Vnitr̆ní lékar̆ství
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Early reperfusion is the treatment of choice for acute coronary syndrome. In the Czech Republic, reperfusion therapy is well accessible thanks to the network of 22 catheterization centres. ⋯ These steps than has to be accompanied by effective pharmacotherapy to prevent remodelling of the left ventricle, re-stenosis of the coronary artery, re-thrombosis and arrhythmias. Four drug groups provide the desired effects--renin-angiotensin-aldosterone system blockers, beta-blockers, antiplatelet agents and statins.
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Vnitr̆ní lékar̆ství · Nov 2011
Review[Pathophysiological background for incretin therapy: is it capable of more than we think?].
Incretin-based therapy functions through the increase of endogenous glucagon-like peptide-1 (GLP-1) levels due to inhibition of dipeptidyl peptidase-4--an enzyme degrading GLP-1 (gliptins) or through the administration of drugs activating GLP-1 receptor (GLP-1 agonists). Both approaches increase insulin and decrease glucagon secretion leading to improved diabetes compensation. The advantages of gliptins include little side effects, body weight neutrality and potential protective effects on pancreatic beta cells. ⋯ Direct positive effects of incretin-based therapy on myocardial metabolism and function as well as its positive influence on endothelial dysfunction and neuroprotective effects are intensively studied. The possible indications for GLP-1 agonists could be in future further widened to obese patients with type 1 diabetes and obese patients without diabetes. The aim of this review is to summarize both metabolic and extrapancreatic effects of incretin-based therapies and to outline perspectives of potential wider use of this treatment approach.
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Vnitr̆ní lékar̆ství · May 2011
Review[Infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia].
Therapeutic hypothermia is currently recommended neuroprotective therapeutic measure for comatose patients after cardiac arrest. Hypothermia has been proven not only to affect the neurological outcomes but also the survival of patients after cardiac arrest. This communication summarizes the issue of early infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia. ⋯ Furthermore, there are discussed limited diagnostic options of infectious complications. The significance of the usual symptoms of infections is reduced, as well as the value of laboratory markers such as procalcitonin and C-reactive protein. Finally, the possibility of antibiotic treatment and eventual antibiotic prophylaxis during therapeutic hypothermia in patients after cardiac arrest outside hospitals is mentioned.
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Vnitr̆ní lékar̆ství · Mar 2011
Review[Residual risk of cardiovascular complications and its reduction with a combination of lipid lowering agents].
Most patients treated with statins die due to cardiovascular events. The risk of cardiovascular event during statin treatment is called residual risk. ⋯ Residual risk can be decreased by combination therapy statins with fibrates or statins with niacin; niacin can affect almost all lipids and lipoproteins that participate in residual risk. There are evidences from clinical trials that combinations statin with fibrates or statin with niacin are safe.
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Vnitr̆ní lékar̆ství · Feb 2011
Review[Bicuspid aortic valve--ethiopathogenesis and natural history].
Bicuspid aortic valve is a disease with autosomal dominant inheritance with small penetration. The population of patients with bicuspid aortic valve is heterogenous. In the absence of dilatation of ascending aorta, valvular lesion or degenerative changes of valve leaflets patients are considered to belong to the low risk population. ⋯ Surgery is the treatment of choice. Physiology and pathophysiology of bicuspid and tricuspid aortic valves, prevalence of bicuspid aortic valve in general population and in the group of patients operated on for aortic valve disease, phenotypes of bicuspid aortic valve and follow-up of asymptomatic patients with normal bicuspid valve are reviewed in this article. Indications for operation of dilated ascending aorta according to american, european and czech guidelines are discussed.