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.     

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.     

Criteria for evaluating the effectiveness of myocardial infarct patient rehabilitation (posthospital phase)

On the basis of the analysis of a 24- to 30-month posthospital phase of rehabilitation in 486 patients with myocardial infarction, critera were elaborated for dividing them into 4 classes with mathematically determined severity index. Criteria for analysing rehabilitation efficacy available for wide practice and a definite algorithm for differentiated management of patients with stage by stage appraisal of the condition and reaching alternate decisions are suggested. The strict dependence of the results of the post-hospital rehabilitation phase on the appraisal of the patients, condition and the corresponding correction of the rehabilitation program is shown.     

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.     

Hemodynamic studies of patients with recent myocardial infarct by means of radiocardiography

The effect of endotoxin to depress the hepatic drug-metabolizing enzyme activity has been studied in the C3H/HeJ and C3H/HeN strains of mice. The C3H/HeJ mouse strain is generally considered to be unresponsive to the biological effects of endotoxin. However, injection of these mice with 0.5 mg/kg body weight of E.coli endotoxin (Westphal extracted) produced a decrease in the rate of N-demethylation of ethylmorphine and in the levels of cytochrome P-450 and cytochrome b5 comparable to that observed in the endotoxin-sensitive C3H/HeJ mouse strain. Although the mechanism of endotoxin action to decrease hepatic microsomal drug-metabolizing activity is presently unknown, the results suggest that: 1) the C3H/HeJ mouse stain is responsive to this endotoxin effect, and 2)that cellular constituents other than B-cells or macrophages are probably involved in eliciting the response, since these cells of the C3H/HeJ mouse are unresponsive to endotoxin.     

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.     

Morphogenesis of atypical myocardial infarct

Morphology of atypical myocardial infarctions and their morphogenesis were studied in 120 cases. The importance of atherosclerosis as the background process, the secondary development of coronary thrombosis and the leading role of metabolic factors (hypoxy, acidosis, etc) in the origin of atypical myocardial infarctions were established.     

Secondary prevention of myocardial infarct

Preventive measures are the most powerful measures to treat manifestations of ischemic cardiopathy. Secondary prevention of myocardial infarction involves the following intervention areas: a) Limitation of adverse physiological and emotional consequences of the acute illness; b) Identification of the patients particularly exposed to the risk of new episodes of ischemic cardiopathy or to their consequences, namely reinfarction and sudden death; c) Institution of therapeutic attitudes, surgical or medical, that can prolong life and can oppose functional deterioration and prevent symptoms; d) Institution of measures that can oppose the progression of the initial disease that is, in almost all cases, atherosclerosis. Measures that can oppose the progression of cardiac disease and its consequences after an episode of myocardial infarction, and measures that can oppose the evolution of atherosclerosis are described in this article. The measures that can influence the risk factors after an episode of myocardial infarction are briefly commented: characteristics related to life style and physical exercise; smoking habits; plasmatic lipid levels; high blood pressure; and therapeutic substitution with estrogens after menopause. Pharmacological interventions in secondary prevention of myocardial infarction are described, namely with the following groups of substances: beta-adrenergic blocking agents; platelet active agents; anticoagulants; and angiotensin-converting enzyme inhibitors.     

Stress echocardiography in myocardial infarct

For patients with recent myocardial infarction, the main determinants of prognosis are: extent of transmural necrosis, state of the infarct-related artery and the presence and extent of myocardium at risk. The basic principle underlying the use of stress echocardiography states that myocardial ischaemia produces abnormalities of regional wall motion which are by themselves early, sensitive and specific markers of decreased perfusion. Dobutamine infusion allows for evaluation of myocardial contractile reserve by increasing inotropism. In low doses it gives us information on regional viability. In high doses, wall motion under increased oxygen demand, it becomes dependent on the ability of the coronary arteries to increase blood flow. Dipyridamole induces coronary vasodilation. In low doses it produces an increase in the blood flow. In high doses the steal effect deviates blood from the regions dependent on stenosed arteries. Ischaemia and regional wall motion abnormalities ensue. A negative stress echocardiogram, either under dobutamine or dipyridamole, has an excellent negative predictive value while a positive stress echocardiogram is predictive of an increased rate of events in the follow-up.