[Localization of myocardial infarction with the help of EKG and two-dimensional echocardiography. Controversies]. / Lokalizacja zawalu serca za pomoca ekg i echokardiografii dwuwymiarowej. Kontrowersje.

A multicentre study of the localization of myocardial infarction (MI) using ECG and 2-dimensional echocardiography (Echo-2D) was performed on the 21st day of the onset of MI. The study population consisted of 650 pts (mean age 55.0 years), 553 males and 97 females. The purpose of the study was: 1) to compare the site of MI as diagnosed by ECG and Echo-2D, 2) to determine the controversies in the diagnosis between these two methods. Consistent results of both methods were obtained in 408 pts (62.8%) of the group. In 61 pts (9.4%) the diagnosis of MI by ECG and Echo-2D was undefined. In 181 pts (27.8%) the inconsistencies of ECG and Echo-2D evaluations were demonstrated; in 106 pts ECG changes were undefined, but evident Echo-2D changes were found; on the contrary, in 51 pts MI diagnosed by ECG was not confirmed by Echo-2D. In 24 pts entirely inconsistent results were shown. 209 pts (32%) with myocardial contractility disorders in the apical region of the heart diagnosed by Echo-2D showed different MI localisation as determined by ECG: 147 pts had anterior or antero-lateral MI, 28 pts--postero-inferior MI, 12 pts--apical MI and 22 pts--another one. By these findings it has been shown that ECG and Echo-2D are compatible methods but not replaceable ones.

[Aneurysms in acute myocardial infarction (multicenter studies)]. / Tetniaki w ostrym zawale serca. (Badania wieloosrodkowe).

The authors present outcomes concerning frequency of appearance and clinical course of aneurysms after acute myocardial infarction. The study population consisted of 730 patients (mean age 54 +/- 9 years) with acute myocardial infarction, including 579 men and 151 women. The diagnosis was based on the following criteria: 1) coronary artery disease history, 2) physical examination, 3) ECG, 4) 2-dimensional echocardiography, 5) biochemical data. Post-infarction aneurysm was revealed in 42 patients (5.8%, 33 men and 9 women); antero-lateral aneurysm--in 36 patients (85.7%), and inferior-posterior aneurysm--in 6 patients (14.3%). Ventricular arrhythmias in the first day of infarction had a high frequency in both groups; with aneurysm--92.9%, without aneurysm--82.2%. The frequency of arrhythmia in 21-st day of infarction decreased similarly in both groups with aneurysm--40.5%, without aneurysm--38.9%. There was no statistically significant difference among both groups. There was no correlation between localisation of aneurysms and degree of contractility disturbances of the heart muscle (dyskinesis, akinesis). Heart failure--class III and IVK (Killip-Kimball classification) occurred in 19.0% of patients with aneurysm and in 10.4% of patients without aneurysm. That was no essential correlation between localisation of aneurysms and advancement of the heart failure.

[Thrombolytic therapy of myocardial infarction. Prognostic value of early reduction of elevation of ST segment]. / Zawal serca leczony trombolitycznie. Znaczenie rokownicze wczesnej redukcji uniesienia odcinka ST.

In-hospital mortality, infarction mass (estimated enzymatically) and electrocardiographic indexes (total ST-segments elevation, number of leads with R-wave presence and total R-waves amplitude) were assessed in 532 patients with acute myocardial infarction, randomized to two treatment groups: 272 treated with streptokinase (SK) and 260 with heparin (H). Echocardiographic contractility indexes (contractility disturbances area index, contractility disturbances index, left ventricle diastolic diameter) and heart volume estimated from X-ray film were also assessed. There were no significant differences in mortality and infarction area between the two groups. In 175 patients total ST-segments elevation was reduced by at least 50%, in the rest 340 patients this reduction was less significant. In the group with early elevated ST-segment reduction there were less in-hospital deaths (p less than 0.01), smaller infarction mass (p less than 0.0001) and significantly less disturbed electrocardiographic contractility indexes. Results suggest that simple electrocardiographic index, namely reduction of ST-segment elevation by 50% after 2 hours of treatment may be a useful prognostic tool, independent on treatment options, as far as in-hospital mortality, necrosis mass and left ventricle contractility disturbances are concerned.

[Hypertension and obesity]. / Nadcisnienie tetnicze a otylosc.

An epidemiological study was carried out in a population of men aged 35-64 years in the Bródno District of Warsaw. The study included 2123 subjects, the frequency was noted of hypertension and obesity as risk factors for ischaemic heart disease, and their correlations were studied. As hypertension the following values were accepted: --borderline hypertension = 140/90 less than 160/95 mm Hg, --stabilized hypertension = greater than or equal to 160/95 mm Hg. Overweight was accepted as Quetelet's index 29.0 weight in kg/height in cm. Stable hypertension was found in 35.0% of obese men and 18.5% of non-obese men (p less than 0.001). Borderline hypertension was demonstrated in 31.6% of obese men and 22.9% of non-obese men (p less than 0.002). Normal blood pressure was found in 58.4% of non-obese men and in only 33.4% of the obese ones (p less than 0.001). The prevalence of hypertension in obese men, both systolic and diastolic hypertension, was related to age: the highest proportion of hypertensive subjects was in the oldest group, the lowest one in the youngest group. The results agree with those reported by other authors who also demonstrated a high correlation between hypertension occurrence and increasing overweight.

[Relation between ischemic heart disease and tobacco smoking]. / Chorobowosc na chorobe niedokrwienna serca zwiazana z nalogiem palenia tytoniu.

The incidence of ischaemic heart disease related to tobacco smoking was studied in a population of males aged 35-64 years in the Bródno District of Warsaw. The population comprised 2123 subjects (attendance rate 62%). A relationship was demonstrated between cigarette smoking in the past and the ischaemic heart disease, its incidence was twice as high in former smokers than in non-smokers. No significant difference was found in this incidence between non-smokers and present smokers. A more deep analysis shows that former smokers who quitted smoking due to intensification of clinical symptoms are frequently included into the group of non-smokers, and they are the group at highest risk for ischaemic heart disease development.