Wpływ nieklasycznych czynników ryzyka sercowo-naczyniowego na wybór terapii hipolipemizującej i hipotensyjnej

Cardiovascular risk assessment in clinical practice isessential. It affects treatment methods of cardiovascular diseasesin patients. Recommended tools such as POL-SCORE do not take into account the clinical picture of all the patients.The clinical case shows that the use of nonclassical elements of risk factors in clinical practice changes the scheme ofaction undertaken so far.Ocena ryzyka sercowo-naczyniowego w codziennej praktyce klinicznej jest niezwykle istotna. Wpływa ona na sposób leczenia wielu pacjentów z chorobami układu krążenia. Zalecane narzędzia, takie jakie jak POL-SCORE nie uwzględniają całego obrazu klinicznego wszystkich chorych. Opisany przypadek kliniczny pokazuje, jak zastosowanie nieklasycznych czynników ryzyka w praktyce klinicznej, zmienia przyjęty dotąd schemat postępowania

Attitudes of Polish physicians towards new antihypertensive agents — a final report from the ALMONDS survey

Introduction. Arterial hypertension is the most frequent modifiable risk factor for cardiovascular disease and premature mortality globally. Availability of novel antihypertensive agents with unique pharmacological characteristics improves the efficacy and safety of antihypertensive therapy. The aim of the ALMONDS survey was to identify the attitude of Polish medical professionals towards novel pharmacological agents used in the therapy of hypertension. In particular, we sought to investigate the views regarding the “class effect” for antihypertensive agents. Material and methods. The study was conducted using a standardized survey, which was filled in by 784 specialists or trainees in cardiology, internal medicine, family medicine, and diabetology. The letter form and anonymity of the survey allowed to maximize the reliability of the collected data. Results. The majority of the study group were females 46-60 years of age. A substantial proportion of the physicians specialized in internal medicine and had more than 20 years of professional experience. The management was mostly guided by the Polish Society of Hypertension (PTNT) guidelines or the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines. In patients with hypertension and coronary artery disease, the most commonly chosen drug treatment included a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor or an ACE inhibitor and a vasodilating beta-blocker. The latter combination was also selected most frequently in patients with hypertension and heart failure. In women in reproductive age, a vasodilating beta-blocker and a calcium antagonist were selected most frequently, while a combination of nebivolol and zofenopril was indicated as the best in young men with hyperkinetic circulation. In patients with resistant hypertension, the most frequently chosen regimen included furosemide, amlodipine, zofenopril, and nebivolol. Another popular combination included torasemide, lercanidipine, telmisartan, and carvedilol. Conclusions. The results of our study indicate that Polish medical professionals have clear preferences regarding specific pharmacological agents within drug classes. Vasodilating agents are preferred among beta blockers, newer agents among ACE inhibitors, dihydropyridines among calcium antagonists, and loop diuretics among diuretics. This attitude is generally consistent with the 2015 PTNT guidelines

Apple Watch-assisted supraventricular tachycardia detection and qualification for electrophysiological study

Zaburzenia rytmu są częstą przyczyną odczuwanych kołatań serca. Najczęściej objawy występują jedynie okresowo, dlatego też postawienie prawidłowego rozpoznania niejednokrotnie może stanowić wyzwanie. Na rynku dostępnych jest obecnie szereg zakładanych na nadgarstek urządzeń monitorujących czynność rytmu serca. W przedstawionym przypadku, nowoczesna technologia — AppleWatch®, wykryła epizod AVNRT. Przyczyniło się to do szybszej kwalifikacji pacjentki do badania elektrofizjologicznego i wcześniejszego wykonania skutecznej ablacji. Dzięki temu nie dopuszczono do dalszego pogarszania się jakości życia pacjentki oraz rozwoju potencjalnych poważnych powikłań, w tym kardiomioptaii tachyarytmicznej. W przedstawionym przypadku zilustrowano przydatność kliniczną aplikacji mobilnych wykonujących badanie EKG w monitorowaniu rytmu serca pacjentów w codziennej praktyce. Możliwość wykorzystania AppleWatcha® w innych typach zaburzeń rytmu serca wymaga dalszych badań. Poszerzenie obecnych wytycznych, dotyczących wykorzystania nowoczesnych technologii w zaburzeniach rytmu serca, pozostaje tematem dalszych dyskusji.Cardiac arrhythmias are a common cause of heart palpitations. As symptoms usually occur only temporarily, diagnosis is often challenging. The current market offers a variety of wearable heart rhythm monitors. In the presented case, a novel technology, the AppleWatch®, detected an episode of AVNRT. It contributed to faster qualification for electrophysiological study and subsequent successful ablation. As a result, a further decrease in patients’ quality of life was halted. The development of potentially severe complications, including tachycardia-mediated cardiomyopathy, was prevented. This case exemplifies the clinical utility of ECG-based mobile applications in monitoring patients’ heart rhythms in everyday clinical practice. The feasibility of AppleWatch® in other types of arrhythmias remains underinvestigated. Broadening current guidelines for the use of digital health solutions in cardiac rhythm abnormalities should be further discussed

Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion. Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation. Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 } 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05). Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group

The relationship between the use of cement during total hip replacement and blood pressure values

Background Total hip replacement is a common orthopaedic procedure associated with an elevated cardiovascular risk. There are several methods for total hip replacement, including whether or not to use cement for the prosthesis fixation. The aim of the study was to compare clinical characteristics, including blood pressure, in patients undergoing total hip replacement with and without the use of cement. Material and methods The study included patients with elective total hip replacement surgery, who were divided into those in whom the procedure was performed with or without the use of medical cement. The criteria for using cement were assessed during operation by the operator, according to the current protocol. All patients were interviewed, screened, and had their medical records checked for the prior diagnosis of cardiovascular risk factors. Blood pressure values were measured before and after the procedure according to the current guidelines. Results The study population consisted of 65 patients in whom the total hip replacement was performed (mean age 61.5 ± 15.0 years; 50.8% male). 60% of patients had the hip replacement without cement and 40.0% had a procedure with the use of cement. Patients in whom the cement was used were significantly older (75.0 ± 8.5 vs. 53.0 ± 11.5 years; p < 0.0001) and more often diagnosed with arterial hypertension (61.5 vs. 33.3%; p = 0.04), than those in whom it was not used. Systolic blood pressure values were significantly higher before and after the procedure (138.8 ± 18.2 vs. 130.8 ± 21.5 mm Hg, p = 0.04; 122.6 ± 13.3 vs. 113.8 ± 14.1 mm Hg, p = 0.03; respectively) in the group which required cement. Conclusions Patients with hip replacement using cement have higher systolic values before, and after the surgery than in patients in whom cement wasn’t used. Therefore careful management and risk assessment is especially important in patients receiving the total hip replacement with the use of cement.Background Total hip replacement is a common orthopaedic procedure associated with an elevated cardiovascular risk. There are several methods for total hip replacement, including whether or not to use cement for the prosthesis fixation. The aim of the study was to compare clinical characteristics, including blood pressure, in patients undergoing total hip replacement with and without the use of cement. Material and methods The study included patients with elective total hip replacement surgery, who were divided into those in whom the procedure was performed with or without the use of medical cement. The criteria for using cement were assessed during operation by the operator, according to the current protocol. All patients were interviewed, screened, and had their medical records checked for the prior diagnosis of cardiovascular risk factors. Blood pressure values were measured before and after the procedure according to the current guidelines. Results The study population consisted of 65 patients in whom the total hip replacement was performed (mean age 61.5 ± 15.0 years; 50.8% male). 60% of patients had the hip replacement without cement and 40.0% had a procedure with the use of cement. Patients in whom the cement was used were significantly older (75.0 ± 8.5 vs. 53.0 ± 11.5 years; p < 0.0001) and more often diagnosed with arterial hypertension (61.5 vs. 33.3%; p = 0.04), than those in whom it was not used. Systolic blood pressure values were significantly higher before and after the procedure (138.8 ± 18.2 vs. 130.8 ± 21.5 mm Hg, p = 0.04; 122.6 ± 13.3 vs. 113.8 ± 14.1 mm Hg, p = 0.03; respectively) in the group which required cement. Conclusions Patients with hip replacement using cement have higher systolic values before, and after the surgery than in patients in whom cement wasn’t used. Therefore careful management and risk assessment is especially important in patients receiving the total hip replacement with the use of cement

Association between vitamin D levels and arterial hypertension in women at very high cardiovascular risk

Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m2. Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients.Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m2. Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients

Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results

Background: Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter, QDot MicroTM (Biosense Webster) was designed to improve the effectiveness of AF ablation within a shorter procedure time. The aim of this study was to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode and conventional ablation-index-guided ablation (ThermoCool Smarttouch SF catheter). Methods: This single-center, retrospective, observational study enrolled 108 patients with AF, referred for catheter ablation between December 16, 2019 and December 3, 2021. In 54 procedures (mean age: 58.0 ± 12.3; 66.67% male), a QDot MicroTM catheter was used (vHPSD-group), and 54 patients (mean age: 57.2 ± 11.8; 70.37% male) were treated with a ThermoCool SmarttouchTM SF catheter (AI-group). The primary endpoint was freedom from AF 3 months after ablation. Results: Atrial fibrillation was found to recur in 14.81% of patients in the vHPSD-group and in 31.48% of patients in the AI-group (p = 0.07). There was no difference in treatment-emergent adverse events between the two groups (6.3% vs. 0%; p = 0.10). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during QDot MicroTM catheter-based PVI (p < 0.01). The vHPSD-based PVI was associated with shorter radiofrequency application time (p < 0.001), fluoroscopy time (p < 0.0001), and total procedure time (p < 0.0001). Conclusions: This study suggests vHPSD ablation is safe, can reduce the dosage of analgesics during significantly shorter procedures and may enhance the success rate of catheter-based PVI

Zespół kruchości w gabinecie lekarza praktyka — o czym należy pamiętać?

The aging process does not occur in the same way for all patients. The pace of this process, both physical and mental, is very different. The quality of life of an elderly patient depends on many factors, including lifestyle, genetic predisposition and appropriate medical care. The quality of health care depends, among other things, on how quickly and, whether or not, the doctor sees correctly signs of premature or „abnormal” aging. To facilitate this, a set of symptoms was identified, the occurrence of which should alert the doctor due to the relationship with increased mortality. In the English-language literature, this group is called frailty syndrome. In the Polish literature, the most widely used description of this phenomenon is probably zespół kruchości. The aim of this paper was to present the importance of this syndrome in clinical practice.Nie u wszystkich pacjentów proces starzenia się przebiega w ten sam sposób. Tempo postępowania tego procesu, zarówno fizycznego, jak i psychicznego, jest bardzo różne. Jakość życia pacjenta w podeszłym wieku zależy od bardzo wielu czynników, w tym stylu życia, predyspozycji genetycznych oraz odpowiedniej opieki medycznej. Jakość opieki zdrowotnej zależy między innymi od tego, jak szybko i czy prawidłowo lekarz dostrzeże u pacjenta oznaki przedwczesnego, czy „nieprawidłowego” starzenia się. Aby to ułatwić, wyodrębniono zespół objawów, których występowanie powinno zaalarmować lekarza ze względu na związek ze zwiększoną śmiertelnością. W piśmiennictwie anglojęzycznym zespół ten nosi nazwę frailty syndrome. W piśmiennictwie polskim najszerzej używane określenie tego zjawiska to prawdopodobnie „zespół kruchości”. Celem niniejszego opracowania było przedstawienie znaczenia tego zespołu w praktyce klinicznej

Ocena ciśnienia centralnego w grupie pacjentów poddawanych alloplastyce stawu biodrowego lub stawu kolanowego

Introduction: The assessment of pre-operative cardiovascular risk is extremely important especially in the case of procedures involving increased perioperative risk, which include orthopedic surgery i.e. hip or knee alloplasty. From the point of view of care during the surgery itself and immediately after it, correct control of the arterial blood pressure is very important. Useful in this aspect may be the assessment of modern hypertensive markers suchas central arterial blood pressure (CBP).The aim of the study was to assess the value of CBP in a group of consecutive patients with periodontal disease who were qualified for hip or knee replacement surgery. Material and methods: The study included consecutive patients scheduled for hip or knee arthroplasty, in which, apart from the standard risk assessment, peripheral blood pressure and CBP measurements were taken and the pulse wave velocity (PWV) was measured. All patients enrolled in the study also had a periodical assessmentperformed to assess the severity of another non-classical risk factor — periodontal disease. Results: The study population included 29 patients, of which 17 (59%) were scheduled for a hip replacement and 12 (41%) for a knee replacement. The mean age of the study population was 66.9 ± 10.9. All 29 patients had periodontal disease of which 11 (37.9%) had advanced disease. In the whole cohort 23 (79.3%) patients hada diagnosis of hypertension, 23 (79.3%) were overweight, 4 (13.8%) were diabetic and 8 (27.6%) were smokers.Dyslipidemia was present in 19 (65.5%) of patients but only 9 (31%) were taking a statin on admission. Most notably only 13 patients (44.8%) had a normal central blood pressure and 8 patients (27.6%) had a raised PWV. These findings were independent of the type of orthopaedic procedure the patients were due to undergo. Conclusions: Abnormal CBP values are highly prevalent among patients scheduled for elective hip or knee replacement. This along with the high prevalence of other cardiovascular disease contributes negatively to theperioperative risk in these patients.Wprowadzenie: Ocena przedoperacyjnego ryzyka sercowo-naczyniowego jest niezmiernie ważna, zwłaszcza przy przeprowadzaniu zabiegów obciążonych podwyższonym ryzykiem okołooperacyjnym, do których zalicza się operacje ortopedyczne, w tym alloplastykę stawu biodrowego i kolanowego. Z punktu widzenia opieki w czasie samego zabiegu i bezpośrednio po nim bardzo istotna jest prawidłowa kontrola wartości ciśnienia tętniczego. Przydatna w tym aspekcie może się okazać ocena nowoczesnych markerów hipertensjologicznych, takich jak wartości centralnego ciśnienia tętniczego (CBP). Celem badania była ocena wartości CBP w grupie kolejnych pacjentów z chorobą przyzębia, których zakwalifikowano do operacji alloplastyki stawu biodrowego lub kolanowego — zależnie od współistniejących czynników ryzyka. Materiał i metody: Do badania włączono kolejnych pacjentów poddawanych operacjom alloplastyki stawu biodrowego lub kolanowego, u których poza standardową oceną ryzyka wykonano pomiary wartości obwodowego ciśnienia tętniczego i CBP oraz zmierzono prędkość fali tętna (PWV). U wszystkich włączonych do badania osób dokonano również oceny periodontologiczną w celu określenia stopnia nasilenia innego nieklasycznego czynnika ryzyka — choroby przyzębia. Wyniki: Badana populacja obejmowała 29 pacjentów, spośród których u 17 (59%) zaplanowano wymianę stawu biodrowego, a u 12 (41%) — operację kolana. Średni wiek badanych wynosił 66,9 ± 10,9 roku. U wszystkich 29 pacjentów rozpoznano chorobę przyzębia, w tym u 11 (37,9%) w stopniu zaawansowanym. W całej kohorcie 23 (79,3%) pacjentów miało rozpoznane nadciśnienie tętnicze, 23 (79,3%) — nadwagę, 4 (13,8%) — cukrzycę, a 8 (27,6%) było palaczami tytoniu. Dyslipidemia występowała u 19 (65,5%) chorych, ale tylko 9 (31%) z nich przyjmowało statynę przy przyjęciu do szpitala. Tylko u 13 pacjentów (44,8%) stwierdzono prawidłowe CBP, a 8 chorych (27,6%) PWV była podwyższona. Obserwacje te były niezależne od rodzaju procedury ortopedycznej, której poddawano pacjentów. Wnioski: Nieprawidłowe wartości CBP są szeroko rozpowszechnione wśród pacjentów zakwalifikowanych do planowej wymiany stawu biodrowego lub kolanowego. Wraz z dużą częstością występowania innych chorób układu sercowo-naczyniowego wpływa to negatywnie na ryzyko okołooperacyjne u tych osób

Zespół kruchości w gabinecie lekarza praktyka — o czym należy pamiętać?

Nie u wszystkich pacjentów proces starzenia się przebiega w ten sam sposób. Tempo postępowania tego procesu, zarówno fizycznego, jak i psychicznego, jest bardzo różne. Jakość życia pacjenta w podeszłym wieku zależy od bardzo wielu czynników, w tym stylu życia, predyspozycji genetycznych oraz odpowiedniej opieki medycznej. Jakość opieki zdrowotnejzależy między innymi od tego, jak szybko i czy prawidłowo lekarz dostrzeże u pacjenta oznaki przedwczesnego, czy „nieprawidłowego” starzenia się. Aby to ułatwić, wyodrębniono zespół objawów, których występowanie powinno zaalarmować lekarza ze względu na związek ze zwiększoną śmiertelnością. W piśmiennictwie anglojęzycznym zespół ten nosi nazwę frailty syndrome. W piśmiennictwie polskim najszerzej używane określenie tego zjawiska to prawdopodobnie „zespół kruchości”. Celem niniejszego opracowania było przedstawienie znaczenia tego zespołu w praktyce klinicznej