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Heart failure with preseved ejection fraction
Charvátová, Běla ; Neckář, Jan (advisor) ; Galatík, František (referee)
Heart failure (HF) has been considered to be one of the biggest challenges in modern medicine. As a leading cause of mortality in industrialised countries, it is vital to understand the disease properly. Heart failure with preserved ejection fraction (HFpEF) represents approximately half of all HF cases. Even though it has been studied a lot recently, little we know about the pathophysiology and the treatment of this complex syndrome. Not only does it affect heart function, but also damage can be caused in other organs such as lungs, kidneys, skeletal muscle etc. It used to be called a diastolic heart failure, because in this syndrome the heart is unable to stretch, relax and fill properly during diastole causing a diastolic dysfunction. In addition, HFpEF is often associated with other diseases that can worsen the patients' outcomes, such as hypertension, diabetes mellitus type 2. obesity, chronic kidney disease, pulmonary hypertension etc. This link to other diseases (comorbidities) can complicate the treatment because of a great heterogeneity between patients with HFpEF. The need for specific treatment pathways for each patient's phenotype is the main drive for searching for adequate suiting animal models in research. In the first half, this work provides a comprehensive overview of HFpEF,...
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The role of renal dysfunction in pathophysiology of congestive heart failure progression: preclinical animal studies
Kala, Petr ; Veselka, Josef (advisor) ; Štengl, Milan (referee) ; Štěrba, Martin (referee)
The role of renal dysfunction in pathophysiology of congestive heart failure progression: preclinical animal studies. Abstract The thesis describes effects and pharmacological targets of eicosanoids, especially epoxyeicosatrienoic acids (EETs) that are epoxygenase metabolites of arachidonic acid (AA), in animal model of congestive heart failure (CHF) induced by volume overload via aorto- caval fistula (ACF) in hypertensive transgenic rats (TGR). Our data show that ACF TGR exhibits tissue deficiency of EETs in the left ventricle and kidney, probably mainly caused by increased EETs degradation by soluble epoxide hydrolase (sEH). Treatment by orally active EETs analogue (EET-A) improved the survival rate in ACF TGR compared to placebo. However, after adding EET-A to angiotensin-convertase enzyme inhibitor (ACEi) treatment, the survival of ACF TGR only tended to improve compared with the effects of EET-A or ACEi given alone. The protective effects of EET-A treatment were mediated by improving cardiac parameters and reducing lung congestion, not dominantly by renal mechanisms. We also found that among male (not in female) the combination of sEH inhibitor (sEHi) and ACEi treatment worsened the mortality of ACF TGR compared to ACEi monotherapy. Our data support the notion that targeting the CYP-dependent...
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The role of hypoxia inducible factor-1α in the progression of chronic heart failure
Kordač, Petr ; Neckář, Jan (advisor) ; Vebr, Pavel (referee)
Transcription factor hypoxia inducible factor-1α (HIF-1α) is a key regulator of physiological and cellular mechanisms to adapt to deficiency of oxygen. In hypoxia (or ischemia) HIF-1α level increases as HIF-1α-degrading enzymes prolyl hydroxylases are inactive due to low oxygen level. HIF-1α plays also essential role in triggering cellular protection and metabolic alteration during pathophysiological conditions in the heart. It has been suggested that stabilization of HIF-1α in myocardium may prevent deleterious remodelling induced by various forms of chronic heart failure (CHF). The project aims to outline current knowledge about the role of HIF-1α in the progression of CHF.
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Care for patient with chronic heart failure
FORMÁNKOVÁ, Hana
The bachelor thesis refers to the aspects of the nursing care for patients with chronic heart failure. The aim of the thesis is to identify the specifics of the nursing care for patients with chronic heart failure. Furthermore, the subsequent aim is to identify the most frequent nursing problems with patients with chronic heart failure. The qualitative research inquiries were used to reach the defined aims. Semi-structured conversation with patients suffering with chronic heart failure and with nurses working at cardiology intermediary care and the ambulance of heart failure was the most used method to collect the data. Interesting results were achieved with the research. Respondents had a limited knowledge about the classification according to NYHA, but the knowledge of diseases was at a good level. Nurses and even patients agreed on regimes measures, which were implemented upon patients with chronic heart failure at the emergency and at the department. There were some references to Fowler positions, ECG, blood collection and following checkup. Nurses added further professional information, but they coincided with patients. Patients bore the best knowledge of the regime measures. The efficiency of education of nurses about the regimes measures has been reflected in responses of respondent patients. Patients knew which measures are related to their disease, what they should change and what they should start to do. Based on the answers, it can be stated that measures like sinking kitchen salt, restricting of intake liquids and No smoking are getting the overbearing role within regimes. An information booklet, which can serve for medical staff, for student of medical branches or for patients with chronic heart failure was created as an outcome of the Bachelor Thesis. In booklet they can find: what is it chronic heart failure, what causes it, what symptoms the disease has, classification according to NYHA, what is the prevention of the disease, pharmacotherapy, regimes and dietary measures, procedure upon acceptance patients to hospitalization, and further information.
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The effect of physiotherapy on cardio-respiratory parameters in patients with chronic heart failure indicated for cardiac surgery intervention
MELECHOVÁ, Dominika
The bachelor thesis deals with the preoperative physiotherapy in patients with chronic heart failure who are indicated for cardiac surgery intervention and with the description of physiotherapy procedures utilized before and after the operation. The cardiovascular disease is in developed countries still the main cause of morbidity and mortality. (UNIFY, 2008) The improved treatment of acute conditions allows so that more patients reached a stage of the chronic heart failure. (Špinar, Vítovec, Hradec, 2012) The chronic heart failure is a sign for a number of symptoms that are caused by disruption of the heart work. It is a disorder in which despite adequate ventricular filling drops a cardiac output and the heart is unable to cover metabolic needs of the tissues (supply of oxygen and nutrients and removing of carbon dioxide and metabolic waste products). (Štejfa a kol., 2007) In the theoretical part is described the anatomy of the heart, the physiology of the heart and the blood circulation, the chronic heart failure, the response and the adaptation of the organism to physical load, the cardiovascular rehabilitation and physiotherapy procedures carried out before and after the operation. The practical part of the bachelor thesis is performed by method of the qualitative research with the using techniques: the anamnesis, the kinesiology analysis and the data analysis. The research set was formed by 2 patients of the cardiac surgery department of Hospital České Budějovice a. s. who were indicated for cardiac surgery intervention. The total time of the research was 4 weeks. The first purpose of this thesis was chart the effect of the preoperative physiotherapy on cardio-respiratory parameters and the condition of the patient. The second purpose was describe physiotherapy procedures carried out before and after the operation. I chose 2 research questions for the research: 1. What effect has the preoperative physiotherapy on cardio-respiratory parameters in patients with the chronic heart failure? 2. What are possibilities of physiotherapy procedures before and after the operation? The preoperative physiotherapy was carried out 5 times a week for 1 month in the home of the patient. It included a physical therapy, a respiratory physiotherapy and relaxation methods. Selected cardio-respiratory parameters were taken before and after each training unit. Results of therapy are processed through case studies. The component of the bachelor thesis is also a list of references, key words and abbreviations. Next it includes image attachments and graphs. The thesis can be a benefit for physiotherapists, general and professional public and for possible further research in this issue.
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Verification of knowledge about self-management in patients with heart failure
VOJTĚCHOVÁ, Veronika
Congestive heart failure (CHF) is a disease with increasing incidence, which requires an adequate and costly management. Repeated hospitalisations due to decompensated CHF contribute to disease progression and herald dismal prognosis. An important goal of heart failure clinics is reduction in number of hospitalizations due to decompensated CHF. The main approaches to reach this aim seem to be effective diagnostics and treatment of CHF, and importantly, education of patients and their families. We aimed to evaluate knowledge of CHF patients regarding self-care in secondary prevention of CHF. We constructed three hypotheses and three research questions to reach the goal of the project. The theoretical part described recommended life-style interventions, pharmacologic and non-pharmacologic CHF management, and specifically, the role of nurses in education of patients with CHF. The practical part described the methods of analysis, the study group and the process of evaluation. To fulfil the study goal, we performed collection of data using qualitative and quantitative methods of research. The qualitative part of the research project included a non-standardized questionnaire for patients with CHF. A total of 260 questionnaires were distributed in six heart failure clinics. 183 completed questionnaires were returned and analysed. The obtained data were evaluated using descriptive statistical methods. Pearson´s chi-test and Student´s t-test were applied to test the hypotheses. Collection of qualitative data was performed using the technique of a semi-structured interview based on pre-prepared questions. The study respondents included general nurses from out-patient heart failure clinics. Six of nine contacted nurse respondents agreed to participate. Answers were recorded on Dictaphone. Data were analysed using the method of "card display". The quantitative part tested the following hypotheses: 1. CHF patients know symptoms and signs of decompensated CHF. 2. CHF patients follow the life-style recommendations. 3. CHF patients perform daily self-monitoring of their weight, blood pressure and pulse. Our study revealed insufficient knowledge of patients regarding symptoms of possible CHF decompensation. This finding was alarming because suboptimal knowledge of symptoms of decompensated CHF may cause inadequate response of the patient and may delay initiation of treatment. Assessment of compliance with life-style measures revealed that most patients did not use tobacco products and had a limited alcohol consumption. Most individuals reported a regular use of heart failure medication and knew the timing of the next follow-up in their heart failure clinic. Life-style measures included also some dietary restrictions modified by the current nutritional status. Respondents preferred recommended food over inappropriate foodstuffs, however, they did not follow neither the salt restriction nor the optimal frequency of meals. Most respondents did not report a regular exercise A significant ignorance was found in the process of self-monitoring. Most respondents did not monitor their body weight, blood pressure and pulse. The qualitative assessment evaluated the following questions: 1. Do we educate the CHF patients appropriately? 2. Are we able as nurses to pass correct information to CHF patients? 3. How is the process of education implemented in practice? Based on the above mentioned methods, we found that the process of education is a domain of doctors. Nurses have only a limited role in education of CHF patients...
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Specifics of nursing care for patients with chronic heart failure
GEGNEROVÁ, Michaela
This thesis deals with chronic heart failure, which is described as when the heart fails as a pump. The disease is a medical, social and economic problem. It uses many diagnostic methods. Treatment is aimed at influencing symptoms and to influence the occurrence and progression of disease. The treatment regimen includes measures inherent pharmacotherapy and surgical treatment and instrumentation. Part of the work is devoted to the role of nurses and patients' needs. Nursing care is focused on the overall condition of the patient. Quality nursing care nurse can not be performed without communication, uses it as part of their professionalism. The aim of my thesis was to identify specific nursing care for patients with chronic heart failure. Bachelor thesis was prepared in the form of qualitative research. The technique of data collection were obtained by semistructured interview with patients with chronic heart failure. Interviews were recorded in case reports. On the basis of case reports was created categorization of data in tables, which contains the most important results. The sample consisted of 10 respondents with chronic heart failure. Interviews were obtained from patients hospitalized in the Hospital and the Czech Budejovice Were established 3 research questions have been answered. The research findings were obtained that provide information regarding the patient's specific needs and limitations arising in connection with the disease. This work can be a source of information for patients who suffer from chronic heart failure, but also for nurses and students of medical disciplines. With the knowledge gained can be provided higher quality nursing care and professional level.
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