{"id":30849,"date":"2018-09-07T13:43:46","date_gmt":"2018-09-07T11:43:46","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=30849"},"modified":"2018-09-07T13:43:46","modified_gmt":"2018-09-07T11:43:46","slug":"i-po-infarktu-myokardu-se-lze-vratit-ke-kvalitnimu-zivotu-diky-urovni-lecby-ktera-v-ceske-republice-patri-ke-svetove-spicce","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=30849","title":{"rendered":"I po infarktu myokardu se lze vr\u00e1tit ke kvalitn\u00edmu \u017eivotu d\u00edky \u00farovni l\u00e9\u010dby, kter\u00e1 v \u010cesk\u00e9 republice pat\u0159\u00ed ke sv\u011btov\u00e9 \u0161pi\u010dce"},"content":{"rendered":"

V\u010dasn\u00fd interven\u010dn\u00ed z\u00e1krok, dodr\u017eov\u00e1n\u00ed n\u00e1sledn\u00e9 l\u00e9\u010dby a d\u016fsledn\u00e1 \u00faprava \u017eivotn\u00edho stylu vedou u naprost\u00e9 v\u011bt\u0161iny pacient\u016f, kte\u0159\u00ed prod\u011blali infarkt myokardu, k n\u00e1vratu ke kvalitn\u00edmu \u017eivotu bez v\u00fdrazn\u00fdch limitac\u00ed. \u010cesk\u00e1 republika pat\u0159\u00ed na prvn\u00ed m\u00edsto v Evropsk\u00e9 unii v z\u00e1chytu a l\u00e9\u010db\u011b akutn\u00edch infarkt\u016f myokardu.<\/strong> <\/p>\n

\u010casn\u00e1 intervence v jednom z dvaadvaceti specializovan\u00fdch katetriza\u010dn\u00edch center, rychl\u00fd dojezd do nich, dvaceti \u010dty\u0159hodinov\u00e1 p\u00e9\u010de na \u00farovni sv\u011btov\u00e9 \u0161pi\u010dky, to jsou d\u016fvody, pro\u010d pacienti po nekomplikovan\u00fdch infarktech odch\u00e1zej\u00ed nejpozd\u011bji po p\u011bti dnech dom\u016f. Podm\u00ednkou n\u00e1vratu do kvalitn\u00edho \u017eivota je v\u0161ak dodr\u017eov\u00e1n\u00ed p\u0159edepsan\u00e9 l\u00e9\u010dby i \u00faprava \u017eivotn\u00edho stylu.<\/p>\n

Kardiovaskul\u00e1rn\u00ed onemocn\u011bn\u00ed v \u010dele s ischemickou chorobou srde\u010dn\u00ed jsou st\u00e1le zodpov\u011bdn\u00e1 za polovinu v\u0161ech \u00famrt\u00ed ve vysp\u011bl\u00fdch zem\u00edch a p\u0159edstavuj\u00ed tak v\u00fdznamn\u00fd socioekonomick\u00fd probl\u00e9m. Podle \u00daZIS byla v roce 2015 v \u010cesk\u00e9 republice nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou \u00famrt\u00ed pr\u00e1v\u011b onemocn\u011bn\u00ed ob\u011bhov\u00e9 soustavy, a to v 50 % p\u0159\u00ed\u010dinou \u00famrt\u00ed \u017een a v 45 % p\u0159\u00ed\u010dinou \u00famrt\u00ed mu\u017e\u016f. Celkem se jednalo o t\u00e9m\u011b\u0159 51 000 \u00famrt\u00ed.<\/p>\n

Na prvn\u00edm m\u00edst\u011b v r\u00e1mci kardiovaskul\u00e1rn\u00edch onemocn\u011bn\u00ed je u obou pohlav\u00ed ischemick\u00e1 choroba srde\u010dn\u00ed, na druh\u00e9m infarkt myokardu. P\u0159edpokl\u00e1d\u00e1 se, \u017ee a\u017e 30 % pacient\u016f se srde\u010dn\u00edm infarktem zem\u0159e. K drtiv\u00e9 v\u011bt\u0161in\u011b \u00famrt\u00ed p\u0159itom dojde je\u0161t\u011b p\u0159ed p\u0159\u00edjezdem z\u00e1chrann\u00e9 slu\u017eby u nemocn\u00fdch, kte\u0159\u00ed podcen\u00ed p\u0159\u00edznaky infarktu a nep\u0159ivolaj\u00ed z\u00e1chrannou slu\u017ebu v\u010das. \u00damrtnost po p\u0159ijet\u00ed do nemocnice d\u00edky pokrok\u016fm v sou\u010dasn\u00e9 medic\u00edn\u011b v posledn\u00edch p\u011btadvaceti letech v\u00fdrazn\u011b poklesla z cca 13 % na dne\u0161n\u00edch 5-6 %.<\/p>\n

Srde\u010dn\u00ed infarkt neboli tzv. infarkt myokardu (IM) lze zjednodu\u0161en\u011b definovat jako \u00famrt\u00ed \u010d\u00e1sti srde\u010dn\u00edch bun\u011bk, vznikl\u00e9 na podklad\u011b n\u00e1hl\u00e9ho uz\u00e1v\u011bru nebo v\u00fdrazn\u00e9ho z\u00fa\u017een\u00ed v\u011bn\u010dit\u00e9 (koron\u00e1rn\u00ed) tepny, kter\u00e1 z\u00e1sobuje p\u0159\u00edslu\u0161nou oblast. Akutn\u00ed infarkt se nej\u010dast\u011bji projevuje jako siln\u00e1, v klidu vznikl\u00e1, tlakov\u00e1, sv\u00edrav\u00e1 nebo p\u00e1liv\u00e1 bolest na p\u0159edn\u00ed stran\u011b hrudn\u00edku. Nemocn\u00fd s akutn\u00edm infarktem myokardu je v p\u0159\u00edm\u00e9m ohro\u017een\u00ed \u017eivota. Z\u00e1sadn\u00edm faktorem, kter\u00fd ovliv\u0148uje \u0161anci na p\u0159e\u017eit\u00ed, je \u010das. Objev\u00ed-li se proto u n\u011bkoho v\u00fd\u0161e popsan\u00e9 p\u0159\u00edznaky \u2013 p\u0159edev\u0161\u00edm bolest na hrudi (zvl\u00e1\u0161t\u011b trv\u00e1-li d\u00e9le ne\u017e deset minut), m\u011bl by posti\u017een\u00fd nebo jeho okol\u00ed co nejd\u0159\u00edve kontaktovat zdravotnickou z\u00e1chrannou slu\u017ebu (telefon 155 nebo 112).<\/p>\n

Profesor MUDr. Milo\u0161 T\u00e1borsk\u00fd, Ph.D., MBA, FESC, p\u0159ednosta I. intern\u00ed kardiologick\u00e9 kliniky Fakultn\u00ed nemocnice a Univerzity Palack\u00e9ho v Olomouci a p\u0159edseda v\u00fdboru \u010cKS situaci komentuje: \u201eV \u010cesk\u00e9 republice je \u0161iroce dostupn\u00e1 s\u00ed\u0165 katetriza\u010dn\u00edch center i vysok\u00e1 organizovanost l\u00e9ka\u0159sk\u00e9 z\u00e1chrann\u00e9 slu\u017eby. V\u011bt\u0161ina pacient\u016f s akutn\u00edm infarktem myokardu se dostane k pomoci v\u010das. P\u0159esto n\u011bkte\u0159\u00ed nemocn\u00ed zbyte\u010dn\u011b um\u00edraj\u00ed d\u00edky nedostate\u010dn\u00e9 informovanosti a edukaci laick\u00e9 ve\u0159ejnosti. Lid\u00e9 s podez\u0159en\u00edm na infarkt by nem\u011bli v\u00e1hat se zavol\u00e1n\u00edm rychl\u00e9 z\u00e1chrann\u00e9 slu\u017eby.\u201c<\/p>\n

L\u00e9\u010dba infarktu myokardu je v \u010cesk\u00e9 republice na sv\u011btov\u00e9 \u00farovni<\/p>\n

Pro \u00fasp\u011bch l\u00e9\u010dby infarktu myokardu je kl\u00ed\u010dov\u00fd v\u010dasn\u00fd z\u00e1krok ve specializovan\u00e9m katetriza\u010dn\u00edm centru, kter\u00fdch je v \u010cesk\u00e9 republice dvacet dva, ale z\u00e1rove\u0148 i n\u00e1sledn\u00e9 dodr\u017eov\u00e1n\u00ed re\u017eimov\u00fdch opat\u0159en\u00ed a u\u017e\u00edv\u00e1n\u00ed doporu\u010den\u00e9 medikace a re\u017eimov\u00fdch opat\u0159en\u00ed po n\u00e1vratu z nemocnice.<\/p>\n

\u201eC\u00edlem tzv. perkut\u00e1nn\u00ed koron\u00e1rn\u00ed intervence (katetriza\u010dn\u00ed metody prov\u00e1d\u011bn\u00e9 v katetriza\u010dn\u00edm centru) je zpr\u016fchodn\u011bn\u00ed koron\u00e1rn\u00ed tepny, jej\u00ed\u017e uz\u00e1v\u011br nebo v\u00fdrazn\u00e9 z\u00fa\u017een\u00ed zp\u016fsobilo infarkt. D\u00edky \u010dasn\u00e9mu zpr\u016fchodn\u011bn\u00ed posti\u017een\u00e9 tepny je tak mo\u017en\u00e9 zabr\u00e1nit dal\u0161\u00edmu odum\u00edr\u00e1n\u00ed srde\u010dn\u00edch bun\u011bk v d\u016fsledku jejich nedokrevnosti. Pro udr\u017een\u00ed pr\u016fchodnosti c\u00e9vy je p\u0159i tomto z\u00e1kroku mo\u017eno zav\u00e9st i tzv. stent (v\u00fdztu\u017e c\u00e9vy). Katetriza\u010dn\u00ed metody se v \u010cesk\u00e9 republice pou\u017e\u00edvaj\u00ed ke zpr\u016fchodn\u011bn\u00ed koron\u00e1rn\u00ed (srde\u010dn\u00ed) tepny u v\u011bt\u0161iny nemocn\u00fdch s infarktem a prokazateln\u011b sni\u017euj\u00ed riziko \u00famrt\u00ed nebo vzniku dal\u0161\u00edho infarktu. Vedle interven\u010dn\u00edho z\u00e1kroku by m\u011bla b\u00fdt pacient\u016fm sou\u010dasn\u011b nasazena protidesti\u010dkov\u00e1 l\u00e9\u010dba. Ta omezuje vznik desti\u010dkov\u00e9ho trombu (sra\u017eeniny) jak v srde\u010dn\u00edch tepn\u00e1ch, tak v zaveden\u00e9m stentu,\u201c vysv\u011btluje doc. MUDr. Petr Kala, Ph.D., FESC, z Intern\u00ed kardiologick\u00e9 kliniky FN Brno a LF MU, \u010dlen v\u00fdboru \u010cKS.<\/p>\n

Sekund\u00e1rn\u00ed prevence<\/p>\n

Je\u0161t\u011b p\u0159ed propu\u0161t\u011bn\u00edm z nemocnice je pacient\u016fm obvykle p\u0159edeps\u00e1na n\u00e1sledn\u00e1 farmakologick\u00e1 l\u00e9\u010dba. Jej\u00ed kl\u00ed\u010dovou sou\u010d\u00e1st\u00ed je pod\u00e1v\u00e1n\u00ed modern\u00edch inhibitor\u016f desti\u010dek, kter\u00e9 oproti star\u0161\u00edm l\u00e9k\u016fm sni\u017euj\u00ed riziko \u00famrt\u00ed z kardi\u00e1ln\u00edch p\u0159\u00ed\u010din a\u017e o 21 %. Sou\u010d\u00e1st\u00ed sekund\u00e1rn\u00ed prevence jsou i tzv. nefarmakologick\u00e9 postupy zahrnuj\u00edc\u00ed odvyknut\u00ed kou\u0159en\u00ed, \u00fapravu stravovac\u00edch n\u00e1vyk\u016f, pravideln\u00e9 fyzick\u00e9 aktivity i eliminace stresov\u00fdch situac\u00ed. Dodr\u017eov\u00e1n\u00ed p\u0159edepsan\u00e9 l\u00e9\u010dby i \u00faprava \u017eivotn\u00edho stylu jsou kl\u00ed\u010dov\u00e9 pro \u00fasp\u011b\u0161n\u00fd n\u00e1vrat pacient\u016f ke kvalitn\u00edmu \u017eivotu. P\u0159esto se v\u011bt\u0161ina nemocn\u00fdch dostate\u010dn\u011b nel\u00e9\u010d\u00ed, do roka po infarktu u\u017e\u00edv\u00e1 podle zahrani\u010dn\u00edch zdroj\u016f p\u0159edepsanou l\u00e9\u010dbu jen p\u0159ibli\u017en\u011b 20 % z nich.
\nT\u00edm se vystavuj\u00ed zna\u010dn\u00e9mu riziku, proto\u017ee ateroskler\u00f3za, kter\u00e1 je p\u0159\u00ed\u010dinou infarktu myokardu, je postupuj\u00edc\u00edm onemocn\u011bn\u00edm a statistiky dokl\u00e1daj\u00ed, \u017ee u ka\u017ed\u00e9ho p\u00e1t\u00e9ho pacienta se infarkt myokardu v horizontu p\u011bti let zopakuje.<\/p>\n

Zm\u011bny v ochrann\u00fdch limitech<\/p>\n

Pacienti s infarktem myokardu se nemusej\u00ed b\u00e1t doplatk\u016f za kvalitn\u00ed l\u00e9ky, kter\u00e9 jsou jim p\u0159edeps\u00e1ny v r\u00e1mci sekund\u00e1rn\u00ed prevence.<\/p>\n

Pro ka\u017ed\u00e9ho poji\u0161t\u011bnce v \u010cesk\u00e9 republice je stanoven ochrann\u00fd finan\u010dn\u00ed limit, tzn. celkov\u00e1 \u010d\u00e1stka, kterou od n\u011bj zdravotn\u00ed syst\u00e9m sm\u00ed vybrat na poplatc\u00edch. Od 1. ledna 2018 se ochrann\u00fd limit u star\u0161\u00edch osob a d\u011bt\u00ed sni\u017euje. Lid\u00e9 sta\u0159\u00ed 70 a v\u00edce let maj\u00ed ochrann\u00fd limit 500 K\u010d ro\u010dn\u011b. Lid\u00e9 star\u0161\u00ed 65 let a mlad\u0161\u00ed ne\u017e 18 let maj\u00ed ochrann\u00fd limit 1000 K\u010d ro\u010dn\u011b. Lid\u00e9 ve v\u011bku 19-64 let maj\u00ed limit 5000 K\u010d ro\u010dn\u011b.<\/p>\n

Ka\u017ed\u00e1 poji\u0161\u0165ovna hl\u00edd\u00e1 ochrann\u00e9 limity za sv\u00e9 pacienty. Ti tedy o pen\u00edze nemus\u00ed \u017e\u00e1dat, poji\u0161\u0165ovna jim pen\u00edze za\u0161le do \u0161edes\u00e1ti dn\u016f v n\u00e1sleduj\u00edc\u00edm \u010dtvrtlet\u00ed, kdy byl limit p\u0159ekro\u010den.<\/p>\n

Virtu\u00e1ln\u00ed srdce pro jednoduchou edukaci po infarktu myokardu<\/p>\n

Pro pacienty, kte\u0159\u00ed prod\u011blali infarkt myokardu, ale i jejich rodinn\u00e9 p\u0159\u00edslu\u0161n\u00edky byla vyvinuta aplikace Virtual Heart. Ta informuje nejen o p\u0159\u00ed\u010din\u00e1ch a n\u00e1sledc\u00edch infarktu myokardu, ale tak\u00e9 o interven\u010dn\u00ed terapii, n\u00e1sledn\u00e9 medikaci a \u00faprav\u011b re\u017eimu. Aplikaci je mo\u017en\u00e9 si st\u00e1hnout zdarma z App Storu nebo Google Play nebo pomoc\u00ed QR k\u00f3du.<\/p>\n

Tiskov\u00e1 zpr\u00e1va<\/p>\n","protected":false},"excerpt":{"rendered":"

V\u010dasn\u00fd interven\u010dn\u00ed z\u00e1krok, dodr\u017eov\u00e1n\u00ed n\u00e1sledn\u00e9 l\u00e9\u010dby a d\u016fsledn\u00e1 \u00faprava \u017eivotn\u00edho stylu vedou u naprost\u00e9 v\u011bt\u0161iny pacient\u016f, kte\u0159\u00ed prod\u011blali infarkt myokardu, k n\u00e1vratu ke kvalitn\u00edmu \u017eivotu […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14888,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-30849","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30849","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30849"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30849\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14888"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30849"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30849"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30849"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}