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Myocardial ischemia can be assessed by ECG at rest or doing the stress test, which also serves to evaluate the results of cardiac rehabilitation., Aim: The aim of this study was to determine the usefulness of the scale before exercise and exercise to assess the risk of coronary heart disease and recognition by physiotherapists., Materials and Methods: The study included three groups of people: 1. 65 patients with stable coronary heart disease (IHD), including 45 men and 20 women, ranging in age from 33 to 79 years, an average of 60.18 ± 9.43 years who exercise test was positive; 2. 24 patients after myocardial infarction undergoing subsequent rehabilitation, including 20 men and 4 women, aged from 42 to 78 years, an average of 58.75 ± 8.45 years; 3. 70 healthy subjects without ischemic heart disease, including 34 men and 36 women, ranging in age from 24 to 70 years, an average of 56.24 ± 12.33 years. All healthy people and patients were hospitalized in the Department of Internal Medicine and Cardiac Rehabilitation, University Hospital im. WAM in Lodz. The study groups were assessed risk of coronary heart disease based on the result obtained in the scale before exercise and exercise. The results were statistically analyzed using Statistica version 12 (StatSoft, Poland). For the statistically significant level of p<0.05., Results: Compared to healthy individuals in both the ischemic heart disease (p=0.04) and in the group treated with rehabilitation (p=0.03) results in a scale before stress was significant higher. Compared to healthy individuals, both in the group of ischemic heart disease (p <0.001) and in the group treated with rehabilitation (p<0.001) The results on a scale of exercise were significantly higher., Conclusions: The use of scale before exercise to assess the risk of coronary heart disease is useful for physical therapists in their professional practice. There legitimacy of the use of scale exercise for the initial diagnosis of coronary artery disease without knowing the interpretation of the ECG stress test.

Unlabelled: Measurement of oxygen uptake at the maximal exercise (VO2max) in the cardio-pulmonary exercise test provides the most reliable information about exertion tolerance., Aim of the Study: Establishment of VO2peak, VE/CO2 and AT value in the early diagnosis of asymptomatic heart dysfunction in patients with coronary disease (CAD) and prognosis during 2-years observation. The study population: 57 patients (35 M) with CAD, without any signs or symptoms of heart dysfunction, without any features of myocardial infarction, in the age 51.08 +/- 4.01., Methods: The analysis was performed twice: in the beginning and after 2-years observation. Physical examinations, echocardiographic parameters [(assessment of systolic and diastolic dysfunction of the left ventricle (LV)] and spiroergometric parameters (VO2peak, VE/CO2 at AT). On the basis of echocardiographic examination, there were created groups of patients: Group A--the patients with normal LV function (n=32; 56.2%; 23 M); Group B--the patients with diastolic heart dysfunction (n=22; 38.6%; 10 M);, Results: Group A--32 patients in the age of 50.9 +/- 4, 23 men. Values of VO2pe ak :28.8 +/- 6 ml/kg/min, VE/CO2 28.8 +/- 4.9 and AT 18 +/- 2.5. Group B--the patients with diastolic heart dysfunction: 22 (39%) patients; 10 men, in the age of 51.2 +/- 4.3. Values of VO2peak: 26 +/- 3.4 mi/ kg/min, VE/CO2 31.2 +/- 5.1 and AT 16 +/- 2.5. In the beginning of the study was established significantly differences between anaerobic threshold and degree of heart dysfunction (p=0.039)., Conclusions: (1) There was observed that VO2 A and VE/CO2 depended on filling LV profile LV and also of systolic LV function. Anaerobic threshold significantly depended on LV filling pattern. (2) In asymptomatic patients with LV diastolic dysfunction and VO2peak < or = 18.4 ml/kg/min was observed progression of LV diastolic dysfunction during two years.

Acute coronary syndrome (ACS) are the result of a sudden imbalance between myocardial demand for oxygen and its supply. The most common reason (90%) is the sudden reduction of coronary artery lumen by clot formation on a damaged atherosclerotic plaque. Among the uncommon causes, such as spasm, obstruction, inflammation or trauma of the coronary arteries, carbon monoxide poisoning could be the cause of ACS. Carbon monoxide intoxication can lead to ACS both healthy and non-critical restricted coronary artery The paper presents three cases of acute carbon monoxide poisoning complicated by acute coronary syndrome, troponino - positive. Case I: patient 60 years old, smoker, with symptoms of peripheral atherosclerosis of the lower limbs, Case II: patient 50 years old without signs of atherosclerotic disease. Case III: patients aged 20 previously healthy.

There are large numbers of people suffering from simultaneous coronary heart disease and ischaemic heart disease who remain under home palliative care. When concentrating on oencological palliative treatment, there exists sometimes a tendency to forget about the possibility of deterioration in the general condition of a patient with cardio-vascular system dysfunctions. Deterioration in the patient's condition and persistent somatic complaints are frequently interpreted as progress in neoplastic disease or side effects of the employed therapy. It frequently leads to unnecessary discontinuation of palliative oencological treatment. Severe general condition of most patients limits the possibility of ischaemic heart disease diagnosis. It is also impossible to perform stress tests. Resting ECG is a simple and relatively inexpensive diagnostic method, possible to be performed at home by the patient's bed. Basing on a medical survey and an analysis of ECG record, diagnosis of deterioration in CHNS is very successful. The management of a patient with advanced neoplastic disease coexistent with ischaemic heart disease demands careful oencological and cardiologic treatment. ECG examinations carried in the patient's bed constitutes a crucial element of diagnostics in deteriorating coronary heart disease and in heart rate disregulations in patients under home palliative care.

Ischemic heart disease is mainly caused by atherosclerosis and its complications. Platelets have important role in initiation of atherosclerotic lesions. Increase platelet activation and aggregation within coronary circulation initiate thrombus formation at a ruptured or eroded plaque. Large platelets are enzymatically and metabolically more active and have a higher potential thrombosis ability than smaller one. There is growing evidence that myocardial cell injury not only is related to platelet activation of neutrophils (PMNs). PMNs have been demonstrated to release myeloperoxidase (MPO) into coronary circulation. MPO promotes destabilization and rupture of the atherosclerotic plaque surface, impairing vasodilatory and anti-inflammatory function.

Factor involved in the pathogenesis of cardiovascular diseases, especially coronary heart disease is the endothelium. The balance between endothelial substances originating from the action, and narrowed the extension is the essence of vascular hemostasis. The main dish is shrinking substances endothelin-1 (ET-1). The aim of the study was to determine the role of signs ET-1 levels in the diagnosis of cardiovascular diseases, especially coronary heart disease. In numerous reports described the impact of increased blood pressure, caused by the press on blood vessels. Most authors reported higher concentrations of ET-1 in serum of patients with ischemic heart disease, particularly its unstable character. High values were observed in patients with myocardial infarction. ET-1 level in the blood is markedly increased in patients with heart failure, correlating with NYHA functional class. High concentrations of ET-1 in many disease entities, and thus its low specificity makes the need for further research on the importance of this substance in the diagnosis of cardiovascular diseases.

Introduction: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular morbidity and mortality. The aim of this study was to assess relations between cardiovascular diseases (CVD) and age in OSA subjects., Material and Methods: Consecutive OSA subjects (AHI/RDI > 10, Epworth score > 9 points) were evaluated. The chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP., Results: We studied 533 consecutive OSA patients, mean age 55.6 +/- 10.3 years (range 24-81), with obesity (BMI 34.4 +/- 6.6 kg/m(2)) and severe OSA (AHI/RDI 37.8 +/- 21.8). To evaluate relations between CVD and age, patients were divided into three groups. Group 1 < 50 years (123 subjects, 23.1%), Group 2 aged 50-60 years (250 subjects, 46.9%) and Group 3 > 60 years (160 subjects, 30%). Subjects < 50 years were more obese and had higher AHI/RDI when compared to older groups. Incidence of arterial hypertension, coronary artery disease, atrial fibrillation, heart failure and stroke increased with age (higher in subjects > 60 years)., Conclusions: Cardiovascular diseases were prevalent in OSA patients > 60 years. However the youngest group presented with more severe obesity and higher AHI/RDI.

Unlabelled: Coronary artery disease (CAD) in women remains a difficult diagnostic problem. The usefulness of exercise electrocardiography (EXT) in these patients is limited. The value of other noninvasive tests including Tc99m-MIBI single photon emission computed tomography (SPECT), is still to be determined. Aim of the study was to assess the usefulness of Tc99m-MIBI SPECT in the diagnosis of CAD in women in comparison to EXT MATERIAL AND METHODS: 48 women age 38-64 years (mean 50 +/- 6) with symptoms of CAD were included to the study. EXT ECG and Tc99m-MIBI SPECT with dipyridamole were performed in all patients. The diagnostic value of the tests was assessed in comparison to coronary angiography. Sensivity, specifity and accuracy were calculated according to the generally accepted rules., Results: In 21 patients (44%) significant stenosis (> 50% diameter narrowing) in coronary angiography was found. In 18 (38%) of them single-vessel disease was detected. In 2 pts (4%) vasoconstriction was observed. EXT was positive in 28, negative in 17 and undiagnostic in 3 women with sensivity 72%, specificity 46% and an accuracy 58%. Perfusion defects were detected in 15 pts at rest and in 30 after dipyridamole infusion. MIBI SPECT had sensivity 91%, a specifity 60% and accuracy 74%. Evaluating tests enhanced sensivity to 100%, specifity to 71% and accuracy to 86%. SPECT sensivity was related to the localisation of coronary vessels changes: LAD 100%, Cx 66%, RCA 88% in case of single-vessel disease., Conclusion: Tc99m-MIBI SPECT proved to be a highly useful test in the diagnosis of CAD in women. Its diagnostic sensivity and accuracy is further enhanced by combination with ECG EXT. It has particular value in detection of one vessel disease.

Unlabelled: In modern world the risk of circulatory system diseases is increasing. Effective techniques are sought of prevention and detection of coronary artery disease. The development of diagnostic modalites is directed to reduction of invasiveness and risk for patients with providing as much information from a single examination, as possible. Gated scintigraphy examinations by single photon emission method (GSPET) seem to meet these requirements. They combine information that could be obtained as yet only with two separated examinations. They provide data on left ventricular perfusion and function., Aim of the Study: The aim of the study was application of gated single photon emission tomography (GSPET) technique by means of polar maps and beating cross-sections in the assessment of parameters describing left ventricular function in various degrees of myocardial perfusion disturbances. A comparison was also done of GSPET processing by polar map and beating cross-section methods in the diagnosis of perfusion disturbances., Material and Methods: The study group included 142 patients (mean age 55.8 +/- 10.9 years), in whom myocardial scintigraphic examination was carried out by GSPET method using Tc99m-MIBI complex according to two-day protocol. The examinations were performed using a two-head Varicam gamma camera. For study data processing Xpert Pro software for workstation was used. The examinations were analysed using both polar maps and beating cross-sections. Additional values were considered offered by gated GSPET examinations. In all, 284 examinations were analysed. The patients were divided into groups according to gender and changes in perfusion both in the maps and cross-sections., Results: The total number of 112 consistent results of perfusion changes were obtained both in the polar maps and cross-sections (71%). Most differences were observed in the group with effort perfusion disturbances. During processing of GSPET examination by the method of polar maps were obtained more reversible perfusion disturbances then in the beating cross-sections, differences were found which required further studies and comparison with clinical data., Conclusions: On the basis of the obtained results the conclusions were drawn that processing of gated single photon emission tomography (GSPET) by methods of both polar maps and mobile cross-sections makes possible to assess the parameters describing left ventricular function at rest and during exercise in various degrees of myocardial perfusion disturbances.

A case of a 61-year-old patient with acute coronary syndrome (ACS) and minimal ECG changes is presented. The patient was admitted to a community hospital, where non-ST-segment elevation ACS was diagnosed. He was given standard pharmacotherapy and was transferred very early to an invasive facility, where coronarography and percutaneous coronary intervention of the large diagonal branch were performed. We stress the importance of non-invasive assessment with ECG and echocardiography, in addition to coronary angiography, for diagnosis and treatment decisions in complex cases.

Ischemia modified albumin (IMA) is a new biological marker for early identification of chest pain and ruling out myocardial infarction among patients with acute syndromes submitting to emergency department. Recently IMA has been investigated in the light of other cardiac markers (cTnT, CK-MBmas, NT-proBNP) in various states of ischemia (acute coronary syndromes, after percutaneous coronary intervention, in coronary vasospasm). Ischemia modified albumin levels were elevated in these states what suggests myocardial ischemia. However decrease in IMA concentration after exercise-induced skeletal muscle ischemia still remains unclear. Increased IMA concentration in patients with acute ischemic stroke and exposed to trauma limits its ability for detection myocardial ischemia. Specificity of IMA measurement is limited also in patients with peripheral vascular disease, systemic sclerosis, diabetes, end stage renal disease, pulmonary embolism and other pathological states with accompanying oxidative stress.

Unlabelled: Human fatty acid-binding protein (h-FABP) is an early marker of myocardial ischemia. It has high sensitivity and specificity comparing with conventional biomarkers such as troponin or creatine kinase., Material and Methods: The examinated group consisted of 83 patients, 31 (37,3%) women and 52 (62,7%) men. Every patient with chest pain typical for acute coronary syndrome was diagnosed from May until September 2005 in the emergency room of the Clinic of Cardiology. Every blood sample was tested for h-FABP with Cardio Detect med. test., Results: Sensitivity for h-FABP at STEMI patients was: during first 3h - 95, 83%, 3-6h - 100%, 6-12h - 100%, over 12h - 100%. Sensitivity for h-FABP at NSTEMI patients was: 100%, 100%, 83% and 71,4%., Conclusions: H-FABP is an early diagnostic marker. Its sensitivity and specificity during first 6h from the beginning of chest pain comparing to troponin T and CK-MB is very high. Fast results given by measurements of h-FABP allow to make an early decision about further invasive treatment of patients.

We describe the patient at whom sudden cardiac arrest was the first symptom of coronary heart disease. In the paper, we describe factors which influence the effectiveness of resuscitation in out of hospital cardiac arrest. Applying the cardiac massage by a bystander, the presence of defibrillation rhythm and short period of time to the first defibrillation, determined the survival of the patient.

Recent years have brought many new advances concerning etiology and pathology of atherosclerosis and cardiovascular risk. However, there are still researches taking place to improve currently used Scales of Cardiovascular Risk, which introduce novel biomarkers of inflammatory process, hemostasis or oxidative stress in order to identify individuals who are the most endangered group of cardiovascular event. This study's aim was to review existing cardiovascular risk factors and risk assessment scales and to confront their clinical usefulness with novel biomarkers emerging in this field with special respect to high sensivity C-reactive protein (hsCRP). Existing cardiovascular risk assessment scales seem not to be endangered in their prognostic role mainly due to crucial role of individual medical history in diagnosis ischaemic heart disease and evaluating the cardiovascular risk. For the time being, despite many novelties appearing in cardiovascular risk evaluation, only hsCRP has unarguably proven prognostic ability in terms of coronary events and may have addictive informative power towards existing cardiovascular risk scales. The level of hsCRP < 1 mg/l should be interpreted as low cardiovascular risk (CVR), 1-3 mg/I as moderate CVR and > 3 mg/I as high CVR. Unfortunately, hsCRP is unpopular and not widely used in standard biochemical tests in Polish hospitals in patients with ischaemic heart disease.

Rupture of the interventricular septum is a serious complication of myocardial infraction (MI). It occurs in 1-3% of all MI cases, usually within 2 weeks after infraction. In 60% of the cases post-MI ventricular septal defects (VSD) are the result of completely occluded coronary artery supplying anterior wall of left ventricle and subsequent transmural MI. 50% of patients die within the first week after the rupture unless they are surgically treated. In this case report we describe an 87-year-old woman with post-MI VSD who was successfully operated (endocardial patch exclusion technique, proposed by David). In spite of a very high predicted risk (97% by Euroscore), calculated high risk should not be considered as the contraindication for life-saving operation.

A case of a 48 year old male scheduled for early invasive treatment of acute coronary syndrome with ST segment elevation is presented. Clinical suspicion of acute pulmonary embolism was undertaken because of normal coronary angiogram and was confirmed by pulmonary angiography. Differential diagnosis based on medical history, electrocardiogram and laboratory findings was discussed.

Electrocardiographic abnormalities in lead aVR and V1 are rarely analyzed on exercise electrocardiograms. Clinical significance of exercise-induced ST-segment changes in lead aVR and V1 during strongly positive electrocardiographic exercise test (EET) in patients with chronic stable angina pectoris remains unclear. The aim of the study was to assess the value of lead aVR and V1 on the exercise electrocardiogram for the detection of left main coronary artery stenosis (LMCAS) and its equivalent (LMCASE) in patients with chronic stable angina pectoris and the strongly positive EET result. The study group consisted of 118 consecutive patients (mean age 58.8 +/- 9.5 years, range 38-77 years), including 30 (25.4%) women. Patients were divided into three groups. In group I, 31 patients with ST elevation in lead aVR and V1, in group II 66 patients with isolated ST elevation in lead aVR, and in group III 21 patients without ST elevation in lead aVR, induced with exercise, were included. Coronary arteriography results were compared among these groups. In patients with isolated exercise-induced ST elevation in lead aVR, the prevalence of LMCAS was five times more frequent than in patients without lead aVR ST elevation (25.8% vs 4.8% p<0.05). There were no differences in the prevalence of LMCASE and multi-vessel coronary disease in the studied groups. In patients with LMCAS significant ST elevation in lead aVR during strongly positive EET were observed (0.25 +/- 0,4 mm vs 1.43 +/- 0.6 mm p = 0.003), whereas there were no significant exercise-induced electrocardiographic changes in lead V1 (0.61 +/- 0.6 mm vs 0.77 +/- 0.6 mm p = 0.08). Sensitivity of isolated exercise-induced ST elevation in lead aVR in detection of LMCAS was 85.0%, specificity - 50.0%, positive predictive value - 25.8%, negative predictive value - 94.2%, and total accuracy - 55.9%. Exercise-induced ST elevation in lead aVR on the strongly positive exercise ECG may detect LMCAS in patients with chronic stable angina pectoris.

The objective of the research was to assess nutritional habits of men with coronary heart disease aged > 60 years old (n=132), stratified by educational level. The examined men were divided into 3 groups: group I--men with primary education (n=33), group II--men with secondary education (n=42), group III--men with higher education (n=57). Nutritional habits of examined men were assessed on the basis of a 3-day food record. The research showed that nutritional habits of examined men were characterized by too much saturated fat and cholesterol and were in accordance to hipolipemic diet. Educational level did not significantly influence the parameters of the subjects' diet, but had an impact on the structure of the intake of selected products.

Risk stratification in acute coronary syndromes (ACS) without ST segment elevation plays an important role in choosing treatment strategy and making further prognosis. We aimed at 1) assessing the usefulness of TIMI Risk Score in risk stratification and prognosis in unselected patients with ACS without ST elevation who underwent early percutaneous revascularization, 2) comparing the frequency of adverse events (death, MI, repeat revascularization in high-risk and moderate-risk patients during 14 days from revascularization, 3) comparing the efficacy of percutaneous revascularization in the high-risk and in the moderate-risk group. High-risk (TIMI Risk Score > or = 5 points) and moderate-risk (TIMI Risk Score 3-4 points) group comprised 324 and 240 patients respectively. High-risk group comprised older patients, fewer men, more diabetics and hypertensive patients. Peripheral vessel disease and prior MI was also more frequent in the high-risk group. More high-risk patients had initial TIMI flow < 3 in target vessel, as well TIMI 3 flow after revascularization was achieved in fewer high-risk patients. During 14-day follow-up the frequency of combined end-point (death, MI, repeat revascularization) was more frequent in the high-risk group (8.95% vs 1.67%). TIMI Risk Score is an easy to use and useful method in risk stratification and prediction of adverse events in patients with ACS without ST segment elevation assigned to early percutaneous intervention in the early post-procedure period.

Unlabelled: The aim of the study was to develop simple algorithm for non-invasive estimating probability of the presence of CAD to optimize indications for cardiac catheterization. A prospective collection of clinical, electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed. All patients (n = 551, 65% male) complaining of chest pain, without prior history of myocardial infarction undergone EE (regarded as positive on the basis of > or = 1 mm ST-depression) SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA): CAD was defined as > or = 50% narrowing of at least one major vessel. Two algorithms were developed with the use of probability analysis by computer program which employs Bayes' theory. They incorporated pretest variables: (age, gender, chest pain classification according to Diamond), ECG and results of one or two non-invasive test: EE and (or) SE. The studied population was divided into 3 groups on the basis of pretest likelihood of CAD: 1. low (< 10%), 2. intermediate (10-70%, in man divided into intermediate--low.: 10-29% and intermediate--high: 30-70%) and 3. high (> 70%)., Results: The prevalence of CAD in studied population was 61%. The sensitivity of the algorithm is 96% and specificity was 44%. Sensitivity and specificity of EE and SE was respectively: 93%, 21% and 85%, 69%)., Conclusions: 1. An algorithm derived in our study is simple and may be useful in decision making that relates to CA. 2. We showed that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA, when the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).

Acute coronary syndromes (ACS) without ST elevation (which include unstable angina [UA] and non ST elevation MI [NSTEMI]) are caused by dynamic changes in the atherosclerotic plaque and coronary blood flow. To determine characteristics, in-hospital outcome and management of patients with ACS without ST elevation. The total of 502 patients were enrolled. Inclusion criteria were: rest angina within the last 24 hours, ST-segment deviation (>0,05 mV), T-wave inversion (>0,1 mV) in at least two leads, positive serum cardiac markers. There were 63,3% of patients with Braunwald's IIIB UA and 6,8% with IIIC UA, 29,9% of patients were diagnosed with NSTEMI. All patients were diagnosed invasively with subsequent revascularization (PCI-73,1% or CABG-16,7%) if apprioppriate. 1,6% of patients underwent PCI and elective CABG and 16,7% of patients were treated conservatively. Overall mortality was 2,98%--PCI subgroup (N = 367) 1,36%, CABG subgroup (N = 84) 8,33% and conservative subgroup (N = 43) 6,07%. Non-fatal myocardial infarction (MI) complicated the hospital course in 0,99%, 0,27%, 3,57%, and 2,32% of patients respectively. 1,4%, 0,54%, 6% and 0% of patients respectively had fatal MI. Early invasive strategy in patients with ACS without ST elevation is efficacious method of treatment.

Systemic autoimmune diseases form a diverse group which includes: systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), scleroderma, dermato-polymyositis, Wegener's granulomatosis, Sjögren syndrome. Although multisystem involvement is the hallmark of these diseases, the heart seems to be less affected than other organ systems. The aim of the study was to study possible cardiac abnormalities in patients with documented systemic autoimmune diseases and to assess whether there was any relation between antiphospholipid, anti-dsDNA antibodies and myocardial dysfunction findings. 76 patients (53 with SLE, 9 with MCTD, 8 with scleroderma, 6 with Wegener's granulomatosis) were subjected to our study, 69% of these patients manifested cardiac involvement, based on two-dimentional echocardiografic examination (36%--post-inflammatory valvular thickening, 20%--pericardial effusions, 15%--valvular regurgitation, 7%--left atrial enlargement, 5%--left ventricular hypertrophy, 4%--left ventricular dysfunction). None of the patients showed characteristic, acute Libman-Sacks endocarditis, which probably can be explained by chronic corticosteroid-treatment. Clinical evidence of cardiac abnormalities has been observed, in as many as 58% of cases with positive echocardiographic findings. The frequency and extend of cardiac pathology positively correlated with the detection of antiphospholipid antibodies. No such relationship was observed in patients with the presence of very high titers of antinuclear antibodies (anti-dsDNA). In conclusion, our results indicate that echocardiography is a useful method for assessment and monitoring cardiac involvement in the systemic autoimmune diseases.

During the coronary artery bypass off pump procedure thermal angiography was evaluated for the intraoperative assessment of the patency and the flow in the left internal mammary to the left anterior descendens. Our observation confirms that thermal angiography may be used as an intraoperative method which improves graft quality control during coronary bypass procedures.

Clinical picture of coronary artery disease is different in men and women. Later incidence of coronary disease in women than in men, presence of less typical symptoms, lower specificity of non invasive diagnostic tests as well as higher mortality during percutaneous or surgical revascularization are underlined. Aim of the study was to examine clinical variables, diagnostic and treatment methods in women with coronary disease on the basis of retrospective analysis of patients hospitalized in the Department of Coronary Artery Disease of the Jagiellonian University Medical School in Cracow between 1991 and 1999. 929 patients aged 31-95 years mean 56.95 +/- 10.02 years were enrolled in the study. Clinical usefulness in women with coronary disease of diagnostic tests: electrocardiographic exercise test, exercise thalium-201 scintigraphy and stress echo-cardiography with dobutamine were analyzed. The highest sensitivity was found in exercise scintigraphy (92.9%) compared to ECG exercise test (80.6%) and stress echocardiography with dobutamine (76.9%). The highest specificity characterized stress echocardiography with dobutamine (76.9%) versus exercise scintigraphy (34.7%) and ECG exercise test (25.9%). Between 1991 and 1999 women with coronary artery disease consisted 19.4% of all patients hospitalized in the Department of Coronary Artery Disease in Cracow. Among patients investigated with coronary angiography there were 18.2% of women. Among percutaneously revascularized patients women constituted 17.8%. In the analyzed period 3.5-fold increase of the number of women with CAD hospitalized in the Department of Coronary Artery Disease in Cracow, 7.5-fold increase of the number of women investigated with coronary angiography and 10.5-fold increase of the number of percutaneously or surgically revascularized women was observed. On the basis of performed diagnostic tests 650 women (69.9%) were treated pharmacologically. In 157 patients (16.9%) percutaneous coronary angioplasty was performed, in 118 patients (12.7%) coronary artery bypass surgery was done. In 4 women (4.3%) heart transplantation was performed.

Aim of the study was comparing the early results of coronary artery bypass grafting (CABG) in women (W) and in men (M). This study comprises 1640 consecutive patients (1390 male and 250 female) at the age from 29 to 78 years (mean 57.2 +/- 8.9 years) operated on between January 1995 and June 2001 because of coronary artery disease. At least one myocardial infarction in history was noted in 156 W (62.4%) and 848 M (61.0%) (NS). Prior to surgery, coronary angioplasty (PTCA) was performed in 10 W (4.0%) and 63 M (4.5%) (NS). Left main stenosis in the preoperative angiocardiography was seen more often in W (26.3%) than in M (20.4%) (p < 0.05). All patients were operated on from median sternotomy with the use of cardiopulmonary bypass. Less grafts per patient were implanted in W (2.3 +/- 0.5) than in M. (3.0 +/- 0.4) (p < 0.05). In-hospital mortality in W (6.8%--17 W) was higher than in M (3.2%--44 M) (p < 0.05). Low cardiac output syndrome (LCOS) (11 W--4.4% vs 34 M--2.4%; p < 0.05), followed by respiratory failure (1 W--0.4% vs 5 M--0.4%; NS) and mediastinitis with sternal instability (3 W--1.2% vs 4 M--0.2%; p < 0.001) were the main reasons of death. Eight W (3.2%) and 41 M (2.9%) were reoperated, 5 W (2.0%) and 20 M (1.4%) (p < 0.05) because of mediastinitis and 3 W (1.2%) and 21 M. (1.5%) (NS) because of bleeding. Perioperative myocardial infarction confirmed in ECG and in the laboratory tests had 16 W (6.4%) and 90 M (6.5%) (NS). After operation, 20 W (8.0%) and 107 M (7.7%) developed LCOS. Efficacy of intraaortic balloon pump (IABP) in the treatment of LCOS was lower in W (45.0%) than in M. (65.7%) (p < 0.05). Infectious complications including mediastinitis and superficial wound infections were more frequent in W (9.2%) than in M (6.6%) (p < 0.05). The rate of other surgical complications (cardiac tamponade, pneumothorax or postoperative bleeding) and organ dysfunctions (respiratory, renal, neurological) was similar in W and M. Female patients are at higher mortality risk of coronary artery bypass grafting. Efficacy of IABP in the treatment of LCOS is lower in W. Infectious complications are more frequent in females.

We discuss a case of a 60-year old man admitted to our Department with symptoms of unstable angina and stenosis of carotid artery. Coronary angiography revealed three-vessel coronary artery disease. Doppler ultrasound (USG) and multislice spiral computed tomography (MSCT) of carotid and vertebral arteries showed a high-grade stenosis of the left internal carotid artery with a poststenotic aneurysm containing thrombi. Since the risk of a simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) was assessed as high, a two-staged procedure was performed. The CEA was performed first and one month later patient underwent CABG with a good result.

The coronary disease is nowadays one of the main causes of death in Poland. To fight epidemy of the coronary disease, not only the prevention and proper treatment are necessary, but the sufficient availability of the diagnostic methods, as well. The aim of our work was to evaluate the availability of coronarography among the patients from Northern Poland. We analysed the data of the patients who underwent the coronarography in years 1997-1998. During that time there were 3916 examined patients. In the analysis the sex, age and place of residence were taken into consideration. Women were 28.93% of all the diagnosed patients. The sex structure basically didn't differ according to the place of residence (city--women 28.7%, village--30.64%). The average age of the diagnosed patients was 58 years. There was a statistically significant difference between the average age of women and men (women 59 years, while men 57 years). The age distribution varied also in the statistically significant degree according to the place of living--the average age of village people was 56 years, little cities 58 years, big cities 59 years. The village people were only 10% of all diagnosed patients. In the analysis of the collected data significant differences in availability of coronarography were found-especially between rural and urban areas. Also the age and sex of the diagnosed patients varied significantly-most probably due to the distribution of the risk factors.

Unlabelled: The relation of chest pain characteristics and other features of the history of disease to coronary angiograms was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. A standardised questionnaire was used to record demographic details and chest pain characteristics of interviewed patients. The differentiation between typical, atypical or nonanginal pain was based on classification proposed by Diamond. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery)., Conclusion: Chest pain characteristics remains an effective tool for estimating probability of coronary artery disease.

Unlabelled: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. Clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery., Results: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%., Conclusion: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

A possible role of infectious agents in the pathogenesis and progression of cardiovascular system diseases has been postulated by many scientists. The purpose of our study was to evaluate the correlation between Chlamydia pneumoniae infections and coronary heart disease. A group of 211 patients including: 120 patients with coronary heart disease (CHD) [63 patients enrolled for precutaneous coronary interventions (PTCA), 14 with proven restenosis after PTCA and 43 after coronary artery bypass grafting with recurrence of CHD symptoms], 17 patients suffering from congenital heart diseases or mitral valve stenosis with normal coronary angiograms and 74 healthy volunteers were tested. The levels of serum IgM, IgG and IgA antibodies for Chlamydia pneumoniae were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). C. pneumoniae specific IgG antibodies were detected in both, patients as well as healthy volunteers. They were seropositive with similar frequency (28.3% and 28.6% respectively). Among CHD patients, however, in PTCA/rest patients, specific C. pneumoniae antibodies have been detected more often (42.9%). Prevalence of C. pneumoniae specific antibodies correlated with patients' age, sex. There was no relation between behavioral habits (smoking) and presence C. pneumoniae antibodies.

Unlabelled: The aim of the present study was to examine the effect of exercise test on QT dispersion (dQT) and to compare the result in women with syndrome X with women with coronary artery disease and normal subjects. We examined 53 women in mean age 54.2 +/- 9.2 who were divided into groups: 20 women with one-vessel coronary artery disease (group I), 19 women with syndrome X (group II) and 14 healthy control women (group III). All subjects underwent a modified Bruce protocol exercise test and QT intervals were measured manually at rest and peak exercise. The value of dQT was calculated as a difference between the longest and the shortest measured value in each of the 12 ECG leads. Corrected QT (dQTc) dispersion was measured after the QT interval was corrected with Bazett's formula. There were no significant differences in rest values of dQT between groups but rest dQTc was significantly greater in group I and II then in group III. We observed significant increase in dQT and dQTc on peak exercise in group I and II when compared with group III., Conclusion: At rest dQTc is significantly greater in women with syndrome X and coronary artery diseases in comparison with control subjects. The exercise caused increase in the value of dQT and dQTc both in women with syndrome X and coronary artery disease. The value of dQT and dQTc makes impossible to differentiate between women with syndrome X and women with coronary artery disease.

Increased plasma fibrinogen level is an important prognostic factor of recurrent unstable angina and myocardial infarction in patients with acute coronary syndrome (ACS). The aim of our study was to assess the plasma fibrinogen level at baseline condition in patients admitted to hospital due to coronary artery disease (CAD). Plasma fibrinogen was measured in 51 consecutive patients presenting with ACS within the last 24 hours and in 50 patients with angiographically proven CAD that was stable for the past 30 days. For statistical analysis Mann-Whitney U test, Student t-test, chi-square test and Pearson correlation was used, p < 0.05 being considered statistically significant. There was significant correlation between fibrinogen level and diagnosis of ACS or CAD (r = 0.29, p = 0.002). In our population plasma fibrinogen levels (g/L +/- SD) were significantly different in patients with ACS when compared to CAD subjects (3.87 +/- 1.2 vs. 3.26 +/- 0.65, p = 0.002). There was difference between ACS and CAD subjects in male:female ratio (40/11 vs. 47/4, p < 0.001) and age (63.4 +/- 10.1 vs. 58.4 +/- 10.0, p = 0.014). Our results confirm the role of fibrinogen in pathogenesis of CAD. In our opinion plasma fibrinogen level may be an important diagnostic tool in assessment of patients with chest pain.

[1] CASS Principal Investigators and their Associates.: Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation 1983; 68: 951-960. [2] Danchin N i wsp. Effect of late percutaneous angioplastic recanalization of total coronary artery occlusion on left ventricular remodeling, ejection fraction, and regional wall motion. Am J Cardiol 1996; 78: 729-735. [3] Dilsizian V i wsp.: Enhanced regional left ventricular function after distant coronary bypass by means of improved collateral blood flow. J Am Coll Cardiol 1989; 14: 312-318. [4] European Coronary Surgery Study Group.: Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982; 27: 1173-1183. [5] Frick MH, Harjola PT, Valle M. Persistent improvement after coronary bypass surgery: ergometric and angiographic correlations at 5-years. Circulation 1983; 67: 491-496. [6] Gasior Z i wsp. Chirurgiczna rewaskularyzacja mieśnia serca a funkcja skurczowa lewej komory. Kardiol Pol 1997; 46: 200-211. [7] Hirnle T i wsp.: Badanie histologiczne wycinków tetnicy piersiowej wewnetrznej, zyły odpiszczelowej wielkiej i aorty pobranych w czasie operacji kardiochirurgicznych. Kardiol Pol 1991; 34: 155-159. [8] Hultgren HN i wsp.: The 5 year effect of bypass on relief of angina and exercise performance. Circulation 1985; 72: (suppl V) 79-89. [9] Kmieć G, Zwirski W, Moczurad K. Ocena odległych wyników leczenia operacyjnego choroby niedokrwiennej serca w oparciu o testy wysiłkowe, badanie polikardiograficzne oraz powrót do pracy zawodowej. Kardiol Pol 1990; 3: 179-183. [10] The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group.: Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med 1984; 311: 1333-1339.

In this study the group of 30 patients with coronary artery disease (mean age 55 +/- 7 years) were examined. All patients underwent repeated percutaneous transluminal coronary revascularisation (rePTCR) due to coronary artery restenosis after primary coronary angioplasty. QT dispersion (dQT) and the corrected QT dispersion (dQTc), obtained applying Bazett's (dQTB) and Hodge's (dQTH) formulas, were measured before rePTCR and 7 days after rePTCR. Standard 12-lead electrocardiograms, 25 mm/s speed, were used. QT dispersion, defined as a difference between maximal and minimal QT intervals, was manually measured. The significant decrease of dQT after rePTCA was observed. Mean dQT before rePTCR was 88.67 +/- 29.09 ms and 64.00 +/- 28.96 ms after rePTCR (p < 0.0001). The changes of dQTc (dQTB, dQTH) were similar. Mean values of dQTB before and after rePTCR were 92.97 +/- 34.40 ms and 65.42 +/- 29.80 ms respectively, and mean values of dQTH were 94.90 ms +/- 37.31 ms and 70.98 ms +/- 32.85 ms. It was also noted that the frequency of appearance of dQT exceeding 80 ms significantly decreased after rePTCR (dQT exceeded 80 ms in 17 cases before rePTCR vs 5 cases after revascularisation). Increased QT dispersion can be a marker of the coronary artery restenosis.

The aim of the study was to evaluate the level of lipid risk factors in a random sample of Warsaw population aged 35-64 years, 764 men and 775 women, were screened within framework of the Pol-MONICA Warsaw Study. The lipids were determined by enzymatic methods in laboratory controlled by CDC Lipid Standardization Program in Atlanta. In the screened sample the observed levels of total cholesterol (5.76 +/- 1.01 and 5.68 +/- 1.03 mmol/l respectively in men and in women) and LDL cholesterol (3.67 +/- 0.90 and 3.56 +/- 0.94 mmol/l respectively) were rather high what can indicate on rather high coronary risk of Warsaw population. On the other hand the high mean level of HDL cholesterol (1.36 +/- 0.36 and 1.53 +/- 0.35 mmol/l respectively) and its subfractions HDL2 (0.24 in men and 0.39 mmol/l in women) as well as HDL3 (1.12 and 1.14 mmol/l respectively) observed in this sample can decrease this global risk. The compared mean level of cholesterol in lipoprotein fractions in the group of investigated persons with and without clinical manifestations of coronary heart disease confirm the observed in the other studies the higher mean levels of total cholesterol and LDL cholesterol in persons with coronary heart disease.