The detection of early myocardial changes in asymptomatic diabetic individuals by 99mTc - Myoview gated-SPET and heart rate variability measurement.

AIMS: Incidence of early myocardial changes in asymptomatic diabetic individuals is not clearly documented. In the present study, we examined diabetic patients without a history of cardiovascular disease with negative treadmill test and no signs of systolic dysfunction for presence of cardiac autonomic neuropathy established by measurement of heart rate variability (HRV) and (99m)Tc - Myoview gated-SPET. MATERIALS AND METHODS: 47 type I and type II diabetic patients were subjected to prospective study including echocardiography and HRV measurement using the combination of Ewing´s testing and spectral analysis. Subsequently, patients underwent treadmill test and stress myocardial perfusion scintigraphy. Additionally, vascular and metabolic parameters were collected. RESULTS: Treadmill test was negative in all patients. Diastolic dysfunction was found in 10 % of T1DM and 11 % of T2DM patients by echocardiography, whereas none of the patients had systolic dysfunction. SPET confirmed hypoperfusion in 35 % T1DM (p=0.01) and in 60 % T2DM (p=0.001). Diagnosis of cardiac autonomic neuropathy based on Ewing´s testing and HRV examination was established in 60 % of T1DM patients (p=0.001) and 77 % of T2DM patients (p=0.001). In T1DM group, significant association was found between cardiac autonomic neuropathy (CAN) and frequency of hypoglycaemia (p=0.04). No such correlations were found in patients with T2DM. CONCLUSION: The results of the present study show high incidence of myocardial hypoperfusion and cardiac autonomic neuropathy among asymptomatic diabetic patients, whereas the standard diagnostic approaches including treadmill test and echocardiography failed to show any changes. Therefore, we conclude that diabetic heart disease remains underdiagnosed by standard approaches, but could be detected in asymptomatic patients by more sensitive methods, such as HRV measurement and myocardial scintigraphy (Tab. 2, Fig. 2, Ref. 26).

[Syncope as first and only sign of left atrial myxoma]. / Synkopa ako prvý a jediný príznak myxómu lavej predsiene.

Myxoma is the most frequent primary heart tumor. It is localised in the left atrium in majority of cases, but each of heart chambers may be affected. Left atrial myxoma becomes symptomatic in case it leads into mitral valve obstruction, systemic embolisation or it manifests with unspecific systemic symptoms. Echocardiography is a golden standard of myxoma diagnostics. We present a case of 61-years old woman patient in whom exercise induced syncope was the first and only sign of far gone left atrial myxoma with left ventricle inflow tract obstruction, leading to mitral pseudostenosis.

[Pulmonary embolism, prolonged diagnosis in young man]. / Pl'úcna embólia, zdlhavá diagnóza u mladého muza.

Despite progress in early detection and treatment, the rates of mortality and recurrences of pulmonary embolism remain high. Cardiovascular specialists must keep pulmonary embolism in mind when they evaluate patients with unexplained substernal or pleuritic chest pain, dyspnea and syncope because these symptoms constitute the cardinal clinical presentation of pulmonary embolism. Authors are presenting a case report of a patient with repeating pleuritic chest pain with pleural effusion. The patient was treated as suspected tuberculous pleuritis. Authors diagnosed pulmonary embolism as a cause of pleural effusion by elevated plasmatic D-dimer and perfusion lung scan. Thrombosis in left subclavian vein established by angiography was source of embolus. Patient was evaluated regarding primary risk factors for venous thromboembolism and Prothrombin 20210A mutation was detected. Subsequent adequate medical treatment led to significant clinical upturn in this patient.

[Beta-blockers in the treatment of chronic heart failure]. / Beta-blokátory v liecbe chronického srdcového zlyhania.

The authors discuss in the submitted review the problem of therapeutic use of beta-blockers in the treatment of cardiac failure. n the introduction they emphasize the medical and societal consequences of this disease with emphasis on necessary prevention. In the subsequent part they present a review of the most important clinical studies (completed and under way) focused on the mentioned problem. In the discussion they analyze the role of the sympathetic nervous system in the pathogenesis of cardiac failure and the theoretical basis of the use of beta-blockers in its treatment. In the conclusion they present a summary of practical principles for the use of beta-blockers in this indication.