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The needs of the ICU patient after myocardial infarction requiring V-A ECMO support
Procházková, Tereza ; Konopásková, Marie (advisor) ; Pražáková, Zuzana (referee)
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...
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Casuistics of physiotherapy care for patient diagnosed with cerebellar lesion after a brain hypoxia
Vyhnánek, Štěpán ; Reckziegelová, Petra (advisor) ; Křížková, Štěpánka (referee)
Title: Casuistics of physiotherapy care for patient diagnosed with cerebellar lesion after a brain hypoxia Goal: The goal of this work is data collection and processing of theoretical information on cerebellar ischemia and a preparation of casuistics of a patient with cerebellar hypoxia after heart attack. Summary: My thesis deals with cerebellar hypoxia after leaving sufferd from loss of heart as a result of heart attack. Thesis is divided in to parts. The first part, a theoretical one, describes anatomical and functional structure of the cerebellum, a brief description of ISCH and treatment options. This part also contains a description of rehabilitation methods used in patients with cerebellar syndrome. The second part of my thesis, a practical one, is focused on a precise description of the work with the patient after having suffered from loss of cerebellar hypoxia, I have collaborated with on inpatient department of regional hospital in Kladno from January 5th to January 22nd, 2016. The practical part contains results of patient's examination in time of admision to hospital and in time of release from hospital and a description of individual therapautical units (used methods, the progress of the therapy and the success of treatment). Keywords: heart attack, cerebellum, rehabilitation
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Cardiac ischemic tolerance of hypertensive rats
Jelínek, Jan ; Neckář, Jan (advisor) ; Sotáková, Dita (referee)
The aim of this thesis is to summarize current knowledge about the influence of the ischemic- reperfusion injury at the myocard of hypertensive subjects. First part of this thesis is focused on the description of ischemia, reperfusion and changes in the myocardial metabolism during these processes. These changes in the myocardial metabolism are for example necrosis or apoptosis of the myocardial cells. The second part describes the currently known cardioprotective phenomena. This part also compares their effects. The signalization of preconditioning, the second window of preconditioning and the postconditioning are described here in more details. Third part is focused on the description of the risk factors connected to the ICHS and hypertension. It describes also classes of hypertension, clinical and experimental methods of hypertension treatment, description of the laboratory breeds of hypertensive rats. In the last part of this thesis I describe the influence of hypertension on the I-R injury in current laboratory studies. In the most studies spontaneously hypertensive rats (SHR) were used. As a normotensive controls Wistar-Kyoto rats were mostly used. For some other experiments transgenic genetic rats (TGR) were used. Powered by TCPDF (www.tcpdf.org)
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The needs of the ICU patient after myocardial infarction requiring V-A ECMO support
Procházková, Tereza ; Konopásková, Marie (advisor) ; Jankovcová, Kateřina (referee) ; Hocková, Jana (referee)
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 postcardiotomy cardiogenic shock with the urgency of the venoarterial extracorporeal membrane oxygenation (V-A ECMO). The quality of very specialized and complex care for these long-term hospitalized patients depends on understanding their needs and ways of saturation. The aim of this study is to present these needs from the perspective of the patient and their family. Research questions ain to identify the main aspect of recovery, the factors negatively affecting the mental state of patients, the ways to help them by healthcare professionals and family, how can healthcare professionals help the family and how this experience has affected both the family and the patient. The research is carried out using a qualitative method of semistructured interview with six respondents with this type of anamnesis, who were hospitalized between 2015 and 2021 in the ICU of cardiac surgery department, and three of their relatives. According to the study's findings the main aspect of recovery is the patient's mental well-being. The dependence on help of others, muscle weakness and loss of intimacy...
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The role of succinic acid in cardiac ischemic tolerance in rats
Kordač, Petr ; Neckář, Jan (advisor) ; Husková, Zuzana (referee)
Succinate is one of the intermediate in the Krebs cycle, which in recent years has been shown to interfere with other cellular events, some of which may affect cardiac ischemic tolerance. The aim of this project was to clarify its cardioprotective role in rat hearts subjected to acute ischemia-reperfusion. The myocardial resistance to acute ischemia (infarct size and incidence and severity of ischemic and reperfusion arrhythmias) was analyzed using the Langendorff method of isolated perfused heart at a constant flow with acute succinate administration. Local ischemia was induced by ligation of left anterior descending coronary artery. Acute administration of 1 mM succinate before 60 minutes of ischemia or before reperfusion only had a beneficial effect on reducing the infarct size by 25-30 % compared to the control group. At the same time, it had an adverse effect on the incidence and severity of ischemic and reperfusion arrhythmias. Key words: Succinate, heart, rat, heart-attack, ventricular arrhythmias
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Pre-hospital phase of acute myocardial infarction from the patient's perspective
Pokorná, Petra ; Hocková, Jana (advisor) ; Jankovcová, Kateřina (referee)
Acute myocardial infarction (AMI) represents severe complication of atherosclerotic vascular disease. Despite therapeutic advances and better risk factor control, acute myocardial infarction remains the leading cause of death worldwide. Goal of this thesis was to interview a group of patients hospitalized for acute myocardial infarction and evaluate their knowledge of disease course, perception of disease representing a sudden change of health status, awareness of disease symptoms and motivation for future lifestyle changes. Quantitative research with inductive approach was chosen for our research. Data was collected using individualized non-standardized semi-structured interview. Seven selected patients hospitalized for acute myocardial infarction with ST elevation were entered into our analysis. All the patients were informed in advance about our research methods and ethical aspects. All the participants had insufficient awareness of AMI symptoms. However, intensity of disease symptoms was severe, so they contacted health system early. Majority of them called emergency service. Level of education had significant impact on patient behavior. Patients with university degree had the best awareness of disease symptoms and shortest times from symptom onset to medical system contact. They were...
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Genetic and Proteomic Screening in Patients with Cardiovascular Disease.
Boháčová, Jana
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...
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Development of Material Based on Hyaluronic Acid s Hydrogels for Myocardial Regeneration
Kovářová, Lenka ; Kubala,, Lukáš (referee) ; Prokš,, Vladimír (referee) ; Pekař, Miloslav (advisor)
The thesis is focused on material development based on hyaluronic acid usable in regenerative medicine, especially for heart tissue regeneration after myocardial infarction. The object of the study is the oxidized form of hyaluronic acid (HA-Ox) and hydroxyphenyl derivative of HA (HA-TA). HA-Ox can be crosslinked with a bifunctional alkoxyamine POA and HA-TA undergoes an enzymatic reaction in the presence of hydrogen peroxide catalysed by horseradish peroxidase leading to gel formation. To describe the materials, chemical and physical properties, gelation kinetics and conditions of crosslinking reactions were studied. Hydrogels were characterized by mechanical and viscoelastic properties, degradability or stability in simulated body fluids. These hydrogels serve as scaffolds for the selected cell type. To promote cell adhesion and viability, an RGD sequence has been bonded to the structure of HA-TA. This resulting material is also compatible with selected applicators. Its viscosity and extrusion force are low enough to allow application with a catheter with a very small internal diameter. The applicability of the material through the supply tube to the hydrogel reservoir of the second SPREADS device showed good homogeneity, cell distribution and viability. Finally, the material was applied in vivo using these devices during a preclinical study.
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The role of C-reactive protein in cardiac ischemic tolerance
Perglerová, Aneta ; Neckář, Jan (advisor) ; Vebr, Pavel (referee)
Ischemic heart disease (CHD) is a set of pathophysiological states, disorders of blood flow and oxygen supply of the myocardium due to vascular constriction or thrombus blockage. Inflammation plays an important role in CHD. The inflammatory response is associated with the synthesis of acute phase proteins in the liver such as C-reactive protein (CRP). CRP plays an important role in acute forms of CHD such as myocardial infarction (MI). The development of CHD may be supported by the occurrence of some of the risk factors (eg. atherosclerosis, hypertension, plasma CRP). Increased CRP levels may support the initiation of atherosclerotic plaque formation as well as in the case of hypertension the presence of CRP increases the risk of developing CHD. The healing proces after acute MI is accompanied by an inflammatory phase where CRP occurs naturally and CRP is important to accelerate inflammation. There may be a situation which inflammation goes into a chronic phase because it is not terminated in time, with constant CRP synthesis. High levels of CRP may decrease the prognosis after MI. The elevated plasma CRP has a negative effect on the expansion of MI and the associated ventricular dilatation, which may result in a rupture of the cardiac wall. Hypertrophy is the compensatory mechanism of the...
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The needs of the ICU patient after myocardial infarction requiring V-A ECMO support
Procházková, Tereza ; Konopásková, Marie (advisor) ; Pražáková, Zuzana (referee)
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...
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