Reverzibilní defekt na perfuzní scintigrafii myokardu znamená zvýšené riziko srdeční příhody, i když koronární angiografie neodhalí závažnou stenózu koronární tepny. Některé studie prokázaly, že antiischemická léčba může redukovat nebo dokonce normalizovat perfuzní poruchu detekovanou při scintigrafii. Mezi léky, které lze v této indikaci použít, patří také inhibitory enzymu konvertujícího angiotenzin, ACE inhibitory. Stabilizují aterosklerotický plak tím, že inhibují proliferaci hladké svaloviny, mají antioxidativní účinek a inhibují také makrofágy. Kromě toho působí antitromboticky tím, že inhibují agregaci krevních destiček a usnadňují fibrinolýzu.
A reversible defect on MPI study is closely associated with increased risk of cardiac events even if coronary angiography does not demonstrate a significant coronary artery stenosis. Recent studies have shown that anti-ischemic drugs can reduce or even normalize perfusion defects detected on MPI. ACE inhibitors have many properties that may be effective in the treatment of ischemic syndromes. They stabilize atherosclerotic plaques by inhibition of smooth muscle proliferation, by anti-oxidative properties and by inhibition of macrophages. They also prevent thrombotic complications by inhibition of platelet aggregation and facilitation of fibrinolysis.
- MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage pharmacology blood MeSH
- Myocardial Ischemia * diagnostic imaging drug therapy blood pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Perindopril * administration & dosage pharmacology blood MeSH
- Myocardial Perfusion Imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Arteriální hypertenze je významný ovlivnitelný rizikový faktor kardiovaskulárních chorob, postihující necelou čtvrtinu populace ČR. Pouze 16 % pacientů ale dosahuje optimálních hodnot krevního tlaku. Aktuální doporučené postupy pro diagnostiku a léčbu arteriální hypertenze doporučují její včasnou diagnostiku, neodkladné zahájení léčby a případně její včasnou eskalaci při nedosažení cílových hodnot do tří měsíců. Primárním cílem léčby arteriální hypertenze je snižování KV rizika. Jako léky první volby by měly být voleny fixní kombinace antihypertenziv. Za fixní kombinaci první volby je považována kombinace inhibitoru ACE a kalciového blokátoru. Prezentovaná kazuistika popisuje využití fixní kombinace perindopril/amlodipin k dosažení cílových hodnot krevního tlaku. Tato kombinace disponuje robustními daty o pozitivním dlouhodobém ovlivnění kardiovaskulární prognózy.
Arterial hypertension is a significant modifiable risk factor for cardiovascular disease, affecting almost a quarter of the Czech population. However, only 16% of patients achieve optimal blood pressure values. Current guidelines for the diagnosis and treatment of arterial hypertension recommend its early diagnosis, prompt initiation of treatment and, if necessary, its early escalation if target values are not reached within three months. The primary goal of treating arterial hypertension is to reduce CV risk. Fixed combinations of antihypertensive drugs should be chosen as the first choice drugs. A combination of an ACE inhibitor and a calcium blocker is considered the fixed combination of first choice. This case report describes the use of a fixed combination of perindopril/amlodipine to achieve target blood pressure values. This combination has robust data on positive long-term effects on cardiovascular prognosis.
- MeSH
- Patient Compliance MeSH
- Amlodipine administration & dosage pharmacokinetics therapeutic use MeSH
- Adult MeSH
- Drug Combinations MeSH
- Hypertension * drug therapy MeSH
- Humans MeSH
- Perindopril administration & dosage pharmacokinetics therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Amlodipine administration & dosage therapeutic use MeSH
- Antihypertensive Agents * administration & dosage therapeutic use MeSH
- Adult MeSH
- Drug Combinations MeSH
- Hypertension * drug therapy MeSH
- Indapamide administration & dosage therapeutic use MeSH
- Non-ST Elevated Myocardial Infarction therapy MeSH
- Humans MeSH
- Perindopril administration & dosage therapeutic use MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Keywords
- Triplixam,
- MeSH
- Amlodipine administration & dosage therapeutic use MeSH
- Antihypertensive Agents * administration & dosage therapeutic use MeSH
- Adult MeSH
- Drug Combinations MeSH
- Hypertension * drug therapy MeSH
- Indapamide administration & dosage therapeutic use MeSH
- Non-ST Elevated Myocardial Infarction therapy MeSH
- Humans MeSH
- Perindopril administration & dosage therapeutic use MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Blood Pressure Monitoring, Ambulatory MeSH
- Adrenergic beta-Antagonists administration & dosage adverse effects therapeutic use MeSH
- Bisoprolol administration & dosage adverse effects therapeutic use MeSH
- Hypertension * diagnosis drug therapy complications MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage adverse effects therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Middle Aged MeSH
- Humans MeSH
- Perindopril administration & dosage adverse effects therapeutic use MeSH
- Heart Rate MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Newspaper Article MeSH
x
x
- MeSH
- Amlodipine administration & dosage pharmacology therapeutic use MeSH
- Adult MeSH
- Drug Combinations MeSH
- Hypertension * diagnosis drug therapy MeSH
- Indapamide administration & dosage pharmacology therapeutic use MeSH
- Blood Pressure drug effects MeSH
- Humans MeSH
- Perindopril administration & dosage pharmacology therapeutic use MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Keywords
- Lipertance,
- MeSH
- Amlodipine administration & dosage MeSH
- Atorvastatin administration & dosage pharmacology MeSH
- Dyslipidemias diagnosis drug therapy MeSH
- Drug Combinations MeSH
- Hypertension * diagnosis drug therapy MeSH
- Cardiometabolic Risk Factors MeSH
- Middle Aged MeSH
- Humans MeSH
- Perindopril administration & dosage MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Antihypertensive Agents pharmacology therapeutic use MeSH
- Drug Combinations MeSH
- Hypertension * drug therapy MeSH
- Indapamide administration & dosage pharmacology therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Obesity * complications therapy MeSH
- Perindopril administration & dosage pharmacology therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Newspaper Article MeSH
- MeSH
- Antihypertensive Agents administration & dosage therapeutic use MeSH
- Adrenergic beta-Antagonists therapeutic use MeSH
- Bisoprolol administration & dosage therapeutic use MeSH
- Calcium Channel Blockers therapeutic use MeSH
- Adult MeSH
- Drug Combinations MeSH
- Hemodynamic Monitoring methods MeSH
- Hypertension drug therapy physiopathology MeSH
- Angiotensin-Converting Enzyme Inhibitors therapeutic use MeSH
- Humans MeSH
- Perindopril administration & dosage therapeutic use MeSH
- Heart Disease Risk Factors * MeSH
- Heart Rate drug effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Newspaper Article MeSH
Prezentovaná kazuistika představuje dva pohledy na pojem "trojkombinace" v léčbě konkrétního pacienta s koronární nemocí. V prvním, poněkud netradičním, významu slova popisujeme neobvyklý případ tří chronických totálních uzávěrů (CTO) ve třech rozdílných koronárních povodích s klinickou manifestací srdečního selhání při ischemické kardiomyopatii. Všechny uzávěry byly postupně rekanalizovány technikami CTO PCI s dobrým angiografickým i klinickým efektem. Došlo k výraznému zlepšení původní systolické dysfunkce levé komory. Jednotlivé procedury jsou obrazově dokumentovány a jsou doprovázeny obecnými informacemi o CTO PCI. Druhý význam slova "trojkombinace" v tradičnějším farmakoterapeutickém významu představuje fixní spojení tří léčiv ze skupiny antihypertenziv a hypolipidemik, které jsme u téhož pacienta použili v rámci optimalizace sekundárně preventivního léčebného schématu.
The case report presents two views on the concept of "triple combination" in treating a particular patient with coronary artery disease. The first, somewhat untraditional meaning of the two-word expression is used to describe an unusual case of three chronic total occlusions (CTO) in three different coronary territories clinically manifested by heart failure in the setting of ischaemic cardiomyopathy. All the occlusions were gradually recanalized using CTO PCI techniques with a good angiographic and clinical effect. There was a marked improvement in the original systolic left ventricular dysfunction. The individual procedures are illustrated by images and accompanied by general information on CTO PCI. A second meaning of the words "triple combination" - in a more traditional pharmacotherapeutic sense - represents a fixed combination of three antihypertensive and lipid-lowering drugs which were used in the same patient to optimize the secondary preventive therapeutic regimen.
- MeSH
- Amlodipine administration & dosage therapeutic use MeSH
- Atorvastatin administration & dosage therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Percutaneous Coronary Intervention methods MeSH
- Coronary Occlusion * surgery drug therapy prevention & control MeSH
- Humans MeSH
- Perindopril administration & dosage therapeutic use MeSH
- Secondary Prevention methods MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
