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Fejfar, Z. (Cardiovascular Research Center, IKEM, Budejovickd 800 PavB-5, 14000 Prague4, Czechoslovakia). Surveillance and monitoring of cardiovascular disease: assessment of trends. , 1976, 5: 77–81. This paper describes the current state of surveillance and monitoring of acute, chronic and asymptomatic cardiovascular disease with particular reference to the situation in Czechoslovakia. It goes on to discuss some of the difficulties involved in obtaining adequate data on which to base surveillance and of creating a coherent central information system. The importance of combining registration or notification with active intervention is emphasized, and the possibility suggested of introducing simple techniques of cardiovascular investigation into health screening procedures or consultations established primarily for another purpose. [ABSTRACT FROM PUBLISHER]

Background: The aim of the present paper is to review the evolution of concepts regarding the use of Class I and III antiarrhythmic drugs (AADs) in myocardial infarction over the past four decades., Methods: Results of animal experiments carried out by the authors and papers published between 1970 and 2012 in journals and the PubMed search system were used., Results: Animal experiments carried out as early as the 1970s showed that Class IB and IC AADs lose their antiarrhythmic effect and electrically destabilize ventricles in the very early phase of myocardial ischemic focus formation. The cause of this is interaction between Class IB and IC AADs as well as Class III AADs with sympathetic neural activation (SNA) of the heart in the early phase of myocardial ischemia. Given the extremely high and uneven distribution of noradrenaline in tissue, SNA results in dispersion of the depolarization and repolarization processes in the ventricles. The clinical sequels of the interaction between the effects of AADs and SNA are as follows: the antiarrhythmic effect of AADs is restored in AMI once SNA has resolved; membrane-destabilization of the ventricles can be restored any time in the presence of randomly occurring SNA not only due to increasing myocardial ischemia but, also, as a result of psychological stress (emotions), and any pre-existing structural heart disease will enhance the pro-fibrillatory effect of a randomly occurring SNA., Conclusions: Despite the above risks, AADs continue to play an irreplaceable role in suppressing post-myocardial arrhythmias and in preventing sudden cardiac death following ICD placement. The risk of AADs' proarrhythmic effect in SNA can be reduced by combining them with beta-blockers. The last recourse when attempting to suppress malignant ventricular tachyarrhythmias is left sympathetic denervation of the heart.

Investigation of causes, pathogenesis, therapy and prevention of the most frequent circulatory diseases has been the key task of the Institute for Cardiovascular Research founded in 1951. The Institute's Working groups were created accordingly: Arterial hypertension (headed by Jan Brod), Coronary heart disease (Vilém Ganz), Arteriosclerosis (Tibor Zemplényi), Higher nervous activity in relation to circulation (Walter Ehrlich), Disturbance in the circulatory regulations (Zdenĕk Fejfar). Rheumatic heart disease, disturbed function of the kidneys and of the electrolyte metabolism and peripheral vascular disease were also of the clinical interest. The care of patients was the indispensable basis for clinical research. Consisted of the clinical department with 80 beds, large outpatient department, RTG, ECG, biochemical and haematological laboratories. Research projects originated from clinical problem investigated primarily in man. Animal experiment was used only in the solution on man proved not possible. Within a couple of years the Cardiovascular Research Institute became well known abroad and one of the leading clinical centres in Czechoslovakia.

Review of major activities in Czechoslovak cardiology before the second world war and afterwards until the present time. International relations, achievements, problems and failures were closely linked with the Czechoslovak Society of Cardiology, established in 1929.

In the last 15 years, measurement of the ventricular fibrillation threshold (VFT) after ligation of the coronary artery in anaesthetised dogs has become our standard method for the evaluation of the stabilizing effect of antifibrillation drugs. Analysis of a group of 143 dogs revealed that in 75 animals the VFT 8 minutes after the ligation of the coronary artery dropped to less than 1 mA (high risk group), while in the remaining 68 dogs the decrease was smaller and not below 1 mA (low risk animals). The difference between the groups could be seen already before the ligation of the coronary artery. The high risk animals had a lower VFT and a higher heart rate. The groups also differed in the response to drugs administered 15 minutes after the ligation of the coronary artery. Metipranolol, a liposoluble beta blocker of the beta 1 and 2 cardiac receptors (Trimepranol Spofa 0.3 mg.kg-1 b.w.), increased greatly the VFT in both groups already 8 minutes after the injection of the drug and eliminated the difference between the groups. Flunitrazepam (Rohypnol Hoffmann-La Roche 0.25 mg.kg-1 b.w.) increased the VFT less than metipranolol and the difference between the groups disappeared only 30 minutes after its injection. Celiprolol (Selectol Linz Chemie 3.0 mg.kg-1 b.w.) blocking beta 1 and stimulating beta 2 receptors as well as trimecaine (sodium channel blocker, Mesocain Spofa 3.0 mg.kg-1 b.w.) led only to a small insignificant increase in the VFT and the difference between the groups of dogs remained.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodic heart rate fluctuation depends on the oscillation of sympathetic and vagal activation of the heart. Periodic retardation and acceleration of heart rate related to respiration and to blood pressure changes can be registered on the ECG as the "variability of R-R intervals". Testing procedures of the variability of R-R intervals at rest, during deep breathing, daily activities, during exercise and other stress tests are described in the paper. For the evaluation of the R-R interval's variability, current statistical methods are used (e.g. mean with standard deviation, variation coefficient, mean beat to beat differences in R-R intervals etc.). Power spectral analysis in the variability of 200-600 successive R-R intervals commonly performed today uses either rapid Fourier transformation or the autoregulation model. The analysis shows high- and low frequency peaks corresponding to the rapid and slow oscillations in heart rate. Evaluation of the R-R interval variability, especially using power spectrum analysis, gave good results in testing drugs, e.g., beta blockers, calcium antagonists and antiarrhythmic drugs. Variability of R-R intervals is reduced in conditions affecting the cardiac autonomous nervous system such as diabetes. It is also decreased in patients with ischaemic heart disease and in those with cardiac failure of different aetiology. The decrease is not an expression of the disease itself: it shows an alteration in neurovegetative tonicity in the particular disease condition. The decreased variability of R-R intervals in patients with ischaemic heart disease has an important prognostic value. The predominance of the sympathetic over the depressed vagal activity signalizes an increased risk of sudden coronary death.

Fourteen physicians headed by Jan Evangelista Purkynĕ signed the proposed by-laws of the Czech medical society in october 1861. Emperor's approval was received 26th june 1862 and in july Purkynĕ was elected the first president. The same illuminated personalities were the founders of the Casopis lékarů ceských--the Czech medical Journal which has remained the most important Czech periodical until the present time. The aims of the Society were to cultivate medical science and promote Czech language in medicine. Weekly scientific sessions, medical periodical and publication of monographs related to medicine were the means how to achieve the aims. The Czech Medical Society became soon the centre of medical science in Bohemia. Its members were among the foremost fighters for the use of Czech language in Charles university and their relentless effort helped much to the establishment of the Czech Univerzity in 1882 and Czech medical faculty a year later. In subsequent years the Society was also involved in professional problems related to social health insurance, medical fees, ethical problems and other relevant questions such as the establishment of medical chambers. The activity of the Czech medical Society was never interrupted during its 130 years of existence, although there were several difficult periods in its life, mainly during the first and second world war and also in the past 40 years. In spite of the atomization of medicine the Czech medical Society has been continuing its eminent mission to create communication and establish close links between the medical science and practical medicine by systematically bringing new knowledge in medicine and biology to general physicians and by putting together physicians, surgeons and basic scientists. The task for the future is seen in optimal transfer of new knowledge and ideas from scientists to practicians and vice versa; and to take care of the highest possible moral and ethical standard required for humane medicine. Tradition and achievements of our teachers is binding and we are looking forward to better future in united Europe.