Between 1 January, 1989, and 28 April, 1990, a total of 888 selective coronary arteriographies were performed at the Institute for Clinical and Experimental Medicine in Prague. Of that number, 58 findings were assessed as at least 50% stenosis of the left main coronary artery (LCA). Having applied exclusion criteria, 50 patients (i.e., 5.63% of all those examined) were entered into a retrospective study. They were 45 men (90.0%) and 5 women (10.0%) with significant cumulation of risk factors for IHD; more than half on them had a history of coronary event. The patients had marked symptomatology--NYHA Class III and higher angina pectoris was present in 96%, a low tolerance of exercise was found in 26 patients undergoing ergometry (average workload of 13 kJ and heart rate of 111/min); exercise testing was invariably evaluated as positive. Coronary angiography regularly revealed multiple coronary artery lesions; the right coronary artery was also involved in 90%; a collateral circulation was present in as little as 34%. The localization of coronary stenoses and the mostly preserved left ventricular mechanical function allowed operative management of IHD in 84% of cases. In the group of patients undergoing surgery, hospital mortality was 4.8%. On long-term follow-up (mean 6.2 months) of the group of patients operated on, 59.9% were free of problem, 31% had NYHA Class II angina pectoris, and there was no improvement at all in one patient only (2.4%). In the group provided conservative therapy (not operated on primarily for severe left ventricular dysfunction), one patient died of recurrent myocardial infarction and cardiogenic shock, 2 have NYHA Class IV angina pectoris, and the remaining subjects continue experiencing NYHA Class III problems.

• MeSH
• Angina Pectoris diagnostic imaging   mortality   MeSH
• Adult MeSH
• Electrocardiography MeSH
• Myocardial Infarction diagnostic imaging   mortality   MeSH
• Coronary Angiography * MeSH
• Coronary Disease diagnostic imaging   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Survival Rate MeSH
• Follow-Up Studies MeSH
• Coronary Artery Disease diagnostic imaging   mortality   MeSH
• Recurrence MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Arrhythmias, Cardiac diagnostic imaging   mortality   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Pulmonary hypertension is a condition characterized by elevation of the mean blood pressure in pulmonary artery above 25 mm Hg at rest or above 30 mm Hg during exercise. Pulmonary hypertension signs are not specific. They are frequently camouflaged by signs of a primary disease causing pulmonary hypertension. That causes difficulties with diagnosing and often doesn't lead to recognition of pulmonary hypertension till pressure in pulmonary artery is difficult to manage therapeutically. Treatment of secondary pulmonary hypertension tries to affect primary disease. In patients with pulmonary artery hypertension with preserved vasoreactivity so called conventional treatment is still recommended (vasodilatation treatment with calcium channels blockers, anticoagulation, oxygentherapy, treatment of heart failure). New ways of pharmacotherapy represent administration of prostacyclin, antagonists of endothelin receptors, and phosphodiesterase inhibitors. Nonpharmacology treatment of pulmonary hypertension includes balloon atrial septostomy, lung transplantation, and in chronic thromboembolic pulmonary hypertension pulmonary endarterectomy. Current recommendations for pulmonary hypertension treatment concentrate especially on patients in functional classes NYHA III and IV. In less symptomatic patients there is usually lack of unambiguous clinical data needed for treatment. Owning to seriousness of the disease, its difficult diagnosing and frequently difficult treatment the global trend is to concentrate care of patients with pulmonary hypertension in specialised centers. This problem systematically addresses a center at the 2nd Clinic of Internal Medicine of the 1st Medical Faculty of the Charles University and the General Teaching Hospital in Prague in close cooperation with the Clinic of Cardiovascular Surgery at the General Teaching Hospital in Prague, and the transplantation center at the 3rd Surgical Clinic of the Teaching Hospital Motol in Prague, the Czech Republic.

• MeSH
• Diagnosis, Differential MeSH
• Humans MeSH
• Hypertension, Pulmonary diagnosis   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH