Angina in the acute phase of myocardial infarct

Factor VIII (AHG) activity was assayed in the plasma specimens from 1016 regular and controlled blood donors. Age and ABO blood groups had highly significant effects on factor VIII concentrations, whereas the effect of sex was not significant. The median in the donors of blood group O rose from 87% at the age of 20 to 119% at the age of 60 years, and the median in blood groups A and B+AB of corresponding ages rose from 108 to 147%. An interaction effect of age and blood groups was present only at the 5% level of significance. The present data and the previous findings of others suggest the existence of an association between high factor VIII levels and thrombotic states.     

Early and long-term results of direct PTCA in patients with acute myocardial infarct

A review of the literature suggests that direct PTCA for acute myocardial infarction is indicated and feasible in 90-95% of unselected, consecutive patients; direct PTCA is reported to be successful in > 90% of procedures. This results in a hospital mortality of 3-7% for unselected patients and a 4% re-infarction rate. A recent meta-analysis of direct PTCA vs i.v. thrombolysis in patients with acute infarction demonstrates a lower mortality after PTCA (4.4% vs 6.5%, p = 0.02) as well as lower mortality/re-infarction rate (7.2% vs 11.9%, p < 0.001). Mortality in the 1st year after discharge is < 5% with about half of the fatalities being due to cardiac causes. Patients presenting with or developing cardiogenic shock in the acute infarct phase experience a 20-50% acute mortality. Mortality rests at < 10% in these patients in the first year after discharge. In conclusion, (1) direct PTCA is feasible without additional risks in patients with acute myocardial infarction, (2) angiographic and clinical success rates of direct PTCA are favorable and superior to i.v. thrombolysis in the hands of expert operators, and (3) referral to an institution providing the option of immediate, direct PTCA must be considered in the patient with acute infarction but contraindication(s) to i.v. thrombolysis.     

Treatment acute myocardial infarct in the pre-hospital phase

OBJECTIVE: To examine the circadian variation in the signal averaged electrocardiogram (saECG) and heart rate variability and investigate their relations in healthy subjects. METHODS: 24 hour ECGs were obtained with a three channel recorder using bipolar X, Y, and Z leads in 20 healthy subjects. The following variables were determined hourly: heart rate, filtered QRS (f-QRS) duration, low and high frequency components of heart rate variability (LF and HF), and the LF/HF ratio. RESULTS: Heart rate, f-QRS duration, HF, and the LF/HF ratio showed significant circadian rhythms, as determined by the single cosinor method. Heart rate and the LF/HF ratio increased during daytime, and f-QRS duration and HF increased at night. f-QRS duration was negatively correlated with heart rate (r = 0.95, p < 0.001) and the LF/HF ratio (r = 0.94, p < 0.001) and positively with HF (r = 0.93, p < 0.001). CONCLUSIONS: f-QRS duration has a significant circadian rhythm in healthy subjects and is closely related to the circadian rhythm of autonomic tone.     

Adjuvant therapy in patients with acute myocardial infarct

Besides the thrombolytic therapy several adjuvant therapeutic measures were identified which significantly improve the prognosis of patients with acute myocardial infarction (AMI). These measures include the treatment by means of acetylsalicylic acid (ASA), beta-blockers and ACE inhibitors. Early administration of ASA and beta-blockers are indicated in all patients with AMI who have no contraindications for this therapy. They are especially the patients with manifest heart failure or asymptomatic left ventricular dysfunction who benefit from ACE inhibitors. The effectivity of routine administration of other medicaments such as anticoagulants, nitrates, calcium channel blockers and magnesium, have not been convincingly proved. However, some selected patients with AMI can benefit from these medicaments. Intravenous administration of heparin is unambiguously justified only in thrombolysis with t-PA. Thrombolyses with streptokinase, urokinase, and anistreplase are justified only at high risk of thromboembolic complications. Their prevention and therapy include also the necessity to restrict the administration of pelentan. The use of nitrates is indicated in patients with AMI in case of sustaining stenocardia, arterial hypertension and manifest heart left ventricular failure. Until the definitive standpoint is gained regarding the effect of magnesium in patients with AIM, its administration remains especially indicated in cases of arterial hypertension, tachycardiac disturbances of the heart rhythm and states of assumed or proved hypomagnesiemia. In AMI cases when magnesium is used in order to protect the patient from reperfusion lesion, it must be administered prior to the reperfusion therapy. An intensive research in the field of therapeutical measures in patients with AMI still continues. It is certain that it will soon bring further knowledge which will in turn improve the prognosis and quality of life of patients with AMI. (Tab. 4, Ref. 133.)     

Long-term electrocardiographic monitoring of patients after acute myocardial infarct

The authors present an account on detailed electrocardiographic follow-up of a patient for 12 months after an inferior myocardial infarction. The patient died 14 months after the IM due to arrhythmia after previous remodelling of the left ventricle. The results assembled by means of superstandard methods of signal averaging electrocardiography (method of cumulative amplitudes, RMS signal and frequency analysis) and electrocardiographie body surface mapping (isointegral maps) are confronted with detailed clinical examinations and repeated echocardiographic investigations. The assembled results indicate that the applied superstandard methods make it possible to extract electrocardiographic parameters (presence of pathological high frequency peaks, raised values of partial cumulative amplitudes at the end of the QRS complex at higher frequencies, negative correlation coefficients from comparisons of integral maps with controls) which are a signal that the patient's life is threatened.     

Cardiac gammagraphy with technetium 99 pyrophosphate in myocardial infarct

The predominant fatty acids (C10-C18) of dermatophytes were investigated by the Landsteiner-Draize test to establish their allergenicity. It was demonstrated that fatty acids can give rise to sensitization of delayed type in guinea pigs. The middle-chain fatty acids (C10-C12) showed a high allergenicity compared to the (C13-C18) acids with moderate to weak contact sensitizing properties. The fatty acids may act as contact sensitizers and, at least sometimes, be responsible for the skin lesions in dermatophytosis.     

The pre-hospitalization period in acute myocardial infarct

The article reviews the possibilities of biochemical markers in coincidence with the assessment of prognosis in acute coronary syndromes and in the revealing of effectivity of their therapy. The current options of clinical biochemistry in many cases allow to supplement, confirm, or exclude the results of modern physical and other clinical examination methods and in this way to contribute to the accuracy of the diagnostic process, and enable to comment the prognosis and the risk measure of the patient. A significant progress has been achieved in the assessment of effectivity in thrombolytic therapy in acute myocardial infarction, where especially the series assessment of myoglobin levels or specific troponin cardiomarkers can facilitate the process of physician's decision as to the assessment of the subsequent procedure in the treatment of patients. The assessment of levels of both specific and partly less specific cardiomarkers becomes one of the criteria of the decision in coincidence with ischaemic episodes in the peri and postoperative periods (the diagnosis of peri-operative myocardial infarction). Specific troponin cardiomarkers acquire an extraordinary significance in the prediction of the measure of risk in patients with unstable angina pectoris where already one single assessment of the level of these markers is sufficient for hospitalization of the patient and thus enables to change the physician's strategy of further therapy. (Ref. 95.).     

Therapy with glucose-insulin-potassium reduces the complications in the acute phase of myocardial infarct. Arguments against

Glucose-insulin-potassium therapy has shown its efficacy in diminishing the myocardial damage under ischemia-reperfusion conditions in experimental models. This effect appears to be mainly due to the increase of anaerobic glycolysis in ischemic cells with a consequent reduction in the use of fatty acids. On the other hand, clinical studies in the acute phase of myocardial infarction are out-dated and almost non-existent in the thrombolytic era. The absence of current consistent data makes it difficult to draw conclusions concerning the real utility of this therapy in the clinical practice.     

The cellular substrates of the acute myocardial infarct syndrome

Immunoassay techniques yield estimates of concentrations of analytes based on comparison to known concentrations of a reference solution. The use of the nonlinear logistic model makes the error estimates and confidence levels approximate. When the goal of such a study is estimation of several unknowns, methods in common usage do not account for 'simultaneous' inference, i.e. the repeated use of the standard curve for estimating several concentrations. Alternative methods are described which take multiple use of the reference curve into account. Simulations using normally distributed data with variance proportional to a power of the mean compare different methods of obtaining calibration intervals and illustrate the approximate nature of all such techniques. Calibration intervals based on simple, commonly used methods do not provide the coverage promised, even for one-at-a-time estimation, and are not suited for multiple estimation and comparison.     

Early evaluation of results from systemic thrombolysis in acute myocardial infarct: the value of troponin I

STUDY OBJECTIVES: This paper compares the performance of an experimental nasal positive airway pressure device that automatically adjusts the level of applied pressure (APAP) with the performance of a conventional continuous positive airway pressure (CPAP) in a sleep laboratory study. DESIGN: In a randomized sequence, conventional CPAP therapy was applied for 1 night (CPAP night) and APAP therapy the following night (APAP night). SETTING: The study was conducted in an accredited sleep disorders center. PATIENTS OR PARTICIPANTS: Twenty-six men and 5 women between the ages of 35 to 73 (51 +/- 9.6) years with body mass index 35.82 +/- 8.35 (kg/m2) who were diagnosed (using standard nocturnal polysomnography [NPSG] methods) as having OSA syndrome were studied. The subjects were treated with conventional CPAP for approximately 8 (7.79 +/- 3.16) weeks at home prior to their participation in this study. MEASUREMENTS AND RESULTS: All standard polysomnography data and nasal mask pressures were recorded using a computer-based data acquisition system. Sleep and respiratory data were scored by a registered polysomnographer. The mean apnea-hypopnea index (AHI) for subjects for the NPSG night was 55.2 +/- 33.7. It dropped to 4.2 +/- 3.8 for the CPAP night and to 5.4 +/- 5.4 for the APAP night. There was no significant (p = 0.05) difference between mean AHI indices, sleep stages, sleep stage shifts, and snore arousals for CPAP night and APAP night. However, all the measures showed significant (p = 0.05) improvement over NPSG night. The mean of APAP applied pressure (8.4 +/- 3.3 cm H2O) was significantly (p = 0.05) lower than the prescribed pressure (11.5 +/- 3.1 cm H2O), but there was no significant (p = 0.05) difference between the maximum APAP applied pressure (12.8 +/- 4.3 cm H2O) and the prescribed pressure (11.5 +/- 3.1 cm H2O). All mean comparison tests were carried out using two-tailed statistics. CONCLUSIONS: APAP appears to be as effective as CPAP in treating OSA patients. APAP delivers the same level of therapy as CPAP, but it reduces the average airway pressure while providing needed peak pressures.     

Catamnestic studies on the prodomal phase of myocardial infarct

In a retrospective study by means of a half-standardized method of interview in 154 patients with acute myocardial infarction and in a control group of the same age (n = 100) anamnestic data were established, particularly taking into consideration the preinfarction phase. 27% of the patients were surprised by an acute myocardial infarction without prodromal symptoms, in 32% the first occurrence of complaints of angina pectoris was during the last two months before the infarction. 41% had a preexisting angina pectoris which usually showed a crescendo-course with increasing approximation to the infarction. More than half of the patients reported on physical activity or/and emotional stress as causal factors of the preinfarction complaints. The correlation with the localisation of the infarction showed above all an occurrence of the prodromal symptoms in infarctions of the anterior wall and in lesions of the myocardium which in most cases could be ascertained only enzymatically. A greater accumulation of the prodromi was furthermore found in younger patients, in hypertension and preexisting restriction of the heart function. 70% of the patients with warning symptoms consulted a physician because of their heart complaints. In the control group 22% of the persons reported on heart complaints.     

Emergency department use of aspirin in patients with possible acute myocardial infarction

OBJECTIVE: To determine the relevance of the functional affinity of IgM rheumatoid factor (RF) to the clinical and serological characteristics of patients with rheumatoid arthritis. METHODS: The functional affinity of IgM RF of 57 seropositive rheumatoid arthritis patients was evaluated by an enzyme linked immunosorbent assay based on the use of a chaotropic agent. The inhibition index was taken as an estimate of functional affinity. The patient group was divided into high functional affinity subgroup 1 (functional affinity < 0.5, n = 37) and low functional affinity subgroup 2 (functional affinity > 0.5, n = 20). The medical records of all patients were reviewed with a particular note of the disease activity and the articular damage score. RESULTS: The disease duration was shorter (P < 0.01) in subgroup 1 patients [7.9 (SD 6.4) years] than in subgroup 2 patients [13.4 (11.29) years], so that Ritchie's, Lee's, and Steinbrocker's indices were lower in the former than in the latter (P < 0.01, 0.001, and 0.01, respectively). In contrast, erythrocyte sedimentation rates, C reactive protein concentrations, antinuclear antibody, and HLA DR4 prevalences were similar in the two subgroups. CONCLUSIONS: Different forms of RF are present during progression of the disease.     

The effect of rehabilitative treatment on left ventricular performance in myocardial infarct patients in the convalescent phase

There have been studied the left ventricular performance at 71 patients (66 B/5 F) with myocardial infarction during the convalescence period, admitted in the Department of Clinical Rehabilitation in a period of time between 01.01.1992-31.10.1993. Mean age was 49.9 +/- 4.3 years. Most of the patients had antero-septal (33 patients--46%) and posteroinferior (29 patients--41%) myocardial infarction. The left ventricular performance was assessed by the study of exercise electrocardiography (TTI), of the systolic intervals using the Weissler equations and echocardiography (M-mode and 2D). After the period pf training (21 days), we saw a significant reduction of TTI at the same step of the test. The systolic intervals significantly modified after the training were PEVS (p < 0.025), PEP/PEVS (p < 0.025), EF (p < 0.025). EF and SF measured echographically do not indicate significant differences after the training. There are not important improvements of the wall motion disorders at the end of the period.     

Cardiac death and acute myocardial infarct after psychological or physical stress--causality questions and insurance law

Often, it is the question to the medical expert, if there is a causality in the lawful sense from professional effort or psychical stress to acute coronary death or acute myocardial infarction. Following the German social law the connection has to be probably. Probability is well defined juridically opposite to possibility. The medical expert has to answer if the physical or psychical stress has caused the fatality or not more than manifested. Here are discussed arguments that the atheromatosis of the coronary vessels has much more importance than the manifestation of acute death or myocardial infarction caused by spasmus. There is no evidence for the existence of spastic genesis without any arteriosclerotic focus.