Evaluation of eosin-fluorescence in the diagnosis of sudden cardiac death.

The diagnostic significance of the eosin-fluorescence method was evaluated and compared with the enzymehistochemical beta-hydroxybutyrate-dehydrogenase method (beta-HBDH) and the degree of hyperchromasia in 568 samples from 24 bets-HBDH-negative and beta-HBDH-positive sudden cardiac deaths (SCD) and 23 non-cardiac deaths as controls. The effect of autolysis was investigated separately on isolated human hearts at +4 degrees C and +22 degrees C. All samples were examined without any knowledge of clinical or autopsy data. Normal olive-green fluorescence was observed in only five individuals of the control group and two in the beta-HBDH-negative one. The frequency of the yellow-fluorescence and hyperchromasia increased from the control subjects towards the beta-HBDH-positive-ones. The difference in frequency distribution of fluorescence between the groups was statistically highly significant (P less than 0.001). The change in fluorescence did not correlate with the loss of beta-HBDH-reaction or the distribution pattern of hyperchromasia. Postmortem autolysis did not change the fluorescence significantly but the 78% wrong positive subjects in the control group render this method too sensitive and unreliable for medicolegal purposes.

Diagnosis of sudden coronary death in the autopsy room: guidelines for forensic pathologists.

The pathological techniques employed in examining cases of sudden coronary death can vary widely. Visual assessment of coronary narrowing can lead to over-estimation of the true stenosis and may result in overdiagnosis of sudden coronary death. On the other hand, inappropriate examination of the whole epicardial coronary tree while searching for acute coronary lesions may lead to underdiagnosis. The approach recommended in this paper should minimize the possibility of such errors in the diagnosis of sudden coronary death.

[Role of ambulatory ECG in the evaluation of interventions: rehabilitation]. / Ruolo dell'ECG dinamico nella valutazione degli interventi: nella riabilitazione.

Rehabilitation represents an important moment in the diagnostic and therapeutic approach to cardiopathic patients in general and particularly to those with myocardial infarction. In the field of rehabilitation, Holter Monitoring lends itself as an irreplaceable tool of evaluation, able to provide information on: 1) incidence of complex arrhythmias; 2) ischemic attacks; 3) heart-rate trends in relation to physical activity. In the report, the following points are developed: a) How best to record information gathered during the acute and subacute phases of myocardial infarction, necessary to decide on which patients to perform Holter Monitoring. b) Which information derived from ergometric test necessitate the use of Holter Monitoring? c) Can the Holter Monitoring's recorded results offer sufficient contraindications to the starting of physical training? d) The Holter Monitoring's ability to evaluate the risk potential during physical activity and also how this activity influences the arrhythmic situation. e) The prognostic value of the parametres obtained by Holter Monitoring, paying particular attention to the analysis of heart-rate for typical neuro-vegetative signs from the infarct patient. f) Role of Holter Monitoring in the starting of active working lives again. To conclude, new trends in Holter Monitoring evaluations are discussed: --analysis of recordings made during events of sudden-death; --the facility to simultaneously record, in ambulatory patients, electrocardiogram and pulmonary artery pressure.

Five-year follow-up of maximal treadmill stress test in asymptomatic men and women.

A five-year follow-up of 888 asymptomatic men and women without known coronary heart disease (CHD) who had a maximal treadmill stress test (MTST) revealed a CHD incidence of 1.1% per year. In women, exercise duration of 3 minutes or less by the Ellestad protocol correlated with subsequent development of CHD (p less than 0.001), although abnormal ST-segment and R-wave responses did not. In men 40 years of age or younger, the MTST did not correlate with subsequent CHD. In men older than 40 years, ischemic ST response (p less than 0.01), an increase or no change in R wave (p less than 0.01), and an exercise duration of 5 minutes of less (p less than 0.001) all correlated with subsequent development of CHD. Five of five men (100%) who had all three criteria developed CHD within 5 years. When men older than 40 years who had all three criteria either present or absent were considered, specificity was 100%. The sensitivity, specificity, predictive value of an abnormal test, and risk ratio for developing CHD within 5 years for the various MTST criteria alone and in combination are tabulated.

Predictability of sudden death from resting electrocardiogram. Effect of previous manifestations of coronary heart disease.

The sudden death rate from coronary heart disease over a mean period of 4 years was related to the electrocardiographic findings in 3 groups of subjects, survivors of myocardial infarction, employed men, and employed men with no symptoms or history of coronary disease. Within each group the sudden death rate correlated with the number of electrocardiographic findings, particularly Q, ST, and T wave items. However, between groups there were large differences in sudden death rates in subjects with the same findings. These were greatest in the case of ventricular conduction disturbances and disturbances of rhythm and rate which appeared to be benign in those free of symptoms but ominous after infarction. Findings predictive of sudden death were also predictive of non-sudden coronary deaths. It is concluded that the electrocardiogram is only one of several aids to the diagnosis and assessment of severity of disease and not a substitute. Prognoses derived from clinical case series are inappropriate to symptomless individuals in whom isolated electrocardiographic findings denote little increase in risk.