Slovakia
online
Volume 97 / No. 8 / 1996
TRANSTHORACIC ECHOCARDIOGRAPHY IN THE EARLY PHASE OF ACUTE MYOCARDIAL INFARCTION
DUBRAVA J., MURIN J., CAGAN S.
The authors present an article reviewing the fundamental importance
of transthoracic echocardiography in the early phase of acute myocardial
infarction (AMI). They refer to its significance in the diagnostics and
differential diagnostics statements of AMI and its complications, evaluation
of left ventricular systolic and diastolic function. The authors emphasize
its possibilities in risk stratification and prognostic evaluation of the
patients after AMI.
Regarding the valuable possibilities of transthoracic echocardiography
which in a decisive manner often determine the further diagnostic
and therapeutic procedures, the authors postulate that this procedure should
be performed in each patient with AMI already in early phase. They consider
the inaccessibility of early bed-side transthoracic echocardiography as
a management failure. (Fig. 2, Ref. 72.)
Key words: echocardiography, acute myocardial infarction.
Bratisl Lek Listy 1996; 97: 439–448
STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
DURIS T., FABIAN J., KARVAJ M., KLOBUCNIKOVA Z., PAVLOVIC M., URGEOVA L.
Stratification of patients after myocardial infarction by a scale
of non-invasive examinations – Holter monitoring, early ergometry, examination
of late ventricular potentials, heart rate variability, echocardiography,
monitoring of haemodynamic parameters by means of electric bioimpedance,
clinical state monitoring, evaluation of MI localisation, and the age of
the patients enable a sufficiently accurate assessment of residual
myocardial ischaemia, and to reveal electrical instability and dysfuntion
of myocardium. The signs detected in this way enable, after mathematical
analysis of the results, to assess the degree of risk in individual patients,
and to evaluate accurately the defined groups (men, women) regarding the
prognosis. These relatively simple examinations help to identify the patients
whose states require coronarographic examination or revascularization intervention,
or on the contrary, to select those patients who may return to their occupation
without major risk of re-infarction and sudden death. (Tab. 3, Fig.
7, Ref. 52.)
Key words: prognostic stratification, myocardial infarction, factor
analysis, secondary prevention.
Bratisl Lek Listy 1996; 97: 449–456
NONINVASIVE ELECTROCARDIOGRAPHIC STUDIES AND VENTRICULAR ARRHYTHMIAS IN PATIENTS AFTER MYOCARDIAL INFARCTION
GONSORCIK J., SZAKACS M., PALKO S., FRANKO J., MUDRIKOVA T.
It is generally accepted that ventricular arrhythmias represent a predictor
of prognosis after myocardial infarction, and that their impact on the
increase of risk is especially unfavourable when associated with myocardial
ischaemia or reduced left ventricular function. The aim of the study was
to assess the significance and contribution of noninvasive ECG methods
in detection of risk due to sudden cardiac death in Q postmyocardial infarction
patients. Two-hundred and seventy patients were examined by exercise testing
which in 5.2 % of cases revealed couplet ventricular extrasystoles and
0.8 % yielded non-sustained ventricular tachycardia. 24-hour-Holter ECG
recording was performed in 168 patients (19.0 % of couplet ventricular
extrasystoles, 9.0 % of non-sustained and 0.6 % of sustained ventricular
tachycardia respectively), and 300 patients were examined by late ventricular
potentials analysis with a result of 25 % positive cases. During 3
years of follow-up, 20 out of 300 patients (6.7 %) died suddenly; in this
group late ventricular potentials occurred significantly more frequently
than in survivors. Exercise testing plays a major role in the detection
of myocardial ischaemia, while Holter recording and signal averaging for
detection of late ventricular potentials are important in noninvasive diagnosis
of ventricular arrhythmias. Their combination with other ECG techniques
(heart rate variability, QT dispersion) and determination of global function
of the left ventricle may help to identify the group of patients in whom
subsequent electrophysiological study is indicated in order to determine
the optimal therapy for mortality reduction after myocardial infarction.
(Fig. 5, Tab. 3, Ref. 20.)
Key words: stratification after myocardial infarction, ventricular
arrhythmias, noninvasive ECG methods.
Bratisl Lek Listy 1996; 97: 457–462
INCIDENCE OF ABNORMAL LATE VENTRICULAR POTENTIALS IN PATIENTS WITH MYOCARDIAL ISCHAEMIA AND THE ASSESSMENT OF THE RISK OF SUDDEN CARDIAC DEATH IN PATIENTS AFTER MYOCARDIAL INFARCTION
FILIPOVA S., MIKUS P., CAGAN S.
Background: The crucial step in prevention of sudden cardiac
death (SCD) is a method of a precise and most accessible identification
of those patients with ischaemic cardiac disease (ICD), especially after
MI, who are highly presumptive candidates of malign ventricular arrhythmias.
The selection of individuals exposed to risk, and individual judgement
of the threat to patients after MI is a complex problem. Patients
after MI are endangered by reinfarction, cardiac failure, heart wall rupture
and primary ventricular tachyarrhythmia. Stratification of patients exposed
to a presumably higher risk of probable new coronary event and malign
ventricular arrhythmia with an early decision to intervene, gains practical
clinical significance. Similarly, It is important to identify also the
patients after MI exposed to lower risk, who need no interventional therapeutical
procedure. The cardiologic practice utilizes several examinatory procedures
and tests, prevailingly of non-invasive character.
Aims and objectives: The study reviews the latest information
on pathophysiology and current level of clinical interpretation of non-invasive
ecg procedure from the field of high-resolution electrocardiography including
the late ventricular potentials (LVP). The study is aimed at: a) presentation
of a review of available information from the field of electrophysiology
and clinical electrocardiography and the mechanism of impact of myocardial
ischaemia on the existence of high-frequency, but at the same time extremely
low-amplitude potentials abnormalities in the course of QRS complex and
S-T segment (LVP), b) presentation of a review on the informative
value and clinical significance produced by non-invasively detected electrophysiological
heterogenity of myocardium during ischaemia, aiding the short-term and
long-term prognosis judgements in patients with ICD, especially after undergoing
its most serious form - myocardial infarction. Beside the group analysis
the study is also aimed at individual non-invasive judgement of risk of
the development of malign ventricular arrhythmias in patients with acute
coronary syndromes. (Fig. 3, Ref. 41.)
Key words: high-resolution electrocardiography, late ventricular
potentials, acute coronary syndromes, myocardial infarction, risk stratification
after MI, sudden cardiac death.
Bratisl Lek Listy 1996; 97: 463–472
AUTONOMOUS NERVOUS SYSTEM TESTING IN STRATIFICATION OF PATIENTS ENDANGERED BY SUDDEN HEART DEATH
KALISKA G., KMEC P.
The authors present an insight into the role of the nervous system in
relation to the risk of sudden cardiac death. They present the basic diagnostic
possibilities provided by examination of the autonomous nervous system,
namely heart rate variability and baroreflex sensitivity. Reduced heart
rate variability and the depression of baroreflex sensitivity represent
independent risk markers of sudden heart death. Their role in complex risk
stratification of patients endangered by sudden cardiac death especially
after myocardial infarction and with congestive heart failure. (Fig.
5, Tab. 2, Ref. 24.)
Key words: autonomous nervous system, sudden cardiac death, heart
rate variability, baroreflex sensitivity.
Bratisl Lek Listy 1996; 97: 473–478
HEART FAILURE IN ACUTE MYOCARDIAL INFARCTION AND THE SIGNIFICANCE OF HAEMODYNAMIC MONITORING
KOHN R.
In his study the author deals with etiopathogenesis, diagnosis and therapy
of heart failure in acute infarction of myocardium (AMI) with special attention
paid to haemodynamic monitoring. The therapy of AMI is based especially
on thrombolysis, or urgent revascularisation. In therapy of left ventricular
failure we prefer nitrates, diuretics, and ACE-inhibitors. A severe
heart failure requires haemodynamic monitoring and administration of positive
inotropic substances (dopamine, dobutamine, amrinone) and sodium nitroprusside.
Digoxin is indicated only in atrial fibrillation and flutter with fast
response of ventricles. In cardiogenic shock it is necessary to introduce
an intraaortic balloon contrapulsation and urgent revascularisation (coronary
angioplasty, or aortocoronary bypass). Special attention has to be paid
to the diagnosis and therapy of AMI of the right ventricle. We avoid the
administration of diuretics, nitrates, or morphine which cause hypotension.
The therapy is based on thrombolysis, hypotension requires volume expansion,
sustained hypotension needs administration of dobutamine, and haemodynamic
monitoring. In case of complete AV block, sequence atrioventricular cardiostimulation
is recommended. (Ref. 11.)
Key words: acute myocardial infarction, heart failure, haemodynamic
monitoring.
Bratisl Lek Listy 97; 1996: 479–481
ANTITHROMBOTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION
OKRUCKA A.
Thrombotic occlusion of coronary arteries is the reason of most acute
coronary syndromes. A significant role in their prevention and therapy
is taken by antiplatelet therapy. Acute coronary syndrome justifies also
the use of anticoagulation therapy, namely by heparine. The adjuvant therapy
by means of heparine in thrombolysis seems to be necessary especially when
alteplase (t-PA) is used. Peroral anticoagulants represent a further
therapeutical procedure in patients with coronary ischaemia. Regarding
the increased risk of bleeding, the cost and difficulties coinciding with
therapy by cumarine derivates, the antiplatelet therapy is currently preferred.
Cumarine derivates, however, should be used in patients with simultaneous
atrial fibrillation, venous thromboembolism and it should be considered
in patients with heart failure and pre-thrombotic states. Studies aimed
at the assesment of the role of low-molecular heparine in acute coronary
ischaemia currently take place. Encouraging results are gained from experience
with high effective direct inhibitors of thrombin (e.g. hirudin) and antagonists
of glycoprotein IIb/IIIa. It seems that they soon will find justification
in the therapy of arterial thrombosis. Interesting field of the research
is represented by the studies which compare low doses of acetylosalicylic
acid with low doses of cumarine derivates. (Ref. 43.)
Key words: acute myocardial infarction, antiplatelet therapy, anticoagulative
therapy, cumarine derivates.
Bratisl Lek Listy 1996; 97: 482–486
SECONDARY PREVENTION IN CARDIOVASCULAR DISEASES IN THE AGED
KVETENSKY J., BESTVINA D., FUNIAK S., MOKAN M., LACKO A.
Secondary prevention in cardiovascular diseases has its meaning also
in elderly people. It is specific in some factors. The currently known
facts gradually include measures which are not associated with old age
of individuals. They include: influencing of the deteriorated adaptation
of old organism to internal and external effects, decreased physical activity,
restricted self-sufficiency, social isolation, incorrect life style, polymorbidity
and subsequent polypragmatic therapy, etc. Prolongation of life span of
man, the struggle against CVD and the improvement of the quality of life
of patients can be secured only by means of a complex of racional
preventive measures. (Ref. 22.)
Key words: ischaemic heart disease, cardiovascular diseases, secondary
prevention, quality of life, prevention in old age.
Bratisl Lek Listy 1996; 97: 487–489