[Can the exercise test with nitroglycerin be useful for differentiation of patients with and without changes in coronary arteries--syndrome X?]. / Czy próba wysilkowa z uzyciem nitrogliceryny moze byc przydatna w róznicowaniu chorych ze zmianami i bez zmian w naczyniach wiencowych--zespól X?

UNLABELLED: The aim of this study was to compare the results of ECG exercise test performed before and after oral administration of nitroglycerine (NTG) in patients with coronary artery disease (CAD), and patients with typical chest pain without any changes in coronary arteriography--syndrome X. We examined 98 patients with typical chest pain, positive result of ECG exercise test, then accordingly to results of coronary arteries assessed with coronary arteriography, patients (pts.) were divided into two groups: group 1--35 pts. without any changes in coronary arteriography--syndrome X, and group 2--48 pts. with significant stenosis present in one or more coronary vessels. Each patient underwent two ECG exercise tests: first without any medication and second performed average 30 minutes after first test, and 5 min after oral administration of 1 table of nitroglycerine. During both tests the following parameters were evaluated: test duration, presence of chest pain, max. ST-T changes, heart rate (HR), and systolic blood pressure (SBP). RESULTS: In group 1 after NTG time of test duration had shortened from 5.9 +/- 0.4 min to 5.7 +/- 0.6 min. We also observed an increase in max. ST-T complex depression (2.2 +/- 0.5 mm vs 2.4 +/- 0.4 mm) but these differences were not statistically significant. In CAD group, duration of test after NTG was longer (6.2 +/- 1 vs 7.4 +/- 1.2), and normalization of max. ST-T complex depressions (2.7 +/- 0.5 vs 2.0 +/- 0.3 mm) was observed p < 0.01. CONCLUSION: Our study suggests that ECG exercise test with NTG may be useful in differentiation of patients with syndrome X and patients with typical coronary artery disease.

Ischaemic episodes detected by early exercise test and Holter monitoring after myocardial infarction: which are of most prognostic value?

BACKGROUND: The aim of this study was to assess the significance of ST-segment depressions (ST-SD) detected during exercise test or Holter monitoring and to determine which parameters of ST-SD are the most important prognostic factors in patients after myocardial infarction. METHODS: The study group consisted of 164 patients (126 men and 38 women) who survived their first uncomplicated myocardial infarction. Twenty-four-hour Holter monitoring on day 10 (+/- 2) after infarction and a treadmill exercise test 1 or 2 days later were performed. The following parameters of ST-SD were taken into consideration: amplitude, localization according to the area of infarction and presence or absence of concomitant angina. Patients were observed for 24 months to assess the occurrence of new cardiac events. RESULTS: In 78 patients (group I) ST-SD were detected in both Holter monitoring and the exercise test, and in 32 patients (group II) in the exercise test only. Fifty-four patients (group III) were without ST-SD. During follow-up there were 83 cardiac events in group I, 24 in group II and 16 in group III (P < 0.01, group I versus II; P < 0.0001, group I versus III; P < 0.05, group II versus III). In multivariate analysis the presence of ST-SD during Holter monitoring or the exercise test, or both, appeared to be of most prognostic significance (P < 0.0001). The number of new cardiac events was significantly higher in patients with painful ST-SD greater than 3 mm, detected outside the area of infarction (distant ischaemia). CONCLUSIONS: This study shows a significant prognostic value of early post-infarction ischaemia detected by Holter monitoring and an exercise test. Distant, painful ST-SD greater than 3 mm were more powerful determinants of poor prognosis than others. Electrode placement during Holter monitoring appears to be very important, particularly in post-infarction patients.

[Analysis of risk factors for coronary disease in women with their first acute myocardial infarction]. / Analiza czynników zagrozenia choroba niedokrwienna serca u kobiet z pierwszym zawalem miesnia sercowego.

Based on the analysis of the results of the investigation performed in 92 women hospitalized between 1989 and 1992 with the first acute myocardial infarction (AMI), frequency of coronary artery disease (CAD) risk factors was assessed with attention to the patient's age. It was proved that in women under 44 yrs the most common factors are: cigarette smoking, family history of CAD or myocardial infarction (MI), decreased levels of HDL-cholesterol and hypertriglyceridemia. In older age there are: hypercholesterolemia, decreased levels of HDL-cholesterol, hypertriglyceridemia, arterial hypertension, obesity and diabetes mellitus. Furthermore, some differences in the frequency of CAD risk factors between the both sexes were noted. In women under 44 yrs cigarette smoking, significant family history, decreased levels of HDL-cholesterol and hypertriglyceridemia occurred more often than in men. In women above 56 yrs we found significantly higher levels of total cholesterol and triglycerides, lower levels of HDL-cholesterol, higher frequency of hypertension, diabetes and obesity, compared to men.

[Heart rupture in the course of acute transmural myocardial infarction]. / Pekniecie serca w przebiegu ostrego, pelnosciennego zawalu serca.

The purpose of the work was an assessment of the incidence of heart rupture as the complication of acute transmural myocardial infarction, and establishing of risk factors. In a retrospective study, among 150 patients hospitalized in the department in the years 1982-1992 and dying in the course of acute transmural myocardial infarction, in whom postmortem examination was done, 19 cases complicated with heart rupture were found. The analysis was carried out on the basis of autopsy results and clinical documentation. The studied group included 12 women (63.2%) and 7 men (36.8%). Most frequently encountered were ruptures of the free wall of the left ventricle (n = 12). The risk factors are: age over 60 years, female sex, arterial hypertension, left ventricular hypertrophy and the first myocardial infarction without earlier coronary complaints.

[Transvenous ablation of the conduction under fluoroscopic control in a case of refractory supraventricular arrhythmia]. / Przezzylna ablacja ukladu przewodzacego pod kontrola radiologiczna w przypadku uporczywych czestoskurczów nadkomorowych.

Transvenous ablation of atrioventricular (AV) junction is an accepted method for treatment of refractory supraventricular arrhythmias. In the classic method the proper position of the ablation electrode is based on registration of the potentials of the conduction system. However according to Bredykis et all. Localization of the catheter is also possible under fluoroscopic control. The study presents a 67-year old patient with recurrent supraventricular tachycardias. Repeated bouts of arrhythmia, refractory to various antiarrhythmic drugs, caused severe hemodynamic consequences. Several cardioversions were performed for arrhythmia termination. Electrophysiologic study using transesophageal pacing showed a concealed accessory pathway conducting only in retrograde direction and the patient was designated for transvenous ablation of AV junction. The specially developed 6F USCI electrode with enlarged tip was used. The catheter was introduced into the right ventricle under fluoroscopic control and then slowly withdrawn until the tip was placed within the tricuspid valve at the border of atrium and ventricle. Cathodal pole of the defibrillator was connected with the electrode. Then the procedure was similar to the classic ablation. Single 200 joules DC shock caused complete AV block. No complications were seen during and after the procedure. A permanent cardiac pacemaker was implanted at the 4th day after ablation. The patient was doing well, without medication and no arrhythmias were observed during the 9 month period. The AV block persisted stable, also retrograde conduction was absent.