Cor et Vasa Case Reports (special issue 2024)

Postavení gliflozinů v léčbě srdečního selhání se zachovanou ejekční frakcí 

T. Švarcová

Our case report presents a typical example of an elderly woman with heart failure with preserved ejection fraction (HFpEF) with comorbidities often associated with HFpEF such as hypertension, obesity, atrial fibrillation, chronic obstructive bronchopulmonary disease. The diagnosis of HF PEF is also confirmed by the value of H2FPEF1 Score 94.8% and HFA-PEFF2 score 6, as well as NT-proBNP – 2 771 pg/ml in this case. A viral respiratory infection caused progression of HFpEF symptoms in correlation with the rise of NT-proBNP. Combination of diuretics and an ACE inhibitor treatment was complicated by hyperkalemia. Significant reduction of the symptoms occurred first after the introduction of empagliflozin into treatment. The clinical outcome in our case report correlates with the results of randomized studies demonstrating the efficacy and safety of gliflozins in the treatment of heart failure. The gliflozin treatment is newly recommended as a IA class recommendation in the focused updated guidelines of the European Society of Cardiology for the diagnosis and treatment of heart failure3 for patients with HFpEF.

Úspěšná léčba těžkého srdečního selhání za užití komplexní moderní farmakologické léčby 

M. Čutková, L. Pávková, J. Haniš

Heart failure is a clinical syndrome consisting of major symptoms (for example dyspnea and fatigue) that may be accompanied by physical signs (for example increased pressure in the neck veins, pulmonary crackles, and peripheral edema). In the Czech Republic, chronic heart failure afflicts more than one quarter of a million of people and its prevalence will increase in the future. It is the most common cause of hospitalization in departments of internal medicine in the Czech Republic. Treatment of patients with heart failure is very expensive and time-consuming. It requires maximum cooperation of patients and regular checkups at an ambulatory cardiologist, very commonly cooperating with other ambulatory specialists. In our case report, we demonstrate a successful treatment of heart failure with severe systolic dysfunction. Our patient’s ejection fraction increased from 20% to 60%, along with the NYHA classification improving from III–IV to I.

Promarněná šance 

V. Ryšavý

This case report presents a patient with chronic heart failure of ischemic etiology. The diagnosis was established in 2002, when systolic dysfunction of the left ventricle was demonstrated by echocardiography and subsequently coronary angiography revealed 3-vessel disease. The patient underwent an aorto-coronary bypass in February 2003. After surgery, he used standard therapy for coronary heart disease and chronic heart failure. He was treated with anticoagulant therapy for the presence of a thrombus in the apex of the left ventricle too. In 2005, he underwent a surgery for peripheral artery disease. As a part of the primary prevention of sudden cardiac death, ICD was implanted in 2009. In the long term, the patient was in functional group NYHA II, left ventricle EF was around 25%. In 2018, atrial fibrillation was newly diagnosed, worsening of symptoms appeared, NYHA class III, the patient was indicated for rhythm control and modification of HF therapy. The possibility of complex heart failure therapy was repeatedly discussed with the patient, including the consideration of device therapy or heart transplantation. However, due to the patient’s workload and the COVID-19 pandemic, this issue was not resolved in time. In 2021, he underwent a re-examination at the cardiology clinic (age 68) – due to his age and comorbidities, only conservative therapy for chronic heart failure was indicated. Empagliflozin was newly included in the medication. The patient, despite the current maximum pharmacological treatment, suffers from worsening symptoms of heart failure and is in functional group NYHA III.

Srdeční selhání se sníženou systolickou funkcí s časným zahájením terapie inhibitory SGLT2 

K. Kyšperská

Chronic heart failure is a progressive chronic disease associated with poor prognosis and diminished quality of life, despite ongoing advancements in therapy. The most common causes of chronic heart failure with reduced systolic function include ischemic heart disease, arterial hypertension, and cardiomyopathies. The disease course is often complicated by cardiac decompensation, frequently requiring hospitalization. Each episode of heart failure worsens the overall prognosis for the patient. Our case report describes a patient, a type 2 diabetic, who had an acute coronary event followed by heart failure with reduced systolic function. The patient was hospitalized multiple times for cardiac decompensation shortly after the coronary event. Early comprehensive therapy for heart failure with reduced systolic function was initiated. As part of the heart failure treatment, the early administration of sodium-glucose cotransporter 2 (SGLT2) inhibitors was also initiated with good tolerance of the medication and gradual stabilization of the patient’s condition.