Migotanie przedsionków czy przetrwały otwór owalny — gdzie leży przyczyna nawracających udarów niedokrwiennych mózgu?

Ischemic stroke is one of the major causes of death and disability in high-developed countries. Closure of PFO is recommended if other causes of ischemic stroke, like atrial fibrillation, were excluded, especially in young patients. We present a case report of a 75-years-old female patient with five ischemic strokes in her medical history and newly diagnosed patent foramen ovale. Atrial fibrillation was detected 25 years after first ischemic event. Implementation of anticoagulation therapy has prevented new ischemic strokes in our patient. According to emerging meta-analyses such treatment is sufficient not only in AF, but also in PFO related ischemic strokes. The patient had another risk factors for paradoxical embolism such as varices, post-thrombotic syndrome of lower limbs and the Eustachian valve, so it is unclear whether AF has been the major cause of all ischemic stroke in present case. Significant bleeding from limb varices during anticoagulation treatment occurred and required urgent surgical intervention. Because of the high risk of recurrent haemorrhages (HAS-BLED Score – 4 points), the patient was considered to two percutaneous procedures: occlusion of the left atrial appendage (LAA) and consecutively second - PFO closure as additional prevention of stroke. This is an illustrative case that opens discussion on necessity and timing of cardiac interventions once possible cardiac sources of ischemic strokes are found and new facts arise.Ischemic stroke is one of the major causes of death and disability in high-developed countries. Closure of PFO is recommended if other causes of ischemic stroke, like atrial fibrillation, were excluded, especially in young patients. We present a case report of a 75-years-old female patient with five ischemic strokes in her medical history and newly diagnosed patent foramen ovale. Atrial fibrillation was detected 25 years after first ischemic event. Implementation of anticoagulation therapy has prevented new ischemic strokes in our patient. According to emerging meta-analyses such treatment is sufficient not only in AF, but also in PFO related ischemic strokes. The patient had another risk factors for paradoxical embolism such as varices, post-thrombotic syndrome of lower limbs and the Eustachian valve, so it is unclear whether AF has been the major cause of all ischemic stroke in present case. Significant bleeding from limb varices during anticoagulation treatment occurred and required urgent surgical intervention. Because of the high risk of recurrent haemorrhages (HAS-BLED Score – 4 points), the patient was considered to two percutaneous procedures: occlusion of the left atrial appendage (LAA) and consecutively second - PFO closure as additional prevention of stroke. This is an illustrative case that opens discussion on necessity and timing of cardiac interventions once possible cardiac sources of ischemic strokes are found and new facts arise

Standardy hemodynamicznej i angiograficznej oceny krążenia płucnego. Wspólne stanowisko Sekcji Krążenia Płucnego i Asocjacji Interwencji Sercowo-Naczyniowych Polskiego Towarzystwa Kardiologicznego

Right heart catheterisation (RHC) is the ‘gold standard’ for haemodynamic assessment of the pulmonary circulation. For the diagnosis of pulmonary hypertension (PH), the guidelines of the European Society of Cardiology require a mean pulmonary arterial pressure ≥ 25 mm Hg to be confirmed by direct haemodynamic measurement. Additionally, RHC provides a lot of valuable information about the differential diagnosis and severity of PH, and also helps determine the patient’s prognosis. Acute vasoreactivity testing performed in patients with pulmonary arterial hypertension is intended to identify the group of patients who should be treated with calcium channel blockers. Patients referred for heart transplantation require advanced pulmonary vascular disease to be ruled out either on resting examination or during vasoreactivity testing. RHC is a component of such interventional procedures as balloon atrial septostomy, closure of intracardiac shunts in congenital heart and great vessel defects, valvuloplasty for pulmonary valve stenosis, and pulmonary angioplasty. Pulmonary angiography is an examination recommended when selecting patients for pulmonary endarterectomy or balloon pulmonary angioplasty in thromboembolic PH. Due to the dynamic growth in the number of patients diagnosed with and treated for PH in Poland, the Boards of the Polish Cardiac Society’s Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions have undertaken a joint project to develop recommendations to standardise guidelines for RHC procedure, acute vasoreactivity testing and pulmonary angiography at cardiac wards and haemodynamic laboratories in Poland. This document has been prepared by experts delegated by the Working Group on Pulmonary Circulation and the Association of Cardiovascular Interventions, and subsequently approved by the Boards of both organs of the Polish Cardiac Society

Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation

Pulmonary arterial hypertension is a rare but progressive disease that leads to death. Modern drug treatment slows the progression of the disease and prolongs patients’ lives, but often, even maximal treatment with parenteral prostacyclin does not prevent deterioration. In the case of inadequate clinical response to drug treatment, lung transplantation (LTx) should be considered. This article aims to analyze thoroughly indications to refer a patient for consultation with a transplant center, the optimal timing of listing for LTx, contraindications for the procedure, bridging techniques, as well as tests needed before and after transplantation. We outline the technique of the procedurę and evaluate psychological aspects of LTx

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation and the Polish Society for Rheumatology on the diagnosis and treatment of pulmonary hypertension in patients with connective tissue disease

Systemic connective tissue diseases (CTDs) comprise a large group of diseases that are auto-immune in nature and characterized by the involvement of multiple systems and organs. Pul-monary hypertension (PH) of various etiologies may develop in the course of CTD, including pulmonary arterial hypertension (PAH), PH secondary to the lung disease, postcapillary PH in the course of left heart disease, and chronic thromboembolic pulmonary hypertension (CTEPH). In addition, the different forms of PH may coexist with each other. Among patients with CTD, PAH occurs most commonly in those with systemic sclerosis, where it affects ap-proximately 8%–12% of patients. The prognosis in patients with untreated PAH is very poor. It is particularly important to identify the high-risk CTD-PAH population and to perform effi-cient and accurate diagnostics so that targeted therapy of the pulmonary arteries can be intro-duced. Echocardiography is used to screen for PH, but clinical and echocardiographic suspicion of PH always requires confirmation by right heart catheterization. Confirmation of PAH ena-bles the initiation of life-prolonging pharmacological treatment in this group of patients, which should be administered in referral centers. Drugs available for pharmacological management include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclins

Characterization of patients with pulmonary arterial hypertension : data from the polish registry of pulmonary hypertension (BNP-PL)

Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic (n = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, n = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, n = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy

Obraz elektrokardiograficzny tętniczego nadciśnienia płucnego – od diagnozy poprzez ciążę do przeszczepienia płuc

The frequency and nature of electrocardiographic changes in patients with pulmonary hypertension varies significantly depending on the severity of the illness. In mild cases, electrocardiogram (ECG) may be normal. We present the consecutive ECGs of a patient with pulmonary arterial hypertension (PAH) in the 5-year course of the disease – from diagnosis to lung transplantation. The described case shows the variability of ECG changes in correlation with the clinical state of the patient. The observed ECG abnormalities in PAH are reversible and in the presented case ECG normalized after lung transplantation.Częstość i charakter zmian w zapisach elektrokardiograficznych u pacjentów z nadciśnieniem płucnym znacząco różni się zależnie od ciężkości choroby. U pacjentów z łagodnym nadciśnieniem płucnym zapis elektro-kardiograficzny (EKG) może być prawidłowy. W niniejszej pracy prezentujemy kolejne zapisy EKG pacjentki z tętniczym nadciśnieniem płucnym (pulmonary arterial hypertension – PAH) w 5-letnim okresie choroby – od postawienia diagnozy aż do przeszczepienia płuc. Opisany przypadek pokazuje różnorodność zmian w zapisach EKG, których nasilenie korelowało ze stanem klinicznym pacjentki. Obserwowane nieprawidłowości w zapisach EKG w przypadku PAH są odwracalne i w prezentowanym przypadku doszło do ich normalizacji po przeszczepieniu płuc