Statins in the Prevention of Cardiovascular Diseases: Facts and Prejudices.

Unatoč brojnim dokazima o neposrednoj učinkovitosti statina u snizivanju ukupnog i LDL kolesterola te dugoročnih učinaka u primarnoj i sekundarnoj prevenciji srčanožilnih bolesti, još uvijek se u svakodnevnoj praksi susrećemo s različitim predrasudama vezanima za neželjene učinke liječe- nja i eventualnu štetnost statina ne samo bolesnika nego i nekih liječnika. Osnovni mehanizam djelovanja statina inhibicija je enzima hidroksi-metil-glutaril koenzima A reduktaze (HMG CoA), enzima koji je ključan u sintezi kolesterola. Drugi potencijalni mehanizmi njihove učinkovitosti jesu stabilizacija aterosklerotskoga plaka, smanjenje endotelne disfunkcije, upalnih te protrombotskih intrava- skularnih procesa. Nuspojave liječenja statinima većinom su blage s učestalošću na razini placeba i najčešće ne zahtijevaju prekid liječenja. Treba istaknuti da uvijek treba poticati bolesnike na aktivni, nesedentarni način života, odnosno redovitu tjelesnu aktivnost, zbog njezinih jasnih pozitivnih učinaka u prevenciji te u liječenju dislipidemije i srčanožilnih bolesti.In spite of ample evidence supporting the direct effectiveness of statins in the reduction of total and low-density lipoprotein (LDL) cholesterol and long-term effects in primary and secondary prevention of cardiovascular diseases, in everyday practice we are still faced with various prejudices against the undesired effects of treatment and the possible adverse effects of statins, not only among patients, but among some physicians as well. The basic mechanism of action of statins is inhibiting 3-hydroxymethyl-3-methylglutaryl coenzyme A reductase (HMG-CoA), a key enzyme in cholesterol synthesis. Their other potential mechanisms are stabilization of atherosclerotic plaque and reduction of endothelial dysfunction, as well as in ammatory and post-thrombotic intravascular processes. The side effects of treatment with statins are generally mild, with a frequency comparable to placebo, and usually do not require the termination of treatment. It is necessary to emphasize that patients must always be encouraged to adopt an active, non-sedentary lifestyle that includes regular physical activity, due to its clear positive effects in the prevention and treatment of dyslipidemia and cardiovascular diseases

Exercise test – Yesterday and Today. From the History of the World and Croatian Cardiology

Test opterećenja ili ergometrijski test nezaobilazna je neinvazivna metoda u dijagnostici koronarne bolesti već desetljećima. Unatoč razvoju drugih suvremenih i sofisticiranih neinvazivnih i invazivnih metoda dijagnosticiranja koronarne bolesti, do današnjih dana ergometrija ne gubi svoje mjesto već je, u pravilu, prva karika u dijagnosticiranju koronarne bolesti srca. U radu je prikazan povijesni razvoj ergometrijskog testa u svijetu i Hrvatskoj.The exercise test has for decades been an unavoidable non-invasive method in the diagnosis of coronary artery disease. Despite the development of other modern and sophisticated noninvasive and invasive methods for coronary artery disease diagnosis, the exercise test has not lost its place to this day and is usually the first line in the diagnosis of coronary artery disease. This paper gives an overview of the historical development of exercise testing in the world and in Croatia

Torsades de pointes u bolesnice starije životne dobi s paroksizmalnom atrijskom fibrilacijom liječene kratkoročnom parenteralnom primjenom amiodarona

One of the drugs that are widely used in the treatment of atrial fibrillation is amiodarone. Despite considerable prolongation of the corrected QT interval and a substantial degree of bradycardia, amiodarone exhibits a remarkably low frequency of pro-arrhythmic events and <1.0% incidence of torsades de pointes, mostly after long-term usage. We present a case of an 80-year-old female with paroxysmal atrial fibrillation accompanied by acute heart failure treated by short-term parenteral amiodarone therapy and development of torsades de pointes.Jedan od lijekova koji se široko rabi u liječenju atrijske fibrilacije je amiodaron. Unatoč značajnom produljenju korigiranog QT intervala i usporavanju srčanog rada, amiodaron pokazuje iznimno nisku učestalost pro-aritmičkih događaja i <1,0% učestalosti torsades de pointes, uglavnom nakon dugotrajne uporabe. U radu je prikazan slučaj 80-godišnje žene s paroksizmalnom atrijskom fibrilacijom praćenom akutnim zatajenjem srca liječenom kratkotrajnom parenteralnom primjenom amiodarona i razvojem torsades de pointes

Je li kardiološka rehabilitacija korisna u bolesnika s koronarnom bolešću starijih od sedamdeset godina?

Elderly patients with coronary heart disease (CHD) are frequently not referred to cardiac rehabilitation programs. The aim of the study was to assess the effect of 3-week inpatient cardiac rehabilitation in CHD patients older than seventy. The study included 103 consecutive CHD patients older than 70 who underwent 3-week inpatient rehabilitation. A history of myocardial infarction was recorded in 77% of patients, whereas 23% had previously undergone coronary artery bypass surgery. The patients who could not perform exercise test or those with congestive heart failure were not included in the study. Functional capacity, lipid profile, blood glucose, body weight and body mass index were determined before and at the end of rehabilitation. After 3-week inpatient cardiac rehabilitation, functional capacity markedly improved (p<0.0001). The levels of cholesterol (p<0.0001), triglycerides (p=0.01), LDL-cholesterol (p<0.0001) and blood glucose (p=0.004) were significantly lower in comparison with initial values. There were no significant differences in HDL-cholesterol, body weight and body mass index between initial values and those measured at the end of rehabilitation. Results of the study suggest that elderly patients with CHD benefit from cardiac rehabilitation and should be routinely referred to cardiac rehabilitation and encouraged to attend these programs.Bolesnici s koronarnom bolešću starije životne dobi često se ne upućuju na kardiološku rehabilitaciju. Cilj ovoga rada bio je procijeniti učinak trotjedne stacionarne kardiološke rehabilitacije u bolesnika s koronarnom bolešću starijih od 70 godina. U studiju je bilo uključeno 103 uzastopnih bolesnika starijih od 70 godina tijekom trotjedne stacionarne kardiološke rehabilitacije. Infarkt miokarda bilo je preboljelo 77% bolesnika, dok ih je 23% bilo prethodno podvrgnuto kirurškoj revaskularizaciji miokarda. Bolesnici koji nisu mogli izvesti ergometrijsko testiranje ili oni s kongestivnim srčanim popuštanjem nisu bili uključeni u studiju. Funkcionalni kapacitet, lipidogram, razina glukoze u krvi, tjelesna težina i indeks tjelesne mase mjereni su prije te odmah nakon završetka rehabilitacije. Nakon trotjedne kardiološke rehabilitacije funkcionalni se kapacitet značajno poboljšao (p<0,0001). Razine kolesterola (p<0,0001), triglicerida (p=0,01), LDL-kolesterola (p<0,0001) i glukoze u krvi (p=0,004) bile su značajno niže u odnosu na početne vrijednosti. Nije bilo značajne razlike u razini HDL-kolesterola, tjelesnoj težini i indeksu tjelesne mase na kraju rehabilitacije u odnosu na početne vrijednosti. Rezultati ovoga rada pokazali su da kardiološka rehabilitacija koristi bolesnicima s koronarnom bolešću starijim od 70 godina, te da ih treba rutinski upućivati i poticati na provođenje ovih programa

Physiotherapeutic competencies in the process of rehabilitation of cardiovascular patients

U procesu kardiološke rehabilitacije, fizikalna terapija primjenjuje se za postizanje što boljeg fizičkog, psihičkog i socijalnog stanja bolesnika te njegova povratka aktivnostima svakodnevnoga života u obitelji i zajednici. U tom procesu, koji provodi interdisciplinarni tim, fizioterapeuti i njihove kompetencije imaju bitnu ulogu. Proces fizikalne terapije i rehabilitacije obuhvaća procjenu, intervenciju i evaluaciju u svim fazama, od koronarne jedinice pa do završne faze rehabilitacije. Fizioterapeutska procjena bolesnika sastoji se od subjektivnog i objektivnog pregleda, analize medicinske dokumentacije, fizioterapeutske anamneze, plana intervencija, postupaka mjerenja i testova. U procesu kardiološke rehabilitacije, posebne kompetencije fizioterapeuta potrebne su u dijagnostičkim pretragama (ergometrijsko testiranje, spirometrija, kontinuirano snimanje 24-satnog elektrokardiograma, kontinuirano snimanje 24-satnog krvnog tlaka, EKG, TCD i ehokardiografija), kojima se evaluiraju rezultati intervencija i opseg koronarnih bolesti. Kardiološka rehabilitacija dijeli se u tri međusobno povezane faze. Prva faza obuhvaća akutno i rano postakutno liječenje nakon akutnog koronarnog sindroma ili kardiokirurške operacije u koronarnim jedinicama i kardiološkim odjelima. Druga faza obuhvaća kasno postakutno liječenje, a obavlja se stacionarno, u specijaliziranim ustanovama za rehabilitaciju. Treća je faza doživotna, a obuhvaća trajno praćenje i skrb za bolesnike, što se provodi periodički, ambulantno te u bolničkoj ili izvanbolničkoj službi. Bitnu ulogu ima i prevencija kardiovaskularnih bolesti, kroz kontrolu čimbenika rizika, tjelesnu aktivnost, odnosno provođenje strategija djelovanja na razini pojedinca i cijele populacije. U radu su detaljno opisane fizioterapeutske kompetencije u procesu rehabilitacije kardioloških bolesnika.During cardiac rehabilitation, the aim of physical therapy is to achieve the best possible physical, psychological and social state of the patient and his return to daily activities within his family and the community. The rehabilitation of cardiac patients is a process conducted by an interdisciplinary team. In this team, physical therapists, with their competences, play an important role. Physical rehabilitation encompasses assessment, intervention and evaluation, from its beginning at the coronary unit to the end phase of rehabilitation. Physiotherapeutic assessment of the patient consists of subjective and objective examination, the analysis of medical documentation, patient physical therapy history, intervention plan, measurement procedures and tests. In cardiac rehabilitation, physiotherapy competences are important in diagnostic procedures (ergometry, spirometry, continuous 24-hour EKG, continuous 24-hour blood pressure monitoring, TCD and echocardiography) and are used to evaluate the results of interventions as well as the extent of coronary disease. Cardiac rehabilitation consists of 3 phases: 1) the phase of acute and early post-acute treatment, after the acute coronary syndrome or cardiac surgery (i.e., in coronary units and cardiology wards); 2) the phase of later (postacute) treatment, in specialized rehabilitation institutions; 3) the phase of continuing (lifetime) follow-up and patient care, with periodic visits to health care institutions. The prevention of cardiovascular diseases is very important and is implemented through the control of risk factors and regular physical activity, at the level of individual patients and the entire population. In this paper, we describe physiotherapeutic competences required for the successful rehabilitation of cardiac patients

Antitrombocitna terapija nakon aortokoronarnog premoštenja - neujednačenost svakodnevne kliničke prakse

Antiplatelet therapy is an integral part of optimal medicamentous therapy in patients with coronary artery disease. The strategy of antiplatelet/anticoagulant therapy is adjusted (combination of drugs, dosing and duration of therapy) depending on the stage of the disease (acute coronary syndrome with percutaneous coronary intervention, chronic coronary syndrome, or coronary surgical revascularization) and comorbidity of each patient (e.g., atrial fibrillation, left ventricular thrombus, etc.). Guidelines and clinical practice in particular are not uniform and specific regarding dual antiplatelet therapy in patients undergoing coronary artery bypass grafting, especially in the setting of chronic coronary syndrome.Sastavni dio optimalne medikamentne terapije u bolesnika s koronarnom bolešću je antitrombocitna terapija. Terapija antitrombocitnim te antikoagulantnim lijekovima (kombinacija lijekova, doziranje i trajanje terapije) prilagođava se ovisno o stadiju bolesti (akutni koronarni sindrom s perkutanom koronarnom intervencijom, kronični koronarni sindrom ili kirurška revaskularizacija) i komorbiditetu pojedinog bolesnika (npr. atrijska fibrilacija, tromb lijeve klijetke itd.). Smjernice, a osobito klinička praksa, nisu jedinstvene u pogledu dvojne antitrombocitne terapije u bolesnika koji su podvrgnuti operaciji aortokoronarnog premoštenja, naročito u postavkama kroničnog koronarnog sindroma