[Is the negative T-wave on the ECG always a sign of ischemia? (human stress cardiomyopathy?) ]. / Je negativní vlna T na EKG vzdy známkou ischemie? (lidská stresová kardiomyopatie?).

A 74-year-old woman was admitted on account of chest pain which developed after a death in the family. On the ECG on admission there were negative T waves (the picture of extensive subapicardial ischaemia). Coronarography made on the subsequent day was quite normal. The laboratory finding (CK, CK-MB, AST) did not suggest an acute coronary attack. Ultrasound examination of the heart revealed only slight hypokinesia of the anterior wall. ECG returned to normal within 3 months. Four years later the patient is asymptomatic. The ECG finding and clinical course suggest the clinical entity of "stress cardiomyopathy", which is not a well known and unequivocally accepted diagnosis.

[Primary PTCA in the treatment of acute myocardial infarct. Experience at the Faculty Hospital in Hradec Kralove]. / Primární PTCA v lécbe akutního infarktu myokardu. Zkusenosti ve FN Hradec Králové.

INTRODUCTION: Primary coronary angioplasty is at present a fully accepted and worldwide method of treatment of acute myocardial infarction. As proved by a number of randomized studies, this treatment is associated with a higher rate of coronary patency, a smaller infarction focus an better clinical results as compared with thrombolytic treatment. METHOD: The authors analyzed a register of 233 consecutively treated patients with primary coronary angioplasty in the Faculty Hospital in Hradec Králové with elevation of the ST sections on electrocardiographic examination during the period from September 1997-January 2001. RESULTS: Acute success defined as a residual stenosis < 30%, normal flow through the vessel (TIMI III) and survival for the first 24 hours was 91.0% and without patients with cardiogenic shock even 96.0%. The total mortality on hospitalization was 9.1%. The mortality of patients without cardiogenic shock was only 1.9%. A high mortality was recorded in patients in cardiogenic shock (74.0%). A stent was implanted in 65.0% patients, subacute thrombosis of the stent occurred in 1.9%. During a 6-month follow up the total mortality was 10.3%. The percentage of patients without any cardiovascular even (event free survival, EFS) after discharge from hospital was 81.0%. CONCLUSIONS: The authors provided evidence that primary coronary angiolpasty is a safe and highly effective method in the treatment of acute myocardial infarction. It is associated with a total hospitalization mortality of ca 10% and a mortality of less than 2% in patients without cardiogenic shock. Cardiogenic shock, on the other hand, remains a problem despite intensive treatment such as inotropic support, mechanical reperfusion and intraortal balloon counterpulsation. In the presented work the mortality of patients with cardiogenic shock was 74.1%. Implantation of a stent does not involve a major risk for the patient, the incidence of subacute thrombosis of the stent is low and does not differ from elective procedures. The fate of patients during the follow up after primary angioplasty is favourable. In the presented work the total 6-month mortality was 10.3% and EFS was 81.0%.

[Percutaneous rescue transluminal coronary angioplasty]. / Záchranná (rescue) perkutánní transluminální koronární angioplastika.

Rescue angioplasty is an operation performed in the acute stage of myocardial infarction where systemic thrombolysis did not lead to opening of the artery. Investigations made in recent years indicate the benefit of rescue angioplasty only in those patients where the infarcted artery is patent several hours after evidence that thrombolysis failed. At the same time they provide evidence of the increasing safety and technical success of the operation. The authors present a brief review of the literature pertaining to the development of views, and emphasize the need of early and correct indication.

[An invasive approach in patients with non-Q myocardial infarct. Yes or no?]. / Invazivní postup u nemocných s non Q infarktem myokardu. Ano ci ne?!

The objective of the presented retrospective work was to evaluate the expedience of general indication of an invasive procedure in patients with non-Q myocardial infarction (non-Q IM). The group is formed by 40 patients with non-Q IM, after a first coronary attack. The authors investigated the premorbid condition, the clinical course, early and late mortality, they evaluated the coronarographic findings of those who were subjected to angiographic examination and compared conservatively treated patients with those who had a revascularization operation. The results are in favour of an invasive procedure in all patients with a non-transmural IM, in particular when the lesions are in the anterolateral area.

[The role of the atrium and optimal values of AV intervals in sequentially paced patients]. / Sínový príspevek a optimální hodnota AV intervalu u sekvencne stimulovaných nemocných.

In 1995, 2249 dual chamber pacemakers were implanted in the Czech Republic. These pacemakers make it possible to set an optimal AV delay between the atrial and ventricular impulse. Although the optimization of the AV interval has its well defined physiologic advantages, it does not seem to be necessary in otherwise healthy individuals with a good atrial and ventricular function. In these patients the default value, usually about 170 ms, is acceptable. However, AV interval optimization--i.e. finding the interval at which the atrial contribution to ventricular filling is maximal--should be done in all patients with left ventricular dysfunction, indicated for pacing because of bradyarrhthmia. In this subset of patients, even a small improvement in ventricular filling is believed to be clinically useful. Moreover, it has been documented, that in some types of ventricular dysfunction the so-called "primary optimization" (i.e. optimization of the AV interval in patients, in whom the pacemaker is not indicated for bradyarrhthmia but for ventricular dysfunction that might be improved by AV interval optimization) may be clinically useful. It is the case in patients with hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy with presystolic regurgitation and AV interval prolongation, and perhaps even in some patients with impairment of ventricular systolic function and substantial prolongation of the AV interval. Despite all that, optimization of the AV interval is not routinely performed because even the best available optimization procedures (stroke volume measurements at different AV intervals by aortic Doppler echography) is observer dependent, time-consuming and costly.

[Arrhythmogenic right ventricle]. / Arytmogenní pravá komora.

A 26-year-old patient with an irrelevant personal and family-history was treated on account of attacks of relapsing ventricular tachycardia and cardiac failure, mostly dextrolateral. After ruling out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, Ebstein's anomaly, the diagnosis of an arrhythmogenic right ventricle was established. This disease is suggested by negative T waves in the thoracic leads V1-V3 during sinus rhythm and by the shape of the QRS complex which was the type found in block of the Tawara branch with an axis of + 100 degrees during attacks of ventricular tachycardia. Moreover, ventricular tachycardia of the same type was produced during electrocardiographic examination. On angiographic examination ARVD is suggested by marked trabeculization and impaired kinetics of the outflow tract of the right ventricle. In the prevention of relapses of ventricular tachycardia beta-blockers and Cordarone were successful when used simultaneously with cardiac stimulation type AAI applied on account of a confirmed sinoatrial block.

[The clinical picture of stenoses of the trunk of the left coronary artery]. / Klinický obraz stenózy kmene levé vencité tepny.

In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive only in complete obstruction of the left coronary, in case of multiarterial affection almost in all cases. Coronarography revealed only in 4 patients (9%) isolated stenosis of the trunk of the left coronary, most frequently the finding was also on two other (36.4%) or 3 (34.1%) arteries. Complete occlusion of the trunk of the left coronary was recorded in 6.8%. An ejection fraction of 50% or more was recorded in 75% of the patients. Surgical revascularization was performed in 35 patients. Twenty-nine patients are followed up after operation on a long-term basis (on average for 7.8 months), 23 of the patients report improvement of their complaints (65.7%). The investigation provided evidence that stenosis of the trunk of the left coronary is a relatively frequent finding in the patient population with ischaemic heart disease and that it is most frequently associated with affection of two and three arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Actilyse (a recombinant tissue-type plasminogen activator] in the treatment of acute myocardial infarct. Comparison of the effects of Actilyse and streptokinase]. / Preparát Actilyse (rekombinacní tkánový typ aktivátoru plazminogenu) v lécbe akutního infarktu myokardu. Srovnání úcinku Actilysy a Streptokinázy.

The preparation Actilyse--a tissue plasminogen activator prepared by recombination--is an effective fibrinolytic drug. The authors recorded in a group of 33 patients reperfusion in 91%, evaluated on the basis of indirect criteria. In a group of 18 patients treated with streptokinase reperfusion was achieved in 74%. Based on changes of CK and CK-MB values--an earlier rise of values following Actilyse administration and conversely their more marked increase during subsequent sampling after streptokinase administration--it may be assumed that earlier dissolution of the thrombus in the coronary artery occurs after Actilyse administration, as compared with streptokinase. It may be thus assumed that there is also a smaller necrotic focus after Actilyse treatment, as compared with streptokinase. Early re-occlusion--according to indirect indicators--occurred in 8.6% in the Actilyse treated groups, as compared with 5.9% in the streptokinase treated group. The fibrinogen values decline in the Actilyse group to 40% and in the streptokinase group to 28%. Later enhanced new formation of fibrinogen occurs and the fibrinogen values rise to 160% in the Actilyse treated group and to 250% of the initial value in the streptokinase treated group. The elevated fibrinogen value, as compared with the baseline value, persists for the 12 days of the follow-up. No severe spontaneous haemorrhage was recorded, haemorrhagic manifestations were associated with blood sampling and i.v. administration of drugs only. The necessity to administer blood was due to a complication during puncture of the subclavian vein in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Iatrogenic clubbing of the fingers.

We report on a 39-year-old female who had been operated on for an atrial septal defect at the age of 14 years. On operation the inferior vena cava was iatrogenically misdirected into the left atrium. The cyanotic patient, in functional group IV of the NYHA classification, with polyglobulia and clubbing of the fingers was successfully reoperated after 25 years.

[Non-heart surgical procedures in patients with mechanical valve prostheses. Experience with surgery in 38 patients]. / Problematika nekardiochirurgických výkonu u nemocných s mechanickými chlopenními protézami. Zkusenosti s operacemi 38 nemocných.

The authors discuss their own experience with noncardiac surgery in continuously Coumarine anticoagulant treated patients with mechanical valvular prostheses. Of 38 patients treated since 1986 were 12 operated under full Coumarine anticoagulant treatment, on eighteen patients were given Heparin preoperatively in a continual infusion, five patients were given an anti-agreggation dose of Heparin and other didn't receive any anticoagulant treatment. According to the authors' opinion it is safer to change the patients before the planned surgical treatment to intravenous Heparin. In case of urgent surgery it is, however, possible to operate also anticoagulant treated patients on. The authors in principle don't recommend K vitamin administration before surgery. Antibiotic prophylaxis before surgery is a matter of course.

[Successful treatment of the superior vena cava syndrome caused by thrombosis and a fibrous septum in a patient with a permanent cardiac pacemaker]. / Uspesne lécený syndrom horní duté zíly zpusobený trombózou a vazivovým septem u nemocného s trvalou kardiostimulací.

A patient with a ten-year permanent implantation of a pacemaker was admitted on account of a clinically serious syndrome of the vena cava superior. The cause of the syndrome was an angiographically confirmed extensive thrombosis and after its dissolution a fibrous septum in the area of the orifice of the vena cava superior into the right atrium. The septum caused by a fibrous strip at the orifice of the vena cava superior into the right atrium was removed by surgical operation during thoracotomy by dilatation of the original opening in the fibrous septum by a Broca dilator and digitally. The authors recommend, based on their own experience and data in the literature, to use fibrinolytic therapy in clinically severe thrombosis in the area of the vena cava superior or the right atrium caused by an electrode--during temporary or permanent pacing--or by a catheter used for parenteral nutrition.

[An unusual complication of myxoma of the left atrium]. / Neobvyklá komplikace myxomu levé srdecní predsíne.

The authors give an account of a 59-year-old female patient with a myxoma of the left atrium which was complicated by repeated multiple embolizations into the systemic circulation. The cause of death after a successful operation was haemorrhage into the abdominal cavity from a ruptured spleen, as a result of a new lienal infarction after embolization of a portion of the myxoma into the lienal artery, 24 before the operation. The authors emphasize the necessity of immediate removal of an intracardiac formation as soon as it is detected.

[A heparin-like anticoagulant in a patient with Wegener's granulomatosis]. / Antikoagulans heparinového typu u nemocného s Wegenerovou granulomatózou.

We identified a circulating, heparin-like anticoagulant in a patient with Wegener's granulomatosis. Routine coagulation studies revealed a significant prolongation of the coagulation time, thrombin time, prothrombin time and activated partial thromboplastin time. Thrombin time and activated partial thromboplastin time failed to improve in a 1:1 mixture with pooled normal plasma. Both test were corrected in vitro by addition of protamine sulfate or toluidine blue and in vivo by intravenous administration of protamine sulfate. Recognition of the existence of this or other similar inhibitors in bleeding patients is of value because of the possibility of treatment with protamine sulfate, which neutralizes the anticoagulant.

[Serum levels of oxacillin and cephalothin in patients with extracorporeal circulation during surgery]. / Sérové hladiny oxacilinu a cefalotinu u nemocných operovaných v mimotelním obehu.

The authors investigated the oxacillin and cephalotine serum levels in patients operated under conditions of extracorporeal circulation. They found that the time for which the patients are adequately protected against staphylococcal infection is in oxacillin cca 180 mins. and in cephalotine 150 mins. after administration of the first dose of antibiotic. They recommend to administer a second dose of the antibiotic along with protamine sulphate after removal of the aortal cannula to obtain a maximum concentration of the antibiotic in the newly formed blood clots. If the surgical operation lasts longer, they recommend to administer the antibiotic in the given time interval regardless of the operation and to administer a third dose when removing the cannula. The authors investigated a total of 30 patients. In one case they encountered an early and in another case a urinary infection.

[Propafenone--a promising anti-arrhythmia agent?]. / Propafenon--slibné antiarytmikum?

Propafenone hydrochloride (Rytmonorm, Prolekofen) belongs to the membranous anti-arrhythmical agents of IC group. Simultaneously, it produces a mild beta blocking effect and blocks slow Calcium channels. The mentioned agent is of current use in treating both the supraventricular and ventricular tachyarrhythmias. Literary experience is referred to in management of arrhythmias with propafenone as well as electrophysiologic properties, pharmacokinetics, hemodynamic effect and side-effects.

[Aortic stenoses and pulmonary hypertension]. / Aortální stenózy a plicní hypertenze.

Authors have been catheterized a total of 36 patients with isolated aortal stenosis. In 14 from them (38%), the mean pression value in pulmonar artery was ranged as over 25 torrs (3.33 kPa). It was proved on the statistical evaluation of hemodynamic data that the pulmonar hypertension is correlated with the pression on the end of diastola of the left ventricle (correlation coefficient r = 0.89), being irrelated of the extent of aortal gradient, bed surface, heart index, age, pulmonar vascular resistence and functional classification. The pression value in pulmonar artery is correlated negatively with the ejection fraction of left ventricle (r = -0.76). Pulmonar hypertension in isolated aortal stenoses is inflicted with functional disorder of left ventricle. The significance of pression value in pulmonar artery is discussed from the scope of indicatory strategy as to provide an urgent surgery, i.e. the exchange of the aortal valve.

[Experience with implantation of a permanent electrode for cardiac pacing directly through the subclavian vein in 2,309 patients]. / Zkusenosti se zavádením stimulacních elektrod pro trvalou srdecní stimulaci prímo pres podklíckovou zílu u 2,309 nemocných.

Since April 1975 to the end of 1988 permanent cardiac stimulation was employed in 2,309 patients. The stimulating electrode was placed in the right ventricle in 2,258 patients and in the right atrium in 29 patients. Two electrodes were introduced in 22 patients one in the right ventricle and the other in the right atrium. All electrodes were introduced directly through the subclavian vein. No other approach was used. Serious complications appeared in 4 patients (i. e. in 0.17%). Pneumothorax on the side of the introduced electrode occurred in 3 patients. One woman of 80 died in connection with this complication. Another woman, who was overdosed with Pelentan, experienced hemothorax on the side of electrode insertion. After drug discontinuation and thoracic puncture the patient was doing well. In our opinion the subclavian approach for permanent electrode introduction is much more convenient than the introduction via either the cephalic or the jugular vein respectively. The former approach is considerably quicker and less traumatic in use. This method may be used in practically all patients. The repetitive introduction of the electrode through the same subclavian vein is much appreciated in patients in whom a new electrode has to be introduced. This method may be used for right atrium stimulation and for sequential pacing as well.

[Mediastinal inflammation as a complication of heart surgery under extracorporeal circulation]. / Zánet mezihrudí jako komplikace srdecních operací v mimotelním obehu.

The authors describe mediastinitis in two patients operated on account of ischaemic heart disease. In both patients they used the closed approach which involved suture of the sternum and surgical wound, perfect drainage and the administration of antibiotics (general and local). They describe the applied method of fixation of the sternum. In both patients the sternum and surgical wound healed.