RESUMEN
AIM: to elucidate relationship between parameters of negative ischemic stress test and subclinical atherosclerosis of carotid arteries. MATERIAL AND METHODS: Electrocardiographic stress test on treadmill and ultrasound study of carotid arteries (CA) were carried out in 204 patients (100 women and 104 men, mean age 54.16±8.07 years without verified ischemic heart disease and with ≥ 1 traditional factors of cardiovascular risk). Measurements of intima media thickness (IMT) in three extracranial CA segments and identification of atherosclerotic plaques (AP) were used for detection of subclinical atherosclerosis. CA total atherosclerotic plaque area (TAPA) was calculated when appropriate. RESULTS: Multifactorial regression analysis revealed the following predictors of increased IMT and TAPA: physical working capacity, increment and reserve of heart rate (HR), HR restoration, and increment of systolic arterial pressure (SAP). Presence of atherosclerotic plaque was associated with SAP rise > 42% during exercise test and slow HR restoration (≤42 bpm at 2-nd minute of recovery period). CONCLUSION: Analysis of nonelectrocardiographic parameters of negative relative to ischemia induction exercise test allows predicting severity of atherosclerotic changes in CA. The information obtained can supplement assessment of traditional factors of cardiovascular risk.
Asunto(s)
Aterosclerosis/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Prueba de Esfuerzo/métodos , Isquemia Miocárdica/diagnóstico , Adulto , Anciano , Enfermedades de las Arterias Carótidas/complicaciones , Grosor Intima-Media Carotídeo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
Choice between revascularization and conservative strategy in patients with stable coronary heart disease (CHD) is an important clinical problem, especially when the need for revascularization is not urged by severe ischemic symptoms. Revascularization aimed to improve prognosis is most justified in patients having high risk, based both on results of coronary angiography and functional tests. In the opinion of many experts, the high-risk features at stress-test is a key to identify patients in whom revascularization is most required among persons with high-risk coronary anatomy, as well as to select candidates for invasive treatment among patients with more favorable variants of coronary lesions. The advantage of revascularization over conservative treatment was demonstrated primarily in relation to coronary bypass surgery; however, the prospect of replacing surgery by an interventional treatment for prognostic reasons is extremely attractive. Although comparison of prognostic efficiency of percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) for some categories of patients with stable ischemic heart disease has yielded encouraging results, improved survival when using the PCI in direct comparison with optimal medical therapy was not convincingly confirmed to date. Implementation of PCI to improve prognosis in stable ischemic heart disease is still limited by a rather narrow range of indications and the relief of symptoms of ischemia remains its main purpose.
Asunto(s)
Angina Estable/cirugía , Angina Estable/terapia , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/terapia , Angina Estable/diagnóstico por imagen , Enfermedad Crónica , Angiografía Coronaria , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Intervención Coronaria Percutánea/métodos , Resultado del TratamientoRESUMEN
Correction of traditional risk factors (RF) at the population level resulted in considerable progress in prevention of coronary heart disease (CHD) in many countries. At the same time existing approaches to individual prediction of cardiovascular diseases based on the analysis of traditional RF and global risk scoring are in some cases ineffective. This problem most notably relates to a large group of persons with low calculated risk (young patients, persons without multiple RF, women) which accounts for the greatest in absolute numbers quantity of primary cardiovascular events. Attempts of improvement of individual CHD prediction deal with 1) discovering of new RF and their introduction in global scoring models, 2) cardiovascular imaging modalities which facilitate diagnosis of subclinical atherosclerosis, first of all an ultrasonic study of carotids and multi-detector computed tomography of coronary arteries. This review considers the prognostic value of most important standard global risk scoring models, the added value of new RF and role of data received from atherosclerosis imaging.
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Prevención Primaria/métodos , Medición de Riesgo/métodos , Enfermedad de la Arteria Coronaria/prevención & control , Humanos , Factores de RiesgoRESUMEN
Prediction of adverse left ventricular remodeling after acute myocardial infarction (AMI) may have important clinical implications. In this study, we evaluated the incidence of unfavorable changes of left ventricular volumes and ejection fraction after AMI. The ability of several cardiac markers, electrocardiographic and echocardiographic (including tissue Doppler) variables to predict adverse remodeling was demonstrated. The prognostic algorithm based on the investigated variables may help improve the treatment of patients after AMI.
Asunto(s)
Biomarcadores , Forma MB de la Creatina-Quinasa , Infarto del Miocardio , Volumen Sistólico , Disfunción Ventricular Izquierda , Remodelación Ventricular , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía , Electrocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Pronóstico , Medición de Riesgo , Terapia Trombolítica , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Heart failure (HF) is one of the most unfavorable consequences of the acute myocardial infarction (AMI), resulting in increased hospitalization level and mortality. The patients of advanced age constitute the major part among patients with HF due to AMI. In 123 patients a number of variables of the acute phase were investigated as potential predictors of developing HF within 12 months after AMI and the role of age was assessed. The relation of HF, echocardiographic variables measured 12 months after infarction and age was also studied. On completion a one-year follow-up, 54 patients (44%) developed HF, mainly of 2nd NYHA class. The age of the patients was the only independent predictor of HF among the variables of the acute phase (OR = 1.06 under 95% CI (1.01-1.12). The age over 65 years demonstrated 78% sensitivity and specificity in predicting development of HF. Among parameters estimated at the end of 12-months follow-up, age (OR = 0.934 under 95% CI (0.889-0.983) and echocardiographic wall motion score index (WMSI) (OR = 0.031 under 95% CI (0.003-0.333) independently influenced the presence of HF The factor of age had decisive importance for HF development in group of the patients with medium infarct size. At WMSI range 1.6-1.89, 11 of 20 patients younger than 65 had no HF, whereas 8 of 9 patients older than 65 developed HF (p < 0.05). Thus, age is a major independent predictor of development of HF within the first year after AMI. The patients of the senior age group 65+) have a high risk of HF with medium infarct size, which does not result in HF in patients of younger age.
Asunto(s)
Insuficiencia Cardíaca/etiología , Infarto del Miocardio/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/epidemiología , Pronóstico , Factores de Riesgo , Terapia TrombolíticaRESUMEN
By choosing antiarrhythmic therapy, ritmilen, 3 mg/kg, was given to 30 patients with atrial, atrioventricular, reciprocal and ventricular tachycardias. The agent was found to have the highest effect on atrial myocardial refractoriness in patients with atrial tachycardias and on ventricular refractoriness in patients with ventricular tachycardias (longer effective and functional refractory periods). Intraventricular pathways are the major site of ritmilen's effect on anterograde conduction. Profound changes were found in patients with atrial and ventricular tachycardias. The cholinolytic action of ritmilen on the atrioventricular node was detected in 20% of the patients, whereas sinus rhythm increased in 90%, which may be attributable to asymmetric vagus innervation of sinoatrial and atrioventricular nodes.
Asunto(s)
Antiarrítmicos/uso terapéutico , Disopiramida/uso terapéutico , Sistema de Conducción Cardíaco/efectos de los fármacos , Conducción Nerviosa/efectos de los fármacos , Taquicardia por Reentrada en el Nodo Atrioventricular/tratamiento farmacológico , Taquicardia Paroxística/tratamiento farmacológico , Adulto , Anciano , Atrios Cardíacos/efectos de los fármacos , Atrios Cardíacos/inervación , Sistema de Conducción Cardíaco/fisiopatología , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/inervación , Humanos , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia Paroxística/fisiopatologíaRESUMEN
In 29 patients with cardiac arrhythmias, refractory periods (RP) of the atrium, atrioventricular node and ventricle were defined before and after intravenous administration of cordarone in a dose of 5 mg/kg body weight. The effective RP (ERP) of the atrio-ventricular node showed the most profound changes: in 73% of the patients, the increase was 22.8% as compared to the pretreatment value. The most response of atrial RP to cordarone was also an increase of right atrial ERP by an average of 16.5%, FRP, by 13.1% versus the baseline values. The least effect was produced by cordarone on ventricular RP, namely the maximal increase in right ventricular FRP and ERP did not exceed 10%, but these parameters remained unchanged in a third of the patients.
Asunto(s)
Amiodarona/administración & dosificación , Arritmias Cardíacas/tratamiento farmacológico , Nodo Atrioventricular/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Arritmias Cardíacas/fisiopatología , Nodo Atrioventricular/efectos de los fármacos , Femenino , Atrios Cardíacos/efectos de los fármacos , Atrios Cardíacos/fisiopatología , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , Humanos , Inyecciones Intravenosas , MasculinoAsunto(s)
Fascículo Atrioventricular/fisiopatología , Bloqueo de Rama/diagnóstico , Sistema de Conducción Cardíaco/fisiopatología , Bloqueo de Rama/fisiopatología , Diagnóstico Diferencial , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Síndrome del Seno Enfermo/diagnóstico , Factores de TiempoAsunto(s)
Complejos Cardíacos Prematuros/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Taquicardia/fisiopatología , Complejos Cardíacos Prematuros/diagnóstico , Diagnóstico Diferencial , Electrocardiografía , Atrios Cardíacos/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Taquicardia/diagnósticoAsunto(s)
Anestesia/efectos adversos , Aleteo Atrial/inducido químicamente , Nodo Atrioventricular/efectos de los fármacos , Barbitúricos/efectos adversos , Cardioversión Eléctrica , Sistema de Conducción Cardíaco/efectos de los fármacos , Tiopental/efectos adversos , Adulto , Aleteo Atrial/diagnóstico , Aleteo Atrial/terapia , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
Twenty-six patients with idiopathic and secondary hypertrophic cardiomyopathies were examined. The diagnostic value of echo- and electrocardiographic signs of hypertrophic cardiomyopathy is discussed, the more important among those being the thickness and shape of the interventricular septum, anterosystolic movement of the anterior cusp of the mitral valve, electrocardiographic evidence of left-ventricular hypertrophy and left-atrial changes, abnormal Q waves.
Asunto(s)
Cardiomiopatía Hipertrófica/diagnóstico , Ecocardiografía , Electrocardiografía , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Cinetocardiografía , Masculino , Persona de Mediana Edad , FonocardiografíaAsunto(s)
Cardiomiopatía Alcohólica/complicaciones , Bloqueo Cardíaco/etiología , Adulto , Humanos , MasculinoAsunto(s)
Bloqueo Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Nodo Atrioventricular/fisiopatología , Bradicardia/fisiopatología , Fascículo Atrioventricular/fisiopatología , Electrocardiografía , Bloqueo Cardíaco/diagnóstico , Bloqueo Cardíaco/etiología , Humanos , Masculino , Persona de Mediana Edad , Nodo Sinoatrial/fisiopatologíaRESUMEN
The results of treatment of paroxysmal forms of atrial fibrillation and flutter are analysed in a group of 503 patients with attacks lasting up to 3 weeks. The sinus rhythm was restored in 84.7% of patients, in only 3% of cases was electro-impulse therapy resorted to. In alcohol toxic form of atrial fibrillation and flutter potassium chloride was the most effective drug for restoration of the sinus rhythm in 47.1% of cases, and if used with cardiac glucosides in 64.7%. In atrial fibrillation and flutter of other etiology the method of choice was a combination of quinidine with isoptine either by itself, or after saturation of the body with potassium chloride (85% cases of sinus rhythm restoration).
Asunto(s)
Antiarrítmicos/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Aleteo Atrial/tratamiento farmacológico , Adulto , Anciano , Glicósidos Cardíacos/administración & dosificación , Quimioterapia Combinada , Femenino , Hospitalización , Hospitales Especializados , Humanos , Masculino , Persona de Mediana Edad , Cloruro de Potasio/administración & dosificación , Procainamida/administración & dosificación , Quinidina/administración & dosificación , Estrofantinas/administración & dosificación , Verapamilo/administración & dosificaciónAsunto(s)
Alcoholismo/complicaciones , Fibrilación Atrial/fisiopatología , Aleteo Atrial/fisiopatología , Cardiomiopatías/complicaciones , Hemodinámica , Enfermedad Aguda , Adulto , Volumen Sanguíneo , Gasto Cardíaco , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Volumen Sistólico , Resistencia VascularRESUMEN
The indications for the catheterization of the heart and the recording of cavity electric potentials at the emergency aid centre are being considered. The possibilities have been studied of the electrography of the conductive system of the heart for differentiation of supraventricular paroxysmal tachycardias with blocks of pedicles of the His' bundle and ventricular paroxysmal tachycardias, and of irregular ventricular tachycardia and attacks of auricular fibrillation with pedicle blocks, and for the determination of the level of the atrioventricular blocks.