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Úvod: Syndrom posturální tachykardie (postural tachycardia syndrome, POTS) je jednou z častých příčin ortostatické intolerance. Jde o patofyziologicky heterogenní poruchu charakterizovanou ortostatickou intolerancí a zvýšením srdeční frekvence o 30 tepů/min v prvních deseti minutách po změně polohy z vleže/ vsedě do polohy vstoje nebo během vyšetření na nakloněné rovině (head-up tilt test, HUTT) bez ortostatické hypotenze. Klinické charakteristiky: Symptomy provázející tento syndrom jsou důsledkem hypoperfuze mozku a hyperaktivity sympatiku a dělí se na ortostatické, neortostatické a difuzní přidružené. Klasifi kace: Pro tuto heterogenní skupinu poruch byla navržena řada různých klasifi kačních systémů. Nejpraktičtějším z nich, který je ve shodě se současnými poznatky v oblasti medicíny i z hlediska užitečnosti v klinické praxi, je zřejmě klasifi kace založená na fenotypech POTS: parciální dysautonomní (neuropatická) forma POTS, hyperadrenergní POTS, POTS v souvislosti s nízkou tělesnou zdatností a POTS s dysregulací objemu cirkulující krve. Diagnostika a vyšetření: Pro správnou léčbu POTS je naprosto zásadní systematický a praktický přístup. U pacienta je nutno provést důkladné kardiologické a neurologické vyšetření včetně holterovského i ambulantního monitorování krevního tlaku. Je prokázán přínos HUTT v rámci vyšetření u pacientů se synkopou neznámé etiologie včetně POTS. Diferenciální diagnostika: Klinické projevy POTS mohou připomínat feochromocytom, vasovagální synkopu, sinusovou tachykardii a jiné supraventrikulární tachyarytmie. U pacientů s neurologickým defi citem, jehož příčinou je autonomní neuropatie, např. diabetes mellitus, je nutné tento defi cit diagnostikovat, kompenzovat a vyloučit jako primární příčinu. Léčba: Léčba POTS je především nefarmakologická. Všechny pacienty je nutno edukovat a seznámit je s různými aspekty POTS. Nesmírně přínosný může být strukturovaný cvičební program. Farmakoterapie má podpůrnou úlohu a je zaměřena na volumexpanzi, sympatolýzu, vasokonstrikci a zvýšení vagového tonu. Závěr: I když byl POTS poprvé popsán již v 90. letech 20. století, řada aspektů této multisystémové ortostatické poruchy zůstává nejasná. Tento syndrom významně ovlivňuje kvalitu pacientova života. Je třeba rozšířit obecné poznatky lékařů v první linii, kteří pracují v soukromých a specializovaných praxích, aby se uměli postarat o pacienty s POTS a odesílat je na specializovaná pracoviště s dostupnými komplexními diagnostickými postupy a péčí.

Objective: Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary hypertension among patients with resistant hypertension is not exactly known. Design and method: We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics, Mann-Whitney U test and Fisher's exact test were used for statistical evaluation. Results: Among the 432 patients with resistant hypertension, secondary etiology of hypertension was found in 135 (31.1%). The most frequent cause was primary aldosteronism in 85 cases (63% relatively), followed by renovascular hypertension (21 cases, 15.6%), renal parenchymal hypertension (20 cases, 14.8%). Less common causes were hyperreninism (3.7%), hypercortisolism (1.5%), pheochromocytoma (0.7%) and adrenogenital syndrome (0.7%). Obstructive sleep apnoea has been found in 63 (14.7%) patients. Patients with secondary hypertension were more frequently male (70.4% vs. 52.2%, p < 0.001), had a higher left ventricular mass index (LVMI 119 vs. 106 g / m2, P = 0.037) and lower estimated glomerular filtration rate (69 vs. 75 ml/min/1.73m2, P = 0.009). Both groups did not differ in age, office blood pressure or albuminuria. Conclusions: Secondary etiology was much more frequent (31%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Patients with secondary hypertension had more advanced target organ damage. This work was supported by the grant UP - IGA_LF_2019_036 a IGA_LF_2019_035. This work was supported by the grant IGA_LF_2020_039

, Milos Taborsky aBackground. Internal carotid artery stenosis (ICAS) is associated with significantly higher risk of stroke. Autonomic function can be impaired in the presence of atheroma in the carotid sinus region. Two parameters of autonomic nervous system (ANS) function e.g. heart rate variability (HRV) and baroreflex sensitivity (BRS) are respected predictors of cardiovascular prognosis. We assessed the effect of elective unilateral carotid endarterectomy (CEA) on cardiovascular autonomic functions as a major prognostic factor for cardiovascular health. Methods. Nineteen patients indicated for CEA underwent formal autonomic assessment in the laboratory. Hemodynamic profiles, HRV and BRS were evaluated with the dedicated high-tech device Task Force Monitor before surgery (day-1) and postoperatively (day 3±1). Data were obtained during 5 min orthostatic challenge and subsequent 5 min in a supine position. Results. There were no significant early postoperative changes in evaluated parameters after CEA. There was a mild decrease of blood pressure and therefore only a slight increase in BRS. It was also possible to observe a rise in the value of total power and high frequency power. Conclusion. In the early postoperative period, healing processes are occurring and the sympatho-vagal interaction is probably still unbalanced. Given the considerable clinical potential of BRS and HRV measurement, further short-term and, more importantly, long-term investigations are needed.

Introduction Sleep disordered breathing (SDB) is a group of ventilatory disorders during sleep which includes obstructive sleep apnea (OSA), central sleep apnea (CSA), and sleep related hypoventilation. In patients with SDB, the prevalence of pulmonary hypertension (PH) ranges from 17% to 52%. While SDB is prevalent in the general population with recent estimates of 20% to 30%, in those with cardiovascular disease, particularly left ventricular failure, there is a higher reported prevalence of 47%. Aims The aims of this study were to determine the prevalence and prognostic relevance of sleep apnea in a cohort of patients with newly diagnosed pulmonary arterial hypertension (ESC/WHO Group 1 pulmonary hypertension). Methods We evaluated prospectively 76 patients with the pulmonary arterial hypertension (mean age 54±16 years; 45% male). All patients underwent right heart catheterisation, clinical assessments, sleep study, standard laboratory testing and evaluation of subjective sleepiness by the Epworth Sleepiness Scale. Sleep test was provided with an ApneaLink Plus, consisting of nasal pressure sensor, respiratory effort band, and pulse oximeter worn on the finger. Subjects previously treated for or diagnosed with SDB were excluded from the study. Results Sleep apnea (SA) – defined as apnea-hypopnea index (AHI) ≥5/h – was found in 59 (77.6%) of the pulmonary arterial hypertension (PAH) patients. Mean AHI in the cohort of PAH patients with SA was 26.1±16.6/h. Mean follow-up was 24 months, during which 15 (19.7%) patients died. Characteristics of parameters related to SA in groups of survivors and deceased are in table 1. From the sleep apnea-related parameters, only time with O2Sat &lt;90% – T90 was significantly associated with mortality (AUC 0.856; 95% CI 0.693 – 1.019; p&lt;0.001). Conclusions The presence of sleep apnea in pulmonary arterial hypertension patients is high. The prevalence of sleep apnea is higher in PAH patients than in the general population. The presence of sleep apnea in patients with PAH was not associated with worse prognosis, but noctural hypoxemia (time with O2Sat &lt;90%) was related to poor prognosis. Sleep apnea in patients with PAH should be screened for systematically. Funding Acknowledgement Type of funding source: None