RESUMEN
BACKGROUND: The achievement of low density lipoprotein cholesterol (LDL-C) target levels, as recommended by the evidence-based international guidelines, represents the crucial prerequisite for maximal cardiovascular risk reduction in patients with dyslipidemia. OBJECTIVES: The efficacy of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) monotherapy administered in ambulatory practice was evaluated in cooperation with 387 ambulatory specialists in Slovakia. PATIENTS AND METHODS: Data of 5640 adult patients (21-88 years, 42.8% males) with low (7.4%), high (16.8%), and very high cardiovascular risks (75.7%), treated at least for 12 weeks with a stable statin dose were evaluated regarding the achievement of target LDL-C levels (< 4.2 mmol/L in low risk patients, < 3.4 mmol/L in high risk patients and < 2.6 mmol/L in very high risk patients). RESULTS: The target levels were achieved in 74% of low risk patients (mean level of LDL-C 3.55 mmol/L), in 37.9% of high risk patients (3.7 mmol/L), and in 12.4% of very high risk patients (3.64 mmol/L). The proportion of received statins and their average daily doses were as follows: 64.3% simvastatin (22.5 mg); 21.3% atorvastatin (15.6 mg); 12.2% fluvastatin (69.7 mg); 1.5% pravastatin (19.4 mg), and 0.7% lovastatin (25.4 mg). CONCLUSION: Statin therapy does not correspond with the current guidelines in common clinical practice. In patients with treated hypercholesterolemia the use of low doses of statins without titration seems to be the main reason of poor achieving of LDL-C target levels representing the critical values for reducing the atherosclerosis and its life-threatening complications (Tab. 3, Fig. 1, Ref 19). Full Text (Free, PDF) www.bmj.sk.
Asunto(s)
LDL-Colesterol/sangre , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Adhesión a Directriz , Humanos , Hipercolesterolemia/sangre , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , EslovaquiaRESUMEN
Since beginning, NMR examination is fully established in experimental work and common clinical praxis. Its extensive use in cardiology is determined by non-invasive character and relatively short examination time. After solving predominately economical problems, NMR examination will rapidly develop even in Slovak Republic (Tab. 2, Fig. 2, Ref. 29).
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Cardiopatías/diagnóstico , Espectroscopía de Resonancia Magnética , Humanos , Internacionalidad , EslovaquiaRESUMEN
Imaging of human internal organs by exact and non-invasive methods is very important for medical diagnosis, treatment and follow-up. 2003 Nobel Laureates in Physiology or Medicine have made original discoveries in the use of magnetic resonance to visualize different structures. Their discoveries have led to the development of modern magnetic resonance imaging, MRI, which represents a breakthrough in medical diagnostics and research. Atomic nuclei within a strong magnetic field rotate with a frequency depending on the strength of the magnetic field. Their energy can increase if they absorb radio waves with the same frequency (resonance). When atomic nuclei return to their previous energy status, radio waves are emitted. These discoveries were awarded the Nobel Prize in Physics in 1952. During the following decades, magnetic resonance was used mainly for studies of the chemical structure of substances. In the beginning of the 1970s, 2003 Nobel Laureates made pioneering contributions, which later led to the applications of magnetic resonance in medical imaging. Paul Lauterbur (born 1929), Urbana, Illinois, USA, discovered the possibility to create a two-dimensional picture by introducing gradients to a magnetic field. Analysing the characteristics of the emitted radio waves he could determine their origin. This fact made it possible to build up a two-dimensional picture of structures that could not be visualized by other methods. Peter Mansfield (born 1933), Nottingham, England, further developed the utilization of gradients in the magnetic field. He showed, that the signals could be mathematically analysed, which made it possible to develop a useful imaging technique. Mansfield also showed how extremely fast imaging could be. It became technically possible within a decade. Magnetic resonance imaging, MRI, is now a routine method in medical diagnostics. Worldwide, more than 60 million investigations are performed each year, and the method is still rapidly evolving. MRI is often superior to other imaging techniques and significantly improves diagnostics in many diseases. MRI has replaced several invasive methods of examination and in this way has reduced the risk and discomfort of many patients. (Fig. 3, Ref. 3.).
Asunto(s)
Imagen por Resonancia Magnética/historia , Premio Nobel , Inglaterra , Historia del Siglo XXI , Estados UnidosRESUMEN
Non-invasive stratification of patients after AIM represents the basic procedure in identification of patients at high risk of the origin of complications after AIM. It enables to tip a group of patients at the highest risk of the development of reinfarction, sudden cardiac death (SCD) or general cardiac mortality, i.e. the patients who can benefit the most from the early therapy. The presented review describes pathophysiological and clinical aspects of stratification of patients after acute myocardial infarction.
Asunto(s)
Infarto del Miocardio/clasificación , Muerte Súbita Cardíaca/etiología , Humanos , Infarto del Miocardio/fisiopatología , Pronóstico , Factores de RiesgoRESUMEN
After six months of antihypertensive treatment the regression of the initially present myocardial hypertrophy was observed: The decrease in blood pressure values is in correlation with the regression of the left ventricular hypertrophy. No correlation with parameters of high-resolution electrocardiography was noted. In one patient, a deterioration of late potentials was observed. It became more pronounced following the treatment. The monitoring of antihypertensive treatment effects by echocardiography and high-resolution electrocardiography may be therefore considered useful, especially in expected regression of the left ventricular hypertrophy. In individual cases of very outstanding regression, there exists the potential possibility of the process, resulting in the risk of arrhythmogenic substrate formation and subsequent generation of dysrhythmias.
Asunto(s)
Electrocardiografía , Hipertensión/tratamiento farmacológico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , UltrasonografíaRESUMEN
In the period of two years the authors treated at the coronary care unit 146 patients inflicted by the acute myocardial infarction (AMI). In 15 of them (13 men, 2 women, 13 times Q and twice non-Q, 5 times anterior, 10 times inferior) they performed intravenous thrombolytic treatment by use of streptokinase. The success rate of the thrombolytic therapy was evaluated by noninvasive markers: 1.) rapid withdrawal of chest pain, 2.) rapid (in 6 hours) and essential improvement of ST segment elevation and 3.) presence of reperfusion arrhythmias (in 6 hours). The authors detected insufficient medicinal conciousness among their health district population as regard to their response after the AMI origin (absolute majority of patients delayed their arrival). Minor complications due to therapy (allergy and minor local hemorrhage) occurred in 4 patients. Nobody died. Only those cases were considered as being successful, in which all three success rate markers were present. This condition was fulfilled in 8 patients (i.e. in 53% of cases) and with minor insufficiencies in further two patients (which would increase the percentage of the success rate to 67%). This success rate of the thrombolytic therapy ranges within the limits given by literature. In five patients the authors evaluated the behaviour of the left ventricular asynergy (its range and index) prior to and following the thrombolytic therapy and this examination they consider to be appropriate for observance of the thrombolytic therapy success rate in patients with AMI. (Tab. 3, Ref. 20.).
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Infarto del Miocardio/tratamiento farmacológico , Terapia Trombolítica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors present their experience concerning the time-delay in 357 patients with acute myocardial infarction admitted to the coronary unit over the years 1988-1991. This time indicator was evaluated by using two approaches, i.e. the global time-delay (the time between the onset of the patient's complaints and his/her admission to the coronary unit) and patient's time-delay (the time between the onset of the patient's complaints and his/her decision to notify the health care service). Arbitrary criteria were set up: 10 hours for the former and 5 hours for the latter parameter. The established criteria were met by 40% of the patients. Only 24% of the patients presented at the coronary unit within 6 hours, and these could receive thrombolytic treatment. The decision time (patient's time-delay) amounted that the education level of our population has to be enhanced so as to increase the number of patients with acute myocardial infarction presenting at the coronary unit at an early stage. (Tab. 1, Ref. 9.)
Asunto(s)
Infarto del Miocardio/terapia , Admisión del Paciente , Unidades de Cuidados Coronarios , Humanos , Factores de TiempoRESUMEN
Indapamide (Fludex) administered in daily doses of 2.5 mg resulted in optimal improvement of the blood pressure in patients with mild or moderate hypertension. During the period of 6 months treatment that was tolerated well by the patients, no influence of indapamide on the levels of glucose, cholesterol, triglycerides, and creatinine in blood was observed. A mild decrease of serum potassium in blood was clinically not relevant. Using echocardiography and electrocardiography a regression of the hypertrophy of the left ventricle of the heart was observed.
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Hipertensión/tratamiento farmacológico , Hipertrofia Ventricular Izquierda/tratamiento farmacológico , Indapamida/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Volumen Cardíaco/efectos de los fármacos , Ecocardiografía/efectos de los fármacos , Electrocardiografía/efectos de los fármacos , Femenino , Humanos , Hipertensión/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Cuidados a Largo Plazo , Masculino , Persona de Mediana EdadRESUMEN
Based on the presumption of the activation front splitting, the authors present their own proposal for the estimation of the myocardial electric activation course and for the detection of micropotentials 'hidden' within QRS complexes by the method of high-resolution electrocardiography. After filtration of QRS complex the values of delta RMS and those of cumulative amplitudes are calculated from the initial and from the terminal parts of QRS complexes. The presence of late potentials is reflected in a slowing down of the termination of activation course. As compared with healthy subjects, a slower rise of activation was observed in patients with myocardial infarction of the anterior wall. The curves of cumulative amplitudes rose very slowly during the first 70 ms of heart ventricle activation, explained according to the hypothesis of authors as being due to splitting of the activation front at the infarction focus. The usefulness of the proposed method was checked in patients with arterial hypertension and left ventricular hypertrophy, and in a group of patients with myocardial infarction. By the construction of cumulative amplitude curves from the onset of filtered QRS complexes, myocardial foci not reflected by 'classic' late potentials can be detected. The partial cumulative amplitudes of the QRS complex are suitable for comparative studies.
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Electrocardiografía , Adolescente , Adulto , Humanos , Hipertensión/fisiopatología , Hipertrofia/fisiopatología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatologíaRESUMEN
The authors report on their experience with the semiquantitative echocardiographic evaluation of left ventricular asynergy (group of 36 patients examined by two-dimensional echocardiography, dividing the left ventricle into 20 segments) in the early stage of myocardial infarction and its application in the prediction of complications of infarction. The authors evaluated asynegry using two parameters: RA (range of asynergy and IA (asynergy index) which characterizes the grade of ventricular affection. They describe the calculation of these parameters. The authors revealed a significant correlation (p less than 0.005) between RA or IA and the incidence of decompensation or cardiogenic shock. RA and IA values (median values and scatter) in three groups of patients (non-complicated infarction, complicated infarction and infarction with cardiogenic shock and death) give the opportunity of early stratification of patients with acute infarction. RA above 50% and IA above 20 indicate that the patients is at high risk. On the other hand, RA lower than 25% and IA lower than 5 suggest a minor infarction and probably an uncomplicated course of the disease. In the investigated group anterior infarctions affected a greater mass of the left ventricle than diaphragmatic ones and the higher death rate in this group (20% vs. 14%) was consistent with this.
Asunto(s)
Ecocardiografía , Infarto del Miocardio/diagnóstico por imagen , Función Ventricular Izquierda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Infarto del Miocardio/complicaciones , PronósticoRESUMEN
The authors give an account of their experience with early echocardiography (two-dimensional examination, division of left ventricle into 20 segments) during stratification of patients with acute myocardial infarction (a group of patients with a first infarction). They evaluated the presence or absence of serious asynergy (akinesia or dyskinesia) of the left ventricle and its relationship to the incidence of complications (serious dysrhythmia, decompensation, cardiogenic shock and death). The relations between asynergy and different complications were tested by means of multidimensional contingency tables. A statistically significant partial correlation (p less than 0.01) was recorded between the most serious asynergy and the presence of decompensation and also cardiogenic shock. The detection of serious asynergy of the left ventricle is a useful stratification indicator of the risk of the acute infarction, as no patient without asynergy died or overcame cardiogenic shock.
Asunto(s)
Ecocardiografía , Infarto del Miocardio/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Factores de TiempoRESUMEN
The authors describe the first case of myocardial infarction in their department which occurred during 5-fluorouracil treatment. In a 37 year-old patient two years before the infarction an epidermoid carcinoma of the lower lip was found. The patient was subjected to operation and radiotherapy. Because of a relapse of the process after one year the patient was re-operated with subsequent chemotherapy (vincristine, methotrexate, cis-platinum). Because the effect was not satisfactory, after another year 5-fluorouracil treatment was started (i.v. infusion of 3000 mg in two days). In the course of the infusion the patient developed the clinical picture of a non-transmural infarction of the anterior wall. The course was uncomplicated. The ECG returned to normal on the 9th day after discontinuation of 5-fluorouracil treatment. The effect of 5-fluorouracil on the heart is explained by a coronary vascular spasm. The authors recommend therefore administration of calcium blockers.