RESUMO
In order to characterize postinfarction ischemia, 68 patients were studied by 24 hours Holter-monitoring and exercise testing. Twenty-four (35%) patients in Holter-monitoring and 26 (38%) in exercise testing had transient ischemic episodes. A significant coefficient of agreement was found between both tests. Nineteen (79%) of the patients had only silent ischemic episodes in Holter monitoring, and 87% of all episodes were asymptomatic. Twenty-two (87%) of the patients during positive exercise testing had silent ischemia. Eleven (46%) patients had transient ischemia at low and also at high heart-rates. Ten (37%) patients had ischemic episodes at lower charges than 100 watts, and all of them had more than 60 min of total ischemic burden in Holter-monitoring. A significant correlation was found between total ischemic burden and maximum ST segment shifts. The number of ischemic episodes were significantly higher during morning hours. A significantly higher rate of ventricular extrasystoles was found in recurrent ischemic patients, however, no difference was found in complex arrhythmias. After 1 year follow-up, 3 residual ischemic patients have died. The morbidity-calculated relative-risk is 13.9 times higher in patients with recurrent ischemia.
Assuntos
Doença das Coronárias/diagnóstico , Eletrocardiografia Ambulatorial , Eletrocardiografia , Adulto , Idoso , Complexos Cardíacos Prematuros/diagnóstico , Complexos Cardíacos Prematuros/etiologia , Doença das Coronárias/etiologia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , RecidivaRESUMO
Hemodynamic effects of nicardipine (60 mg) were evaluated in 20 patients whose left ventricular ejection fraction was less than 55%. Nicardipine significantly reduced the mean arterial blood pressure by 28 mmHg (p less than 0.0005). Left ventricular ejection fraction and maximal rate of ventricular diastolic filling were increased in 12% and 84.0 VDF/s (p less than 0.0005) respectively. The end diastolic volume was reduced by 26 ml (p less than 0.001). The decrease in mean arterial blood pressure correlates with the increase in the left ventricular ejection fraction (r = 0.76, p less than 0.001) as well as with the reduced end diastolic volume (R = 0.43, p less than 0.05). The results obtained corroborate the beneficial effects of nicardipine on ventricular function of ischemic patients, whose cardiac reserve is reduced.