[Drugs acting on the heart-conductive system in suicide attempts]. / Leki dzialajace na uklad bodzcotwórczo-przewodzacy serca spozywane w celach samobójczych.

UNLABELLED: The prevalence of diseases of the cardiovascular system is the cause of their frequent use, and thus, easy availability of drugs acting on the cardiovascular system, including people they do not require. In Poland, annually are taken from 4.5 to 5.5 thousand suicide attempts, about 3.7% of them due to excessive consumption of pharmaceuticals. The aim of this study was to analyze patients who for suicidal attempts ingested drugs acting on the cardiac conduction system, and to study performed diagnostic and therapeutic procedures and obtained results. MATERIAL AND METHODS: The study included all hospitalized in the years 1995-2010 in the Department of Anesthesiology and Intensive Care patients after excessive suicidal ingestion of drugs acting on the heart conductive system. The study group comprised a total of 40 patients aged from 15 to 70 years. RESULTS: Suicide attempts in the study group were mostly taken by the lonely people and by the subjects with disturbed adaptation. The patients were unconscious mainly after ingestion of psychotropic drugs. From the 40-person group of patients after suicidal ingestion of drugs affecting the conduction system of heart eight patients (20%) required respirator. It has not been shown that any group of drugs significantly more frequent induced respiratory distress requiring mechanical assistance. Rhythm and conduction disturbances during hospitalization occurred in 15 patients (38%), of which 12 (30%) required temporary endocardial stimulation. The study revealed the longest ventricular stimulation need in patients after consumption of calcium channel blockers. Blood pressure in half of the patients was depressed, and 15 of them (38%) required the use of pressor amines. From the 40-person group 2 people died (one patient after ingestion of 4000 mg of propranolol and the other after eating 6000 mg of verapamil). Patients who died differed from the other patients with in younger age, longer time elapsed since the consumption of drugs to their hospitalization, during admission they had undetectable blood pressure, bradycardia, and decreased serum potassium levels. The remaining 38 patients (95%) were discharged from the Department of Anesthesiology and Intensive Care. CONCLUSIONS: Attempts to take his own life with the use of drugs in the cardiac conduction system in the study group were taken by a lonely and adaptive disturbances. The most commonly used preparations for suicide were beta-adrenergic receptors blockers, whereas hemodynamic abnormalities, arrhythmias and conduction disturbances were observed more frequently after the drugs that block calcium channels. In patients with life-saving use in suicide attempts important role in addition to medication dosage plays an elapsed time of their consumption and speed of action taken to remove and prevent absorbtion the poison", as well as close supervision in the intensive care unit.

[The clinical implications in patients after calcium channel blockers overdose--own observations]. / Implikacje kliniczne u chorych po spozyciu nadmiernej dawki leków blokujacych kanaly wapniowe--obserwacje wlasne.

UNLABELLED: Calcium channel blockers are drugs often used in circulatory system diseases. Their overdose can cause asystoly, III grade of atrioventricular dissociation, heart insufficiency and cardiogenic shock. Due to wide availability of these drugs access to them for subjects who want commit suicide is easy. In a specialist literature predominantly you can find case reports about calcium channel blockers suicidal overdose. Our experience includes 12 such cases. The aim of the study was to analyze patients after suicidal calcium channel blockers overdose. MATERIAL AND METHODS: In all cases medical interview, physical examination, neurological consultation, ecg, echocardiography, laboratory tests and in most cases--gasometry and toxicology test were performed. RESULTS: In analyzed 12 subjects group during admission, 7 patients were conscious, 2 had consciousness disturbances and 3 subjects were unconscious. Due to significant hypotonia 10 patients were treated with pressive amines. Arrhythmia and conduction disturbances were treated with endocavitary heart stimulation. There were 2 patients who needed mechanical respiratory support and one person, who due to refractory on farmacologic treatment, cardiogenic shock - needed intra aortal balloon pumping assistance. One person died during the first day of hospitalization. All other patients were discharged from the ward with improvement. CONCLUSIONS: Calcium channel blockers intoxications are rare, but usually are characterized by serious course and uncertain prognosis. Temporary endocavitary heart stimulation during calcium channel blockers intoxication usually needs electrode repositions due to ineffective stimulation depending on stimulation threshold increase. Our results show, that extremely fundamental for intoxicated patient are, easy to perform, activities which limit gastro-intestinal drug absorbtion.

[Percutaneous coronary intervention effectiveness in acute coronary syndromes in patients over 80 years old--follow-up study]. / Odlegla obserwacja skutecznosci przezskórnych interwencji wiencowych u chorych z ostrym zespolem wiencowym po 80. roku ycia.

UNLABELLED: Atherosclerosis is a chronic and progressive inflammatory process that causes the most advanced changes in elderly people. In 2006 we published the results of the analysis of acute coronary syndromes in patients after 80 years of age. Conducted the study have decided to extend the observation of distant patients. THE AIM of this study was to assess the effectiveness of remote monitoring percutaneous coronary intervention (PCI) performed in patients with acute coronary syndrome after 80 years of age and to demonstrate the potential benefits of the treatment on the basis of well-being and quality of life of studied patients. MATERIALS AND METHODS: The study included 15 women and 16 men aged from 80 to 92 years, which in 2005 because of acute coronary syndrome (ACS) PCI was performed with stenting of coronary vessels. RESULTS: The 31-person group of patients after percutaneous coro-: nary intervention to the end of the observation period 24 patients survived, while seven died. A comparison group of patients living with the deceased showed a number of differences, both clinical as well as the biochemical parameters evaluated. Women accounted for up to 72% among the deceased patients. Moreover, increased posthospitalization mortality in patients with ST elevation myocardial infarction was documented. The majority of patients during the observation period was in class II according to the criteria of the Canadian Society of Cardiology. CONCLUSIONS: Analysis of the obtained results in the observation of distant percutaneous balloon therapy with stenting of coronary vessels in patients after 80 years of age showed a majority of respondents declared by the benefit of the treatment administered in the form of improved well-being and quality of life. The analysis of deaths during follow-up period showed the increased mortality during posthospitalization period in patients with ST elevation myocardial infarction and documented the predominance of patients with diabetes and other co-morbidities, especially in women.

[Effectiveness of heart tumor therapy in the cardiology department during 7 year follow-up]. / Skutecznosc leczenia guzów serca rozpoznanych w klinice kardiologii w siedmioletniej obserwacji.

UNLABELLED: Neoplasms of the heart are rare. Usually asymptomatic on the early stage are diagnosed incidentally. Among primary heart neoplasms the most often benign tumors are diagnosed--mostly myxomas, whereas the majority of malignant heart tumors are sarcomas. The aim of this paper was to present heart tumors diagnosed in the cardiology department, their symptoms, used diagnostic tests and therapy and to show after therapy quality of life changes. MATERIAL AND METHODS: There were 18 patients included to the study, whom during hospitalization in the cardiology department heart tumors were diagnosed. There were 11 women and 7 men, aged from 33- to 76-years-old (mean 60,5 years). To all of the patients medical interview, physical examination, EKG, UCG and laboratory test were performed. Additionally in some cases computed tomography or magnetic resonance imaging of the chest and coronary angiograms were done. Based on the diagnostic tests results the patients were qualified to conservative or surgical treatment. RESULTS: Among 18 heart tumor patients in 12 cases primary benign tumors were diagnosed (66,6%), 1 patient had primary malignant tumor (5,5%), there were 3 cases of metastatic tumors (16,6%) and 2 patients with non-neoplasmic tumors--clots (11,1%). From 18 subjects with heart tumor 3 patients died because of advanced stage of neoplasmic disease and presence of metastatic tumors in the heart. CONCLUSIONS: Results of the study show, that heart tumors, regardless of development of diagnostic tests, are still diagnosed too late. The study group follow-up proved, that early diagnosis and proper heart tumor treatment prevented complications and improved the quality of life. It is worth to emphasize, that coronary angiogram in some cases allowed to diagnose coronary artery disease, to treat heart tumor and to perform coronary artery by-pass grafting simultaneously.

[Inferior vena cava obstruction in patient with coronary artery disease]. / Niedroznosc zyly próznej dolnej u chorego z zaawansowana choroba wiencowa.

76-year-old male with inferior myocardial infarction and right nephrectomy due to cancer in the past, was admitted to our Department due to incidents of chest pain and syncope. During physical examination we found dilated superficial veins of abdomen, chest and lower extremities. Laboratory tests, except creatinine and D-dimer levels were normal. Consulting neurologist excluded neurological reasons of syncope. Holter monitoring showed ventricular extrasystolies and results of transesophageal stimulation of left atrium were normal. Coronary angiogram demonstrated critical stenoses in some of the coronary arteries. Doppler examination showed left femoral vein obstruction. Computer tomography of abdominal cavity demonstrated inferior vena cava obstruction and abdominal wall veins dilatation. Due to thromboembolic disease symptoms pulmonary embolism was suspected. Consulting surgeon and cardiosurgeon decide against surgery due to it's extensive risk, among other things due to possibility of renal function worsening. To prevent embolic complications patient started antithrombotic therapy. Our patient's case shows many vital pathologies in cardio vascular system which occur in one subject. His example demonstrates need to perform multidirectional diagnostics and therapy of such patients.

[Acute coronary syndromes in patients over 80 years old]. / Ostre zespoly wiencowe u chorych po 80 roku zycia.

UNLABELLED: Atherosclerosis is regarded as a chronic disease. Because of its progressive character the most advanced cases of atherosclerosis are expected to be found in elderly population. AIM OF THE STUDY: We decided to take a closer look at a population of patients above 80 years of age who were admitted to our Center because of ACS. MATERIAL AND METHODS: Included in our study were 50 consecutive cases of patients admitted with less than 12-hour history of symptoms of ACS . Their age ranged from 80 to 93 years with a mean of 82 years. All patients were subjected to: complete history and physical examination, 12-lead ECG, 2-D Echocardiography and laboratory studies including CPK, CK-MB, lipid profile, glucose and creatinine level. In the researched group 44 patients underwent coronary angiography and 32 of them required PTCA. Six patients in the group managed with invasive studies subsequently expired. Patients were analyzed in respect to: infarct site, coronary vessel lesion localization, cardiac enzymes levels, LV ejection fraction and renal insufficiency. We also compared groups with ST segment elevations, NSTEMI and unstable angina. Separately analysis of a group of deceased patients was conducted. RESULTS: Six of our patients expired. Their mean age was higher than of the whole group. They also presented with significantly higher levels of cardiac enzymes. In majority of cases right coronary artery occlusion was found to be the culprit lesion. CONCLUSION: Therefore, in complicated cases of elderly with multi-vessel atherosclerotic changes not qualifying for surgical revascularisation attempts to improve blood supply in the territory of the RCA might be considered.

[Standard electrocardiography and Holter monitoring changes in acromegalic patients]. / Ocena standardowego i 24-godzinnego zapisu elektrokardiograficznego u chorych na akromegalie.

UNLABELLED: Aberrations in circulation related to improper thyroid, parathyroid, adrenal and gonadal function were well researched and recognized. Our knowledge of relation between growth hormone and cardiovascular system is somewhat limited. AIM OF THE STUDY: Our attention was describe occurring in acromegaly complications of cardiovascular function detectable by standard 12-lead ECG and 24-hour Hotter monitoring. MATERIAL AND METHODS: Our research compared 28 patients (15 with hypertension among them) with acromegaly with mean 10-years duration of disease, 20 patients with hypertension and 20 normal subjects. All subjects underwent physical examination followed by standard resting ecg and 24-hour Holter monitoring. Several different ECG parameters were compared: heart reate, arrhythmia (in Holter), times of QRS, QT and QTc intervals and features of atrial and ventricle hypertrophy. RESULTS: Result of this comparison indicates presence of substantial electric cardiac disturbances in acromegaly patients. Patients with acromegaly have substantial QT and QTc prolongation. ECG analysis showed QRS complex prolongation in this group. Much often they had supraventricular and ventricular arrhythmias. Those are complex aberrances which may have important implications for patient's well-being. CONCLUSION: In acromegaly patients significant electrical heart function disturbances were shown. These could be threatening for their life. This group should be early monitored by cardiologist.

[Cardioversion and atrial stunning]. / Kardiowersja a ogluszenie przedsionków.

Stunned atrium is defined as a state of temporary mechanic atrial dysfunction with preserved bioeletrical function. It may follow up to 38-80% successful cardioversions performed to convert atrial fibrillation to regular sinus rhythm. Lack of effective atrial contractility leads to hemodynamic changes, which may result in thrombus formation with subsequent thromboembolic events. It becomes a priority to research in depth the pathophysiology of stunned atrium phenomenon and form strategies to avoid complications associated with it. Studies have shown, that even patients who had no evidence of thrombotic material (as proven by transesophageal echocardiography performed prior to cardioversion), are still at increased risk of embolic events. This fact created basis for hypothesis, that conditions for clot formation may be met only when sinus rhythm is restored. 93% of thrombi are accompanied by so-called spontaneous contrast phenomenon. The purpose of our study was to find relations between factors contributing to stunned atrium and its cellular mechanisms. It is suggested, that stunned atrium results from changes in atrial muscular membrane which occur during atrial fibrillation. Stunned atrium is encountered more frequently in patients with coronary artery disease than in hypertensive heart disease or even lone atrial fibrillation. It is also associated with rheumatic valvular abnormalities and left ventricular dysfunction from other causes. Studies have shown no correlation between the frequency of stunned atrium and the mode of cardioversion. It was observed, that duration of atrial fibrillation and dimensions of atria have substantial impact on time to mechanical function recovery and magnitude of atrial stunning. Studies on subjects undergoing cardioversion due to atrial fibrillation proved that there is a higher tendency to stunned atrium in patients with atrial enlargement. Due to significant delay until full mechanical function recovery, it is of prominent importance to continue anticoagulation for at least 4 weeks after cardioversion.

Transcriptional activity of genes encoding interferon gamma (IFNgamma) and its receptor assessed in peripheral blood mononuclear cells in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X is typically characterized by effort induced anginal pain with ST segment depression suggestive of myocardial ischemia and normal coronary arteries at angiography. The possible mechanism that may participate in the pathology of CSX is a microvascular dysfunction related to inflammatory process affecting endothelium. Interferon gamma (IFN-gamma) is an important cytokine in inflammatory reaction. It acts through its specific receptor composed of 2 subunits IFN-gamma R1 (ligand binding) and R2 (signal transduction). The expression and proportion of these subunits influences IFN-gamma activity. The aim of the study was to assess the gene expression of IFN-gamma and its receptors in peripheral blood mononuclear cells (PBMC) from patients with syndrome X. METHODS: The study was carried out in 36 patients aged 44-77 (average 57 years old) with cardiac syndrome X and 23 sex- and age-matched healthy subjects (control group). To evaluate gene expression of IFNgamma and its receptor total mRNA was extracted from peripheral blood mononuclear cells (PBMC) and the number of mRNA copies were assessed by quantitive reverse transcriptase polymerase chain reaction (QRT-PCR). RESULTS: We have not observed statistically significant differences in INFgamma gene expression between studied group and control. Genes encoding IFNgamma receptor subunits showed higher expression in PBMCs from patients with cardiac syndrome X vs control subjects (IFNgammaR1, 97,244 +/- 26,956 c/microg vs 12,120 +/- 2,940 c/microg, p < 0.005, respectively and IFNgammaR2, 129,153 +/- 36,883 c/microg vs 16,445 +/- 2,923 c/microg, p < 0.005, respectively). CONCLUSION: Variation in transcriptional activity of genes encoding INF-gamma receptor subunits may affect function of microvasculature and thereby participate in the pathology of cardiac syndrome X.

["Heart attack in humans"--the health belief model in comparison with the health reality of patients with myocardial infarction]. / "Czlowiek w zawale"--system prezentowanego modelu zdrowia w konfrontacji z rzeczywistoscia zdrowotna osób z zawalem miesnia sercowego.

Myocardial infarction (MI) is the direct cause of 40% of all deaths, independently of the high standard of medical treatment. The main aim of the study was to define the relationship between the declarative health model (declarations) and the real health activity of the sufferers (realization). The research was performed on 107 patients after acute MI, hospitalized in the Cardiology Department Medical University of Silesia. They were questioned in direct interviews. In addition, the modified form of Shalit's circle was applied. The results indicated the coexistence of two health models of patients. In declarations, there is a model of person with interior attribution of MI (90.65%) that has a feeling of ability to influence his/her health (e.g. through the lifestyle: 63.55%; an individual's character: 41.12%). In realization, there is a model of sick patient with exterior attribution of heart attack (e.g. political and economic crisis, innate predisposition). A similar tendency in the perception of health factors and planning of changes after MI was observed. For instance, 50.47% patients talked about "the increase caution" or "slowing down" as a new planned form of activity. Moreover, of 92% patients who have the social support only 33.64% consider that as an important factor for health. The results suggest a divergence between declarations and real health activity. The launched health model of beliefs seems to be too costly and not attractive enough. Taking into consideration the complete risk factors in MI and making the proposed health belief system more accessible seem to be essential for creating an adequate prevention program.

[Patients' opinions about the reasons for their heart attacks in the context of their health belief models--a preliminary report]. / Opinie pacjentów po zawalach serca na temat przyczyn wystapienia zawalu w kontekscie przyjetego przez nich modelu przekonan zdrowotnych--doniesienia z badan pilotazowych.

The importance of psychological factors in Myocardial Infarction (MI) is well documented. The aim of the study was to define a relationship between the perception of the reasons for MI and real health activity of the sufferers, in order to prepare an adequate psychological intervention. 30 patients after acute MI hospitalized in the Cardiology Department were included to the study. They were questioned in directed interviews. The modified form of Shalit's Circle was used to infer the model of health activity. Perceived reasons for the heart attack (first in 67% cases) appeared as a manifold area, which was divided into eight categories: stressful situations and occurrences (66.67%), an individual's character (40%), lifestyle (36.67%), connected illnesses 36.67%), genetics (20%), age (13.33%), weather (10%), "spontaneous" heart attack (6.67%). The results indicated exterior attribution of MI (e.g. political and economic crisis, innate predisposition, loss of relatives). Similar tendency in the planning of changes after heart attack was observed. For instance 43.33% patients just said they planed to restrict or give up their previous sickness-promoting behaviour, 33.33% talked laconically about "the increase of caution" or "slowing down" and only 26.67% intended to undertake new forms of activity. These opinions illustrate the general model of health beliefs (in declarations and realization), which seems to be of very limited use (or even disadvantageous) with regard to the future. Moreover, the contemporary clinical conditions are conducive to such model. Modern medical methods of treatment reduce the time spent by patients in hospital, thereby reducing the hospitalization stress. On the other hand it limits or even eliminates the most important part of treatment--the "doctor-patient" relationship. Because of the limited number of subjects a further research is needed to combine the psychological intervention aimed at health behaviour change with the high standard of cardiology treatment those patients are being given now. The psychological program should tackle emotional and social costs of heart attack and strive to change patients' health belief system.

[Results of treating myocardial infarction patients with ST segment elevation in Górnoslaskim Osrodku Kardiologii in Katowice]. / Wyniki leczenia chorych z zawalem serca z uniesieniem odcinka ST w Górnoslaskim Osrodku Kardiologii w Katowicach.

BACKGROUND: Reperfusion therapy reduces mortality rate in patients with acute myocardial infarction with ST-segment elevation (STEMI). AIM: The aim of the study was to access the early outcome of patiens (pts) with STEMI admitted to Upper Silesian Cardiology Centre in 2002. METHODS: 957 pts with AMI were enrolled into the study. The influence of several factors on in-hospital mortality was analised. RESULTS: Out of 957 pts 51 died during hospitalization (5,3%). Coronary angiography was performed in 98,0% of pts. Primary PTCA was performed in 94,5% of pts. Stents were implanted in 85,9% of patients who underwent PTCA. The following factors significantly contributed to increased mortality among pts with acute myocardial infarction: female sex (p<0,02), multivessel disease (p<0,05), age above 65 yrs (p<0,001), time from the onset of chest pain above 6 hours (p<0,01) and 12 hours (p<0,001). The use of GP IIB/IIIA inhibitors significantly reduced the mortality rate (p<0,05). Cardiogenic shock was the only independent factor of the increased risk of mortality in multivariate regression analysis (p<0,0001) with relative risk of death (RR 33,5). The mortality rate in pts with shock was 40,2%: 70,8% in case of conservative treatment, 70% in the group of failed PTCA and only 17,2% in the group of successful PTCA. Among pts who underwent primary PTCA the failure to restore coronary blood flow of the infarct related artery contributed to increased relative risk of death (RR 14,5) (p<0,001). Stents improved the survival rate (p<0,01). In PTCA group cardiogenic shock and failed PTCA were independent risk factors in multivariate regression analysis. CONCLUSIONS: The results of our study show low rate of in-hospital mortality in pts without cardiogenic shock (1,2%). PTCA is highly successful method of treatment of pts with shock with mortality rate 17,2% in pts who underwent successful procedure.

[Atrial fibrillation in patients after coronary artery bypass grafting: the role of autonomic nervous system]. / Migotanie przedsionków u chorych poddanych pomostowaniu tetnic wiencowych--rola autonomicznego ukladu nerwowego.

In 42 patients the 24-hour ECG was performed before and on the fifth day after the elective coronary artery bypass grafting. In general 34 bouts of atrial fibrillation occurred in 14 patients. According to frequency analysis of the HRV 23 (67.6%) of these paroxysms were found sympathetically driven, 6 (17.6%) vagally driven and 5 (14.7%) undefined. The predominating role of adrenergic activation in the initiation of the bouts of atrial fibrillation in this group of patients suggests the need to use adequate doses of beta-adrenolytic agents during the perioperative period of ischaemic heart disease treatment.