Characteristics of therapy of acute myocardial infarction in diabetes

Therapy of acute myocardial infarction (STEMI and NSTEMI) in diabetics does not principally differ from that of non-diabetic patients. Due to the higher mortality in diabetics reperfusion measures, such as direct percutaneous coronary intervention (PCI), should be rapidly performed. An intensive drug treatment with thrombocyte aggregation inhibitors, angiotensin-converting enzyme (ACE) inhibitors and beta-receptor blocking agents must be carried out according to the current guidelines. An important factor is the high risk of renal failure due to the contrast dye administered during PCI in the presence of pre-existing diabetic kidney damage which should be limited to 100?ml if possible. Direct PCI should be limited to the infarcted vessel. After stabilization a comprehensive strategy to cure coronary artery disease, whether with PCI or coronary artery bypass graft (CABG) should be finalized. If severe coronary 3-vessel disease is present, CABG should be favored in diabetic patients. After surviving an acute myocardial infarction differentiated metabolic monitoring is mandatory.     

Nearly fatal idiopathic anaphylactic reaction resulting in cardiovascular collapse and myocardial infarction

We report a case of nearly fatal cardiovascular collapse attributable to an idiopathic anaphylactic reaction in a 76-year-old man. The event began with gastrointestinal symptoms of abdominal cramps, diarrhea, nausea, and vomiting as manifestations of IA. The patient subsequently progressed to develop urticaria, flushing, cardiovascular symptoms of chest pain, hypotension, and eventually cardiovascular collapse and myocardial infarction over a five-hour interval. This case emphasizes that the potential for life-threatening cardiovascular events from IA exists in patients without previously defined cardiac risk factors.     

Acute myocardial infarction after anaphylactic reaction to amoxicillin]

A 62-year-old man was admitted to the hospital in a state of shock with electrocardiographic signs of inferior-wall acute myocardial infarction. He was initially diagnosed of cardiogenic shock. An urgent coronary angiography showed an irregular stenosis of 90% in the right coronary artery. Coronary angioplasty was performed, and a stent was placed in this lesion. In-depth questioning of the family revealed that the patient had taken an oral dose of amoxicillin 15 minutes before the onset of the symptoms. Further tests proved that he was allergic to amoxicillin, and was diagnosed of anaphylactic shock, complicated with acute myocardial infarction. There are several reports of myocardial infarction as a complication of anaphylactic reaction. We have found very few cases related to antibiotics, and none associated with amoxicillin. The most frequently quoted mechanism in these cases is coronary artery spasm due to the mediators of anaphylaxis. In the case reported herein, the irregular lesion suggests that disruption of an atherosclerotic plaque and platelet aggregation have occurred.     

C-反应蛋白水平对于急性心肌梗塞预后评价的意义

目的：评价C-反应蛋白（CRP）对于急性心肌梗塞（AMI）患者预后价值的意义。方法：测定65例AMI患者的血清CRP含量，并观察其心脏事件的发生率。结果：CRP≥8mg／L的AMI患者其心力衰竭（17．24％），心律失常（20．69％），心脏事件发生率（40．83％）明显高于CRP〈8mg／L的13．89％，5．56％，5．56％（P〈0．01）。结论：血C反应蛋白水平升高是急性心肌梗塞预后的预测因子。     

82例中青年急性心肌梗死临床特点分析

目的分析中青年AMI的临床特点。方法回顾性分析82例中青年AMI患者危险因素、诱发因素、初发症状、并发症、住院期间病死率和死亡原因等,并与同期住院的112例老年AMI患者比较。结果中青年AMI患者男性明显多于女性,吸烟、酗酒比例高于老年AMI组;发病前多有明显的诱因;胸痛症状典型,多为单支冠脉病变,而严重心律失常、心力衰竭发生率及病死率明显低于老年A-MI组。结论中青年AMI患者发病多有明显的诱因、胸痛症状典型、冠脉病变多累及单支血管、并发症和急性期病死率低于老年患者。     

Characteristics and management of diabetic patients hospitalized for myocardial infarction in France

AimThe objective of this study was to compare the management of diabetic and non-diabetic patients before, during and after hospitalization for myocardial infarction (MI).MethodsHospital admissions for MI in France from January to June 2006 were obtained from the national hospital-discharge database and merged with data on medications, 6 months before and after hospitalization of patients covered by the general health insurance scheme. Diabetic patients were identified by having at least two refunds for antidiabetic medications 6 months before the index hospitalization. Results comparing diabetic and non-diabetic patients were adjusted for age and gender.ResultsOf the 14,007 patients included in the study, 2545 were diabetic (18.2%). Before hospital admission, diabetic patients more frequently received secondary cardiovascular preventative medications (12.7% vs 4.2%; P < 0.0001) and stent implants (4.2% vs 2.2%; P < 0.0001) than did non-diabetic patients. During hospitalization and the following month, angioplasty (56.1% vs 61.7%; P = 0.0001) and stent implantation (53.3% vs 59.3%; P < 0.0001) were less frequently performed in diabetic patients and only coronary angiography was done in similar proportions of diabetic and non-diabetic patients (16.7% vs 15.2%). In addition, during the 6 months after hospitalization, diabetic vs non-diabetic patients had more admissions for cardiovascular reasons (36.9% vs 29.5%; P < 0.0001) and were prescribed more secondary preventative medications (65.9% vs 61.7%; P < 0.0001). They were also more frequently treated with insulin only (19.6% 6 months before vs 27.2% 6 months after) or oral antidiabetic drugs (14.6% vs 19.7%, respectively) than were non-diabetics.ConclusionFrench diabetic patients subsequent to MI undergo fewer angioplasty procedures than do non-diabetic patients. After the acute stage, secondary preventative medications are used more often, with a marked rise in the use of insulin.     

Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries

STUDY OBJECTIVES: Myocardial infarction with angiographically normal coronary arteries (MINC) is a life-threatening event with many open questions for physicians and patients. There are little data concerning the prognosis for patients with MINC. DESIGN: Retrospective follow-up study. SETTING: Tertiary referral center. PATIENTS: Patients with MINC were investigated and compared to age- and sex-matched control subjects with myocardial infarction due to coronary artery disease (CAD). The patients were examined clinically using stress exercise and hyperventilation tests. Migraine and Raynaud's symptoms were determined by means of a standardized questionnaire. Serum lipoproteins; the seroprevalence of cytomegalovirus, Helicobacter pylori, and Chlamydia pneumoniae infections; and the most frequent causes of thrombophilia were assessed. Measurements and results: From > 4,300 angiographies that were performed between 1989 and 1996, 21 patients with MINC were identified. The mean +/- SD patient age at the time of myocardial infarction was 42 +/- 7.5 years. When compared to control subjects (n = 21), patients with MINC had fewer risk factors for CAD. In contrast, MINC patients had more frequent febrile reactions prior to myocardial infarction (six patients vs zero patients; p < 0.05), and the migraine score was significantly higher (7.1 +/- 6.3 vs 2.2 +/- 4.1; p < 0.01). The seroprevalence of antibodies against cytomegalovirus, C pneumoniae, and H pylori tended to be higher in patients with MINC and CAD as compared to matched healthy control subjects. Three patients with MINC vs none with CAD had coagulopathy. During follow-up (53 +/- 37 months), no major cardiac event occurred in the MINC group; no patients with MINC vs nine with CAD (p = 0.0001) underwent repeated angiography. CONCLUSION: High migraine score and prior febrile infection together with a lower cardiovascular risk profile are compatible with an inflammatory and a vasomotor component in the pathophysiology of the acute coronary event in MINC patients. The prognosis for these patients is excellent.     

冠状动脉造影正常的心肌梗死患者的病因分析

目的　探讨冠状动脉造影正常患者心肌梗死病因。方法　对我院近 10年因心肌梗死而行冠状动脉造影检查的 12 0 0例患者中有 4 0例 (3 3% )造影正常并行血管内超声检查 ,回顾分析其可能的病因 ,并进行定期 (门诊和电话询问 )随诊观察临床预后。结果　 4 0例心肌梗死患者中 2 9例患者由于冠状动脉痉挛所致 ,4例患者为结缔组织病 ,1例冠状动脉畸形 ,6例冠状动脉肌桥。所有患者随诊 (2 5± 17)个月 ,无主要心脏事件发生。结论　心肌梗死的病因中部分患者为冠状动脉痉挛、血管炎 ,冠状动脉畸形或肌桥等其他病因所致 ,这些患者预后良好。     

Characteristics of psycho-autonomic regulation in patients with myocardial infarction and circulatory failure

Three hundred and fourteen patients with myocardial infarction were studied by using psychodiagnostic tools and measuring blood levels of neuromediators and neurohormones. It was ascertained that the hemodynamic status determined not only various clinical syndromes, but also contributed to the development of psychoemotional and vegetative and humoral abnormalities. Situation-induced anxiety and moderate activation of the sympathetic-adrenal+ system were observed in uncomplicated myocardial infarction; astheno-hypochondriac disorders and prevalent parasympathetic regulation were seen in cardiogenic shock; pulmonary edema displayed depressive and phobic reactions and activation of the both autonomic nervous system portions with predominant adrenocortical function; congestive decompensation exhibited anxiety and depressive disorders and sympathetic activation at the normal and mediatory levels. This leads to the conclusion that it is necessary to perform multimodality therapy with regard to the status of psychovegetative control.     

STEMI患者炎症反应水平及罪犯斑块特征与PCI术前TIMI血流分级的关系

目的:明确ST段抬高型心肌梗死（STEMI）患者的炎症反应水平及罪犯斑块形态特征与经皮冠状动脉介入治疗（PCI）术前心肌梗死溶栓（TIMI）血流分级的关系。方法:本研究为回顾性研究。选取1 268例PCI术前对罪犯斑块行光学相干断层成像（OCT）检查的STEMI患者,按照TIMI血流分级分为TIMI 0~1组964例（...     

Acute myocardial infarction after wasp sting without anaphylactic reaction]

Bites of hymenopterans (bees, wasps and hornets) are very frequent phenomena that can stir up allergical reactions in venom-susceptible patients but that seldom provoke acute myocardial infarction. In the literature we can find case reports of myocardial infarction after bites of hymenopterans, and preceded by an allergic reaction (sometimes with angiographic evidence of undamaged coronary arteries). The pathophysiological determinant seems to be related to the chemical composition of hymenopterans venom, basically made up by vasoactive and thrombogenic substances able to create vasospasm and coronary thrombosis. Our report refers to a 65-year-old male patient without prior cardiological and allergic events who, bitten by a sharm of three bees, complains of an acute large anterior myocardial infarction with angiographic evidence of thrombotic lesion of the proximal left anterior descending artery treated with direct stenting with procedural success, without showing allergical symptoms. The pathophysiological determinant seems to be related to the release of vasoactive amines and thrombogenic substances contained into the hymenopterans venom, the former able to produce vasospasm, the latter able to create diffuse thrombosis. The use of adrenaline itself to counteract the possible systemic allergic reaction appears to advise against the treatment of patients with cardiological symptoms or coronary artery disease and because of its strong vasoactive activity (it leads, in fact, to vasoconstriction) and thrombogenic effects.     

Early and late physical activation of patients with acute macrofocal myocardial infarct in a central regional hospital]

The favourable effect of early physical activization and the unfavourable effect of delayed activization on the haemodynamics and complications were established in cases of acute large-focal myocardial infarction. The distinct informative capacity of the haemodynamic values determined by means of the commonly available and known physical methods was established. It is recommended to use widely the indices of pulse rate and pulse pressure as the simplest criteria for the beginning of physical activization and for the adequacy of physical exercises in the process of rehabilitation of hospitalized patients with large-focal myocardial infarction.