[Internal medicine and cardiology, internists and cardiologists].

A retrospective on the development of internal medicine as a base from which other specific fields of medicine, including cardiology as one of the largest, branched as consequence of technological progress and transformation from an empirical to a scientific discipline. Similar to the internal medicine tree, cardiology also branches into a number of subspecialities. This is because no one human brain has a capacity to remember and know everything.

[Physical training in patients with chornic heart failure: haemodynamics, effects].

Unlabelled: The objective of the investigation is to assess the safety and contribution of physical training in patients with chronic heart failure and to assess the effect of training on central haemodynamics, left ventricular function evaluated by echocardiography and humoral substances.

Patients And Methods: Patients with cardiac failure NYHA II and III incl. 17 on t he background of IHD and 21 on the background of dilatation cardiomyopathy.

[Pathways in the development of electrocardiography].

Electrocardiography celebrates hundred years of its existence. The historical article on the cornerstones of its development was written on request of the editorial board of Vnitrní lékarství (Internal Medicine) and the Czech Society of Internal Medicine. After summarizing the beginnings of the discovery of bioelectric current and attempts of its registration the author describes the construction of the string galvanometer by Willem Einthoven.

[Lipids and acute coronary syndromes].

Eccentric atherogenic plaques which cause only insignificant narrowing of the diameter of coronary arteries are the cause of 60-80% of all acute coronary syndromes. The plaque becomes unstable (vulnerable) due to cytokines released by macrophages in the lipid rich core. Weakening of the fibrous capsule of the core then leads to rupture of the plaque and subsequently to intracoronary thrombosis with a wide spectrum of ischaemia or even necrosis of the myocardium.

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

Objective: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg].

Methods: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg.

Humoral response in patients with chronic heart failure.

Aim: Correlation of five humoral markers with laboratory, echocardiographic and right heart catheterization parameters in patients with chronic heart failure.

Study Population: 29 patients, heart failure NYHA II and III, ejection fraction below 40% with coronary artery disease or dilated cardiomyopathy.

Methods: evaluation of thromboxane, prostaglandin F (PGF), tumor necrosis factor (TNF) alpha, endothelin-1 and big endothelin rest levels and their correlation with: (1) laboratory parameters: Sodium, urea, creatinine, fibrinogen, (2) chest X-ray: cardiothoracic index (CTI), pulmonary congestion, (3) right heart catheterization parameters at rest, hand-grip and bicycle ergometry: mean pulmonary artery pressure (AP), wedge pressure (WP), systemic and pulmonary vascular resistance (SVR, PVR) and cardiac index (CI), (4) echocardiographic parameters at rest, hand-grip and bicycle ergometry: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), mitral flow E/A, filling period of left ventricle and time of duration of mitral regurgitation.

Systolic and diastolic function in patients with chronic heart failure at rest and during exercise.

In our study we tried to evaluate systolic and diastolic function in patients with chronic heart failure (CHF) by using some echocardiographic parameters and invasively measured pulmonary capillary wedge pressure (PCWP). We studied 19 patients with CHF NYHA II-III at rest, at the end of isometric exercise (handgrip) and during a bicycle stress test. Right heart catheterization and echocardiography were simultaneously performed.

[Acute and chronic heart failure].

Cardiac failure is a syndrome which comprises ventricular dysfunction (confirmed by echocardiography) and compensating mechanisms (immediate activation of the sympathetic nerve and functioning of Starling's mechanism, within hours or days activation of RAAS within days or weeks hypertrophy of the heart). Cardiac failure develops rapidly either in a previously healthy subject (first extensive IM, diffuse myocarditis, acute aortic or mitral regurgitation) or in a damaged heart (IHD, KMP, defect) as a result of sudden excessive burdening (ischaemia, arrythmia, infection, surgery etc.) or spontaneously (end-stage).

[Antianginal therapy '95].

The submitted review deals with contemporary possibilities of antianginal treatment. After a brief account of pathophysiological and morphological data in different types of cardiac ischaemia and angina pectoris the author submits algorithms which should be the basis for therapeutic decisions. It is a question of proper timing of invasive examinations leading to revascularization operations in relation to medicamentous treatment.

[Betaxolol hydrochloride in the treatment of mild and medium hypertension--long-term effects].

All available beta-blockers are effective in the treatment of high blood pressure. Differences in the pharmacokinetics are important as they can have an impact on their clinical use. Betaxolol, a beta-1-selective blocker has a long biological half-life which can control the blood pressure and pulse rate for 24 hours.

[Development of internal medicine as a discipline at the Medical School of Masaryk University].

The lecture presented in extenso at the Conference held to commemorate the 75th anniversary of the Medical Faculty, Masaryk University in the assembly hall of the New Townhall in Brno on November 11, 1994 deals with the development of medical disciplines at the Medical Faculty, Masaryk University since the opening of the first general hospital in 1786, where after the foundation of Masaryk University in 1919 the clinics of the Medical Faculty were established. The author mentions the difficult beginnings when the discipline was gradually established, the destruction of equipment during the Second World War after the universities were closed down, the difficult postwar restoration, changes after 1948 and in particular during the "normalization period" in the seventies and subsequent changes after 1989. The author mentions the foundation of different disciplines which are part of internal medicine and the foundation of clinics, as well as the profiles of their leading personalities.

[Stress tests in chronic heart failure].

The authors compared two types of spiroergometric tests in 14 patients with chronic heart failure (NYHA II-III, ejection fraction < 40%). Test A: 0.25 W/kg 3 minutes, 1 minute break, increase by 0.

[Are central hemodynamics the decisive factor in the manifestation of chronic heart failure?].

In the past some authors revealed that data assembled during examinations of the central haemodynamics, echocardiography, subjective complaints, physical findings and load tolerance in patients with chronic heart failure are not mutually consistent. The authors examined therefore comprehensively 40 patients with different grades of cardiac failure. They revealed very loose relations between the grade of functional classification, echocardiographic and invasive haemodynamic parameters at rest on the one hand and spiroergometric indicators on the other hand.

[Tiracizine in the treatment of ventricular arrhythmia (preliminary study)].

Tiracizine a new antiarrhythmic drug class Ia was tested in a open crossover study in a group of 46 patients with more than 2500 ventricular extrasystoles per 24 hours or with ventricular arrhythmias III or a higher Lown class. The authors revealed a statistically significant drop of ventricular extrasystoles and a significant reduction of arrhythmias class IV of Lown's classification with a general shift of arrhythmias to lower classes. Improvement by at least one class occurred in 63%, deterioration without clinical impact in 11%.

[The present status of nitrates in the treatment of ischemic heart disease].

The authors describe the development of nitrates from substances of the first generation (nitroglycerin and isosorbit dinitrate) to the second generation (isosorbit-5-mononitrate). They explain the mechanism of their action, haemodynamic effects and the problem of nitrate tolerance. Indications of their rational use are given.

[The effect of creatine phosphate (Neoton) in acute myocardial infarct (a prospective multicenter pilot study].

The authors investigated in a group of 106 patients with a first myocardial infarction treated by thrombolysis the effect of i.v. administration of creatine phosphate (a new drug with cardioprotective action--Neoton Alfa Schiapparelli Wassermann Co).

Amlodipine in patients with stable angina pectoris treated with nitrates and beta-blockers. The influence on exercise tolerance, systolic and diastolic functions of the left ventricle.

The effects of 5 and 10 mg of amlodipine and of placebo were compared in 21 patients with stable angina pectoris and multivessel coronary artery disease. The blind comparison was performed by means of bicycle ergometry and stress echocardiography using esophageal stimulation of the left heart atrium. All patients subsequently received placebo, amlodipine 5 mg and 10 mg for 2 weeks.

Radiologic changes in chronic heart failure.

The relationship between chest X-ray findings and NYHA classification or haemodynamic parameters (ejection fraction, end-diastolic and end-systolic volumes by echocardiography, right atrial pressure--RAP, pulmonary artery pressure--PAP and pulmonary wedge pressure--PAWP by right heart catheterization) was evaluated in 44 and 22 patients with chronic congestive heart failure, respectively. In chest X-ray, the cardiothoracic index (CTI) and authors' own classification of pulmonary congestion (PCG) of classes 0, 1 and 2 were used. A significant correlation was found between CTI and NYHA classification or haemodynamic parameters, and between PCG (classes 0 and 2) and echocardiographic parameters or right heart pressures (EDV, ESV, RAP, PAP, PAWP), but there was no significant relationship between X-ray and left ventricular ejection fraction.

Cardiac arrhythmias in chronic heart failure.

It has been proven that treatment of chronic heart failure (CHF) with some modern drugs is able to reduce mortality in groups of patients with the severest grades of this disease. The risk of sudden death has been unchanged, however. Out of 49 patients on long-term follow-up, 28 patients are surviving (group A) and 21 died (group B).

[Angina pectoris revisited].

Based on data in the literature and his own experience, the author presents modern views on angina pectoris. He discusses anamnestic signs of typical and atypical angina and non-anginous chest pain. He mentions the pathogenesis and clinical picture of stable angina (secondary and mixed angina, syndrome X), unstable angina (mixed and primary angina) and silent ischaemia.

[Is accurate dosing possible using infusion sets?].

The authors discuss factors which influence the dispensing of infusion solutions by means of infusion sets regulated by a button. They draw attention to the fact that by means of infusion sets IS 103 and TS 203 accurate dispensing is not possible as the rate of flow changes markedly with the time of administration of the infusion. On the other hand, in the EXADROP dispenser marked slowing down of the infusion in relation of time does not occur and the authors recommend it therefore for common use in standard departments.

[Practical use of infusion pumps].

The authors present a brief characteristic of infusion pumps on the drop principle and factors which influence the size of the drop. They also pay attention to the knowledge of drop size for nutritional needs and accurate dosage of drugs.

[The development and use of nitrate therapy].

The authors describe the development of nitrates from substances of the first generation (nitroglycerin and isosorbide dinitrate) to the use of mononitrates. They explain the mechanism of their action, the haemodynamic effects and the phenomenon of nitrate tolerance. The authors present also their own experience with nitrate therapy in angina pectoris and heart failure based on haemodynamic monitoring and recommend its rational use.