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EN
Background: Coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease is associated with poor prognosis. We assessed the effect of renal function on exercise capacity and clinical parameters of patients with HF. Material and methods: Forty five patients aged 58.2 ± 10.6 years with stable severe HFrEF were recruited. Patients were divided into 3 groups: group 1 - eGFR: 30-59 ml/min/1.73 m2; group 2 - eGFR: 60-89 ml/min/1.73 m2 and group 3 - eGFR: ≥90 ml/min/1.73 m2. Biochemical analysis, echocardiography, 6-minute walking test and cardiopulmonary stress testing were performed. Results: Patients in group 1 were significantly older than patients in group 3 (60.4 ± 11.1 years vs. 49.25 ± 11.2 years, respectively, p<0.05). Patients in group 2 had significantly higher BMI in comparison to group 3 (29.8 ± 4.4 vs. 25.1 ± 4.2; p<0.05). Interestingly, patients in group 1 had significantly lower peak oxygen uptake (10.2 ± 3.1 ml/kg/min vs. 16.1 ± 3.5 ml/kg/min, p<0.05) and oxygen uptake at anaerobic treshold (7.9 ± 2.4 ml/kg/min vs. 10.7 ± 1.9 ml/kg/min, p<0.05). Conclusions: Diminished renal function in patients with stable, advanced HFrEF may be associated with significantly worse peak VO2 and VO2 in AT.
EN
INTRODUCTION: Systematic analysis of risk factors, causes of sudden death and patient survivability allows implementation of increasingly effective methods and procedures for emergency cardiac arrest (SCA). The conditions of the emergency room (ER) allow for initial medical imaging and laboratory diagnostics, which facilitate the assessment of critical parameters that may be a predictor of SCA. The aim of the study is to determine the survival level of patients with SCA that were staying in ER and to indicate the factors that increase the likelihood of SCA. MATERIAL AND METHODS: The study was conducted in 2018 based on medical records of SOR in 73 patients with sudden cardiac arrest in SOR. Descriptive statistics and data analysis were performed using parametric tests (Pearson test). The level of significance was determined for p <0,05. RESULTS: The average age of SOR patients was 72 years (SD ± 16.29). In most cases, the patients were brought to the ER by the EMS. Sinus rhythm dominated in ECG tests,before the onset of SCA,. The ECG mechanisms in which SCA occurred were: asystole (50.7%), PEA (32.9%) and VF / pVT (16.4%), respectively. Among half of the patients (50.7%) of ER spontaneous circulation was restored, while 49.3% of ER patients were fatal. The relationship between mortality and O2 partial pressure, methanol, MPV, D-dimer, pH and HCO3 has been demonstrated. CONCLUSIONS: In the examined group of patients with SCA,non-defibrillatory rhythms (asystole, PEA) dominate. Half of the patients manage to achieve ROSC under ER conditions. There are predictors of SCA in patients in ER.
PL
WSTĘP: Systematyczna analiza czynników ryzyka, przyczyn nagłej śmierci oraz przeżywalności pacjentów pozwala na wdrażanie coraz skuteczniejszych metod i procedur postępowania w nagłym zatrzymaniu krążenia (NZK). Warunki Szpitalnego Oddziału Ratunkowego pozwalają na wstępną diagnostykę obrazową i laboratoryjną, co pozwala na ocenę parametrów krytycznych, mogących stanowić czynnik predykcyjny nagłego zatrzymania krążenia. Celem pracy jest określenie poziomu przeżywalności pacjentów z NZK przebywających w SOR oraz wskazanie czynników wpływających na wzrost prawdopodobieństwa wystąpienia nagłego zgonu sercowego. MATERIAŁ I METODY: Badanie zostało przeprowadzone w 2018 r. na podstawie dokumentacji medycznej SOR-u 73 pacjentów z nagłym zatrzymaniem krążenia na SOR. Dokonano statystyki opisowej oraz analizy danych za pomocą testów parametrycznych (test Pearsona). Poziom istotności ustalono dla p<0,05. WYNIKI: Średnia wieku pacjentów SOR-u wynosiła 72 lata (SD ± 16,29). W większości przypadków chorzy zostali przywiezieni na SOR przez zespół ratownictwa medycznego (ZRM). Przed wystąpieniem NZK w badaniach EKG dominował rytm zatokowy. Mechanizmy EKG, w jakim doszło do NZK to kolejno: asystolia (50,7%), PEA (32,9%) oraz VF/pVT (16,4%). U ponad połowy pacjentów (50,7%) SOR nastąpił powrót spontanicznego krążenia, natomiast u 49,3% pacjentów SOR odnotowano zgon. Wykazano zależność śmiertelności od ciśnienia parcjalnego O2, poziomu metanolu, MPV, D-dimerów, pH oraz HCO3. WNIOSKI: W przebadanej grupie pacjentów z NZK na SOR, zdecydowanie dominują rytmy niedefibrylacyjne (asystolia, PEA). U połowy pacjentów udaje się uzyskać ROSC w warunkach SOR. Istnieją czynniki predykcyjne występowania nagłej śmierci sercowej u pacjentów przebywających w SOR.
EN
Introduction: Heart failure (HF) is a growing global pandemic that affects millions of people around the world. Despite the progress in medicine, diagnosis and treatment of HF remains problematic. Recently, noncoding micro ribonucleic acids called miRNAs have become significant in the diagnosis and stratification of HF risk. Aim: The aim of this study was the attempt to identify the profile of circulating miRNAs specific for ischemic HF with moderately reduced left ventricular ejection fraction (HFmrEF). Methods and Results: A number of changes in the miRNA profile can characterise patients with ischemic HFmrEF. This is a pilot study before further research on a larger group of patients. Conclusions: Using the quantitative reverse transcription-polymerase chain reaction (qRT-PCR), serum levels of 84 miRNA were measured and compared between a patient with ischemic HFmrEF and a healthy volunteer. Analysis reveals a down-regulation of let-7f-5p and miR-1-3p, as well as up-regulation of miR-100-5p, miR-10b-5p, miR-125a-5p, miR-140-5p, miR-144-3p, miR-149-5p, miR-15b-5p, miR-183-5p, miR-208b-3p, miR-224-5p, miR-26b-5p, miR-27b-3p, miR-302a-3p, miR-320a, miR-7-5p, miR-99a-5p.
4
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Central sleep apnea – a case report

100%
EN
Central sleep apnea (CSA) is a disease characterized by repetitive episodes of the socalled central apneas during sleep. The disease has a very complex etiology. In clinical practice, the most important causes of CSA are disorders of the central nervous system, congestive heart failure or certain pathological changes of the respiratory muscles. We present a case of a 43-year-old male with severe CSA, who was successfully treated with BiPAP ST equipment.
EN
Background: Heart failure (HF) is a leading cause of poor outcome. Age is considered one of the most critical risk factors for both the incidence and prognosis of HF. Therefore we aimed to assess the predictors of poor prognosis in HF patients with particular attention to the elderly population. Material and methods: We retrospectively enrolled patients hospitalized due to HF exacerbation during 2016-2017 (203 patients). The end-points were all-cause mortality and emergency rehospitalizations within a two-year follow-up period. A detailed analysis was performed in the subgroups of patients younger and older than 65 years old. Results: 121 (60%) patients experienced the end-points. Age, low systolic blood pressure, NYHA class IV, right ventricle HF symptoms, high C-reactive protein, troponin, NT-proBNP, hyponatremia, catecholamine therapy and mechanical ventilation during hospitalization independently predicted the end-points. The elderly were characterized by a higher incidence of concomitant diseases and HF with moderately reduced or preserved LVEF, worse laboratory parameters and pharmacological treatment, as well as worse prognosis. Conclusion: The prognosis of patients hospitalized due to HF, mainly the elderly, is poor. Simple clinical parameters could be useful in further decision-making regarding the intensification of their treatment.
EN
Diagnosis and treatment issues among heart failure (HF) patients are becoming one of the most important points in public health of developed countries, largely due to the aging of population and the fact that HF affects mainly the elderly. In this review we would like to focus on pathophysiology of exercise intolerance in patients with heart failure and potential benefits of cardiac rehabilitation (CR). Analysis of articles in the EBSCO database using keywords: heart failure, cardiac rehabilitation, exercise training, pathophysiology. HF can be described as a composite syndrome which results from structural or functional impairment of ventricular filling or blood ejection. Patients have variety of symptoms which usually are nonspecific. The most frequently occurring symptoms of HF are dyspnea and fatigue, which may restrict exercise capacity, and fluid retention. There are many possible pathophysiological factors involved in the development of exercise intolerance. Based on the available literature pathological changes in central hemodynamic function, pulmonary system, skeletal muscles, endothelial function and neurohumoral system can be distinguished. They play a crucial role in the pathogenesis of HF symptoms and represent a potential curative object. HF patients are characterized by diminished functional performance. Exercise training has many potential profits in patients with heart failure, including an increase in peak oxygen uptake, improvement in central hemodynamics, peripheral vascular and skeletal muscle function and has become part of evidence-based clinical therapy in these patients.
EN
Most heart defects form between 4 and 6 weeks after fertilization. The detection rate is still growing. Despite significant progress in prenatal diagnosis some cases still go undetected. We present two cases of similar defects: prenatally detected and undetected, both presenting with a normal four chamber view in mid-pregnancy. We compared the follow-up of both neonates along with sustained health and economic consequences. The dynamics of the development of heart defects during prenatal life suggests the legitimacy to perform additional, late echocardiography exams (35-38 weeks of gestation)
EN
Introduction. In Poland, it is estimated that HF is observed in approximately 0,7 million of patients. The aim of the study was to assess health behaviour in geriatric patients diagnosed with HF regarding pharmacotherapy and non-pharmacological treatment. Material and methods. The study group comprised 72 patients with diagnosed HF, over 65y. The study was performed using a questionnaire survey including 20 closed-ended questions. Results. The mean number of medicinal products prescribed by physicians for the treatment of HF and other diseases was 6.59±1.8. 50% of subjects were additionally taking medications and supplements for self-treatment, 63% declared they managed to take medications prescribed on their own. A diet is followed only by 50%, but only 18% limit their sodium intake. 46% still consume alcohol, and 10% of still smoke cigarettes. 46% declared the use of body weight monitoring, but none of them measured their body weight every day. Conclusion. Health behaviour of geriatric patients with HF in Poland indicates their low compliance with medical guidelines and it may explain a high hospitalisation rate and increasing costs of treatment.
EN
The case reports about a 75-years-old man without a previous medical history, in whom a heart failure NYHA III de novo was diagnosed together with persistent atrial fibrillation and hepatocellular carcinoma in clinical stage IV. Based on echocardiography and computed tomography there were pulmonary hypertension in course of lymphangiosis carcinomatosa as well as diffuse metastases in the abdomen diagnosed. Before the treatment initiation the patient was classified 3 in WHO performance status. After an improvement in control of the rhythm frequency and the heart failure treatment stabilisation with a β-blocker, an ACE-inhibitor, spironolactone and furosemide, the patient’s performance status improved to WHO 2. He was further disqualified from surgical procedures due to the advanced clinical stage of the oncological disease. Considering high probability of further cardiotoxic influence of sorafenib on the heart failure despite its satisfactory control, the patient was assigned to palliative chemotherapy with FOLFOX. Parallel he was strictly followed up cardiologically in an outpatient clinic what certainly supported the oncological treatment. The patient survived 32 weeks from the first hospitalization and the progression free survival was 12 weeks from the chemotherapy initiation.
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2019
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vol. 1
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issue 2
17-22
EN
Background Coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease is associated with poor prognosis. We assessed the effect of renal function on exercise capacity and clinical parameters of patients with HF. Material and methods orty five patients aged 58.2 ± 10.6 years with stable severe HFrEF were recruited. Patients were divided into 3 groups: group 1 - eGFR: 30-59 ml/min/1.73 m2; group 2 - eGFR: 60-89 ml/min/1.73 m2 and group 3 - eGFR: ≥90 ml/min/1.73 m2. Biochemical analysis, echocardiography, 6-minute walking test and cardiopulmonary stress testing were performed. Results Patients in group 1 were significantly older than patients in group 3 (60.4 ± 11.1 years vs. 49.25 ± 11.2 years, respectively, p<0.05). Patients in group 2 had significantly higher BMI in comparison to group 3 (29.8 ± 4.4 vs. 25.1 ± 4.2; p<0.05). Interestingly, patients in group 1 had significantly lower peak oxygen uptake (10.2 ± 3.1 ml/kg/min vs. 16.1 ± 3.5 ml/kg/min, p<0.05) and oxygen uptake at anaerobic treshold (7.9 ± 2.4 ml/kg/min vs. 10.7 ± 1.9 ml/kg/min, p<0.05). Conclusions Diminished renal function in patients with stable, advanced HFrEF may be associated with significantly worse peak VO2 and VO2 in AT.
EN
Introduction Heart failure (HF) is a growing global pandemic that affects millions of people around the world. Despite the progress in medicine, diagnosis and treatment of HF remains problematic. Recently, noncoding micro ribonucleic acids called miRNAs have become significant in the diagnosis and stratification of HF risk. Aim The aim of this study was the attempt to identify the profile of circulating miRNAs specific for ischemic HF with moderately reduced left ventricular ejection fraction (HFmrEF). Methods and Results A number of changes in the miRNA profile can characterise patients with ischemic HFmrEF. This is a pilot study before further research on a larger group of patients. Conclusions Using the quantitative reverse transcription-polymerase chain reaction (qRT-PCR), serum levels of 84 miRNA were measured and compared between a patient with ischemic HFmrEF and a healthy volunteer. Analysis reveals a down-regulation of let-7f-5p and miR-1-3p, as well as up-regulation of miR-100-5p, miR-10b-5p, miR-125a-5p, miR-140-5p, miR-144-3p, miR-149-5p, miR-15b-5p, miR-183-5p, miR-208b-3p, miR-224-5p, miR-26b-5p, miR-27b-3p, miR-302a-3p, miR-320a, miR-7-5p, miR-99a-5p.
EN
Aim: Arterial hypertension leads to progressive cardiovascular dysfunction and heart failure. The aim of the study was to assess exercise capacity in hypertensives with the use of a cardiopulmonary exercise test, impedance cardiography and 6-minute walk test with special emphasis on haemodynamic response to exercise workload. Methods: 114 patients (53.5% women, 55.7 ± 9.1 years) were evaluated for reported symptoms, N-terminal pro-B-type natriuretic peptide (NTproBNP) levels, echocardiographic parameters and exercise capacity with 6-minute walk test, cardiopulmonary exercise test and haemodynamic parameters (by means of impedance cardiography). Results: 50% of patients had reported symptoms of impaired exercise tolerance, mostly dyspnoea on exertion (37.7%). NTproBNP levels exceeded 125 pg/mL in 19.3% of patients. Left ventricular diastolic dysfunction was found in 8.8% and heart failure was diagnosed in 6.2% of patients. A wide range of peak oxygen uptake (peak VO2) and 6-minute walk test distance was observed: 19.4 ± 5.2 mL/min/kg and 526.7 ± 112.0 m, respectively. A major proportion of patients demonstrated decreased exercise capacity parameters: 56.1% achieving peak VO2 < 22 mL/min/m2; 45.9% achieving peak VO2 < 80% of the predictive value; 37.3% achieving 6-minute walk test distance shorter than the predicted values. The impedance cardiography recorded at peak exercise: heart rate 147.2 ± 22.4 bpm, stroke volume 110.2 ± 21.8 mL, cardiac output 15.9 ± 4.2 L/min, peak systemic vascular resistance 587.4 ± 168.0 dyn.s/cm5. Conclusions: Although a very small proportion of patients with uncomplicated arterial hypertension meet the criteria for being diagnosed with heart failure, the symptoms of impaired exercise tolerance as well as abnormal results of objective exercise capacity assessments are quite common in these patients.
PL
Cel: Nadciśnienie tętnicze prowadzi do postępującej dysfunkcji układu krążenia i niewydolności serca. Celem pracy była ocena wydolności fizycznej chorych z nadciśnieniem tętniczym z wykorzystaniem sercowo-płucnego testu wysiłkowego, wysiłkowej kardiografii impedancyjnej oraz 6-minutowego testu marszowego, ze szczególnym uwzględnieniem odpowiedzi hemodynamicznej na obciążenie wysiłkiem. Metody: 114 chorych (53,5% kobiet, wiek 55,7 ± 9,1 roku) oceniono pod względem zgłaszanych objawów, stężenia N-końcowego propeptydu natriuretycznego typu B (N-terminal pro-B-type natriuretic peptide, NTproBNP), wykładników echokardiograficznych oraz wydolności fizycznej za pomocą 6-minutowego testu marszowego i sercowo-płucnego testu wysiłkowego, a także parametrów hemodynamicznych za pomocą wysiłkowej kardiografii impedancyjnej. Wyniki: W badanej grupie 50% osób zgłaszało obniżenie tolerancji wysiłku, w tym 37,7% duszność wysiłkową. U 19,3% chorych stężenie NTproBNP przekroczyło wartość 125 pg/ml. Dysfunkcję rozkurczową stwierdzono u 8,8% z nich, ale kryteria rozpoznania niewydolności serca z zachowaną frakcją wyrzutową spełniło jedynie 6,2%. Obserwowano szeroki zakres szczytowego pochłaniania tlenu (peak VO2) i dystansu 6-minutowego testu marszowego, odpowiednio 19,4 ± 5,2 ml/min/kg i 526,7 ± 112,0 m. Wysoki odsetek badanych prezentował obniżone parametry wydolności fizycznej: 56,1% osiągnęło peak VO2 < 22 ml/min/m2, a 45,9% – peak VO2 < 80% wartości predykcyjnej; 37,3% badanych nie osiągnęło należnej wartości dystansu 6-minutowego testu marszowego. W wysiłkowej kardiografii impedancyjnej zarejestrowano na szczycie wysiłku: częstość rytmu serca 147,2 ± 22,4/min, objętość wyrzutową 110,2 ± 21,8 ml, pojemność minutową 15,9 ± 4,2 l/min, opór obwodowy 587,4 ± 168,0 dyn.s/cm5. Wnioski: Objawy obniżonej tolerancji wysiłku i nieprawidłowe wyniki obiektywnej oceny wydolności fizycznej u pacjentów z niepowikłanym nadciśnieniem tętniczym są częste, chociaż niewielki odsetek tych chorych spełnia kryteria diagnostyczne niewydolności serca.
EN
Background. There is an increasing interest in the role of adipocytokines in cardiovascular pathophysiology. Aim. The aim of the study was to compare visfatin levels, a novel adipokine, in patients with heart failure (HF) due to the left ventricular systolic dysfunction with those in age- and body mass index (BMI) - matched healthy controls in relation to the parameters of glucose metabolism and high sensitivity C-reactive protein (hsCRP) levels. Material/Subjects and Methods. The study population consisted of 28 males with systolic HF referred for cardiopulmonary exercise testing, divided into two subgroups based on their NYHA class (HF patients NYHAI+II, n=17, and HF patients NYHAIII+IV, n=11), and 23 controls. The following indices were measured in a serum samples: visfatin, hsCRP, glucose and lipid metabolism parameters, and the insulin resistance index HOMAIR (homeostasis model assessment insulin resistance) was calculated. Results. Concentrations of visfatin and high-density lipoprotein cholesterol (HDL-cholesterol) in the HF subjects were significantly lower (p≤0.01) than in controls. The Kruskal-Wallis test showed significant differences between three groups (controls and both subgroups of heart failure patients) in mean levels of visfatin, hsCRP, glucose, HOMAIR and HDL-cholesterol. Conclusion. Serum visfatin concentrations in patients with systolic HF, particularly with more advanced NYHA classes, are significantly lower in comparison to healthy controls and are independent of age or anthropometric and metabolic parameters.
EN
Heart failure (HF) due to its universality has become a huge challenge for modern medicine. Second part of the twentieth century brought significant changes in the rehabilitation, diagnostic and pharmacological procedures. There are no definitive guidelines for Cardiac Rehabilitation (CR) in HF. Based on previous studies, the article tried to describe and illustrate the mechanism of effective CR and its intensity in HF patients, which could be helpful in CR protocol development. Cardiac Rehabilitation has confirmed efficacy in increased physical level of participation in inter alia, home/work/recreational activities, improved psychosocial well-being, functional independence, prevention of disability, long-term adherence to maintaining physically active lifestyle, improved cardiopulmonary fitness, strength, muscle endurance, and flexibility, reduced cardiovascular events risk and risk of mortality. Before and after CR conduction, baseline and final aerobic capacity should be examined with an ergospirometry test to evaluate CR protocol intensity and check its effectiveness, respectively. Frequency of training-bouts in CR protocol in HF patients were from 3 to 7 days per week, intensity ranged from 40% to 80% VO2max or 9 to 14 on rating of the perceived exertion (RPE) scale or 6 to 20 on the Borg scale. Duration of single bout-exercise ranged from 20 to 60 minutes.
EN
Background: Inflammatory markers in prenatal ultrasound are a heterogeneous group of images that can evolve during pregnancy, due to regression or exacerbation of infection in pregnant women. Objective:The assessment if effective rebalancing of the bacterial flora of the vagina can lead to withdrawal of the symptoms of inflammation in ultrasound examination (US). Methods: A retrospective pilot study, among pregnant woman admitted to the Department of Prenatal Cardiology ICZMP in 2013-2014 in whom ultrasonographic signs of intrauterine infection were present. Electronic database were searched for key words ”infection, placentitis, tricuspid regurgitation, poly/oligohydramnion, IUGR, CRP, antibiotics, vaginal treatment”. The analysis included 238 patients, 30 received antibacterial vaginal treatment, from 27 patients a complete follow-up (control ultrasound after 10-14 days and data on labor) were obtained. Results: The average age of patients was 29 years. In 22% of patients tricuspid regurgitation was observed and it was the most commonly recognized marker of infection. Regression of infection signs were observed in 21 patients (77.8%) after 2 weeks of vaginal treatment. 2 patients presented with ultrasound image stabilization, in 3 patients worsening of tricuspid regurgitation or cardiac hypertrophy were detected. Polyhydramnios, the second most common parameter (18.51% of patients) resolved after treatment in all studied patients. The delivery took place an average at 39th week of gestation (SD +/- 1.93). Conclusions: Effective anti-inflammatory vaginal treatment improved ultrasound images in 21 out of 27 fetuses. These preliminary observations suggesting a beneficial role of the vaginal treatment on inflammatory markers in pregnancy ultrasound require further investigation.
EN
MicroRNAs (miRNAs) are small non-coding, single-stranded RNAs (19–25 nucleotides long) that regulate expression of multiple target genes, predominantly by binding to the 3′ untranslated region of messenger RNA (mRNA) transcripts, resulting either in translational inhibition or mRNA degradation. miRNAs are found in many bodily fluids, including plasma and serum, and are protected from degradation in the circulation through association with lipids, proteins, or microparticles, making them attractive disease biomarker candidates. Circulating levels of cardiac miRNAs (including miR-1, miR-133a, miR-208a, miR-208b, and miR-499) have been frequently reported as elevated in both coronary heart disease (CHD) and heart failure (HF) and have been proposed as candidate biomarkers that reflect the severity of myocardial injury. Subsequent large, array-based screening studies comparing patients and controls have identified altered expression of additional miRNAs, not just those of cardiac origin. However, among these studies there has been little consensus as to which miRNAs are top candidates for diagnosis or prognosis in either CHD or HF. The measurement of circulating miRNAs is further complicated by the timing of collection, especially after acute cardiac events while miRNA levels in blood may be rapidly changing; confounding influences from medications or contaminating blood cells at the time of sampling; and the need for standardization of normalization strategies. This review evaluates recent developments in the identification of circulating miRNAs as markers for diagnosis and prognosis in CHD and HF, and the methodological issues in measurement of circulating miRNAs.
20
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Cardiac sarcoidosis

63%
EN
Cardiac sarcoidosis (CS) is a rare and difficult-to-diagnose condition that leads to conduction disorders, arrhythmias, and sudden cardiac death. Diagnosing CS is extremely difficult because it can be asymptomatic in its early stages and often mimics other conditions. The diagnostic tools used in the diagnosis of CS are: echocardiography, magnetic resonance imaging, positron emission tomography and biopsy of the affected tissue. Treatment involves the use of drugs that suppress the immune system. Some of the arrhythmias and conduction disturbances associated with CS may be reversible, but more often they require protection with devices such as pacemakers or defibrillators. More research is needed to develop more effective diagnostic strategies to improve the detection and treatment of this condition.
PL
Sarkoidoza serca (cardiac sarcoidosis – CS) jest rzadkim i trudnym do zdiagnozowania schorzeniem prowadzącym do zaburzeń przewodzenia, rytmu i nagłej śmierci sercowej. Rozpoznanie CS jest niezwykle trudne, ponieważ we wczesnych stadiach może nie dawać objawów i często imituje inne stany. Narzędziami diagnostycznymi wykorzystywanymi w diagnostyce CS są: echokardiografia, rezonans magnetyczny, pozytonowa tomografia emisyjna oraz biopsja zmienionej tkanki. Leczenie polega na zastosowaniu leków hamujących układ odpornościowy. Niektóre zaburzenia rytmu serca i przewodzenia zwią-zane z CS mogą mieć charakter odwracalny, jednak częściej wymagają one zabezpieczenia urządzeniami takimi jak rozruszniki serca czy defibrylatory. Konieczne są dalsze badania w celu opracowania skuteczniejszych strategii diagnostycznych dla poprawy wykrywania i leczenia tego stanu.
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