[Wellens's syndrome -- the ominous T-waves]. / Zespól Wellensa -- grozne oblicze zalamków T.

We describe three patients with Wellens's syndrome: biphasic T-waves or deeply inverted T-waves in the precordial leads plus a history of acute coronary syndrome without serum marker abnormalities. Wellens's syndrome is due to critical stenosis of the proximal left anterior descending artery and there is a high risk for anterior wall myocardial infarction and/or sudden cardiac death within a few weeks. Early coronary angiography with subsequent PCI or CABG should be performed in these patients. The T-wave changes usually occur during a pain-free interval but resolve within 12 months after revascularisation.

Effect of parathormone on heart rate variability in hemodialysis patients.

INTRODUCTION: Parathormone (PTH) is a very potent uraemic toxin, which affects heart structure and function. PTH also plays the role in uraemic autonomic neuropathy (AN). The aim of the study was to investigate the relationship between high PTH level and AN assessed with frequency domain measures of heart rate variability (HRV). MATERIALS AND METHODS: A 24-h ECG was performed in 40 HD (F=19, M=21) patients aged 49+/-11 years, duration of HD therapy 37+/-30 months. Frequency domain measures of HRV were obtained according to European Society of Cardiology recommendations. Total spectral power (TP), high frequency band (HF) and low frequency band (LF) were computed as indexes of: total autonomic nervous system (ANS) activity, parasympathetic and sympathetic activities, respectively. LF/HF ratio was calculated. TP, HF, LF and LF/HF were expressed as natural logarithm. Patients were divided into two groups due to PTH level: PTH+ (PTH> or =275 pg/ml) and PTH- (PTH<275 pg/ml). RESULTS: The values of lnTP and lnLF were lower in patients PTH+ than in patients PTH- (6,58+/-0,76 vs. 6,99+/-0,44 ms2, p<0,05, and 4,91+/-0,99 vs. 5,33+/-0,65 ms2, respectively, p=0,06). We also found negative correlation between lnPTH and lnTP (r=-0,47; p<0,005), lnPTH and lnLF (r=-0,35; p<0,05), lnPTH and lnHF (r=-0,34; p<0,05). On multiple regression analysis, lnTP, lnLF and lnHF were independently related to lnPTH. CONCLUSIONS: Parathormone exerts effect on activity of both parts of autonomic nervous system: sympathetic and parasympathetic. High PTH level deteriorates total autonomic activity.

Myocardial infarction with normal coronary arteriogram: the role of ephedrine-like alkaloids.

BACKGROUND: The overwhelming majority of myocardial infarctions result from atherosclerosis, generally with superimposed coronary thrombosis. The prevalence of patients who develop myocardial infarction and in whom subsequent angiography shows normal coronary arteries is approximately 5%. Many of these cases are caused by coronary artery spasm and/or thrombosis, perhaps with an underlying endothelial dysfunction of the epicardial coronary arteries. CASE REPORT: The authors present a case of acute myocardial infarction with normal coronary arteriogram which occurred in a 19-year-old, cigarette-smoking male following usage of a pseudoephedrine-containing drug for an upper respiratory tract infection. Coronary artery spasm, associated with taking pseudoephedrine, and a prothrombotic state, related to the platelet and endothelial effects of cigarette smoking and infection, were the possible mechanisms of myocardial infarction in the reported case. CONCLUSIONS: A diagnosis of acute myocardial infarction should be seriously considered even in relatively young tobacco-smoking patients, especially after acute alcohol intoxication or cocaine, amphetamine or ephedrine exposure. It is very important to obtain a complete history of the use of such 'safe' drugs, which do not need to be administered by a doctor but may contain treacherous components. These data provide the necessary background for making an accurate diagnosis and appropriate decisions concerning therapy.

[Coronary artery stenting in the treatment of 5-fluorouracil-induced unstable angina]. / Stentowanie wiencowe w leczeniu dusznicy bolesnej niestabilnej ujawnionej w trakcie farmakoterapii 5-fluorouracylem.

Cardiotoxicity is a rare but very serious side effect of 5-fluorouracil (5-FU) treatment. Many theories have been suggested to explain the mechanism of this problem. Most commonly, coronary artery spasm is considered responsible in cardiovascular toxicity. Ischemic symptoms and signs related to 5-FU therapy are observed during the late phase of the administration of the drug. The close and careful monitoring of all patients, especially the ones with pre-existent coronary artery disease, during 5-FU infusion is mandatory. Because there is not a single and effective modality of prevention of 5-FU cardiotoxicity, the patients should be selected carefully for its administration, 5-FU infusion should be stopped as soon as symptoms are encountered. A case of a 58-year-old woman treated with 5-FU due to colon cancer is described. In the late phase of 5-FU administration, the patient developed anginal pain with transitional ST segment elevation in ECG. Patient, after coronary angiography, was successfully treated with percutaneous coronary intervention. Interventional methods, most of all stent implantation, seem to be the best treatment of 5-FU-related acute coronary syndromes.

[Incomplete percutaneous coronary revascularization in 82-year-old patient with chronic renal failure and neoplastic disease. Case report]. / Niepelna przezskórna rewaskularyzacja wiencowa u 82-letniego chorego z przewlekla niewydolnoscia nerek i choroba nowotworowa. Opis przypadku.

We report a case of octogenarian with pharmacotherapy resistant angina pectoris, who was successfully treated by percutaneous coronary intervention.

Endothelial dysfunction in acute coronary syndrome without ST segment elevation in the presence of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection is one of the most common chronic infections in humans. While a causative relationship between H. pylori infection and several gastrointestinal disorders has been well established, the association between this condition and the development of atherosclerosis and coronary artery diseases (CAD) is less clear. AIM: To examine the relationship between H. pylori infection and endothelial function in patients with acute coronary syndrome (ACS) without ST segment elevation. METHODS: The study group consisted of 31 patients (17 males aged 38-78 years and 14 females aged 45-80 years) with ACS and without ST segment elevation in whom we measured antibodies to H. pylori and haemostatic factors indicating endothelial function, such as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA:Ag), tPA inhibitor (PAI-1:Ag) and fibrinogen. RESULTS: The proportion of patients with H. pylori seropositivity was 93.5%. No significant relationship between parameters of endothelial function and IgG antibodies to H. pylori were found. There was a significant association between antibodies to p54 protein and vWF (p=0.027) and between antibodies to p33 protein and PAI:Ag concentration (p=0.019). CONCLUSIONS: These results suggest that the type of H. pylori antigens and antibodies to these antigens rather than the presence of IgG antibodies to H. pylori may play a role in the development of CAD.