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Unlabelled: The aim of our study was to evaluate the impact of comprehensive 3-phases cardiac rehabilitation in patients aged up to 55 years after acute myocardial infarction treated with primary coronary intervention (PCI) of the infarction related artery on the cardiovascular status, modification of coronary risk factors, psychological and physical status and exercise tolerance., Methods: Out of 106 consecutive patients aged up to 55 years with acute myocardial infarction (AMI) with ST-segment elevation, treated with primary coronary intervention (PCI) of the infarction related artery 71 patients entered the study and were randomized either to the Study Group (GB) or to the Control Group (GK). 31 patients of GB underwent 3-phases cardiac rehabilitation program and 40 patients of GK did not participate in phase III of the program. At phase I of the rehabilitation and 6 months after myocardial infarction physical examination, echocardiography and treadmill exercise test were performed., Results: At 6-months follow-up chest pain and symptoms of heart failure were significantly less common (p < 0.001) and a tendency for fewer new cardiac events and re-PCI was noted in GB. Self-evaluated, significantly greater improvement in the emotional and physical status as well as in physical activity (p < 0.001) was achieved in GB. In GB better exercise tolerance on treadmill exercise test, greater improvement in left ventricular ejection fraction (p < 0.05) and contractile index (p < 0.05) on echocardiography were observed. The effects of the secondary prevention in terms of smoking cessation and obesity were not satisfactory in both groups., Conclusion: 3-phases comprehensive cardiac rehabilitation in patients with AMI treated with PCI of the infarction related artery improves recovery at 6-month follow-up. It has a favorable impact on the anginal and heart failure symptoms, cardiac risk factors (especially physical activity, restrictive diet), psychological and physical status. It contributes towards maintaining a further event-free period. It improves selected cardiovascular parameters such as exercise tolerance, segmental and global left ventricular function.

Background: Acute myocardial infarction (AMI) is one of the main causes of death in the elderly, however, the optimal therapy of AMI in this age-group has not yet been established., Aim: To compare the early outcome of patients with AMI aged > or =75 years who underwent primary percutaneous coronary interventions (PCI) or were treated conservatively., Methods: In-hospital outcome of 180 patients aged > or =75 years, hospitalised due to AMI, was retrospectively analysed. Ninety two consecutive patients, admitted with AMI between May 2001 and October 2002, underwent primary PCI whereas 88 patients, treated for AMI between 1993 and 2002, received standard pharmacological therapy without thrombolysis., Conclusions: Primary PCI in the elderly with AMI is significantly more effective than conservative therapy, except with patients with cardiogenic shock in whom mortality is similar regardless of the therapy used.

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI), with a reported incidence of 7-18%. The incidence of congestive heart failure, in-hospital mortality, and long-term mortality is higher in AMI patients with AF than in those without. P-wave duration (PWD) on Signal-Averaged ECG is a non-invasive marker of intra-atrial conduction disturbances, which are believed to be the main electrophysiological cause of AF., Material/methods: In the present study we investigated whether PWD can predict development of AF in 130 AMI patients (100 men and 30 women, aged 56.9+/-12). PWD was recorded, along with clinical and hemodynamic characteristics., Results: During the observation period (up to 21 days) 22 patients (16.9%) developed AF. In univariate analysis the variables associated with development of AF were age>65, Killip class III-IV, and PWD>125 ms. Stepwise logistic regression analysis showed that age>65 and PWD>125 ms were independently associated with AF., Conclusions: PWD measured in a very early period of AMI is a useful tool in predicting AF.

Background: Survivors of acute myocardial infarction (AMI) are at increased risk for arrhythmic events (AE), which include sudden death (SD) or sustained ventricular tachycardia (sVT). In the prethrombolytic era, abnormal parameters of depolarization and repolarization were considered to be markers of susceptibility to these events. The purpose of the present study was to assess whether these variables should still be considered predictors of AE in postinfarction patients with normal intraventricular conduction., Material/methods: The study population consisted of 236 survivors of AMI, in whom the parameters of depolarization on SAECG (QRSd, LAS, RMS, LPs) and repolarization on ECG (QTc-max, QTd) were assessed before hospital discharge. The patients were followed for 18 months, and all episodes of SD and sVT were recorded., Results: During long-term observation, 3 patients died from SD, and sVT occurred in 1 patient. Univariate Cox regression analysis showed that among the SA-ECG and ECG variables, only QRSd was significantly related to the incidence of AE (p<0.04). A comparison of event-free survival curves by the Kaplan-Meier method at the dichotomy limit of 119ms showed significantly worse prognosis in patients with QRSd> or =119ms (p<0.01)., Conclusions: In postinfarction patients with normal intraventricular conduction treated in the acute and chronic phase of MI according to recent management strategies, QRSd> or =119ms on SAECG is associated with arrhythmic events. Other parameters of depolarization, such as LAS, RMS, and positive LPs, and also repolarization, such as prolonged QTc-max and QTd, seem to be of little use in predicting these events.

Background: In survivors of acute myocardial infarction (AMI), an occluded infarct-related artery (IRA) is an important predictor of cardiac death (CD) and sudden death (SD). Early reperfusion of the IRA was associated with improved survival rate. The purpose of the present study was to assess if late IRA revascularization, performed 10-30 days after AMI, also has a beneficial effect on the incidence of CD and SD during an 18-month follow-up., Material/methods: The study population consisted of 93 post-MI patients with occluded IRA on coronary angiography. The patients were divided into 2 groups according to IRA status at discharge -- revascularized (47 patients) or occluded (46 patients) -- and followed. Before revascularization, the two groups of patients did not differ in the prevalence of clinical and angiographic variables, or in the incidence of risk factors for SD. In patients who underwent angioplasty or bypass graft surgery of closed IRA, the markers of electrical instability demonstrated no significant improvement after revascularization., Results: During the 18-month follow-up a significantly lower incidence of CD (0% vs 15%, p<0.01) and SD (0% vs 11%, p<0.03) was observed in the group of patients with revascularized IRA than in the group of patients with occluded IRA., Conclusions: In survivors of AMI, late reperfusion of occluded IRA is associated with reduced 18-month cardiac mortality. The beneficial effect of this procedure on the incidence of sudden death, not associated with improvement in myocardial electrical stability, suggests that ischemia can be considered an important factor modulating the arrhythmogenic substrate.

Unlabelled: In patients suffering from angina like exertional pain or dyspnea with a negative or undiagnosed exercise treadmill test (u/n TET), controversy exists regarding indications to perform coronary angiography. This study was performed in order to evaluate the diagnostic significance of dobutamine echo-stress (DSE) in assessing the possible causes of symptoms in such patients. We retrospectively analysed 550 patients. Out of this number, 128 patients had a u/nTET (study group--SG) and 422 patients had a positive TET--control group (CG). The exercise treadmill test was performed according to the Bruce protocol. Dobutamine stress echocardiography was performed according to a standard protocol., Results: In patients that were DSE(+), no significant differences in the analysed parameters were found between study and control groups. In patients that were DSE(-), monovariate analysis detected that gender, age, history of hypertension, LVH, sigmoid IVS, small LV and EF as factors predicting clinical symptoms. Multivariate analysis revealed that middle-aged women, elderly men, and history of hypertension were independent predictors of exertional symptoms. Multivariate analysis also showed that intracavitary LV obstruction or LV outflow tract obstruction in hypertensive females was an independent predictor of reproducibility of symptoms., Conclusions: 1. Angina-like symptoms in patients with non-diagnostic/negative TET and negative DSE depends on several clinical and echocardiographic factors. 2. Dynamic intracavitary LV obstruction or LV outflow tract obstruction, especially with a hypotensive reaction, are potential causes of symptoms in patients with non-diagnostic/negative TET and negative DSE. 3. Reproducibility of symptoms during negative DSE occurred in hypertensive females with dobutamine-induced intracavitary LV obstruction or LV outflow tract obstruction.

QT interval prolongation is discussed as a possible risk factor of dangerous arrhythmias. The aim of this study was to evaluate the influence of different interventional treatment of coronary artery disease in patients after myocardial infarction on QT interval duration. Two groups of patients were analyzed. The first group (G1) consisted of 37 patients in whom PTCA was performed; the second group (G2)--42 pts after surgical myocardial revascularisation (CABG). The 24-hour electrocardiography monitoring was performed in all the patients. Results were analyzed especially considering the average daily values of QT, QTp, QTc and RR duration. In patients after CABG we observed statistically significant prolongation of QTc interval duration what was not noticeable in patients after PTCA. The cardiosurgical procedure of coronary by-pass grafting in patients with coronary artery disease after the myocardial infarction in contrary of PTCA may lead to significant prolongation of QTc interval duration. This problem needs further investigation.

This study aimed at evaluating predictive value of exercise tests in case of left coronary artery stenosis. The study involved 57 patients with left coronary artery stenosis, including 10 patients with isolated left main stenosis (group X), and 47 patients with left coronary artery stenosis and multivessel involvement (group Y). Unstable angina was staged according to Booth et al. classification as type I or II. Exercise tests were performed according to Bruce's protocol. Unstable angina of type I was diagnosed in 51 (89%) patients, and type II in 6 (11%) patients. Electrocardiographic evidence of myocardial ischemia both et rest and anginal pain was seen in 46 (80%) patients. Electrocardiographic recording was within normal limits in 11 (20%) patients at rest. Clinical and ECG improvement was seen in 38 (66%) patients. Exercise tests in all of these patients were positive at low load work--mean 50 W. The obtained results suggest that patients with left coronary stenosis constitute heterogenous group. Therefore, prediction of the left main stenosis on the clinical ground alone is impossible. Exercise tests producing positive results at low load indicate with high probability critical multivessel lesions and/or left main stenosis in such patients.

It is reported on 108 patients with the symptoms of the impending myocardial infarction, of whom 80 patients were treated conservatively. 51 patients developed a fresh definitive myocardial infarction. 28 patients were surgically treated, 5 of them died. Therefore, in patients with instable angina pectoris the possibility of an early coronary-surgical intervention should be taken into consideration to prevent the development of a definitive myocardial infarction.

In 41 patients with cardiac defects cardiac catheterization and echocardiographic examination were performed to evaluate the usefulness of Doppler echocardiography for estimation the grade of pulmonary hypertension. Parameter for noninvasive estimation of mean pulmonary artery pressure was the acceleration time (AcT) calculated basing on pulsed Doppler recordings of blood flow through the right ventricular outflow tract. Technics of examination and calculation of mean pulmonary artery pressure (MPAP) were concordant with Kitabatake's methodology. Patients were divided into 3 groups according to MPAP values measured by the invasive method. MPAP values obtained using Doppler method were not identical with results of direct measurements, but in the majority of patients (85%) Doppler method allowed to properly qualify patients to a respective group--with normal, moderate or very high pulmonary artery pressure. We think that the presented method is a semiquantitative one and useful for monitoring of pulmonary pressure in patients with cardiac defects.

This report describes the use of dobutamine in patients presenting a low output syndrome after cardiosurgical operations i EEC. Of 565 patients operated on valvular heart defects and coronary artery disease in 89 patients (15.7%) a low output syndrome was diagnosed and treated. Dobutamine proved to be effective in patients with moderate impairment of the left ventricular contractility. In those with severe left ventricular dysfunction, dobutamine was ineffective and other catecholamines ought to be used. The authors support the view that combined administration of dobutamine (or other catecholamines) and nitroglycerin in patients with low output syndrome proves to be superior to the effect of each single drug.

A 74-year-old patients is described who had typical attacks of glossopharyngeal neuralgia associated with very frequent episodes of cardiac arrest. Pacemaker implantation made possible controlling of episodes of cardiac arrest while full remission of attacks was obtained after carbamazepine treatment 900 mg daily.

The results of pharmacological treatment are presented in a group of 60 patients with exacerbation of coronary disease. The patients were divided into two subgroups: subgroup 1 of 26 patients with intensification of angina of effort, subgroup II of 34 patients with unstable angina. Combined pharmacological treatment was given: nitrates, B-adrenolytic drugs and nifedipine (Cordipin, Krka) Addition of Cordipin produced clinical and electrocardiographic improvement in 44 cases (73%): all patients in subgroup I and 18 (53%) in subgroup II. Cordipin was well tolerated, and produced no serious side effects.