Treatment Of AMI Research Articles

Catheterization and Mortality in Elderly Patients With Acute Myocardial Infarction

<h3>To the Editor.</h3> —I read with great interest the recent article by Dr McClellan and colleagues¹regarding the treatment of AMI in the elderly. McClellan et al are to be commended for their novel approach to the analysis of outcomes after an AMI. While they concluded that there was only a modest and possibly no true incremental effect of catheterization and associated revascularization procedures on mortality after an AMI in the elderly, they failed to mention a key point regarding the issue of age itself and AMI. While it has been reported that the in-hospital mortality after AMI in the elderly can be as high as 17.8% for patients aged 75 years and older and 2% for those aged 55 years and younger,²Smith et al³have reported age itself not to be an independent risk factor for mortality after an AMI. We presented data on 208

Sleep EEG and amitryptiline treatment in depressed inpatients

We studied the baseline sleep electroencephalogram (EEG) variables and treatment-related sleep changes after 35–46 days of amitryptiline treatment (AMI) in a group of 18 depressed inpatients, mostly suffering from a major depressive disorder endogenous subtype (according to the Research Diagnostic Criteria, RDC), with a short rapid eye movement (REM) latency. The aim of the study was to identify potential sleep “predictors” of clinical response to AMI as well as short-term sleep changes associated with alleviation of depression. Clinical response to the drug was defined as a reduction of more than 50% of the Hamilton Rating Score for Depression (HRSD). Eleven men and 7 women, 25–68 years old, were included in the study. Their sleep was recorded at baseline and after an average of 39 ± 4 days of AMI treatment, at a mean daily dose of 165 ± 35 mg. The comparison of responders (n = 9) and nonresponders (n = 9) with Wilcoxon's test showed that responders (1) were more severely depressed at baseline, and (2) had less stage 4 sleep. A discriminant function using baseline HRSD, stage 4 and the number of stage shifts allowed for discrimination between responders and nonresponders with a 100% hit rate. Antidepressant treatment had, however, no differential effect on sleep parameters in the two response groups.

Anticoagulants and Thrombolytics: Risks and Benefits

Anticoagulation is being used increasingly in the critical care areas. Thrombolytic therapy is now commonly used in emergency departments and coronary care units for treatment of AMI. Heparin therapy for unstable angina and for a 48 to 72 hour period following thrombolytic therapy for AMI is becoming commonplace. Beginning warfarin therapy concomitantly with heparin to decrease the total duration of heparin and the duration of hospital stay for DVT therapy is encouraged. The use of low-dose warfarin to prevent DVT in hip surgery, improve catheter patency, and prevent catheter-related subclavian thrombosis is increasing. Along with the increased use of anticoagulation must come a greater appreciation of the complications associated with the agents used, and of how to prevent or treat the hemorrhagic or thrombotic morbidity that may arise. Acute hemorrhage with thrombolytic agents must be recognized and the immediate implementation of conservative and aggressive measures begun. Heparin-induced thrombocytopenia with thrombosis is an often-unrecognized problem that may occur in 1% to 2% of heparin recipients and result in limb amputations. A delayed onset (6-10 days) requires frequent platelet counts for early diagnosis and treatment. The resurgence of warfarin use for prevention of cardiovascular and cerebrovascular disorders demands observation for skin necrosis from protein C and S inhibition. Early recognition of symptoms and syndromes associated with organ system hemorrhage in patients receiving chronic anticoagulation is imperative. The use of antagonists, such as protamine sulfate for heparin, vitamin K1 for warfarin, and antifibrinolytic drugs for thrombolytic agents, may be necessary in treating hemorrhagic events. However, their use may worsen the thromboembolic event initially treated.

Chronic amitriptyline potentiates feeding induced by intrahypothalamic norepinephrine injections

Feeding responses to microijecctions of 37 nmol norepinephrine (NE) into the medial hypothalamus of rats were assessed before and after chronic amitryptyline treatment (AMI, 10 mg/kg twice daily for 21 days). AMI-treated rats showed a 55% increase in NE-induced feeding over their pre-treatment baseline. Control rats which received daily vehicle injections showed only a non-significant 3% increase on retests. These results are consistent with recent evidence suggesting that chronic AMI may enhance the responsivity of postsynaptic alpha adrenoceptors. The data also suggest that altered hypothalamic NE mechanisms may contribute to the enhanced appetite changes reported by patients undergoing long-term AMI treatment.