Journal: Kardiologia polska
Patients after prior coronary artery bypass graft surgery (CABG) often need repeat percutaneous revascularization due to saphenous vein grafts (SVG) poor patency rates and higher risk of re-CABG. The data of different percutaneous revascularization strategies in patients with prior CABG is scarce.
The main goal of treatment in patients with atrial fibrillation is to counteract the effects of embolization, considering the relatively high risk of cerebral embolic events. The aim of our study was an assessment of the efficacy and safety of rivaroxaban in the secondary stroke prevention in patients with non-valvular atrial fibrillation (NVAF).
According to current ESC Guidelines for the diagnosis and treatment of heart failure cardiac resynchronization therapy (CRT) is indicated in patients suffering from heart failure (HF) with reduced ejection fraction (EF) with significantly widened QRS complexes. Presence of vital myocardium proved by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is on the other hand known factor of unfavorable outcome in HF.
From the physiological point of view carotid bodies are mainly responsible for the ventilatory response to hypoxia; however, they also take part in the regulation of sympathetic tone. According to pre-clinical data these structures likely contribute to the development and progression of sympathetically mediated diseases. Moreover, carotid bodies deactivation in animal models, apart from the reduction in sympathetic activity, improved blood pressure control in hypertension and reduced mortality in heart failure. On this basis two first-in-man studies have been recently performed to investigate the safety and feasibility of such an approach in humans. In this review we summarize the current knowledge regarding carotid bodies function, the prevalence of its abnormalities and the consequences of carotid bodies excision in human hypertension and heart failure.
Nordic Walking ( NW) is an effective form of endurance training in cardiac rehabilitation (CR). The key parameter for the safety and effectiveness of training is its intensity. The direct measure of intensity is the volume of oxygen consumption (VO₂), the indirect measure is chronotropic cardiac response to exercise. Data on the size of VO₂ during NW in field conditions among rehabilitated patients after coronary events were not previously published. The AIM: of the study was to assess the intensity of NW training in the field by measuring VO₂ and energy expenditure (EE) as well as heart rate (HR) in comparison with cardiopulmonary exercise test (CPET) on a treadmill in a group of rehabilitated patients after coronary events.
The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender.
Patients suffering from cardiogenic shock, who don’t respond to a conventional therapy, may substantially benefit from support systems such as the extracorporeal membrane oxygenation (ECMO), which maintains the blood flow in the systemic and pulmonary circulation, unburdening the heart. The authors present their personal experience in the qualifying and treatment of patients in cardiogenic shock, with the use of ECMO of the veno-arterial (VA) type.
Intravascular administration of contrast media is an irreplaceable step of percutaneous coronary intervention (PCI). Being the latter a very common procedure, contrast-induced acute kidney injury (CI-AKI) has become one of the most frequent causes of acute nephropathy, and a relevant prognostic impact of CI-AKI has been observed. Some patient comorbidities and procedural characteristics have been identified as key risk factors of CI-AKI. In this review, current evidences and future research directions on CI-AKI prevention for patients undergoing PCI are discussed.
Nutrition modification is one of the cornerstones of arterial hypertension (AH) treatment. Current American and European guidelines recommend to ingest fruits, vegetables, whole grains, and low-fat dairy products, and decrease the consumption of red meat, sugar, and trans fats. The aim of our review is to summarize the available evidence on the topic of dietary patterns associated with lower blood pressure (BP). Dietary Approach to Stop Hypertension (DASH) diet is able to lower BP equally or even more significantly than some antihypertensive drugs. The Mediterranean diet also leads to the significant reduction in BP. Vegans and vegetarians are showed to have a lower prevalence of AH than omnivores. Caloric restriction may decrease BP in normotensive, prehypertensive and hypertensive populations. BP can also be lowered by certain nutraceuticals (beetroot juice, magnesium, vitamin C, catechin-rich beverages, soy isoflavones etc). Conclusions. Diet effects on BP are mediated by the decrease of body weight, amelioration of inflammation, increase of insulin sensitivity, and antihypertensive effects of some single nutrients. Vegetarian and vegan diets have robust evidence proving their ability to reduce BP. The existence of floor effect makes these diets usable for normo- and prehypertensive people with high risk of developing AH. The dietary and nutraceutical approach to the BP lowering never has to substitute the drug treatment when the latter is needed.
Cardiovascular diseases are the most common cause of death in patients over 60 years old. Imaging methods of a pivotal role in cardiological diagnostic processes are echocardiography, magnetic resonance, multi-row-detector computed tomography, coronary angiography, and radioisotope tests. In this paper, we summarize the techniques of nuclear medicine (positron emission tomography, single-photon emission computed tomography, radionuclide ventriculography) that could be implemented in the cardiovascular diagnostic algorithms. Despite being acknowledged and positioned in a few cardiological guidelines, these imaging methods are still underestimated by practitioners. Nevertheless, noninvasive diagnostic tools are of increasing potential and should be implemented whenever possible. We discuss the usefulness of particular techniques in the management of patients with obstructive and non-obstructive coronary artery disease, including assessment of myocardial perfusion, contractility, viability, and detection of unstable atherosclerotic plaques. Radioisotope imaging can also be valuable in the diagnosis of infective endocarditis, as well as cardiac sarcoidosis and amyloidosis. Apart from presenting the theoretical principles of nuclear cardiology, this paper also provides three case reports illustrating a practical implementation of these imaging modalities.