[Is the reduction of the plasma levels of endothelin in the acute and sub-acute stage of myocardial infarct one of the beneficial effects of early treatment with ace inhibitors?]. / La riduzione dei livelli plasmatici dell'endotelina nelle fasi acute e sub-acute dell'infarto miocardico e uno degli effetti benefici del precoce trattamento con ace-inibitori?

BACKGROUND: Studies showed that endothelin-1 (ET-1) was increased in the acute myocardial infarction (AMI). Experimental studies reported that captopril was able to reduce ET-1 secretion. In addition increased levels of ET-1 were reported as a negative prognostic index. The study was aimed to verify whether captopril was able to reduce plasma ET-1 levels in the acute and subacute phases of AMI. METHODS: Forty five patients, hospitalized for suspected anterior AMI within 4 h since the onset of symptoms, suitable for thrombolysis (first episode), in Killip class 1-2, were randomized (double blind) into two groups: Group A (23 patients, pts), 7 females and 16 males, received captopril 6.25 mg orally (as first dose) 2-4 h after starting thrombolysis, and the doses of captopril were successively increased up to 25 mg every 8 h. Group B: (22 pts), 5 females and 17 males, received placebo after thrombolysis. All the patients met the reperfusion criteria. RESULTS: The two groups were similar for age, sex, CK peak, ejection fraction, end systolic volume and risk factors. Plasma ET levels were checked on admission, and 2, 12, 24, 48, 72 hours, after starting thrombolysis. Mean concentrations of ET +/- SD: Group A: basal 1.50 +/- 0.67, at 2 h 2.31 +/- 1.24, 12 h 1.84 +/- 1.45, 24 h 1.30 +/- 0.72, 48 h 0.95 +/- 0.50, 72 h 0.60 +/- 0.15 fmol/ml (p < 0.001). Group B: basal 1.58 +/- 0.83, at 2 h 2.38 +/- 1.35, 12 h 2.33 +/- 1.71, 24 h 1.80 +/- 1.41, 48 h 1.46 +/- 0.88, 72 h 0.93 +/- 0.44 fmol/ml (p < 0.001). Difference between the two groups was significant at 48 h (p < 0.05), and 72 h (p < 0.001). CONCLUSIONS: Our data suggest that captopril affects plasma endothelin levels in the acute and subacute phases of AMI. In addition, our results seem to be an additional support to the beneficial effects of early captopril treatment in patients with AMI.

[Sexual dysfunction in infarct patients and their partner: repercussions on the couple's relations]. / La disfunzione sessuale nell'infartuato e nel suo partner: ripercussione sul rapporto di coppia.

We have studied the sexual dysfunction in 115 couples under 60 years a member of whom had overcome a myocardial infarction (M.I.) not less than 6 months and no more than 2 years. We used two distinct questionnaires filled in anonymously one by the patients, the other by their partners. 70 (60,8%) patients have sexual dysfunction in post infarction as: partner's lack of co-operation 34 (48,6%), premature ejaculation 12 (17,1%), erectile failure 7 (10%), frigidity 6 (8,6%), sexual dissatisfaction 4 (5,7%), retarded ejaculation 2 (2,9%), various disorders 5 (7,1%), 58 (50,4%) partners have sexual dysfunction as: frigidity 22 (37,9%), sexual dissatisfaction 19 (32,8%), partners lack of co-operation 7 (12,1%), erectile failure 3 (5,2%), retarded ejaculation 2 (3,5%), various disorders 5 (8,6%). An important factor in sexual dysfunction is the partner's fear concerning the coitus which could provoke another heart attack due to stress and consequently the consort's death. We emphasize the importance acquired by the physician's tasks in favouring a complete psychophysical recovery in patients with previous M.I. whenever there are no rehabilitation institutes.