Cardiac outcomes after myocardial infarction in elderly patients with diabetes mellitus.

OBJECTIVES: To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non-insulin- or insulin-treated diabetes. METHODS: Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalizedfor acute myocardial infarction in Connecticut were reviewed by trained abstractors. RESULTS: One year after myocardial infarction, elderly patients with non-insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function. CONCLUSIONS: Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non-insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.     

The 1996 New York blizzard: Impact on noninjury emergency visits

The purpose of this study was to investigate the impact of the January 1996 New York blizzard on emergency visits to 12 Suffolk County hospitals for 10 noninjury health conditions. Emergency charts from the blizzard week (January 7–11) and a nonblizzard week (January 21–25) were reviewed and information was abstracted from the records meeting the criteria. Blizzard conditions were associated with increased visits for myocardial infarction/angina, primarily shoveling-related, and with decreased visits for asthma. Diagnoses for the other noninjury conditions did not differ significantly between time periods. The decrease in asthma visits possibly resulted from asthmatics avoiding exposure to blizzard conditions. An unexpected finding was that most patients with shoveling-related myocardial infarction/angina did not report pre-existing heart disease. Also of interest was that one quarter of myocardial infarction/angina visits by women were reportedly shoveling-related. This suggests that health warnings may be less effective at decreasing shoveling-induced myocardial infarction if they are directed primarily at men and at people with heart disease.     

Evaluation of acute chest pain syndromes by two-dimensional echocardiography: its potential application in the selection of patients for acute reperfusion therapy

Two-dimensional echocardiography is useful for the immediate diagnosis of acute myocardial infarction when diagnostic electrocardiographic changes are absent. The technique is also helpful in distinguishing myocardial infarction from other conditions that may clinically or electrocardiographically mimic infarction. The extent of myocardial infarction can be estimated by the two-dimensional echocardiographically derived wall motion score index. Therefore, two-dimensional echocardiography seems to be ideally suited for the initial noninvasive assessment of patients with acute chest pain syndromes, especially those who are considered for acute reperfusion therapy.     

Post-myocardial infarction pericarditis. Chronic symptoms in a middle-aged man

Post-myocardial infarction pericarditis can be confused with other conditions, including recurrent myocardial ischemia. The decline in the incidence of this type of pericarditis is thought by some to be linked to the decreasing use of anticoagulants in the treatment of myocardial infarction.     

经静脉实时心肌造影超声心动图评估心肌梗死后存活心肌

目的探讨经静脉实时心肌造影超声心动图（RT-MCE）评估心肌梗死后存活心肌。方法18例准备进行血运重建术心肌梗死患者,于术前1-5天行RT-MCE检查,并于术后3个月再次行常规超声心动图检查,室壁运动分析采用18节段分析法,分为运动正常、运动减弱、无运动和反常运动。心肌存活定义为术后超声检查室壁运动明显改善。将造影结果分为3种情况：充盈缺损,造影剂充盈延迟、回声稀疏不均匀或心内膜下充盈缺损,回声均匀性增强。其中后两种情况定义为存活心肌。结果在18例心肌梗死患者中共检出109个室壁运动异常节段,运动减弱为47个,无运动为56个,反常运动为6个。注射造影剂后回声均匀性增强的心肌节段中有2个节段术前室壁运动减弱,术后运动均改善;回声不均匀或心内膜下充盈缺损的心肌节段中术前室壁运动减弱有24个节段,术后运动改善14个,术前室壁无运动有24个节段,术后运动改善20个;充盈缺损的心肌节段中术前室壁运动减弱有21个节段,术后运动均未改善,术前室壁无运动32个,术后运动改善2个。RT-MCE检出存活心肌的敏感性、特异性分别为94.7%、78.9%。结论RT-MCE能比较准确的判断心肌梗死后心肌的存活性。     

Acute myocardial infarction in a previously healthy adolescent

Acute myocardial infarction in an adolescent is rare, with most episodes occurring in individuals with preexisting traumatic or medical conditions. Acute myocardial infarction in a previously healthy adolescent is an even more rare event. This report details such an event and briefly reviews the recent medical literature.     

Clinico-mathematical methods of diagnosis, prognosis of outcome and selection of optimal variant of treatment of myocardial infarction during hospital stay

The authors have developed methods for diagnosing and forecasting myocardial infarction outcomes with the use of current mathematical approaches. Studied the problems of simulating appropriate conditions and processes. Developed some effective algorithms of predicting myocardial infarction outcomes on the basis of the models obtained. Using the approaches (algorithms) suggested the authors have reviewed the methods for finding optimal correction of myocardial infarction treatment, based on the idea of maximization of the survival probability as one of the outcomes of the disease in question. The computer-aided methods for diagnosing, forecasting outcomes and choice of optimal treatment tactics for myocardial infarction during stay at a hospital can be very instrumental in raising the efficacy of the treatment and diagnosis of the disease under consideration.     

The use of antiplatelet agents in acute cardiac care.

Antiplatelet therapy with aspirin has long been established as standard therapy in the management of conditions such as ST-elevation myocardial infarction and the acute coronary syndromes (unstable angina and non-ST-elevation myocardial infarction). Recently, several more potent platelet inhibitors have been developed and tested in randomized clinical trials. This article reviews the current state of the art of antiplatelet therapy.     

Association of serum immunoglobulin G (IgG) levels against two periodontal pathogens and prothrombotic state: a clinical pilot study

Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.     

院内外一体化绿色通道对急性心肌梗死患者直接经皮冠状动脉介入术疗效的影响

目的 探讨院内外一体化急救绿色通道在急性心肌梗死转运急诊介入治疗中的价值.方法 2010年3月至2011年3月我院实施院内外一体化急救绿色通道以来“120”出车接诊的急性心肌梗死行急诊冠状动脉介入治疗的患者38例,选择同期由院外至我院患者40例采取急诊-病房-导管室模式,即患者经急诊进入病房,由病房心血管专业医生依据患者的临床症状及心电图检查确诊急性ST段抬高性心肌梗死后,联系导管室及介入组成员行急诊PCI术作为对照组.结果 一体化组明显缩短再灌注时间,减少住院天数,降低住院费用,减少近期病死率及心力衰竭发生率.结论 院内外一体化急救绿色通道的实施可以节省心肌梗死患者在诊断、转运、治疗过程中的时间,增加转运过程的安全系数,使心肌梗死患者得到及时救治.     

Complete heart block

Complete heart block (CHB) occurs when atrial impulses are not conducted to the ventricles. It occurs in association with many conditions, including acute myocardial infarction. In the setting of acute myocardial infarction (MI), certain characteristic conduction disturbances tend to precede development of CHB. Knowledge of these disturbances provides rational indications for emergency temporary pacing of acute MI patients.     

Including emergency and acute care as a global health priority

The clinical findings of Takatsubo Cardiomyopathy and acute myocardial infarction can be very similar. While Takatsubo cardiomyopathy rarely leads to severe complications, acute myocardial infarction can be life threatening. Treatment of both these conditions is different and so it is imperative for clinicians to have a high index of suspicion for either. Several EKG differences between the two entities have been proposed. This article summarizes the EKG changes most likely seen in Takatsubo cardiomyopathy and compares them to those seen in Acute Myocardial infarction.     

骨髓单个核细胞治疗急性心肌梗死患者的临床观察

目的：探讨自体骨髓单个核细胞通过冠脉内注射对于急性心肌梗死患者心功能的改善作用及其机制，并评估其安全性。方法：选择15例急性心肌梗死患者，利用Ficoll-淋巴细胞分离液分离出骨髓单个核细胞，在对患者进行标准药物和介入治疗的基础上，将骨髓单个核细胞经导管注射到心肌梗死的相关动脉内。同时选择17例接受标准药物和介入治疗的急性心肌梗死患者做对照。结果：在4个月的随访中，通过对患者进行超声心动图和心肌核素显像检查比较得出：细胞移植组的心肌梗死面积显著减少。两组的射血分数和左室收缩末期和舒张末期容积均有提高，而细胞移植组提高更为显著。结论：经冠脉自体骨髓单个核细胞移植在临床应用上是安全有效的，其机制可能是骨髓细胞介导的心肌再生和血管再生。     

The beta-receptor, atheroma and cardiovascular damage

In man a close interrelationship exists between hyperadrenergic states, myocardial ischemia, necrosis, infarction and sudden cardiac death. Persistent high catecholamine levels may also be associated with increased vascular endothelial turnover and permeability to calcium and lipoproteins, increased blood velocity, abnormal blood flow patterns and atheroma formation. There are thus good reasons to predict a cardiovascular protective effect of beta-blockers. Animal data indicate that in spite of apparently adverse plasma lipoprotein changes beta-blockers retard atheromatous plaque formation under conditions of high cholesterol diet with or without stress. A slow heart rate, as well as a reduction in calcium influx and inhibition of both esterification of arterial wall cholesterol (by ACAT) and endothelial permeability to lipoproteins, may be central to this process. Beta-blockers benefit a spectrum of conditions related to the atheromatous process and myocardial necrosis. These are silent ischemia; stable (including mixed), unstable and preinfarction angina; periinfarction events (including myocardial rupture and dissection of the ascending aorta); and myocardial necrosis associated with stress conditions such as head injuries and subarachnoid hemorrhage. In one study coronary deaths in hypertensive men, particularly in smokers, were significantly reduced by metoprolol (a beta 1-selective blocker) compared to a diuretic. In contrast in the MRC study of mild hypertension only nonsmoking men with mild to moderate hypertension who received a nonselective beta-blocker appeared to experience fewer myocardial infarctions. Recent clinical data showed that moderate-severe hypertensives who were optimally controlled by atenolol-based treatment over a 10-year period were less likely to die from myocardial infarction than those suboptimally controlled, irrespective of a rise in serum triglyceride levels. Thus the net effect of acute beta-blockade in hyperadrenergic states, including myocardial infarction, is to limit cardiovascular damage. Chronic beta-blockade inhibits atheroma formation (in animals) and beneficially modifies the incidence of stroke and myocardial infarction, which in man are the long-term consequences of hypertension.     

超声心动图诊断急性心肌梗死及其并发症的价值

目的评价超声心动图在急性心肌梗死及其并发症诊断中的应用价值。方法分析本院62例住院急性心肌梗死发病2周内患者的超声心动图特征，并将超声心动图与心电图对心肌梗死部位的判断结果进行比较，并注意观察有无急性心肌梗死并发症发生。结果超声心动图与心电图对心肌梗死部位及范围的判断基本相符。62例急性心肌梗死患者的超声心动图图像显示心肌梗死征象57例，并发症23例（室壁瘤11例，左室附壁血栓2例，室间隔穿孔3例，中、重度二尖瓣反流7例）。结论超声心动图可及时发现急性心肌梗死时心脏的一些特征性的形态和功能变化，检查方法简单准确，可与心电图相互印证与补充。     

高龄患者急性心肌梗死发作的时间节律与梗塞部位的分析

目的探讨急性心肌梗死(AM I)发作的时间节律的规律性。方法对997例(其中包括412例前壁和423例下壁的AM I患者)的梗塞发生时间、梗塞部位进行分析。结果高龄患者急性心肌梗死的发生率在06∶00到12∶00最高(n=257,占30.78%),而00∶00到06∶00,发生下壁心肌梗死的危险性明显高于其它时间点(n=138/423,32.62%,P<0.01),从06∶00到12∶00,发生前壁心肌梗死的危险性却明显高于其它时间点,(n=156/412,37.86%,P<0.01)。结论急性心肌梗死的发病具有明显的时间节律性,护士应掌握急性心肌梗死发作的时间节律,有针对性的进行监护,提高抢救成功率。     

冠状动脉完全闭塞无心肌梗死患者临床特点

目的探讨冠状动脉完全闭塞无心肌梗死患者的临床特点。方法选取冠状动脉造影显示冠状动脉完全闭塞而无心肌梗死发生的23例患者（无心肌梗死组）和冠状动脉造影显示冠状动脉完全闭塞有明显临床心肌梗死证据的27例患者（心肌梗死组），比较两组患者的临床特点。结果两组在高血压、年龄、性别等方面比较差异无显著性。无心肌梗死组在糖尿病、血脂异常、吸烟、心绞痛史等方面与心肌梗死组比较，差异均有显著性（均为P〈0．05）。无心肌梗死组冠状动脉病变血管支数较心肌梗死组多，侧支循环建立较好。但经皮冠状动脉介入治疗的成功率要低于心肌梗死组。结论冠状动脉造影显示有冠状动脉完全闭塞患者中，部分患者可无心肌梗死表现。除年龄、性别等不可控制因素外，糖尿病、血脂异常、吸烟等危险因素可能促进冠状动脉粥样硬化的发展。部分冠状动脉完全闭塞而无心肌梗死的患者常有较长的心绞痛史，冠状动脉病变弥散，侧支循环建立较好，所以在某支冠状动脉病变发展到完全闭塞时可不表现心肌梗死。