Nowe możliwości terapii osób z zespołem metabolicznym

The occurrence of metabolic syndrome is a risk factor for developing cardiovascular disease. Moreover, the size oflow-density lipoprotein (LDL) particles, and liver dysfunction identified as nonalcoholic fatty liver disease (NAFLD) both represent important biomarkers for the development of cardiometabolic risk in patients with metabolic syndrome. Patients being treated with bergamot polyphenolic fraction show significant reductions in fasting plasma glucose, serum LDL cholesterol and triglycerides along with an increase of high-density lipoprotein cholesterol level. This effect is accompanied in ultrasonography examination by significant reduction NAFLD.Zespół metaboliczny jest uznawany za czynnik ryzyka schorzeń układu sercowo-naczyniowego. Zarówno małe, gęste cząsteczki lipoprotein o małej gęstości (LDL), jak i dysfunkcja wątroby pod postacią niealkoholowego stłuszczenia wątroby (NAFLD) są markerami ryzyka metabolicznego u chorych z zespołem metabolicznym. U pacjentów z zespołem metabolicznym leczonych kompozycją polifenoli z bergamoty stwierdza się obniżenie stężeń glukozy na czczo, triglicerydow i cholesterolu frakcji LDL oraz zwiększenia stężenia cholesterolu frakcji lipoprotein o dużej gęstości we krwi. Towarzyszy im cofanie się cech NAFLD w badaniu obrazowym, ultrasonograficznym

Preparat złożony atorwastatyna/perindopril — nowoczesna prewencja zdarzeń sercowo-naczyniowych

Cardiovascular diseases are the leading cause of death in Poland. The most common cardiovascular risk factors are dyslipidemia and hypertension. Unfortunately, the percentage of patients with well-controlled dyslipidemia and hypertension remains very low. This is mainly due to insufficient statin therapy. Perindopril and atorvastatin are substances with a documented efficacy in reducing the incidence of cardiovascular events. The use of these drugs in one capsule can cause a significant increase in the percentage of patients properly treated and reaching the target values of blood pressure and LDL-cholesterol.Choroby układu sercowo-naczyniowego są główną przyczyną zgonów w Polsce, a najczęściej występujące czynniki ryzyka sercowo-naczyniowego to dyslipidemia i nadciśnienie tętnicze. Niestety odsetek chorych z dobrze kontrolowanymi dyslipidemią i nadciśnieniem tętniczym pozostaje bardzo niski. Wynika to głównie z niedostatecznej terapii statynami. Perindopril i atorwastatyna to substancje o udokumentowanym wpływie na ograniczenie częstości występowania zdarzeń sercowo-naczyniowych. Zastosowanie tych leków w jednej kapsułce może spowodować istotny wzrost odsetka chorych właściwie leczonych i osiągających docelowe wartości ciśnienia tętniczego i cholesterolu frakcji LDL

Atrial paralysis due to progression of cardiac disease in a patient with Emery-Dreifuss muscular dystrophy

We present the progressive nature of the disease in a 26 year-old woman who had suffered from Emery-Dreifuss muscular dystrophy detected at the age of three. In 2002, at the age of 20, due to recurring presyncopal states accompanied by sinus bradycardia and atrioventricular block, she was implanted with a dual chamber pacing system. During testing of the pacing in 2008, permanent electrical atrial stand-still without atria stimulation were detected and the mode of heart stimulation was changed to VVIR. (Cardiol J 2011; 18, 2: 189-193

Concomitant recovery of atrial mechanical and endocrine function after cardioversion in patients with persistent atrial fibrillation

AbstractObjectivesThe purpose of this study was to evaluate left atrial mechanical function recovery and plasma atrial natriuretic peptide (ANP) release following successful cardioversion of persistent atrial fibrillation (AF).BackgroundAtrial fibrillation is characterized by functional deterioration, loss of atrial contraction, and elevation of plasma ANP levels. The response of ANP release toward atrial mechanical function after cardioversion of AF has not been fully examined.MethodsWe examined 29 patients with successfully cardioverted persistent AF in whom sinus rhythm was maintained for at least 30 days after cardioversion. We assessed mechanical function of the left atrium at 24 h and 7 and 30 days after cardioversion and evaluated plasma ANP level at the same time. Atrial mechanical function was assessed during echocardiographic examination by means of the peak velocity of the transmitral A-wave, early transmitral to atrial flow velocity ratio, and atrial filling fraction (AFF). The plasma ANP level was determined by the radioimmunoassay method.ResultsPlasma ANP levels were significantly reduced from 59.4 ± 16.6 pg/ml to 31.1 ± 9.2 pg/ml at 24 h after successful cardioversion. Within 30 days, we noted progressive improvement of atrial systolic function (increase in AFF from 21% to 31%, p < 0.05). At the same time, plasma ANP levels gradually increased from 31.1 ± 9.2 pg/ml at 24 h to 36.9 ± 12.8 pg/ml on day 30 following cardioversion (p < 0.05).ConclusionsPlasma ANP levels significantly decreased in patients with persistent AF after successful cardioversion. In the 30 days after cardioversion, gradual elevation of plasma ANP concentration was observed concomitantly with an increase of AFF. Plasma ANP release after successful cardioversion of persistent AF might be due to recovery of atrial mechanical function

The influence of permanent cardiac pacing on plasma levels of B-type natriuretic peptide in patients with sick sinus syndrome

Background: Unequivocal data presenting the impact of different pacing modes on B-type natriuretic peptide levels has never been published. The aim of the study was to assess changes of plasma B-type natriuretic peptide (BNP) during permanent cardiac pacing in patients with sick sinus syndrome (SSS). Methods: Patients with SSS undergoing routine pacemaker implantation were enrolled. Each subject underwent medical history and examination, echocardiography and blood sampling. Analysis was performed on 12 females (42.9%) and 16 males (57.1%), mean age 71.3 &plusmn; 9.03 years, range 49-90 years. There were 11 pacemakers with AAIR pacing mode (39.3%; AAI group) and 17 with DDDR mode (60.7%; DDD group) implanted. There were no significant differences in age, concomitant diseases or echocardiographic parameters between the groups in baseline characteristics or plasma BNP levels (94.05 &plusmn; 54.1 vs. 73.57 &plusmn; 70.13 pg/mL; p > 0.2). Results: During six months follow-up no significant changes in plasma BNP levels in AAI group (94.05 &plusmn; 54.1 vs. 94.05 &plusmn; 54.1 pg/mL; p > 0.5) as well as in DDD group (73.57 &plusmn; 70.1 vs. 82.39 &plusmn; 58.9 pg/mL; p > 0.5) were noticed. Conclusions: Atrial (AAIR) and dual chamber (DDDR) pacing did not influence plasma BNP levels in patients with SSS and preserved left ventricular systolic function. (Cardiol J 2008; 15: 39-42

Percutaneous left atrial appendage occlusion: New perspectives for the method

Ischemic stroke is a common complication of atrial fibrillation (AF). Currently, oral anticoagulant drugs are the most commonly used method of stroke prevention. Left atrial appendage occlusion is thought to be the main source of thrombi in patients with AF. Percutaneous left atrial appendage is a valuable therapeutic option for selected high-risk patients with AF and contraindications for oral anticoagulation therapy. While complete closure of the left atrial appendage is the goal of a device implantation the variable nature of the left atrial appendage anatomy makes this goal difficult to achieve. Currently, there are several types of devices available for left atrial appendage occlusion. Since the first percutaneous left atrial appendage occlusion in 2002 many studies have investigated both the safety and efficacy of this therapy using different closure devices. Still unresolved issues include a lack of data on optimal patient selection, risk of complications, and anticoagulant treatment after left atrial appendage occlusion.

Propafenone overdose: Cardiac arrest and full recovery

Intoxication caused by propafenone is very rare, and there are no known detailed epidemiological studies. We present the clinical manifestation of severe propafenone intoxication,successfully treated in a 17 year-old male. He was brought to the Intensive Care Unit after he had taken 3.0 g propafenone. The main clinical findings included: sudden cardiac arrest, coma, hypotension, left ventricular failure, bradycardia, sinoatrial block, atrioventricular junctional or/and ventricular tachycardia. During the treatment, transient heart pacing was performed and catecholamines were administered by means of continuous intravenous infusion of pressure doses as well as of infusion liquids. Cessation of toxic signs four hours after admission to hospital was observed. This relatively rare, fully symptomatic intoxication with propafenone deserved to be presented due to the drug&#8217;s common usage in the treatment of dysrhythmia and life-threatening symptoms of overdosing. The course of the disease was dramatic and the patient survived only thanks to quick resuscitation, artificial ventilation, transient heart pacing, acidosis treatment and administration of pressure doses of catecholamines. (Cardiol J 2010; 17, 6: 619-622

Guzy serca leczone chirurgicznie — doświadczenie jednego ośrodka

Introduction. Cardiac masses may be of neoplastic or non-neoplastic nature. The most common benign primary cardiac tumour is myxoma, and the most common malignant tumour is sarcoma. Metastatic tumours are more prevalent than primary cardiac tumours. Surgical excision of the cardiac mass is the treatment of choice. The aim of this study was to evaluate the prevalence of specific types of cardiac masses and their effect on outcomes in surgically treated patients with cardiac masses. Material and methods. We studied all patients treated at the Department of Cardiac Surgery, Świętokrzyskie Cardiology Centre in Kielce, with the echocardiographic diagnosis of a cardiac mass who were operated in 2008–2014. Results. Our study group included 19 patients aged 25 to 80 years (mean age 60.8 years). Based on histologic evaluation of the resected mass, myxoma was diagnosed in 13 patients (68.4%), thrombus in 4 patients (21.1%), lipoma in one patient (5.3%), and metastatic right adrenal tumour in one patient (5.3%). The mass was most commonly located in the left atrium (n = 13, 68.4%), followed by the left ventricle and right atrium (n = 2 each, 10.5%), and the right ventricle and both atria (n = 1 each, 5.3%). Three patients (16%) died in the early postoperative period, and all 16 patients who were discharged from the Department of Cardiac Surgery were alive at long-term follow-up (mean 2.5 years). Conclusions. Surgical excision is the treatment of choice in patients with cardiac masses, except for those in whom the tumour is a manifestation of an advanced neoplastic disease. Long-term outcomes in patients operated due to a cardiac mass are favourable.  Wstęp. Guzy serca mogą mieć podłoże nowotworowe lub nienowotworowe. Najczęściej występującym nowotworem pierwotnym łagodnym jest śluzak, a złośliwym — mięsak. W sercu częściej niż guzy pierwotne występują guzy przerzutowe. Leczenie operacyjne guzów serca jest leczeniem z wyboru. Celem pracy była ocena częstości występowania poszczególnych guzów serca oraz ich wpływu na rokowanie u operowanych chorych z guzami serca. Materiał i metody. Badaniem objęto wszystkich chorych operowanych na Oddziale Kardiochirurgii Świętokrzyskiego Centrum Kardiologii w Kielcach z guzem serca rozpoznanym na podstawie badania echokardiograficznego w latach 2008–2014. Wyniki. Badana grupa obejmowała 19 osób w wieku 25–80 lat (średnio 60,8 roku).W badanej grupie, na podstawie badania histopatologicznego usuniętego guza, u 13 pacjentów (68,4%) stwierdzono obecność śluzaka, u 3 chorych (16%) — skrzeplinę, u 1 chorego (5,3%) tłuszczaka — oraz także u 1 chorego (5,3%) — przerzut prawego raka nadnercza. Zmiana najczęściej była zlokalizowana w lewym przedsionku (13 przypadków; 68,4%); poza tym występowała w lewej komorze (2 przypadki; 10,5%), prawym przedsionku (2 przypadki; 10,5%), prawej komorze oraz w obu przedsionkach (odpowiednio po 1 przypadku; 5,3%). W badanej grupie 3 chorych (16%) zmarło we wczesnym okresie pooperacyjnym. W obserwacji długoterminowej (średnio 2,5-letniej) 16 chorych, których po operacji guzów serca wypisano z oddziału kardiochirurgii, przeżyło okres obserwacji. Wnioski. Leczenie operacyjne jest leczeniem z wyboru u chorych z guzami serca, dotyczy jednak tylko tych osób, u których guz ten nie jest manifestacją zaawansowanej choroby nowotworowej. Rokowanie długoterminowe u chorych operowanych z powodu guza serca jest pomyślne.