Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

[The level of erythropoietin in serum of patients with anemia during infective endocarditis]. / Stezenie erytropoetyny w surowicy krwi u pacjentów z niedokrwistoscia w przebiegu infekcyjnego zapalenia wsierdzia.

The infective endocarditis is a septic syndrome caused by an infection in endocardium or in heart valves. The majority of patients with infective endocarditis develop normocytic anemia. The metabolic studies in septic shock syndromes documented an intensive proteolysis of muscles, visceral organs and blood proteins, and probably of erythropoietin as a glycoprotein as well. The aim of the study was to assess the erythropoietin level in patients with infective endocarditis severe anemia and preserved renal function. Erythropoietin concentration was measured in blood serum in 12 patients (11 men and 1 woman), mean age 48 +/- 8 years, with infective endocarditis. The patients had clinical symptoms of endocarditis, positive blood bacteriological cultures and echocardiography features. All patients had serious normocytic anemia with mean hemoglobin concentration 5.40 +/- 0.48 mmol/L. The control group consisted of 7 healthy persons (5 men and 2 women), mean age 50 +/- 7 years, with hemoglobin concentration 8.70 +/- 0.60 mmol/L. The concentration of erythropoietin at the patients with bacterial endocarditis was 144.04 +/- 17.80 mIU/mL versus 67.28 +/- 6.29 mIU/mL in the control group (p = 0.0002). We conclude that in patients with infective endocarditis and serious normocytic anemia without renal insufficiency the concentration of erythropoietin is increased.

[Arterial hypertension complicated by aortic dissection. Clinical analysis, results of conservative treatment]. / Nadcisnienie tetnicze powiklane tetniakiem rozwarstwiajacym aorty. Analiza kliniczna, wyniki leczenia zachowawczego.

Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.

Results of long-term medical treatment of patients with arterial hypertension complicated by aortic dissection.

UNLABELLED: The purpose of the study was to analyse results of ambulatory treatment of patients with arterial hypertension complicated by aortic dissection. Twenty patients (19 men, one woman), aged between 39 and 72 years, underwent full physical examination. In all cases the diagnosis of aortic dissection was confirmed by at least two different imaging methods (ultrasonography, digital subtractional angiography, computer tomography or nuclear magnetic resonance). During follow-up (3-75 months, mean 34.3 months), physical examination was performed every 6-8 weeks, chest radiograph was taken once a year. All patients controlled their blood pressure (BP) at home. According to the mean number of in-home BP measurements per month all patients were divided into two groups: group I good (n = 10) and group II bad compliers (n = 10) (28 +/- 30 vs 3 +/- 2 in-home BP measurements a month). Ten patients (6 in group I, 4 in group II) underwent 24 h automatic BP measurement examination. Blood samples were collected for serum cholesterol and uric acid measurements. All patients suffered from arterial hypertension and in five cases at least one parent suffered from this disease. Only three of 20 have never smoked cigarettes. Elevated serum cholesterol was observed in 10 (50%) cases and elevated uric acid in six (30%). Proximal (type A) aortic dissection (DeBakey classification type I and II) was found in 13 patients, distal aortic dissection (type B) in seven patients. All patients were treated with beta-blockers. In 75% of 20 cases three or more hypotensive drugs were used simultaneously to control BP. In the group I lower values of mean of maximal SBP (160 +/- 10 vs 177 +/- 7 mm Hg, P < 0.05) and lower mean circadian heart rate (58.6 +/- 7.5 vs 80.9 +/- 7.9 beats/min, P < 0.005) were observed. The most frequent complaints were intermittent claudication, 9 (45%); angina pectoris 8 (40%), other chest pain, 4 (20%). During follow-up period (3-75 months, mean 34.3 months) five of 20 patients (25%) died (all had proximal, type A dissection) and 15 of 20 patients (75%) are still alive. All deaths in group II were sudden, whereas the only one in group I was because of chronic renal insufficiency. Mortality rate in the two groups were 10% (one of 10) vs 40% (four of 10), respectively, in groups I and II. IN CONCLUSION: patients who control their BP more often have the lower values as well as lower heart rate and therefore a better prognosis.

[Unusual clinical course of ruptured aortic aneurysms--reports of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadów.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Unusual clinical course of ruptured aortic aneurysms--report of three cases]. / Niezwykly przebieg kliniczny peknietych tetniaków aorty--opis trzech przypadków.

Three cases of unexpected clinical course of ruptured aortic aneurysm have been presented in patients of their 7th decade life. All of them had arterial hypertension. Signs and symptoms on admission to hospital (dysphagia, chest and interscapular pain, hematemesis, abdominal pain, elevated body temperature and diminished exercise tolerance) were non-specific of aortic aneurysm, suggesting other disease. Dramatic clinical course with hypovolemic shock in two cases led to death. One of them refused surgery. In the third one, in spite of blood effusions to pleural cavity, pericardial sac and mediastinum, effective hypotensive therapy with a preservation of the slow heart rate and fluid evacuation from pericardial sac, gave the opportunity to perform elective surgery. Aortic dissection often presents an atypical course and when suspected, all available imaging technics including computed tomography and nuclear magnetic resonance must be used.

[Ventricular arrhythmia in patients treated with diuretics]. / Komorowe zaburzenia rytmu u chorych leczonych lekami moczopednymi.

A quantitative and qualitative analysis of ventricular arrhythmia was performed in 120 patients (64 men and 56 women, mean age 54 +/- 16) who suffered from arterial hypertension or congestive heart failure in the course of organic heart disease or ischaemic heart disease. 60 of them were treated with diuretics and the other 60 were control group. Neither antiarrhythmic drugs nor digitalis were used. There were no signs of left ventricular hypertrophy. Most patients treated with diuretics received potassium supplementation. Besides clinical examination all patients underwent 24 hours monitoring of Holter ECG. 38 patients treated with diuretics were evaluated before and after 6 months of therapy. In the diuretic group significantly higher percentage of patients with greater density of premature ventricular beats (count of premature ventricular beats [PVB]/100,000 heart evolutions) was observed. Number of patients with complex ventricular arrhythmia (Lown IVa and IVb) was also greater in this group. Serum levels of potassium and magnesium fell within the normal range, but the latter was significantly lower (p < 0.05) in those treated with diuretics.

[Cardiac arrhythmias during extracorporeal shock wave lithotripsy]. / Zaburzenia rytmu serca w czasie kruszenia kamieni nerkowych za pomoca fali uderzeniowej.

Holter monitoring was performed in 55 patients (24 women, 31 men), mean age 50.7 +/- 11.3 who underwent ECG-triggered extracorporeal shock wave lithotripsy (ESWL). Patients were divided into two groups A--30 with history of cardiac disease and B--25 control. The heart rate was significantly higher before and after ESWL in the first group. The number of premature ventricular contractions was higher during ESWL in the same group. No other cardiac complication was observed.

[24-hour ECG monitoring by the Holter system in early diagnosis of coronary disease]. / 24-godzinne monitorowanie EKG systemem Holtera we wczesnym rozpoznawaniu choroby wiencowej.

The aim of this study was to investigate the value of continuous ECG monitoring in early diagnosis of coronary heart disease. 312 patients (59 women, 253 men, aged 20-60 years) with chest pain since 3-6 months were studied. All patients underwent clinical examination, serum lipid determination, exercise ECG test, ambulatory ECG monitoring and coronary angiography. 194 patients had normal or nonsignificant irregularities of coronary arteries, in 118 patients significant atherosclerotic stenoses were found. Sensitivity and specificity of ECG monitoring were: 46 and 54% respectively. Significantly higher frequency of changes and longer duration of depression or elevation of ST segment in patients with significant coronary artery stenosis was found. ST segment changes without angina were observed in 23,7% of patients.

[Early and late ventricular fibrillation in myocardial infarction. Prognostic value of clinical and echocardiographic indicators]. / Wczesne i pózne migotanie komór w zawale serca. Wartosc prognostyczna wskazników klinicznych i echokardiograficznych.

Our studies were aimed at evaluating the prognostic value of certain clinical and echocardiographic parameters as well as cardiac arrhythmias in patients with acute myocardial infarction complicated by ventricular fibrillation. The studies comprised 66 patients with previous ventricular fibrillation selected out of 637 patients undergoing treatment after recent myocardial infarction at the Clinic of Cardiology, Institute of Cardiology, Medical Academy, Poznan. The group included 51 males and 15 females aged 30-83, mean age 68. Anterior and/or lateral infarction were diagnosed in 44 patients (67%) whereas inferior and/or posterior infarction in 22 patients (33%). Fifty-eight patients (88%) had transmural infarction. The 2D and M-mode echocardiographic examinations and 24-hour Holter monitoring were performed in all patients. The group of patients resuscitated successfully was compared to the group of deceased patients. The observation period ranged from 1 to 7 years, mean 4 years. The analysis indicated that high mortality of patients with late ventricular fibrillation results from an extensive myocardial infarction and severe ventricular contractility disorders. In patients with late ventricular fibrillation, the main prognostic factor proves to be congestive heart failure and intraventricular conduction disorders with the fascicular and/or bundle-branch block types.

[Value of two-dimensional echocardiography in predicting the clinical course and fates of patients 2 years after myocardial infarction]. / Wartosc echokardiografii dwuwymiarowej w przewidywaniu przebiegu klinicznego i losów chorych w okresie 2 lat od zawalu serca.

133 patients with acute myocardial infarction, admitted to hospital 24 hours or less from the beginning of chest pain were investigated. Two-dimensional echocardiography (ECHO 2D) was performed 1-2, 3-5, 7-10, 21-28 days and 3, 6, 9, 12, 18 and 24 months after myocardial infarction. Relations between ECHO parameters, clinical course and prognosis. 2 years after myocardial infarction were analysed. Worse clinical course and prognosis during 2 years after myocardial infarction predict high values of 1) asynergy index (greater than or equal to 1), 2) percentage of asynergy segments (greater than or equal to 50) and 3) percentage of left ventricular (LV) akinetic and (or) dyskinetic segments (greater than or equal to 37.5). Right ventricular asynergy and maintenance or increase of LV asynergy degree aggravate clinical course and prognosis too.

[The effect of intravenous streptokinase on selected echocardiographic and clinical parameters of patients followed up for 2 years after myocardial infarction]. / Wplyw podanej dozylnie streptokinazy na wybrane parametry echokardiograficzne i kliniczne oraz losy chorych w okresie 2 lat po zawale serca.

54 patients (pts) aged 70 years or younger with acute transmural myocardial infarction and onset of chest pain less than 12 hours were assigned in a blind manner to streptokinase group (SK), 54--to control group, 34 pts received intravenous infusion of 1,500,000 IU of SK/hour, 14 pts--2,000,000 IU/hour, and 6 pts--3,000,000 IU/2.5 hours. Intravenous streptokinase reduced left ventricular (LV) asynergy during hospital phase, decreased LV thrombus formation, and limited myocardial necrosis size 2 years after myocardial infarction. Its effect on clinical course and prognosis after myocardial infarction was of small importance.

[ECG Holter monitoring during endoscopic examination]. / Monitorowanie zapisu EKG systemem Holtera w czasie badan endoskopowych.

The aim of the study was an evaluation of ECG changes during endoscopy. In 57 hospitalized patients (34 female, 18 male, mean age 54) who had gastroscopy (n = 23), endoscopic retro-cholangiopancreatography (ERCP) (n = 17) or colonoscopy (n = 17) two hours before and two hours after the examination, an ECG monitoring by Holter method was done. The patients also filled a questionnaire to measure their level of anxiety. Arrhythmias and ST depression/elevation were seen in 37 (65%) patients during endoscopy. In 12% complex arrhythmias (III, IV A and IV B type Lown) were recorded. Complex arrhythmias and/or horizontal ST depression greater than 1 mm were observed more frequently (p less than 0.01) in the group of patients with clinically evident diseases of the cardiovascular system; this group was older than the group without cardiac symptoms. There was no correlation between ECG changes and the level of anxiety before the examination. During ERCP ECG changes were more complex than during colonoscopy (p less than 0.01) or gastroscopy (p less than 0.05).

[Effect of psychological stress on the development of arrhythmia in patients with acute myocardial infarction]. / Wplyw stresu psychicznego na powstawanie zaburzen rytmu u chorych ze Swiezym zawalem serca.

The effect of mental stress was demonstrated on the development of arrhythmias in patients after acute myocardial infarction. During 24-hour Holter's monitoring (3 weeks after infarction onset) a stressful psychological experiment (free association test) was carried out on the patients observing their reactions during the experiment, and heart action during and after it. During the experiment changes were observed in heart action such as increased heart rate, appearance or intensification of quantitative and qualitative ventricular arrhythmias. The authors discuss the relationship between mental stress and the development of arrhythmias.

[Echocardiographic studies and electrocardiographic examination by the Holter method of patients with insulin-dependent diabetes mellitus]. / Badanie echokardiograficzne i elektrokardiograficzne metoda Holtera u chorych z cukrzyca insulino-zalezna.

The aim of the study was to evaluate the left ventricular function and cardiac arrhythmias in patients with insulin-dependent diabetes, but without observable changes of the circulatory system in clinical examination. 30 patients underwent the study with the insulin-dependent diabetes treated for 2 months--30 years. There was no evidence of hypertension, renal and hepatic failure. Well controlled diabetes was stated in all of them. The control group consisted of 20 healthy persons. M-mode echocardiographic examination and 24-hour Holter ecg monitoring was performed in all patients. Decreased left ventricular compliance and complex ventricular arrhythmias were stated in patients with insulin-dependent diabetes.

[Myocardial infarction in patients with hypertension]. / Zawal serca u chorych z nadcisnieniem tetnicyum.

Hypertension is a well known risk factor of coronary artery disease. The aim of the study was to evaluate a clinical course and prognosis in hypertensive patients with acute myocardial infarction (MI). 100 consecutive patients with acute MI underwent the study. In 38 of them (28 males and 10 females) a history of hypertension and intermittent rises of arterial blood pressure in a course of MI were stated. All patients underwent 2-DE examination and 24 hours Holter ecg monitoring. Clinical characteristics consisted of the heart failure and arrhythmias occurrence as well as the in-hospital mortality. Significantly higher rate of MI in the past and/or angina pectoris as well as a diabetes mellitus was stated in hypertensive patients. In these patients inferior, transmural MI was more often observed, while there was no difference in life-threatening arrhythmias, pulmonary edema and cardiogenic shock between normotensive and hypertensive patients.