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It is frequently difficult to differentiate between perimyocarditis and acute myocardial infarction (AMI). Diagnosis is usually established by excluding obstructive coronary disease. The primary process in perimyocarditis is inflammation, associated with high C-reactive protein (CRP) and low

Vernakalant is a novel antiarrhythmic agent with a preferential effect on atrial tissue and limited action on ventricular tissue. Intravenous vernakalant effectively converts recent onset atrial fibrillation; conversion is usually achieved quickly with a short half-life and allows early hospital

Objectives. This study sought to establish the risk ratio for mortality associated with calcium antagonists in a large population of patients with chronic coronary artery disease. Background. Recent reports have suggested that the use of short-acting nifedipine may cause an increase in overall mortality in patients with coronary artery disease and that a similar effect may be produced by other calcium antagonists, in particular those of the dihydropyridine type. Methods. Mortality data were obtained for 11,575 patients screened for the Bezafibrate Infarction Prevention study (5,843 with and 5,732 without calcium antagonists) after a mean follow-up period of 3.2 years. Results. There were 495 deaths (8.5%) in the calcium antagonist group compared with 410 in the control group (7.2%). The age-adjusted risk ratio for mortality was 1.08 (95% confidence interval [CI] 0.95 to 1.24). After adjustment for the differences between the groups in age and gender and the prevalence of previous myocardial infarction, angina pectoris, hypertension, New York Heart Association functional class, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and current smoking, the adjusted risk ratio declined to 0.97 (95% CI 0.84 to 1.11). After further adjustment for concomintant medication, the risk ratio was estimated at 0.94 (95% CI 0.82 to 1.08). Conclusions. The current analysis does not support the claim that calcium antagonist therapy in patients with chronic coronary artery disease, whether myocardial infarction survivors or others, harbors an increased risk of mortality.

The rationale for the use of calcium enamel bleckers in patients with chronic heart failure lies in their vasodilator action, antiischemic effect, ability to lessen left ventricular diastole dysfunction and data showing their effect in preventing progression of myocardiai dysfunction in animals with cardiomyopathy. Despite initial studies reporting improvement of the hemodynamic profile with nifedipine, further evaluation showed variable results, with hemodynamic worsening seen in up to 29% of patients. Longer-term controued studies evaluating Symptoms and clinical status demonstrated worsening chronic heart failure in ~25% of patients within 8 weeks of nifedipine therapy. Although diltiazem has a lesser myo cardial depresseset effect and its short-term use was associated with less frequent hemodynamic and clinical worsening, long-tern exposure te the drug in a large group of paients with chronic heart failure due to left ventricular systolic dysfunction after myocardial infarction resulted in an increased incidence of cardiac events, with worsening heart failure and death. The use of verapamil in a simiar patient cohort showed the loss of its demostrated protective effect in patients with clinical evidence of heart failure.In an attempt to improve the safety of calcium channel blockers, the following approaches were suggested 1) use of second-generation drugs with less myocardial depressant effect; 2) concomitant use of angiotensin-converting enzyme inhibitors to prevent reported neurohormonal activation; and 3) development of drugs with favorable neurohormonal effects. These approaches led to mixed results. The use of some second-generation calcium channel blockers such as nisoldipine, felodipine and nicardipine resulted in no change or worsening of clinical status, which did not seem to be prevented by concomitant use of angiotensin-converting enzyme inhibitors. A recent study using amlodipine demonstrated improvement of both the clinical and neurohormonal profiles. Two large ongoing studies are evaluating the effects of felodipine and amlodipine on morbidity and mortality of patients with chronic heart failure and are likely to provide further information regarding the role of calcium blockers in the treatment of this condition.

Several studies have shown an association between low total cholesterol (TC) and increased mortality. Among 13,753 patients (pts) of both genders with coronary artery disease (CAD) aged 45–70 yrs (mean 61 yrs) screened for the Bezafibrate Infarction Prevention (BIP) Study, 554 pts (4.0%) had low TC(≤160 mg/dl) mean (147 ± 12 mg/dl). Age, clinical findings and medical treatments were similar in pts with low TC and pts with TC g 160 mg/dl (mean 222 ± 36 mg/dl). The former had lower mean HDL-C (32.5 ± 8.6 mg/dl) and triglyceride levels (119 ±66 mg/dl) in comparison to pts with TCg 160 mg/dl (37.9 ± 10.0 mg/dl and 164 ± 93 mg/dl respectively). Three year mortality rates after screening were as follows for both groups: Pts group Mortality Total Cardiac Non-cardiac Low T-C (n = 554) 3.8 * 4.3 * 8.1 * Others (n = 13199) 2.7 1.9 4.6 * p l 0.001 Multivariate logistic analysis adjusting for age, gender, past history, clinical and laboratory findings, yielded a relative risk for total mortality among pts. with low TC of 1.48 (90% Confidence Interval 1.14–1.93). Conclusion In this large group of pts with CAD, low TC was associated with excess total and cardiac mortality. Longer follow-up and further investigation are necessary to clarify the meaning of this association.