Hemorheologic disorders in the threatened myocardial infarct syndrome

Haemorrheological disturbances have already been described in ischaemic heart disease. However, it has not been established whether these changes are secondary to the ischaemia and/or myocardial infarction or whether they play a role in initiating or sustaining the haemodynamic abnormalities which cause infarction. We report our results observed in 14 patients aged 48 to 75 years admitted to the coronary care unit with a diagnosis of acute coronary insufficiency defined as typical persistent anginal pain resistant to glyceryl trinitrate associated with specific ECG changes (without pathological Q waves or increased serum CPK concentrations). Blood samples were obtained on admission for determination of: haematocrit, total blood viscosities at different levels of shear with the patients hematocrit and with corrected hematocrits, total blood filtrability, plasma viscosity and plasma albumin fraction. All patients received 800 mg lidocaine, 40 mg chlorezepate, adequate anticoagulant doses of heparin and a specific antianginal drug: amiodarone, nifedipine or diltiazem. Six patients had a favourable outcome and were discharged from the Coronary Care Unit without myocardial infarction (Group I); the remaining 8 patients (Group II) developed documented changes of myocardial infarction between the 12th and 4th day after admission (see the Table in the text). The haemorrheological parameters on admission of the two patients groups were compared. The abnormalities observed were significantly more severe in the group developing myocardial infarction. This suggests that these changes may play a major role in initiating conditions leading to myocardial necrosis. These observations confirm the results of other workers who have also shown a relationship between the severity of infarction and the incidence of haemodynamic complications and changes in blood viscosity and filtrability.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical course and risk stratification of myocardial infarct survivors with three-vessel disease

Prevalence of three-vessel disease was prospectively analyzed in a series of 462 consecutive infarct survivors aged 60 years or less. Eighty-seven percent (403) of the patients were catheterized within one month of the acute event, and were followed for a mean of 43 months (range 21 to 69). Three-vessel disease was present in 96 cases (24%) and these patients form the study population. The primary goals of this study were to determine the prevalence of three-vessel disease and to identify predictors of survival and new coronary events among this subset of infarct survivors. During follow-up, 15 patients died, 17 had a recurrent nonfatal infarction, and 54 developed angina (4-year probability of each cardiac event being 0.20, 0.22, and 0.59, respectively). Cox's stepwise multivariate analysis identified the ejection fraction (EF) as the only predictor of survival (p less than 0.001). No predictors for nonfatal ischemic events were found among the independent variables considered. Patients were stratified in risk categories according to the EF. Four-year probability of survival was 1.0 in participants with EF = greater than 50% (n = 23), 0.77 for those with EF = 21% to 49% (n = 66), and 0.22 in patients with more severe left ventricular dysfunction, EF = less than 20% (n = 7). Probability of occurrence of nonfatal reinfarction or angina was similar in the three risk categories. Thus, our results indicate that a normal ejection fraction is found in 25% of infarct survivors with three-vessel disease, and that this subset of patients has a low incidence of early and intermediate range coronary events.     

Various mechanisms of disorders of carbohydrate metabolism in myocardial infarct]

A group of 112 patients with acute myocardial infarction was studied. Methods for determining the content of immunoreactive insulin, uric acid, triglycerides, and sugar in blood on a fasting stomach and under conditions of carbohydrate load in dynamics were used. The data obtained show that patients, mainly those with uncomplicated myocardial infarction, are marked by relative insulin insufficiency as well as by a high level of triglycerides and uric acid in the acute period of the disease. The causal relationship between hyperuricemia, hypertriglyceridemia, and carbohydrate metabolism disorders is discussed.     

Incidence and characteristics of cardiac rhythm disorders after myocardial infarct]

In the course of 1 year 130 patients were examined who had survived myocardial infarction and were alive 2 months after the onset of the disease and were included into the Myocardial Infarction Registry. After 2,3,6,9 and 12 months ECG of various duration was recorded. The prolongation of ECG recording permits to give a more precise characteristics of the incidence and nature of the rhythm disorders observed in chronic ischaemic heart disease patients. Repeated heart rhythm examinations at rest during 1 hour, or during physical exercises (bicycle test) permitted to reveal rhythm disorders in 72.2--66.7% of the patients, and among them ventricular extrasystole in 62.6--66.7% of those examined, respectively. The appearance of ventricular extrasystoles correlates with the state of the patients surviving myocardial infarction A higher incidence of ventricular extrasystoles is observed in pateints with distinct tecg changes, with angina pectoris and elevated blood pressure (larger than or equal to140/90mm Hg).     

Combined disorders of the central and regional hemodynamics and microcirculation in myocardial infarct

Central and regional hemodynamics was studied in 228 patients with acute myocardial infarction by a complex of radio-indication tests. It was established that the degree of changes in central hemodynamics correlates to a definite extent with the severity of myocardial involvement (size of the damaged zone). Regional hemodynamics did not always change parallel to the reduction in cardiac output. The character of circulation in the organs of patients with myocardial infarction depends greatly on the internal control factors and the degree of tonic tension of the regional vessels. Changes in the regional circulation in myocardial infarction lead to hypoxia of the organ and severe disturbances in its function. In most patients the intraorganic hemodynamics decrease gradient was 11/2-2 times more than the cardiac output reduction gradient. Hemodynamic changes in myocardial infarction at the level of different vessels are of a multicomponent and non-linear character. The extent and rate of restoration of intra-organic hemodynamics are greatly determined by the severity of myocardial infraction and the presence of complications.