Risk factor reduction behaviours in coronary angioplasty and myocardial infarction patients

A recent study asked percutaneous transluminal coronary angioplasty (PTCA) patients in Saskatchewan (n = 210) to identify specific information surrounding their rehabilitation behaviours and motivation to change lifestyle. The scale used to elicit this information was developed and previously used to determine patient risk factor knowledge and lifestyle change behaviours among myocardial infarction (MI) patients during rehabilitation phases. The purpose of this article is to discuss the results of PTCA patients' responses and compare these findings to previously obtained data from MI patients. Risk factors most frequently reported by both PTCA and MI patients as causative factors of their heart problems included diet, job stress, low levels of exercise, and other patient-perceived factors. When asked about lifestyle restrictions post-hospitalization, PTCA patients reported more lifestyle restrictions in activities of daily living (recreation, job, social life, sexual activity and driving) following hospitalization than MI patients. Both groups of patients reported high levels of dietary changes made post-hospitalization but findings reflected that MI patients had initiated more modifiable risk factor changes overall than PTCA patients. Comparative results showed that MI patients were more likely to initiate risk factor reduction behaviours for modifiable factors such as smoking, weight reduction, job/family stress, and exercise than PTCA patients. These findings offer insight into differences between PTCA and MI patients with respect to cardiac rehabilitation behaviours and may suggest the need for different teaching-learning approaches and/or more focused patient education for PTCA patients. A goal of cardiac rehabilitation is to encourage patient initiation and maintenance of lifestyle modification behaviours based on identified risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Enterovirus infections as a possible risk factor for myocardial infarction

BACKGROUND: An increasing body of evidence suggests that, in addition to the well-known classic risk factors, some microbial infections may be associated with the development of atherosclerosis and myocardial infarction (MI). The aim of our study was to evaluate the possible role of enteroviral infections in the pathogenesis of MI. METHODS AND RESULTS: Stored sera, collected in Eastern Finland in 1977, from a set of 12 155 randomly selected men and women aged 25 to 64 years were used in prospective, nested case-control study. The study sample comprised 183 men and 81 women with MI and matched controls. The sera were tested for IgG antibodies to a newly identified enterovirus-common (EVC) antigen, to heat-denatured coxsackievirus B5 (CBV-5), and to adenovirus hexon protein. Raw data from enzyme immunoassays were converted to relative units before analysis. In univariate analysis, EVC antibodies were significantly associated with the risk of MI in men (P=0.009) but not in women. Men with MI had a significantly higher mean level of EVC antibodies than matched controls (P=0.014). High antibody levels to EVC were associated with an increased risk of MI in men aged 25 to 49 years (relative risk [RR] 4.34, P<0.001) but not in older men (>50 years of age). Women with MI also showed a trend toward higher antibody levels than control women, but the difference was not statistically significant. Antibody levels to whole CBV-5 or adenovirus hexon protein appeared to be no different among case patients versus control subjects. CONCLUSIONS: If we assume that a high level of EVC antibodies reflects a history of relatively frequent enterovirus infections, the present observation might suggest that enterovirus infections increase the risk of MI at least in middle-aged men. Further studies are needed to understand possible clinical significance of this observation.     

Serum levels of basic fibroblast growth factor in acute myocardial infarction

As it has been reported that basic fibroblast growth factor (bFGF) is a circulating peptide and bFGF gene expression is increased after myocardial ischemia, this study was designed to investigate the serum levels of bFGF in patients with acute myocardial infarction (AMI). Using a bFGF enzyme-linked immunoassay, bFGF levels were determined in venous blood of 15 patients with AMI on admission, at 10 days, and 30 days after infarction, and of 15 age-matched healthy volunteers who were used as controls. bFGF serum levels on admission were similar to normal values (7.48 +/- 2.3 vs 8.14 +/- 2.9 pg/ml). However, they significantly increased (16.82 +/- 3.4 pg/ml; p <0.05) 10 days after the onset of AMI, and at 30 days they returned to baseline (7.07 +/- 2.9 pg/ml). The increased bFGF levels at the second week post AMI suggest that bFGF plays an important role in mediating the development of coronary collateral circulation after myocardial ischemia in humans.     

Dietary magnesium deficiency increases Gi alpha levels in the rat heart after myocardial infarction

OBJECTIVE: Magnesium (Mg) is crucial for the function of G proteins which play important roles in mediating the inotropic effects of beta adrenergic agonists in the heart and are altered in heart failure. This study was performed to determine whether or not dietary Mg deficiency alters functional activity and levels of the two major ventricular G proteins, Gi alpha and Gs alpha in the heart after myocardial infarction (MI). METHODS: Six week old rats were fed an Mg adequate or deficient diet for 6 weeks. At the end of week 3, MI was induced by coronary artery ligation. A sham operation was performed as control. After surgery, surviving animals were maintained on their assigned diets for another 3 weeks. Then, cardiac function was measured, plasma and tissue were collected. RESULTS: Severe hypomagnesemia and increased plasma catecholamine level were observed in all animals fed the Mg deficient diet. A significant reduction of myocardial Mg concentration accompanied by elevated plasma and myocardial calcium concentrations was observed in MI animals with existing Mg deficiency vs. animals fed the Mg adequate diet. Cardiac function was impaired in MI rats and further reduced in MI rats with existing Mg deficiency. Gi alpha level was not altered by either Mg deficiency or MI alone, but was dramatically elevated in animals with combined Mg deficiency and MI (9.9 +/- 0.7 arbitrary unit.mg-1 protein) as compared to MI alone (5.8 +/- 0.6, P < 0.05) and Mg deficiency alone (6.1 +/- 0.8, P < 0.05). Gs alpha level did not differ between groups. GppNHp-, but not fluoride-stimulated adenylyl cyclase activity was slightly reduced in MI animals with existing Mg deficiency. CONCLUSION: The findings suggest that dietary Mg deficiency increases the expression of Gi alpha in the heart after MI, while levels and function of Gs alpha are not compromised during dietary Mg deficiency either with or without MI.     

Angina pectoris and myocardial infarction

This investigation assessed the physical characteristics, functional capacities, and body composition of 45 professional fire fighters, aged 23 through 49 years. Maximum oxygen uptake (VO2), Recovery Oxygen Uptake, arm and leg strength, all showed a negative linear relationship with age. On the other hand, percent body fat increased with age from 18% to 21%. Hand grip strength did not decline significantly as the grip strength values remained fairly constant for all of the fire fighters. Most of the data collected were considered to be within the normal range of the sedentary North American population. It was concluded from these data that professional fire fighters might well benefit from a training program designed to develop and maintain a higher level of personal fitness.     

Prognostic value of plasma atrial natriuretic factor, norepinephrine and epinephrine in acute myocardial infarction

Case reports from the United Kingdom (UK) in 1989 have suggested that the introduction of human insulin in 1985 was associated with an increased risk of sudden death in insulin-treated diabetic patients. If human insulin increases the risk of sudden death, the number of these should have increased during the period where human insulin was introduced. We therefore identified all cases of sudden death in Denmark in younger insulin-treated diabetic patients, age at death below 50 years. During this period the consumption of human insulin went from 0.2% to 70% of the total consumption in Denmark. The total number of cases fulfilling the inclusion criteria was 226, and the annual number of sudden deaths did not change during the study period (p = 0.14). The number of deaths due to hypoglycaemia and cases with unexplained cause of death also remained constant (test for trend: p = 0.44). Chronic alcohol abuse or acute alcohol intoxication was found in 50% of the 135 patients dying from hypoglycaemia, ketoacidosis or unknown cause of death (including found dead in bed), while this was the case in only 16% of the remaining 91 cases dying from other natural causes. We conclude that introduction of human insulin in Denmark was not followed by an increase in sudden deaths among younger insulin-treated diabetic patients.     

Role of infection as a risk factor for atherosclerosis, myocardial infarction, and stroke

An increasing body of evidence has linked infections to atherosclerosis and thrombosis. Herpesviruses cause atherosclerosis in experimental animals. Herpesviruses can also be detected in atherosclerotic lesions in humans. Cytomegalovirus may play a role in arteriosclerosis in transplanted hearts, and this virus, together with tumor suppressor protein p53, can be found in restenosis lesions following angioplasty. Chlamydia pneumoniae and dental infections are associated with coronary heart disease in cross-sectional and longitudinal studies, and preceding respiratory infections are associated with ischemic stroke. Infections may favor formation of atherosclerosis and thrombosis by elevation of blood levels of fibrinogen, leukocytes, clotting factor, and cytokines and by alteration of the metabolism and functions of endothelial cells and monocyte macrophages. Low-grade infections may also be one of the causes of the inflammatory reaction observed in atherosclerotic lesions and acute ischemic symptoms, reflected in elevated levels of C-reactive protein. These observations warrant further studies in this field.     

The Fletcher method

Graphological signs of extraversion were rated from handwriting samples of undergraduates (ns = 35 males, 31 females; 23 males, 20 females) and correlated with extraversion scores from an objective psychological test. No evidence was found for the validity of the graphological signs.     

Non-atherosclerotic acute myocardial infarction

AIM: The aim of the study is to analyse the benefits and risks of PEE in patients, cared for by a team with many years experience. PATIENTS AND METHODS: From 16. 2. 1988 until 31. 12. 1993 246 PEEs (229 gastrostomies, 6 duodenostomies, 7 jejunostomies, 4 attempts) were performed on 234 patients (56% male, 44% female, mean age 68.3 years). 117 patients had tumorous and 117 neurological diseases. We used the pull technique with the Fresenius Freka PEG-system. Analysis was performed using a standardised documentation sheet which was filled out until the end of tube feeding. In total, we registered 39,678 days of tube feeding, 4513 of which were in hospitalized patients. RESULTS: The mean intubation time was 192.6 days (maximum 1496). In 8 cases, the tube could be explanted before the patient was discharged; 68 patients were discharged to a nursing home and 71 patients were allowed to go home. The tube-independent hospital lethality was 36.64%. A PEE-specific lethality had not been registered. Complications arose in a total of 37 patients (15.04%), 4 of which were severe (1.63%) Fifty-nine patients (25.43%) reported short-term feelings of ill health (vomiting, diarrhoea, pain). CONCLUSION: PEE is an effective and low-risk method of long-term nutrition. The advantages are simple insertion, safe handling by patients and relatives/nursing staff and the low cost.     

Rhinomanometry in myocardial infarction

Describing two new cases of so-called Central Core Disease, the authors revealed certain atypical features: The cores were formed in central as well as in peripheral position; they were observed in some apparently type II fibers; typical "structured" and "unstructured" cores coexisted with "reversed" core. Starting from this pictures a cycle of core formation was imaginated supposing to be initiated as the consequence of abnormal functional interrelationship between muscular and neural components in early myogenesis.