[Psychological factors and heart diseases]. / Psychické faktory a srdecní choroby.

We are often faced with patients with increased psychosocial stress, anxiety and depression and various cardiovascular symptoms such as hypertension, tachycardia, arrhythmia and chest pain. Psychological factors are important in particular in ischaemic heart disease and in arterial hypertension. In this respect chronic as well as acute stress plays a part. The problem of stress as a risk factor of these diseases of civilization is investigated. Some psychopathological signs may lead first to cardiological examination but their origin is within the psychic sphere of the patient. In the diagnostic sphere of some diseases which belong primarily into the cardiological or psychiatric sphere collaboration at a scientific as well as practical level is necessary.

[The process of ventricular remodeling after acute myocardial infarct associated with left ventricular aneurysm and ventricular septum rupture treated with radical surgery]. / Proces komorové remodelace po akutním infarktu myokardu s aneurysmatem levé komory a rupturou komorového septa po radikálním chirurgickém zákroku.

Even after a successful operation of mechanical complications on account of acute myocardial infarction gradually developing adverse remodelling of the left ventricle has to be envisaged. In a six-year clinical study by means of echocardiography the authors followed up systematically some cardiac dimensions and volumes and functional systolic and diastolic left ventricular parameters. The changes pertained in particular to the endsystolic and enddiastolic volume, the ejection fraction, the peak maximum rate, early and late diastolic filling and their ratio as well as to indirect values of the mean pressure in the pulmonary artery. These changes, which at first indicated impaired relaxation, are caused subsequently by increasing stiffness of the left ventricle. With regard to the large number of complicated pathophysiological phenomena pertaining to active relaxation and passive elastic properties of the left ventricle during ventricular diastole, different Doppler parameters must be evaluated very carefully, individually and with regard to the clinical condition. Attention is drawn to the importance of complicating mitral regurgitations and an increased pressure in the left atrium and lesser circulation after aneurysmectomy of the left ventricle. Mitral regurgitation has an impact on the process of left ventricular filling investigated by means of diastolic Doppler functions. Despite limitations of echocardiographic methods within the framework of assessment of diastolic left ventricular functions after myocardial infarction echocardiography remains the main means for evaluating left ventricular function by a non-invasive route and its position in this respect is irreplaceable. Further experimental work is needed for better understanding, use and more intelligent interpretation of non-invasive parameters of left ventricular function also in these complicated conditions after surgery of mechanical complications resulting from myocardial infarction.

[Principals of clinical examinations of mitral stenosis prior to invasive treatment]. / Zásady klinického vysetrení mitrální stenózy pred invazivním osetrením.

Mitral stenosis, being a progressive disease, remains even at present an important specialized diagnostic field of cardiology which deserves special attention. Although a substantial regression of rheumatic disease was recorded in our country, we have to take into account that there are patients after surgery of mitral stenosis made in the past, that restenosis may develop and that there is also a certain number of non-rheumatic forms of mitral stenosis. Clinical cardiological examination still remains the basis for evaluation of mitral stenosis. A central position in the diagnosis of mitral stenosis for assessment of structural morphological changes in the area of the mitral valve and functional flow changes in the cardiac area is played by echocardiography which, when modern techniques are used, usually suffices for indication of invasive treatment on the stenotic mitral valve. The drug of choice in selected patients with mitral stenosis is balloon mitral commissurotomy which clearly dominates in the majority of patients needing a radical procedure and leads to release of the close block in this area and substantial improvement or sometimes complete disappearance of the symptomatology of the disease. Similarly as in surgical commissurotomy this invasive procedure must be described as palliative and not as a curative procedure.

[Determination of pulmonary hypertension using echocardiography in clinical practice]. / Urcování pulmonální hypertenze pomocí echokardiografie v praxi.

In 1992 the author assessed in 130 patients the acceleration time by means of spectral analysis of the Doppler signal in the effluent tract of the right ventricle. In 12 patients this value was compared with direct assessment of the median pressure in the pulmonary artery during catheterization of the heart. The author revealed a relatively satisfactory correlation between these two methods and presents his own regression equation: median pressure in the pulmonary artery (mm Hg) = 73.296--0.426 acceleration time (msec), correlation coefficient--0.86. This equation can be used in practice. The above mentioned examination must be properly performed, but even then it has significant limitations, which must be respected in practice and this method must therefore be considered semiquantitative rather than quantitative. It is probable that progressive echocardiographic functional diagnosis will make possible further progress in the assessment of the type of pulmonary hypertension and resistance in the lesser circulation.

[Perspectives in ultrasonic examinations in cardiology]. / Perspektivy ultrazvukového vysetrení v kardiologii.

Cardiac ultrasound is a perspective and mostly non-invasive examination method, which has theoretical and practical prerequisites of wider use. The unexpected rapid progress of the echo-cardiographic technique will continue and penetrate into all spheres of diagnosis of the cardiovascular system. The prerequisite is ever improving equipment, incl. basic instruments, transducers and the standard of echocardiologists. Only then it will be possible to improve by echocardiography the present diagnostic and therapeutic procedures in cardiovascular medicine for the benefit of all specialists engaged in prevention, diagnosis and treatment of cardiovascular diseases.

[Quantitative determination of left ventricular size using echocardiography]. / Kvantitativní urcování hmotnosti levé komory srdecní pomocí echokardiografie.

Echocardiography makes it possible to examine the mass of the left ventricle both by a two-dimensional and one-dimensional approach. The method of one-dimensional echocardiography is simpler and more accurate than two-dimensional echocardiography. There are two most frequently used conventions for assessment of the thickness of the wall and the diameters of its cavity: 1. the method of the American echocardiographic society, 2. the Penn-convention. The latter correlates better with left ventricular mass assessed on autopsy. The prerequisite for use of one-dimensional echocardiography is that the mass of the left ventricle is evenly distributed along the whole circumference. This assumption must be assessed in advance by two-dimensional echocardiography and it is necessary to eliminate from examinations those patients where the left ventricle is geometrically impaired. The authors mention also other limitations of one-dimensional echocardiography when used for assessment of left ventricular mass. The mass of the left ventricle is an independent risk factor and indicator of elevated morbidity and mortality in arterial hypertension and therefore its assessment is very important in clinical practice. The authors present their own observations of dynamic serial examinations used to assess the mass of the left ventricle in a female patient with pheochromocytoma and its total regression after radical surgery.

[Evaluation of heart disease in rheumatoid arthritis using echocardiography]. / Hodnocení srdecního postizení u revmatoidní artritidy pomocí echokardiografie.

The authors examined, using one- and two-dimensional echocardiography, 95 patients with rheumatoid arthritis and 11 patients with lupus erythematodes generalisatus. They revealed acute and chronic changes on the pericardium, impaired left ventricular function and valvular changes in percentages which are not negligible. Although the problem of the aetiopathogenesis of these pathological changes is frequently speculative, their detection is of considerable importance for further treatment and the life-style of these patients. Echocardiography is a suitable method for the comprehensive examination of patients with rheumatoid arthritis, in particular when the course is severe or when patients of advanced age groups are involved.

[Effectiveness of the delayed-action form of isosorbide 5-mononitrate in ischemic heart disease]. / Studie úcinnosti retardované formy isosorbit 5-mononitrátu u ischemické choroby srdecní.

Isosorbit 5-mononitrate is useful in ischaemic heart disease and in cardiac failure because of its favourable pharmacokinetic properties, in particular the absence of the so-called first pass effect, the great biological availability and long elimination time. The authors demonstrated on the preparation Elentan long, Schwarz Monheim GFR, which contains 50 mg isosorbit 5-mononitrate the improved efficiency of the left ventricle after three months administration to 15 patients with confirmed ischaemic heart disease, by exerting a favourable effect on the diastolic, systolic and global left ventricular function. Nitrates are drugs of first choice in some forms of ischaemic heart disease and are also effective in cardiac failure because they exert a marked effect on some cardiac functions on which the efficiency of the left ventricle depends. Elentan long proved, while using simple dosage, a preparation with favourable characteristics as regards biological availability and nitrate tolerance.

[Cardiotoxicity of anthracycline cytostatic agents--a proposal for routine monitoring and supportive therapy]. / Sledování kardiotoxicity antracyklinových cytostatik--návrh rutinního monitorování a podpurné lécby.

The authors investigated a group of 57 patients with acute leukaemia and 30 patients with malignant lymphomas, who were treated by combinations of cytostatics containing the anthracycline antibiotics daunorubicin and adriamycin. Using examination methods which are widely available they tried to find indicators which detect early manifestations of cardiac damage during this treatment. The most valuable indicators of incipient anthracycline cardiomyopathy were the heart rate at rest and the QTc interval on the ECG tracing. The validity of polygraphy and echocardiography could not be assessed in the present work. The authors suggest a procedure of routine monitoring of patients treated with anthracycline cytostatics and methods of supportive therapy to ensure safe treatment.

[Left ventricular ejection fraction estimated by 2-dimensional echocardiography]. / Ejekcní frakce levé komory urcovaná odhadem pri dvourozmerné echokardiografii.

Visual assessment of the reduction of left ventricular volumes during the cardiac cycle, which is the basis for calculation of the left ventricular ejection fraction followed up from several planes in real time is close to the objectively assessed changes estimated by various time consuming methods from two-dimensional echocardiography by the one- or two-plane method. The author's method makes it possible to assess the left ventricular ejection fraction and to divide it for clinical needs into four groups: normal above 60%, slightly reduced 45-60%, reduced 30-45% and markedly reduced 30% or less. The described echocardiographic examination method is invaluable when practiced by an experienced worker with restricted time for examination.

[The effect of extreme endurance loading on the chronometry of cardiac systole]. / Vliv velkého vytrvalostního zatízení na chronometrii srdecní systoly.

1. Extreme long-term endurance loads of great intensity lead during the recovery period to significant changes of the preejection period and Weissler's index. The cause of this change is most probably the reversibly impaired contractility of the heart muscle after fatigue of the left ventricle as a result of a certain degree of overburdening. 2. Systolic time intervals are suitable means for the dynamic follow-up of the performance of the left ventricle in subjects after sports performances.

[Myxoma of the left ventricle. Indications for cardiosurgery without invasive examination]. / Myxom levé síne. Indikace ke kardiochirurgickému zákroku bez invazívního vysetrení.

Two-dimensional echocardiographic examination in patients with myxoma of the left atrium is the basis of reliable diagnosis and is satisfactory as regards visualization and functional aspect for the final indication for a radical surgical operation. Myxoma of the left atrium is thus one of the heart diseases where we do not need preoperative invasive diagnostic examinations for indication of cardiosurgery.

[Personal experience with implementation of the nationwide program in cardiology in the West Bohemia Region]. / Nase zkusenosti s plnením celospolecenského programu v oblasti kardiologie v Západoceském kraji.

The authors submit experience regarding the implementation of the cardiovascular programme in the West Bohemian region. The implementation of the programme is pretentious as regards staff as well as investments and treatment. In these spheres reasons must be sought why the cardiovascular programme is not always implemented, as required by the authorities and our medical responsibility.

[Biventricular thrombosis in dilated cardiomyopathy. Echocardiographic and pathophysiologic study of intra-cardiac thrombosis]. / Biventrikulární trombóza u dilatované kardiomyopatie. Echokardiografická a patofyziologická studie nitrosrdecní trombózy.

The paper reports on the observations of biventricular intracardiac thrombosis in dilated cardiomyopathy. The diagnosis was made with the aid of two-dimensional echocardiography used as the method of choice in suspected intracardiac thrombosis. In the authors' opinion, the principal hemostatic disorder in intracardiac thrombosis in dilated cardiomyopathy can be caused by insufficient fibrinolysis whose degree of reduction was confirmed with stimulations tests, some of which were developed at the authors' department. Adequate treatment of intracardiac thrombosis in dilated cardiomyopathy is open to discussion. At present, apart from the standard therapy, the authors mainly suggest anti-coagulation treatment as this can prevent embolization affecting the greater or lesser blood circulation.