Fixed Combinations

Fiksna kombinacija antihipertenzivnih lijekova pojednostavnjuje liječenje i poboljšava suradljivost bolesnika. Fiksne kombinacije omogućuju jednostavnije doziranje te ih bolesnici bolje prihvaćaju. Proces titriranja do optimalnog učinka se pojednostavnjuje, što sve pridonosi boljem poštivanju uputa o uzimanju lijeka i većoj djelotvornosti. Kombiniranje lijekova koji imaju komplementaran mehanizam djelovanja može pospješiti korisne učinke obiju komponenata, dok se neželjena djelovanja visokodozne monoterapije mogu reducirati. Osim reguliranja arterijskog tlaka, ovakve kombinacije dokazano dodatno smanjuju pojavnost kardiovaskularnih događaja djelujući na sam mehanizam nastanka bolesti. Posljednje smjernice za liječenje hipertenzije Europskog društva za hipertenziju i Europskoga kardiološkog društva (ESH/ESC) iz 2007. godine koje su obnovljene 2009. godine, kao i rezultati brojnih novijih istraživanja daju prednost kombinacijama ACE-inhibitora ili angiotenzinskih receptora s blokatorom kalcijskih kanala ili diuretikom kao kombinacijom izbora.Fixed combinations of antihypertensive drugs simplify treatment and enhance patient compliance. They facilitate dosage and they are therefore better accepted by patients. Drug titration to optimal effects is simplified, which improves compliance and efficacy. The combination of drugs with complementary mechanisms of action may enhance useful effects of both components, while undesirable effects of highdose monotherapy may be reduced. In addition to blood pressure regulation, such combinations additionally decrease the rate of cardiovascular events, acting on the mechanisms causing the disease. The latest guidelines for the treatment of hypertension of the European Society of Hypertension and European Society of Cardiology (ESH/ESC) issued in 2007 and renewed in 2009, as well as the results of numerous new studies indicate the combinations of ACE inhibitors or angiotensin II receptor blockers with calcium-channel blockers or diuretics as combination therapies of choice

Occupational Diseases, Working Ability and Employment Status in the Working Population of Croatia

The paper gives insight into the working ability and employment status of workers with recognized occupational diseases in Croatia. The analysis based on working ability data from 212 workers shows that 12 (5.5%) workers have general disability for work, 75 (35.5%) occupational disability for work, 98 (46.4%) danger of disability onset, 13 (6%) no disability and 14 (6.5%) are sent for further medical treatment. The highest frequency of occupational diseases is in the group of workers with 41–50 years of age, in the category of 20–24 exposure years. Official data imply that the incidence rate of occupational diseases in Croatia is 4 times lower than in European Union. Such a low incidence rate derives from problems in the system of healthcare and health insurance, and also from problems in the system of monitoring and registering of occupational diseases

Staying Focused on Cardiovascular Patients During the COVID-19 Pandemic

Tijekom pandemije COVID-a 19 smanjio se broja pregleda te dijagnostičkih i terapijskih zahvata u bolesnika s kardiovaskularnim bolestima. U nekoliko zemalja zabilježen je porast mortaliteta u iste skupine bolesnika, kako od COVID-a 19, tako i od samih kardiovaskularnih bolesti. Važno je nastaviti liječiti takve bolesnike i spriječiti nedostupnost zdravstvene zaštite zbog subjektivnih ili objektivnih razloga. U tome nam može pomoći i telemedicina, no velik dio odgovornosti ostaje na samim bolesnicima da samokontrolom i redovitim uzimanjem terapije spriječe pogoršanje bolesti. Mi im možemo pomoći olakšavanjem te zadaće (telefonski kontakt, fiksne kombinacije lijekova). Također je važno zdravstvenu zaštitu prilagoditi pandemiji kako bi ta zaštita bila učinkovita i sigurna i za bolesnike i za pružatelje zaštite.During the COVID-19 pandemic, there fewer examinations and diagnostic and therapeutic procedures were performed in patients with cardiovascular diseases. In several countries, an increase in mortality has been reported in this group of patients, both from COVID-19 and from cardiovascular diseases. It is important to continue to treat these patients and to prevent the unavailability of health care for subjective or objective reasons. Telemedicine can also help us in this, but much of the responsibility remains with the patients themselves to prevent the disease from getting worse through self-monitoring and regular therapy. We can help them by facilitating this task (telephone contacts, fixed drug combinations). It is also important to adapt healthcare to the pandemic in order to make it effective and safe for both patients and caregivers

Right ventricular strain for detecting subclinical dysfunction of the right ventricle in systemic sclerosis

Introduction: Right ventricular (RV) function and cardiac involvement in systemic sclerosis (SSc) is important factor for the prognosis of SSc but often remains undetectable despite echocardiographic screening. 1,3 Speckle derived strain (2D-STE) of the right ventricle (RV GLS) was utilized to detect subclinical abnormalities in regional and global contractility in SSc patients with no echocardiographic signs of pulmonary arterial hypertension. Aim of pilot study was to study the advantages of 2D speckle-tracking echocardiographic derived parameters in identifying RV dysfunction in SSc patients for quantifying myocardial deformation and conventional RV indexes in patients with SSc and to investigate whether these could be indicative of right heart failure or can be used as non-invasive methods of screening in SSc. Methods and Results: 27 SSc patients (mean age, 54.3 years; 96% female) with technically adequate echocardiograms were studied. Standard morphological measurements of RV chamber function, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tricuspid tissue Doppler annular velocities (TDIs,), right ventricular myocardial performance index (RIMP) and global longitudinal right ventricular free wall strain (RV FW GLS) were obtained. Twenty-two patients without pulmonary arterial hypertension (PAH) due to systemic sclerosis were studied. When we used the cutoff value recommended by the American Society of Echocardiography Guidelines to identify abnormal RV function4, patients were determined to have normal RV function, TAPSE 21.9 (±2.21), RV FAC 49.4 (±3.45), RIMP 0.44 (±0.08) respectively. Global longitudinal strain (LS) of the RV was calculated by averaging the LS value of 3 segments of the RV free wall in RV focused apical 4-chamber view (Figure 1). 40.9% of those patients had abnormal RV FW GLS (-14.8%) more pronounced in the basal regional longitudinal strain. Conclusion: Right ventricular strain reveals a diverse pattern of regional strain in SSc that is not detected by conventional measures of function, suggestive of subclinical RV myocardial disease and could be used as non-invasive method in screening for PAH in SSc to select patients eligible for right heart catheterization or to monitor the effects of PAH therapy.1-

B-mode and Color Doppler Ultrasound of the Forearm Arteries in the Preoperative Screening Prior to Coronary Artery Bypass Grafting

The objective of this paper was to establish the normal findings of B-mode and color Doppler ultrasound of the forearm arteries in candidates for coronary artery bypass grafting with radial artery graft. Examination of radial and ulnar arteries was performed in 127 patients. The vessel diameters and peak systolic velocities were measured and the presence of atherosclerotic changes, calcifications and anatomical variants was assessed. Radial artery proved to be dominant forearm artery with non-significant sideto- side asymmetry. The luminal changes were present in 30% of the patients. Ulnar arteries were more prone to these changes than radial arteries (28.4% vs. 24.4%). The anatomical variants found included ulnar artery hypoplasia in 3.9% of patients and high brachial artery bifurcation in 2.4% of patients. No cases of high-grade stenosis or occlusion were found. The results of the present study indicate that B-mode and color Doppler are valuable methods for preoperative screening as they enable morphological and functional evaluation of the forearm circulation

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope

Ortostatska intolerancija: sindrom posturalne ortostatske tahikardije s vazovagalnom sinkopom

A 28-year-old female with a history of situational syncope and a new-onset right sided hemiparesis is described. Tilt-up table test revealed the postural orthostatic tachycardia syndrome followed by vasovagal syncope. Neurological and internal medicine tests showed no particular disorders. The patient underwent autonomic physical training and the tilt-up test performed three months later showed improvement of the autonomic system in terms of lower heart beat rate of the postural orthostatic tachycardia syndrome and longer duration of the test. This case report describes longstanding idiopathic dysautonomia that can be improved by nonpharmacological treatment, while reminding that this medical condition may also be the cause of syncope.Prikazuje se 28-godišnja bolesnica s anamnezom višegodišnje situacijske sinkope i novonastalom desnostranom hemiparezom. Učinjen tilt-up table testom utvrđen je sindrom posturalne ortostatske tahikardije (engl. POTS , postural orthostatic tachycardia syndrome), nakon kojeg je uslijedila vazovagalna sinkopa. Neurološkom i internističkom obradom nije utvrđen eventualan drugi uzrok sinkope. Tijekom slijedeća tri mjeseca bolesnica je u kućnim uvjetima provodila ortostatske vježbe autonomnog sustava, nakon čega je učinjen kontrolni tilt-up table test kojim je objektivizirano poboljšanje statusa autonomnog sustava u smislu nižih vrijednosti frekvencije tahikardije POTS -a i duljeg trajanja testa, odnosno održavanja ortostaze. Ovaj slučaj govori o višegodišnjoj idiopatskoj disautonomiji na koju je moguće utjecati nefarmakološkim metodama te je ujedno i podsjetnik na jedan od mogućih uzroka sinkope