Falls: a significant cause of morbidity and mortality in elderly people.

The incidence of falls of older people is increasing. Falls are the most common cause of injuries of older adults. Costs for the treatment of injuries caused by falls are constantly increasing too. In fragile and polymorbid individuals, falls are most often of multifactorial ethiology; age-related frailty, coinciding chronic diseases and interactions with the external environment. The most serious consequences of falls include hip fractures and intracranial injury. The American Geriatric Society recommends an annual falls and instability screening in people 65 years of age. Multifactorial interventions should be targeted primarily at people with two or more falls or with a history of injury after a fall and at high-risk patients. It includes treatment of diseases that increase the risk of falls, management of podiatric problems, correction of visual deficit, optimization of medication, use of compensatory aids, home environment adaptation and education of older people and their family members. Vitamin D supplementation is recommended for indicated patients. Recently published reports, however, are reserved for its fall reduction effect. The results of rehabilitation studies are not consistent, with the best effect being reported in special programs for older adults. Using 3D technologies to simulate virtual reality can represent a new approach to improve patient adherence to physical activity. Key words: falls - multifactorial intervention - older people - prevention - risk factors - screening.

Arrhythmias and ECG changes in life threatening hyperkalemia in older patients treated by potassium sparing drugs.

BACKGROUND: Severe hyperkalemia is a life threatening condition that can cause fatal rhythm disturbance and terminal heart arrest. The most common cause of hyperkalemia in older patients is that of iatrogenic medication-related etiology due to associated polymorbidity, polypharmacy and reduced reserve metabolic capacity. The aim of this paper is to increase awareness in the clinicians of the risk of hyperkalemia in elderly patients treated by potassium sparing drugs. METHODS AND RESULTS: We present two case reports of hyperkalemia ≥ 9.0 mmol/L induced by potassium sparing medications with cardiac arrhythmias and severe ECG changes including atrial asystole, disturbance of intraventricular conduction and morphological changes such as tenting T waves and deformed wide QRS complexes. The most frequent causes of hyperkalemia in elderly patients are discussed and electrocardiogram changes and arrhythmias in hyperkalemia are analyzed, as well as their treatment and prevention. CONCLUSION: Potassium sparing drug therapy in older persons requires more frequent monitoring especially when drugs or their doses are changed, or during concomitant acute illness.

[Correlation of intracardiac pressures and electrical atrial potentials with morphology and function of overloaded atria assessed by echocardiography]. / Korelace intraatriálních elektrických potenciálu a tlaku s morfologickými a funkcními ukazateli pretízených síní stanovenými echokardiografií.

BACKGROUND: In patients with chronic complete heart block or single chamber pacing and preserved sinus depolarization, left and right atria (LA, RA) may suffer from increased intraatrial pressure resulting from atrioventricular dyssynchrony (AVDys), dilate and lose their contractile function. The purpose of the study was to find out whether any correlation exists between the echocardiographically measured LA, RA morphological and functional parameters on one hand and the intracardiac RA pressures and electrical potentials on the other hand in patients with chronic AVDys. METHODS: In 26 pts (77 +/- 10 years, 16 males), where a chronic AVDys was the most important patophysiological mechanism of atrial overloading, the intraatrial pressures (atrial, right ventricular, pulmonary arterial and wedge pressure/PWP/) and electrical potentials (upper, middle, lower part of RA and RA appendage) were correlated with atrial diameters, volumes, ejection fraction and filling parameters. RESULTS: There was a moderate inverse correlation between the LA ejection fraction and PWP: r = -0,489, p = 0,025 at a level of significance 0.05, but no relationship between PWP and LA size/volumes. No correlation between RA potentials or intracardiac pressures and RA morphologic or functional features were documented. CONCLUSIONS: In this study, an inverse correlation between the capillary wedge pressure and left atrial ejection fraction in pts with chronic atrioventricular dyssynchrony was documented. No other correlation between echocardiographic parameters and intracardiac pressures or electrical potentials was found.

Left ventricular diastolic filling in young persons with type 1 diabetes mellitus.

The purpose of this study was to evaluate the influence of diabetes mellitus on left ventricular function. Using Doppler echocardiography we examined a group of 49 young (20-32 years old) persons with type 1 diabetes mellitus and a group of healthy age-matched men and evaluated the parameters of diastolic filling of the left ventricle (LV). We found significant differences in peak velocity of early filling of the left ventricle ((70.07+/-10.84 vers. 78.2+/-10.59 cm.s(-1), p+/-0. 01), peak velocity of late diastolic filling of LV (A = 47.74+/-11.6 vers. 43.15+/-7.48 cm.s(-1), p < or = 0.027), ratio E/A (1.53+/-0.4 vers. 1.84+/-0.33), time velocity integral of peak E (TVIE = 0.083+/-0.014 vers. 0.1+/-0.022 m, p < or = 0.001), time velocity integral of peak A (TVIA = 0.039+/-0.011 vers. 0.037+/-0.012 m, p < or = 0.3), ratio TVIE/TVIA (2.3+/-0.73 vers. 2.9+/-0.9, p < or = 0.001), time E (204.4+/-31.59 vers. 198.4+/-19.09 ms, p < or = 0.27), time A (126.9 < or = 23.0 vers. 113.5+/-15.59 ms, p < or = 0.002), time E/time A (1.64+/-0.3 vers. 1.76+/-0.22, p < or = 0.039) and duration of isovolumic relaxation period (IVRT = 88.2+/-10.8 vers. 71.13+/-8.4 ms, p < or = 0.0001). Despite significant differences all the results were in the range of values for the healthy population. However in detailed analysis we found that the values measured in young (20-32 years old) persons with type 1 diabetes mellitus corresponded with diastolic parameters of healthy men of the age of 50 years and more. Thus, diabetes mellitus can influence the relaxation properties of the left ventricle.