Hormonalna terapia zastępcza a choroby układu sercowo-naczyniowego

The results of large randomized trials such as the Women's Health Initiative (WHI), Heart and Estrogen / Progestin Replacement Study (HERS) or Estrogen Replacement and Atherosclerosis Study (ERAS) as well as the Million Women Study (MWS) which does not meet criteria RCT, concerning, among others the impact of HRT on breast cancer risk, thromboembolism, or the aging processes in the central nervous system caused the recent big confusion in the medical community , causing distrust about the safety and advisability of HRT in menopausal women. The paper presents an overview of the available, current literature on HRT. It was found that HRT should not be used in both primary and secondary prevention of coronary heart disease Great expectations was associated with an earlier initiation of therapy, before the advent of atherosclerosis - but there is currently no conclusive data about its role in the primary prevention of coronary disease. Oral HRT increases the risk of thromboembolic events - that is why you should prefer the form of a transdermal. HRT may increase the risk of ischemic stroke (but early initiation of therapy does not increase the risk of stroke) and should not be used in the primary prevention of stroke.Wyniki dużych randomizowanych badań klinicznych, takich jak Women’s Health Initiative (WHI), Heart and Estrogen/Progestin Replacement Study (HERS), czy Estrogen Replacement and Atherosclerosis Study (ERAS), jak również niespełniającego kryterium RCT dużego badania Million Women Study (MWS), dotyczących m.in. wpływu HTZ na ryzyko raka piersi, powikłania zakrzepowo-zatorowe, czy procesy starzenia w ośrodkowym układzie nerwowym wywołały w ostatnim czasie duże zamieszanie w środowisku lekarskim, powodując nieufność, co do bezpieczeństwa i celowości stosowania HTZ u kobiet menopauzalnych. Praca przedstawia przegląd dostępnej, aktualnej literatury na ten temat. Stwierdzono, ze nie należy stosować HTZ zarówno w pierwotnej, jak i wtórnej prewencji choroby niedokrwiennej serca. Duże nadzieje wiąże się z wcześniejszym rozpoczęciem terapii, przed pojawieniem się zmian miażdżycowych – obecnie brak jest jednak jednoznacznych danych o jej roli w pierwotnej prewencji choroby niedokrwiennej. Doustna HTZ zwiększa ryzyko zdarzeń zakrzepowo-zatorowych – dlatego należy preferować formę transdermalną. HTZ może zwiększać ryzyko udaru niedokrwiennego (ale wczesne rozpoczęcie terapii nie wpływa na zwiększenie ryzyka udaru). HTZ nie należy stosować w pierwotnej prewencji udaru mózgu

Acute myocardial infarction in an 80 year-old woman caused by left main occlusion with concomitant chronic total occlusions of right and left coronary artery: Successful treatment with percutaneous revascularization

Although acute left main coronary artery occlusion is rare, it carries a very high mortality rate. Following the encouraging results of trials testing the effect of primary percutaneous coronary intervention, more cases of left main stenosis are treated as culprit lesion in acute myocardial infarction. Few cases of primary percutaneous intervention on left main occlusion have been published. We present the case of an elderly patient presenting with acute myocardial infarction complicated by cardiogenic shock due to left main occlusion, with concomitant chronic total occlusion of right and left anterior descending coronary arteries. Successful percutaneous intervention as a bridge to coronary artery bypass grafting was performed with stent implantation, which resulted in the relief of obstruction, the restoration of blood flow and the immediate clinical improvement of the patient. The patient left the hospital in good condition after 11 days, although she had refused the proposed coronary artery bypass graftin

Transcatheter aortic valve implantation: The new option for high-risk patients with aortic stenosis

Calcific aortic valve stenosis is the most common valvular heart disease in developed countries. Without surgery, the prognosis is extremely dismal. Therefore there is general agreement that surgical aortic valve replacement should be offered to patients with symptomatic severe aortic valve stenosis. However, surgery is denied to approx. 30–40% of elderly patients with severe, symptomatic aortic stenosis due to high perioperative risk. Transcatheter aortic valve implantation (TAVI) is a novel and effective procedure which provides a promising treatment option for some of these patients. This review focuses on TAVI systems, the patients who would benefit from TAVI, and the advantages and disadvantages of the procedure. (Cardiol J 2011; 18, 4: 461–468