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Decision Aid Rules in Elderly Patients with Chest Pain
Hrečko, Juraj ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute chest pain is a common reason for examination at the emergency department. Elderly patients often have atypical symptoms, nonspecific changes on the electrocardiogram, and elevated levels of cardiac biomarkers from various causes. Differential diagnosis is quite broad and the aim of the examination at the emergency department should be to quickly rule out life-threatening conditions such as acute coronary syndrome, pulmonary embolism, or aortic dissection. Structured decision aid rules are accurate and can accelerate the diagnostic process, however we do not have sufficient data for the use of decision aids in the population of elderly. The aim of this work was: 1) to describe the clinical characteristics and occurrence of cardiac events in seniors examined at the emergency department for acute chest pain, 2) to identify risk factors for major cardiac events and 3) to compare the effectiveness and safety of selected decision aid rules for the rapid diagnosis of acute myocardial infarction in the population of elderly. We performed an analysis of patients older than 70 years who were examined within one year at the Department of Emergency Medicine of the University Hospital Hradec Králové for acute chest pain. Patients with ST segment elevations on the electrocardiogram were excluded from the...
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Heart Failure - Analysis of Risk Factors of Morbidity and Mortality
Dokoupil, Jiří ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute heart failure represents a medical condition with very high mortality. Accurate risk stratification can help physicians to improve the health care about these patients. The aim of our study was to characterise patients admitted for acute heart failure, describe their demographic and clinical findings and to assess risk factors of short-term and long-term mortality. We further analysed risk factors of longer hospital stay among initial signs and precipitating factors of heart failure. We performed a retrospective analysis of patients admitted to the standard care and intensive care units from January to December 2017 to 1st Department of Internal Medicine - Cardioangiology of University Hospital Hradec Králové. We identified 385 patients admitted for acute heart failure. The all-cause in-hospital mortality was 12.7 %, 30-day mortality was 14.6 % and 1-year mortality was 34 %. Among risk factors of in-hospital mortality the most significant factors were the requirement of haemodialysis with ultrafiltration (OR 15.82, 95% CI 2.96-84.57, p = 0.0008), previously known chronic heart failure (OR 4.27, 95% CI 1.66- 11.03, p = 0.001) and STEMI as a precipitating factor of heart failure (OR 4.19, 95% CI 1.23- 14.25, p = 0.023). The requirement of haemodialysis with ultrafiltration (OR 4.28, 95% CI...
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The influence of metabolites and their parent phenolic compounds on blood platelets
Hrubša, Marcel ; Mladěnka, Přemysl (advisor) ; Moťovská, Zuzana (referee) ; Kollár, Peter (referee)
Charles University, Faculty of Pharmacy in Hradec Králové Department: Department of Pharmacology and Toxicology Candidate: Mgr. Marcel Hrubša Supervisor: Prof. PharmDr. Přemysl Mladěnka, Ph.D. Title of dissertation thesis: The influence of metabolites and their parent phenolic compounds on blood platelets Acute cardiovascular events (ACEs), such as stroke and acute coronary syndromes encompassing acute myocardial infarction, are one of the main causes of cardiovascular mortality in the world. Current pharmacotherapy focuses primarily on secondary prevention of their recurrence, where antiplatelet drugs play a key role. These drugs reduce platelet hyperreactivity, which is present in the majority of cardiovascular and metabolic diseases, and significantly decrease the risk of ACEs. However, the palette of currently available drugs faces many issues, such as resistance, high variability in both pharmacokinetics and pharmacodynamics, serious side effects and the route of administration. This thesis firstly briefly summarizes the current knowledge of platelet physiology along with available antiplatelet drugs and their mechanism of action. Second part of the theoretical introduction is dedicated to polyphenolic compounds, as polyphenol-rich diet is associated with many beneficial effects, particularly...
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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...
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The influence of metabolites and their parent phenolic compounds on blood platelets
Hrubša, Marcel ; Mladěnka, Přemysl (advisor) ; Moťovská, Zuzana (referee) ; Kollár, Peter (referee)
Charles University, Faculty of Pharmacy in Hradec Králové Department: Department of Pharmacology and Toxicology Candidate: Mgr. Marcel Hrubša Supervisor: Prof. PharmDr. Přemysl Mladěnka, Ph.D. Title of dissertation thesis: The influence of metabolites and their parent phenolic compounds on blood platelets Acute cardiovascular events (ACEs), such as stroke and acute coronary syndromes encompassing acute myocardial infarction, are one of the main causes of cardiovascular mortality in the world. Current pharmacotherapy focuses primarily on secondary prevention of their recurrence, where antiplatelet drugs play a key role. These drugs reduce platelet hyperreactivity, which is present in the majority of cardiovascular and metabolic diseases, and significantly decrease the risk of ACEs. However, the palette of currently available drugs faces many issues, such as resistance, high variability in both pharmacokinetics and pharmacodynamics, serious side effects and the route of administration. This thesis firstly briefly summarizes the current knowledge of platelet physiology along with available antiplatelet drugs and their mechanism of action. Second part of the theoretical introduction is dedicated to polyphenolic compounds, as polyphenol-rich diet is associated with many beneficial effects, particularly...
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Prevention of postinfarction left ventricular remodeling with stem cells implantation
Pelnař, Jiří ; Moťovská, Zuzana (advisor)
Cell therapy is a tempting and possibly promising therapeutic approach, which could be used in the near future to prevent the serious health effects on the heart and thus on the whole human organism resulting from myocardial infarction. The portion of the heart afflicted by infarction disrupts the architecture of the heart chamber as a whole and causes it to undergo the process of remodeling in a less or more pronounced manner. This process leads to progressive deterioration of the heart function, which may eventually lead to heart failure. The potential regeneration of a viable heart tissue by stem cells implantation would have the means of ceasing or reverting this harmful process. The introduction of stem cells into the heart tissue following a myocardial infarction can be achieved by several different techniques, using various cell types and in various time intervals after the occurence of myocardial infarction. So far, a number of studies using animal models of myocardial infarction, have shown that the stem cells implantation has a favorable effect on the restoration of heart function, while not showing such occurence of adverse effects that would exclude further investigation in the form of clinical studies. The clinical studies described in this work do not allow to make a definite conclusion. Some...
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Selected Immune Markers During Acute Myocardial Infarction
Horáková, Lucie ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute myocardial infarction belongs currently to the most important diseases in the cardiology and the pathogenesis of the ischemic-reperfusion injury still remains an open question. The process of ischemia and reperfusion is complex, it involves a number of pathogenetic processes and activates number of systems among which the activation of immune system has the important place. In this study we have chosen some of the markers and followed their dynamics during the ischemia and reperfusion. We compared them with the standard markers of necrosis and we analysed possible relationship between these markers and the systolic dysfunction of the left ventricle. The aim of this study is to contribute to understanding of ischemia and reperfusion during acute myocardial infarction with the ST segment elevation. Moreover, further benefit of this study is pointing out the possibilities of new technologies in the determination of cardiac markers.
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The Prevention of the organ damage after out of hospital cardiac arrest
Karásek, Jiří ; Widimský, Petr (advisor) ; Vojáček, Jan (referee) ; Moťovská, Zuzana (referee) ; Bonaventura, Jiří (referee)
The publication summarises in four original papers the authors' results in out-of-hospital cardiac arrest (OHCA). The first paper presents a prospective observational study comparing the effect of mechanical chest compression (LUCAS) and manual chest compression (non-LUCAS) on the 30-day and 180-day survival rate of the patients affected by OHCA. The study included 278 patients (144 underwent mechanical chest compression - LUCAS, and 134 manual chest compression - non-LUCAS). There were no significant differences in restoration of spontaneous circulation (ROSC): (25% in LUCAS vs 30.6% in non-LUCAS, p = 0,35). However, we observed significantly more conversions to shock rhythm in the LUCAS group (20.7% vs 10.10%, p = 0,04). The 30-day survival rate was significantly worse in the LUCAS group (5.07% vs 16.31% in non-LUCAS, p = 0,044). In the case of 180-day survival, no significant differences were detected (9.42% in LUCAS vs 5.45% in non-LUCAS, p = 0,25). The second study examined mechanical chest compression-related injuries as a possible explanation for the mechanical compression failure in survival rates. This retrospective observational study relied on 630 patients who died during CPR that involved mechanical or manual chest compressions. The data were drawn from autopsy reports of all patients....
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Identification of preventable factors of reperfusion injury in patients with acute myocardial infarction
Víchová, Teodora ; Moťovská, Zuzana (advisor) ; Malý, Martin (referee) ; Pařenica, Jiří (referee)
Background: The ischemic-reperfusion injury represents an important preventable factor, due to its essential impact on prognosis of patients with acute myocardial infarction (AMI). One of the most important modifiers of the extent of the injury is the time to reperfusion. Great efforts to reduce delays in reperfusion have been made during the previous two decades, however, in spite of significant improvement in organization and quality of AMI treatment, especially ST- segment elevations (STEMI), many patients are not being treated within recommended time frames. Aim: The aim of this work was to acknowledge the importance of time to reperfusion in preventable ischemic and reperfusion injury and patient prognosis at the current era of percutaneous coronary interventions (PCI). Furthermore, we intended to characterize the patient subpopulations in the highest risk of delayed reperfusion and the analysis of its backgrounds. Based on the acquired data, specific recommendations for preventive measures aimed at reducing the time delay to reperfusion would be formulated. Metodika: In the presented original works, study population consisted of 946 consecutive patients with AMI with STEMI or bundle- branch block AMI, who underwent PCI in Cardiocenter Královské Vinohrady. Patient baseline characteristics and their...
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