Long-term follow-up after pacemaker implantation via persistent left superior vena cava

Background: The persistent left superior vena cava (PLSVC) is a relatively common con­genital venous return anomaly. It may have serious clinical implications especially in case of pacemaker/cardioverter-defibrillator implantation, venous catheter insertion, radio-frequency ablation and cardiac surgery. There is also some evidence that PLSVC may be accompanied by arrhythmias. The aim of this report is to present the effectiveness and safety of cardiac pacing via PLSVC, clinical outcome and appearance of arrhythmias in a long-term follow-up. Methods and results: Four cases of pacing electrodes implanted via PLSVC in patients without any other cardiac congenital heart anomalies were observed for at least 6 years. There was 1 patient with AAI, 2 patients with VVI, and 1 with DDD pacemaker. Atrial electrodes were implanted on the free right atrial wall, 2 ventricular electrodes were implanted in right ventricular outflow tract, 1 in postero-lateral cardiac vein. During the mean 110 months of observation, pacing was efficient. One patient underwent an upgrade from AAI to biatrial pac­ing due to progressive interatrial conduction delay during the follow-up. No other intervention or pacemaker related events were noticed except for battery replacement. Conclusions: The presence of PSVC may complicate implantation, but it does not influence the long-term follow-up of pacing parameters.

Prevalence of hypertension and major cardiovascular risk factors in healthy residents of a rural region in south-eastern Poland – 1997–2008/9

Introduction and objective The aim of this study was to show the prevalence of hypertension and major risk factors of cardiovascular disease among healthy adults in an agricultural region of south-eastern Poland, and the changes which have occurred in this area during the 12-year follow-up. Material and Methods 1,233, mostly rural inhabitants of Zamosc County without previous history of diabetes and CVD were subjected to analysis. Prevalence of hypertension and major cardiovascular risk factors were evaluated. Changes in the prevalence of risk factors between 1997 – 2008 were analyzed. Results 33.0% of the examined population are active smokers, and there was a 1.8-fold increase (p = 0.0009). The percentage of people with hypercholesterolemia between 1997 – 2008/9 increased almost 2-fold (p<0.0001) and now it is 62.3%. The number of people with high blood pressure decreased nearly by a half (46%, p<0001) and it is currently 25.8%. Improper waist circumference was observed in 32.8% of the population (33.1% women, 26.5% men). Abdominal obesity decreased among men (48%; p=0.0008) and rural residents (29%, p=0.01). In comparison with 1997, in 2008–2009, the cardiovascular risk assessed using SCORE tables increased. The percentage of people with high-risk (≥5%) almost tripled in the general population (p=0.0183) and increased 4-fold in men (p=0.0145). Conclusions Detection of hypertension in the rural region in which the survey was carried out is still too low. Actions against tobacco addiction should be a major component of health-education programmes for the rural areas of south-eastern Poland

Zastosowanie leków beta-adrenolitycznych w chorobach układu krążenia na podstawie aktualnych zaleceń Europejskiego Towarzystwa Kardiologicznego

Celem niniejszego artykułu jest przedstawienie zastosowania leków beta-adrenolitycznych w chorobach układu krążenia w oparciu o aktualne zalecenia Europejskiego Towarzystwa Kardiologicznego. Rekomendacje te oparte są przede wszystkim na aktualnych wynikach metaanaliz oraz wieloośrodkowych randomizowanych badań klinicznych, coraz w mniejszym stopniu na samych opiniach ekspertów. W artykule tym przedstawiono zalecenia dotyczące wykorzystania leków beta-adrenolitycznych m.in. w chorobie wieńcowej serca, nadciśnieniu tętniczym, niewydolności serca oraz w zaburzeniach rytmu serca. Heterogenność tej grupy leków wskazuje na potrzebę dalszych badań dotyczących ich właściwości terapeutycznych i działań niepożądanych. Interesujące wydają się szczególnie właściwości nowych leków hybrydowych z tej grupy.The aim of this article is to present the application of beta-adrenolytic drugs in cardiovascular diseases based on current guidelines of The European Society of Cardiology. The recommendations derived mainly from current results of meta-analyses as well as from multiple randomized clinical trials, and to a lesser degree only from consensus of opinion of the experts. This article includes guidelines on the use of beta-adrenolytic drugs e.g. in coronary artery disease, hypertension, heart failure as well as in arrhythmias. Heterogeneity of this group of drugs indicates that further researches on their therapeutic properties and adverse events are needed. The properties of new hybrid drugs seem to be particularly interesting

Quality of life of a healthy polish population due to sociodemographic factors during the COVID-19 pandemic – a cross-sectional study

IntroductionThe quality of life should be studied in every person, both among the sick and healthy. Sociodemographic factors affect the level of the perceived quality of life (QoL), and especially in the situation of the COVID-19 pandemic, which forced the enforcement of certain behaviours in society, such as social distancing, as well as introduced panic and fear for one’s own health and life. The main aim of the study was to assess the quality of life in the group of people without the disease, to assess the impact of sociodemographic factors on QoL during the pandemic.Material and method3,511 healthy people were included in the study. The inclusion criteria of the study were: age of respondents over 18 years, no continuously administered medicaments, no diagnosed chronic diseases and no treatment in specialist clinics as well as lack of positive COVID-19 test in 4 weeks before the examination. The SF-36 questionnaire was used to assess the quality of life. The student’s t-test and intergroup comparisons were used in 7 age groups. Factors such as age, gender, place of residence, education, civil status, employment status, smoking, and physical activity were assessed.ResultsThe lowest average QoL level in the studied population was recorded in the Mental Component Summary (MCS) dimension (X = 47.9;Cl:47.6–48.3). A high correlation between age and the SF-36 spheres was noted in the following spheres: physical functioning (PF), role physical (RP), Physical Component Summary (PCS), and ILQ (p &lt; 0.001). The highest chance of a better QoL in the PCS dimension among men was recorded in the 30–39 age group (OR = 3.65;Cl:1.13–11.79). In the group of people over 50 years of age living in the village, there was a greater chance of a better QoL in the PCS dimension in each age group. Practicing physical activity was significantly more often conditioned by a higher chance of developing a better QoL (p &lt; 0.05). In the group of people ≥80 years of age, there was a greater than 4 times higher chance of developing a better quality of life in terms of MCS among physically active people (OR = 4.38;Cl:1.62–11.83).ConclusionWith age, QoL decreases among people with disabilities. Men are more likely to assess their health better. A better QoL among women occurs at age 80 and later. A higher level of education often determined a significantly higher level of QoL felt. The practising of recreational physical activity and the lack of smoking habit determined a higher level of QoL more often. Smoking provided a greater chance of a better QoL in ILQ in the group of people ≥80 years

Correct and incorrect knowledge of the risk factors concerning the development of arterial hypertension. Part 1. Population of people without hypertension

Introduction. Hypertension (HT) is one of the most common causes of death in the adult population in the world. The lifestyle factors play a significant role in its pathogenesis. To be effective in preventing its development or slowing its progress the society needs to have proper knowledge. Material and methods. The study was conducted in a population of 929 adults who had no known HT. Sociodemographic data were collected from each subject, anthropometric measurements were taken, blood pressure and heart rate were measured twice. The knowledge was assessed using the authorial questionnaire, and questions were related to knowledge about the effects of smoking, alcohol, coffee, salt, fat, irregular diet, low fibre and vegetables, and skimmed dairy products in diet, overweight and obesity, cholesterol, physical activity, stressful lifestyle on the development of HT. Results. Incorrect knowledge of the influence on the development of HT in the case of alcohol drinking was found in 16.9% of the respondents, coffee — 58.8%, large amounts of salt — 10.3%, large amounts of fat — 82.7%, small amounts of fibre and vegetables and skimmed dairy products — 26.2%, irregular diet — 46.4%, cigarette smoking — 70.9%, overweight and obesity — 5.1%, high cholesterol — 87.6%, low physical activity — 10.9%, stressful lifestyle — 6.5%. Conclusions. Incorrect knowledge of HT-related risk factors was associated particularly with higher level of cholesterol, excessive fat intake, smoking and coffee consumption. Most frequently incorrect answers were given by men, low-educated and non-smokers. In the above-mentioned groups emphasis on health promotion should be placed the most

Profil chorych z nadciśnieniem tętniczym opornym

Introduction. Resistant hypertension (RHT) is recognized when the blood pressure (BP) is equal to or greater than 140/90 mmHg, despite changes in lifestyle and using at least 3 antihypertensive drugs, including diuretics at optimal doses. Often, patients limit the proper control of BP by voluntary reduction and discontinuation of less tolerated drugs, failure to follow healthy lifestyle rules, and taking medications that increase BP. The reason for the lack of effects in treatment of hypertension (HT) is also unrecognized secondary HT. The aim of the study is to evaluate the occurrence of pseudo-RHT in patients with primary RHT diagnosis. Material and methods. The study was conducted in 2012–14 among patients hospitalized in the Department of Cardiology of The Pope John Paul II Province Hospital in Zamość. 99 patients diagnosed with RHT were examined, (59 men) at age 54.5–67.0 on average 60.0 } 9.8 years. Statistical analysis was performed based on Statistica; Chi2 and U-Mann-Whitney tests were used. Results. The final group consisted of 93 people (55 men). In the course of hospitalization, studies were conducted for secondary causes of HT. Efficacy of treatment was evaluated, education on healthy lifestyle was conducted and in some cases pharmacotherapy was modified. As a result of the diagnostic procedure and increased control of applied therapy, 30 patients with true RHT and 63 patients with pseudo-RHT were identified from a group of 93 patients with initial RHT. Patients with true RHT (16 men) were proposed renal artery denervation. Conclusions. A large group of patients with diagnosed RHT are patients with pseudo-RHT. The common cause of RHT is the presence of an undetected secondary HT.Wstęp. Nadciśnienie tętnicze oporne (RHT, resistant hypertension) rozpoznaje się, gdy ciśnienie krwi (BP, blood pressure) jest większe lub rowne 140/90 mmHg, mimo zmiany stylu życia i stosowania co najmniej 3 lekow przeciwnadciśnieniowych, w tym diuretykow, w optymalnych dawkach. Często pacjenci utrudniają osiągnięcie prawidłowej kontroli BP przez samowolne zmniejszanie dawki lub odstawianie gorzej tolerowanych lekow, nieprzestrzeganie zaleceń dotyczących zdrowego stylu życia lub przyjmowanie lekow zwiększających BP. Przyczyną nieskuteczności leczenia nadciśnienia tętniczego (HT, hypertension) może być rownież nierozpoznane wtorne HT. Badanie przeprowadzono w celu oceny częstości występowania rzekomoopornego nadciśnienia tętniczego u chorych z pierwotnym rozpoznaniem RHT. Materiały i metody. Badanie przeprowadzono w latach 2012–2014 wśrod chorych hospitalizowanych na Oddziale Kardiologii Szpitala Wojewodzkiego im. Jana Pawła II w Zamościu. Zbadano 99 chorych (59 mężczyzn) z rozpoznanym RHT w wieku 54,5–67,0 lat (średnia wieku 60,0 } 9,8 r.). Analizy statystyczne przeprowadzono, korzystając z oprogramowania Statistica; wykonano test Chi2 i test U Manna- Whitneya. Wyniki. Ostatecznie badana grupa składała się z 93 chorych (55 mężczyzn). W trakcie hospitalizacji u chorych wykonano badania pod kątem przyczyn wtornego HT. Oceniono skuteczność leczenia, przeprowadzono edukację chorych odnośnie do zdrowego stylu życia, a w niektorych przypadkach zmodyfikowano leczenie farmakologiczne. Po przeprowadzeniu badań diagnostycznych oraz zweryfikowaniu stosowanego leczenia w grupie 93 chorych z pierwotnym rozpoznaniem RHT zidentyfikowano 30 chorych z rzeczywistym RHT i 63 chorych z rzekomoopornym HT. Chorym z rzeczywistym RHT (16 mężczyzn) zaproponowano denerwację tętnic nerkowych. Wnioski. Dużą grupę chorych z rozpoznaniem RHT stanowią pacjenci z rzekomoopornym HT. Częstą przyczyną RHT jest obecność niewykrytego wtornego HT.

Correct and incorrect knowledge of the risk factors concerning the development of arterial hypertension. Part 2. Population of patients with identified arterial hypertension

Introduction. Hypertension (HT) and its complications significantly shorten the life expectancy in the world population. In addition to pharmacotherapy, life-style changes play a key role in treatment, which requires appropriate knowledge among patients. Material and methods. The study was conducted in a group of 613 adults with HT. After obtaining sociodemographic data, performing anthropometric measurements, measuring resting blood pressure twice, the knowledge was assessed using a personally conducted questionnaire. The questions evaluated the effects of smoking, alcohol, coffee, salt, fat, irregular diet, low fibre and vegetable intake, as well as skimmed dairy products in diet, overweight and obesity, cholesterol, physical activity and stressful lifestyle on the development of HT. Results. False knowledge of the influence on the development of HT in the case of alcohol drinking was found in 16% of the respondents, coffee — 56.4%, large amounts of salt — 7.2%, large amounts of fats — 88%, small amounts of fibre and vegetables and skimmed dairy products — 27.8%, irregular diet — 46.4%, cigarette smoking — 73.4%, overweight and obesity — 4.4%, high cholesterol — 86.9%, low physical activity — 11.2% %, stressful lifestyle — 5.4%. Conclusions. Incorrect knowledge of HT risk factors was most likely to be associated with excessive intake of fat, elevated cholesterol, smoking and coffee drinking. There were no common features of the people who answered the questions incorrectly. The results show the need to educate HT patients about the factors that aggravate this disease

Biopsja mammotomiczna w diagnostyce niepalpacyjnych zmian patologicznych piersi

Background: The aim of the study was to determine the effectiveness of mammotome biopsy (MB) in detecting preclinical breast pathologies. Material/Methods: The material consisted of 847 women, of whom, based on mammography and ultrasound, 349 patients were referred to have stereotactic mammotome biopsy (SMB) guided by digital mammography and 498 women were subjected to hand-held mammotome biopsy (HHMB) guided by US. Results: Ultimately, MB was done in 819 women. In all cases where breast carcinoma or atypical ductal hyperplasia (ADH) were detected, the patients were operated on and postoperative histopathology was treated as the reference for post-biopsy histopathology. Patients in whom post-MB histopathology detected benign lesions were subjected to a strict long-term follow-up using imaging studies. Ultimately, thanks to MB, 94 cases of breast cancer (12%) were detected as well as 725 (88%) cases of benign lesions, which corresponds to a sensitivity of 98.9% and 100% specificity. Conclusions: MB is an alternative to surgical biopsy in differentiating preclinical breast lesions. It is associated with a minimal risk of complications and may be successfully performed in an outpatient setting

Core breast biopsy under MR control : preliminary results

Background: Breast MR examination is capable of detecting suspected lesions that are not visualized by other imaging techniques, such as mammography or ultrasonography. In all cases such lesions should be verified histopathologically by MR-guided core biopsy. The aim of the study was the determination of effectiveness of MR-guided breast core biopsy in detection of breast pathologies. Material/Methods: Twelve women with suspected lesions detected by MR (GEMS Signa Excite 1.5 T with 4-channel open breast coil manufactured by MRI Devices Corporation) were qualified to MR-guided breast biopsy. Obtained image data were transferred to DYNACAD workstation for calibration, lesion localization, and automatic calculation of target coordinates for MR-guided intervention. Biopsy was performed using automated 14G biopsy needle. Results: MR-guided breast biopsy was performed in 9 women and confirmed lobular and ductal carcinoma in 2 patients respectively, lobular carcinoma in situ (LCIS) in 1, intraductal papilloma in 2, and intraductal hyperplasia without atypia. In 3 patients histopathologic examination revealed benign fibrocystic lesions. Three women were disqualified from biopsy because pre-biopsy MR sequences did not reveal the lesion in 1 case, and due to the target localization out of reach of the biopsy needle in other 2 cases. Conclusions: All non-palpable lesions visualized by MR (contrast-enhanced signal in dynamic examination) should be verified by MR-guided breast biopsy. In each case histopathologi

Prawidłowa i nieprawidłowa wiedza na temat czynników ryzyka związanych z rozwojem nadciśnienia tętniczego. Część 2. Populacja pacjentów z wykrytym nadciśnieniem tętniczym

Wstęp. Nadciśnienie tętnicze (HT) i jego powikłania powodują istotne skrócenie średniego czasu życia światowej populacji. W leczeniu nadciśnienia tętniczego — oprócz farmakoterapii — istotną rolę odgrywa zmiana stylu życia, a do tego potrzebna jest odpowiednia wiedza pacjentów. Materiał i metody. Badanie przeprowadzono w grupie 613 dorosłych osób z HT. Po uzyskaniu danych socjodemograficznych, wykonaniu pomiarów antropometrycznych i dwukrotnych pomiarach ciśnienia tętniczego w spoczynku z uczestnikami badania przeprowadzano indywidualne rozmowy w celu wypełnienia kwestionariusza do oceny ich wiedzy na temat HT. Pytania dotyczyły wpływu palenia tytoniu, alkoholu, kawy, soli tłuszczu, nieregularnych posiłków, diety zawierającej mało błonnika, warzyw i chudego nabiału, nadwagi i otyłości, cholesterolu, aktywności fizycznej i stresującego trybu życia na rozwój HT. Wyniki. Nieprawidłową wiedzę na temat wpływu poszczególnych czynników na rozwój HT stwierdzono u następującego odsetka respondentów: błędne informacje na temat wpływu spożywania alkoholu miało 16% respondentów, na temat picia kawy — 56,4%, spożywania dużych ilości soli — 7,2%, spożywania dużych ilości tłuszczów — 88%, niskiego spożycia błonnika, warzyw i chudego nabiału — 27,8%, nieregularnych posiłków — 46,4%, palenia tytoniu — 73,4%, nadwagi i otyłości — 4,4%, wysokiego stężenia cholesterolu — 86,9%, małej aktywności fizycznej — 11,2%, stresującego trybu życia — 5,4%. Wnioski. Nieprawidłowa wiedza na temat czynników HT dotyczyła najczęściej nadmiernego spożycia tłuszczów, podwyższonego stężenia cholesterolu, palenia tytoniu i picia kawy. Nie stwierdzono żadnych wspólnych cech u osób, które udzieliły nieprawidłowych odpowiedzi. Wyniki badania wskazują na potrzebę edukowania chorych na HT na temat czynników, które powodują nasilenie choroby