[Importance of respiration for non-invasive assessment of cardiac autonomic control in patients with ischemic left ventricular dysfunction]. / Znaczenie oddychania w nieinwazyjnej ocenie wegetatywnej regulacji serca u chorych z niedokrwienna dysfunkcja lewej komory.

UNLABELLED: Respiratory rate is an important factor influencing heart rate variability (HRV), but is usually ignored in the studies in patients with ischaemic heart disease (IHD). This factor may significantly contribute to the changes in HRV in ischaemic left ventricular impairment. We examined 186 patients with IHD (46 females, 140 males), including 54 pts with left ventricular ejection fraction < 40% and 132 pts with preserved LVEF (> or = 40%). HRV was evaluated in supine and standing position from short-term ECG (512 beats, 1 kHz, 12 bit) in time- (mean RR interval--RRI, and standard deviation of RRI-SD-RR) and frequency-domain (FFT). Power spectral density of high and low frequency (HF 0.14-0.5 and LF 0.04-0.15 Hz) was estimated and expressed as log-values. The frequency of respiration (fResp, Hz) was defined as the frequency of maximum HF power. RESULTS: Patients with LVEF < 40% had shorter RRI in supine (879 + 157 vs 942 +/- 147 ms, p < 0.05), but similar in standing. FResp was greater both in supine (0.308 +/- 0.05 vs 0.274 +/- 0.047 Hz) and in standing (0.329 +/- 0.055 vs 0.274 +/- 0.047, all p < 0.001) in low, as compared to preserved LVEF. As expected, HRV parameters were more reduced in LVEF < 40%. The differences of raw values were as follows: SD-RR 29 +/- 16 vs 34 +/- 15 i 27 +/- 13 vs 31 +/- 12 ms, both p < 0.05, HF 3.21 +/- 0.36 vs 3.33 +/- 0.32, p < 0.05 and 3.19 +/- 0.32 vs 3.21 +/- 0.29 p > 0.1, LF 3.41 +/- 0.33 vs 31.49 +/- 0.30 and 3.52 +/- 0.30 vs 3.61 +/- 0.32, p < 0.05, ANOVA). The differences were observed despite adjustment for age, sex and RRI. When fResp was added as covariate they became not significant. CONCLUSION: Patients with left ventricular dysfunction had faster rate of respiration. This finding may explain, in part, reduced HRV in these patients. The rate of respiration should be taken into account for correct interpretation of HRV analysis.

[Silent myocardial ischemia before and after revascularization]. / Nieme niedokrwienie miesnia serca przed i po rewaskularyzacji.

In 82 patients with unstable ischemic heart disease (IHD) before and after revascularisation (percutaneous transluminal coronary angioplasty-PTCA-in 11 patients and coronary artery bypass graft-CABG-in 71 patients) silent ischemia incidence was observed. In these patients before and after operation election fraction (EF) and wall motion score index (IK) were compared echocardiographically as well as physical ability according to Bruce protocol in treadmill exercise test. Data (EF and IK and exercise test) before and after operation didn't change significantly. Silent ischemia was directed before operation in 17 patients (21.8%) and in 15 patients (19.4%) one month after those procedures.

[Qualifying patients with unstable angina for invasive tests based on electrocardiographic examinations]. / Kwalifikacja chorych z niestabilna choroba wiencowa do badan inwazyjnych na podstawie badan elektrokardiograficznych.

In 40 patients with unstable angina pectoris a variety of electrocardiographic parameters were analysed. In all patients routine ECG, signal averaged high resolution ECG. 24 hour ECG recordings and heart rate variability analysis were performed at admission and repeated at 7 day of hospitalization. During second week patients underwent also exercise treadmill test. On basis of clinical presentation each patient was qualified to invasive investigation, 31 patients had need for urgent cardiac catherization (group I-urgent indications) and in the remaining 9 patients cardiac catherization was performed 3 months after the relief of acute symptoms (group II-non-urgent indications). The most impressive implications were draw from repeated 24 hour Holter ECG monitoring. In patients with urgent indications (gr. I) more frequent and severe ischemic episodes, as well as more frequent ventricular arrhythmias were observed. Patients from group I were unable to achieve higher grades on exercise treadmill test, while ST segment depression was comparable in both groups. Heart rate variability analysis showed greater disturbances of cardiac vagal control in group I. The number of critically stenosed vessels was similar in both groups, however left ventricular systolic dysfunction was observed mainly in patients with urgent indications for cardiac catherization.

[Analysis of heart rhythm variability in evaluation of treatment for unstable angina pectoris]. / Analiza zmiennosci rytmu serca w ocenie leczenia niestabilnej choroby wiencowej.

Unstable angina pectoris is accompanied by several unfavourable autonomic disturbances. A noninvasive assessment of the autonomic cardiac control is possible by means of heart rate variability analysis (HRV). 26 patients with unstable angina pectoris were enrolled in the study. All patients received obligatory nitroglycerin and heparin intravenously within two days, and gallopamil (G) or metoprolol (M) together with aspirin or ticlopidine orally randomly, which were continued for 3 month or shorter if coronary revascularization was earlier performed. 512 R-R intervals was registered in each patient at 7th day of hospitalization and in 14th at the time of admission. Kardioassist v.1.0 system was used for heart rate variability analysis. After analog to digital conversion, with 12 bit resolution and 1000 Hz of sampling rate, seriogram of R-R intervals was obtained, and then power spectrum density was computed with the Fast Fourier Transform. Time-domain analysis provided mean (basic) R-R interval (BCL) and its standard deviation (SD-RR). In frequency-domain the following spectral variables were analysed: power spectral density (s2/Hz) of the high frequency component (aHF, 0.15-035 Hz), low frequency component (aLF, 0.05-0.15 Hz) and very low frequency component (aVLF, 0.004-0.05 Hz), percentage power of respective components (%HF, %LF and %VLF) and autonomic balance indices: aLF:aHF and %LF:%HF. These variables were compared in patients treated with G (13 patients) against those with M (13 patients). Additionally, the effects of treatment regimen was evaluated also in 14 patients, in whom HRV analysis was performed at admission and 7 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

[Trimetazidine therapy in atrio-cochlear disturbances of vascular origin]. / Trimetazydyna w leczeniu zaburzen przedsionkowo-slimakowych pochodzenia naczyniowego.

Therapeutic effects of TMZ treatment were evaluated in 31 patients with atrio-cochlear disorders caused by an insufficiency of cerebral circulation. It was found that the results of vestibular or cochlear disorders remission was dependent on the time interval between the onset of symptoms and the beginning of trimetazidine therapy. The best results were also found in patients suffering from atrio-cochlear disorders lasting not longer than two years and due to arterial hypertension or cerebral basilar artery insufficiency.

[Leukemic changes in the myocardium of a patient with acquired valvular heart disease]. / Zmiany bialaczkowe w miokardium chorej z nabyta wada serca.

A rare case is described of extensive myocardial infiltrations during myeloid leukaemia in a patient with coexistent valvular heart disease, and active inflammatory process in the endocardium. The coexistence of these diseases caused even greater diagnostic difficulties. This case shows also that differential white blood cell sound should not be disregarded in cardiovascular diseases.

[Changes of thyroid hormone levels in the perioperative period in patients with various types of goiter]. / Zachowanie sie poziomów hormonów tarczycy w okresie okolooperacyjnym u chorych z róznymi postaciami wola.

The thyroid hormone level was studied in the perioperative period in patients with various types of goitre. The clinical material comprised 85 patients treated surgically for nodular neutral goitre, nodular hyperactive goitre, Graves-Basedow disease, and cholecystolithiasis. The determination of total and free thyroid hormone blood serum levels was carried out in three periods of time, that is 4-5 days before operation, immediately after operation, and on the fifth day after operation. The obtained results led us to reaching the following conclusions: 1. Achieving of clinical euthyroid state in patients with Graves-Basedow disease during preoperative preparation with thyrostatic drugs was connected with the decrease of total and free thyroid hormone levels below the lower range of normal values which persisted immediately after, and on the 4th-5th day after operation. 2. During operation no significant increase was found of serum thyroid hormone levels. 3. On the 4th-5th day after operation, especially in patients with nodular neutral goitre and cholecystolithiasis a tendency was observed for a drop of triiodothyronine level, especially of its free fraction level.

[A case of isolated, corrected transposition of great arteries diagnosed with non-invasive techniques]. / Przypadek odosobnionego skorygowanego przelozenia wielkich pni tetniczych rozpoznanego metodami nieinwazyjnymi.

A case of a 34-year female patient with the isolated transposition of the great arterial trunks and mild atrioventricular (tricuspid) valve insufficiency is presented. The disease was diagnosed with non-invasive technique, particularly echocardiography. Cardiac disorders being usually concomitant with this syndrome (interventricular leak, pulmonary arterial wedge stenosis etc.) have been excluded by the aid of the contrast echographic technique and Doppler technique. The results of electrocardiographic records, which are usually helpful in the diagnosis of this abnormality have been completely useless in this case due to atypical ventricular depolarization vector pattern (QS complex in V1-V6 leads).