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Pljučna hipertenzija je pestra bolezen, ki pomembno poslabša napoved izida pri bolnikih, zato stremimo k zgodnjemu odkrivanju, saj določene podrazrede pljučne hipertenzije lahko učinkovito specifično zdravimo. Ključna preiskava, s katero potrdimo ali ovržemo diagnozo pljučna hipertenzija, je desnostranska srčna kateterizacija. Poleg invazivno izmerjenega tlaka v pljučni arteriji med desnostransko srčno kateterizacijo merimo minutni srčni iztis, opredelimo, ali gre za t.i. predkapilarno ali pokapilarno (oz. kombinirano) pljučno hipertenzijo, ter pri izbranih bolnikih izvajamo test vazoreaktivnosti in/ali test obremenitve s tekočino. Ultrazvočna preiskava srca je sicer bolj dostopna, enostavna in manj invazivna preiskava za odkrivanje pljučne hipertenzije, vendar nam lahko poda le verjetnost, da hipertenzija obstaja. Zato se uporablja le kot presejalna metoda za odkrivanje pljučne hipertenzije. Pri utemeljeno povečanem tveganju za pljučno hipertenzijo pa za postavitev diagnoze in spremljanje učinkovitosti zdravljenja redkih oblik pljučne hipertenzije vedno opravimo desnostransko srčno kateterizacijo. Najpogosteje se pljučna hipertenzija pojavlja pri bolnikih z boleznijo levega srca ali pljučno boleznijo. Redkejši obliki pljučne hipertenzije, pri katerih je v ospredju remodeliranje pljučnega žilja, sta pljučna arterijska hipertenzija in kronična trombembolična pljučna hipertenzija. Pri slednjih dveh so zelo učinkoviti specifični ukrepi, kot so uvedba specifičnih zdravil za pljučno hipertenzijo in pri kronični trombembolični pljučni hipertenziji na prvem mestu pljučna endarterektomija in/ali balonska dilatacija pljučnih arterij. Vse to pomembno izboljša napoved izida bolezni in kakovost življenja bolnika. Na Kliničnem oddelku za pljučne bolezni in alergije Univerzitetnega kliničnega centra Ljubljana od septembra 2018 redno, tedensko, opravljamo desnostranske srčne kateterizacije za diagnosticiranje redkih oblik pljučne hipertenzije, spremljanje učinkovitosti zdravljenja in v postopku predpriprave na presaditev pljuč.

Respiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. Tis article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI - transfusion-related acute lung injury, TACO – transfusion-associated circulatory overload, and TAD - transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient’s preexisting diseases. Although the transfusion-related reactions are not very common, knowledge about them can prevent serious consequences. On the one hand preventive measures should be sought, and on the other early recognition is beneficial, so that proper treatment can take place.

Background: Chronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention after acute myocardial infarction (AMI). The aim of our study was to determine the effect of diet, rich with natural antioxidants, added to physical activity (as a part of cardiac rehabilitation (CR) program) on inflammatory markers and ox-LDL, a marker of oxidative stress, closely involved in the process of chronic inflammation. Methods: 41 male patients after AMI undergoing CR were divided into a diet group (supervised cardioprotective diet throughout the CR), and control group (CR without diet). We measured hsCRP, leucocytes, neutrophils, IL-6, oxLDL, exercise capacity and classic risk factors before and after CR program. Results: Patients from the diet group presented with a significant decline in classic risk factors (BMI, waist circumference, waist to hip ratio, systolic blood pressure, heart rate, blood glucose, total cholesterol, LDL, TAG) and inflammatory markers (hsCRP, leucocytes, neutrophils) compared to control group. Furthermore, when studying nonsmokers, we observed significant decline of oxLDL in the diet group. Conclusions: The addition of cardioprotective diet, rich with natural antioxidants, to physical activity as a part of a CR program, positively modifies not just classic risk factors and exercise capacity, but also diminishes chronic inflammation markers. These effects, and oxLDL decline were most prominent in nonsmoking patients.

Background Rehabilitation following acute myocardial infarction (AMI) is a crucial part of secondary prevention for coronary heart disease. The aim of our study was to determine the efficiency of our national in-patient rehabilitation program in improving exercise capacity and lowering risk factors for coronary heart disease.Methods 25 patients 3-9 weeks after AMI, undergoing 2 week in-patient cardiac rehabilitation, were included in our study. We performed exercise stress testing and measurement of classic risk factors before and after the rehabilitation. Classic risk factors were compared with 25 age matched adults without known risk factors for coronary heart disease.Results Patients after AMI had lower exercise capacity than healthy adults (p≤0.002 for double product, maximal load, systolic blood pressure, heart rate and time of load). Patients recieved appropriate drug therapy after myocardial infarction, which presented as lower diastolic and a trend to lower systolic blood pressure (p=0.002 and 0.080), lower total and LDL cholesterol values (both pConclusions In-patient program of cardiac rehabilitation efficiently elevates exercise capacity in patients after AMI, but fails to influence classic risk factors for coronary heart disease, which might be due to lack of controlled cardioprotective diet during rehabilitation.