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Abstract Background Emergency medical technicians (EMTs) and paramedics experience critical incidents which evoke distress and impaired functioning but it is unknown which aspects of incidents contribute to their impact. We sought to determine these specific characteristics by developing an inventory of critical incident characteristics and testing their relationship to protracted recovery from acute stress, and subsequent emotional symptoms. Methods EMT/paramedics (n = 223) completed a retrospective survey of reactions to an index critical incident, and current depressive, posttraumatic and burnout symptoms. Thirty-six potential event characteristics were evaluated; 22 were associated with peritraumatic distress and were retained. We assigned inventory items to one of three domains: situational, systemic or personal characteristics. We tested the relationships between (a) endorsing any domain item and (b) outcomes of the critical incident (peritraumatic dissociation, recovery from components of the Acute Stress Reaction and depressive, posttraumatic, and burnout symptoms). Analyses were repeated for the number of items endorsed. Results Personal and situational characteristics were most frequently endorsed. The personal domain had the strongest associations, particularly with peritraumatic dissociation, prolonged distressing feelings, and current posttraumatic symptoms. The situational domain was associated with peritraumatic dissociation, prolonged social withdrawal, and current posttraumatic symptoms. The systemic domain was associated with peritraumatic dissociation and prolonged irritability. Endorsing multiple characteristics was related to peritraumatic, acute stress, and current posttraumatic symptoms. Relationships with outcome variables were as strong for a 14-item inventory (situational and personal characteristics only) as the 22-item inventory. Conclusions Emotional sequelae are associated most strongly with EMT/paramedics’ personal experience, and least with systemic characteristics. A14-item inventory identifies critical incident characteristics associated with emotional sequelae. This may be helpful in tailoring recovery support to individual provider needs.

Individualized prognosis is a topical problem in the management of acute myocardial infarction. Prediction of clinical course and outcome of the disease encounters many difficulties since it requires highly sensitive and specific measurements that must be safe and technically simple. Prognostic studies related to acute myocardial infarction are many, but combined effect of various factors remains poorly known. Thus far, clinical conditions of the patients were evaluated largely based on medical history data and assays of cardiospecific enzymes. The expected outcome of the disease was deduced from the results of complicated and expensive studies (e.g. coronaroventriculography) available in relatively few medical centres or VEM test usually performed since the 3d week after onset of the disease. Most publications do not mention the use of 24 hour ECG (Holter) monitoring for immediate prognosis although this method is readily available, safe, and can be applied at any stage of the disease. Its sensitivity and specificity for the diagnosis of coronary heart disease is 88 and 69% respectively. The method can be used to evaluate efficiency of therapy, detect arrhythmogenic complications and painless myocardial ischemia in patients with myocardial infarction.

The importance of the problem of primary infective endocarditis (PIE) has become much greater during the last years due to an increase in its incidence, serious early diagnostic difficulties, and high lethality, which makes study of its new diagnostic criteria necessary. The paper presents data on the role of C-reactive protein (CRP) in PIE diagnosis. The authors show that high CRP levels evidence prominent infective-and-toxic manifestations of the disease and that dynamic measurement of CRP levels in patients with infective myocarditis allows monitoring the effectiveness of the therapy and may be applied to the prognosis of the disease.

The issue of atrial fibrillation is covered in the article in detail; the frequency of its individual forms is presented. The systematization of the individual forms of atrial fibrillation, the pathogenesis of its various forms, their reversibility and constancy are given from up-to-date positions. The author adduces a detailed description of modern methods of pharmacotherapy and instrumental therapy.

The aim of the study was assessment of clinical efficacy and safety of terazosine (setegis) in patients with benign prostatic hyperplasia (BPH) and concomitant cardiovascular disease. A total of 62 BPH patients with cardiovascular disease (ischemic heart disease, hypertension) having indications for alpha-adrenoblockers (mean age 74 +/- 11 years, 58-85) received terazosine in a dose 1-5 mg for 2 months. Clinical efficacy of terazosine was assessed by IPSS scale, residual urine, maximal voiding velocity. Safety of the drug was controlled by monitoring of arterial pressure, ECG, echo-CG. All the tests were made before therapy, on the treatment week 2, 4 and 8. The response was 90.3%. Overall symptoms score decreased by 37.0%, quality of life score rose by 23.8%. Amount of residual urine fell by 64.8%, maximal voiding velocity increased by 36.6%. Moderate effects of the drug (vertigo, weakness) occurred in 11.3% patients for 1 or 2 days after start of the therapy and were due to a moderate fall of arterial pressure in normotensive patients. Later artertial pressure stabilized, ECG registered no exacerbations of ischemic heart disease, no anginal attacks, no change in cardiac rhythm. Thus, terazosine (setegis) is effective and safe in BPH patients with cardiovascular disease. Pretreatment consultation of the cardiologist is desirable for correction of basic antianginal therapy.

The article deals with current trends in the prevalence of heart failure (HF) and its pathogenetic forms, presents the area of medication application as well as arguments for the leading role of ACE inhibitors in the treatment of various forms of acute and chronic HF, describes basic effects of ACE inhibitors, indications and contraindications to their use.

Basing on own data and literature survey the authors analyze clinical course of viral myopericarditides. Special emphasis is made on evolution of electrocardiographical signs in which four stages are distinguished. It is noted that incidence of hemorrhagic myopericarditides probably of viral nature is increasing. The paper contains recommendations on treatment of patients with myopericarditis. The disease has favorable prognosis. However prognosis of diffuse myopericarditis remains unfavorable and its rational treatment - insufficiently established.

Isolated systolic arterial hypertension (ISAH) is encountered in more than 20% of elderly patients with arterial hypertension (AH). Changes of elastic properties of large arterial vessels are an essensial pathogenetic factor of AH in the elderly. Tiaside and non-tiaside diuretics, long-acting dihydropiridine calcium antagonists are drugs of choice for treatment of AH and ISAH in the elderly.

This literature review presents current information on mechanisms of realization and action of natriuretic peptides in heart failure and hypertension. Significant role in degradation of natriuretic peptides belongs to neutral endopeptidase. Basing on theoretical and experimental data novel class of drugs - inhibitors of neutral endopeptidase - has been developed. The paper contains discussion of first results of the use of drugs from this class for the treatment of chronic heart failure.

The information is reviewed on significant effectiveness of statins in different forms of coronary heart disease in the range from angina pectoris to acute myocardial infarction. Positive treatment results were achieved both in high and normal hemoglobin.

A uniform set of differential-diagnostic methods was used in 45 patients with dilated cardiomyopathy (DCMP) and 36 patients with ischemic cardiomyopathy (ICMP). The following parameters, significant for differentiation of the above diseases, have been defined: case history data, more deep decrease of global myocardial contractility and dilation of cardiac chambers, prevalence of increased linear sizes of the right ventricle, reduction of linear sizes of the aorta and left ventricular hypertrophy in DCMP; a different direction of left ventricular contractility index in dobutamine test.

There is no doubt now that arterial hypertension in the elderly must be treated. Policy of antihypertensive therapy in the elderly patients is described. Indications to some antihypertensive drugs and relevant side effects are detailed. Other drugs will be considered further--in part II of the lecture.

To decide on treatment policy and specify prognosis in infectious endocarditis (IE) it is necessary to investigate myocardium. This is better to do using most informative criteria of myocardial affection--structural and geometrical changes of the left ventricle, various focal lesions, high-grade ventricular extrasystole, supraventricular tachycardia, atrioventricular block of various degree.

The study has provided strong evidence for the marked antihypertensive and antiischemic effects of isosorbide-5-mononitrate (I-5-M)--the drug Monochinque retard, 50 mg (A Monarini Group, Berlin Chemie). It contributed to the reduction of the number of anginal attacks and to the alleviation of myocardial ischemia, as evidenced by Holter monitoring. The findings also indicate that there are positive changes in central hemodynamic parameters, such as left ventricular systolic and diastolic functions when Monochinque was given. The data presented suggest that Monochinque, 50 mg, an I-5-M has a positive effect on the clinical manifestations of pain and painless forms of coronary heart disease and that it alleviated functional classes II-IV heart failure.

Clinical characteristics of viral myopericarditis are analysed basing on the original and literature data. Four evolutionary stages of electrocardiographic image of the disease are described. Higher incidence of hemorrhagic myopericarditides is stated. These are suggested to have a viral nature. Steroid glucocorticoids produce a satisfactory therapeutic effect. The prognosis of the disease is favourable.

Hemodynamic parameters and survival were studied in 48 patients with noncoronarogenic myocardial diseases (NCMD). The examination included high-resolution electrocardiography and Holter monitoring of cardiac rhythm. Deterioration of pump capacity of the heart was associated with high-grade arrhythmias (4B and higher) while ventricular late potentials were more characteristic for patients with severe hemodynamic disorders and, in particular, with dilated cardiomyopathy. The prognosis in NCMD is based on clinical evidence on functional class of the heart failure, parameters of central and intrapulmonary hemodynamics.

A trial was performed of clinical efficacy of the coenzyme complex incorporating piridoxalphosphate, cobamamide and phosphaden in patients with infectious allergic myocarditis. Myo- cardial dystrophy and correlations of the myocardial enzymatic status with blood lymphocytes in the above patients were taken in consideration. Corrective action of metabolic therapy on myocardial bioenergy was coupled with positive antiarrhythmic and cardiotonic effects. Cytochemical follow-up investigations enabled long-term monitoring over the patients' condition and further catamnesis.

Central and intrapulmonary hemodynamic parameters were examined by direct and indirect methods in 46 patients with myocarditis (25 females and 21 males), which revealed diminished myocardial contractility, which was followed by a regular and significant pulmonary blood pressure and a reduction in the elastic properties of the pulmonary-arteriolar bed. Central and intrapulmonary hemodynamic changes are mostly associated with the development of hypodynamia and more rarely with that of the phase hemodynamic syndrome and more rarely with the volume overloading syndrome.

Hemodynamic studies by direct and indirect methods in patients with myocarditis have revealed that as pulmonary hypertension developed, right-ventricular myocardial contractility and pulmonary arteriolar bed elasticity were decreasing. High pulmonary hypertension and structural shifts in pulmonary artery wall reduced the volumic potentialities of the lesser circulation. The antiorthostatic test was found an important test for the detection of compensatory deposition potentialities of the lesser circulation vessels in myocarditis patients.

The authors describe clinical and morphological features of a rare tumor, pericardial mesothelioma. Their findings lead them to a conclusion that the epithelioid cell form (tubular and papillary variants) is the most incident histologic form of this tumor. They emphasize that life-time diagnosis of pericardial mesothelioma is of paramount importance because rational chemotherapy permits prolongation of the patient's survival.

The paper presents the results of a clinicomorphological study of 50 patients with dilated cardiomyopathy. ECG, echocardiography, x-ray revealed atrial fibrillation, parasystole, extrasystole, impairment of intraventricular conduction, symptoms of a focal cicatricial myocardial lesion, high end-systolic and end-diastolic volumes, reduced ejection fraction, marked axial dilatation of the heart. Morphologic evaluation showed diffuse and diffuse microfocal cardiosclerosis, combination of sites of hypertrophic myocardiocytes with dystrophic foci, atrophy, sclerosis. Morphological evidence is available for arrhythmic, cardiomegalic, aneurysmic, infarction-like and pseudovalvular dilated cardiomyopathy.