19 research outputs found
Nadci艣nienie t臋tnicze a rozw贸j niewydolno艣ci serca - mo偶liwo艣ci prewencji
Niewydolno艣膰 serca (HF, heart failure), z uwagi na
wzrastaj膮c膮 cz臋sto艣膰 wyst臋powania oraz z艂e rokowanie,
jest du偶ym wyzwaniem dla wsp贸艂czesnej medycyny.
Poprawa skuteczno艣ci farmakoterapii i procedur
inwazyjnego leczenia choroby niedokrwiennej
serca, prowadz膮ce do zwi臋kszenia prze偶ywalno艣ci
os贸b po przebytym zawale serca, oraz cz臋ste wsp贸艂wyst臋powanie
wieloletniego nadci艣nienia t臋tniczego,
cukrzycy typu 2, niewydolno艣ci nerek i oty艂o艣ci
sprzyjaj膮 rozwojowi HF w populacji pacjent贸w w podesz艂ym
wieku. Odr臋bny problem to post臋puj膮cy
przebieg choroby, cechuj膮cy si臋 okresowymi zaostrzeniami,
z czym wi膮偶e si臋, wzrastaj膮ca w miar臋
progresji choroby, cz臋sto艣膰 kolejnych hospitalizacji
oraz znaczne koszty - zar贸wno medyczne, jak i niemedyczne.
Najcz臋stsz膮 przyczyn膮 HF w populacji europejskiej
jest choroba niedokrwienna serca (ok. 70%) i wsp贸艂istniej膮ce
z ni膮 lub izolowane nadci艣nienie t臋tnicze
(ok. 60%). Obserwowany w nadci艣nieniu przerost mi臋艣nia
lewej komory jest niezale偶nym czynnikiem ryzyka
sercowo-naczyniowego i rozwoju HF, a dysfunkcj臋
rozkurczow膮 lewej komory stwierdza si臋 u 26-46%
pacjent贸w w podesz艂ym wieku z rozpoznanym nadci艣nieniem
t臋tniczym, bez towarzysz膮cych objaw贸w HF. Dlatego w艂a艣ciwie prowadzona terapia hipotensyjna,
wczesne rozpoznanie dysfunkcji rozkurczowej i zapobieganie
jej progresji do objawowej HF wydaj膮 si臋
mie膰 kluczowe znaczenie w post臋powaniu terapeutycznym
u chorego na nadci艣nienie t臋tnicze.
Uwa偶a si臋, 偶e 艣miertelno艣膰 z powodu niewydolno艣ci
rozkurczowej dor贸wnuje 艣miertelno艣ci spowodowanej
niewydolno艣ci膮 skurczow膮 serca. Co wi臋cej, tak偶e
wska藕niki rehospitalizacji i powik艂a艅 leczenia szpitalnego
s膮 podobne w grupie chorych z HF i zachowan膮
funkcj膮 skurczow膮 lewej komory oraz w grupie
chorych z niewydolno艣ci膮 skurczow膮. Wyniki zako艅czonych
do tej pory bada艅 klinicznych wskazuj膮, 偶e
najwa偶niejszym celem skutecznej terapii hipotensyjnej
u chorego bez organicznych zmian mi臋艣nia
sercowego jest obni偶enie ci艣nienia maj膮ce na celu
zapobieganie rozwojowi przerostu lewej komory,
natomiast u chorych z przerostem powinno si臋 preferowa膰
grupy lek贸w hipotensyjnych (inhibitory konwertazy
angiotensyny, sartany, diuretyki oraz antagonist贸w
wapnia) wp艂ywaj膮ce na jego ograniczenie
Skin microcirculation and echocardiographic and biochemical indices of left ventricular dysfunction in non-diabetic patients with heart failure
Background: We sought to noninvasively investigate skin microcirculation and to assess the
relation between parameters of microcirculation and echocardiographic and biochemical parameters
of left ventricular (LV) function in non-diabetic patients with heart failure (HF).
Methods and Results: We measured skin microcirculation with laser Doppler flowmetry
(LDF) at basal conditions (MFb), after warming to 44 degrees Centigrade (MF44) and after
occlusion (AUC, PF%). Blood was sampled for NT-proBNP. We obtained information on
patients’ medical history and medication status. The mean (SD) age of 100 patients (43 women)
was 68.2 ± 11.5 years. LV ejection fraction (LVEF) averaged 34.9 ± 13.3%, LV end-diastolic
diameter (LVEDD) 6.0 ± 0.9 cm, NT-proBNP 4,582.6 ± 6,339.7 pg/mL. The parameters of
microcirculation averaged: MFb 6.2 ± 4.7 perfusion units (PU), PF% 716.0 ± 437.8%, AUC
794 ± 706.1 PU/s, and MF44 77.9 ± 40.2 PU. NT-proBNP correlated negatively with LVEF
(p £ 0.0001) and positively with LVEDD (p = 0.003). MFb was positively correlated with
LVEF (r = 0.24, p = 0.03), and MF44 was negatively correlated with LVEDD (r = 0.22,
p = 0.02). The relations remained significant after adjustments for sex, age, and use of
medication. We observed no relation between NT-proBNP and microcirculatory derangement.
Conclusions: LDF-derived parameters of skin microcirculation are related to echocardiographic,
but not biochemical, indices of HF. (Cardiol J 2011; 18, 3: 270–276
Skin microcirculation and echocardiographic and biochemical indices of left ventricular dysfunction in non-diabetic patients with heart failure
Specyficzne potrzeby lecznicze os贸b starszych a kszta艂cenie geriatr贸w. Dlaczego geriatria jest specjalizacj膮 wa偶n膮 i dlaczego ci膮gle brakuje geriatr贸w?
Principles of health care in elderly and geriatric education. Why is geriatrics so important and why are we still lacking geriatricians?While population is aging we are facing raising number of geriatric problems. It is obvious nowadays that if we do not start creating certain plans considering medical and social care of elderly people, the situation may get out of control. The natural course of diseases in elderly is different to middle aged and young people. These individuals show different symptoms and social background, different prognosis and complications of the disease and of diagnostic and therapeutic medical procedures themselves. The major feature that distinguishes geriatric medicine from others is comprehensive geriatric assessment which is holistic and considers not only medical condition but also social, psychological background together with identifying aspects of functional status, nutrition, transportation and others. It seems that the need for professionals with experience in geriatrics is growing. The most important in this area are general practitioners and geriatricians. There is also a constant need for educational effort to create society whose members are responsible for their own health
Age-related gap in the management of heart failure patients. The National Project of Prevention and Treatment of Cardiovascular Diseases — POLKARD
Background: Heart failure (HF) is strongly associated with aging. It affects 10–12% of
patients older than 80 years, with five-year overall mortality after first hospitalization for HF
being as high as 81%. The main objective of this study was to assess the diagnosis and
treatment of HF in hospitalized octogenarians compared to younger subjects.
Methods: The survey was performed among a random sample of all Polish hospitals and in
all academic centers, as part of the National Project of Prevention and Treatment of Cardiovascular
Diseases in Poland — POLKARD. Using a questionnaire-based method, hospital
documentation of the last five patients with diagnosed HF was reviewed. Eventually, in 2005,
HF patients of 259 internal medicine and cardiology hospital wards, including 260 very
elderly patients, were selected to the study.
Results: The mean age of the 1,289 studied patients was 69.8 ± 11.4 years (age range: 26–96
years), 57.8% were males, and 80.1% were in NYHA class III or IV. Echocardiography was
performed in 41.7% of octogenarians in comparison with 58.7% of those categorized as
younger elderly, i.e. 60–79 years, and 75.2% of patients aged below 60 years (p < 0.0001).
The most prescribed drugs in very elderly patients were diuretics (86.9%, p = 0.005) and
ACE-I (81.9%), while only 61.5% used beta-blockers (p < 0.0001). In stepwise logistic regression
analysis, hypertension, history of myocardial infarction and admission to cardiology
ward were positively associated with beta-blocker and ACE-I (or ARB) therapy, while older age
and pulmonary diseases (COPD or asthma) were related to their non-prescription.
Conclusions: Despite significant progress in HF management, there is still a need for an
improvement in the medical care of very elderly patients. The major obstacles seem to be
advanced age and the presence of coexistent pulmonary diseases. Therefore, the participation of
geriatricians and pulmonologists should be recommended in caring for octogenarians with HF.
(Cardiol J 2012; 19, 2: 146–152
Age-related gap in the management of heart failure patients : The National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD
Principles of health care in elderly and geriatric education : why is geriatrics so important and why are we still lacking geriatricians?
While population is aging we are facing raising number of geriatric problems. It is obvious nowadays that if we do not start creating certain plans considering medical and social care of elderly people, the situation may get out of control. The natural course of diseases in elderly is different to middle aged and young people. These individuals show different symptoms and social background, different prognosis and complications of the disease and of diagnostic and therapeutic medical procedures themselves. The major feature that distinguishes geriatric medicine from others is comprehensive geriatric assessment which is holistic and considers not only medical condition but also social, psychological background together with identifying aspects of functional status, nutrition, transportation and others. It seems that the need for professionals with experience in geriatrics is growing. The most important in this area are general practitioners and geriatricians. There is also a constant need for educational effort to create society whose members are responsible for their own health
Niewydolno艣膰 serca - standardy post臋powania w 艣wietle rekomendacji Europejskiego Towarzystwa Kardiologicznego 2008
Niewydolno艣膰 serca to znacz膮cy problem w populacji
europejskiej, zar贸wno ze wzgl臋du na zwi臋kszaj膮c膮
si臋 chorobowo艣膰 oraz du偶膮 艣miertelno艣膰, jak
i ogromne nak艂ady finansowe zwi膮zane przede
wszystkim z wysokim wska藕nikiem rehospitalizacji.
Niniejszy artyku艂 powsta艂 na podstawie tegorocznych
wytycznych Europejskiego Towarzystwa Kardiologicznego.
Prawid艂owa diagnostyka i leczenie -
zar贸wno farmakologiczne, jak i niefarmakologiczne
- daj膮 szans臋 na wyd艂u偶enie prze偶ycia, zmniejszenie
chorobowo艣ci i popraw臋 jako艣ci 偶ycia, mimo
bardzo z艂ego rokowania w tej grupie chorych. Odsetek pacjent贸w leczonych zgodnie z aktualnymi wytycznymi
jest ci膮gle niezadowalaj膮cy.
Celem niniejszego opracowania jest przybli偶enie
zagadnie艅 zwi膮zanych z niewydolno艣ci膮 serca, maj膮cych
szczeg贸lne znaczenie w codziennej praktyce
lekarskiej