ABSTRACT
A case of giant cell myocarditis with atrioventricular blockade and progressive cardiac insufficiency is reported that required implantation of an artificial pacemaker and ended in the death of the patient. The diagnosis was confirmed by a histological study following autopsy. The difficulty of diagnosis of this rare form of myocarditis with an aggressive clinical course is emphasized. It is concluded that life-time endomyocardial biopsy, combined immunosuppressive therapy, and frequently heart transplantation taken together may prolong life expectancy in such patients.
Subject(s)
Giant Cells/pathology , Myocarditis/diagnosis , Myocardium/pathology , Biopsy , Diagnosis, Differential , Fatal Outcome , Female , Humans , Immunosuppressive Agents/therapeutic use , Middle Aged , Myocarditis/drug therapyABSTRACT
Patients with acute myocardial infarction (n=161) were in random order divided into 2 groups: (1) those who received thrombolytic therapy (TT), (n=126), (2) those who received TT, optimized coronary angioplasty (TT+CA) on days 2-7 (n=35). During hospital period we assessed systolic and diastolic left ventricular (LV) function, content of cytokine tumor necrosis factor a (TNF a) and its soluble receptor type I (sTNF alphaR-I). Outcomes were registered after 1 year. By the end of hospital period group 2 had significantly higher LV ejection fraction, smaller left atrial dimensions, and lower pulmonary artery pressure. Zones of disturbances of local contractility were more rarely registered in this group. No significant differences were revealed between groups 1 and 2 in parameters of LV diastolic function, levels of TNF alpha and sTNF alphaR-I were revealed by the end of hospital period. After 1 year end point (cardiac death/reinfarction/revascularization) was noted in 47.5% of patients of group 1 and only in 20% of patients in group 2 (relative risk 0.48; 95% confidence interval 0.21-0.84, p=0.0035). Thus delayed CA after TT in acute myocardial infarction is an effective method of reperfusion therapy.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/therapy , Aged , Combined Modality Therapy , Cytokines/blood , Female , Follow-Up Studies , Health Status , Humans , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/drug therapy , Time FactorsABSTRACT
The paper presents a brief review of literature data on cordaron action on thyroid function under a prolonged schedule of its use, and a description of 4 cases of thyrotoxicosis developed by males after 2-10 years of cordaron maintenance for paroxysms of cardiac fibrillation in a dose of 200-600 mg. Probability of thyrotoxicosis necessitates an assessment of thyroid function when planning long-term treatment with cordaron.
