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The impact of positive inotropic and antiarrhythmic drugs on cardiovascular system
Kočková, Radka ; Linhart, Aleš (advisor) ; Janoušek, Jan (referee) ; Štengl, Milan (referee)
Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo A significant increase in cardiovascular medication use during pregnancy has occurred in recent years but only limited evidence on its safety profile is available. We hypothesized that drug-induced bradycardia is the leading mechanism of developmental toxicity. We tested metoprolol, carvedilol, or ivabradine for embryotoxicity and their acute effect on chick embryonic model. We used video microscopy and ultrasound biomicroscopy. Significant dose-dependent mortality was achieved in embryos injected with carvedilol and ivabradine. In ED4 embryos, metoprolol, carvedilol and ivabradine reduced the heart rate by 33%, 27%, and 55%, respectively, compared to controls (6%). In ED8 embryos this effect was more pronounced with a heart rate reduction by 71%, 54%, 53%, respectively (controls 36%). Cardiac output decreased in all tested groups but only proved significant in the metoprolol group in ED8 embryos. The number of -adrenergic receptors showed a downward tendency during embryonic development but a negative chronotropic effect of tested drugs was increasingly pronounced with embryonic maturity. This effect was associated with reduced cardiac output in chick embryos, probably leading to premature death....
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Detection of atrial fibrillation in ECG
Húsková, Michaela ; Vítek, Martin (referee) ; Maršánová, Lucie (advisor)
Aim of this thesis is description of problems of atrial fibrillation and methods that could be used for detection in the electrocardiogram. The introductory part of the theoretical analysis deals with the principle of electrophysiology of the heart and mainly the pathophysiology of atrial fibrillation. Additionally the work is focused on describing methods on automatic atrial fibrillation detection and capabilities of PhysioNet database. In the practical part methods are implemented in the MATLAB environment. After using the statistics to evaluate the quality of the parameters, the automatic classification of the data was performed by the method of The Nearest Neighbour. Finally, the accuracy of testing is presented.
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Influence of autonomic nervous system in the inducibility of atrial fibrillation.
Šrutová, Martina ; Provazník, Ivo (referee) ; Kolářová, Jana (advisor)
Cílem této práce je zjištění změn předcházejícím fibrilaci síní. Pozorována je rovnováha mezi sympatikem a parasympatikem. Do experimentu výzkumného ústavu Cleavlendské kliniky bylo zapojeno šest psů různých ras. Signály EKG byly získány Holterovským 24hodinovým monitorováním. Pomocí 40 vysokofrekvenčních impulsů (TI) byla každých 30 minut vyvolávána AF. Z 24hodinového signálu byly extrahovány kratší epizody. Každá z těchto epizod obsahovala 10 minut předcházejících TI a 3 minuty následující po TI. Desetiminutové epizody byly zpracovány automaticky, byly detekovány QRS komplexy a RR intervaly a vypočteny HRV parametry. Přítomnost a délka trvání AF byly zjištěny manuálně z tříminutových intervalů následujících po TI. Byla-li vyvolána AF o délce trvání kratší než 30 sekund došlo ve srovnání s epizodami bez výskytu AF k významným změnám tří HRV parametrů. HF parametr poklesl pro epizody s výskytem AF. LF parametr byl naopak vyšší v epizodách s AF. Pro AF delší než 30 sekund nebyly významné změny pozorovány. Změny v epizodách s krátkou AF mohly být způsobeny změnami vlivu sympatiku a parasympatiku. Ke vzniku dlouhých AF je pravděpodobně zapotřebí i jiného vlivu, který nemusí nutně souviset s nervovým systémem. K dalším analýzám je zapotřebí většího množství signálů.
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Classification of ECG by artificial neural networks
Loviška, David ; Vítek, Martin (referee) ; Hrubeš, Jan (advisor)
The aim of project with name Classification ECG by artificial neural networks is simplify and speed up working a doctor. That reaches created program that the is capable simply and almost at once classify EKG signal using artificial neuronal nets. Created program will give to the doctor basic information about used electrocardiogram, as are time period and amplitude signal in single surveyed sections. Subsequently will program warn doctor about abnormalities from normal. Part of program is also graphic window with painted signal and on him in color points and partitions marked by program behind special. In next phase program alone classifies gained data and designating without doctor diagnose that doctor can evaluate and in case agreeable it sign and place for true diagnose patient. This program is also fit for data reading from bigger of the number of hours as far as days. It is concerned primarily Holter ECG monitoring.
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Nursing in the development of modern treatment methods for patients with atrial fibrillation
PAVELKOVÁ, Zdeňka
The current period is characterized by profound scientific and technological progress not only in the medicine but also in the field of nursing, which is now based more on scientific knowledge than ever before. Nursing as a science requires professionally trained nurses providing high quality nursing care. Therefore, the development of modern medicine, particularly in the field of cardiology, justifies the need to change the perception and status of nurses with respect to patient care together with strengthening the prestige and status of nurses in society. The main research intention of the dissertation was to determine how the nursing behaviour in connection with the procedure of radiofrequency catheter ablation (RFA) due to atrial fibrillation (AF) is perceived by nurses and patients, what is the impact of the RFA on the life quality of patients with AF, and what is the level of education in patients with AF. To meet these goals the research, the empirical part was divided into two phases. In the first phase, a non-standardized questionnaire was used, role of which was to assess the needs of patients with AF before and after RFA comparing baseline and 1 year follow-up data. In the second phase, which only examined the conditions 1 year after the RFA, a standardized questionnaire CBI - 24 (Caring Behaviour Inventory) was additionally used together with another form with questions investigating education of patients. Further data were obtained from nurses taking care for patients during the medical intervention. The research results show that quality of life of patients with AF before ablation was reduced. Patients´ most common problem areas included pain, physical and mental problems. Our research also showed that if we compared meeting patients´ physical and mental needs, meeting physical needs was evaluated better. Another area under consideration was the education of patients. Evaluated results showed the fact that education was focused on its content rather than its form. Evaluation of the perception of nursing care from the perspective of patients and nurses was the last part of the research. The results of the survey showed that nurses evaluated technical competence better than the humanistic approach to patients. It was also discovered that patients evaluated areas focused on performance of nurses better than creating a relationship of security and safety for patients. Finally, the results indicated that communication is also problematic area. We managed to meet the set goals and gain both theoretical and practical recommendations. Analyzing the results, we found out that there is a need to support humanistic approach in nursing care for cardiac patients, communication and education.
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Nurse-specialist in the diagnosis and treatment of atrial fibrillation.
NEPRAŠOVÁ, Eva
Introduction: Atrial fibrillation is the most common sustained arrhythmia. The quality of atrial fibrillation treatment in clinical practice varies between hospitals and doctors. Due to the increasing prevalence of atrial fibrillation in the more elderly population, it might be difficult in the future to refer patients to a limited number of heart specialists. At the same time, a new generation of University educated nurses is growing, but, unfortunately, their competencies are as low as their colleagues' with high-school education. However, in some areas, such as diabetology or gastroenterology, specialist nurses, whose aim is to supplement medical doctors to some extent, are gradually occurring. In the Czech Republic, there are no specialist nurses in cardiology, even though they are quite common abroad. Our aim is to assess the feasibility of a specialist nurse for diagnosis and treatment of atrial fibrillation. Methods: Main inclusion criterion for our study was a diagnosis of atrial fibrillation made on one of the non-internal medicine wards or in the general practitioners' practice. An exclusion criterion was previous examination by one of the heart specialists either internal medicine doctor or a cardiologist. During the first interview, I checked previous investigations for the atrial fibrillation and the arrhythmia treatment. The questionnaire contained questions on demographic parameters and patients' knowledge about their disease and possible complications. Subsequently, I recorded my recommendations regarding further investigations and therapeutic possibilites. All patients were sent to a cardiologist as required by our national guidelines. The second interview was made over the phone 2 months later and comparison of the doctor's recommendations with my suggestions was made. During this interview, an assessment of the concept of a nurse specialist in atrial fibrillation was performed. Results: Forty patients with atrial fibrillation documented on an ECG were recruited. At a time of the first interview, only 10 patients (25%) had their echocardiogram performed and only 23 (57,5%) patients had their thyroid gland hormones checked. 26 (65%) patients were on anticoagulation medicine while CHADS2-Vasc score of 2 and more was documented in 34 (85%) patients. There was an agreement between doctor's and nurse's recommendations regarding missing investigations and anticoagulation treatment. However, no agreement was achieved in the area of arrhythmia treatment, which means that this should remain a doctor's responsibility. Patients were informed about possible complications in only 11 (27,5%) cases and about all therapeutic options in 2 (5%) cases. 29 (72,5%) patients would be interested in consulting a specialist nurse in the future, whereas 11 (27,5%) patients would prefer a doctor. Results: We managed to confirm that the novel concept of a specialist nurse for the diagnosis and treatment of atrial fibrillation is feasible. The specialist nurse is able to confirm the diagnosis, check the completeness of the investigations, educate patients and assess the risk of the thromboembolic disease. Competencies of the nurses should be extended, so this concept could be introduced into the clinical practice.
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Anticoagulant therapy focusing on patients with atrial fibrillation
VANÍČKOVÁ, Martina
Thrombosis has recently become a widely discussed issue due to an increasing number of cases and problematic treatment. Once developed, thrombosis cannot be cured completely. Currently used anticoagulant treatment is limited to avoid complications such a hemorrhage or stroke. INR value checks (Quick tests) and monitoring covering at least 70% of the treatment period within the therapeutic range are necessary (2-3), but could be rather difficult to maintain in some patients. So-called new anticoagulants could prove themselves as an appropriate solution.
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