Cluster headache je primární bolest hlavy patřící mezi trigeminové autonomní cefalgie. Její léčba vychází z empirických doporučení a zahrnuje akutní, preventivní a přemosťující přístupy, které jsou doplňovány neuromodulačními metodami. Verapamil je považován za preventivní lék první volby, ačkoliv se u cluster headache jedná o off-label použití. Léčba verapamilem má být zahájena co nejdříve na začátku clusterové periody dávkou 240 mg/den, podmínkou je vyloučení kontraindikací a normální elektrokardiografický nález. Již v prvním týdnu léčby je pak dosažena obvyklá účinná dávka 360 mg/den. Další navyšování probíhá postupně dle individuálních potřeb pacienta a za pravidelných kontrol elektrokardiogramu. Léčba vysokou (≥ 480 mg/den) a velmi vysokou dávkou (≥ 720 mg/den) verapamilu probíhá pod dohledem specialisty a souběžně vyžaduje kardiologické sledování. Maximální doporučená dávka k preventivní léčbě cluster headache je 960 mg/den. Preventivní léčba probíhá několik týdnů až měsíců a ukončuje se postupně.
Cluster headache is a primary headache disorder classified under trigeminal autonomic cefalalgias. Its treatment is based on empirical recommendations and includes acute, preventative and bridging treatment strategies, and complemented by neuromodulatory methodes. Verapamil is considered first-line preventative medication, although its use in cluster headache is off-label. The treatment should be started at the very beginning of the cluster period with an initial dose of 240 mg/day, prior it is mandatory to rule out contraindications and confirm that patient ́s echocardiographic finding is normal. During the first week of treatment, the typical effective therapeutic dose of 360 mg/day is achieved. Further increase of the dose is provided stepwise according the needs of the patient and with routine electrocardiogram monitoring. If high (≥ 480 mg/day) or very high doses (≥ 720 mg/day) of verapamil are necessary, treatment should be administered under the specialist ́s supervision with close cardiological follow-up. The maximu recommended dose for preventative treatment of cluster headache is 960 mg/day. Preventative treatment usually continues for several weeks or months and must be withdrawn gradually.
- MeSH
- Atrioventricular Block diagnostic imaging classification MeSH
- Cluster Headache * diagnosis drug therapy prevention & control MeSH
- Electrocardiography methods MeSH
- Contraindications MeSH
- Humans MeSH
- Pain Management methods MeSH
- Drug-Related Side Effects and Adverse Reactions classification MeSH
- Verapamil * administration & dosage pharmacokinetics pharmacology adverse effects therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- MeSH
- Atrioventricular Block diagnostic imaging etiology MeSH
- Anesthesia, General methods instrumentation MeSH
- Child MeSH
- Hypoxia etiology classification complications MeSH
- Anesthesia, Inhalation methods MeSH
- Injections, Intramuscular methods MeSH
- Cardiac Surgical Procedures methods MeSH
- Humans MeSH
- Intraoperative Complications etiology MeSH
- Surgical Clearance methods MeSH
- Preanesthetic Medication MeSH
- Arrhythmias, Cardiac drug therapy classification MeSH
- Heart Failure diagnostic imaging etiology MeSH
- Heart Defects, Congenital * surgery classification physiopathology MeSH
- Check Tag
- Child MeSH
- Humans MeSH
Atrioventrikulární (AV) blokáda vyššího stupně nebo kompletní AV blokáda je raritní extraartikulární manifestací revmatoidní artritidy (RA). Prezentujeme kazuistiku 34leté pacientky s rekurentními synkopami. Pacientka je 17 let léčena pro RA. Ambulantní EKG monitorace odhalila intermitentní AV blokádu 2 : 1 a 3 : 1. Nebyly identifikovány jiné příčiny poruchy funkce převodního systému srdečního. Pacientka podstoupila primoimplantaci dvoudutinového trvalého kardiostimulátoru.
High-grade or complete atrioventricular (AV) block is a rare extraarticular manifestation of rheumatoid arthritis (RA). We reporta case of a 34-year-old patient with recurrent syncope. She had been receiving treatment for RA for 17 years. Ambulatory ECGmonitoring revealed an intermittent 2 : 1 and 3 : 1 AV block. No other causes of the conduction system disorder have been found.The patient underwent DDD-R permanent pacemaker implantation.
- MeSH
- Atrioventricular Block * diagnostic imaging etiology therapy MeSH
- Adult MeSH
- Electrocardiography MeSH
- Cardiac Pacing, Artificial MeSH
- Humans MeSH
- Arthritis, Rheumatoid * diagnosis MeSH
- Syncope diagnostic imaging etiology therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Atrioventricular Block diagnostic imaging drug therapy mortality MeSH
- Dexamethasone administration & dosage MeSH
- Digoxin therapeutic use MeSH
- Flecainide therapeutic use MeSH
- Hydrops Fetalis epidemiology drug therapy MeSH
- Tachycardia, Ventricular diagnostic imaging epidemiology MeSH
- Humans MeSH
- Fetal Diseases * diagnostic imaging mortality therapy MeSH
- Fetus MeSH
- Atrial Premature Complexes diagnostic imaging epidemiology MeSH
- Tachycardia, Supraventricular diagnostic imaging drug therapy MeSH
- Ultrasonography, Prenatal MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Left ventricular (LV) dyssynchrony may occur as a result of right ventricular (RV) pacing and is a known risk factor for the development of heart failure. In children with complete atrioventricular block, pacing-induced dyssynchrony lasting for decades might be especially deleterious for LV function. To determine the hemodynamic and ultrastructural remodeling after either RV free wall or LV apical pacing, we used a chronic minipig model. METHODS AND RESULTS: Fourteen piglets 8 weeks of age underwent atrioventricular node ablation and were paced from either the RV free wall or the LV apex at 120 bpm for 1 year (7 age-matched minipigs served as controls with spontaneous heart rates of 104 +/- 5 bpm). Echocardiographic examinations, pressure-volume loops, patch-clamp investigations, and examinations of connexin43, calcium-handling proteins, and histomorphology were carried out. RV free wall-paced minipigs exhibited significantly more LV dyssynchrony than LV apex-paced animals, which was accompanied by worsening of LV function (maximum LV mechanical delay/LV ejection fraction: RV free wall pacing, 154 +/- 36 ms/28 +/- 3%, LV apical pacing, 52 +/- 19 ms/45 +/- 2%, control 47 +/- 14 ms/62 +/- 1%; P=0.0001). At the cellular level, both pacemaker groups exhibited a significant reduction in L-type calcium and peak sodium current, shortening of action potential duration and amplitude, increased cell capacity, and alterations in the calcium-handling proteins that were similar for RV free wall- and LV apex-paced animals. CONCLUSIONS: The observed molecular remodeling seemed to be more dependent on heart rate than on dyssynchrony. LV apical pacing is associated with less dyssynchrony, a more physiological LV contraction pattern, and preserved LV function as opposed to RV free wall pacing.
- MeSH
- Atrioventricular Block diagnostic imaging physiopathology therapy MeSH
- Chronic Disease MeSH
- Ventricular Dysfunction, Left diagnostic imaging physiopathology therapy MeSH
- Ventricular Dysfunction, Right diagnostic imaging physiopathology therapy MeSH
- Echocardiography MeSH
- Electrophysiological Phenomena MeSH
- Hemodynamics physiology MeSH
- Cardiac Pacing, Artificial * MeSH
- Connexin 43 metabolism MeSH
- Patch-Clamp Techniques MeSH
- Swine, Miniature MeSH
- Disease Models, Animal MeSH
- Myocardium cytology metabolism MeSH
- Swine MeSH
- Heart physiology MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Animals MeSH
