigate the safety of early carotid endarterectomy (CEA) in relation to the delayed CEA after acute ischemic neurological events (TIA / CVI). The second objective was to investigate whether there is a difference in speed of neurological recovery between these groups. Methods: A total of 157 patients in the prospective study followed 30 days postoperatively. Group I or early CEA, had 50 patients operated from 3 to 14 days after TIA / CVI event. Group II or delayed CEA, had 107 patients operated from 15 to 180 days after the TIA / CVI. Accompanied by the general and specific procedural morbidity and mortality in 30-day postoperative folow up. Rankin score (mRS) were used for evaluation of neurologic disability. In relation to the value of mRS score we formed two subgroups mRS &lt;3 i mRS3. In the statistical analysis we used the Pearson chi test, Student&#39;s test, ANOVA analysis of variance, Boniferony test and multiple analysis of variance for repeated measures (GLM- general line model), as well parametric and nonparametric correlation and regression. The significance level was 0.05. Results: The mean age was 66.72 years with 66.2% of males. In Group I is the average time to intervention was 9.5 days, and in group II 72.22 days. The groups were homogeneous in relation to risk factors and comorbidities. Group I had 54% of unstable atherosclerotic plaques compared with group II, where it was 31.8% (&chi;2 = 7.084; p &lt;0.01). In the group I TIA had 50% of respondents, while in group II CVI was 68.2% (&chi;2 = 4.825; p &lt;0.05). CVI to 1 cm in size were significantly more frequent in the group I, a CVI to 2 cm in group II (&chi;2 = 6.913; p &lt;0.05). CVI rate in the group I was 2.0%, and in group II was 2.8% (F = 0.083, p&gt; 0.05). Postoperative myocardial infarction (MI) in the group I is 2.0%, and in group II was 1.9%. Specific surgical morbidity rate in the group I and 4.0% in the group II 3.7%. In group I total morbidity was 6.0% in group II 7.5%, the difference was not statistically significant (F = 0.921; p&gt; 0.05). Mortality in both groups was not. CVI/IM/death rate in group I was 4.0% in group II was 4.7% (F = 0.122; p&gt; 0.05). Hyperlipidemia is a significant risk factor for CVI/IM/death (&chi;2 = 4.083; p&lt;0.05). Improving mRS in the group I had 52% and in group II 31.8% of patients (&chi;2 = 5.903; p &lt;0.01). The relative risk was 2.4 times as much and is more likely to occur in patients mRS changes if the patient in group I. Improving mRS that occurs between the third and tenth days after CEA was highly statistically significantly greater in the group of early CEA (F 3,701 df 1 p = 0.029). In patients with TIA in 60% of cases there was a decline mRS, and those had CVI in about 25.5% (&chi;2 = 18.050; p &lt;0.01). In Rankin score subgroups mRS &lt;3 i mRS 3 the decline was significant and time (F 18,774; df 6; p =0.000) and in the subgroup but it is far more rapid decline observed in the subgroup mRS &lt;3 (F 6.010; df 1; p = 0.003). Conclusions: Early CEA is as safe as the delayed CEA in respect incidence of perioperative morbidity and mortality. Early CEA is achieved significantly faster recovery of neurological patients, especially those with TIA and mRS &lt;3 compared with delayed CEA.

This diploma thesis deals with the role of nutrition in the prevention and treatment of cardiovascular diseases. The theoretical part describes basic knowledge about cardiovascular diseases, prevalence, risk factors and the importance of nutrition in their prevention and treatment. The theoretical part describes in detail the effect of intake of carbohydrates, fiber, describes the role of glycemic index of foods, fat intake and their chemical composition, minerals, alcohol and coffee. One part of the theoretical part also describes the role of nutrition in the treatment. The research part is devoted to the dietary habits of patients who have already had an acute myocardial infarction. The aim of the research is to find out whether patients follow current recommendations for the prevention and treatment of CVD, or how the actual diets of these patients differ from recommendations. The data were collected using a questionnaire filled in during interviews with selected patients. It was found out that patients hospitalized for acute myocardial infarction have insufficient knowledge to build a balanced diet, or that nutritional recommendations are consciously violated. Problematic is especially the choice of fats, the unbalanced composition of the diet, the frequent consumption of too fat and sweet...

Introduction: The coronary heart disease is still an actual topic. The mortality has been in recent years declining, but prevalence in the population stagnates, so involve a large group of patients. The incidence of acute myocardial infarction is still high. One of the methods of reperfusion therapy is the cardiac surgery by coronary artery bypass graft, which may be postoperatively complicated by the development of low cardiac output syndrome with the need of the extracorporeal membrane oxygenation. These patients require very specialized not only during the critical phase, but also during the long-term convalescence including rehabilitation, weaning from the artificial lung ventilation, self-sufficiency training and help with return to normal life. Literature search: The theoretical part is based on the research of National Medical Library (NLK) and Study and Scientific Library of the Pilsen Region (SVKPL). The PubMed, Scopus, Web of science and Science direct databases were used to search articles in professional publications, including the latest cohort studies. The periodicals Cor et Vasa, the European Heart Journal, Critical Care and the European Journal of Cardiovascular Nursing were used. An important source of information is the guidelines of the Czech Society of Cardiology (ČKS), European...

Univerzita Karlova 1. lékařská fakulta Studijní program: Doktorské studium biomedicíny 1. LF UK Studijní obor: Oborová rada Fyziologie a patofyziologie člověka MUDr. Gabriela Dostálová Disertační práce Vybrané aspekty akutního infarktu myokardu u mladých nemocných Specifics of Acute Myocardial Infarction in Young Adults Školitelé: prof. MUDr. A. Linhart, DrSc., doc. MUDr. D. Karetová, CSc. Praha 2017 Abstract Coronary heart disease is the leading cause of death in adults in the western world. Myocardial infarction can represent the lethal manifestation of coronary heart disease leading to sudden cardiac death. Although myocardial infarction mainly occurs in patients older than 45 years, the young population can be affected as well. Despite the relatively low incidence of myocardial infarction in the young population, the mortality rates and long-term disability make acute myocardial infarction in young patients an important clinical issue. Consequences of myocardial infraction usually have great impact on the young patient's psychology, ability to work and the overall quality of life. The management of young myocardial infarction patients should differ at least slightly from the older ones. Young patients usually have a different risk factor profile, clinical presentation, and prognosis in comparison with...

The goal of this thesis was to discover the influence of adaptation to chronic hypoxia on ischemic tolerance of heart - this experiment was carried out on two different hypertension kinds of laboratory rats. Spontaneously hypertensive rats (SHR) and rats from a conplastic strain SHR/OlaIpcv-mtBN/Crl , whose mitochondrial genome of the SHR strain was replaced with a mitochondrial genome of the normotensive strain Brown Norway, were exposed to continuous normobaric hypoxia (10% O2) for a period of 3 weeks. On the other hand, the control group of rats was kept in normoxia. At the end of the adaptation period, the ischemic tolerance of heart and the mitochondrial aconitase expression were examined. In the case of both hypertensive strains, the chronic hypoxia led to a significant drop in the size of a myocardial infarction and also to a drop in the number of reperfusion arrhythmias. In the case of the SHR strain, the incidence of ischemic arrhythmias decreased. Chronic hypoxia had no impact on the aconitase expression for both analysed strains. This thesis showed that the ischemic tolerance of heart can be enhanced in the case of the SHR strain. On the other hand, the mitochondrial genome of the SHR strain does not seem to play any significant role in protection mechanism. Key words: chronic hypoxia,...

Prevention of cardiovascular disease including myocardial infarction is in recent years a widely discussed topic. Cardiovascular diseases are currently the most widespread disease among the worldwide. This thesis deals with the participation of patients after myocardial infarction in active care of their health in secondary prevention. For failure principles of secondary prevention is increased morbidity of these cardiovascular diseases and subsequently increase the costs for further treatment. Well-timed and targeted prevention is very important how to reduce the cost of treatment and the restoration of health and maintaining a good quality of life. The thesis is composed of two parts, theoretical and empirical. The theoretical part of the thesis describes cardiovascular diseases, especially acute myocardial infarction, prevention and education, including educational process of secondary prevention. The empirical part was realized by qualitative research. Information was collected by semi-standardized interview technique. The interview was composed of both closed and open-ended questions where had respondents the opportunity to express individually. The research group consisted of patients and nurses of three selected cardiocenters in Czech Republic - University Hospital Motol, České Budějovice Hospital, a.s. and Faculty Hospital Plzeň. In the first phase of the research we examined the awareness of patients of secondary prevention. In addition we inquire into the level of their activities in the care of their health and the impact of realized changes to their life satisfaction. The research sample is consisted of 12 respondents - patients who in former times have had a myocardial infarction and now were re- hospitalized due to symptoms of heart problems. For the research were patients selected by random sampling and divided into three groups, four from each cardiocenter. In the second phase of the research, we investigated the options and rate of education of nurses taking care of patients after myocardial infarction in pursuance of secondary prevention and types of nursing documentation kept by nurses of cardiology ward. This part of the study sample was consisted of nine nurses working in selected cardiocentre. For one interview were approached three nurses from each chosen department with longer experience in the field of cardiology. For the research was established six goals and eight research questions. The results of the research showed that the patients are relatively well educated in the principles of secondary prevention of cardiovascular disease, but not enough by nurses. The knowledge of patients of prevention of myocardial infarction and secondary prevention measures is at a relatively good level. The rate of changes in the approach to secondary prevention is unsatisfactory and doesn´t meet the rate of improvement of capabilities of modern medicine regardless of their age and length of treatment. The research also showed a positive effect of the principles of secondary prevention on the quality of life of patients.

The aim of this study is to analyse a genetic and proteomic aspects that could play an important role in development of chosen cardiovascular disease. Matrix metalloproteinases are enzymes that contribute strongly to the degradation of extracellular matrix components. In this study the serological levels of MMP-2 and MMP-9 were investigated using immunological testing in patients with aortic valve disease and in patients with myocardial infarction. Significantly higher levels of MMP-2 and MMP-9 were determined in both above mentioned groups of patients. Association of serum levels of MMP-2 and MMP-9 and development of concomitant aortic dilatation was not confirmed in patients with aortic valve disease. Changes in serum levels within 24 hours and after 6 months post myocardial infarction were characterized. About 10 % of patients operated for aortic valve disease suffer simultaneously from ascending aortic dilatation. The current study did not reveal any significant genetic variation in TGFBR2 gene and in chosen exons of FBN1 gene in these patients. Further genetic research is needed to identify the cause of the pathology in aortic wall. Gene expression of selected genes was measured by microarray screening in patients with myocardial infarction. These genes were related to MMPs and did not show...

Morphine is a clinically very important drug from the opioid group that is used for treatment of severe pain because of its strong analgetic effect. Opioid receptors mediating the morphine effect interact with the Gi/o class of trimeric G-proteins. Opioid receptors also occur in heart tissue and morphine can thus potentially exercise its effect on the function of this organ. The major aim of this project was to pursue consequences of long-term treatment with morphine on expression and distribution of selected heterotrimeric G-protein subunits in the rat heart. Potential cardioprotective effects of this drug have also been studied. Laboratory rats of the Wistar strain were treated with morphine (1 mg/kg/day or 10 mg/kg/day) for 10 or 28 days. The control group was treated with saline solution. Prolonged treatment with morphine did not cause any effects on Gs, Gi, Gz, Gq/11, G subunits, but the expression of Go rather decreased. The results of subsequent experiments showed that prolonged administration of high doses of morphine may reduce the area affected by infarction and reduced the frequency of ventricle arrhythmias depending on dose and duration of morphine administration. Key words: morphine, myocardium, opioid receptor, G-protein subunits, infarction.

Introduction: Acute coronary syndromes (ACS) belong to cardiovascular diseases and contribute significantly to mortality, morbidity and disability in developed countries. Therefore the aim of current therapy is to reduce the risk of subsequent complications, including early death, and to increase patients' quality of life. For successful therapy it is necessary to follow regimen and dietary principles which are along with pharmacotherapy an integral part of treatment. Therefore sufficient knowledge of these principles by patients is a basic precondition for their successful treatment. Objectives: The aim of the diploma thesis was to assess dietary and regime knowledge in patients diagnosed with ACS. The specific objectives were: to determine an effect of sex or previous education on the knowledge; to describe patients' dietary habits; to specify their knowledge of nutrition; and to identify which knowledge is the most deficient. Methods: The research was carried out as a questionnaire survey. The questionnaire was compiled directly for the purposes of this thesis and was approved by the VFN Ethics Committee for use in inpatient wards at II. and III. internal clinics and at the Coronary unit of II. internal clinics of VFN. A total of 80 patients diagnosed with ACS were included in the study....

Abstract In the Czech Republic there is no doubt about the tendency of gradual increase in median life expectancy, which is significantly affected by the fact that mortality from cardiovascular diseases, especially from acute coronary syndromes, has been decreasing. Besides the provable effect of a healthy lifestyle, diet and, by all means, a quality and effective pharmacotherapy, a significant development in the field of interventional cardiology contributes to this accomplishment. The number of coronographies, coronary angioplasties and implanted stents have multiplied, and today the invasive coronarographic diagnostics and percutaneous myocardial revascularization belong to the the most common diagnostic and therapeutic methods in treatment of acute forms of ischemic heart diseases. An obvious prerequisite for such a rapid development in the field of intervention coronary angiography was the establishment of a sufficiently dense network of catheter laboratories and specialized facilities, which provide a highly professional and intensive care for patients. This thesis is focused on three basic objectives: ? To survey and characterize differences in nursing care concerning various complications in patients after SKG / PCI ? To survey bio / psycho / social impacts of complications after SKG / PCI on a patient ? To identify and summarize personal and material prerequisites and requirements to ensure quality nursing care for these complicated conditions The research was conducted by using a qualitative methodology. The methods used were observation, non-standardized interviews and medical and nursing records analyses. The research survey samples on which the investigation was focused were patients with the acute coronary syndrome hospitalized in the coronary care unit in the Cardio Center in České Budějovice, their family members and also the nursing staff providing the comprehensive nursing care. The outcomes of this survey were eleven descriptive case reports characterizing the occurrence of the most frequent complications in patients with ACS after SKG / PCI. To ensure clarity, each case study is complemented by a thought map with an account of the most important nursing interventions in the management of specific acute conditions. The paper also contains a framework analysis of bio / psycho / social impacts of complicated situations on patients. It is interesting to compare this matter from the perspective of nurses and patients, which is seen in correlation graphs. The section describing the organizational and personnel provision is introduced with the characteristics of the medical process and it also contains the list of medical personnel with their qualifications and the length of experience in the Coronary care unit in České Budějovice. Summarization of the instrumental medical equipment is also based on the analysis of previous cases and is accompanied by photographs of the equipment typical and indispensable for the care of patients in the Coronary care unit, which primarily has an informative and complementary character to get an integrated view of the Coronary care unit running and the nursing staff work.