RESUMO
OBJECTIVES: This study sought to establish the risk ratio for mortality associated with calcium antagonists in a large population of patients with chronic coronary artery disease. BACKGROUND: Recent reports have suggested that the use of short-acting nifedipine may cause an increase in overall mortality in patients with coronary artery disease and that a similar effect may be produced by other calcium antagonists, in particular those of the dihydropyridine type. METHODS: Mortality data were obtained for 11,575 patients screened for the Bezafibrate Infarction Prevention study (5,843 with and 5,732 without calcium antagonists) after a mean follow-up period of 3.2 years. RESULTS: There were 495 deaths (8.5%) in the calcium antagonist group compared with 410 in the control group (7.2%). The age-adjusted risk ratio for mortality was 1.08 (95% confidence interval [CI] 0.95 to 1.24). After adjustment for the differences between the groups in age and gender and the prevalence of previous myocardial infarction, angina pectoris, hypertension, New York Heart Association functional class, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and current smoking, the adjusted risk ratio declined to 0.97 (95% CI 0.84 to 1.11). After further adjustment for concomitant medication, the risk ratio was estimated at 0.94 (95% CI 0.82 to 1.08). CONCLUSIONS: The current analysis does not support the claim that calcium antagonist therapy in patients with chronic coronary artery disease, whether myocardial infarction survivors or others harbors an increased risk of mortality.
Assuntos
Bloqueadores dos Canais de Cálcio/efeitos adversos , Doença das Coronárias/mortalidade , Bloqueadores dos Canais de Cálcio/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Estudos de Casos e Controles , Estudos de Coortes , Doença das Coronárias/tratamento farmacológico , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de TempoRESUMO
PURPOSE: The purpose of this study was to report the prevalence and the clinical significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute myocardial infarction. PATIENTS AND METHODS: During 1981 to 1983, a secondary prevention study with nifedipine (SPRINT) was conducted in Israel among 2,276 survivors of acute myocardial infarction. During the study, demographic, historical, and medical data were collected on special forms for all patients with diagnosed acute myocardial infarction in 13 hospitals (the SPRINT Registry, n = 5,839). Mortality follow-up was completed for 99% of hospital survivors for a mean follow-up of 5.5 years (range: 4.5 to 7 years). RESULTS: The prevalence of COPD was 7% (406 of 5,839). The latter rate increased significantly in men (7.6%), smokers (9.7%), and older patients (70 years or older, 10.0%). Patients with COPD exhibited a complicated hospital course with an in-hospital mortality rate of 23.9%. Subsequent mortality rates in survivors at 1 and 5 years were 12.3% and 35.9%, respectively. Rates at the same time periods in patients without COPD were 17.2%, 9.2%, and 26.9% (p < 0.005 for in-hospital and 5 years). In a multivariate analysis that included age, gender, and history of myocardial infarction and congestive heart failure, COPD was not independently associated with either in-hospital or postdischarge excess fatality rates. CONCLUSION: In this large cohort of consecutive patients with myocardial infarction, the prevalence of COPD was 7% and higher among smokers, men, and elderly patients. Although in-hospital and postdischarge mortality rates were higher among patients with COPD, this condition did not independently increase either the risk of early death or the risk of long-term mortality among survivors of acute myocardial infarction.
Assuntos
Pneumopatias Obstrutivas/epidemiologia , Infarto do Miocárdio/complicações , Análise Atuarial , Fatores Etários , Idoso , Causas de Morte , Comorbidade , Unidades de Cuidados Coronarianos , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar , Humanos , Israel/epidemiologia , Pneumopatias Obstrutivas/complicações , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Prevalência , Prognóstico , Sistema de Registros , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Análise de Sobrevida , Taxa de SobrevidaRESUMO
Restrictive ventricular filling pattern derived from Doppler echocardiography after anterior wall AMI may serve as an indicator of diastolic dysfunction due to initial myocardial stiffness and complications such as extension of the infarction, Dressler syndrome, septal rupture, or myocardial failure. Later changes, such as prolongation of deceleration time, may indicate remodeling process, healing of the complications of AMI, or improved revascularization.
Assuntos
Ecocardiografia Doppler , Infarto do Miocárdio/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Velocidade do Fluxo Sanguíneo , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologiaRESUMO
We report on the experience accumulated by the subscribers of SHAHAL cardiac services who self-injected intramuscular lidocaine (using an automatic injector "LidoPen") for documented ventricular tachyarrhythmias which were not associated with an acute myocardial infarction. SHAHAL provides professional care to its subscribers who telephone a monitor center and describe their symptoms, whereupon therapeutic measures are decided upon. Patient data are stored in a central computer, and the center can dispatch mobile intensive care units. All subscribers carry a portable transtelephonic electrocardiographic transmitter and are provided with the LidoPen. Indications for self-injection were: transmission of a wide-QRS tachycardia (rate > 100 beats/min), symptomatic multiple or complex ventricular premature complexes in association with chest discomfort, and when the time of arrival of a medical team to the patient was estimated to be at least 8 to 10 minutes. Successful usage of the LidoPen was reported in 137 cases (123 patients). An additional 11 patients failed to use the injector properly. There was a success rate in abolishing rapid sustained ventricular tachycardia (27 of 76 patients) and nonsustained ventricular tachycardia and/or multiple and complex ventricular ectopic activity (8 of 30 patients) of 33% (total 35 of 106 patients). In another 9%, those arrhythmias were slowed markedly. The remaining 31 cases were eventually interpreted as being of supraventricular origin. No complications attributed to the use of the injector were reported and its use was found to be both feasible and effective in the prehospital setting.
Assuntos
Antiarrítmicos/administração & dosagem , Primeiros Socorros , Lidocaína/administração & dosagem , Taquicardia Ventricular/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , Angina Pectoris/tratamento farmacológico , Cuidados Críticos , Eletrocardiografia Ambulatorial , Serviço Hospitalar de Emergência , Estudos de Viabilidade , Feminino , Humanos , Injeções Intramusculares , Israel , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Segurança , Autoadministração , Taquicardia Supraventricular/tratamento farmacológico , Resultado do Tratamento , Complexos Ventriculares Prematuros/tratamento farmacológicoRESUMO
We combine the results of terahertz time-domain spectroscopy with far-infrared transmission and reflectivity to obtain the conductivity of SrRuO3 over an unprecedented continuous range in frequency, allowing us to characterize the approach to zero frequency as a function of temperature. We show that the conductivity follows a simple phenomenological form, with an analytic structure fundamentally different from that predicted by the standard theory of metals.
RESUMO
The relationship between levels of potassium in the serum and the development of malignant arrhythmias was examined in a retrospective study involving 1011 patients presenting with acute myocardial infarction. Thirteen percent of the overall patients studied had significant hypokalemia (k less than 3.5 mmol/liter). The average initial level of potassium in patients who developed malignant arrhythmias was (4.10 mmol/liter) significantly lower (P less than 0.01) than those patients who did not develop such arrhythmias (4.19 mmol/liter). To determine whether the level of potassium was, in itself, the primary cause of malignant arrhythmias following myocardial infarction, a subgroup analysis of factors influencing these levels was performed. It was determined that diabetics have a higher level of potassium than nondiabetics (4.2 mmol/liter versus 4.11 mmol/liter - P = 0.01) and a lower incidence of malignant arrhythmias (50.5% versus 63.5% - P = 0.002). No correlation was found between treatment with either digitalis or diuretics and malignant arrhythmias. Size and location of infarcted areas was found to have a direct relationship with development of arrhythmias. Size and location of infarctions, however, were not found to be related to levels of potassium in the serum. Our findings support and clarify earlier suggestions establishing the levels of potassium in the serum as an important causative factor, together with size and location of infarctions, in the development of malignant arrhythmias.
Assuntos
Arritmias Cardíacas/etiologia , Infarto do Miocárdio/sangue , Potássio/sangue , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/sangue , Diabetes Mellitus/sangue , Digoxina/uso terapêutico , Diuréticos/uso terapêutico , Feminino , Bloqueio Cardíaco/sangue , Bloqueio Cardíaco/etiologia , Homeostase , Humanos , Hiperpotassemia/sangue , Hipopotassemia/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Estudos Retrospectivos , Taquicardia/sangue , Taquicardia/etiologia , Fibrilação Ventricular/sangue , Fibrilação Ventricular/etiologiaRESUMO
An unusual case of atrial septal defect secundum type, associated with intermittent severe mitral insufficiency due to billowing anterior mitral leaflet, in a 56-year old female is described. The degree of mitral insufficiency ranged from severe to none. This phenomenon manifested itself by an intermittent systolic apical thrill and intermittent mitral regurgitation on angiocardiography. Pulling the anterior mitral leaflet at operation through the atrial septal defect demonstrated that this leaflet could be caught in the left atrium, thus causing intermittent mitral insufficiency. Closure of the atrial septal defect and replacement of the mitral valve was performed.
Assuntos
Comunicação Interatrial/complicações , Insuficiência da Valva Mitral/etiologia , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Próteses Valvulares Cardíacas , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , RadiografiaRESUMO
Acute myocardial infarction causes a substantial number of patients to experience difficulties in readjustment to daily activities. It also has an effect on the patient's spouse and emotional state and on the dynamics of interpersonal familial relationships. It is suggested that an interdisciplinary (cardiologist, psychologist, physiotherapist, nurse, dietitian) family-oriented rehabilitation program, which provides medical follow-up, accurate information, psychological understanding and support, and physical training, will contribute to the improvement in life-style for the patient and his family. A long-term rehabilitation program for male patients is described along with a short-term program for those who are unable to take part in the main program. The conviction of the medical team as well as that of the patients, following 8 years of experience, is that the rehabilitation program is responsible for remarkable changes in patient life-style, improvements of family atmosphere, and adjustments of family members to the new situation.
Assuntos
Adaptação Psicológica , Família , Infarto do Miocárdio/reabilitação , Equipe de Assistência ao Paciente , Adulto , Idoso , Exercícios Respiratórios , Feminino , Processos Grupais , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Esforço Físico , Aptidão Física , Terapia de RelaxamentoRESUMO
Recent studies have demonstrated a trend toward improved survival in coronary artery disease. Contributing to this trend are advances in medical therapy. In order to evaluate the preventive effect of drugs in secondary prevention of coronary heart disease, many multi-centered trials were conducted. There is evidence that beta-adrenergic blocking agents may decrease mortality following myocardial infarction. Platelet-active drugs reduce the rate of reinfarctions and may have a beneficial effect on survival. In contrast lipid lowering agents, anticoagulants, antiarrhythmic drugs and calcium channel blockers have not shown convincing beneficial effect on the survival of patients following myocardial infarction, and further studies are required to determine the effect of the various modalities in different clinical settings.
Assuntos
Doença das Coronárias/tratamento farmacológico , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Humanos , Hipolipemiantes/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêuticoRESUMO
Although their effects cannot be shown to statistically alter coronary heart disease mortality or morbidity, voluntary health organizations throughout the world clearly play an important role in bringing about favorable changes in the natural history of this disease and in the community phase of its management. In particular, voluntary organizations are able to conduct research surveys and field trials and by so doing favorably influence state health administration. They are able to correct temporary deficiencies in health services, particularly in the form of psychosocial support and cardiac health education. Observers note that the major change in community phase management has occurred with the wider use of coronary bypass surgery since 1975. More objective data, especially relating to psychosocial factors, can be expected when further research (especially the MONICA Study) is completed. Throughout the world, however, existing voluntary health organizations could be more active in the community phase of cardiac rehabilitation. It would seem an area where such organizations could well do more. A challenging question that should be constantly reviewed is 'Can we do more to reduce the effects of invalidism in cardiac patients?'
Assuntos
Infarto do Miocárdio/reabilitação , Austrália , Assistência Integral à Saúde/organização & administração , Finlândia , Alemanha Ocidental , Política de Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Educação de Pacientes como Assunto , Reabilitação/economia , VenezuelaRESUMO
Since the pacing threshold of artificial pacemakers sometimes increases and causes ineffective pacing, emergency restoration of cardiac pacing may occasionally be required. In such situations sympathomimetic agents, such as isoproterenol, increase excitability and lower threshold. A 83-year-old man with acute ineffective pacing and hemodynamic instability is reported. Intravenous administration of isoproterenol restored effective, artificial cardiac pacing.
Assuntos
Estimulação Cardíaca Artificial , Isoproterenol/administração & dosagem , Idoso , Humanos , Injeções Intravenosas , MasculinoRESUMO
A 61-year-old woman who was being treated with verapamil because of atrial fibrillation with rapid ventricular rate, went into anaphylactic shock. Verapamil is safe and effective for treating supraventricular tachyarrhythmias and serious adverse effects are uncommon. However, hypotension, cardiogenic shock, bradycardia and precipitation or aggravation of heart failure have been described. The patient presented was successfully treated with corticosteroids and antihistaminics.
Assuntos
Anafilaxia/induzido quimicamente , Verapamil/efeitos adversos , Corticosteroides/uso terapêutico , Anafilaxia/tratamento farmacológico , Fibrilação Atrial/tratamento farmacológico , Feminino , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Infusões Intravenosas , Pessoa de Meia-IdadeRESUMO
A 70-year-old man was treated with oral mexiletene because of ventricular premature beats due to ischemic heart disease. He developed a severe maculopapular rash which did not respond to antiallergic treatment, but disappeared after discontinuation of the drug. Adverse effects on the central nervous, cardiovascular and gastrointestinal systems have been described. A rash is rare, and in our case was of unusual severity.
Assuntos
Toxidermias/etiologia , Mexiletina/efeitos adversos , Idoso , Complexos Cardíacos Prematuros/tratamento farmacológico , Toxidermias/tratamento farmacológico , Humanos , MasculinoRESUMO
External cardiac pacing has recently been reintroduced as an effective method in emergency cardiac stimulation. We report for the first time the results of external cardiac pacing in a mobile intensive cardiac care unit. In 9 of 10 patients treated during the first 3 months of 1990, effective pacing was achieved. We conclude that external cardiac pacing is a rapid, safe and effective means of temporary pacing during emergency treatment, before admission to hospital.