Myocardial Infarction and Complete Heart Block

The clinical and electrocardiographic records of 20 patients with complete A-V block due to acute myocardial infarction have been analyzed. This study indicated that patients with an inferior wall myocardial infarction had, most commonly, a block above the bifurcation. The block was transitory, the patients had no Stokes-Adams attacks and the outcome was good. None of our patients required artificial pacing. On the other hand, patients with an anteroseptal myocardial infarction suffered from a bilateral bundle branch block (below the bifurcation). They had severe Stokes-Adams attacks and they all required artificial pacing. The destruction of the conducting system was extensive and the outcome was poor. Five out of seven patients treated with artificial pacing recovered the A-V conduction through the left bundle within a few days. However, in spite of this they all died.From this small series clearly defined clinical and electrocardiographic features can be identified in two different groups of cases.     

Bundle-branch Block in Acute Myocardial Infarction

Bundle-branch block was present in 41 out of 415 patients admitted to a coronary care unit with acute myocardial infarction and was associated with more severe clinical infarction and an overall mortality of 56%. It is probable that permanent bundle-branch block develops soon after infarction and that most of the patients with permanent block have had clinically severe infarction. Bundle-branch block developing during observation is usually transient, and the later it develops the sooner it resolves.Analysis of the arrhythmias and clinical course of the patients suggests that those with bundle-branch block and shock and those in whom bundle-branch block is present on admission may benefit from the use of a demand pacemaker attached to a transvenous pacemaker catheter, though the dividends of pacing may be small and the risks of the procedure significant. Post-mortem examination of 17 hearts showed extensive infarction, usually involving the septum, and severe coronary artery disease.     

Suppression of Ventricular Tachyarrhythmias by Transvenous Intracardiac Pacing after Acute Myocardial Infarction

Transvenous intracardiac pacing was carried out on nine patients with recurrent ventricular tachyarrhythmia after drug treatment had failed. In eight patients recurrent Ventricular ectopic activity was suppressed by pacing at a rate above the sinus rate. With this technique the need for D.C. shock and repeated antiarrhythmic drugs can be avoided.     

Leukocyte Activity in Patients with ST-Segment Elevation Acute Myocardial Infarction Treated with Anakinra

Anakinra, the recombinant form of the human interleukin (IL)-1 receptor antagonist, blunts the acute systemic inflammatory response in patients with ST-segment elevation myocardial infarction (STEMI), by determining a fall in peripheral blood leukocyte and plasma C-reactive protein levels. The aim of the present study was to determine the effects of anakinra on the activity of leukocytes measured ex vivo. Blood was collected 72 h after admission in 17 patients enrolled in the Virginia Commonwealth University - Anakirna Remodeling Trial (2) (VCU-ART2) and randomly treated with anakinra (N = 7) or placebo (N = 10). Whole blood was cultured at 37°C for 24 h to measure spontaneous production of IL-6 or stimulated with Escherichia coli lipopolysaccharide (LPS) for toll-like receptor (TLR)-4 or heat-killed Staphylococcus epidermidis (SE) for TLR-2 activation. The cultures of anakinra-treated patients produced significantly less IL-6 spontaneously (71 pg/mL [27–114]) compared with placebo-treated patients (290 pg/mL [211–617], p = 0.005). LPS- or SE-induced IL-6 production, on the other hand, was not statistically different between anakinra-versus placebo-treated patients (344 pg/mL [94–560] versus 370 pg/mL [306–991], p = 0.32 for LPS, and 484 pg/mL [77–612] versus 615 pg/mL [413–871], p = 0.31 for SE, respectively). IL-1 blockade with anakinra in STEMI patients results in reduced spontaneous leukocyte activity ex vivo without impairing the responsiveness to bacterial stimuli.     

Depression and Anxiety after Acute Myocardial Infarction Treated by Primary PCI

AimsThe main objective of the study was to find out prevalence of depression and anxiety symptoms in the population of patients with AMI with ST-segment elevation (STEMI), treated with primary PCI (pPCI). Secondary target indicators included the incidence of sleep disorders and loss of interest in sex.ConclusionsPatients with STEMI treated by primary PCI have relatively low overall prevalence of symptoms of depression and anxiety. A significant decrease in mental stress was observed before discharge from the hospital, but in a period of one year after pPCI, prevalence of both symptoms was gradually increasing, which should be given medical attention.     

血栓抽吸联合PCI术前阿托伐他汀强化治疗急性ST段抬高型心肌梗死

目的:探讨急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用GOODMAN血栓抽吸装置联合术前阿托伐他汀强化治疗对心肌组织灌注及临床预后的影响.方法:选择梗死相关血管心肌梗死溶栓试验血流0级的急性ST段抬高型心肌梗死患者80例,随机分为血栓抽吸联PCI术前阿托伐他汀强化治疗组(试验组)40例和标准PCI治疗组(对照组)40例.比较两组患者术后心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、心电图ST段回落百分比、左心室射血分数(LVEF)及住院期间主要心血管不良事件(MACE).结果:试验组TIMI血流分级、TMPG、ST段回落百分比、LVEF均明显优于对照组(P＜0.05).两组患者住院期间MACE发生率比较,差异无统计学意义(P＞0.05).结论:在急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用血栓抽吸联合术前阿托伐他汀强化治疗安全可行,可有效清除冠状动脉内血栓,改善心肌组织灌注及术后心脏功能,并且不增加主要心血管事件的发生率.     

Association of Interleukin 8 and Myocardial Recovery in Patients with ST-Elevation Myocardial Infarction Complicated by Acute Heart Failure

Background

No data from controlled trials exists regarding the inflammatory response in patients with de novo heart failure (HF) complicating ST-elevation myocardial infarction (STEMI) and a possible role in the recovery of contractile function. We therefore explored the time course and possible associations between levels of inflammatory markers and recovery of impaired left ventricular function as well as levosimendan treatment in STEMI patients in a substudy of the LEvosimendan in Acute heart Failure following myocardial infarction (LEAF) trial.

Methods

A total of 61 patients developing HF within 48 hours after a primary PCI-treated STEMI were randomised double-blind to a 25 hours infusion of levosimendan or placebo. Levels of IL-6, CRP, sIL-6R, sgp130, MCP-1, IL-8, MMP-9, sICAM-1, sVCAM-1 and TNF-α were measured at inclusion (median 22 h, interquartile range (IQR) 14, 29 after PCI), on day 1, day 2, day 5 and 6 weeks. Improvement in left ventricular function was evaluated as change in wall motion score index (WMSI) by echocardiography.

Results

Only circulating levels of IL-8 at inclusion were associated with change in WMSI from baseline to 6 weeks, r = ÷0.41 (p = 0.002). No association, however, was found between IL-8 and WMSI at inclusion or peak troponin T. Furthermore, there was a significant difference in change in WMSI from inclusion to 6 weeks between patients with IL-8 levels below, compared to above median value, ÷0.44 (IQR÷0.57, ÷0.19) vs. ÷0.07 (IQR÷0.27, 0.07), respectively (p<0.0001). Levosimendan did not affect the levels of inflammary markers compared to control.

Conclusion

High levels of IL-8 in STEMI patients complicated with HF were associated with less improvement in left ventricular function during the first 6 weeks after PCI, suggesting a possible role of IL-8 in the reperfusion-related injury of post-ischemic myocardium. Further studies are needed to confirm this hypothesis.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00324766","term_id":"NCT00324766"}}NCT00324766     

小剂量洋地黄对急性心肌梗死PCI术后合并心力衰竭患者心率变异性的影响

目的:探讨早期应用小剂量洋地黄类药物对急性心肌梗死(Acute myocardial infarction,AMI)行经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后合并心力衰竭患者心率变异性(Heart rate variability,HRV)的影响。方法:入选32例在发病24小时内接受PCI治疗且合并心力衰竭的AMI患者,再灌注后随机分为洋地黄组(西地兰0.2 mg,n=17)和对照组(生理盐水20 m L,n=15)。在用药前、用药后30分钟、用药后3小时、用药后6小时、用药后12小时、用药后24小时进行5分钟HRV分析。结果:1洋地黄组的心率在用药6小时后显著小于对照组(P0.05);2洋地黄组SDNN在用药后3小时-6小时显著大于对照组(P0.05),两组RMSSD比较无显著统计学差别(P0.05);3洋地黄组LFnorm在用药后3小时-6小时显著大于对照组(P0.05);用药3小时后,洋地黄组HFnorm显著大于对照组(P0.05),LF/HF显著小于对照组(P0.05)。结论:小剂量洋地黄可以显著降低AMI PCI术后合并心力衰竭患者的心率、逆转迷走神经与交感神经活性的失衡状态,改善HRV。     

Pericarditis after Acute Myocardial Infarction

Fifty-two (6·8%) of 779 patients admitted to a coronary monitoring unit with acute myocardial infarction developed a pericardial friction rub. A diagnosis of postmyocardial infarction syndrome was made in three of these.The course of the 52 patients with pericarditis was compared with that of a consecutive series of 100 patients without pericarditis. As a group those with pericarditis manifested a longer period of pyrexia, a greater rise in serum enzymes, and a higher incidence of major arrhythmias and of radiological pulmonary oedema. The Peel prognostic index, however, did not differ significantly in the two groups. The hospital mortality of the pericarditis group was not significantly different from that of the 727 non-pericarditis patients. No specially adverse features were found in a follow-up of the pericarditis group.Though the presence of a pericardial rub in the first few days after a myocardial infarction may be a sign of extensive myocardial damage and is associated with a relatively high incidence of ventricular fibrillation, it does not appear to influence the hospital mortality of patients treated in a monitoring unit.     

急性下壁心肌梗死急诊PCI术中应用临时起搏器与阿托品的对比研究

目的：探讨临时起搏器与阿托品在急性下壁心肌梗死急诊经皮冠状动脉介入治疗（PCI）中应用的疗效。方法：入选2012 年2 月至2013 年8 月我院收治的发病12 小时内,诊断为急性下壁心肌梗死并接受急诊PCI治疗的患者92 例,依据治疗方法的不同 将病例分为临时起搏组和阿托品组,并对病例进行为期一年的追踪随访,收集患者平均住院天数、平均住院费用、再灌注心律失 常、心肌梗死后心绞痛、心肌梗死后心衰发生率资料。结果：临时起搏组的平均住院天数、平均住院费用、心肌梗死后心绞痛、心肌 梗死后心衰发生率均显著低于阿托品治疗组（P 均<0.05）,阿托品治疗组的再灌注心律失常发生率则明显低于临时起搏组（P<0. 05）。结论：急性下壁心肌梗死急诊PCI中应用临时起搏器,具有治疗成本低,降低心血管事件发生率的优点,而阿托品治疗在改 善再灌注心律失常的疗效上则显著优于临时起搏治疗。     

Interleukin-18 as a Therapeutic Target in Acute Myocardial Infarction and Heart Failure

Interleukin 18 (IL-18) is a proinflammatory cytokine in the IL-1 family that has been implicated in a number of disease states. In animal models of acute myocardial infarction (AMI), pressure overload, and LPS-induced dysfunction, IL-18 regulates cardiomyocyte hypertrophy and induces cardiac contractile dysfunction and extracellular matrix remodeling. In patients, high IL-18 levels correlate with increased risk of developing cardiovascular disease (CVD) and with a worse prognosis in patients with established CVD. Two strategies have been used to counter the effects of IL-18:IL-18 binding protein (IL-18BP), a naturally occurring protein, and a neutralizing IL-18 antibody. Recombinant human IL-18BP (r-hIL-18BP) has been investigated in animal studies and in phase I/II clinical trials for psoriasis and rheumatoid arthritis. A phase II clinical trial using a humanized monoclonal IL-18 antibody for type 2 diabetes is ongoing. Here we review the literature regarding the role of IL-18 in AMI and heart failure and the evidence and challenges of using IL-18BP and blocking IL-18 antibodies as a therapeutic strategy in patients with heart disease.     

远端保护装置在急性心肌梗死急诊PCI中的应用研究

目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、术后TIMI分级、TIMI记帧、和心肌blush分级以及术后一周内及3个月后左室射血分数(LVEF)。结果:两组全部病例均成功地置入支架,GW组全部成功放置GuardWire PlusTM保护装置,GW组ST段回落□50%的百分比明显高于NGW组(68．4%vs41．2%,p＜0．05)。术后TIMI分级两组没有明显差别,TIMI记帧(p=0．043)和心肌blush分级有明显差别(p=0．000)。GW组的左室射血分数(LVEF)明显高于NGW组。结论:急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。     

尿激酶静脉溶栓治疗急性心肌梗死的疗效观察--附35例报告

目的 观察尿激酶静脉溶栓治疗急性心肌梗死的疗效.方法将66例急性心肌梗塞住院患者随机分成两组,溶栓组35例在常规治疗的同时,用尿激酶静脉溶栓治疗,非溶栓组仅用常规治疗,两组进行比较分析.结果 溶栓组血管再通率74.3%,非溶栓组为25.81%,两组间有明显差异(P<0.05),住院4周的病死率,溶栓组为2.86%,非溶栓组为16.16%,两组间有显著差异(P<0.01).结论 尿激酶静脉溶栓能明显提高急性心肌梗死患者的血管再通率和抢救成功率,降低近期病死率.