Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease.

BACKGROUND: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease. METHODS: A group of 27 patients with SSc were subjected to standard electrocardiography (ECG) examination and 24-hour Holter monitoring. Analysis of HRV in time and frequency domains, HRT, and echocardiography were also performed. RESULTS: Holter monitoring revealed a larger number of premature supraventricular contractions (PSVCs), as well as premature ventricular contractions (PVCs) in the patients with systemic scleroderma, as compared with the control group. Moreover, the SSc patients showed decreased parameters of time and frequency domains, as referred to the controls, especially during night hours. In four patients, abnormal HRT values were present. On echocardiography, only slight changes were found, however in five patients left ventricle diastolic dysfunction was diagnosed. CONCLUSIONS: The noninvasive electrocardiographic methods seems to be useful for detecting early heart involvement in course of SSc and could be recommended for routine used in clinical practice. Significance of HRT analysis in patients with SSc needs further elucidation.

[Erectile dysfunction vs. physical capacity and physical activity at invasive treated patients with ischemic heart disease]. / Zaburzenia erekcji a wydolnossc fizyczna i aktywnosc ruchowa leczonych inwazyjnie chorych na chorobe niedokrwienna serca.

UNLABELLED: The numerous researches proved a thesis of the connection between the erectile dysfunction (ED) and atherosclerosis risk factors. The special part among the risk factors plays the low physical activity, which, due to rapid development of civilization, makes a serious problem concerning mainly the well-developed countries. THE AIM OF THE STUDY: Bearing in mind the fact of the physical activity influence on physical capacity and ED intensity, was an analysis of ED intensity in the population of patients with ischemic heart disease (IHD) and the evaluation of the relations connecting quality of erection with physical activity and physical capacity. MATERIAL AND METHODS: The analysis concerned 207 men with IHD at the age of 61-71 years (the mean: 66.77 +/- 2.63 years), treated invasively (163--PTCA, 44--CABG). All the men were professionally inactive for 3.23 +/- 2.12 years. All of them were in the relationships with the same partner for many years. The inclusion criteria were: a correctly filled questionnaire IIEF-5 (all categories), a Framingham questionnaire and ECG treadmill test assessed as a negative one. RESULTS: The erectile dysfunction was recognized when in the questionnaire IIEF-5 the total number of points was < or =21. A parameter of an exercise test subjected to evaluation was the value of metabolic equivalent (MET) and analyzed parameter from the Framingham questionnaire was activity intensity in free from work time (MET/h). In the analyzed group of 207 patients with IHD, the erectile dysfunction showed 71.5% of the population. The average value obtained for the examined IHD patients from the IIEF-5 questionnaire was 14.05 +/- 7.40. Taking into account the number of obtained in the questionnaire points, the patients with ED were divided into four categories: severe--29.5% of the whole group, medium-severe--8.2% of population, medium--20.8% of population and moderate--13% of the IHD population. The effort test and the analysis of Framingham questionnaire revealed information about physical capacity and physical activity of particular patients with IHD. The analysis of dependence between physical capacity and quality of erection conducted for the group of patients with IHD showed the lack of statistically significant correlation between these parameters (Pearson's correlation coefficient r = 0.013). The analysis of dependence between physical activity and quality of erection showed statistically significant correlation between these parameters (Pearson's correlation coefficient r = 0.781). Considering the dependence of results on the credibility of data from the IIEF-5 chart, the last element was the analysis of 'truthfulness test', which did not show any statistically significant difference between the results from the first and the next questionnaire. CONCLUSIONS: High everyday physical activity is significantly connected with the decreasing erectile dysfunction intensity and its evaluation may be a simple method allowing preliminary qualification of the patient to the group being at higher risk. The physical capacity presented by the patients with IHD is not significantly associated with quality of erection.

Relation of Postexercise Reduction of Arterial Blood Pressure and Erectile Dysfunction in Patients with Coronary Heart Disease.

Penile erection is a hemodynamic process consisting of 2 synchronized components in which the first (active) requires proper vascular endothelium functioning, whereas the second one (passive) is based on a veno-occlusive mechanism. Antihypertensive treatment reduces the passive component, often leading to the development of erectile dysfunction (ED), but lifestyle modifications can improve the sexual functioning. The study aimed to evaluate the association between blood pressure (BP) reduction caused by cardiovascular training and the intensity of ED in men with coronary heart disease. A total of 101 men (mean age 59.50 ± 7.93) with ED treated invasively for coronary heart disease and subjected to cardiac rehabilitation were enrolled. Patient characteristics, the International Index of Erectile Function 5 (IIEF-5) questionnaire (IIEF-5), and BP values were collected at baseline and after 6 months of cardiac rehabilitation and were analyzed. Cardiac rehabilitation led to a significant reduction of 5.08 mm Hg in systolic BP (p <0.001) and of 1.60 mm Hg in diastolic BP (p <0.001). The IIEF-5 score (EQ) significantly increased (median 15, interquartile range 11 to 19 vs median 18, interquartile range 12 to 21, p <0.001). Greater improvement in sexual performance was significantly negatively correlated with age, concentration of triglycerides, and high-density lipoprotein, whereas it was positively correlated with the presence of diabetes and baseline IIEF-5 score. After excluding patients with diabetes, a greater decrease in systolic BP was found to be significantly associated with greater improvement in erectile performance. In conclusion, a reduction of arterial BP caused by cardiac training is accompanied by improvement in erectile performance. This effect is the strongest in patients with hypertension and those with dyslipidemia.

Sexual health of male cardiac patients - present status and expectations of patients with coronary heart disease.

INTRODUCTION: Due to the pathogenetic association between erectile disorders and cardiovascular diseases, cardiologists consult many patients with erectile dysfunction (ED). The aim of the study was to evaluate sexual function in patients with coronary heart disease (CHD) and the use of sexual knowledge in cardiology practice, both current use and that expected by patients. MATERIAL AND METHODS: One thousand one hundred and thirty-six patients (average age: 60.73 ±9.20) underwent a dedicated survey which encompassed demographic data and the presence of modifiable ED risk factors. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) Questionnaire. RESULTS: Sexual problems were discussed by cardiologists with 45 (3.96%) patients. The frequency of initiating the topic was significantly associated with the respondents' education level (p = 0.0031); however, it was not associated with the patients' age, duration of CHD, presence of ED, or modifiable risk factors. Four hundred and sixteen (36.62%) respondents indicated that they expect their cardiologist to take an interest in their ED. Nine hundred and twenty-six (81.51%) patients claimed good sexual function to be important or very important to them. Attitude to sexual function was significantly associated with age (p < 0.0001), duration of CHD (p = 0.0018), education (p = 0.0011), presence of ED (p = 0.0041), diabetes (p = 0.0283) and hyperlipidaemia (p = 0.0014). CONCLUSIONS: The low frequency with which cardiologists initiate the topic of ED is in contrast to the expectations of patients with CHD. The majority of these patients regard good sexual maintenance as an important part of their life.

[Contact urticaria syndrome]. / Zespól pokrzywki kontaktowej.

Current point of view on patho-mechanism, diagnosis, clinical features and prevention of contact urticaria syndrome was presented, especially with emphasis on systemic symptoms existing in this disease. The importance of allergic and non-allergic reaction in pathogenesis of this syndrome was also discussed. Special attention was paid to possibility of life threatening symptoms appearing during the contact of allergens or other physical agents with the skin. In addition the principles of prophylaxis in such cases were described.

[Transient pancytopenia due to ticlopidine--a case report]. / Przejsciowa pancytopenia jako powiklanie leczenia tiklopidyna--opis przypadku.

Transient pancytopenia as an adverse hematologic reaction due to ticlopidine. We present a case of transient pancytopenia due to ticlopidine in 66-year-old woman who was administrated with ticlopidine as a primary prevention of heart failure. The first sign was a skin rush which was followed by ticlopidine cessation. Two days later she developed septic shock, pneumonia and neutropenia (600 cells/mm3) with decrease of platelats, erytrocytes count and hemoglobin. Blood transfusions were not required. After treatment with antibiotics according to antibiogram the patient recovered and was dismissed after 38 days with normal blood morphology. We conclude that ticlopidine was the most probable cause of transient pancytopenia. Severe adverse hematological effects due to ticlopidine occur in 0.8-2.3% cases. Thus treatment with ticlopidine should be cerfully considered.

[Blood and tissue eosinophilia in patient with angioedema caused by inhibitor of angiotensin converting enzyme (ACE)--case report and a view of literature]. / Eozynofilia obwodowa i tkankowa u pacjenta z obrzekiem naczynioruchowym wywolanym inhibitorem enzymu konwertujacego angiotensyne (ACE)--opis przypadku i przeglad pismiennictwa.

A case of angioedema caused by enalapril, undiagnosed for 5 years was presented. Enhanced blood and tissue eosinophilia shown in nasal smear was observed. In addition increased activity of coagulation system was shown manifested by enhance of concentration of Hageman factor and cardiolipin antibodies IgM and IgA isotype. The role of coagulation, complement and fibrinolysis systems in pathogenesis of ACE-inhibitors induced angioedema was discussed. The influence of bradykinin on activity of eosinophils was analyzed.