[Dissecting aortic aneurysm complicated by rupture of the right coronary artery and acute myocardial infarction--in a person treated with fibrinolysis]. / Tetniak rozwarstwiajacy aorty wstepujacej powiklany odwarstwieniem prawej tetnicy wiencowej i zawalem serca--u osoby laczonej fibrynolitycznie.

A case report of 45-year-old woman with acute inferior wall and right ventricle myocardial infarction treated with i.v. Streptokinase is presented. Few days later acute aortic dissection involving right coronary artery was detected. After six days the patient was successfully operated. She is in good condition 10 months afterwards.

[Chronic thromboembolic pulmonary hypertension--observation of personal case reports]. / Nadcisnienie plucne na tle przewleklej zatorowosci do duzych naczyn plucnych--obserwacja wlasnych przypadków.

The clinical picture, differential diagnosis and prognosis in chronic thromboembolic pulmonary hypertension (CTEPH) is being discussed on the basis of a dozen of the authors' cases. The clinical course of CTEPH in 2 patients fulfilling the main criterium for pulmonary thromboendarterectomy and undergoing one year anticoagulation is examined. As a result patient with one large pulmonary vessel occlusion (a. lobaris superior sinistra) improved his clinical status as well as hemodynamic and echocardiographic outcome. In patient with multivessel pulmonary occlusion gradual clinical aggravation and hemodynamic-echocardiographic progression of CTEPH was observed.

[Atrial fibrillation with chronic obstructive pulmonary disease]. / Migotanie przedsionków w przewleklej obturacyjnej chorobie pluc.

We compared 8 patients with COPD and fixed atrial fibrillation (group I) and 46 patients with COPD and sinus rhythm in ecg (group II). None of the patients had valvular heart disease, arterial hypertension or clinical signs of coronary artery disease. The studied groups did not differ while comparing their gas measurements, spirometry, pulmonary hypertension and right ventricular diameter (as measured in echo study). Patients with fixed atrial fibrillation had larger circuit and area of right atrium (p = 0.001), left atrial and left ventricular diameter (p = 0.001) as well as lower LV function (expressed by FS%). In conclusion, enlargement of both atria may be considered as a cause for fixed atrial fibrillation in patients with COPD. However symptomless coronary artery disease rather then COPD may be the reason for this arrhythmia.

[Chronic obstructive lung disease: does accompanying arrhythmia have any clinical significance?]. / Przewlekla obturacyjna choroba pluc. Czy towarzyszaca arytmia ma znaczenie kliniczne?

Clinical significance of cardiac arrhythmias in patients with advanced and stable chronic obstructive pulmonary disease was assessed 22-24 hour Holter monitoring revealed supraventricular and ventricular arrhythmias in all 65 patients. There was a great variation of arrhythmia quality and quantity in the study group. Among others, 1808 complex ventricular extrasystoles in 33 patients and 302 episodes of nonsustained ventricular tachycardia in 19 patients were recorded. No sustained symptomatic ventricular arrhythmias were observed. We found no correlation between the intensity of ventricular and supraventricular extrasystoles and clinical parameters as assessed by echocardiography, spirometry and gasometry. However, patients with complex ventricular arrhythmias had larger right ventricular diameter in echocardiography. Of 65 studied patients, 14 (21%) died during follow-up ranging from 1 month to 3.2 years, mean 12.2 months. Two outpatients died suddenly. These 14 patients had larger right ventricle and left atrial dimension, more pronounced PaO2 decrease as well as lowered FEV1 as compared to the survivors. No differences in the incidence of cardiac arrhythmias were noted. Summarizing, despite the great prevalence of cardiac arrhythmias in patients with advanced stable COPD we found no life-threatening ventricular arrhythmias during approximately 1500 hours of holter monitoring. Cardiac arrhythmias seem not to influence the prognosis in these patients.