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Of 3,981 patients with a first Q-wave acute myocardial infarction (AMI), 1,929 (48%) had an anterior and 1,724 (43%) an inferior wall AMI. These 2 groups were well-matched with respect to age, gender and relevant history. The in-hospital mortality rate was 18%, and the 1- and 5-year postdischarge mortality rates were 9 and 2S%, respectively, in patients with anterior wall AMI co pared with the corresponding rates of 11, 6 and 19% in those with inferior wall AMI (p more...

Among 4,720 consecutive hospital survivors from acute myocardial infarction (AMI) treated in 13 coronary care units between July 1981 and August 1983, the estimated prevalence of electrocardiographic left ventricular (LV) hypertrophy was 6.1%. The prevalence of electrocardiographic LV hypertrophy increased with age and was higher in patients with previous myocardial infarction, angina and systemic hypertension. Mean age of patients with electrocardiographic LV hypertrophy was 67.2 vs 61.4 years in counterparts free of electrocardiographic LV hypertrophy. Patients with electrocardiographic LV hypertrophy had a higher rate of congestive heart failure on admission, or developing during their stay in coronary care units. The 1- and 5-year mortality rates were 19.7 and 46.6% among patients with electrocardiographic LV hypertrophy versus 8.7 and 26.2%, respectively (p more...

PURPOSE: The PUrPOSe Of this study was to report the incidence, the antecedents, and the clinical signficance of clinically recognized cerebrovascular accidents or transient ischemic attacks (CVA-TIA) complicating acute myocardial infarction. PATIENTS AND METHODS.- During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in 14 hospitals in Israel among 2,276 survivors of acute mmocardial infarction. During the study, demographic, historical and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 of these 14 hospitals (the SPRINT registry, n = 5,839). MortalitY followup was completed for 99% of hospital survivors for a mean follow-up of 5.5 Years (range. 4.5 to 7 years). RESULTs: The incidence of CVA-TL4, was 0.9% (54 of 5,839). The latter rate increased significantly only with age, from 0.4% among patients up to 59 years old to 1.6% among those aged greater than or equal to 70 years. Multivariate analysis identified age, congestive heart failure, and history of stroke as PredictOrs Of CVA-TIA during the acute phase of myocardial infarction. Patients with CVA-TIA exhibited a complicated hospital course, with a 15-day mortality rate of 41%. Subsequent mortality rates in survivors at 1 and 5 years were 34% and 59%, respectively. Rates at the same time points in patients without CVA-TIA were 16%, 11%, and 29% p CONCLUSION: In this large cohort of consecutive patients with myocardial infarction, CVATIA was a relatively infrequent complication of acute myocardial infarction. Factors independently favoring the occurrence of CVA-TIA were old age, previous CVA, and congestive heart failure. CVA-TIA occurring during acute myocardial infarction independently increased the risk of early death threefold as well as the risk of long-term mortality in early-phase survivors (2.5-fold)., The occurrence of heart attack may be complicated by cerebrovascular accident (CVA), which refers to conditions resulting from ischemia (insufficient blood supply) or bleeding within the brain. A more common term for cerebrovascular accident is stroke. CVA may occur in 0.6 to 8.6 percent of heart attack patients. Anticoagulants, or agents that prevent blood coagulation, may help to reduce the number of emboli, or blood clots in the circulation, but they do not improve death rates due to heart attack. The incidence, risk factors, and clinical importance of CVA or transient ischemic attacks (CVA-TIA) associated with heart attack were assessed in 2,276 survivors of 5,839 heart attack patients. CVA-TIA occurred in 54 of 5,839 patients. The incidence of CVA-TIA increased from 0.4 percent among patients 59 years or less to 1.6 percent among patients 70 years or older. Older age, a history of congestive heart failure, and previous stroke influenced the development of CVA-TIA in the early stage of heart attack. Forty-one percent of patients with CVA-TIA died within 15 days of the attack, 34 percent within one year, and 59 percent within five years. In comparison, death rates among heart attack patients without CVA-TIA were 16 percent at 15 days, 11 percent at one year, and 29 percent at five years. The findings show that CVA-TIA is a rare complication of heart attack. Older age, previous CVA-TIA, and a history of congestive heart failure increase the risk of CVA-TIA in heart attack patients. The development of CVA-TIA in a heart attack patient increases the risk of early death three-fold, and even increases the risk of later death among survivors of heart attack. (Consumer Summary produced by Reliance Medical Information, Inc.) more...

Angina pectoris, or chest pain, results from an increased oxygen demand to the heart in the presence of myocardial ischemia, an insufficient blood supply to the heart muscle. Since blood pressure affects both oxygen demand and blood supply, antihypertensive agents such as calcium antagonists and beta blockers, which reduce blood pressure, are effective in treating angina. Calcium antagonists prevent the entry of calcium into the cell and beta blockers prevent the activation of beta receptors, which are cell membrane proteins involved in specific cell processes. Both calcium antagonists and beta blockers reduce blood pressure and thereby reduce the oxygen demand of the heart. However, the drop in blood pressure produced by calcium antagonists may also reduce the blood supply to the heart; hence these agents should not be used for treating angina in patients with low or normal blood pressure. Beta blockers reduce the oxygen demand but do not improve blood supply to the heart and are of limited use for treating angina. Angiotensin-converting enzyme (ACE) inhibitors prevent the formation of angiotensin, which constricts blood vessels and raises blood pressure. Although ACE inhibitors may reduce the oxygen demand of the heart by lowering blood pressure, their effects in myocardial ischemia, which leads to angina, are not clear. Nitrates also reduce oxygen demand by decreasing blood pressure, but their antianginal effect is largely due to their ability to improve blood supply to the heart by dilating the coronary arteries, the major blood vessels supplying the heart. Nitrates are generally not used to treat hypertension, because their antihypertensive effect is diminished during long-term use. Studies indicate that nitrates remain superior to other antianginal agents for treating myocardial ischemia and preventing angina. (Consumer Summary produced by Reliance Medical Information, Inc.) more...