High prevalence and suboptimal treatment of risk factors in Greek coronary patients.

OBJECTIVE: We assessed the current clinical practice in relation to secondary prevention of coronary heart disease in a general district hospital in Greece. METHODS AND RESULTS: A total of 819 consecutive patients ( < 75 years) with a history of myocardial infarction (> 6 months) was recruited from the outpatient cardiology clinic. All patients were interviewed and blood was taken for lipids and glycosylated haemoglobin measurements. Thirty-one percent of the patients were obese (body mass index > or = 30 kg/m2), 36% smoked cigarettes, 25% were diabetic and 36% were treated for hypertension. Reported prophylactic medication was aspirin 89%, beta-blockers 61%, angiotensin-converting enzyme inhibitors 33% and hypolipidaemic drugs 28%. Of those taking hypolipidaemic drugs 21% had achieved LDL cholesterol < 115 mg/dl while in total only 15% had LDL cholesterol < 115 mg/dl. Patients aware about the target cholesterol levels had lower cholesterol levels from those unaware (217 +/- 36 versus 231 +/- 46 mg/dl, p = 0.0001). Only 50% of the coronary patients had desirable blood pressure levels (both systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg) and half of the diabetic patients had an optimal glucose control (glycosylated haemoglobin < 7.5%). CONCLUSIONS: Our results show a high prevalence and suboptimal management of modifiable risk factors in Greek coronary patients. This should alert physicians and cardiologists to encourage their patients for effective lifestyle interventions together with more vigorous management of hyperlipidaemia, hypertension and diabetes and appropriate use of prophylactic drugs.

High incidence of dyslipidaemia in the offspring of Greek men with premature coronary artery disease.

AIM: The present study aimed to assess the incidence and type of lipid disorders in the offspring of young Greek coronary patients. METHODS: One hundred and ninety-three children and youngsters were divided into two groups. Group A consisted of 104 children whose fathers had sustained a myocardial infarction before the age of 55 years. Eighty-nine young subjects matched for age, gender, dietary and smoking habits without a familial history of coronary artery disease served as controls (group B). Total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol and lipoprotein(a) were measured in the children and the affected fathers. RESULTS: Fifty-three percent of the offspring of young coronary patients had elevated total cholesterol or elevated triglycerides or decreased high density lipoprotein cholesterol or a combination, while the 80.4% of the affected fathers had lipid disorders. The distribution of lipid disorders in the children bore a striking resemblance to those seen in their affected fathers and there was a significant correlation between offspring-father total cholesterol, low density lipoprotein cholesterol and lipoprotein(a). When excess lipoprotein(a) was added to the lipid disorders the incidence of dyslipidaemia in the offspring of the affected individuals was increased to 63.5%. CONCLUSIONS: Dyslipidaemia is very common in the offspring of Greek men with premature coronary artery disease; this occurrence emphasizes the need always to evaluate the lipid profile in these children. The detection of dyslipidaemia necessitates the early institution of preventive measures with the expectation that the incidence of cardiovascular disease will decrease later in life.

A case of severe hypocalcaemia mimicking myocardial infarction.

Long-standing hypocalcaemia can be complicated by congestive heart failure. We report a 46-year-old woman with chronic severe hypocalcaemia due to untreated hypoparathyroidism. This patient developed severe heart dysfunction but when first presented was misdiagnosed as acute myocardial infarction based mainly on the biochemical, electrocardiographic and echocardiographic findings. The near-normal cardiac function a few months after the correction of hypocalcaemia demonstrates that even advanced forms of cardiomyopathy are potentially reversible with treatment of hypoparathyroidism.

Successful treatment of staphylococcal pericarditis with early catheter drainage and antibiotics.

We describe a 26-year-old man with staphylococcal pericarditis who was treated successfully by percutaneous catheter drainage combined with antibiotics. One year later he remains in good condition without echocardiographic evidence of constriction.

The use of the subclavian vein for temporary transvenous pacemaker therapy.

Temporary artificial pacing of the heart has been available clinically for the past twenty years. It was introduced as a life saving procedure for the treatment of complete arterioventricular (A-V) block and other symptomatic bradyarrhythmias. Recent developments in the field of cardiac pacemakers have resulted in pacemaker application in a wide variety of patients and the technique chosen may vary considerably with the purpose. It is of value to separate the indications for temporary pacing into urgent, semi-urgent and elective. Application of this mode of therapy requires access to the heart, a pulse generator capable of emitting a controlled electrical stimulus, and a conducting channel. In each of these areas a technology and body of knowledge has been developed. Subclavian venipuncture with catheterization is a practical procedure for the prolonged or continuous intravenous administration of different kinds of fluids. The technique of the insertion of temporary pacing lead and the point of entry vary with the indication for the procedure and the skill and experience of the operation. For the insertion of a temporary pacing electrode, several veins can be utilized; femoral, anticubical, external and interval jugular, and subclavian. Successful electrode insertion can be accomplished with relative ease through each of these veins. Selection of a vein depends upon the clinical (table: see text) situation, the availability of flouroscopic equipment and the familiarity of the operator with a specific approach.