Téma: Overview works

Heart rate and cardiovascular risk

Jindřich Špinar, Jiří Vítovec

Heart frequency is a risk factor for cardiovascular morbidity and mortality in general population, but also in patients already treated for a cardiovascular disease. In placebo arm of the study SYST-EUR in hypertonics the heart rate was an important risk factor. In patients with acute myocardial infarction the heart frequency at admission is a risk factor according to the study CRUSADE, similarly in patients after myocardial infarction in the study GISSI 3 with increasing heart rate increased also mortality. Increased heart rate is a risk factor in patients with heart failure. The heart frequency 50-70/min. seems to be optimal. For lowering of the heart frequency 4 basic groups of drugs are used: digitalis, betablockers, calcium blockers of verapamil type and If - channel blockers (bradins). Digitalis is fully indicated in patients with heart failure and atrial fibrillation, but in the DIG study in patients with sinus rhythm it did not lead to mortality decrease. Betablockers are used for treatment of hypertension, ischemic heart disease and heart failure and in all indications they have a proof of mortality decrease. It is not clear to which extent is this effect caused by a negative chronotropic effect and to which extent by other effects mainly by antiarrhythmic one. Verapamil in patients after myocardial infarction had in the INVEST study comparable effect to betablockers, in the DAVIT 2 study it led to 20 % decrease of cardiovascular events. If - channel blockers in the BEAUTIFUL study did not decrease mortality and they are still intensively tested.In the study SHIFT ivabradin decreased mortality and hospitalization for heart failure by 26 %, primary combined aim (cardiovascular mortality and hospitalization for heart failure) by 18 %.
Key word: heart frequency, mortality, digitalis, betablockers, verapamil, ivabradin

Ročník 2010  Témy časopisu Cardiology for practice 3 / 2010

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1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981: 15-27.

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In which patients, after overcoming of a thromboembolic cerebral or peripheral event, the least suitable catheter closure is foramen ovale patents:
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