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.

[Comparison of amlodipine and the nifedipine retard preparation in the treatment of arterial hypertension]. / Usporedba amlodipina i retard pripravaka nifedipina u lijecenju arterijske hipertenzije.

The efficacy and acceptability of amlodipine (5-10 mg o.d.) and sustained-release nifedipine (20-40 mg b.i.d.) were compared in a multicenter, double-blind clinical trial. After a two-week placebo period, 71 essential hypertensives of both sexes, aged 51.7 +/- 8.5 years, having diastolic blood pressure of 95-114 mmHg were randomly allocated to either amlodipine 5 mg once daily (group A) or nifedipine 20 mg twice daily (group B). With respect to the blood pressure response, the initial dose was doubled after two weeks. No significant differences in blood pressures recorded at baseline and at the end of the placebo period were demonstrated. A significant reduction in both systolic and diastolic blood pressures in the supine position was observed already two days after the start of treatment. In the group A it decreased from 163.2 +/- 21.4/102.7 +/- 8.5 to 155.7 +/- 20.7/98.2 +/- 8.9 mm Hg (p < 0.05) and in the group B from 160.5 +/- 16.2/100.5 +/- 12.2 to 152.2 +/- 17.0/95.4 +/- 9.5 mm Hg (p < 0.05). The similar changes of blood pressure were observed in the standing position, as well. At the end of the study, the overall reduction of the supine diastolic blood pressure was 12.5% in the group A versus 5.2% in the group B (p < 0.05). In the standing position, amlodipine decreased diastolic blood pressure by 8.8% and nifedipine by 6.4% (p < 0.05). Furthermore, amlodipine decreased the standing diastolic blood pressure to a greater extent (8.8% versus 6.4%; p < 0.05) than nifedipine.(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).

[Clinical significance of the QRS-complex in the determination of myocardial infarct size]. / Klinicko znacenje QRS-kompleksa u odredivanju velicine infarkta miokarda.

In 60 patients myocardial infarction size was determined by electrocardiogram (ECG) using Selvester's QRS scoring system. These values were compared with the size of infarction as determined enzymatically using gram equivalent isoenzyme MB creatine kinase (gEq) and using maximum values of isoenzyme MB-CK. The results showed no statistically significant difference between the size of anterior and inferior infarction determined by gEq (25.19 +/- 13.59 vrs 22.48 +/- 14.04; p = 0.12 NS) and by maximum MB-CK (125.5 +/- 76.0 vrs 98.4 +/- 60.7; p = 0.12 NS). The size of myocardial infarctions determined by ECG was significantly larger anteriorly compared with the inferior infarcts (9.6 +/- 2.9 vrs 4.5 +/- 2.6; p = 0.001). In patients with anterior infarcts good correlations between the size of infarction determined by QRS scoring system and by gEq or maximum MB-CK were found (r = 0.69; p = 0.004 and r = 0.72; p = 0.001). In patients with inferior infarcts the correlations between QRS score and gEq or maximum MB-CK were poor (r = 0.37; p = 0.02 and r = 0.45; p = 0.15). The causes of weak correlations in the results of described methods in inferior infarcts are discussed. Thus QRS scoring system provides new noninvasive and simple possibilities in determining the size of anterior and in inferior infarctions of the left ventricle.

[Advantages and hazards of the intraoperative control of endocardial electrode pacemakers]. / Prednosti i opasnosti intraoperativne kontrole polozaja endokardne elektrode pacemakera.

Discussed in this study are the authors' experiences with electrostimulation of the heart. The study is based on 276 pacemaker operations performed in the past 7 years. The authors remain partial to the transvenously introduced endocardial pacemakers monitored by X-raj. When radiation symptoms manifested themselves in 2 team members, a revision was made in the procedure. As a result, the means by which one may be exposed to uncontrolled and, prolenged stron radiotion were cited. Such radiation can result in pathologic changes in the blood, damage to the skin, nails, germinative epithelium and bone marrow. To prevent such an outcome, certain precautionary measures are taken which protect both the patient and surgical team. Also mentioned is that the surgical personnel should have the same benefits as radiologists.