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Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of age). Blood flow restoration in the infarct-related artery is a fundamental therapeutic strategy, however reperfusion therapy is rarely used in the elderly as compared with younger groups. Mortality and complication rates are much higher in the elderly than in younger patients irrespective of the type of reperfusion therapy. Elderly patients are modestly represented in studies undertaken to analyze the efficacy of various types of reperfusion therapy. For this reason the choice of an optimal therapy in acute myocardial infarction in the elderly remains an open question.In the I Department of Cardiology PCI has been the strategy of choice in the treatment of acute myocardial infarction. This is a retrospective analysis of early and late outcomes of primary coronary angioplasty in elderly patients with myocardial infarction. Between June 2001 and December 2003 four hundred and five (405) consecutive patients were admitted to our centre due to acute myocardial infarction. A group of 352 patients treated by primary coronary angioplasty was analyzed. Patients were divided into two subgroups one subgroup--over 70 years of age (84 patients) and the second one--below 70 years of age (268 patients) serving as controls. Early (in-hospital) and late (at 30 days, 6 and 12 months) outcomes were assessed.The most important observation was that elderly patients with myocardial infarction may be safely and effectively treated with primary coronary angioplasty. In-hospital mortality (5.9% vs. 2.2%, p0.05) and the number of bleeding complications (9.5% vs. 4.1%, p0.05) were higher in the elderly than in younger patients, but still lower than in the studies where fibrinolysis was used as a reperfusion strategy. Another important fact was the relatively frequent use of a platelet glycoprotein IIb/IIIa inhibitor (abciximab) in the elderly group (46.4% patients).Our results prove that these agents may also be safely administered in elderly patients with myocardial infarction. It is probable that the relatively frequent use of platelet glycoprotein IIb/IIIa inhibitors in our elderly patients was one of the reasons for lower early mortality as compared with the findings of other investigators.

Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.

We present a case of a 44-year-old male with recurrent episodes of cardiac arrest in the course of Prinzmetal's angina. Episodes of variant angina can be life threatening due to episodes of advanced atrioventricular block, asystole, ventricular tachycardia or ventricular fibrillation. It has been suggested to implant an ICD in all patients with variant angina after cardiac arrest. This patient received an ICD, however, he died suddenly 6 months later. The possible mechanism of cardiac arrest was an electromechanical dissociation.

Pheochromocytoma, a relatively rare (0.1-0.8% of hypertensives), catecholamine-secreting tumor, is almost always lethal unless recognised and appropriately treated. Histological changes in myocardium can be often found in patients with hypertension crisis due to pheochromocytoma, however, only a few patients with clinical manifestations of acute myocarditis were described. We report a 18-year-old man hospitalised with symptoms of acute myocarditis. Precise clinical assessment allowed to diagnose pheochromocytoma.

Restenosis after coronary angioplasty is still a significant problem despite the dynamic development of intervention cardiology. Homocysteine causes endothelial dysfunction and disorders of the coagulation system, increases in platelets aggregation and stimulates the proliferation of the vascular smooth cell. These were the reasons for investigating the relation between homocysteine level and the risk of restenosis. Some studies indicate that higher homocysteine levels increase the risk of restenosis after coronary angioplasty, while it has not been proven in other studies. The results of the only one randomized trial demonstrated that pharmacological lowering of the homocysteine level decreased the risk of restenosis after coronary angioplasty. At this time there are some studies which started focusing on the role of lowering homocysteine level in cardiovascular risk. These investigations may explain the importance of homocysteine level in the development of cardiovascular diseases. There is a need of a large prospective multicenter trial assessing the relationship between increased homocysteine level and the frequency of restenosis after coronary angioplasty. Using intravascular ultrasonography could be especially helpful in assessing the role of decreasing homocysteine level on neo-intima formation and arterial remodeling after intervention.

The case concerns a 56 year old male with the diagnosis of squamous cell carcinoma, which clinically presented as a rapidly increasing cardiac tamponade. The patient underwent a pericardio-centesis. Due to the expansion of the process within the bronchus, the patient underwent chemotherapy according to the Taxol + Carboplatine scheme. After 8 months of treatment the patient was hospitalized again due to a further increase in fluid in the pericardium, and symptoms of cardiac insufficiency which lead to patient death. Autopsy revealed neoplastic change within the pericardium (fibrinous-hemorrhagic pericarditis and hemopericardium). Cardiac tumors occur rarely, they may be primary or secondary. Squamous cell carcinoma metastases may be the cause of pericardial effusion, which is associated with poor prognosis.