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Pharmacological therapy for heart failure (HF) shows the strongest evidence in patients with reduced ejection fraction (HFrEF). The four drug pillars with proven mortality benefit in patients with HFrEF are as follows: a renin-angiotensin-aldosterone blocker (angiotensin receptor – neprilysin inhibitor should be preferred), a beta-blocker, a mineralocorticoid receptor antagonist, and a sodium-glucose cotransporter-2 inhibitor (SGLT2i). Furthermore, their early prescription reduces mortality more markedly. Optimally, they should be prescribed during hospitalization, after hemodynamic stabilization. The goal is to initialize all four drugs but strategy of drug selection, sequence of application and dosage adjustment should follow the individual patient profile. For the treatment of patients with HF with mildly reduced ejection fraction (EF) the same drugs as for HFrEF can be used, in spite of a weaker evidence of benefit. It has been confirmed recently that SGLT2i reduce mortality and hospitalization for HF in patients with HF with preserved ejection fraction. SGLT2i (dapagliflozin and empagliflozin) are drugs with prognostic benefit in patients with HF regardless of the left ventricular EF. Renin-angiotensin-aldosterone blockers, beta-blockers, and mineralocorticoid antagonists show weak evidence of benefit in patients with HF with preserved EF. Diuretics are indicated in all patients with HF and congestion to alleviate symptoms and to maintain euvolemic state. In patients with improved EF, including asymptomatic patients, as well as patients with normalized EF and chamber geometry, continuation of disease- modifying therapy is recommended to avoid relapse of the disease. [ABSTRACT FROM AUTHOR]

Supraventricular arrhythmias in pulmonary arterial hypertension (PAH) are common and often result in severe clinical and hemodynamic deterioration. The management is complex and involves conservative and interventional approaches. We present a case of a patient with idiopathic PAH with multiple recurrent supraventricular arrhythmias. The female patient (b. 1978) was diagnosed with idiopathic PAH in 2006 and sildenafil treatment was initiated in 2007. Due to disease progression, SQ treprostinil was started in 2012 and bosentan was added in 2013. In April, 2014, she was admitted to hospital due to abrupt worsening of dyspnea and hypotension. Regular tachycardia with the rate of 150/min was detected and terminated by intravenous adenosine. On electrophysiology study (EPS), atrio-ventricular nodal re-entrant tachycardia (AVNRT) was confirmed and a successful slow pathway modulation by radio frequency (RF) ablation was performed. In addition, several regular and irregular atrial tachycardias other than typical atrial flutter were inducible by isoprenaline at EPS. A small dose of short-acting beta-blocker (metoprolol) was initiated and the patient was discharged from hospital in a clinically stable status and in sinus rhythm. However, she was re-admitted to hospital due to dyspnea at rest, signs of right ventricular failure, and persisting atrial tachycardia 6 weeks later. Electric cardioversion was performed and sinus rhythm was restored. Amiodarone was added. Further interventional treatment was not indicated due to high risk and low probability of success of the procedure in context of multiple foci of arrhythmia. Atrial tachycardia recurred soon and persisted. Unfortunately, the patient's status further deteriorated in spite of treatment escalation and she was listed for lung transplant. Atrial tachycardia with adequate ventricular rate persisted in the long-term. The patient died of heart failure early after lung transplant. Conclusion: SV arrhythmia can result in an abrupt destabilization of the patient's status. We believe it is of the utmost importance to aim for reconstitution of the sinus rhythm using all available conservative and interventional approaches. On the other side, it is also possible that SV arrhythmia represents one of the signals of disease progression and a marker of unfavourable outcome. We therefore presume that on the occurrence of SV arrhythmia, pulmonary hypertension specific treatment escalation should be considered to minimize further PAH progression. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a rare disease affecting small pulmonary arteries. It results in right ventricular pressure overload and failure. Despite the availability of new targeted pharmacologic treatment, PAH remains an incurable disease. The disease course is variable and it is thus necessary to identify patients with unfavourable prognosis. New tools for risk assessment both at initial presentation and at periodical examination have recently become available. They integrate individual risk markers. The aim of therapeutic measures is to achieve and maintain the low risk status. If this goal is not achieved, treatment escalation is recommended. The authors analyse recent approaches to risk assessment in PAH and its clinical importance for treatment decision making. [ABSTRACT FROM AUTHOR]

Purpose: Analysis of predefined characteristics and outcomes in a non-selected population of patients hospitalized for acute heart failure (AHF) in Slovakia., Methods: We conducted a nationwide prospective multicenter survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia--two centres with a non-stop catheterization service, two central and 7 regional hospitals. Relevant data of 78 characteristics in 9 categories were collected during 3 months (between 1 May 2009 and 31 July 2009). There was a specific form designed for this survey. Collected data were then transferred into the electronic database and statistically analysed., Results: Mean age was 72 years, 81% of patients were in NYHA class III/IV (52% male). The majority of patients were admitted with decompensated heart failure (68.4%), frequency of cardiogenic shock was 0.3%. New-onset AHF (AHF de novo) was diagnosed in 31.1%, of which 20.8% was due to acute coronary syndromes. Coronary heart disease was the predominant primary aetiology of AHF (67%), followed by almost equally represented hypertension (10.5%), valvular disease (10%) and dilated cardiomyopathy (9%). Hypertension was referred as the most frequent comorbidity (82%), followed by atrial fibrillation (48%), diabetes mellitus (42%), history of renal failure (31%) and with anaemia at admission (38%). Rales were the dominant physical sign (69.9%). Systolic blood pressure greater than 140 mm Hg was present in 37.8% and QRS length > 120 ms in 21.4% of patients. Preserved left ventricular ejection fraction (> or = 40%) was observed in 57% out of 70% documented cases in the whole survey. 23.3% of patients had a history of coronary angiography. 84.3% of patients received intravenous treatment, diuretics, nitrates and inotropes were given to 82.2%, 18% and 6%, respectively. The number of patients with cardiac resynchronization therapy (CRT), with or without defibrillator function, was 0.9%. Mean length of stay was 9.2 days and in-hospital mortality was 9.1%. At discharge, 76% of patients were on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), 62% were using beta-blockers (BB), however the doses of drugs were lower then recommended values., Conclusions: Results of the survey are comparable with other observational studies, surveys and large registries. Although the percentage of patients with ACE-I/ARB and BB at discharge seems promising, there is still area for improvement in AHF patients health care.

Background: Management of cerebrovascular insufficiency (CVI) is one of the greatest medical challenges in our country. Retardation in this field has been causing serious medical and socioeconomic consequences., Main Purpose and Starting Points (objectives): In spite of existing unfavourable conditions the authors of this paper have managed to standardize their own policy in diagnosis, surgical indications and techniques. This caused substantial improvement of their results, as well as cooperation with the neurologic clinics. In connection with the increasing numbers of operations and improved results, the authors report their recent experience in this field and compare them with the results from previous years., Methods: The authors compare two series of patients. The first series of 65 consecutive patients surgically treated from 1st Jan. 1987 to 31st Dec. 1990 (69 operations altogether). The 2nd series of 169 consecutive patients surgically treated from January 1st 1993 to December 31st 1994 (191 operations altogether), 149 due of them were subjected to carotid endarterectomy (CEA). Mean age of the first series was 55.3 (35-73), 2nd series 59.7 years (42-86). The authors have studied participation of neurologically and angiographically unstable patients. In the first series the ratio of neurologically stable and unstable patients was 63.4:36.6%, while in the 2nd series it was 75.4:24.6%. The ratio of angiographically stable and unstable patients was in the 1st series 60.2:39.8%, while in the 2nd series it was 50.3:49.7%. In the 2nd series the authors observed also the percent age of ulcerated lesions in the carotid bifurcation and found a surprisingly high number-59.2%., Results: The combined mortality-morbidity index of the first series was 11.6%, of the 2nd series 3.1%. In the first series there were two deaths (2.9%) and 6 brain infarctions. In the 2nd series four patients died from acute myocardial infarction (2.1%) and there were two cases of a perioperative brain infarction, respectively. The necessity of wound revision due to of bleeding was found in two patients (2.9%) in the first series, and in two cases (1%) in the 2nd series., Conclusions: The authors emphasize the complicated nature of these problems, the necessity to recognize the surgical indications and techniques, and protective measures to prevent serious complications. There is, in their opinion, inevitable to increase bringing the patients in need of surgical reconstruction under control. On the other hand, there is the necessity to increase the accessibility of qualified surgery in the CVI. That means in the first place to increase the number of centers able to accomplish these operations with minimal combined mortality-morbidity index. (Tab. 10, Ref. 37.).

Background: There has been an obvious evidence of a rising incidence of the supraaortic arteries aneurysms during the last 10-15 years. It is probably the consequence of both improved diagnostics and surgical technique. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES). Because of a relatively high incidence of this group of aneurysms the authors of this paper analyzed their own patients population., Methods: From 1st Jan. 1987 to 31st Dec. 1994 10 patients were admitted 10 patients with altogether 11 supraaortic trunk aneurysms. Last year 5 patients with 5 aneurysms (45 percent) were admitted. The mean age of all patients was 57.5 (20-88) years. The mean age in the group of carotid artery aneurysms was 75.2 (71-88) years, and 31 (20-43) years in the group of subclavian artery aneurysms, respectively. Both carotid and subclavian arteries aneurysms were managed by the same technique--aneurysm resection and graft interposition. There were two exceptions. One of them was a young woman with a small asymptomatic subclavian artery aneurysm in connection with the thoracic outlet syndrome. The aneurysm has been left in its place and followed up. The second exception was a young man with a posttraumatic false aneurysm of the intrathoracic part of the right subclavian artery. He died without surgery because of massive haemorrhage due to the a false aneurysm rupture., Main Results: The hospital mortality of the group of operated patient was zero. There has been one head nerve injury in this group and 100 percent immediate patency, as well. All patients have been followed up. There have been found an asymptomatic internal carotid artery occlusion, the rest of reconstructions has been functioning., Conclusions: The aneurysms of the extracranial supraaortic arteries are rare vascular lesions. They have, however, a high incidence of unfavorable sequelae, most of them of neurologic nature. The authors emphasize the importance of proper diagnosis and early surgical intervention in selected cases put into the hands of an experienced vascular surgeon. (Tab. 2, Fig. 1, Ref. 17.).

A review of angiographic findings in vasculitides classified according to Lie is introduced. Angiography is an important investigation in angiitis that affects large, medium and visualizible small vessels. Its importance resides in 1. diagnosis, 2. selection of adequate therapeutic intervention. This work includes the description of angiographic findings in Takayasu's arteritis and Buerger's disease. (Fig. 4, Ref. 26.).

The contribution of the tumor marker CA 19-9 to differential diagnosis between malignant and nonmalignant diseases of the pancreas was assessed in a group of 120 patients. On using border values of CA 19-9 80 U/ml, its sensitivity was found to be 84.4% and its specificity 84.8% for carcinomas of the pancreas. Correlation of CA 19-9 values with results of computer tomography and endogenous retrograde cholangiopancreatography in the patients studied yielded an over 80% accordance. In the light of the obtained results, the authors consider determination of CA 19-9 levels to be a suitable method supplementing the imaging examination methods in suspect carcinoma of the pancreas.

Operation of the biliary pathways in patients with obstructive jaundice is still associated with a significant morbidity and high mortality, in particular in geriatric patients. Recently in the therapy of icteric patients percutaneous or endoscopic drainage of the biliary pathways was introduced. At the Surgical Clinic of the Hospital with Policlinic, Bezrucova in Bratislava in 1988 52 patients with obstructive jaundice were hospitalized. In patients with more than three risk factors the authors introduced preoperative drainage of the biliary pathways. In patients with malignant disease they describe preoperative percutaneous transhepatic drainage with subsequent enterobiliary anastomosis with an in-dwelling drain. Of 52 patients 9 died, i.e. 17.3%. Non-surgical drainage of the biliary pathways in icteric patients reduces the number of risk factors, eliminates the adverse effects of jaundice and improves the prognosis of the icteric patient.