|
|
Impact of Admitting Department on the Management of Acute Coronary Syndrome after an Out of Hospital Cardiac Arrest
Jánský, Pavel ; Moťovská, Zuzana (advisor) ; Hutyra, Martin (referee) ; Ošťádal, Petr (referee)
Aim. This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. Methods: We studied 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. Results: Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on- site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (p<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (p<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU...
|
|
|
Effect of continuous blood flow on cerebrovascular perfusion and hemocoagulation in patients with implantable left ventricular assist device
Koňařík, Miroslav ; Szárszoi, Ondrej (advisor) ; Ošťádal, Petr (referee) ; Brát, Radim (referee)
Implantation of left ventricular assist devices (LVADs) is an integral treatment modality in patients with heart failure. In most cases, it refers to a machine which generates continuous blood flow with reduced pulse pressures. The effect of reduced pulsatility on organ function, such as homeostatic regulatory mechanisms is still unknown. The goal of our study was to understand whether continuous blood flow generated by mechanical support devices affects cerebrovascular regulatory mechanisms (study A), and whether or not hemocoagulation is affected in regard to complications relating to hemocompatibility (study B). Study A utilized finger plethysmography and TCD ultrasonography to detect possible changes in static cerebral auto-regulation when compared to a range of rotations per minute (rpm) of the LVAD, which served as a model for either accentuation or reduction in residual arterial pulsatility. Study B divided patients with implanted LVADs based on the incidence of selected thrombophilic mutations. Both groups of patients were placed on individualized anticoagulation protocols. The results were focused on the incidence of thromboembolic and hemorrhagic complications, and eventual morbidity/mortality of the patient. Our findings did not confirm disruption to static cerebral auto-regulation,...
|
|
|
Neuromodulation in heart failure
Naar, Jan ; Ošťádal, Petr (advisor) ; Rokyta, Richard (referee) ; Vízek, Martin (referee)
The prognosis of heart failure with reduced ejection fraction remains poor. Neurohumoral activation, including increased cardiac sympathetic nerve activity, plays an important role in the pathogenesis as well as disease progression. Recently, several neuromodulation strategies have been proposed that aim to directly affect the residual autonomic imbalance. Spinal cord stimulation is one of the proposed methods. In the clinical part of this project, we assessed the mid-term effect of spinal cord stimulation on cardiac sympathetic nerve activity and the acute effect on autonomic balance. In the total study population, we did not detect any changes in cardiac sympathetic nerve activity or heart rate variability. However, we observed that the patients with high baseline sympathetic nerve activity or low heart rate variability responded favourably to therapy, reflected in reduced cardiac sympathetic nerve activity and increased heart rate variability. Considering these results, we conducted an experimental study focused on the effect of acute severe heart failure on heart rate variability. In a porcine model of hypoxic myocardial dysfunction, we observed a significant reduction in heart rate variability in all parameters recorded. Our results indicate that spinal cord stimulation may improve autonomic...
|
|
|
New aproaches to myocardial atrophy attenuation after mechanical unloading - Experimental study of heterotopic heart transplantation in rats
Pokorný, Martin ; Malý, Jiří (advisor) ; Ošťádal, Petr (referee) ; Rohn, Vilém (referee)
Cardiac atrophy, as a result of a long term mechanical unloading observed in patients treated with mechanical circulatory supports, represents a substantial obstacle in cardiac recovery. The first aim of this thesis was to evaluate the course of unloading-induced cardiac atrophy in healthy and failing heart. Mechanical unloading was studied in an experimental model of heterotopic heart transplantation in rats. Heart failure was experimentally induced by chronic volume overload achieved by creation of aorto-caval fistula. The second aim of this thesis was to discover if dietary induced increase in fatty acids concentration in heart tissue, specifically myristic, palmitic and palmitooleic, that are believed to promote physiological heart growth, could attenuate the course of cardiac atrophy. The third aim of this thesis was to examine if increased isovolumic loading obtained by intraventricular implantation of newly designed spring expander would attenuate the development of cardiac atrophy. The level of cardiac atrophy was evaluated as the weight loss of the heterotopically tranplanted heart compared to the control heart on days 7, 14, 21 and 28 after heterotopic transplantation. The cardiomyocyte width and the level of cardiac fibrosis was studied simultaneously. Mechanical unloading following heterotopic...
|
|
|
Risk factors of atherosclerosis
Kratochvíl, Filip ; Ošťádal, Petr (advisor)
The topic of my thesis I chose based on their interest in this issues. Atherosclerosis is a multifactorial disease occurring in the vessel wall due to the interaction of metabolic and structural properties of the vessel wall , the blood components and hemodynamic forces. It's a long ongoing inflammatory process, which affects the inner wall of the damaged artery chemical, physical or biochemical effects and leads to structural changes in the vascular wall Consequently fibroproliferative inflammation. The term arteriosclerosis was first used in 1829 to describe calcifications in the wall of the artery . The term atherosclerosis was then used in 1904 to describe lipid deposits in atherosclerotic arteries. The discovery of the relationship between clinical symptoms of myocardial infarction , atherosclerosis and coronary artery thrombosis made in 1912 by James Herrick . Atherosclerosis is the process involved in pathophysiological mechanisms of organ changes , which are manifested serious complications , such as coronary heart disease, peripheral vascular disease or ischemic cerebrovascular event . Taking a number of risk factors may condition the not only atherosclerosis , but also its rapid progress and spread to other areas.
|
|
|
Radial approach to coronary catheterizations and interventions
Bernat, Ivo ; Rokyta, Richard (advisor) ; Vojáček, Jan (referee) ; Ošťádal, Petr (referee)
Radial approach in coronary catheterizations and interventions has been only an alternative of the femoral approach. But due to some important advantages radial approach has a chance to become the first choice in majority of catheterized patients. The most important advantage is the reduction of vascular access site bleeding complications. Additonal benefits are patient satisfaction, cost reduction, shorter hospital stay and possibility of the same-day discharge catheterizations and interventions. The aim of our work was to try to answer three open questions: 1. is it possible to catheterize majority of our patients from the left radial artery when 90% of them are right-handed ? 2. what is the optimal care for the radial artery after the procedure in prevention and treatment of radial artery occlusion? 3. is it effective to implement radial approach in primary PCI as a first approach for STEMI patients? The first part relates the left radial approach. After construction of our special variable support for the left arm and forearm we succesfully used this approach in our studies in almost 90% of patients. The second part of this work contains our randomized trial comparing two different doses of unfractionated heparin in prevention of radial artery occlusion after diagnostic cardiac catheterizations....
|
|
|
Evaluation of nutritional status and cardiac risk in patients with anorexia nervosa.
Pálová, Sabina ; Charvát, Jiří (advisor) ; Ošťádal, Petr (referee) ; Zamrazil, Václav (referee)
Anorexia nervosa (MA) is serious psychiatric disease associated with significant mortality. One of the main causes of mortality in these patients is cardiac complications. In 2003 - 2010 we examined 30 patients with established diagnosis of MA. Routinely used nutritional parameters are normal even in severe malnutrition in MA patients and we can ́t use them to diagnose or monitor nutritional status. Therefore we evaluated plasma aminoacids levels to detect minor changes of protein metabolism. According to our results we found mild hyperaminoacidemia and significant elevation of Gly/Val and Phe/Tyr ratio. In the second part of our research we performed non invasive examination s in risky patients with AN to consider possible cardiac complications. Results of ECG and echocardiography confirm results of the previous published studies. Original finding is significant decrease in flow mediated dilatation of brachial artery and its normalization after realimentation. We found also in ambulatory blood pressure monitoring significant decrease in blood pressure during the active period which was the consequence of changes in the heart rate variability. Decrease of the blood pressure in patients with AN in standing position was associated with increase of HF power in supine position and particularly with the lack of...
|
|
|
The Primary Prevention of Atherosclerosis
Suchecká, Barbora ; Ošťádal, Petr (advisor)
The topic of atherosclerosis and its complications is currently the subject of much attention because it is a very common disease and the complications caused by her dying a large number of people. Cardiovascular disease (CVD) is the cause of 30% of all deaths worldwide. In the Czech Republic are the main cause of CVD death (in 2004 contributed to the overall CVD mortality of 51, 4%). 8 The topic I chose it because I care about, and in his medical practice with him will meet. I consider the prevention of atherosclerosis for a better solution than to treat complications or consequences that disease caused.
|
|
|
Advanced heart failure in the 21st century: new physiological insights and new therapeutic avenues
Boilson, Barry Anthony ; Aschermann, Michael (advisor) ; Vítovec, Jiří (referee) ; Ošťádal, Petr (referee)
Countries with developed economies are currently facing an epidemic of heart failure (HF) and the prognosis of patients with advanced HF remains extremely poor. One of the therapeutic options for patients with advanced HF is heart transplant. The number of cardiac transplants performed in USA and other states each year has stagnated despite an increasing number of cases of end-stage heart failure each year, primarily due to limited donor supply. Therefore, novel therapies for cardiac replacement (such as left ventricular assist devices, LVADs), other cardiac assistance devices including arrhythmia treatment (cardiac resynchronization therapy, CRT or implantable cardiac defibrillators (ICDs) have been tested and are being used in clinical practice. Moreover, stem cell therapy has been tested as well as a role of endogenous progenitor cells has been explored. However, effects of the novel therapeutic approaches or their combination on pathophysiology of HF as well the involvement of endogenous progenitor cells are incompletely understood, which requires further research. The main aims of the thesis with corresponding main hypotheses were three as follows. First, to study the physiological effects of LVADs on pulmonary vascular resistance and the incidence and clinical tolerance of ventricular...
|
|
|
Changes of the electric field of the heart in disorders of glucose metabolism and ways of influencing them by correction of impaired autonomic nervous regulation
Fialová, Elena ; Kittnar, Otomar (advisor) ; Danzig, Vilém (referee) ; Ošťádal, Petr (referee)
Diabetes mellitus (DM) is not just a simple metabolic disorder, however, it is considered to be a cardiovascular disease of a metabolic origin. This is apparent especially when speaking about type 2 diabetes (DM II). Patients with DM have a high occurrence of vegetative nervous system (VNS) disorders that manifest themselves as an increased activity of the sympathetic nervous system that correlates with peripheral autonomic neuropathy and is considered to be the major pathophysiological mechanism for the development of DM II. The objective of our study was to determine whether a comprehensive spa treatment (ST) may affect the level of the sympathetic tone of patients suffering from DM II. As an indicator of the sympathetic tone, selected electrocardiographic parameters derived from the HRV, microvolt T-wave alternans, and microvolt R-wave alternans were evaluated. The electrophysiological examination of patients was performed before and after a three-week spa treatment using the KARDiVAR system. The method is used to examine the current state of the autonomic nervous system and carry out an analysis of risk factors and adaptive capabilities of the organism. The results showed favorable changes in DM II patients after the ST, primarily in terms of reduced sympathetic adrenal system activity,...
|
guest ::
