[BRNO Register 2: post-myocardial infarction pharmacotherapy]. / Registr BRNO 2: farmakoterapie po infarktu myokardu.

We assessed 850 patients with a history of myocardial infarction >1 month ago who attended outpatient clinics of the Clinic of Internal Medicine and Cardiology at the Faculty Hospital Brno between 1st September 2009 and 31st December 2009. There were more men (650 vs. 200) and patients under 70 years of age (576 vs. 264) in the cohort. 87.8% of patients experienced one myocardial infarction only and the mean age at the first infarction was 59.0 years in men and 65.5 in women (p < 0.001). 75.8% of patients had been prescribed all recommended pharmacotherapeutic groups according to guidelines (RAAS blockers, beta-blockers, statins, antiagregation agents) and each group individually was used in > 90% of patients. There were no differences between men and women and older and younger patients. ACE inhibitors and statins were not always prescribed in recommended (high) doses. Perindopril was the most frequently prescribed ACE inhibitor and atorvastatin the most frequently prescribed statin. Blood pressure of< 140/90 mm Hg was identified in 60.1% of patients, 75% of men and 65% of women had cholesterol level of <5 mmol/l and > 50% of patients had cholesterol < or = 4.5 mmol/l, metabolic syndrome was found in about 1/2 of patients and smoking was admitted by 12.5% of patients.

[Restrictive cardiomyopathy as a manifestation of primary amyloidosis]. / Restriktivní kardiomyopatie jako projev primární amyloidózy.

Primary amyloidosis is a rare disease, cardiac involvement occurs in up to 40% of patients. Diffuse amyloid deposits cause an impairment of myocardial systolic and diastolic function. In this paper we are presenting a case of a 54-year-old woman. The woman was admitted because of progressive fatigue, dyspnoea, chest pain, later she experienced hypotension, dyspepsia, and enterorrhagia. ECG showed decrease in QRS amplitude. We have found an echocardiographic evidence of wall hypertrophy. Right cardiac catheterization showed a restrictive situation. Immunobinding of serum and urine revealed monoclonal kappa light chains. The diagnosis was determined by rectal biopsy. Unfortunately, amyloid deposits caused progressive heart failure, hemorrhage, and death just before the diagnosis of primary amyloidosis could be determined on the basis of results of the immunofixations of serum and urine proteins (detection of the monoclonal light chains kappa) and from biopsy specimens taken from rectum (amyloid deposits).

[What does the ECG reveal in infectious endocarditis?]. / Co vypovídá EKG krivka u infekcní endokarditidy?

The electrocardiogram should be recorded at the very beginning of infectious endocarditis. It provides information on the origin and complications of possible organic disease (aortal stenosis--left ventricular hypertrophy). Moreover regular follow up of ECG tracings can reveal changes signalizing spread of the infection beyond the endocardium. Thus the conduction system may be affected--bundle branch block, atrioventricular blocks grade I to III, ectopic functional tachycardia, extrasystoles, myocardium--by development of typical ECG changes during myocardial infarction after embolization of the vegetation into the coronary artery, or last not least, the pericardium, after spread of the infection into the pericardial cavity with the serious finding of purulent pericarditis with diffuse ST-T elevations on the ECG tracing.

[Pitfalls in the diagnosis of infectious endocarditis]. / Uskalí diagnostiky infekcní endokarditidy.

A group of 63 patients with infectious endocarditis (IE) (1991-1998) was subjected to a detailed retrospective analysis. The authors investigated the age of the patients, site of IE, type of infectious agent, incidence of coinciding diseases or interventions in the close premorbid period of IE, size of vegetation, incidence of embilizations, heart failure, indications for vital early cardiosurgery, number of deaths. From the clinical analysis it may be concluded: 1. There is a new group of patients with IE, who before development of the disease have no manifest cardiac disease who however frequently suffer from another coinciding disease; 2. There is a significant increase of dextrolateral IE (frequently "pacemaker" IE); 3. The ratio of staphylococcal strains in the etiopathogenesis of IE is rising; 4. The mean age of the affected patients is rising (as well as the age scatter); 5. IE is unfortunately frequently diagnosed only after embolization of the vegetation (mostly cerebrovascular attacks) in obscure febrile conditions.

A mutation in the X-linked Emery-Dreifuss muscular dystrophy gene in a patient affected with conduction cardiomyopathy.

A screening for mutation in the X-linked Emery-Dreifuss muscular dystrophy (X-EMD) gene was performed among patients affected with severe heart rhythm defects and/or dilated cardiomyopathy. Patients were selected from the database of the Department of Cardiology of the University Hospital Brno. One patient presented a mutation in the X-EMD gene and no emerin in his skeletal muscle. The patient had a severe cardiac disease but a very mild muscle disorder that had not been diagnosed until the mutations was found. This case shows that mutations in X-EMD gene, as it was shown for autosomal-dominant EMD, can cause a predominant cardiac phenotype.

[Solitary cardiac metastasis from carcinoma of the cervix]. / Solitární metastáza v srdci u karcinomu delozního cípku.

Authors report the case of 37 years old women after radiotherapy for spinocelular cervical carcinoma which was presented by a solitary metastasis in the right ventricle causing right ventricle output tract obstruction. Cardiosurgical intervention as well as chemotherapy were not indicated for the great extension of cardiac involvement. The patient died from a massive pulmonary embolism. Echocardiography, although limited by the discrimination ability, seems to be the best method for the cardiac metastasis detection.