Non-coronary Patients Research Articles

Better outcome after cardiopulmonary resuscitation using percutaneous emergency circulatory support in non-coronary patients compared to myocardial infarctions

Better outcome after cardiopulmonary resuscitation using percutaneous emergency circulatory support in non-coronary patients compared to myocardial infarctions

Long-term cardiac rehabilitation and exercise training programs improve metabolic parameters in metabolic syndrome patients with and without coronary heart disease

Background and aims The effectiveness of long-term cardiac rehabilitation and exercise training programs on metabolic parameters was evaluated in metabolic syndrome subjects with and without coronary heart disease (CHD). Methods and results Fifty-nine CHD and 81 non-coronary patients with metabolic syndrome (59 ± 8 vs 56 ± 9 years) were identified retrospectively at entry into identical cardiac rehabilitation and exercise-training programs. Metabolic syndrome was defined using modified Adult Treatment Panel III criteria. Exercise training occurred approximately twice per week. Metabolic and exercise testing data were collected at baseline and after 12 months during the course of the program. Mean duration of cardiac rehabilitation and exercise training programs was over one year in both coronary and non-coronary patients (366 ± 111 vs 414 ± 102 days for CHD and non-coronary CHD cohorts respectively, p < 0.01). Significant improvements in bodyweight, body mass index, blood lipids, triglyceride/HDL ratio and exercise tolerance were noted in both cohorts. At the end of follow-up, 31% of CHD and 20% of non-CHD subjects no longer possessed diagnostic criteria for metabolic syndrome ( p < 0.0001 and p < 0.001 respectively). Conclusions A long-term cardiac rehabilitation program reduces metabolic syndrome prevalence in CHD patients and results in a similar improvement in risk factor control for metabolic syndrome patients without CHD.

Serial evaluation of the Sequential Organ Failure Assessment score in non-coronary medical patients

To determine the usefulness of daily Sequential Organ Failure Assessment (SOFA) score [1] for prediction of mortality in non-coronary medical ICU patients.

Correlation of premature coronary artery disease in parents with dyslipidemia in their children

Background and Objective : Recognition and modification of risk factors of coronary artery disease (CAD) has obtained great attention. Early recognition of the risk factors, especially in youth, may decrease incidence and complications of CAD. Dyslipidemia is a risk factor of CAD. We studied the correlation of dyslipidemia in parents and their children. Material and methods: In a cross sectional study, 312 patients , all younger than 55, were evaluated. These patients underwent coronary angiography in Imam Ali hospital during the year 1380. According to the angiographic findings, the patients were divided into coronary and non-coronary groups. Fasting blood samples were obtained from patients, their spouses, and their children to determine the serum levels of total cholesterol, HDL, LDL, and triglyceride. Statistical analysis was done using t test and χ 2 test. Results: Compared with the children of the non-coronary patients, LDL was significantly higher in the children of the coronary patients (p<0.014). No significant difference was found in other lipids among the children. Mixed results were obtained when comparing various age groups in children. There was a significant correlation between serum LDL of the spouses of the coronary patients and their children (p<0.032). Mixed results were obtained when comparing the correlation of other lipids in various age groups of spouses and children. Discussion: Compared with previous reports, we found abnormally high serum lipid levels in the children of the coronary patients. There is a significant correlation between the parents' CAD and their children's dyslipidemia, especially children of younger than 12. There is no simple, linear correlation between risk factors of CAD in parents and their children. Considering the possible influence of genetic factors, we suggest that more studies should be done on this subject.

The increased histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by specific IgE.

The release of histamine by iodinated contrast media (ICM) is higher in coronary artery disease patients than in noncoronary patients during coronary angiogram. Eighty-eight patients who underwent a coronary angiography were classified either as having coronary artery disease or as noncoronary patients. Histamine concentration was higher than the 6.8 nM upper limit in 7 cases (group 1), of whom six were coronary artery disease patients. We compared the IgE and complement fractions in plasma of these patients to two control groups with normal histamine blood level, one (group 2) with and the other (group 3) without coronary artery disease. No difference of total IgE and C(3c) and C(4) complement fractions was found among the three groups. Anti-ioxaglate IgE-RIA was positive in only one patient from group 1. The affinity of drug-IgE binding in the serum of this patient was very low (Kd: 18.7 mM). The level of anti-ICM IgE detected by ioxitalamate- and iomeprol-Sepharose RIA was significantly higher in groups 2 and 3 than in group 1. The higher histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by IgE or complement activation. Further studies are needed to investigate the implication of histamine release factors.

Validity of the Structured Interview for the Assessment of Type A Behavior Pattern

Summary: This is an analysis of a Spanish version of the Structured Interview (SI) employing a sample of 486 males, predominantly manual workers. The subjects are grouped into three subsamples: coronary heart patients, heart patients without coronary disease, and healthy people. SI questions are coded for contents on a 5-point scale. Frequency of specific Type A speech characteristics and clinical judgments are rated on the same scale. Factor Analysis resulted in four factors: Competitiveness and Pressured Drive, Clinical Ratings, Expression of Anger, and Speed-Impatience. The first factor differentiated between heart disease patients (coronary and noncoronary) and healthy people; the third factor showed the dissimilarities between coronary patients on the one hand, and noncoronary patients and healthy people on the other. Finally, the Global or Type A Scale also distinguished heart patients, both coronary and noncoronary, from healthy people.

A Simple Classification of the Risk in Cardiac Surgery

Since 1980, the operative risk in all our cardiac surgical patients has been assessed before surgery. In light of reports of changes in cardiac surgical populations, we reexamined our practice and risk classification. The purpose of this study was to compare the surgery performed, the characteristics of the patients operated upon and the hospital mortality in our institution in two epochs ten years apart. In 1989-90, the 2029 consecutive cardiac surgical patients who had the same operations as the 500 patients of a 1980 study in our institution were prospectively stratified using our risk classification based on the number of risk factors (RFs) present: normal-risk patient = no RF, increased risk = 1 RF, high risk > or = 2 RFs. These two cohorts of patients were compared. From 1980 to 1990, the proportion of high-risk patients tripled whereas the proportion of normal-risk patients diminished by one third and the proportion of increased risk remained unchanged. The incidence of the following RFs increased: poor left ventricular function, advanced age, emergency surgery, reoperation and other systemic disorders. In coronary artery surgery patients, the incidence of unstable angina/recent myocardial infarction and of obesity also increased. In noncoronary artery surgery patients, the incidence of heart failure increased while obesity remained unchanged. The difference in hospital mortality among the three risk classes was significant within both study periods. The mortality in each risk class and total mortality did not change between 1980 and 1990.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary heart disease risk factors in hansen's disease sufferers

In the frame of an epidemiologic study of Hansen's disease (HD) sufferers, several risk factors have been investigated which might explain the high prevalence of coronary heart disease (CHD) among HD patients. The data analyzed in the present study are derived from 293 HD patients (157 men and 136 women). The patients, after having completed a WHO adopted questionnaire, were given a complete physical examination, a resting and an exercise electrocardiogram, and biochemical as well as hematological examinations. Coronary HD patients, when compared to noncoronary HD patients, showed statistically significant differences in the following parameters: (1) mean age, (2) mean concentration of the electrophoretic fraction of alpha-lipoproteins, (3) deviation from mean weight, (4) prevalence of hypertension, and (5) prevalence of the borderline lepromatous form of HD. However, the differences found when comparing other parameters, such as blood pressure, smoking, diabetes mellitus, total cholesterol, triglycerides, pre-beta and beta-lipoproteins, uric acid, erythrocyte sedimentation rate, ABO blood groups, etc., did not reach the level of significance. These findings suggest that HD sufferers are a special population subgroup with reference to CHD risk factors, differing in many ways from the general population.

Resuscitation -- Time for a Re-think?

The introduction of closed-chest cardiac massage and external DC shock defibrillation in the 1960s established the science, or some would say the art, of cardiopulmonary resuscitation. It was soon appreciated that patients with acute myocardial infarction were a particularly rewarding group for resuscitation, and the early years of resuscitative coronary care have been described by Geddes [1] and by Julian [2]. In an audit of their resuscitative experience published in 1968, Julian and his colleagues from Edinburgh pointed out the poor long-term results of resuscitation in patients over the age of 60 [3]. Nearly 25 years later, O'Keefe and colleagues have produced a report which in many ways echoes these early experiences [4]. Long term results of resuscitation are still very disappointing in non-coronary care unit patients over 70, and in those where the arrest was not witnessed or the initial rhythm not ventricular fibrillation. O'Keefe's paper also emphasizes that cardiac arrest in the elderly commonly occurs in the context of multiple causes of morbidity. Can we build positively on these experiences? There have been several strands in the development of modern resuscitation practice. There has been a commendable emphasis on training as many people as possible to carry out resuscitation, and to facilitate this, strenuous effort have been made to standardize resuscitation techniques [5]. A distinction has been made between 'basic' resuscitation, emphasizing airway care, ventilation and cardiac compression, and 'advanced' resuscitation which, even in 'standardized' form remains fairly complex, with an emphasis on arrhythmia recognition, defibrillation and pharmacological intervention. At the same time, the hardware of resuscitation has improved early defibrillators so large and clumsy that they had to be mounted on wheels (and often called 'fire engines' from their red paint and general air of drama) have given way to smaller hand-portable units, and most recently to the 'advisory defibrillator' which can detect the electrocardiogram through its electrodes, analyse the rhythm using a built-in computer chip, and advise the operator whether to proceed to defibrillation [6, 7].

Study of the Electrophysiological Properties of Intravenous Bisoprolol in Patients With and Without Coronary Artery Disease by Programmed Stimulation

The objective of this study was to assess the electrophysiological properties of intravenous bisoprolol in patients with and without coronary artery disease (CAD) by programmed stimulation. Sixteen inpatients subjected to an electrophysiological investigation because of dizziness or palpitations were given 10 mg of intravenous bisoprolol after basal measurement and were checked again 15 and 45 min after infusion. Eight patients with CAD (seven males and one female; mean age of 60+/-4 years) and eight patients without CAD (five males and three females; mean age of 59+/-4 years) were investigated after washout of prior antiarrhythmic drugs. For coronary patients, the CAD was documented by a history of myocardial infarction or by a confirmatory coronary arteriography. Main outcome measures were parameters of invasive electrophysiological exploration, with measurement of conduction intervals at rest and during pacing and of refractory periods by means of extrastimulus technique. No significant difference was noted at baseline between the two groups except for CSNRT. After infusion of 10 mg of bisoprolol, with the exception of CSNRT (increased in the group without CAD), no significant differences were noted on comparison between coronary and noncoronary patients. Bisoprolol significantly increased the sinus cycle length, SACT, and FRP of the atria. Regarding atrioventricular nodal conduction, bisoprolol significantly increased the AH 100, ERP, and FRP and significantly decreased the Wenckebach point. In the right ventricle, bisoprolol moderately, but significantly, decreased the corrected QT and induced a small, temporary, significant increase in ERP. Bisoprolol appears to be a very potent beta-blocker that is well tolerated at an intravenous dose of 10 mg. Its depressant effects concern mainly the atrial function and the nodal conduction, without significant differences between the two groups of patients. The decrease in QTc may be a favorable aspect regarding its electrophysiologic tolerance especially in the acute phase of myocardial infarction.

Study of the Electrophysiological Properties of Intravenous Bisoprolol in Patients With and Without Coronary Artery Disease by Programmed Stimulation

The objective of this study was to assess the electrophysiological properties of intravenous bisoprolol in patients with and without coronary artery disease (CAD) by programmed stimulation. Sixteen inpatients subjected to an electrophysiological investigation because of dizziness or palpitations were given 10 mg of intravenous bisoprolol after basal measurement and were checked again 15 and 45 min after infusion. Eight patients with CAD (seven males and one female: mean age of 60 ± 4 years) and eight patients without CAD (five males and three females; mean age of 59 ± 4 years) were investigated after washout of prior antiarrhythmic drugs. For coronary patients, the CAD was documented by a history of myocardial infarction or by a confirmatory coronary arteriography. Main outcome measures were parameters of invasive electrophysiological exploration, with measurement of conduction intervals at rest and during pacing and of refractory periods by means of extrastimulus technique. No significant difference was noted at baseline between the two groups except for CSNRT. After infusion of 10 mg of bisoprolol, with the exception of CSNRT (increased in the group without CAD), no significant differences were noted on comparison between coronary and noncoronary patients. Bisoprolol significantly increased the sinus cycle length. SACT, and FRP of the atria. Regarding atrioventricular nodal conduction, bisoprolol significantly increased the AH 100, ERP, and FRP and significantly decreased the Wenckebach point. In the right ventricle, bisoprolol moderately, but significantly, decreased the corrected QT and induced a small, temporary, significant increase in ERP. Bisoprolol appears to be a very potent β-blocker that is well tolerated at an intravenous dose of 10 mg. Its depressant effects concern mainly the atrial function and the nodal conduction, without significant differences between the two groups of patients. The decrease in QTc may be a favorable aspect regarding its electrophysiologic tolerance especially in the acute phase of myocardial infarction.

Electrophysiologic changes after tiapamil in coronary and noncoronary patients.

26 patients who had undergone right heart catheterization were enrolled in the study. The average age was 51.7 +/- 15 years. Half the patients showed coronary artery disease at selective coronary angiography. His bundle recordings and atrial pacing were performed before and 10 min after 1 or 1.5 mg/kg i.v. tiapamil. In addition, arterial blood pressure was recorded. P-R interval increased from a mean value of 153 +/- 36 to 168 +/- 49 ms (p less than 0.05) due to an increase in the A-H time from 88 +/- 19 to 97 +/- 23 ms (p less than 0.05). Arterial blood pressure and heart rate decreased significantly. These changes were more pronounced in patients with coronary artery disease. In the groups with the higher dosage, the differences from the control values were greater than in the patient groups receiving 1.0 mg/kg. Sinus node recovery time tended to increase in all groups but the differences did not reach significance. Patients with the 'sick sinus syndrome' were not studied.

Thallium-201 Myocardial scintigraphy: quantification and its image processing.

Eighty patients with coronary artery disease and 32 non-coronary patients were studied with the following results: 1) Sensitivity of exercise electrocardiography was 66% with coronary stenosis > 50% and 70% with stenosis < 75%. Specificity of this tet was 72%. 2) Sensitivity of the thallium-201 (Tl-201) myocardial perfusion imaging was 77% with coronary stenosis < 50% and 80% with stenosis < 75%, and specificity was 80% and 96% with and without inclusion of cardiomyopathy and myocarditis, respectively. 3) Evaluation of exercise increments of Tl-201 fractional myocardial uptake and tomographic imaging using a 7-pinhole collimator further improve the sensitivity of myocardial perfusion scintigraphy.

Effect of cigarette smoking on free fatty acids in patients with healed myocardial infarction

The effect of smoking on serum free fatty acids was studied in 17 patients with healed myocardial infarction. There was an elevation of FFA in all subjects after smoking two cigarettes in a 10 minute period. A mean maximal rise of 858 μEq. L. (65.6 per cent) occurred 10 to 20 minutes after smoking, and usually some elevation persisted for 40 minutes. Noncoronary patients and normal subjects also developed FFA elevations of 320 μEq. L. (27.2 per cent) and 292 μEq. L. (24.6 per cent), respectively. It is suggested that the greater FFA response in myocardial infarction patients is the result of a greater catecholamine release after nicotine stimulation.