The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied. The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI. Persistent cTnI elevation > 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up. These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.

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Kiruna, a Swedish community situated 300 km north of the Arctic Circle, has a very high mortality in ischemic heart disease (IHD). Acase-control study was undertaken to find out if the risk factors for IHD or their impact differed from those in other populations. The survey methods comprised questionnaires, physical examinations, laboratory tests, a food diary, ecological studies, and a register study. The study group consisted of 219 men who had suffered an acute myocardial infarction (cases) and 438 men without known ischemic heart disease (controls). The main risk factors were: a family history of IHD, hypertension, hyperlipidemia, diabetes mellitus, and smoking. Also psycho-social risk factors like lack of job support constituted a risk factor. Cholesterol ester and adipose tissue triglyceride fatty acids have a slower turn-over rate than other routinely analysed lipids and lipoproteins and thus reflect dietary habits over a longer period of time. They were measured in a subset of our cohort, showing that the cases, judged from lipid and fatty acid composition, lived on a diet comparable to that of the controls. A prospective diet diary showed few differences between cases and controls and between the whole cohort and a reference cohort in Uppsala in the central part of Sweden. Most notable differences were a low level of y-tocopherol, a low proportion of linoleic acid, and a high proportion of palmitic acid in serum cholesterol esters and adipose tissue triglycerides in the Kiruna cohort. The expected reduced morbidity in ischemic heart disease related to alcohol consumption was not seen in our material. This finding was further examined in an ecological study on a national Swedish level, longitudinally, cross-sectionally, and with time-series methodology. There was an inverse correlation between wine consumption and mortality in IHD for women but no correlation between the consumption of beer and distilled spirits, and mortality in IHD. Heart failure, a common sequela of IHD, has an increasing incidence in a hospital-based population. In spite of improved treatments the prognosis has not improved during the last seven years and is still as bad as or worse than that of many malignant diseases. Male sex and high age implied a worse prognosis. Consumption of acetylsalicylic acid (ASA) for pain relief resulted in a greater risk of developing an acute myocardial infarction in our cohort. This was further examined in an ecological study on anational Swedish level also showing a correlation between ASA consumption and mortality in IHD both in the geographical and the longitudinal analysis for the surveyed years, but not in the time series analysis. / <p>Diss. (sammanfattning) Umeå : Umeå university, 1996, härtill 7 uppsatser.</p> / digitalisering@umu

Širdies ir kraujagyslių ligos, tame tarpe ir išeminės širdies ligos, laikomos pagrindine naujojo amžiaus sveikatos problema - tai ligos, kurių daugėja vykstant progresui ir kylant pragyvenimo lygiui. Darbe buvo nagrinėti vieni iš svarbiausių psichologinių IŠL rizikos veiksnių: nerimastingumas, pablogėjusi nuotaika ir tipo A elgsena, taip pat IŠL sergančiųjų sveikatai palankus elgesys, išskirtinį dėmesį skiriant IŠL sergančiųjų nerimastingumui ir pablogėjusiai nuotaikai bei jų kitimams stacionarinio gydymo metu. Šio Tyrimo tikslas – nustatyti išemine širdies liga sergančiųjų nerimastingumo ir pablogėjusios nuotaikos kitimus gydantis stacionare. Tyrime dalyvavo 178 28 – 74 metų (53,52 ± 9,03) respondentai. Iš jų 107 29 – 74 metų (53,91 ± 9,14) asmenys, sergantys IŠL ir 71 28 – 73 metų (52,94 ± 8,89) nesergantys IŠL (lyginamoji grupė). Pablogėjusiai nuotaikai ir nerimastingumui nustatyti naudota A.S. Zigmondo ir R.P.Snaitho ligoninės nerimo ir depresijos skalė (HAD – angl. Hospital Anxiety and Depression Scale). Elgsenos aktyvumui (A tipui) nustatyti naudotas sutrumpintas D. Dženkinso klausimyno (Jenkins Activity Survey – JAS) variantas, kurį sudarė trylika klausimų bei Framinghamo 10 klausimų skalė tipo A elgsenai nustatyti. Besigydančių stacionare IŠL sergančių pacientų nerimastingumas ir pablogėjusi nuotaika sumažėja stacionarinio gydymo pabaigoje. Tačiau nerimastingumas sumažėjo vyrų, sergančių IŠL, grupėje, o pablogėjusi nuotaika sumažėjo moterų, sergančių IŠL, grupėje... [toliau žr. visą tekstą] / Heart and blood vessels diseases including ischemic heart diseases are considered a major issue of health care in the modern age as these are the diseases which are growing in numbers in the times of progress and increasing level of subsistence. The thesis explores some major psychological ischemic heart disease risk factors: anxiety, worsening mood and type A behaviour as well as health-favouring behaviour of ischemic heart disease patients, essentially concentrating upon ischemic heart disease patients’ anxiety and worsening mood and its alterations in the process of hospital treatment. The aim of this analysis is to explore alterations of ischemic heart disease patients’ anxiety and worsening mood at the time of hospital treatment. The analysis covered 178 individuals aged 28 to 74 (53.52±9.03) including 107 ischemic heart disease patients aged 29 to 74 (53.91±9.14) and 71 members of the control group aged 28 to 73 (52.94±8.89) who are not ischemic heart disease patients. In order to assess worsening mood and anxiety, A.S. Zigmond and R.P. Snaith’s Hospital Anxiety and Depression Scale was employed. The assessment of the activeness of behaviour was performed by the brief variant of Jenkins Activity Survey containing thirteen questions and 10 questions scale by Framingham for the identification of type A behaviour. Anxiety and worsening mood of ischemic heart disease patients treated in hospital improve in the final stages of hospital treatment. However, anxiety decreased... [to full text]

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood. Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality. In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995. The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes. Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD. Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Ischemic heart disease (IHD) is a major cardiovascular disease. The term ischemia refers to a lack of oxygen due to inadequate perfusion, which results from an imbalance between oxygen supply and demand. The most common cause of myocardial ischemia is atherosclerotic obstructive coronary artery disease caused by rupture or ulceration of atheromatous plaque and subsequent thrombus formation. Platelets are one of the most important blood components that participate in and regulate thrombus formation by releasing active substances such as adenine nucleotides ATP and ADP. Once their action is exerted, the nucleotides are degraded by a group of enzymes called ectonucleotidases. These enzymes are responsible for the hydrolysis of ATP and ADP to AMP, and consequent formation of adenosine, a cardioprotective and anti-inflammatory molecule. Another important anti-inflammatory molecule is acetylcholine (ACh). However, ACh is rapidly hydrolyzed by the enzymes acetylcholinesterase (AChE) and tyrylcholinesterase (BuChE). Following ischemia, an elevated production of reactive oxygen species (ROS) occurs. The imbalance between ROS production and degradation may lead to an increase in oxidative stress. This study aimed to determine the activity of enzymes involved in thromboregulation, such as NTPDase, 5'-nucleotidase, E-NPP and ADA, the activity of enzymes that degrade choline esters: AChE and BuChE, as well as the parameters of oxidative stress in IHD patients and controls. Evaluation of the oxidant system was carried out by lipid peroxidation and carbonyl protein determination, and the enzymatic and nonenzymatic antioxidant defense measurements were performed in total blood, plasma, and serum of IHD patients. Results showed an increase in the NTPDase and 5'-nucleotidase activities as revealed by nucleotides hydrolysis ATP, ADP and AMP. An increase in E-NPP activity was also observed in IHD patients. However, a decrease in ADA activity was observed. Based on the results presented here we suggest that the pathological condition in IHD produced alterations in ectonucleotidase activities as a compensatory organic response, with the objective of maintaining the levels of adenosine, which is a cardioprotective molecule. An increase in the activity of enzymes that degrade choline esters (AChE and BuChE) in IHD patients was observed. Increasing total blood and serum activities of AChE and BuChE enzymes indirectly reflect reduced levels of ACh. The enhancement of local and systemic inflammatory events is observed due to the absence of the negative feedback control exerted by ACh. Regarding oxidant levels, an increase in TBARS and carbonyl protein levels was observed in acute myocardial infarction (AMI) patients when compared to the control group. The same occurred for the activities of the enzymatic antioxidants, superoxide dismutase (SOD), and catalase (CAT). However, a decrease in nonenzymatic antioxidants, such as vitamin C and vitamin E, was observed in AMI patients when compared to control. These results suggest an increase in oxidative stress in AMI, which was probably a result of the ischemic/reperfusion moment, as well as a decrease of antioxidant defenses. Furthermore, the increased antioxidant defense may act as a compensatory mechanism in consequence of the overproduction of ROS after AMI. In conclusion, IHD results in oxidative and inflamatory damages as well as an increase in the organism defenses as a compensatory response. / A cardiopatia isquêmica (CI) é uma das principais doenças cardiovasculares. O termo isquemia refere-se à falta de oxigênio, secundária à perfusão inadequada do miocárdio, que gera desequilíbrio entre a oferta e a demanda deste gás. A causa mais comum de isquemia miocárdica é a doença aterosclerótica obstrutiva das artérias coronárias, causada por ruptura ou ulceração da placa ateromatosa e consequente formação de trombo. As plaquetas são um dos mais importantes componentes do sangue que participam na regulação dos processos tromboembólicos por liberação de substâncias ativas como os nucleotídeos de adenina, ATP e ADP. Uma vez exercida sua ação esses nucleotídeos são degradados por um grupo de enzimas denominadas de ectonucleotidases. Essas são responsáveis pela hidrólise do ATP e ADP até AMP e consequente formação da adenosina, uma molécula cardioprotetora e anti-inflamatória. Outra importante molécula anti-inflamatória é a acetilcolina (ACh). Entretanto, a ACh é rapidamente hidrolisada pelas enzimas acetilcolinesterase (AChE) e butirilcolinesterase (BuChE). Acompanhando a isquemia temos uma produção elevada de espécies reativas de oxigênio (EROs). Um desequilíbrio entre a produção e a degradação de EROs pode levar a um aumento do estresse oxidativo. Neste trabalho determinaram-se a atividade das enzimas envolvidas na tromboregulação: NTPDase, 5 -nucleotidase, E-NPP e ADA, e a atividade de enzimas que degradam ésteres de colina: AChE e BuChE, além dos parâmetros de estresse oxidativo em pacientes cardiopatas e controles. Foi realizada a avaliação do sistema oxidante através da determinação da peroxidação lipídica e da carbonilação protéica e a medida das defesas antioxidantes enzimáticas e não enzimáticas do organismo, em sangue total, plasma e soro destes pacientes. Os resultados demonstraram um aumento na atividade da NTPDase e da 5 -nucleotidase, revelada através da hidrólise dos nucleotídeos ATP, ADP e AMP. Para a enzima E-NPP também foi observado um aumento na sua atividade em pacientes cardiopatas. Entretanto, para a ADA observou-se uma diminuição na atividade. Esses resultados sugerem uma resposta orgânica compensatória do organismo frente ao estado patológico formado, com o objetivo de manter os níveis de adenosina, uma molécula cardioprotetora. Para as enzimas que degradam ésteres de colina foi observado um aumento tanto na atividade da AChE quanto da BuChE em pacientes cardiopatas. Um aumento na atividade sérica e no sangue total da atividade da BuChE e da AChE pode refletir indiretamente níveis reduzidos de ACh que, por sua vez, irá reforçar eventos inflamatórios locais e sistêmicos, devido à ausência do controle de retroalimentação negativa exercido pela ACh. Em relação aos níveis de oxidantes determinados, observou-se um aumento nos níveis de TBARS e proteína carbonil em soro de pacientes com infarto agudo do miocárdio (IAM) quando comparados com o grupo controle. Esse aumento também foi observado para as defesas antioxidantes enzimáticas superóxido dismutase (SOD) e catalase (CAT). Entretanto, observou-se um decréscimo das defesas antioxidantes não enzimáticas como a vitamina C e a vitamina E no soro de pacientes com IAM. Estes dados sugerem um aumento do estresse oxidativo como resultado do momento de isquemia/reperfusão e da diminuição das defesas antioxidantes não enzimáticas. Além disso, o aumento das defesas antioxidantes enzimáticas poderiam agir como um mecanismo compensatório como consequência da superprodução de EROs após o IAM. Concluí-se então, que a CI resulta tanto em danos oxidativos e inflamatórios como mobilização das defesas do organismo para uma resposta compensatória.

The aim of this thesis is to map regional variability in the intensity of mortality using methods avoidable mortality and a few selected characteristics of health care. The thesis describes the development of the concept of avoidable mortality, which is then used for the Czech Republic for the period 2006-2010 and to individual districts for the period 2006-2010. Furthermore, this thesis focuses on the relationship between expenditures of General Health Insurance Company and the level of mortality in the regions. For showing regional differences depending on the health care intensity of mortality from ischemic heart disease (both acute and chronic forms) was also selected, depending on the distance of specialized medical care. The last chapter focuses on National screening programs and cancer mortality, which are integrated in a comparison of the percentage of people examine in this program for districts. The relationship between spending per insured and intensity of mortality and outcomes related to the intensity of mortality, depending on the availability of specialized health care has been confirmed by statistical methods - correlation (Pearson correlation coefficient). Relationship between the intensity of mortality in cancer within screening programs and the percentage of people who passed...

Univerzita Karlova 1. lékařská fakulta Studijní program: Doktorské studium biomedicíny 1. LF UK Studijní obor: Oborová rada Fyziologie a patofyziologie člověka MUDr. Gabriela Dostálová Disertační práce Vybrané aspekty akutního infarktu myokardu u mladých nemocných Specifics of Acute Myocardial Infarction in Young Adults Školitelé: prof. MUDr. A. Linhart, DrSc., doc. MUDr. D. Karetová, CSc. Praha 2017 Abstract Coronary heart disease is the leading cause of death in adults in the western world. Myocardial infarction can represent the lethal manifestation of coronary heart disease leading to sudden cardiac death. Although myocardial infarction mainly occurs in patients older than 45 years, the young population can be affected as well. Despite the relatively low incidence of myocardial infarction in the young population, the mortality rates and long-term disability make acute myocardial infarction in young patients an important clinical issue. Consequences of myocardial infraction usually have great impact on the young patient's psychology, ability to work and the overall quality of life. The management of young myocardial infarction patients should differ at least slightly from the older ones. Young patients usually have a different risk factor profile, clinical presentation, and prognosis in comparison with...

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This diploma thesis with the management of health support program in a hospital, because of increesing interest in relevance of health support nowadays. Theoretical section attempts to map out health supportin global context and also outline some health support programs, which are in progress in Czech Republic today. Another goal is to specify the most frequent noncommunicable chronic deseases and their risk factors. The last part of theoretical section deals with quality of health care, implementation of quality management and quality planning and also highlits quality as a result of modification of management process. Practical section analyzes data from questionaire survey, colected from in-patients with ischemic heart disease in The Hospital Pelhřimov. Results show, that patients wanted to change their life style. There is also a big group of patients, who don't think of changes of their habits. But this group is interested in informations about changes of their life style. The informations are provided by physicians. As for this group, group consists of patients with overweight or obesity, and patients who are suffering from their disease less then one year. Level of provided information in The Hospital Pelhřimov is very high. Patients are able to realise recommendations, which personal of the...