Electrolyte disorders in the postresuscitation period after acute myocardial infarct

Experiments on 25 dogs demonstrated that ion redistribution between the cellular and extracellular sectors develops during recovery after 5-min clinical death from acute coronary myocardial infarction. Early after resuscitation (5 min-9 h) sodium ion concentration in the cells increases, while that of potassium decreases. Later (9-24 h) part of potassium cations migrates from cells to cell-to-cell space and both cellular and extracellular potassium fractions decrease.     

Incidence of intravenous thrombolytic therapy and fatalities in patients with acute transmural myocardial infarct (Q infarct). A study of observations from 1984 to 1987

All patients admitted to the ICU with acute myocardial infarction (MI) were treated by the same protocol since 1984. We report the results in Q-wave-MI of 1987 compared to 1984. Age (67.2 +/- 12.4 vs. 66.8 +/- 11.4 years), sex distribution (70.1% vs. 71.9% male), time elapse between begin of symptoms and admittance to the hospital (15.5 +/- 27.0 vs. 15.0 +/- 32.5 hours) were similar in both years, but the total number of definite Q-MI decreased by 22% from 135 (1984) to 105 (1987). Inhospital mortality (20% vs. 23%) and ICU mortality (14% vs. 20%) tended to decrease, although differences did not reach statistical significance. This was paralleled by an increase in the rate of i.v. thrombolytic therapy from 17% (1984) to 28% (1987) of all patients with Q-MI. The percentage of patients who definitely received i.v. thrombolysis when all indication criteria were present and all contraindicatory factors excluded increased from 47% (1984) to 97% (1987). We conclude, that the performance of i.v. thrombolysis in all patients, who fulfill the general accepted criteria for thrombolysis may improve clinical course and outcome in a given population of patients with acute Q-wave-infarction.     

Hyperglycemia in acute myocardial infarct

The author values with the glycosylated haemoglobin assay if the hyperglycaemia during acute myocardial infarction is due to the myocardial necrosis or is, on the contrary, a signal of undiagnosed diabetes.     

Celiprolol in acute myocardial infarct

In a randomized trial the effect was studied of celiprolol, a cardioselective beta receptor blocker with strong intrinsic activity (ISA) on the incidence of ventricular arrhythmias in patients with acute myocardial infarction (AMI). All patients received the first (oral) dose of 100 mg celiprolol or placebo exactly 6 hours after the onset of symptoms. Arrhythmia analysis was carried out from Holter recordings using a Pathfinder system. The results in 10 patients receiving celiprolol and 11 patients receiving placebo show that there was no difference in the distribution of the Lown classes between the two groups. The hourly VPC rate was somewhat higher in the celiprolol group from the very onset of the study, but the trend toward a decrease in VPC with time was identical in both groups. There was not a single incidence of ventricular fibrillation in the study population. It is concluded that celiprolol - under the circumstances of this study - did not show a beneficial influence on ventricular arrhythmias in AMI. This may, in part, be due to the strong ISA of this substance, but possibly also to the fact that celiprolol levels in the blood (measured by HPLC) were significantly lower in patients with AMI than in healthy volunteers.