Sedentary lifestyle and obesity increase the risk of coronary disease (CAD). The aims of this prospective study were to estimate the trends in physical activity (PA) level, accuracy of the ...Baecke's/LRC-PA questionnaires, and trends in obesity parameters (body mass index-BMI/waist-to-hip ratio-WHR) in patients with acute coronary syndrome (ACS) in the last two decades. We grouped 209 patients with ACS (UAP-unstable angina, STEMI-ST-elevation myocardial infarction, NSTEMI-non STEMI) by year of admission (Group 2002-05/Group 2017) and compared them by the levels of PA (Baecke's/LRC-PA questionnaires) and obesity parameters (BMI, WHR). Group 2017 had higher WHR (1.02 vs. 0.97) and leisure PA index (LI) (3.00 vs. 2.50), as well as less high and very low activity patients (P<0.05). Patients with UAP/STEMI had higher WHR in 2017 (1.02 vs. 0.96, 1.02 vs. 0.99, respectively) (P<0.05) and had lower LI in 2002-05 (2.50 vs. 3.25, 2.75 vs. 3.50, respectively) (P<0.05). In conclusion, leisure PA and WHR was increased in the study period both in patients with ACS and in the general population. We emphasize the usage of more precise methods for evaluation of PA and obesity (Baecke's/Four-point LRC-PA questionnaires, WHR), and that only increased PA with dietary changes leads to reduction of central obesity and risk of ACS. Key words: physical activity; acute coronary syndrome; anthropometric parameters, obesity; sedentary lifestyle Sedentni nacin zivota i debljina povecavaju rizik koronarne bolest (CAD). Ova prospektivna studija istrazuje trendove razine tjelesne aktivnosti (PA), preciznost Baeckeovog/LRC-PA upitnika i trendove parametara debljine (indeks tjelesne mase-BMI/omjer struk-bokovi-WHR) u kod pacijenata s akutnim koronarnim sindromom (AKS) u posljednja dva desetljeca. U istrazivanju je sudjelovalo 209 pacijenata s AKS (UAP-nestabilna angina, STEMI-infarkt miokarda s ST-elevacijom, NSTEMI-infarkt miokarda bez ST-elevacije), grupiranih prema godini hospitalizacije (Group 2002-05/Group 2017) i kompariranih prema razini PA (Baecke's/LRC-PA upitnici) i parametrima debljine (BMI, WHR). Groupa 2017 imala je vece WHR (1.02 vs. 0.97) i Beckeov indeks PA u slobodno vrijeme (LI) (3.00 vs. 2.50), manji broj visoko i vrlo nisko aktivnih (P<0.05). Pacijenti s UAP/STEMI imali su veci WHR u 2017 (1.02 vs. 0.96, 1.02 vs. 0.99) (P<0.05), a u 2002-05 nizi LI (2.50 vs. 3.25, 2.75 vs. 3.50) (P<0.05). Zakljucno, kao u opcoj populaciji i u pacijenata s AKS porasla je aktivnost u slobodno vrijeme i WHR u periodu od 2002-05 do 2017. Naglasavamo vaznost koristenja preciznijih metoda u procjeni PA i debljine (Baecke's/Four-point LRC-PA upitnici, WHR), te vaznost da povisenje razine PA samo uz promjene prehrane vode smanjenju centralne debljine i rizika od AKS. Kljucne rijeci: tjelesna aktivnost; akutni koronarni sindrom; anthropometrijski parametri; debljina; sedentni nacin zivota.
Objective The aim of this study was to investigate the metabolic syndrome (MS) infl uence on clinical severity and prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated ...with primary percutaneous coronary intervention (PCI).
Methods We prospectively analysed 250 patients with acute STEMI treated with primary PCI, between September 2011-2012. MS was diagnosed by the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients were divided into two groups (with/without MS) and compared by their baseline data (medical history, demographic and anthropometric data) and parameters of severity (clinical, laboratory, echocardiography, coronary angiography and in-hospital complications data) and prognosis (major adverse cardiovascular events and sick leave duration (SLD) during 12 months of follow-up).
Results Our study included 136 (54.4%) and 114 (45.6%) patients with and without MS, respectively. MS patients had longer hospitalization (9.0 vs 8.0 days), higher rates of total in-hospital complications (25.0% vs14.9%), higher number of signifi cantly stenosed coronary arteries (CAs) (2 vs1), higher stent diameters (3.5 vs3.0 mm) ,higher rate of signifi cantly stenosed proximal and middle CAs segments (94.1% vs86.7%), and longer SLD (16 vs10 weeks) (P <0.05). MS was independently associated with higher risk of total in-hospital complications (odds ratio (OR) 1.90, confi dence interval (CI) 1.06-3.64, P= 0.047) and with higher risk of ? 2 signifi cant stenosed CAs (OR 1.72, CI 1.04-2.84, P= 0.034).
Conclusion MS in acute STEMI is an important predictor of total in-hospital complications and severity of CAs disease, but not for other parameters of severity and prognosis. MS patients have longer SLD.
Psychological reactions may adversely affect recovery after major cardiac events. This study investigates the role and frequently negligible importance of ambulatory cardiac rehabilitation (ACR) in ...improvement of quality of life (QoL), anxiety and depression at patients with various cardiac pathology.
This prospective study included subjects treated for acute coronary syndrome (ACS), those with performed elective revascularization, and OTHERS (after valve replacement, implanted pacemaker or other device, with stable heart failure and coronary artery disease). Their anxiety (State Trait Anxiety Inventory (STAI) questionnaire), depression (Beck Depression Inventory (BDI-II) questionnaire) and QoL data (Short Form Health Survey-36 (SF-36) questionnaire, for physical and mental QoL components) were collected initially and after 3-month of ACR.
ACR underwent 170 patients, aged 59 (53-66 years), predominately males (74.7%). At both genders, median duration of ACR was 12 weeks, with reduction of anxiety and depression scores and improvement in almost all components of QoL (P<0.05), except in mental health and bodily pain in males and females, respectively. After ACS (63.5%), ACR lasted 12 weeks, with reduction of anxiety and depression scores and improvement in all components of QoL (P<0.05). After elective revascularization (14.1%), ACR lasted 12 weeks, with reduction of anxiety score and improvement in almost all components of QoL (P<0.05), except mental health. At OTHERS (22.4%), ACR lasted 4 weeks, with improvement in almost all components of QoL (P<0.05), except mental health; ACR duration negatively correlated with anxiety and depressive scores (P<0.05).
ACR during 3-month results with improvement of anxiety, depression and QoL at patients with various cardiac pathology.
Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. It is most frequently caused by degenerative aortic valve fibrosis and calcification, and in a ...lesser number of cases by the calcification of congenital deformed aortic valve (bicuspid); it may occasionally develop after rheumatic fever.
Valve fibrosis and calcification lead to progressive valve restriction, obstruction and increased afterload with left ventricle remodelling for normalization of wall tension and cardiac output. During time, such hypertrophic and fibrotic myocardium deteriorates, resulting in heart failure. Generally, current guidelines of the European Society of Cardiology (ESC) recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic. Most asymptomatic patients with severe AS should be managed conservatively, except for those with systolic LV dysfunction, an abnormal exercise test, very severe aortic stenosis, severe valve calcification, markedly elevated cardiac biomarkers, and severe pulmonary hypertension without other explanation.
This article will review our current understanding of the pathophysiology of AS and provide detailed information about clinical presentation, diagnostic procedures, disease course, and different treatment strategies for various groups of these patients.
Kardiomiopatija (hipertrofijska, dilatacijska, hipertrabekulirana lijeva klijetka, aritmogena kardio- miopatija) je primarno genetska bolest povezana s povećanim rizikom potencijalno fatalnih ...kardijal- nih aritmija i iznenadnom smrću/kardijalnim arestom tijekom vježbanja.
Dijagnoza kardiomiopatije bazirana je na kompletnoj kardiološkoj obradi s detaljnom osobnom
i obiteljskom anamnezom, učinjenim elektrokardiogramom, ultrazvukom srca, magnetskom re- zonancijom srca, stres testiranjem, genetskim testiranjem i savjetovanjem. Razlikovanje fiziološke prilagodbe srca na vježbanje od kardiomiopatije je od neobične važnosti.
U ovom pregledu donosimo najnovije preporuke Sekcije za sportsku kardiologiju pri Europskom drušvu za preventivnu kardiologiju (engl. EAPC) o sportskoj i rekreativnoj fizičkoj aktivnosti u bolesnika s kardiomiopatijom. Ona sadrži preporuke za kardiologe i sportske liječnike koji se bave sportašima s kardiomiopatijama i donosi savjete o sigurnom participiranju u kompetitivnom sportu na profesionalnoj i amaterskoj razini, kao i kod rekreativne fizičke aktivnosti.
We investigated correlation between the normal level of air pollution, weather conditions and stroke occurrence in the region of Southeast Europe with a humid continental climate. This retrospective ...study included 1963 patients, 1712 (87.2%) with ischemic (IS) and 251 (12.8%) with hemorrhagic stroke (HS) admitted to emergency department. The number of patients, values of weather condition (meteorological parameters) air temperature (°C), atmospheric pressure (kPa), relative humidity (%) and concentrations of air pollutants particulate matter (PM
10
), nitrogen dioxide (NO
2
), ozone (O
3
), were recorded and evaluated for each season (spring, summer, autumn, winter) during 2 years (July 2008–June 2010). The highest rate of IS was observed during spring (28.9%) (
p
= 0.0002) and HS in winter (33.9%) (
p
= 0.0006). We have found negative Spearman’s correlations (after Bonferroni adjustment for the multiple correlations) of the number of males with values of relative humidity (%) (day 0, rho = − 0.15), the total number of strokes (day 2, rho = − 0.12), females (day 2, rho = − 0.12) and IS (day 2, rho = − 0.13) with concentrations of PM
10
(µg/m
3
), as well as negative correlations of the number of females (day 2, rho = − 0.12) and IS (day 2, rho = − 0.12) with concentrations of NO
2
(µg/m
3
) (for all
p
< 0.002). In winter, the number of HS (day 0, rho = 0.25,
p
= 0.001) positively correlated with concentrations of O
3
(µg/m
3
). The appearance of stroke has seasonal variations, with the highest rates during spring and winter. Positive correlation between the number of HS and values of O
3
requires an additional reduction of the legally permitted pollutants concentrations.
U ovom preglednom članku donosimo pregled posljednjih smjernica koje je objavilo Američko kardiološko društvo o seksualnoj aktivnosti u bolesnika s koronarnom bolešću, srčanom insuficijencijom, ...strukturnim bolestima srca, aritmijama, ugrađenim elektrostimulatorom ili kardioverter defibrilatorom, kao i o mogućnostima liječenja seksualne disfunkcije. Seksualna aktivnost je ekvivalent blage/umjerene tjelesne aktivnosti tijekom kratkog vremena. Za većinu bolesnika je preporučljivo da se uključe u seksualne aktivnosti nakon sveobuhvatne procjene fizičkog stanja. Oni sa stabilnim kardijalnim simptomima i dobrom funkcionalnom sposobnošću imaju nizak rizik od neželjenih kardiovaskularnih događaja. Ostali zahtijevaju liječenje ili stabilizaciju prije uključivanja u seksualne aktivnosti. Ergometrijsko testiranje je korisno u procjeni sigurnosti spolne aktivnosti u bolesnika s upitnim ili neodređenim rizikom. Liječenje seksualne disfunkcije uključuje seksualno savjetovanje bolesnika i partnera te farmakološku terapiju kod muškaraca inhibitorima fosfodiesteraze (sildenafil, tadalafil, vardenafil), koji su se pokazali sigurnima i učinkovitima, a u žena inhibitorima ponovne pohrane serotonina (flibanserin) i lokalnom vaginalnom aplikacijom estrogena. Zaključno, bolesnicima u svakodnevnoj kliničkoj praksi treba pristupiti indi-vidualno i multidisciplinarno u cilju otkrivanja i otklanjanja čimbenika koji ometaju normalnu spolnu aktivnost i dovode do narušavanja kvalitete života
Mycarditis and pericarditis may be related with sudden cardiac death/cardiac arrest (SCD/CA) in athletes, not exclusively in those with reduced left ventricular systolic function, but also in ...subjects with normal cardiac function related to arrhythmias generated in the area of myocardial necrosis and scar. The diagnosis is based on a complete cardiac evaluation (12-lead ECG, echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy).
In this review, we outline the latest recommendations published by the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC) on sport activity with these patients. It offers recommendations for practicing cardiologists and sport physicians for safe participation in competitive sport at professional and amateur level. Participation in competitive sport should be considered on an individual basis, after the evaluation of the disease characteristics and risk determinants, and complete resolution of the inflammatory process.
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