[Tachycardia-induced cardiomyopathy]. / Tachykardií indukovandá kardiomyopatie.

Tachycardia-induced cardiomyopathy is characterised with a ventricular dysfunction caused by increased ventricular rate. It is a reversible mechanism of the heart failure. Cardiomyopathy can recover after the restoration of sinus-rhythm or after adjusting the heart rate. In the presented paper we are discussing ethiopathogenesis, diagnostics and therapy of tachycardia-induced cardiomyopathy and we are describing the case of a patient with this diagnosis, who was admitted to our department.

Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

AIMS: Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. METHODS: One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). RESULTS: All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). CONCLUSIONS: First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.

[Cross-sectional study of choice of drug therapy in the acute phase of treatment in acute myocardial infarct--part 1]. / Prurezová studie volby farmakoterapie v akutní fázi lécby akutního infarktu myokardu--1. cást.

INTRODUCTION: Treatment of acute myocardial infarction is undergoing changes. In the treatment of acute myocardial infarction in particular the following proved useful: thrombolysis, administration of anti-aggregating drugs, beta-blockers and inhibitors of angiotensin converting enzyme. An decisive part is played by the interval between the onset of symptoms and the beginning of hospital treatment. OBJECTIVE: To describe treatment of patients hospitalized at intensive care units for acute myocardial infarctions. Investigate differences between faculty and other hospitals. METHOD: The authors investigated by means of questionaires in a prospective study during the first three months in 1996 all patients who were hospitalized on account of acute myocardial infarction. The investigation was implemented in seven intensive care units of faculty hospitals and in nine intensive care units of hospitals and information on diagnosis, pharmacotherapy and results of therapy were assembled. During the first 24 hours of treatment more detailed information was procured. RESULTS: Antiaggregants were used in 88%, nitrates in 77.8%, thrombolytics, beta-blockers and and ACE inhibitors in ca 30% patients. Percutaneous transluminal coronary angioplasty was used in ca 7% patients. CONCLUSIONS: The authors describe treatment of the acute stage of myocardial infarction. In faculty hospitals in 1996 thrombolysis, percutaneous transluminal coronary angioplasty, beta-blockers and nitrates by the i.v. route were used more frequently.

[The optimal diagnostic approach in myocardial infarct]. / Optimální diagnostický prístup k infarktu myokardu.

In the submitted review the authors discuss rational criteria for the diagnosis of myocardial infarction, indications for thrombolysis, coronarography and possibly PTCA, the method of indirect (non-invasive) assessment of an occluded coronary artery and the most frequent mistakes in the diagnosis of infarction. Essential examinations in the acute stage of myocardial infarction are: case-history, ECG, CK-MB (possibly echocardiography). For indication of thrombolysis of acute PTCA case-history and ECG (or echocardiography) are sufficient. Indications of early coronarography before discharge from hospital: postinfarction angina pectoris, malignant arrhythmia (except on the first day), haemodynamic instability, evidence of myocardial ischaemia (restricted symptoms) during a maximal load before discharge.

[The role of the myocardial interstitium in left ventricular remodeling after acute myocardial infarction]. / Uloha myokardiálního intersticia pri remodelaci levé komory po akutním infarktu myokardu.

An acute myocardial infarction (MI) is characterized by a change in the protein composition not only in the infarct area but, also, in the area not involved; the remodelling of cardiac tissue is the consequence of synthesis of qualitatively and quantitatively different collagenous and non-collagenous proteins. The authors discuss the biochemical and structural characteristics of extracellular space proteins (the main types of cardiac collagen include collagens I, III, IV and V, with an important role played by glycoproteins). The mechanisms involved in the alteration of the architecture of a left ventricle affected by an MI include the changed ratios of these proteins along with an effect on the structure and enzymatic activity of contractile proteins and myocyte slippage; these factors largely affect not only myocardial function but, also, the patient's prognosis. Despite a number of published data (mainly on the effect of ACE inhibitors), it is evident that the issue of controlling the quality and scar formation following an MI requires further study by clinical and experimental cardiologists.

[Echocardiographic detection of wedged emboli in the right heart in patients with pulmonary embolisms]. / Echokardiografický prukaz zaklínených embolu v pravém srdci u nemocných s plicní embolií.

The authors describe two case-histories of patients with the clinical picture of pulmonary embolism where on echocardiography a mobile formation in the right atrium was detected. In both patients the embolus of peripheral origin wedged in the right atrium was removed by surgery.