ST-segment elevation myocardial infarction in women with type 2 diabetes.

OBJECTIVE: To evaluate the effect of type 2 diabetes on the clinical course and prognosis of women with ST-segment elevation myocardial infarction (STEMI) and diabetes. RESEARCH DESIGN AND METHODS: A total of 26,035 consecutive patients with STEMI who were hospitalized in 456 hospitals in Poland during 1 year were analyzed. The data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS). RESULTS: Type 2 diabetes occurred more frequently in women than in men (28 vs. 16.6%; P < 0.0001). The proportion of women was larger among patients with diabetes (47.1 vs. 31.3%; P < 0.0001), and compared with women without diabetes, diabetic women had worse clinical profiles. Women with diabetes were most frequently treated conservatively. Both women and men with diabetes had significantly more advanced atherosclerotic lesions than women without diabetes. Women with diabetes had the highest in-hospital, 6-month, and 1-year mortality rates. Multivariate analysis indicated that type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Primary percutaneous coronary intervention (pPCI) was a significant factor associated with the decreased 1-year mortality in women without diabetes. CONCLUSIONS: Type 2 diabetes was a significant independent risk factor for in-hospital and 1-year mortality in women with STEMI. Women with diabetes had the poorest early and 1-year prognoses after STEMI when compared with women without diabetes and men with diabetes. Although pPCI improves the long-term prognosis of women with diabetes, it is used less frequently than in women without diabetes or men with diabetes.

[Coronary artery dissection as a cause of acute coronary syndrome STEMI in 45 year-old woman treated for multiple myeloma]. / Dyssekcja tetnicy wiencowej jako przyczyna ostrego zespolu wiencowego STEMI u 45-letniej kobiety leczonej z powodu szpiczaka mnogiego.

We introduce a case of 45 year-old woman treated for multiple myeloma. In this patient acute coronary syndrome STEMI during chemiotheraphy was occurred. Coronary artery dissection was observed in coronarography. Patient was medically treated with a good outcome. In 3 month follow-up the condition of the patient is stable.

[Acute myocardial infarction due to thrombosis of coronary artery aneurysm in a 29-year-old women during postpartum period]. / Ostry zawal serca w przebiegu wykrzepionego tetniaka tetnicy wiencowej u 29-letniej kobiety w okresie poporodowym.

Acute myocardial infarction during pregnancy and postpartum period is rare. A case of a 29-year-old female who developed acute myocardial infarction during postpartum period is presented. Coronary angiography revealed thrombosis of a coronary artery aneurysm of the marginal branch. The patients was treated conservatively and during 5 months of follow-up the clinical course was uneventful.

Dispersion of P wave duration and P wave vector in patients with atrial septal aneurysm.

AIMS: Atrial septal aneurysm (ASA) may be involved in the genesis of atrial arrhythmias as a consequence of disturbances in the propagation of depolarization, which may be easily assessed by P wave dispersion measurement. The aim of this study is to assess the dispersion of P wave duration and P wave vector in patients with ASA and to determine the effect of associated interatrial shunt on the magnitude of P wave dispersion. METHODS AND RESULTS: The study population consisted of 23 healthy volunteers and 88 patients with ASA base more than 15 mm and protrusion more than 7.5 mm. The size of aneurysms and atria was determined by echocardiography and P wave dispersion was measured on the surface ECG. In ASA patients, dispersion of P wave duration was significantly increased when compared with healthy controls (7.8 +/- 12.1 vs. 3.7 +/- 3.5 ms; P < 0.01). Dispersion of P wave vector was also significantly increased (8.5 +/- 10.1 degrees vs. 4.6 +/- 3.6 degrees ; P < 0.005). In healthy volunteers, the mean values of both parameters were below the cutoff points. CONCLUSION: In patients with ASA, there was a significant dispersion of P wave duration and P wave vector. Variation in P wave duration was significantly correlated with the dispersion of P wave vector and age of these patients. Dispersion of P wave vector was significantly decreased in ASA patients with interatrial shunt. P wave dispersion in ASA patients may predispose to the development of atrial arrhythmias.

Cardiac rupture in acute myocardial infarction with ST segment elevation. Clinical course and prognosis.

INTRODUCTION: Cardiac rupture (CR), involving left ventricular free wall, interventricular septum or papillary muscles, accounts for 15% of all deaths in the acute phase of myocardial infarction (MI). After cardiac arrhythmias and cardiogenic shock, CR is the third most common cause of death in acute MI. In spite of progress in the treatment of MI, mortality due to CR did not change in recent years.Aim. To assess the incidence, clinical course and outcome in patients with acute MI complicated by CR who were treated in our centre. METHODS: The study group consisted of 697 consecutive patients who were hospitalised due to acute MI with ST segment elevation (STEMI). The in-hospital and three-month follow-up data were analysed in 27 (3.9%) patients who developed CR. In 20 patients CR occurred in the left ventricular free wall, in 5 interventricular septum, in one both of these structures, and in one papillary muscle. The diagnosis of CR was based on clinical presentation and echocardiography. RESULTS: The overall mortality in 697 patients with STEMI was 10.5%. Mortality rate in patients with CR was 55.6% (15 patients) which accounted for 20.5% of all deaths. Nine patients with CR underwent cardiac surgery whereas 18 were treated conservatively. Two (22.2%) patients from the former group and 13 (72.2%) patients from the latter group died. CONCLUSIONS: 1. Mortality due to CR was increased in patients who were treated conservatively, who received thrombolysis and those who were females. 2. Rapid and accurate diagnosis, proper correction of hemodynamical disturbances and timely introduction of cardiac surgery improve prognosis in patients with CR complicating STEMI.

Efficacy of biphasic shock for transthoracic cardioversion of persistent atrial fibrillation: can we predict energy requirements?

Although electrical cardioversion of atrial fibrillation (AF) is frequently performed, initial energy requirements for cardioversion of persistent AF is still a matter of debate. The aim of the study was to determine the efficacy of biphasic shocks for transthoracic cardioversion of persistent AF and to predict adequate initial energy. A prospective study enrolled 94 consecutive patients with persistent AF, who were referred for elective cardioversion with a biphasic waveform. The paddles were placed in the anterolateral position. A step-up protocol was used to estimate the cardioversion threshold. The initial shock energy was 50 J, with subsequent increments to 100, 200, and 300 J in the event of cardioversion failure. The mean age of the study group was of about 65 years (6 +/- 11 years) and a median duration of AF was 65 days (3-324). Sixty-two out of 94 patients were men, 55% of the study population was classified as having well-controlled hypertension. The overall success rate of cardioversion was 89%, with a mean 2.2 +/- 1.4 shocks, and effective J 217.8 +/- 113 delivered during repeated cardioversions. The success rate of low energy shocks: 50 and 50 +100 J was 51%. By logistic regression analysis the only independent predictor of success at low energy shock was shorter duration of AF (r =-0.51; P = 0.02). Patients with shorter duration of AF have a higher probability for successful cardioversion with low energy. In patients with longer AF duration, a 200 J shock should be considered for cardioversion as the initial energy.

[Prinzmetal's variant angina with transient complete atrio-ventricular block--case report]. / Napadowy blok calkowity z poronnymi zespolami MAS w przebiegu dlawicy naczynioskurczowej.

A case of 44-year-old women with episodes of chest pain with ST-T segment elevation and paroxysmal atrioventricular complete block with syncopal episodes is presented. Coronary angiography did not reveal atheromatous lesions. A patient was treated with nitrates and calcium channel blockers. However syncopal episodes with A-V block reoccurred. A single-chamber (ventricular demand) pacemaker was implanted. A six month follow-up was uneventful.