RESUMEN
OBJECTIVES: To investigate real-world data on warfarinisation rates and results in the elderly patients with atrial fibrillation (AF). BACKGROUND: AF is the most frequent arrhythmia in the elderlies with considerable risk of devastating stroke-related consequences. Guidelines prefer non-vitamin K antagonist oral anticoagulants (NOAC) to warfarin for thromboprophylaxis. Nevertheless, warfarin is still widely used, even if it is challenging, especially in polymorbid elderlies, to achieve the therapeutic international normalised ratio (INR). There are only scarce real-world data on INR in warfarinised elderly AF patients. METHODS: The study was based on multicentric observational Slovak audit of atrial fibrillation in seniors (SAFIS) performed on 4,252 hospitalised AF patients aged over 64 years (mean age 80.9 yrs.). INR data from warfarinised patients were analysed (955 at admission and 870 at discharge). RESULTS: At hospital admission and discharge, the warfarin medication rates were 22.6 % and 23.5 %, respectively, INR lower than 2 was present in 41.8 % and 30.6 % of patients, respectively, and INR higher than 3 was in 27.0 % and 7.7 %, respectively and altogether, 68.8 % and 38.3 % of warfarinised patients, respectively, were out of therapeutic range. CONCLUSION: Warfarin is still frequently used in the elderlies with AF, but the success rates are unsatisfactory in a huge number of patients. It is urgent to improve seniors' access to NOAC (Fig. 2, Ref. 34).
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Tromboembolia Venosa/prevención & control , Warfarina/uso terapéutico , Administración Oral , Anciano , Anciano de 80 o más Años , HumanosRESUMEN
Fungal urinary tract infection (UTI) represents a high-risk event in severely ill patients. Its increasing incidence in recent years is associated with extensive and prolonged use of broad-spectrum antimicrobial agents, corticosteroids, immunosuppressive and cytotoxic drugs. Other important risk factors comprise higher age, diabetes mellitus, chronic renal failure, hemodialysis, renal transplantation, structural or functional abnormalities of urinary tract with indwelling urinary catheter or nephrostomy. Fifty hospitalized symptomatic patients with funguria of > 10(5) CFU/ml and leucocyturia were analysed for etiology, risk factors and outcome. Candida albicans was isolated in 36 patients, non-albicans Candida species (Candida tropicalis, Candida krusei) and non-Candida yeasts (Blastoschizomyces capitatus) in 14 patients, respectively. All patients were treated with systemic antifungals. In total, 42 patients of 50 (84%) were cured (32/36 with C. albicans and 10/14 with non-C. albicans associated funguria). Systemic antifungal therapy should be considered in high-risk patients with fungal UTI.
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Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiologíaRESUMEN
The hypertrophy of the left ventricle in patients with arterial hypertension is an independent risk factor which increases c 9 times the probability of sudden cardiac death. Despite the fact that the incidence of sudden cardiac death in patients with arterial hypertension is low, regarding the high occurrence of hypertension it represents a significant medical problem. The therapy of arterial hypertension is able to decrease the general and cardiovascular mortalities with significant interspecies characteristics of individual antihypertensive drugs, as well as to promote the regression of hypertrophy of the left ventricle. The therapy per se can however increase the risk of cardiovascular complications: until now the complication of the therapy by diuretics rich in potassium and beta-blockers are best distinguished. Calcium antagonists are effective antihypertensive drugs but they do not decrease the total mortality. ACE inhibitors have a marked antihypertensive effect and few adverse effects, but until now there is not a sufficient number of large prospective studies which would definitely confirm the preliminary promising findings. Despite the presented problems the cured patients with arterial hypertension have a substantially better prognosis than patients that are not being cured.
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Antihipertensivos/uso terapéutico , Muerte Súbita Cardíaca/etiología , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/complicaciones , Humanos , Hipertensión/tratamiento farmacológico , Pronóstico , Factores de RiesgoRESUMEN
The problem of sudden cardiac death (SCD) in the aged impends on 14% of the adult population in the Slovak Republic and it often involves people who are still effectively active. It is now generally known that a person ill with his heart is never too old to benefit from the stratification of his/her cardiovascular risk. In clinical practice it is possible to suggest to use the combination of non-invasive methods as the first step in basic stratification of risk in the aged (Holter ECG monitoring, echocardiographically assessed ejection fraction of the left ventricle, ergometric test). Regarding the prevention of SCD it is necessary to teach the patients at risk to distinguish the symptoms of the impending collapse/SCD. After myocardial infarction, also in the aged, the therapy by acetylosalicylic acid, Beta-blockers and ACE inhibitors is indicated. There are fewer contraindications to this therapy than it has been presented until now. Antiarrhythmic drugs class I are not to be used. Also in the aged, regarding the prevention of tachycardiac SCD, the most prospective antiarrhythmic drugs are amiodaron and sotalol. The attention should be paid also to other factors in coincidence with sudden cardiac death that can be influenced by therapy (consequential antiischaemic therapy, homeostasis of the internal environment, early cardiostimulatory therapy of bradycardiac disturbances of rhythm, optimal timing of surgical therapy of valvular defects if indicated, prevention of pulmonary embolism, etc.). In the aged it is necessary to create a wider space in the field of invasive cardiological therapy. In general it is possible to state that the knowledge on etiopathogenetic stratification and specific characteristics of prevention and therapy of SCD in the aged are limited. This fact only emphasizes the inevitability to concentrate on the research in this area.
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Muerte Súbita Cardíaca/prevención & control , Anciano , Muerte Súbita Cardíaca/etiología , Humanos , Infarto del Miocardio/terapia , Factores de RiesgoRESUMEN
The risk of ventricular arrhythmias may recently be analyzed by late ventricular potentials (LVP). The presented paper reviews the pathophysiology of LVP. The author describes some methodological and technical problems of LVP registration and examination in clinical practice. The main aim of the paper is to bring some information on clinical usefulness of LVP. The situations, when the examination of LVP is accepted diagnostic method is presented. The author concludes, that examination of LVP is highly informative, non-invasive, economically acceptable and available from clinical practical point of view. It is helpful for stratification of cardiological patients who need more intensive diagnostics and therapy.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Electrocardiografía , Potenciales de Acción , Arritmias Cardíacas/fisiopatología , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatologíaRESUMEN
After six months of antihypertensive treatment the regression of the initially present myocardial hypertrophy was observed: The decrease in blood pressure values is in correlation with the regression of the left ventricular hypertrophy. No correlation with parameters of high-resolution electrocardiography was noted. In one patient, a deterioration of late potentials was observed. It became more pronounced following the treatment. The monitoring of antihypertensive treatment effects by echocardiography and high-resolution electrocardiography may be therefore considered useful, especially in expected regression of the left ventricular hypertrophy. In individual cases of very outstanding regression, there exists the potential possibility of the process, resulting in the risk of arrhythmogenic substrate formation and subsequent generation of dysrhythmias.
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Electrocardiografía , Hipertensión/tratamiento farmacológico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , UltrasonografíaRESUMEN
The risk of development of ventricular arrhythmias can be evaluated at present also by examination of late ventricular potentials. Late ventricular potentials are high-frequency low-amplitude signals which develop in the terminal part of the QRS complex and are the manifestation of retarded excitation in the myocardial area where islets of vital muscle alternate with islets of fibrosis and/or necrosis. Their detection is very pretentious as regards recording and processing of the electrocardiographic signal. Only relatively complicated procedures ensure that the result of the examination has a clinically acceptable sensitivity and specificity. These procedures are not "observed and appreciated" by the majority of workers because they are "hidden" in the instrumental technique which is used. The objective of the submitted paper is to focus attention of clinicians on the frequently omitted aspect of examinations of late ventricular potentials--its technical prerequisites. The author did not focus attention on complicated mathematical formulations which are the basis of processing of the signal but tried to concentrate on the link between the technical aspect and clinical consequences. Similarly as in other examinations based on the latest technique, also in this case the effect depends to a considerable extent on the knowledge of usable and technical procedures applied in a given case. Unless we are aware of these facts the clinician becomes a mechanical consumer of results of examinations and is restricted to the simplest level of interpretation. The objective of the paper is moreover to remind that it is not possible to adopt and compare uncritically the results of investigations implemented under different technical conditions.
Asunto(s)
Electrocardiografía/métodos , Arritmias Cardíacas/diagnóstico , Humanos , Procesamiento de Señales Asistido por ComputadorRESUMEN
Based on the presumption of the activation front splitting, the authors present their own proposal for the estimation of the myocardial electric activation course and for the detection of micropotentials 'hidden' within QRS complexes by the method of high-resolution electrocardiography. After filtration of QRS complex the values of delta RMS and those of cumulative amplitudes are calculated from the initial and from the terminal parts of QRS complexes. The presence of late potentials is reflected in a slowing down of the termination of activation course. As compared with healthy subjects, a slower rise of activation was observed in patients with myocardial infarction of the anterior wall. The curves of cumulative amplitudes rose very slowly during the first 70 ms of heart ventricle activation, explained according to the hypothesis of authors as being due to splitting of the activation front at the infarction focus. The usefulness of the proposed method was checked in patients with arterial hypertension and left ventricular hypertrophy, and in a group of patients with myocardial infarction. By the construction of cumulative amplitude curves from the onset of filtered QRS complexes, myocardial foci not reflected by 'classic' late potentials can be detected. The partial cumulative amplitudes of the QRS complex are suitable for comparative studies.
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Electrocardiografía , Adolescente , Adulto , Humanos , Hipertensión/fisiopatología , Hipertrofia/fisiopatología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatologíaRESUMEN
The authors selected from a group of 40 hypertonic patients 9 men (mean age 67 years, range 60-73 years) with reliably evaluated echocardiographic tracings without valvular defects and without impaired left ventricular kinetics. After two weeks on placebo every patients was given a single dose of 20 mg nifedipine. The echocardiographic examination, concurrently with a blood pressure reading, was made at the end of the placebo interval and 2.5 and 7 hours after nifedipine administration. As compared with placebo, nifedipine significantly reduced at each time intervals the end systolic stress of the wall and the blood pressure without accelerating the pulse rate. A significant reduction of the total vascular resistance and increased velocity of the circumferential fibre shortening occurred during the 2nd and 5th hour; the pulse pressure was diminished 5 and 7 hours after nifedipine administration. The favourable haemodynamic action of nifedipine after a single dose confirms the advantage of the preparation in elderly hypertensive patients.
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Hemodinámica/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Nifedipino/uso terapéutico , Anciano , Ecocardiografía , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
The authors discuss 11 patients with aortal aneurysms (AA) which they diagnosed in the course of 1983-1988. In seven instances the abdominal aorta was affected; once the ascending part and once the arch; twice the descending part and once the whole aorta. In four patients the aneurysm had a dissecting character. Patients of advanced age were involved (73.9 +/- 9.7 years) with multiple morbidity and frequently also general advanced atherosclerosis which was the main cause of development of aneurysms. The authors analyze the clinical picture and course of AA in different patients and draw attention to their great variability. In the discussion they deal with the position of diagnostic methods, analyze critically the causes, course and prognosis of AA incl. interpretation of their own group of patients. In view of the frequent (and rising) incidence of AA in old age, the authors consider it important to pay attention to this problem also from the aspect of clinical gerontology.
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Aneurisma de la Aorta , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The diagnosis of tissue parasitoses has remained complicated until the present time for variability of clinical picture. Their incidence been increasing due to aimed and accidental findings of foci in parenchymal organs employing new methods of visualization such as computer tomography and especially ultrasonography whose advantage is a good detection rate, availability and a possibility to follow the dynamics of parasitosis development. The authors present a survey of ultra-sonographic findings of the liver in cases of tissue parasitoses occurring in Czechoslovakia, while using their own image documentation. If a focal affection in the liver is established the differential diagnosis considerations should also take into account a tissue parasitosis, whose ultrasound picture may be nonspecific.
Asunto(s)
Cisticercosis/diagnóstico , Equinococosis Hepática/diagnóstico , Parasitosis Hepáticas/diagnóstico , Toxocariasis/diagnóstico , Ultrasonografía , Humanos , Hígado/patologíaRESUMEN
The authors compared the results of duplex ultrasonic examination of 86 sections of the ileo-femoro-popliteal portion of the arterial circulation with angiographic findings. The correlation between angiographically and ultrasonically assessed degrees of stenosis was close and highly significant (r = 0.895, p = 0.001, y = 0.782x + 17.382). The sensitivity of duplex sonography when assessing significant stenoses (60% of the arterial lumen or more) was 100%, the specificity 76.5%, the probable positive value 75%, the probable negative value 100%, the probable positive ratio 3, the reliability of the test 86%. With regard to these results the authors recommend to make a non-invasive duplex ultrasonic examination of the arteries of the lower extremities in all echocardiographic laboratories and to include it in the algorithm of angiological examinations before angiography.