The Swietokrzyskie system for the optimal management of acute myocardial infarction.

We present activities undertaken in Poland's Swietokrzyskie province to shorten the time to recanalization of infarct-related arteries in patients with acute myocardial infarction. All emergency medical institutions have been obliged by the Governor of Swietokrzyskie to implement the System for Optimal Management of Acute Myocardial Infarction. The effects of this action are discussed, and similar systems in Europe are reviewed.

The effect of perindopril and enalapril on plasma resistin levels in normotensive patients with coronary heart disease.

INTRODUCTION: It has been suggested that adipose tissue hormones are involved in the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors. Very little is known as to whether the action on resistin contributes to the clinical effectiveness associated with the use of these agents. MATERIAL AND METHODS: The aim of this study was to compare the effects of plasma- and tissue-type ACE inhibitors (enalapril and perindopril) on plasma resistin content in coronary artery disease (CAD) individuals without arterial hypertension. The samples used in our analysis were obtained at baseline, and again after 30 and 90 days of treatment, from 22 patients receiving enalapril (20 mg/d), 24 receiving perindopril (4 mg/d), 20 receiving no angiotensin-converting enzyme inhibitors, and 20 healthy subjects. Each group consisted of patients sensitive and resistant to insulin. RESULTS: Plasma resistin content was higher in normotensive CAD patients, particularly in the subgroup with reduced insulin sensitivity, than in the control group. Both ACE inhibitors produced a weak effect on blood pressure. Perindopril treatment reduced resistin levels, while enalapril only tended to decrease its content. The effect of perindopril was stronger in insulin-resistant than in insulin-sensitive subjects. CONCLUSIONS: Our results demonstrate the superiority of perindopril over enalapril in reducing plasma resistin levels, particularly in insulin-resistant subjects. They justify the choice of a tissue-type ACE inhibitor in normotensive CAD individuals, requiring administration of this group of agents.

The effect of angiotensin-converting enzyme inhibitors on plasma adipokine levels in normotensive patients with coronary artery disease.

INTRODUCTION: The results of large clinical studies indicate that angiotensin-converting enzyme (ACE) inhibitors are effective agents in patients with coronary artery disease (CAD), even if their blood pressure is within normal limits. MATERIAL AND METHODS: In the present study, we compared the effect of plasma- and tissue-type angiotensin-converting enzyme inhibitors on plasma levels of leptin and adiponectin in normotensive subjects with isolated CAD. We analyzed the samples obtained from 45 patients with isolated CAD, treated for 90 days with enalapril (20 mg/d, n = 15) or perindopril (4 mg/d, n = 16), or not receiving angiotensin-converting enzyme inhibitors (n = 14). Plasma leptin and adiponectin levels were determined at baseline, and after 30 and 90 days of treatment. RESULTS: Compared to healthy subjects (n = 15), CAD patients had lower plasma levels of adiponectin and higher plasma content of leptin. Neither enalapril nor perindopril treatment was associated with any significant changes in blood pressure. Administration of perindopril resulted in an increase in plasma adiponectin and a reduction in plasma leptin. No significant changes in these hormones were observed after enalapril treatment. CONCLUSIONS: Our results indicate that perindopril is superior to enalapril when it comes to affecting the hormonal function of human adipose tissue. This suggests that tissue-type angiotensin-converting enzyme inhibitors are a better treatment option for normotensive individuals with CAD than plasma-type ones.

[Advanced symptomatic atrioventricular block as a complication after transcatheter occlusion of secundum atrial septal defect in a 40-year-old woman with prior left bundle branch block]. / Zaawansowany, objawowy blok przedsionkowo-komorowy jako powiklanie po zabiegu przezskórnego zamknieciaubytku w przegrodzie miedzyprzedsionkowej u 40-letniej chorej z wyjsciowym blokiem lewej odnogi peczka Hisa.

We report a case of a woman with a left bundle branch block and secundum atrial septal defect (ASD) who underwent transcatheter occlusion using Amplatzer device. The patient was treated with antiarrhythmic drugs because of paroxysmal atrial flutter. One and a half month later the patient developed a second degree atrioventricular block. Temporary pacing was introduced, followed by a dual-chamber pacemaker implantation due to recurrent symptomatic atrioventricular block. An association between conduction disorders, the use of antiarrhythmic drugs and the complications after ASD closure is discussed.