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Biomedical subjects

M Kozák

Publications and source records attributed to M Kozák.

At least 19 recordsLinked to original sources
PubMed2006

[Do we always have the possibility to treat "lege artis"?].

The case-history occupies of a case of acute cardiac insufficiency in a patient at early postoperative period, who underwent a small surgical operation. Apparently the banal operation became the starting mechanism of life threatening cardiopulmonary insufficiency. Transthoracic echocardiografic diagnostic process not gave us the unambiguous response about a cause of that distressed state. The primary clinical consideration of the pulmonary embolization was not ambiguously acknowledged, though nor excluded. The clinical had to decided, whether the heparinization or the thrombolysing treatment was justified.

Cardiac Output, Low↗
PubMed2005

[Long-lasting survival of patients with implantable cardioverter-defibrillators implanted for secondary preventive reasons].

BACKGROUND: The effectiveness of therapy with implantable cardioverter-defibrillators is usually evaluated according to the total mortality of ICD patients. The aim of this study is to analyse the total mortality of long-term followed ICD patients and to evaluate mortality according to the main diagnosis and analyse the influence of revascularization in patients with coronary artery disease. METHODS AND RESULTS: We have observed 138 consecutive patients in mean age of 62.0+/-12.2 year (108 M, 30 F) with mean LVEF 0.38+/-0.14, who had ICD implanted for malignant ventricular arrhythmias from X/95 to XII/02 from secondary preventive reasons. The mean follow-up was 47.35 months. 99 patients had coronary artery disease, 16 dilated cardiomyopathy, 5 right ventricle dysplazia, 4 LQT syndrome, 1 valvular disease and 13 pts were without structural heart disease. The total mortality of the group of patients was 22% (31 patients). The terminal heart failure was the main cause of death in our pts--in 84% of the cases. We had no sudden death in our group of pts. The highest mortality (27%) was in pts with coronary artery disease, nobody died in the group of pts without structural heart disease. The higher mortality was in patients in pts where the revascularization was not possible before ICD implantation (38% versus 20%) One-year survival of the whole group of pts covered 90% and two-year survival was 87%. CONCLUSIONS: The survival of ICD pts is shorter if coronary artery disease is present and there is no possibility to revascularize pts before ICD implantation.

Adult↗
PubMed2005

[Comparison of the prevalence of non-invasive risk markers of the sudden cardiac death in patients treated by thrombolysis and by percutaneous transluminal coronary angioplasty].

BACKGROUND: Myocardial infarction survivors may develop a higher risk of sudden cardiac death. The risk markers: left ventricular ejection fraction, ventricular premature beats, late potentials on averaged ECG, baroreflex sensitivity and heart rate variability are used as non-invasive stratification markers. METHODS AND RESULTS: Occurrence of the autonomic and morphologic dysfunction risk markers in the myocardial infarction patients treated by thrombolysis and by primary percutaneous transluminal coronary angioplasty (PTCA) is compared. We studied a cohort of 48 acute myocardial infarction survivors treated by primary PTCA and 96 patients treated by thrombolysis. CONCLUSIONS: Patients treated by primary PTCA had significantly lower occurrence of premature ventricular beats and pathological parameters of the heart rate variability.

Angioplasty, Balloon, Coronary↗
PubMed2004

[Specific complications in the treatment with implantable cardioverter-defibrillators].

BACKGROUND: Using implantable cardioverter-defibrillators in treatment of malignant ventricular arrhythmias revealed new complications specific to this therapy. Inappropriate therapy, arrhythmic storm and device related proarrhythmia belong to the most significant complications. The authors describe specific complications in a group of ICD patients, analyze their etiology and prognostic value. There are some recommendations for the management of specific complications. METHODS AND RESULTS: 138 consecutive patients underwent ICD implantation between 1994-2001. Median follow-up was 47,35 months. Average left ventricular ejection fraction was 38 +/- 14% and 71% of patients suffered from coronary artery disease. From the total of 2490 arrhythmic episodes 1490 were evaluated in detail. 253 episodes (17%) were classified as inappropriate therapy. The most common etiology of inappropriate therapy was atrial fibrillation with rapid ventricular response (68%), atrial flutter (13%) and sinus tachycardia (11%). After the therapeutic intervention, 65% of them remained free of inappropriate therapy. There were 38 arrhythmic storms in 19 patients as another serious complication. CONCLUSIONS: All the observed arrhythmic episodes were ventricular tachycardias (p<0.04). Patients with arrhythmic storm in history had significantly lower survival (p<0.05). The risk factors of cardiac nonsudden death were: age >66 years, left ventricular ejection fraction <35% and arrhythmic storm history. The authors present recommendations for the treatment of the most common specific ICD complications.

Adult↗
PubMed2004

[Defibrillators--end of sudden cardiac death?].

The ventricular fibrillation is still the main cause of a sudden cardiac death, even though it was described 155 years ago in experiment (M. Hoffa 1849) and its therapy--defibrillation--has been known since 1947 (C. Beck). In Europe 2500 inhabitants suffer from cardiac arrest daily and 90% is caused by ventricular fibrillation. A key interval for an effective defibrillation seems to be 3-8 minutes from the begining of a cardiac arrest. Automated (automatized) external defibrillators (AED) have been used for last 15 years, especially in USA. However it is still unclear how many devices will be needed and where to place them. We don't know if they improve the prognosis of patients with out of hospital cardiac arrest during ventricular fibrillation. The individualisation of the risk of a sudden cardiac death has brought a new method to the clinical practise--implantation of cardioverter-defibrillator (ICD). Their efficacy in reduction of total mortality was verified first in the field of secondary prevention--in patients after cardiac arrest (AVID study) and than in the field of primary prevention--in patients with risk markers (left ventricle dysfunction, non sustained ventricular tachycardias) but without sustained malignant arrhythmia in anamnesis (MUSTT, CIDS, MADIT I, MADIT II). Defibrillators (external, automated, implantable) obviously don't mean the end of the sudden cardiac death. The incidence of sudden cardiac death can be reduced significantly with prevention (nutrition, prevention of CAD) and one attention should be drawn to the fact even in the future.

Death, Sudden, Cardiac↗
PubMed2003

[Circadian rhythms in cardiovascular diseases--arrhythmias].

Circadian patterns have been observed for variety of cardiovascular disorders, including cardiac arrhythmias, sudden cardiac death, cerebrovascular events, episodes of stable angina, unstable angina and acute myocardial infarction. The morning predominance of these events has been well documented in a number of large population studies. This fact provides the stimulus for better understanding our own chronobiology and the periodicity of circadian rhythms which contribute to this predominance of adverse events in the morning hours. We now understand that a number of important physiological parameters such as heart rate, blood pressure, vascular reactivity, cardiac contractility, and various hemostatic factors all demonstrate a circadian pattern similar to that described for cardiovascular disorders. Several recent studies have also emphasize the importance of changes in posture, time of awakening, physical activity, mental stress as potential triggers. Circadian patterns have been observed for several supraventricular arrhythmias, premature ventricular beats, ventricular tachycardias including sudden cardiac death. The chronobiological therapeutic systems can help to prevent life threatening events.

Arrhythmias, Cardiac↗
PubMed2003

[Circadian rhythms in cardiovascular diseases--ischemic heart disease].

Several key advances in understanding of pathophysiology now provide the opportunity to develop improved treatment and prevention strategies. First, the importance o mechanism of plaque rupture and thrombosis in onset of myocardial infarction. Second, there has been demonstrated, that plaques that lead to acute occlusion often have only a mild degree of stenosis. A third advance that has stimulated the field has been the recognition that time of onset of cardiac events is not random but instead shows a circadian pattern of onset. In the decade since the 1985 observation by Muller a spol. that the frequency of onset of myocardial infarction peaks at 9 a.m., numerous publications have supported this observation not only for myocardial infarction, but also for sudden cardiac death, transient myocardial ischemia, and stroke. Refinement of these epidemiological observations has led, first, to the conclusion that the morning peak in disease onset is due in part to the physical and mental stressors associated with morning awakening and activity and, second, that stressors such as heavy physical activity and anger can trigger acute cardiovascular events.

Circadian Rhythm↗
PubMed2003

[Use of chronobiology findings in therapy of cardiovascular diseases].

The concept of homeostasis in biology postulates that there is constancy of the intern milieu. Thus is assumed the risk and exacerbation of disease are invariable and independent of the time of day, day of month, and month of year as are the responses of patients to diagnostic tests and medications. Findings from the field of chronobiology, the study of biological rhythms, challenge the concept of homeostasis and the many assumptions and procedures of clinical medicine based on it. It is now recognized that human functions have daily, weekly, monthly and yearly biological rhythms. Plants, animals, and insects also have chronobiological rhythms. Circadian patterns have been observed for variety of cardiovascular disorders, including cardiac arrhythmias, sudden cardiac death, cerebrovascular events, episodes of stable angina, unstable angina and acute myocardial infarction. The morning predominance of these events has been well documented in a number of large population studies. It is now recognized that circadian and other rhythms of the gastrointestinal tract and vital organs are capable of significantly affecting the pharmacokinetics and dynamics of cardiovascular and other medications. This means that the effects of therapeutic interventions administered in identical doses in the morning versus the evening may not be equivalent. The prevention and treatment of cardiovascular disease must take into account chronobiological factors.

Cardiovascular Diseases↗
PubMed2003

[Intracardiac electrocardiography in the diagnosis and therapy of arrhythmia].

The recording of intracardial electrocardiograms (IECG) has made good progress in the arrhythmology during last 15 years. First the aim was to describe the characteristics of the conduction system of the heart (Hisogram recording), followed by the evaluation of pathologies of the conduction system (meaning bradyarrhythmias), electrical activation of the myocardium when tachyarrhythmia is ongoing for diagnosis and punctual localization of accessory pathways during endocardial mapping. The next logical step as a reaction to the knowledge of endocardial mapping was the evaluation of new therapeutic methods--DC followed by radiofrequency ablations--nonpharmacological therapeutic antiarrhythmic procedures, usually used in electrophysiology labs of cardiological departments. Nowadays pacemakers are equipped with possibilities of intracardial atrial and ventricular signal recording which enables the use of accesorial antiarrhythmic functions. Intracardial electrocardiogram recording plays the dominant role in implantable cardioverter-defibrillators, where the main part of algorithms for detection and discrimination is based on the electrocardiograms. From both the diagnostic and therapeutic points of view intracardial signal recording is playing an important part in clinical practice in arrhythmology these days.

Arrhythmias, Cardiac↗
PubMed2002

[Multiorgan failure in pulmonary embolism].

The case-history presents a case of unexpected pulmonary embolization manifestated in a middle-aged patient closely before operation (classical cholecystectomy). The severe respiratory insufficiency was the consequence, which proceeded to a metabolic dysbalance and the state of disseminated intravascular coagulation. The prognosis was very serious, but the patient recovered after 4 weeks of complete resuscitative care. The authors would like to initiate the discussion about the way and timing of antithrombic preoperative preparation in elderly patients and in those with a high risk of thromboembolic complications.

Cholecystectomy↗
PubMed2002

[The intracardiac electrocardiogram in the diagnosis of arrhythmias].

During the last 15 years in arrhythmology brisk development of the use of endocardial electrocardiograms (IECG) occurred. At first the objective was to describe the characteristics of the conduction system of the heart (recording of Hisogram), next assessment of pathological features of the conduction system (such as bradyarrhythmias), electric activation of the myocardium in existing arrhythmias with the outcome of the diagnosis and accurate localization of additional pathways in endocardial mapping. The next logical step reacting to knowledge of intracardial mapping was the development of new therapeutic methods--DC and subsequently radiofrequency ablation--non-pharmacological therapeutic antiarrhythmic approaches which are by now commonly used in electrophysiological catheterization laboratories of cardiological departments. Some contemporary pacemakers can also record intracardial atrial and ventricular IECG and make it possible to use additional antiarrhythmic stimulation. A dominant position is held by the IECG in implantable cardioverters-defibrillators where on the high standard recording of IECG a considerable proportion of detection and decision-making algorithms of this equipment is based. Recording IECG is an integral part of clinical arrhythmological practice from the diagnostic as well as therapeutic aspect.

Arrhythmias, Cardiac↗
PubMed2001

[Implantable cardioverter-defibrillators in the prevention of sudden cardiac death].

The aim of this work is to characterize and analyse the spectrum of therapies delivered from implantable cardioverter-defibrillators (ICD), to evaluate their effectivity and to mark the most effective types of antitachycardia stimulations (ATP), cardioversion (CV) and defibrillation (CD). To compare our results with references and give precautions of trouble-shootings. Our patients had implanted ICDs according to standard criteria for ICD implantations. Before discharge from hospital we performed predischarge test of their ICD. Than we followed them periodically each three months. We have observed 72 ICD pts (55 M, 17 F) in the mean age of 62.7 +/- 12.2 years the with mean LVEF was 0.37 +/- 0.11. The mean follow-up was 21 +/- 12.8 months. Each examination was managed through anamnesis of symptoms accompanying the beginning of arrhythmia, the sensation of ICD therapy by patient, followed by interrogation of the ICD memory. All obtained episodes were analysed. During the follow-up 1023 episodes of malignant ventricular arrhythmias were detected and effectively terminated. 7 pts died. During the therapy the ATP reached 83% in comparison with CV, CD which reached only 17%. The dominating symptoms were palpitations and presyncopes. In comparison with initial arrhythmias leading to implantations of ICDs (ventricular fibrillations for most of the cases--54%) the significantly higher number of spontaneous episodes were caused by monomorphic ventricular tachycardias VT (92.0%). We had no sudden cardiac death in our pts. In the indicated pts with a high risk of sudden arrhythmic death, the ICD therapy is characterized as very effective and is associated with high safety, low discomfort and when up to date algorithms for detection being used, then only adequate part of the inappropriate therapies occurs (10% patients, 3.2% from the number of episodes). The therapy by implantable cardioverter-defibrillators has had an important role in treating pts with life-threatening ventricular arrhythmias.

Adult↗
PubMed2001

[Sudden cardiac death--a problem in cardiology today].

More than 2500 persons from European population die of sudden cardiac death every day. Nearly 90% of these cases are caused by malignant ventricular arrhythmias, which develop most frequently on the basement of structural heart disease. Some subpopulations of patients can be marked as a high risk for sudden cardiac death according to the today stratification procedures and can be treated in a pharmacological or nonpharmacological ways. The ways are as follows: a chronic therapy with beta-blockers agents, therapy of congestive heart failure, myocardial revascularization and implantation of cardioverter-defibrillator. The prognosis of patients treated in those ways in comparison with conservatively treated groups is very good.

Arrhythmias, Cardiac↗
PubMed1999

[Electric programmed ventricular stimulation using a permanent cardiac pacing system--a noninvasive method in arrhythmia].

BACKGROUND: Complex forms of ventricular arrhythmias often occur in patients with an implanted permanent cardiac pacing system. Some of the pacemakers are provided with software which allows electrophysiological testing of the cardiac conduction system by coupling with an external diagnostic pacemaker via their programmer. This method is non-invasive. METHODS AND RESULTS: In a group of 26 patients (19 males, 7 females) with an implanted pacemaker (Paragon III, Synchrony III, Sensorithm--all Pacesetter) complex ventricular arrhythmias were observed (class Lown IVa and higher). In these patients the electrical stability of the myocardium was tested by the described method (protocol: incremental pacing 90-220 bpm, pacing drives 110 bpm and 140 bpm with 1-3 extrastimuli). Complex ventricular arrhythmias were induced in 42% patients (n = 11), in this subgroup 55% (n = 6) was non-sustained ventricular tachycardia, 36% (n = 4) sustained ventricular flutter, 9% (n = 1) sustained ventricular tachycardia. Patients with non-sustained ventricular tachycardia were treated with beta-blockers, in the others the effective therapy was selected according to electrophysiological testing (amiodarone in 4 patients, ICD in 1 patient). During a 24-month follow-up the overall mortality was 7.7% (n = 2), sudden death mortality was 3.8% (n = 1). CONCLUSIONS: Programmed ventricular stimulation performed by a permanent cardiac pacing system is a simple and above all non-invasive method with no need for fluoroscopy. It can be repeated several times. It is not possible to pace from the right ventricle outflow tract. This is the main disadvantage. Nevertheless, by using non-invasive risk stratification methods (echocardiography, signal averaged ECG, heart rate variability, baroreflex sensitivity, dispersion of QT interval) the patients in need of an invasive study can be identified. This method can be considered an alternative screening method and a standard part of the investigation of the algorithm in patients with a previously implanted pacemaker.

Arrhythmias, Cardiac↗
PubMed1998

[Optimalization of rate adaptation using Holter functions in DDD/R pacemakers].

Introduction of the pacing rate adaptation according to the momentary metabolic needs added other programmable parametres which demand physician's attention during the initial postimplantation programmation and also in follow-up of pacemaker patients. The parametres setting is strictly individual with a need of feedback control. In some devices it is enabled by Holter functions as a part of pacemaker software. These methods were used to set the rate adaptive parametres in the group of 23 patients with implanted DDD/R pacemaker. The walking stress test was used. Model follow-up situations are presented in 3 case reports. Using Holter functions enables the physician to put patient's subjective complains in relation with actual heart rate--this is used to optimize the parametres of rate adaptation. The authors consider the Holter functions a necessary part of rate adaptive pacemaker software.

Aged↗