Slovakia
online
Volume 97 / No. 7 / 1996
ATHEROSCLEROSIS PREVENTION AND THERAPY
GAJDOS M., CAGAN S., SPUSTOVA V., DZURIK R.
Atherosclerosis is a complex progressive process with high morbidity
and frequent dramatic mortality. The experience from the developed countries
justifies the effectiveness of atherosclerosis prevention. The combination
of nonpharmacologic, antiaggregatory and antihyperlipemic prevention reaches
currently the effectiveness of surgical intervention, with the exception
of sudden events. On the other hand the surgical intervention does not
restore the process of atherosclerosis and requires the same secondary
prevention if the long term prognosis is to be improved. The review presents
the guidelines on nonpharmacologic, antihyperlipemic (up to the combination
of statin with fibrates) and the antiaggregatory prevention with the initial
dose of ASA being 200 mg and a long term dose being >= 30 mg of ASA/d
treatment. (Tab. 4, Fig. 3, Ref. 25.)
Key words: atherosclerosis, prevention, therapy, aggregability,
atherogenesis.
Bratisl Lek Listy 97; 1996: 382–387
ELECTROCARDIOGRAM IN THE ACUTE MYOCARDIAL INFARCTION IN „THE THROMBOLYTIC ERA"
KUCHAROVA L., CAGAN S.
Authors presented the basic criteria for indicating thrombolytic therapy
in patients with acute myocardial infarction according to literature data
and their own experience regarding the judgement of changes in initial
standard electrocardiogram (without any changes after administration of
nitroglycerine and/or chest pain resolution). They are: 1. ST segment elevation
>= 0,1 mV, in at least two contiguous leads, 2. new or a presumably
new bundle branch block, 3. ST segment depression in thoracic leads V[_1]—V[_3]
in the presumptive presence of acute posterior myocardial infarction. It
is appropriate to repeat the recording, to perform echocardiography (or
coronary angiography) and to evaluate in complexity the general clinical
status in case of nonspecific changes on the electrocardiogram. Authors
include a review of literature data on evaluation of cases with successful
thrombolysis based on standard electrocardiogram. They emphasized strongly
the meaning of a fast and sustained decrease/normalisation of ST segment
and/or presence of so called reperfusion arrhythmias (namely early, frequent,
repetitive accelerated idioventricular rhythm). The authors presented also
the changes of QRS complex, T wave and Q-T interval with thrombolytic therapy.
The evaluation of ST segment reelevation during and after thrombolytic
therapy still requires to be studied into greater detail. (Tab. 5, Ref.
65.)
Key words: acute myocardial infarction, electrocardiogram, thrombolytic
treatment.
Bratisl Lek Listy 1996; 97: 388–396
BIOCHEMICAL MARKERS IN ACUTE MYOCARDIAL INFARCTION
PECHAN I.
Exact and early diagnosis of acute myocardial infarction is essential
for the subsequent routine management of this frequent cardiovascular disease.
At present, the clinical biochemistry possesses a set of more or less cardiospecific
protein markers for early detection of myocardial ischemic damage. After
the admission of patient to the hospital, serial estimations of rather
non-specific enzyme activities (creatine kinase, its MB-izoenzyme, lactate
dehydrogenase, hydroxy-butyrate dehydrogenase) are currently used for the
detection of acute myocardial infarction and for the further monitoring
of the patient and managing his therapy. In the past decade, many cardiospecific
biochemical markers were discovered and gradually introduced into the routine
clinical practice. The most perspective markers are some molecules of contractile
proteins of heart myofibrils (troponins, myosin chains) as well as „rediscovered"
myoglobin.
The aim of this review article is to inform about the commonly used,
as well as about the new biochemical markers, to discuss some problems
of diagnostic strategy in the early and exact detection of ischemic myocardial
damage and to attract attention to the difficulties. However its disadvantage
resides in its presence in both myocardium and skeletal muscles which arise
when the diagnosis of acute myocardial infarction is prematurely excluded
from consideration and such patients are discharged too soon from hospital.
(Fig. 1, Tab. 1, Ref. 72.)
Key words: acute myocardial infarction, exact and early biochemical
detection, enzyme markers, specific and non-specific protein markers.
Bratisl Lek Listy 1996; 97: 397–405
CONTRIBUTION OF SPECIALIZED ECHOCARDIOGRAPHIC MODALITIES IN THE EARLY PHASE OF ACUTE MYOCARDIAL INFARCTION
DUBRAVA J., MURIN J., CAGAN S.
The authors present the clinical contribution of specialized echocardiographic
methods in the early phase of acute myocardial infarction (AMI) — stress
echocardiography, myocardial contrast echocardiography, transesophageal
echocardiography, as well as some latest technologic modalities (tissue
doppler imaging, automatic endocardial detection, digital image processing).
These methods frequently render fundamental information about the patient
after AMI, but with regard to the relatively short period of their clinical
use, some unsolved problems remain to be answered. Meanwhile, there exists
only limited experience with specialized echocardiographic modalities after
AMI in Slovakia. (Fig. 2, Ref. 53.)
Key words: specialized echocardiographic modalities, acute myocardial
infarction.
Bratisl Lek Listy 1996; 97: 406–412
ADJUVANT THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
JURKOVICOVA O., CAGAN S.
Beside the thrombolytic therapy several adjuvant therapeutic measures
were identified which significantly improve the prognosis of patients with
acute myocardial infarction (AMI). These measures include the treatment
by means of acetylsalicylic acid (ASA), beta-blockers and ACE inhibitors.
Early administration of ASA and beta-blockers are indicated in all
patients with AMI who have no contraindications for this therapy. They
are especially the patients with manifest heart failure or asymptomatic
left ventricular dysfunction who benefit from ACE inhibitors.
The effectivity of routine administration of other medicaments such
as anticoagulants, nitrates, calcium channel blockers and magnesium, have
not been convincingly proved. However, some selected patients with AMI
can benefit from these medicaments.
Intravenous administration of heparin is unambiquously justified only
in thrombolysis with t-PA. Thrombolyses with streptokinase, urokinase,
and anistreplase are justified only at high risk of thromboembolic complications.
Their prevention and therapy include also the necessity to restrict the
administration of pelentan.
The use of nitrates is indicated in patients with AMI in case of sustaining
stenocardia, arterial hypertension and manifest heart left ventricular
failure.
Until the definitive standpoint is gained regarding the effect of magnesium
in patients with AIM, its adiministration remains especially indicated
in cases of arterial hypertension, tachycardiac disturbances of the heart
rhythm and states of assumed or proved hypomagnesiemia. In AMI cases when
magnesium is used in order to protect the patient from reperfusion lesion,
it must be admistrated prior to the reperfusion therapy.
An intensive research in the field of therapeutical measures in patients
with AMI still continues. It is certain that it will soon bring further
knowledge which will in turn improve the prognosis and quality of life
of patients with AMI. (Tab. 4, Ref. 133.)
Key words: acute myocardial infarction, adjuvant therapy, acetylsalicylic
acid, beta-blockers, ACE inhibitors.
Bratisl Lek Listy 1996; 97: 413–428