The effect of excessive alcohol consumption on the heart function and working capacity of manual workers.

UNLABELLED: The aim of this study was to investigate the influence of prolonged daily excessive alcohol consumption on the heart function with particular reference to the impact on the working ability of alcoholics. The study was carried out on 54 male manual workers, 32 of whom had a median age of 40.5 years with a history of heavy alcohol consumption of more than 100 g a day over a period of 10 years or more. The study also covered 22 non-alcoholics with a median age of 38.5 years from the same work environment. The study covered laboratory tests (MCV, AST, ALT, GGT), a maximal exercise test, as well as echocardiography. CONCLUSION: In spite of the observed differences, the functional ability in the chronic alcoholics in this study has not yet been disrupted as far as the cardiovascular system is concerned. During the maximal exercise test alcoholics achieved on the average 10.8 METS the same as the non-alcoholics, which shows that they are still capable of performing strenuous manual work. The question which remains to be answered is whether, in view of the already observed accelerated heart rate, higher blood pressure at rest and the echocardiographic changes, the patients would develop a manifest heart disease if they were to continue to drink heavily for a period more than 10 years.

[Echocardiography in the diagnosis and therapy of pulmonary embolism]. / Upotreba ehokardiografije u dijagnostici i terapiji plucne embolije.

A 58 year old woman was admitted to this hospital because of retrosternal pain followed by dyspnea which developed a few hours prior to admission, and two week history of progressive intolerance of physical effort. Echocardiography was done which revealed enlarged cavity of the right atrium (59 x 54 mm) and right ventricle (46 mm) of the heart. (Scintigraphy showed numerous triangular lung zones of sharply decreased or completely absent perfusion. After the diagnosis of recurrent pulmonary embolism, the patient was treated with intravenous heparin at a dosage of 25000 a day for 10 days. Dyspnea settled within 48 hours of starting heparin, analysis of arterial blood gases became normal and the general condition of the patient improved. A repeated echocardigram showed a significantly reduced dilatation of the right atrium from 59 x 45 mm to 47 x 43 mm and decreased pulmonary hypertension from 110 mmHg, on admission, to 65 mmHg.

Incidence and hospital mortality of acute coronary artery disease among civilians in Zagreb during air-raid alarms.

During the period of air-raid alarms in Zagreb (September 1991), the influence of war-induced stress on the incidence and mortality of acute coronary artery disease was investigated. Control periods were September 1989 and September 1990. Among 2903 patients admitted to Emergency Care Units, 369 (13%) were examined for suspect acute coronary artery disease. During the same periods in 1989 and 1990, 10% and 11% of acute coronary artery disease patients were recorded, respectively. The percentage of patients with myocardial infarction or unstable angina, admitted to Coronary Care Units during September 1989, 1990 and 1991, was 49%, 50% and 55%, respectively. The number of Q myocardial patients admitted during September 1991 was significantly higher than that recorded during the same period in 1990. The incidence and mortality patterns in acute coronary artery disease patients were also examined during August, September and October 1991. The peak incidence of acute coronary artery disease was found in the first half of September, while the peak mortality in these patients was found during the second half of September. During the second half of September of 1989, 1990 and 1991, the mortality in Q myocardial patients in Coronary Care Units, was 16.7%, 15.2% and 23.8%, respectively. Besides the war-induced stress, transportation of our patients to shelters or inner parts of the hospital caused additional stress, probably contributing to the development of refractory malignant arrhythmia or heart failure.

Hyperdynamic beta-adrenergic syndrome among Croatian soldiers engaged in battle.

A group of 1592 male Croatian soldiers (average age 32 +/- 9, ranging from 19 to 54) were examined by an internist at the war hospital. Elevated blood pressure was found in 80 men (5%); 61 of them had no history of hypertension (Group A), while in 19 patients hypertensive disease had been diagnosed before (Group B). In group A, systolic blood pressure (BPS in mm Hg), diastolic blood pressure (BPD in mm Hg) and heart rate (HR) were 182 +/- 13, 111 +/- 10, and 115 +/- 9; in group B, the values were 184 +/- 12, 108 +/- 8, 85 +/- 11. Electrocardiograms (ECG) and thorax roentgenograms of group A did not reveal any hypertension-caused signs, neither did the examination of the fundus, nor the serum creatinine values yield any abnormal results. The ECG test showed sinus tachycardia (heart rate > 100/min) but an otherwise normal function in group A. In group B, at least one of the laboratory examinations confirmed the previously diagnosed hypertension. Group A was treated with the cardioselective beta-blocker Atenolol (100 mg daily), while in group B, the previous antihypertensive medication was modified and/or increased. All patients were sent back to the front-line. Three days later, blood pressure and heart rate in group A were: BPS 139 +/- 9, BPD 87 +/- 6 and HR 77 +/- 8; and in group B: 156 +/- 11, 95 +/- 8, 75 +/- 7. A significant decrease in systolic and diastolic blood pressure (p < 0.0001) was found in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of war-induced stress in Croatia on the incidence and mortality of acute ischemic heart disease]. / Der Einfluss des kriegsbedingten Stresses in Kroatien auf die Häufigkeit und Mortalität der akuten ischämischen Herzkrankheit.

During war operations in Croatia and air alarms in Zagreb, a significantly higher incidence of patients with acute coronary artery disease was registered. Higher incidence of patients with acute myocardial infarction was present and the incidence of hospital mortality among patients with myocardial infarction was significantly higher than earlier. Significant difference was not found between various study periods neither for sex ratio, localization of myocardial infarction (anterior vs. inferior) nor in the ECG form of myocardial infarction (Q vs. Non-Q).

[Infarct of the right half of the heart]. / Infarkt desne polovice srca.

Isolated right ventricular infarction is not rare, as it is generally believed. As a rule, right ventricular infarction occurs in association with left ventricular infarction. Diagnosis of right ventricular infarction can not be made clinically alone. It should be confirmed on the basis of the following diagnostic procedures: the transient ST-segment elevation derived from the electrocardiogram, formation of QS-complex in V4 right, hemodynamic monitoring, echocardiography and radionuclide ventriculography. Of all the diagnostic criteria the best sensitivity and specificity is achieved by a rise in right ventricular filling pressure, respectively, the ratio of the right to left ventricular filling pressure should be equal or higher than 0.65. Increasing importance is being attached to the diagnosis of right ventricular infarction, since the treatment of patients with predominant right ventricular insufficiency and low cardiac output differs considerably from that of left ventricular insufficiency. Comparing our experience with previous reports, it may be concluded that adequate fluid administration with positive inotropic drugs, particularly adrenergic substances, if required, is essential in the medical treatment of right ventricular infarction. Vasodilator therapy may be administered, too. If frequent bradyarrhythmias do not respond to usual treatment, atrial pacing or atrioventricular sequential pacing should be initiated.