The aminoterminal propeptide of type III procollagen provides new information on prognosis after acute myocardial infarction.

The aim of the study was to examine sequential changes in serum levels of the aminoterminal propeptide of type III procollagen (S-PIIINP) after acute myocardial infarction (AMI), and to assess the value of S-PIIINP as a predictor of outcome. The study group comprised 74 patients with AMI, and 24 patients in whom AMI was suspected but disproved. S-PIIINP changed characteristically after AMI, and in patients not receiving thrombolytic therapy or having cardiogenic shock, the changes correlated to peak enzyme values (r = 0.4, p < or = 0.03). S-PIIINP was higher at days 0 to 2 in nonsurviving AMI patients than in survivors (p < 0.05). With use of either the upper quartile for S-PIIINP at day 0 for nonsurviving AMI patients or the mean value of S-PIIINP in a normal population plus 2 SDs as a cutoff, the predictive value of a negative test ranged from 0.79 to 0.87 at days 0 to 2, and the predictive value of a positive test ranged from 0.39 to 0.67. Thus, S-PIIINP on admission and for the following few days after AMI is higher in patients with poor outcome.

Acute myocardial infarction during early pregnancy.

A 29-year-old woman with two previous births, suffered a non-fatal Q-wave myocardial infarction early in the second trimester of pregnancy. She gave uncomplicated birth to a healthy child 25 weeks later. Post-partum coronary arteriography revealed a 66% stenosis on the left anterior descending coronary artery. The patient was successfully treated with percutaneous transluminal coronary angioplasty.

Anaphylactic reaction during immunotherapy related to alcohol consumption.

A case of anaphylaxis related to alcohol consumption during immunotherapy is reported. We advise to consider whether there has been noticeable alcohol consumption prior to each injection.

[Treatment of cardiac arrest in general practice. A prospective study]. / Hjertestopbehandling i almen praksis. En prospektiv undersøgelse.

Since 1978, all of the ambulance stations in South Jutland have been equipped with defibrillators, equipment for intubation, drop equipment, infusion fluids and medicaments for treatment of acute medical and surgical emergencies. In 1989, a prospective investigation was undertaken of the results of the treatment of cardiac arrest outside hospital and carried out by general practitioners in cooperation with the ambulance staff or the ambulance staff alone. The investigation revealed that four out of 11 patients with cardiac arrest survived in the group treated by doctors and ambulance staff in the pre-hospital phase while only one out of 22 patients were resuscitated by the ambulance staff alone. As assessed by the clinical investigation, none of the surviving patients had sequelae of cardiac arrest. In addition, treatment in the ambulance proved life-saving for two patients with acute myocardial infarction and pulmonary oedema who were unconscious on account of the pulmonary oedema. The investigation shows the importance of pre-hospital treatment for survival and, in sparsely populated regions far from hospitals, it is essential that this treatment is carried out by general practitioners as the time-factor is decisive for the survival of the patient.

Influence of physical exercise on serum digoxin concentration and heart rate in patients with atrial fibrillation.

Heart rate and serum digoxin concentration in eight patients with atrial fibrillation were studied at rest and during exercise when initial serum digoxin concentrations were zero and at low and high therapeutic values. Eight patients with ischemic heart disease and in sinus rhythm were studied for comparison. Though the serum digoxin concentration decreased significantly during exercise, the absolute reduction in heart rate was the same at rest and during exercise in patients with atrial fibrillation. Compared with the control patients in sinus rhythm, the heart rate in patients with atrial fibrillation was not adequately controlled during exercise by any serum digoxin concentration tested despite a reduction in heart rate with increasing digoxin concentration. The effects of digoxin on heart rate regulation in atrial fibrillation are complex and include direct effects on the myocardium as well as indirect effects mediated by modulation of the autonomic nervous system; the present results indicate that the drug is not displaced from the target organs by decreasing serum concentrations during exercise. In atrial fibrillation, because the demands on the filter function of the atrioventricular node are highly unphysiological, the effect of digoxin on heart rate during exercise is not adequate.

Serum aminoterminal type III procollagen peptide reflects repair after acute myocardial infarction.

In 16 patients with acute myocardial infarction and in 15 controls, procollagen type III aminoterminal peptide in serum (PIIINP) was measured consecutively. Serum PIIINP was increased on the second to third postinfarction day (p less than 0.01) and remained elevated for more than 4 months. Peak values were observed on the third to seventh postinfarction day. The individual peak changes were correlated to infarction size calculated from serum CK-MB and serum lactate dehydrogenase (p = 0.60, p = 0.02). The changes in distribution of PIIINP-related antigens in serum after gel chromatography were similar to changes observed during wound healing in humans. PIIINP is cleaved off procollagen type III during the biosynthesis of type III collagen, which characterizes the early stages of repair and inflammation. Our findings suggest that serum PIIINP reflects the repair processes and scar formation following acute myocardial infarction. The serum PIIINP alterations in acute myocardial infarction differ essentially from the changes in myocardial enzymes reflecting myocardial injury. Serum PIIINP may therefore provide new and clinically relevant information on the healing of myocardial infarction.

Early diagnosis of acute myocardial infarction with a rapid latex agglutination test for semi-quantitative estimation of serum myoglobin.

A rapid latex agglutination test for the detection of elevated levels of myoglobin in serum was evaluated in a prospective study of 236 patients consecutively admitted to a Coronary Care Unit on suspicion of acute myocardial infarction (AMI). The final diagnosis was made according to the WHO criteria. The prevalence of AMI was 0.45 with a male to female ratio of 2:1. In all patients at least two blood samples were collected with 4 hours interval 4-12 hours after the onset of symptoms. All sera were analysed for myoglobin by a latex agglutination test and by a radioimmunoassay (RIA). The latex test was performed twice, first as an emergency test by the technical assistant on duty and later by another well-trained technical assistant as her daily routine work. If the latex test was carried out each day by the same well-trained technical assistant, the test results agreed well with the RIA test results, and the false-negative fraction for patients with AMI constituted 0.06 and the false-positive fraction for patients without AMI 0.46. However, when the latex test was performed by the occasional technical assistant on duty, a relatively high degree of discrepancy was observed between the latex test results and the RIA test results, thus giving a false-negative fraction of 0.11 and a false-positive one of 0.36. In conclusion, performed under optimal laboratory conditions, the latex test can be used as a reliable method to estimate elevated levels of serum myoglobin. However, used as a bedside emergency examination, the test results correlated rather poorly to the RIA test results, and consequently the latex myoglobin test seems to be of minor clinical importance in the early evaluation of patients with suspected AMI.

Early observations of S-myoglobin in the diagnosis of acute myocardial infarction. The influence of discrimination limit, analytical quality, patient's sex and prevalence of disease.

By means of a graphical method the influence of the analytical variation and the discrimination limit (DL) on the diagnostic power of the maximum serum myoglobin value observed from 4 to 12 h after onset of symptoms in 291 patients suspected for myocardial infarction (AMI) was examined. The prevalence of AMI was 0.45 and the male to female ratio 2:1. Serum myoglobin (S-myoglobin) was measured by a radioimmunoassay (RIA) with a coefficient of analytical variation (CVA) of 9%. For the distributions of the log values of maximum S-myoglobin for AMI patients and non-AMI patients straight lines were obtained on a probit scale. A statistically significant difference was found between the distributions for females and males without AMI, whereas no difference was found between females and males with AMI. The distributions of patients with and without AMI overlapped markedly giving a high number of misclassifications. The minimum fraction of misclassifications among all patients admitted occurred at a DL of 325 micrograms/l and was 0.16. When S-myoglobin is used for the purpose of early diagnosis of AMI the DL should be chosen so that the fraction of false negative patients is small. Consequently the fraction of false positive patients will be relatively high. At a DL of, for example, 175 micrograms/l, the false negative fraction was 0.06 of all patients with AMI (sensitivity 0.94), and the fraction of false positive patients was 0.35 (specificity 0.65).(ABSTRACT TRUNCATED AT 250 WORDS)

Complete heart block in Reiter's syndrome.

Severe cardiac manifestations are rare complications of Reiter's syndrome. The literature describes 11 cases of complete heart block. We report a case of complete atrioventricular heart block in a 38-year-old man with HLA-B27 positive Reiter's syndrome. Conduction returned to normal after institution of steroid treatment.

Familial right ventricular dilated cardiomyopathy.

Cardiomyopathy of unknown cause occurred in three of six siblings. The course of the illness was marked by life threatening supraventricular and ventricular arrhythmias, sinoatrial block, atrioventricular block, and embolism (in one patient). The disease was characterised by right ventricular dilatation. Two of the three patients died aged 32 and 48. No new cases of the disease were found when a further 33 family members from three generations were investigated.

Four cases of right-sided bundle-branch block and one case of atrioventricular block in three generations of a family.

Four cases of complete right bundle-branch block and one case of atrioventricular heart block, all occurring within three generations of the same family, are described. The 4 patients with bundle-branch block had no symptoms, whereas the patient with atrioventricular heart block suffered Adams-Stokes attacks from the age of 13 and died at 47 years of age. A 33-year-old man with bundle-branch block had a normal electrocardiogram at the age of 7, suggesting that inherited bundle-branch block does not necessarily manifest itself during the first years of life.