Hypertension and nephrology

[Ventricular arrhythmia]

ZÁMOLYI Károly

SEPTEMBER 30, 2020

Hypertension and nephrology - 2020;24(04)

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Hypertension and nephrology

[Hyperkalaemia IV.]

DEÁK György, PATÓ Éva, KÉKES Ede

[The six-part summary presents the epidemiology, diagnosis, pathogenesis, and treatment of hyperkalaemia.]

Hypertension and nephrology

[Routes of transmission of SARS-CoV-2 virus infection]

KÉKES Ede

[The modes of transmission of SARS-CoV-2 virus have been analyzed in detail recently. It can be stated that the deposition of micro-sized virus particles on different surfaces and in the air is the main reason for the strength and spread of the epidemic all over the world. Spread of virus is present in practically every event of our lives and daily activities. The usual movements of human-human contact, the specific habits of our own lives (face smoothing, eye rubbing etc.) increase the spread. The greatest threat is posed by infected but asymptomatic individuals as carriers of the virus, and the main concern is the speed of transmission dynamics. We have strong evidence that 1.5-2 meter distance, mask wearing, and eye protection are crucial in reducing the rate of virus transmission. It can be assumed that, like normal influenza virus infections, the appearance of the coronavirus shows a seasonal appearance.]

Hypertension and nephrology

[Non-pharmacological treatment of hypertension and reducing cardiovascular risk in general practitioners’ clusters]

MOHOS András, KOZMA Anna, MARKÓ-KUCSERA Mária, MESTER Lajos

[Hypertension and cardiovascular diseases are major public health issues. In their treatment non-pharmacological methods have a role in every case either alone or as a complement. Patient adherence is a key factor. The role of primary care is very important in the management and with general practitioners’ cluster model and with the involvement of new primary care professionals (for example: dietetitian, physiotherapist) the opportunities are expanding. In the A GP Cluster and in the Marosmenti GP Cluster the analysis of the patients’ results who participated in an individual health status examination, in dietetic and in physiotherapy services. Assessing the professionals’ attitudes towards GP cluster model. In the A GP Cluster 2409 people, in the Marosmenti GP Cluster 1826 people participated in an individual health status examination. 14.6% and 19.9% of the participants were under the age of 18. 58.9% and 60.7% of the participants over the age of 18 were female. 1083 and 232 patients used physiotherapy services, 147 and 187 people used dietetic services. The age distribution of the individual health status examinations is correspond to the Hungarian age pyramid. In addition to the preventive approach came into view the community based local health care services. The GP cluster model was welcomed by the patients, the physiotherapy was more popular than dietetic among them. All professionals of the GP clusters had a positive opinion of the professional work done in the project. Conclusion: There is a demand both from the patients and the healthcare professionals for the GP cluster concept. The establishing of an appropriate monitoring system and creating long-term, sustainable operating conditions are essential for achieving lasting social health gains. ]

Hypertension and nephrology

[Kidney transplantation in Hungary]

JÁRAY Jenő

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Clinical Neuroscience

Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

Aim - To evaluate P-wave dispersion before and after antiepileptic drug (AED) treatment as well as to investigate the risk of ventricular repolarization using the Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio in patients with epileptic disorder. Methods - A total of 63 patients receiving AED therapy and 35 healthy adults were included. ECG recordings were obtained before and 3 months after anti-epileptic treatment among patients with epilepsy. For both groups, Tp-e and Tp-e/QT ratio were measured using a 12-lead ECG device. Results - Tp-e interval, Tpe/QT and Tp-e/QTc ratios were found to be higher in the patient group than in the control group (p<0.05, for all), while QTmax ratio was significantly lower in the patient group. After 3 months of AED therapy, significant increases in QT max, QTc max, QTcd, Tp-e, Tp-e/QT, and Tp-e/QTc were found among the patients (p<0.05). When the arrhythmic effects of the drugs before and after treatment were compared, especially in the valproic acid group, there were significant increases in Tp-e interval, Tp-e/QT and Tp-e/QTc values after three months of treatment (p<0.05). Carbamazepine and levetiracetam groups were not statistically significant in terms of pre- and post-treatment values. Conclusions - It was concluded that an arrhythmogenic environment may be associated with the disease, and patients who received AED monotherapy may need to be followed up more closely for arrhythmia.

Clinical Neuroscience

Neurogenic stunned myocardium in acute ischemic stroke

ILERI Cigdem , DOGAN Zekeriya , BULUT Burcu , SUNBUL Murat , SAYAR Nurten , MIDI Ipek , OZBEN Beste

Neurogenic myocardial injury occurs as a result of dysregulation of autonomic nervous system. The aim of this study was to explore the frequency of elevated troponin and dynamic ST segment/T wave changes and their relation with left ventricular (LV) systolic functions in acute ischemic stroke patients. One hundred and twenty-five patients (mean age: 65.1±15.2years, 76 male) presenting with acute ischemic stroke were consecutively included. 12-lead electrocardiogram was taken to assess dynamic ST segment/T wave changes, conventional transthoracic echocardiography to determine LV ejection fraction (LVEF). High-sensitive cardiac troponin I (hs-cTnI) level>0.04ng/mL was accepted as elevated. Twenty-seven patients (21.6%) had elevated hs-cTnI and 60 patients (48%) had dynamic ST segment/T wave changes. The stroke patients with elevated hs-cTnI had significantly higher NT-proBNP values (2302±3450pg/mL vs 799±2075pg/mL p<0.001) and higher frequency of ST segment/T wave changes (85.2% vs 37.8% p<0.001), and lower LVEF (52.2±13.6% vs 61.0±8.5% p=0.002) compared to patients with normal troponin levels. The patients with ST segment/T wave changes had significantly higher frequencies of hyper­lipidemia (31.7% vs 15.4% p=0.031) and coronary artery disease (CAD) (43.3% vs 13.8% p<0.001), hs-cTnI (0.19±0.55ng/mL vs 0.02±0.01ng/mL p<0.001) and NT-proBNP levels (1430±2564pg/mL vs 842±2425pg/mL p=0.016), and lower LVEF (56.1±11.7% vs 61.9±8.3% p=0.009). Linear regression analysis revealed presence of CAD, but not ST segment/T wave changes as an independent predictor of hs-cTnI (p=0.034). LVEF was independently associated with hs-cTnI (p=0.003) and presence of CAD (p=0.009) when adjusted by age, sex and presence of ST segment/T wave changes. Troponin elevation and ST segment/T wave changes occurring in patients suffering acute ischemic stroke, especially in those with CAD, may be a sign of neurogenic stunned myocardium.

Hypertension and nephrology

[Sudden death – ECG – hypertension]

KÉKES Ede

[Sudden death (HH) is not only associated with coronary heart disease or heart failure, but is also present in hypertension, primarily associated with left ventricular hypertrophy, systolic pressure, and age. Co-morbidities of hypertension (diabetes, coronary heart disease, heart failure and renal failure) contribute greatly to its development. HH occurs due to ventricular fibrillation, or asystole. The auther demonstrates depolarization and repolarization pathologies leading to HH and detectable on the ECG and their characteristic ECG patterns. He also emphasizes the importance of resting heart rate and heart rate variability.]

Hypertension and nephrology

[Extrapulmonary multiple organ damage and dysfunction in Covid-19]

KÉKES Ede, NAGY Judit

[SARS-CoV-2 virus attacks nőt only the lungs bút alsó many other or- gans (heart, kidney, liver, pancreas, gastrointestinal tract, brain, hematopoiesis) and regulatory system (RAAS, immuné system) to different degrees and with dif- ferent pathomechanisms. Accordingly, cell death, tissue damage and dysfunction or failure of somé organs has been developed. Our paper provides a detailed analysis of the incidence of extrapulmonary lesions, clinical manifestations, and the underlying pathomechanisms. This multi-organ damages was detected dom- inantly in severe Covid cases, bút may occur in moderate or mild cases. It should alsó be taken intő account that the consequences may occur after the acute phase, in a seronegative State - months after the onset of infection. In particu- lar, the heart (myocarditis, coronary insufficiency, arrhythmia), the kidney (acute renal failure and then permanent GFR decrease), glucose metabolism disorder (diabetes worsening, ketoacidosis, new diabetes) are the biggest therapeutic challenge. Multi-organ damage is due to direct virus-induced cell death, endo- thelial cell damage in the vascular system, and thrombo-inflammation with the formation of microthrombi, imbalance in the RAAS regulatory system, and early and delayed abnormal immuné response (cytokine storm).]

Journal of Nursing Theory and Practice

Use of Imogene King’s Nursing Model in the Care for a Patient with Heart Arrhythmias

CLOUBOVÁ Ivana, BULAVA Alan

Objectives: To discover the benefits of implementation of Imogene King’s nursing model into nursing care in a patient with arrhythmias. To find out how these patients are limited in saturation of their own needs and what are the most severe limitations for patients with arrhythmias. Material and methods: Qualitative research using semi-structured interviews. The interview with patients with arrhythmia was conducted in accordance with the structure of King’s nursing model. Results: The research group consisted of 20 respondents; 13 men and seven women. All respondents expressed satisfaction with their cooperation with staff. The respondents described a change in the subjectively perceived state, the psychic state, and emotions. Conclusions: Assessment of the subjectively perceived quality of life of patients with arrhythmias using the King’s interaction model allows nurses to see the patient from the holistic point of view and plan and provide individualized care.