[Personal experience with determination of endogenous, digoxin-like substances in patients with myocardial infarct and other cardiopathies]. / Nase skúsenosti s vysetrením endogénnych, digoxínu podobných látok u chorých s infarktom myokardu a inými kardiopatiami.

A group of 65 patients with acute infarction of myocardium (IM) who were not treated with digitalis preparations were subdued to examination to the presence of digitalis-like substances in their urine by means of radioimmuno-analytic method with use of anti-digoxin antibodies. The control group was constituted of 69 healthy subjects. Patients afflicted with IM had significantly increased concentrations of DLS in serum in comparison with health subjects. No significant relations of DLS to the activity of creatinkinase, IM localisation, occurrence of dysrhythmias, heart insufficiency and IM mortality were discovered. An increase in DLS in the blood of patients with acute IM probably coincides with a decreased cardiac output, with the activation of the stress axis and retention of sodium and fluids. The second examined group of patients was constituted of 20 subjects with other severe cardiopathies (inborn and acquired heart defects, chronic ischemic heart disease, inflammatory and degenerative diseases of the heart, and hypertension), who were subdued to catheter examinations. The authors discovered no significant differences of DLS concentrations in the blood during catheterization of individual compartments of inferior vena cava, superior vena cava, and the right ventricle. They were not successful in defining the particular site of DLS secretion on the basis of this examination. The authors pay attention to interaction of DLS during the radioimmuno-analytic examination of the digoxin serum concentration.

[Non-invasive assessment of the efficacy of long-term vasodilator therapy of cardiac decompensation in patients with dilated cardiomyopathy]. / Neinvazívne sledovanie úcinnosti dlhodobej vazodilatacnej liecby srdcovej dekompenzácie u pacientov s dilatacnými kardiomyopatiami.

In 18 patients (14 men, 4 women, in the age of 37-52 years, mean = 43 years) with dilated cardiomyopathy allocated into NYHA functional classification groups III-IV, the efficacy of ambulatory long term (mean = 6 years) vasodilator therapy by means of non-invasive methods was evaluated. NITRO-MACK retard (venodilator) in the dosage of 20 mg per day and DIHYDRALAZIN (arteriodilator) in the dosage of 100-200 mg per day were combined simultaneously with continuous administration of cardiotonics and diuretics. Vasodilator therapy had a favourable effect on systolic and diastolic function of the left ventricle with the mostly marked effect at the beginning of treatment. Amidst non-invasive parameters, the diastolic amplitude time index and left ventricular hypertrophy-dilatation index had the greatest prognostic value regarding the treatment efficacy and survival of patients. This objective evidence of the efficacy of vasodilator therapy in patients with dilated cardiomyopathy coincided with the improvement of clinical status, subjective relief, moderation of decompensation, and thus with the improvement of life quality. (Fig. 1, Tab. 4, Ref. 24.).

[Vectorcardiographic and chronotopocardiographic study of septal hypoperfusion]. / Etude vectocardiographique et chronotopocardiographique de l'hypoperfusion septale.

The study has been carried out in 73 patients (63 men and 10 women), aged between 22 and 59 years, suffering from angina pectoris. The localization in space of the extremities of the initial QRS vectors (10 and 20 ms) is an indicator which is relatively very sensitive to the disturbance in the myocardial irrigation in the regions around the septum and the adjacent ventricular wall. A good relationship has been found namely with the data obtained with thallium scintigraphy after effort. The sensitivity of the vectocardiographic method, like that of dipolar chronotopocardiography, was clearly superior to that of scalar graphs.

[Comparison of echocardiography, vectorcardiography, electrocardiography, coronarography and ventriculography in coronary heart disease]. / Porovnanie echokardiografie, vektorokardiografie, elektrokardiografie, koronarografie a ventrikulografie pri koronárnej chorobe srdca.

Fifty patients (9 women, 41 men) with angina pectoris, aged from 22 to 59 years, were examined by means of one- and two-dimensional echocardiography (ECHO), vectorcardiography (VCG) using the McFee-Parungao system of leads, standard 12 lead electrocardiography (ECG), coronarography (CAG), and ventriculography (VG). I of isolated positivity of either of these methods ans considererl as patse positivity and presence or absence of positivity in combination of at least two methods (ECG exeluted) astme positivity, or true negativity then VCG was found to have the highest sensitivity (96%), negative predictive value (80%), as well as the highest overall predictivity (83%), while ECHO had the lowest values, i.e. 55%, 36%, 64%, respectively. On the other hand, ECHO was leading in specificity and positive predictive value with 100%, whereas VCG ranked lowest with 62% and 83% respectively. The combination of ECHO and VCG versus CAG and/or VG positivity exhibited and 80% specificity, 90% sensitivity, 90% positive predictive value and 86% overall predictivity when stenosis of over 50% was considered to be criterion. If obstruction was required the figures were to 75%, 94%, 83% and 86% respectively. ECHO and VCG are complementary noninvasive methods able to predict the results of CAG and VG and have a good predictive value when lowing for mere presence of focal myocardial injury.

Septic complications in patients with permanent pacemakers.

Nine patients with implanted pacemakers had the diagnosis of septicaemia to endocarditis. The diagnosis was established on the basis of a repeatedly positive haemoculture. The interval since the first pacemaker implantation to the onset of sepsis to endocarditis was about 5 years. All nine patients had previous reoperation either of the pacemaker or its lead due to decubitus. While, in four patients, the route of infection was a pacemaker lead in its extravascular couse, in 5 patients the source of infection was a lead placed right in the venous system. All patients were treated with ATB according to the antibioticogram. 4 patients had the pacemaker lead extracted. In the remaining five, the pacemaker lead was removed by catheterization. All patients recovered. There is only one way of eliminating infection that caused the sepsis, that is, to remove the foreign body present in the patient - the pacemaker leas in this particular case.

Post-traumatic coronary occlusion and its consequences in a young child.

A 250-kg metal plate fell on a six-year-old boy. The resulting internal, nonpenetrating trauma caused multiple coronary arterial occlusions leading to complete heart block and ischemic changes in the electrocardiogram. Later two left ventricular aneurysms developed that were resected.

Myocardial infarction at young age.

In a group of 25 men after myocardial infarction (MI) at an age under 40 years the occurrence of risk factors of ischaemic heart disease, the results of both invasive and noninvasive investigations as well as other special examinations within one year after the attack of acute MI were analysed. In 36% there was a normal finding or nonsignificant stenosis on the coronary arteries (less than 50% lumen obstruction at coronary angiography); a significant stenosis was found in 64%, out of which only one coronary vessel was affected in 32%. Dominant risk factors were: smoking, lipid metabolism disturbances, hypertension and a positive family history. The average number of risk factors in the group with a normal finding on the coronary arteries was 2.55, and in the group with a significant coronary sclerosis 4.85. The risk of myocardial infarction is increased by the coexistence of heavy smoking habits and vigorous physical activity. No correlation was found between the extent and location of coronary sclerosis and the functional parametres and wall motion of the left ventricle. An analysis of occupational status before MI revealed that 52% of the patients were workers, 40% professional drivers and only 8% were clerks.

Lipid markers, coronary score and coronary artery disease of stable angina pectoris type.

In 120 middle aged male patients with stable angina pectoris and coronarographically documented CAD all examined serum lipid markers differed significantly in comparison with 30 male subjects with vertebro-cardial syndrome and negative coronaro-angiogram (p less than 0.001). The low mean overall coronary score values (4.017 +/- 2.376) reflect the low extent of the coronary atherosclerosis. The coronary score values were significantly positively correlated to the serum levels of cholesterol, triglyceride, LDL-cholesterol, VLDL-cholesterol and negatively correlated to the serum concentration of HDL-cholesterol and HDL-cholesterol/total cholesterol ratios in all examined subjects (CAD and n-CAD groups) (p less than 0.001). In contrast, no significant correlation between coronary score and the examined lipid markers was exhibited in the CAD group of patients when comparing subjects with low and middle coronary score values. According to our results the ratio HDL-cholesterol/total cholesterol represents the best single indicator of the presence and also discriminator of the severity of the coronary athero-sclerosis in the patients with stable angina pectoris.

Serum lipid and lipoprotein concentration in coronary heart disease.

The relationship between serum lipid and lipoprotein concentration and the severity of coronary artery disease assessed by cineangiography was studied in 38 male patients, aged 44 +/- 11.5 years. According to luminal diameter narrowing of 3 major coronary arteries, the patients were divided into 3 groups: group A -- 10 patients with a normal coronarographic finding; group B -- 8 patients with a 26 to 50% coronary artery stenosis; group C -- 20 men with coronary stenosis exceeding 51%. With the exception of Apo B which in patients of group B was slightly elevated (p less than 0.05), there was no difference in serum lipid and lipoprotein levels between patients of group A and B. Patients of group C had significantly increased Apo B and triglyceride levels and a decreased high density lipoproteins (HDL) cholesterol/total cholesterol ratio in comparison with the control group. In group C, a linear correlation was found between the number of affected major coronary arteries and the serum Apo B level. The results suggest that determination of Apo B, triglycerides and the HDL cholesterol/total cholesterol ratio contributes to assessing the severity of coronary heart disease.