Episodes Of Myocardial Ischemia Research Articles

Secondary Prevention of Multifocal Atherosclerosis Combined with Chronic Obstructive Pulmonary Disease

The problem of secondary prevention of multifocal atherosclerosis (MAS) combined with chronic obstructive pulmonary disease (COPD), is a leading cause of death in the world. Therefore, the search for drugs capable of affecting the destructive mechanisms underlying both MAS and COPD is an extremely urgent problem today. Objective — to reduce the risks of destabilization of atherosclerotic plaques by reducing the levels of metallomatrix metalloproteases (MMP)-2 and MMP-9 in patients on MAS combined with COPD. Materials and methods. The study included 62 men (68.1 ± 4.2) years old with MAS. All patients with MAS had clinical and functional signs of injury in coronary, cerebral and femoral vascular territories, 30 of these patients (group MAS-2) additionally had clinical and functional signs of COPD (GOLD-2). The control group (CG) consisted of 18 practically healthy men, aged (65.4 ± 3.7) years. Examination of the patients included echocardiography, dopplerography of the vessels of the neck and arteries of the lower extremities, determination of walking distance and ankle-brachial index, Holter ECG monitoring, spirography and determination of MMP-2 and MMP-9 levels in blood. Patients of both groups were prescribed cilostazol (50 mg twice a day) and GABA aminalon (250 mg twice a day) on the background of basic treatment. The course of treatment lasted 16 weeks. Results and discussion. During the initial examination of patients, MAS-2 group showed significantly (p < 0.001) lower volumetric blood flow in the studied arteries, and significantly (p < 0.01) higher levels of MMP-2 and MMP-9, as compared to CG, as well as with patients of the MAS-1 group. After 16 weeks of treatment, with the addition of cilostazol and aminalon, the level of MMP in the blood significantly (p < 0.05) decreased in both groups, in particular, in the MAS-2 group, in patients with the combined pathology of MAS and COPD, a significant decrease was found MMP-2 by 23.6 % (p < 0.01), and MMP-9 by 12.1 % (p < 0.05). Volumetric blood flow indicators increased significantly (p < 0.05) in all studied vascular territories, which led to improvement in clinical manifestations of the disease — a decrease in the number of painful and painless episodes of myocardial ischemia, and an increase in walking distance. Conclusions. The use of a complex therapy of statins, cilostazol and GABA in patients with MAS combined with COPD allows to reduce significantly the levels of MMP-2 and MMP-9, which ensures the stability of atheromatous plaques and significantly improves blood supply in vascular territories with atherosclerotic lesions.

AN ISOLATED ACUTE RIGHT VENTRICULAR INFARCTION

Abstract Isolated right ventricular infarction occurs only in about 3% of the overall myocardial ischemic episodes. Clinical presentation is often insidious and variable case by case. The correct diagnosis is therefore crucial for a proper management, and a good prognosis in the short and long term. A 72–year–old patient suffering from arterial hypertension went to the emergency room of our hospital for malaise and asthenia for about 12 hours that have increased in 3–4 hours before the arrival. He was sweating, tachypneic with normal value of the oxygen saturation to the finger (SpO2:96%), with arterial hypotension (pressure values = 85/50 mmHg), turgor of the jugular veins in the absence of peripheral edema. Cardiac examination revealed no pathological noises and lung examination revealed clear lung fields. Electrocardiogram showed sinus tachycardia at a rate of 118 bpm, second degree atrioventricular (AV) block 2:1 type and an AV conduction delay with a first–degree AV block (P–Q interval: 320–330 msec). A pulmonary P wave was present and the QRS complex showed predominant R waves in V2–V3 with slight repolarization abnormalities (figure, panel A). An ST–elevation in right precordial leads, V3R and V4R was evident. (figure, panel B). Echocardiographic evaluation showed a hypertrophic left ventricle with normal volume and function, with marked enlarged right sections (figure, panels C–H). Moreover, we can observe the flattening of the interventricular septum with a D shaped left ventricle. Septal flattening occurred only in diastole, expression of RV volume overload (figure, panels F–H). After taking 180 mg of ticagrelor administrated orally and 150 mg of aspirin intravenously, the patient was immediately transferred to the catheterization laboratory for emergency coronary angiography. Coronary angiography highlighting an ostial thrombotic obstruction of a co–dominant right coronary artery (RCA) in the absence of significant stenosis of the left coronary circulation (figure, panels I–M). Primary percutaneous coronary intervention of RCA was performed with STENT implantation with a good postoperative result. (figure, panels L). During the hospital stay, the patient showed a good clinical status without any CV events, with progressively normalization of electrocardiographic abnormalities and persistent sinus rhythm. He was discharged after ten days.

SILENT MYOCARDIAL ISCHEMIA IN PATIENTS WITH ACUTE CORONARY SYNDROME AND DIABETES MELLITUS

ST-segment elevation myocardial infarction, stenting of the infarct-related coronary artery, silent (painless) myocardial ischemia, diabetes mellitus, 24-hour electrocardiographic monitoring.
 Introduction. Currently, approximately 422 million people in the world have diabetes mellitus, and over 1.3 million individuals in Ukraine are diagnosed with diabetes mellitus. Diabetic neuropathy is known to contribute to the development of atypical and painless variants of ischemic heart disease in individuals with diabetes. This poses a challenge for timely diagnosis and obscures the course of ischemic heart disease, as the prevalence of silent myocardial ischemia is significantly high in these patients. Therefore, the aim of this study is to investigate the occurrence of myocardial ischemia episodes in patients with ST-elevation myocardial infarction within the first day following stenting of the infarct-related coronary artery. Furthermore, we aimed to demonstrate the painless nature of these episodes in the presence of type 2 diabetes mellitus through a clinical case presentation.
 Materials and methods. 30 patients with ST-segment elevation myocardial infarction were examined, and 24-hour electrocardiographic monitoring was performed during the first day after the infarct-related coronary artery stenting. Results. Episodes of transient myocardial ischemia were registered in 50% of people. We found that the majority of episodes (80%) were painless. In the presence of diabetes mellitus, only episodes of painless myocardial ischemia were noted that is supported by the example of a clinical case. The study highlighted the informativeness of 24-hour electrocardiographic monitoring in identifying episodes of myocardial ischemia, particularly in its painless variant. The results demonstrate that patients with ST-elevation myocardial infarction (STEMI) experience episodes of transient myocardial ischemia within the first day after coronary artery stenting, with a majority of these episodes being painless. Furthermore, in the presence of diabetes mellitus, ischemic episodes tend to be painless. Therefore, 24-hour electrocardiographic monitoring serves as a valuable method for the detection of myocardial ischemia.

ГЕМОРЕОЛОГИЯ И ГЕЛИОГЕОФИЗИЧЕСКАЯ ВОЗМУЩЕННОСТЬ: СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА (ОБЗОР)

There are quite a lot of scientific works that reveal some aspects of the heliogeophysical factors’s influence on the state of the rheological properties of human blood. Nevertheless, the study of the mechanisms of such influence remains open, which is associated with the difficulty of reproducing laboratory experiments, the heterogeneity and short duration of the analyzed time series of medical and biological data, as well as the interdisciplinarity of this area. The aim of this review is to analyze current research results and new original approaches to studying this issue. The results of studies published in the PubMed, Cyberleninka and eLibrary databases for the period from 1990-2021 were devoted to the study of the influence of heliogeophysical disturbances on the state of human hemorheology, and also this data was analyzed. The analysis of the literature showed a connection between heliogeophysical disturbance and the development of hemocoagulation disorders of humans, a tendency to an increase in the degree of platelet aggregation and an acceleration of the onset of thrombosis, a deterioration in the state of the microvasculature, which is most pronounced among people with diseases of the cardiovascular system. In patients with coronary artery disease, the same type of reactions was revealed, expressed by an increase in coagulation, there were heart rhythm disorders and the appearance of episodes of myocardial ischemia.

Positive Stress Electrocardiography in Patients With Non-obstructive Coronary Disease.

Introduction The episodes of myocardial ischemia in patients with non-obstructive coronary disease are extremely variable in provoking factors and presentation. Purpose We investigated the significance of coronary blood flow velocity and epicardial diameter as correlates of a positive electrocardiographic exercise stress test (ExECG) in hospitalized patients with unstable angina and non-obstructive coronary artery disease. Methods The study was a single-center cohort retrospective. ExECG was performed and analyzed in a group of 79 patients with non-obstructive coronary disease (coronary stenoses < 50%). Thirty-one percent of the patients (n=25) were diagnosed with slow coronary flow phenomenon, SCFP; 40.5% (n=32) - patients with hypertensive disease, left ventricular hypertrophy (LVH), and slow epicardialflow; 27.8% (n=22) with hypertension, left ventricular hypertrophy and normal coronaryflow. The patients were hospitalized in University Hospital "Alexandrovska," Sofia in the period 2006-2008. Results The frequency of positive ExECG is increased as a trend was associated with smaller epicardial diameters and pronounced delay in epicardial coronaryflow.In the subgroup with SCFP, the risk for a positive ExECG test was determined by slower coronary flow (36.5±7.7 frames vs. 30.3±4.4 frames, p=0.044) and borderline significant by epicardial lumen diameters (3.3±0.8 mm vs. 4.1±1.0 mm, p=0.051) and greater myocardial mass (92.8±12.6 g/m2 vs. 82.9±8.6 g/m2, p=0.054). In cases of left ventricular hypertrophy, which included both patients with the normal and slow epicardialflow, there were no statistically significant correlates of an abnormal exercise stress ECG test. Conclusions In patients with non-obstructive coronary atherosclerosis and predominantly slow epicardial coronary flow, the provoking of ischemia at an electrocardiographic exercise stress test is associated with the lower epicardial flow velocity at rest and with the smaller epicardial diameter. In SCFP, the risk for an abnormal stress test is determined by slower coronary flow, smaller epicardial lumen diameter, and greater myocardial mass.The presence and size of the plaque burden are not associated with a greater risk of a positive ExECG in these patients.

CHARACTERISTICS OF HEART RHYTHM DISORDERS ACCORDING TO THE DATA OF HOLTER ECG MONITORING IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION

Chronic heart failure (CHF) is one of the most significant medical, economic and social problems of the 21st century and remains the main cause of morbidity and mortality worldwide.The purpose. To study the indicators of Holter ECG monitoring, the dynamics of ischemic changes, heart rate, indicators of heart rhythm variability and blood pressure in patients with heart failure and atrial fibrillation.Material and methods. 150 patients aged 45-65 were examined. All patients were divided into groups: Group I – patients with HF with sinus rhythm or atrial fibrillation (AF) (permanent or persistent form), (n=75). Group II – patients without HF with AF, (n=75). Group III – control group: 36 practically healthy people. All patients underwent a clinical examination, ECG, echocardiography (ECHOKG), Holter ECG monitoring (HM ECG) and daily BP monitoring (DMAT).Research results. The analysis of the ECG of the examined patients indicates the presence of heart rhythm disorders, which is an important risk factor and progression of CHF. The results of XM ECG indicate the presence of ventricular arrhythmias of various gradations along with AF. There was a probable difference in the direction of an increase in the number of ventricular extrasystoles (VAS), both single and, most importantly, extrasystoles of high gradations, in patients with CHF and AF compared with healthy subjects. In addition, the number of SHEs in patients with CHF and AF was likely lower than in patients with CHF with sinus rhythm. Indicators of maximum heart rate, ST segment depression and QT interval dispersion in patients with CHF and AF were significantly higher (p&lt;0.05) than similar parameters in patients without CHF with AF.Conclusions: Ventricular heart rhythm disturbances were detected in the examined patients, which is a predictor of an unfavorable prognosis in patients with chronic heart failure. There was a probable difference in the direction of increased levels of maximum heart rate, maximum depression, ST segment elevation, dispersion of the QT interval, QTc, an increase in the total duration of episodes of myocardial ischemia, in patients with chronic heart failure and atrial fibrillation in comparison with healthy subjects.

Review of current ECG consumer electronics (pros and cons)

BackgroundSeveral wearable, medical-grade consumer ECG devices are now available and integrated into consumer electronics like multi sensor fitness watches and scales. Specific consumer ECGs can also come in the form of patches or thin sensor plates in credit card or other shapes. Watches with ECG capabilities are often multi vital sign sensor devices. The majority of these devices are usually connected to a mobile smartphone. However, there are pros and cons to their use. MethodsWe review here an exemplary selection of modern consumer ECG devices based on device type, recording method and the number of standard ECG channels derived. ResultsSingle-channel consumer ECG devices such as Smart Watches can be useful for detecting and monitoring atrial fibrillation and flutter and other arrhythmias, as well as ectopic complexes. However, they are currently limited with respect to recording duration and information content (a single-channel or limb‑lead ECG having less diagnostic information than a 12‑lead ECG). While some non watch-based consumer ECG devices can now record all 6 limb leads to yield increased information, no consumer ECG devices can currently reliably detect ST-segment deviations, potentially indicating myocardial infarction or ischemic episodes. Moreover, barriers to use still exist for at-risk elderly people. Finally, there currently is no universal data exchange format. ConclusionConsumer ECG devices, whether in fitness or fashionable design, allow for reliable detection of atrial fibrillation. Timely detection of atrial fibrillation and subsequent treatment might protect against stroke, especially in high-risk groups, yet prospective evidence is still lacking. Six-channel consumer ECG and longer data collection capabilities extend potential functionality, including for the monitoring of ST-segments and QT intervals. However, no currently available devices are sufficiently suitable for the detection of myocardial infarction or ischemia, which is why portable 12-channel technologies are desirable. For the reliable detection of a myocardial infarction, the determination of specific myocardial infarction blood markers and evaluation of patient medical history still is indispensable in addition to the 12 lead ECG.

Examining the Role of the Linker in Bitopic N6-Substituted Adenosine Derivatives Acting as Biased Adenosine A1 Receptor Agonists.

The adenosine A1 receptor is a therapeutic target based on its ability to provide cardioprotection during episodes of myocardial ischemia and reperfusion injury. However, the clinical translation of A1R agonists has been hindered by dose-limiting adverse effects (bradycardia and hypotension). Previously, we demonstrated that the bitopic agonist VCP746 (1), consisting of an adenosine pharmacophore linked to an allosteric moiety, can stimulate cardioprotective A1R signaling effects in the absence of unwanted bradycardia. This study maps the structure-activity relationships of 1 through modifications to the linker moiety. Derivatives differing in the flexibility, length, and nature of the linker were assessed, which revealed that the linker is tolerant of several modifications including added rigidity. Ligands featuring 1,4-disubstituted 1,2,3-triazoles were the most biased of the novel analogues but also displayed sub-nanomolar potency in a cAMP accumulation assay at the A2BR. To our knowledge, 10 is the most potent A2BR agonist published to date.

Capabilities of long-term ECG monitoring in patients with myocardial infarction: the longer, the better?

Background. In modern cardiology, 24-hour electrocardiogram (ECG) monitoring has a high diagnostic value, but this method has a number of disadvantages in detecting episodes of unstable life-threatening arrhythmias. An increase in ECG monitoring duration allows expanding the possibilities of diagnosing life-threatening arrhythmias.Objective. To study the possibilities of long-term ECG monitoring (48–120 hours) in the detection of life-threatening arrhythmic events and parameters of myocardial electrical instability in patients with ST-segment elevation myocardial infarction (STEMI).Design and methods. The study included 71 STEMI patients. All patients from the 4th day of STEMI underwent multi-day ECG monitoring in 3 leads using a telemetric ECG recording complex with an average recording duration of 90.4 ± 30.2 hours. The analysis of episodes of myocardial ischemia, rhythm and conduction disturbances, turbulence and heart rate variability, late ventricular potentials and dispersion of the QT interval within 5 days was carried out.Results. Long-term monitoring allowed detecting high-grade ventricular extrasystoles. Analysis of episodes of myocardial ischemia in the postinfarction period revealed significant differences in the data of 120h-ECG monitoring in comparison with 24h-ECG. Multiday ECG monitoring made it possible to detect dysfunction of the autonomic regulation of cardiac activity in patients 2 times more often.Conclusion. A comprehensive assessment of the possibilities of multi-day ECG monitoring is a promising direction in predicting severe arrhythmias in patients in the postinfarction period.

236 Variation in cardiac troponin I serum levels after ECG exercise stress test in patients with microvascular angina

Abstract Aims Cardiac troponin I (cTnI) is considered a marker of myocardial necrosis. However, several studies have shown that cTnI increases also after short episodes of myocardial ischaemia. Nevertheless, it is unknown whether the changes in cTnI show differences according to the cause of myocardial ischaemia. Thus, our study aimed to evaluate cTnI response to ischaemia in patients with stable coronary artery disease (CAD), patients with microvascular angina (MVA), and transient ischaemia induced during percutaneous coronary intervention (PCI). Methods and results We studied four groups of patients: (1) patients with stable angina and obstructive CAD (coronary stenosis ≥50% and/or fractional flow reserve &amp;lt;0.80) (Group 1, n = 8); (2) patients with stable angina but no obstructive CAD and a final diagnosis of MVA according to positive intracoronary acetylcholine provocation test and/or coronary flow velocity reserve assessment with transthoracic Doppler echocardiography (Group 2, n = 20); (3) patients with stable angina and obstructive CAD undergoing PCI (Group 3, n = 10); (4) a control group of healthy subjects, with no history of cardiovascular disease (CVD) (Group 4, n = 20). Patients in groups 1, 2, and 4 underwent ECG exercise stress test (EST) according to a standard treadmill Bruce protocol. Peripheral venous blood samples were collected immediately before, at the end and 1, 3, and 24 h after test ending. Patients in group 3 underwent PCI with at least one drug-eluting stent implantation. Peripheral venous blood samples were collected immediately before, at the end and 1, 3, and 24 h after PCI ending. High-sensitivity cTnI (hs-cTnI) levels were measured by chemiluminescent microparticle immunoassay (CMIA). The main results of hs-cTnI in the four groups of patients are summarized in the table. Basal hs-cTnI serum levels were significantly higher in group 3, while there were no significant differences among groups 1, 2, and 4. Hs-cTnI serum levels significantly increased in all groups in response to the procedure (EST or PCI). A greater increase of hs-cTnI was found in group 3 (peak level at 24 h) compared to the other groups (peak level at 3 h). Furthermore, among patients undergoing EST, a significantly higher hs-cTnI increase was found in healthy subjects, compared to patients with CAD and MVA. Heart rate (HR) during stress test (both as an absolute value and predicted maximal HR for age) was the only variable statistically predictive of hs-cTnI increase during EST (HRmax: r 0.289, P 0.04; %HRmax: r 0.307; P 0.03). On the other hand, no clinical and laboratory variable was associated to hs-cTnI response after PCI. Conclusions Hs-cTnI serum levels increase after EST, both in patients with obstructive CAD and coronary microvascular dysfunction (CMD), but a similar increase is also observed in healthy subjects. More consistent hs-cTnI level increase with later peak-level is observed in patients with obstructive CAD after transient ischaemia induced during PCI.

Results of holter monitoring in patients with coronary heart disease depending on the severity of atherosclerotic lesions of the coronary arteries

The aim – to conduct a comparative analysis of the presence, frequency and duration of episodes of myocardial ischemia and arrhythmias based on the results of Holter monitoring in patients with coronary heart disease depending on the condition of the coronary arteries.&#x0D; Materials and methods. We examined 53 patients (group I) with stable coronary heart disease (CHD) and slightly altered coronary arteries (INOCA), who were hospitalized in the period from October 2018 to February 2021 at the “City Clinical Hospital № 8” of Kharkiv City Council. Group II included 52 patients with a diagnosis of stable coronary heart disease, and according to coronary angiography (CAG) had stenosis of coronary arteries (CA) more than 50 %.&#x0D; Results. According to the results of comparative analysis, it was found that in group I there were signs of myocardial ischemia – depression of the ST segment in 62.3 % (n=33) and elevation of the ST segment in 11.3 % (n=6), compared with group II -73 % (n=38) and 5.66 % (n=3), respectively. Ventricular arrhythmias (VA) have been reported in 52 patients of group I, and in 44 patients of group II. VA 4 and 5 type according to Laun, was significantly higher in group II compared with group I (p=0.0324). The occurrence of ventricular tachycardia was recorded in 5.7 % (n=3) of patients in group I and 9.3 % (n=5) patients of group II (p=0.347). In group II, there was a tendency to more episodes of ischemia compared with group I (p=0.072). The duration of ischemia was significantly longer in group I, compared with group II (p=0.042).&#x0D; Conclusions. The results of the study did not show significant differences in the development of the number of episodes of myocardial ischemia according to Holter monitoring depending on the condition of the coronary arteries. The duration of episodes of ischemia in patients with INOCA is significantly longer than in patients with obstructive atherosclerosis. In patients with coronary heart disease with obstructive coronary arteries, ventricular arrhythmia was statistically significantly more severe according to Lown

A telediagnosis assistance system for multiple-lead electrocardiography.

The diffusion of telemedicine opens-up a new perspective for the development of technologies furthered by Biomedical Engineering. In particular, herein we deal with those related to telediagnosis through multiple-lead electrocardiographic signals. This study focuses on the proof-of-concept of an internet-based telemedicine system as a use case that attests to the feasibility for the development, within the university environment, of techniques for remote processing of biomedical signals for adjustable detection of myocardial ischemia episodes. At each signal lead, QRS complexes are detected and delimited with the J-point marking. The same procedure to detect the complex is used to identify the respective T wave, then the area over the ST segment is applied to detect ischemia-related elevations. The entire system is designed on web-based telemedicine services using multiuser, remote access technologies, and database. The measurements for sensitivity and precision had their respective averages calculated at 11.79 and 24.21% for the leads of lower noise. The evaluations regarding the aspects of user friendliness and the usefulness of the application, resulted in 88.57 and 89.28% of broad or total acceptance, respectively. They are robust enough to enable scalability and can be offered by cloud computing, besides enabling the development of new biomedical signal processing techniques within the concept of distance services, using a modular architecture with collaborative bias.

Cardiac Cephalgia: Angina in the Head

Cardiac cephalgia is a migraine like headache that occurs during episodes of myocardial ischaemia. Although most of the patients presenting with ischaemic heart disease have chest pain, there are other rare presenting symptoms like cardiac cephalgia. Headache can be the only presentation of coronary artery disease. We report a case of a 57 years-old man, Presenting with only headache during brisk walking, Exercise Tolerance Test (ETT) was positive for Electrocardiograph (ECG) evidence of provocable myocardial ischemia, who latter was diagnosed as double vessel coronary artery diseaseon Coronary Angiogram (CAG). As the patient preferred remaining without revascularization, he was put onto optimum medical management for ischaemic heart disease. A follow up visit after one month revealed, marked improvement of the headache with anti anginal medications. Early evaluation and diagnosis of the headache symptom should be done because treatment with anti-migraine drugs may deteriorate headache and undermine the diagnosis of coronary artery disease.&#x0D; Bangladesh Med J. 2019 Sep; 48 (3): 46-49

Endothelial β1 Integrin-Mediated Adaptation to Myocardial Ischemia.

Background Short episodes of myocardial ischemia can protect from myocardial infarction. However, the role of endothelial β1 integrin in these cardioprotective ischemic events is largely unknown. Objective In this study we investigated whether endothelial β1 integrin is required for cardiac adaptation to ischemia and protection from myocardial infarction. Methods Here we introduced transient and permanent left anterior descending artery (LAD) occlusions in mice. We inhibited β1 integrin by intravenous injection of function-blocking antibodies and tamoxifen-induced endothelial cell (EC)-specific deletion of Itgb1 . Furthermore, human ITGB1 was silenced in primary human coronary artery ECs using small interfering RNA. We analyzed the numbers of proliferating ECs and arterioles by immunohistochemistry, determined infarct size by magnetic resonance imaging (MRI) and triphenyl tetrazolium chloride staining, and analyzed cardiac function by MRI and echocardiography. Results Transient LAD occlusions were found to increase EC proliferation and arteriole formation in the entire myocardium. These effects required β1 integrin on ECs, except for arteriole formation in the ischemic part of the myocardium. Furthermore, this integrin subunit was also relevant for basal and mechanically induced proliferation of human coronary artery ECs. Notably, β1 integrin was needed for cardioprotection induced by transient LAD occlusions, and the absence of endothelial β1 integrin resulted in impaired growth of blood vessels into the infarcted myocardium and reduced cardiac function after permanent LAD occlusion. Conclusion We showed that endothelial β1 integrin is required for adaptation of the heart to cardiac ischemia and protection from myocardial infarction.

A retrospective study on prescription pattern of drugs used in myocardial infarction in a South Indian Tertiary Care Hospital

Introduction: Angina pectoris, the primary symptom of ischemic heart disease, is caused by transient episodes of myocardial ischemia that are due to imbalance in the myocardial oxygen supply-demand relationship. Various drugs are prescribed which keeps changing during every decade. This study tries to know the current trends in prescription in myocardial infarction. Material and Methods: About108 patients’ data were collected during the period year 2004-2008 admitted with acute myocardial infarction and data were entered in preformed proforma and were analysed by calculating percentage. Statistical Analysis:Data were interpreted in terms of percentage. Results: The percentage of prescription pattern of various classes of drugs was 91, 66.7, 63.9, 35.2, 31.5, 25, 15.7, 13.9, 12.9, 9.3 and 7.4 for Antiplatelet Agents, Antianginal drugs, Hypolipidemics, Beta receptor antagoist, Angiotensin Converting Enzyme Inhibitors (ACEI), Diuretics, Anticoagulants, Calcium Channel Blockers (CCBs), Angiotensin Receptor Blockers (ARBs), Fibrinolytics and Inotropic drugs respectively. Most of the patients received Aspirin as well as Clopidogrel. Conclusion: Antiplatelet drugs was the most commonly prescribed and alpha blockers were prescribed least as evident from our study. Keywords:Myocardial Infarction, Prescription Pattern, Retrospective Study, Tertiary Care Hospital.

Ivabradine for Treatment of Heart Failure with Preserved Ejection Fraction

Aim To evaluate the effect of combination ivabradine-containing therapy for chronic heart failure (CHF) with preserved ejection fraction on quality of life (QoL) and the primary composite endpoint during a one-year follow-up.Material and methods This study included 160 patients aged 45 to 65 years with NYHA functional class (FC) II-III CHF with preserved left ventricular ejection fraction (CHF-PEF) and grade I and II diastolic dysfunction associated with FC III stable angina with sinus rhythm and a heart rate (HR) higher than 70 bpm. Presence of CHF-PEF was confirmed by results of echocardiography and myocardial tissue Doppler imaging. During one year of prospective observation, effects of bisoprolol and ivabradine as a part of the combination therapy on the primary composite endpoint, including death from cardiovascular complications (CVC) and hospitalizations for myocardial infarction (MI) or CHF, were evaluated in patients with CHF-PEF. Patients were randomized to three groups: A, bisoprolol with dose titration from 2.5 to 10 mg; В, combination of bisoprolol 2.5-10 mg and ivabradine 10-15 mg/day; and С, ivabradine 10-15 mg/day. All patients were on a chronic background therapy, including angiotensin-converting enzyme inhibitors (lisinopril) or, if not tolerated, angiotensin II receptor blockers (valsartan), antiaggregants, statins (atorvastatin, rosuvastatin), and short-acting nitrates as required. If edema developed diuretics were added. The follow-up duration was one year.Results After 12 weeks of follow-up, the achievement of goal HR in group A was associated with a tendency to increased distance in the 6-min walk test from 279±19 to 341±21 m (р&gt;0,05); in group B the distance increased from 243±25 to 319±29 m (р&lt;0.05); and in group C the distance increased from 268±21 to 323±22 m (р&lt;0.05). In the combination ivabradine and bisoprolol treatment group, results of the 24-h electrocardiogram monitoring showed a more pronounced anti-ischemic effect associated with a decrease in the number of myocardial ischemic episodes (p&lt;0.05). QoL was evaluated with the Minnesota questionnaire against the background of treatment. At 12 weeks of observation, the total score decreased from 44.5±2.6 to 38.4±2.1 in group A; from 45±2.9 to 38±2.2 in group B; and from 50.9±3.2 to 42.7±2.8 in group C (р&lt;0.05). The risk of acute MI and repeated hospitalization for CHF during the year of observation, as evaluated according to the Kaplan-Meier method, decreased in both bisoprolol and ivabradine combination treatment groups.Conclusion The inclusion of bisoprolol and ivabradine into the background therapy of CHF-PEF patients with stable IHD provided an improvement of QoL and a decrease in the risk of hospitalization for acute MI and CHF during the year of observation.

Old unsolved problems: when and how to treat silent ischaemia.

Silent myocardial ischaemia (SMI) is defined as objective evidence of ischaemia without angina (or equivalent symptoms) in the presence of coronary artery disease, differing from silent coronary artery disease. Silent myocardial ischaemia represents the majority of episodes of myocardial ischaemia at Holter monitoring. During transient myocardial ischaemia, the symptoms appear after the contraction anomalies of the left ventricle and after the ECG changes. The cause of silent myocardial ischaemia is still not well established. The severity and duration of ischaemia have been theorized as important elements in the SMI mechanism. Another possible mechanism responsible for SMI is represented by changes in the perception of painful stimuli with an increased pain threshold. Finally, a neuronal dysfunction of the diabetic, in post-infarction or a cardiac neuronal ‘stunning’ could play a role in SMI. In the pre-stent era, the SMI was associated with a worse prognosis. In patients with diabetes mellitus, SMI seems to be more represented because autonomic dysfunction is present in this category of patients. In conclusion, SMI is more frequent than symptomatic ischaemia. However, despite the presence of countless studies on the subject, it is not clear today whether medical therapy has equalized the risk and what the real prognosis of SMI is.

Ambulatory electrocardiographic monitoring as a diagnostic tool for ischemic heart disease in women

Introduction. Ischemic heart disease(IHD) is currently the leading cause of mortality in women. In this study we aimed to evaluate ambulatory electrocardiographic monitoring(AECGm) as a diagnostic test for IHD in women. Material and method. The study included 225 female who underwent AECGm divided into 2 groups: 136 previously diagnosed with IHD(IHD+) and 89 controls(IHD-). The IHD+ group was subdivided into AECGm ischemia subgroup(I+) and AECGm non-ischemia subgroup(I-). AECGm was assessed for presence of myocardial ischemia (ST segment depression &gt;5mm), duration and ischemic load (the percentage that episodes of myocardial ischemia accounted throughout the recording). Results and discussions. Patients mean age was 62.31±12.51years. The IHD+ and IHD- groups were similar regarding associated risk factors (hypertension, obesity, dyslipidemia, diabetes mellitus), echocardiographic parameters (left ventricular size, ejection fraction, kinetic disorders), minimum and maximum heart rates(MaxHR) on AECGm. Statistically significant differences were identified regarding presence of atrial fibrillation episodes(AFibE) (IHD+:21.3% vs IHD-:8.9%), myocardial ischemia (IHD+:55.14% vs IHD-:42.69%), ischemic load (IHD+:15.23±30.54% vs IHD-:4.7±15.65%), duration of ischemia (IHD+:174.16±380.75 minutes vs IHD-:59.44 ± 209.02 minutes). In multivariate analysis, ischemia episodes, ischemic load and duration of ischemia were predicted by obesity, MaxHR and AFibE. Statistically significant differences were also identified regarding presence of AFibE (I+:30% vs I-:8.9%), MaxHR (I+:120 vs I-:111beats/minute), obesity (I+:20% vs I-:41%), diabetes mellitus (I+:16% vs I-:69%), hypertension (I+:76% vs I-:90%). Conclusions. Although myocardial ischemia was also present in IHD- group, our study demonstrated that the diagnosis of IHD can be established by AECGm using the threshold values of ischemic load (&gt; 27%) and ischemic duration (&gt; 315minutes).

РІВЕНЬ СЕРОТОНІНУ У ХВОРИХ НА ГЕНЕРАЛІЗОВАНИЙ АТЕРОСКЛЕРОЗ ТА ЙОГО ДИНАМІКА ПІД ВПЛИВОМ ЦИЛОСТАЗОЛУ

Метою даної роботи є вивчення впливу цилостазолу на регіональну гемодинамі- ку, рівень серотоніну та функціональну активність мозку, серця, нижніх кінцівок у хворих на генералізований атеросклероз. У 12-тижневе відкрите рандомізоване плацебо-контрольоване дослідження було включено 52 осіб чоловічої статі з генералізованим атеросклерозом та 26 осіб чоловічої статі з хронічним коронарним синдромом (група порівняння). Пацієнти основної групи, які мали генералізований атеросклероз були рандомізовані на дві підгрупи: 26 чоловіків додатково до базисної терапії отримували цилостазол в дозі 100 мг двічі на добу та 26 паці- єнтів, які додатково отримували плацебо. Пацієнти з генералізованим атеросклерозом мали ураження чотирьох судинних басейнів: церебрального, коронарного, мезентеріального та ниж- ніх кінцівок. Виявлено, що у хворих на генералізований атеросклероз рівень серотоніну в плазмі крові перевищував показник групи порівняння в 7,8 рази, а ряд інших показників, таких як: показники об’ємного кровотоку (р&lt;0,001), когнітивної функції, дистанції безбольової ходьби, були нижче групи порівняння. Під впливом лікування, з додаванням цилостазолу протягом 12 тижнів до базисної терапії, стан показників покращився: рівень серотоніну в плазмі зменшив- ся в 2,9 рази (р&lt;0,001), достовірно (р&lt;0,001) збільшився об’ємний кровотік в усіх досліджуваних судинних басейнах, що сприяло зменшенню кількості як больових, так і безбольових епізодів ішемії міокарда (за даними добового електрокардіографічного моніторування), збільшенню безбольової та максимальної дистанції ходьби та поліпшенню когнітивної функції головного мозку. У групі пацієнтів з генералізованим атеросклерозом, які приймали плацебо, під впли- вом лікування зміни були не достовірні. Отримані нами дані вказують на позитивний вплив цилостазолу як доповнення до базисної терапії у хворих на генералізований атеросклероз та важливість проведення подальших досліджень у даному напрямку.

THE EFFECTIVENESS OF CILOSTAZOL IN PATIENTS WITH GENERALIZED ATHEROSCLEROSIS

The aim of the study is to investigate the effectiveness of cilostazol in patients with generalized atherosclerosis (GAS).A comprehensive examination of 65 male patients with proved GAS was performed (lesions of the lower extremities, carotid, mesenteric, coronary, cerebral arteries) and 28 healthy males (comparison group - CG) aged over 60 years. Patients with GAS consisted of 2 groups: GAS1 - patients in addition to basic therapy received cilostazol (C; 100 mg 2 times per day); GAS2 - placebo. Patients with GAS showed a significant deterioration in blood flow (decrease in its volumetric blood flow - FV, increase in peak systolic velocity - PSV) in all studied arteries, episodes of myocardial ischemia according to daily ECG monitoring, decreased cognitive function (CF). In patients with GAS1 on the background of taking C observed improvement (p&lt;0,001) blood flow in the studied arteries (increase in FV and decrease in PSV), decrease in the number and duration of episodes of myocardial ischemia (p&lt;0,01 and p&lt;0,05, respectively), increase distances of painless and maximum walking distance (p&lt;0,01), improvement of CF. The data obtained indicate the effectiveness of C as part of complex therapy in patients with GAS and expediency of further research in this direction to clarify the criteria for its appointment to such patients.