MYOCARDIAL INFARCTION IN DIABETICS

Objective: To analyze the influence of diabetes mellitus on circadian rhythm affecting the onset of acute ST elevation myocardial infarction. Design: Observational study. Period: February to August 2010. Setting: Faisalabad Institute of Cardiology, Faisalabad. Materials and methods: Three hundred and seven consecutive patients who fulfilled the inclusion and exclusion criteria and presented with first MI were studied. All patients were divided into four groups according to the 6:00 hours interval of the day (Circadian rhythm). Group I comprised of patients presenting with onset of symptoms between 0-6 hours, Group II 6:01 to 12:00 hours, Group III 12:01 to 18:00 hours and Group IV 18:01 to 24:00 hours. Data was analyzed for variations within groups. Results: Two peaks of onset of symptoms were observed, first between 0-6 hours 144 (33.9%) patients and the second between 6:01 to 12:00 hours 87 (28.3%) and a non significant association was observed in time of onset of acute myocardial infarction P = 0.082. The trough was evening time 12:01 to 18:00 hours where only 63 (20.5%) patients had acute myocardial infarction. Mean age of study population was 56 ± 12.7 years. Mean age was similar in all the four groups P = 0.155. There were 228 (74.3%) males, 79 (25.5%) females. The circadian morning peak of MI symptom onset was attenuated in patients with diabetes as Group IV consisted of higher number 24 (37.5%) of diabetics followed by group I 23 (34.7%). Overall group II had the maximum number of hypertensive patients 41 (47.1%) as compared to other groups. Obesity was observed in 55 (18%) with similar number of patients in all groups P = 0.492. Majority of patients 117 (38.1%) presented between 4-8 hours after the onset of symptoms. Overall 170 (55.4%) patients had anterior wall myocardial infarction followed by inferior wall myocardial infarction in 82 (26.7%) patients. Conclusions: Our study demonstrates that the circadian morning peak of MI symptom onset was attenuated in patients with diabetes, suggesting a role of autonomic dysfunction. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to differences in the duration of diabetes.

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ACUTE MYOCARDIAL INFARCTION

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.02.5035 ◽

2006 ◽

Vol 13 (02) ◽

pp. 178-185

Author(s):

ABDUL REHMAN ABID ◽

M. Shahid Naveed ◽

LIAQAT ALI ◽

Siraj Munir Ahmed Tarin ◽

M. TAHIR MOHYUDDIN ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Hospital Stay ◽

Group Iv ◽

Age Group ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Group Ii

Women with acute myocardial infarction have higher in-hospital mortalitythan men mainly due to greater age on presentation. Objective: To evaluate the age specific sex difference in inhospitalmortality of acute myocardial infarction. Design: Descriptive study. Place and duration: Coronary Care Unitand cardiology ward of Nishtar Hospital Multan from 15 of th September 2002 till 30th of April 2003. Material & Methods:Four hundred and fifty patients of acute myocardial infarction who fulfilled our inclusion criteria were studied while theywere admitted to the hospital. Patients were divided into four groups according to age and sex i.e. Group I (male <45years), Group II (male $45 years), Group III (female <45 years) and Group IV (female $45 years). In-hospital mortalitywas compared between different age groups by Chi-square test. Results: The total in-hospital mortality was76(16.9%).In Group III none of the patients expired. In Group I in-hospital mortality was 6(7.1%) patients followed byGroup II 50(18.3%) patients and Group IV 20(23.3%) patients p<0.019. In-hospital mortality was greater in Group IVthan in any other group. Group IV patients were more frequently diabetic and hypertensive than patients in any othergroup. Group IV patients presented late to the hospital. There was no significant difference in site of myocardialinfarction in different groups. Higher Killip class was observed in Group II and IV p<0.05. Streptokinase injection wasgiven less frequently in Group IV than in any other group p <0.012. Only 34(39.5%) patients in Group IV had nocomplication during hospital stay while more patients in other groups had uneventful hospital stay p<0.001.Conclusion: Female sex is associated with higher in-hospital mortality in older age group as compared to the malepatients of same age group.

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ACUTE MYOCARDIAL INFARCTION

The Professional Medical Journal ◽

10.29309/tpmj/2006.13.03.5006 ◽

2006 ◽

Vol 13 (03) ◽

pp. 178-185

Author(s):

ABDUL REHMAN ABID ◽

M. Shahid Naveed ◽

LIAQAT ALI ◽

Siraj Munir Ahmed Tarin ◽

M. TAHIR MOHYUDDIN ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Hospital Stay ◽

Group Iv ◽

Age Group ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Group Ii

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Detection and Characterization of Prevotella Intermedia and Its In Vitro Susceptibility to Selected Antimicrobial Agents in Chronic Periodontitis and Acute Myocardial Infarction

10.26810/perioj.2019.a1 ◽

2019 ◽

Vol 3 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Deepa Anumala ◽

Mohan Kumar Pasupuleti ◽

Ravindra Reddy Nagireddy

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chronic Periodontitis ◽

Antimicrobial Agents ◽

Prevotella Intermedia ◽

Causative Role ◽

In Vitro Susceptibility ◽

Group Iii ◽

Group I ◽

Group Ii

Background: Periodontal disease has been reported to play a causative role in acute myocardial infarction (AMI), which may add to the various risk factors associated with coronary heart disease. The objective of the present study was to investigate the presence of Prevotella intermedia – an established periodontal pathogen – in subgingival plaque samples of chronic periodontitis and AMI patients in order to identify a possible association, and to evaluate the susceptibility of Prevotella intermedia to nine antimicrobial agents. Methods: After undergoing screening for eligibility, a total of 50 subjects were included in the present study. Twenty patients were diagnosed with AMI and generalized chronic periodontitis (Group I), 20 patients were diagnosed with only AMI (Group II), and 10 subjects were healthy controls (Group III). The isolated Prevotella intermedia strains were tested for susceptibility to bacitracin, chloramphenicol, penicillin G, polymyxin, gentamycin, neomycin, tetracycline, cefotaxime, and cefoxitin using an antibiotic zonescale to determine minimum inhibitory concentrations (MICs). Results: Periodontal pathogens were identified by phenotypic and enzymatic methods. The mean bacterial load of Prevotella intermedia species was higher in Group I compared to Group II and Group III. It was also found that pencillin G, gentamycin, neomycin, tetracycline, cefotaxime, and cefoxitin inhibited 90% of Prevotella intermedia, whereas bacitracin, chloramphenicol, and polymyxin inhibited 80% of Prevotella intermedia. Thus, only 10% of Prevotella intermedia were resistant to these antibiotics. Conclusion: The present study confirms that Prevotella intermedia is associated with chronic periodontitis and AMI.

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PROTECTIVE EFFECT OF CARNITINE (ST-261, SIGMA-TAU) IN ACUTE MYOCARDIAL INFARCTION IN DOGS

10.1055/s-0038-1643012 ◽

1987 ◽

Author(s):

K Kordenat ◽

J Leasure

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Protective Effect ◽

Myocardial Necrosis ◽

Control Group ◽

Computer Technique ◽

T Wave ◽

Group I ◽

The Mean ◽

Group Ii

Limitation of infarct size (IS), using ST-261, was evaluated in a group (I) of eight dogs, during acute MI. Another group (II) served as the control group. The protocol for both groups was the same except that each dog in the treated group was ST-261 as a single bolus (25 mg/kg, in 20ml normal saline), before inducing an occluding thrombus in the mid-LAD, using a closed-chest model, under x-ray visualization. Percentages of total (gms) myocardium at jeopardy (TMJW) and myocardial necrosis (TMNW), delineated by fluoroscein and TTC dyes, respectively, were calculated and compared to the total ventricular myocardial weight (TVMU), by computer technique for both groups at 3 Hrs post-occlusion of the LAD. Mean serum total CPK (CPK-t) and isozymes (mb-band) were measured before and up to 3 Hrs post-occlusion, as were various hemodynamic and mean precordial (21 lead) ST-segment and T-wave amplitudes. There was 14% less TMJU (p<0.05) and 41% less TMNW (p<0.01) in Group I compared to Group II. The mean % of CPK-mb/CPK-t decreased in I and increased in II over the 3 Hrs of observation. Mean HR decreased (p<0.01) in I compared to II at 3 Hrs postocclusion. The sum of the mean T-wave amplitudes from the precordial electrode sites was less in I at 3 Hrs. It is felt that ST-261 had a protective effect on the myocardium during acute myocardial infarction.

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Clinical effectiveness of thrombolytic therapy with alteplase and double antiplatelet therapy in acute myocardial infarction

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2011-6-59-63 ◽

2011 ◽

Vol 10 (6) ◽

pp. 59-63

Author(s):

D. N. Kuznetsov ◽

V. V. Trusov ◽

I. A. Kazakova

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thrombolytic Therapy ◽

Clinical Effectiveness ◽

Minute Volume ◽

Myocardial Salvage ◽

Group I ◽

General Weakness ◽

Number Of Patients ◽

Group Ii

Aim. To assess the clinical effectiveness of thrombolytic therapy (TLT) with alteplase in patients with acute myocardial infarction (AMI). Material and methods. The study included 54 AMI patients, divided into two groups: Group I (n=26), which underwent TLT, and Group II (n=28), which had contraindications to TLT. The TLT method was an accelerated alteplase infusion. Both groups were comparable by age and sex. In all patients, AMI biomarker levels and echocardiography (EchoCG) parameters were measured. Results. Successful thrombolysis was performed in 19 patients (73 %). The mean “symptom-to-needle” time was 3,7±0,6 hours. In Groups I and II, the 50 % reduction in the ST segment deviation from isoelectric line at 180 minutes was observed in 34,6 % and 0 % of the patients, respectively. In addition, in Group I, there was a reduction in the number of patients complaining of general weakness, dyspnoea, and recurrent angina attacks. The levels of cardio-specific AMI biomarkers were higher in Group II. According to the EchoCG results at 10 days after admission, the Group I patients demonstrated higher minute volume (by 28,8 %), higher ejection fraction (by 30 %), and higher end-diastolic dimension (by 23,8 %). Conclusion. The results obtained confirm high effectiveness of the in-hospital TLT with accelerated alteplase infusion. Alteplase therapy was associated with clinical and morphological myocardial salvage in AMI patients.

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The role of cytokines and cortisol in the non-thyroidal illness syndrome following acute myocardial infarction

Acta Endocrinologica ◽

10.1530/eje.0.1420236 ◽

2000 ◽

pp. 236-242 ◽

Cited By ~ 20

Author(s):

H Karga ◽

P Papaioannou ◽

K Venetsanou ◽

F Papandroulaki ◽

L Karaloizos ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

First Episode ◽

Necrosis Factor Alpha ◽

Ventricular Ejection Fraction ◽

Group I ◽

Cortisol Levels ◽

Group Ii

OBJECTIVE: A number of different hormone changes have been described during the acute myocardial infarction (AMI), including those of the non-thyroidal illness syndrome (NTIS). DESIGN AND METHODS: We assessed the alterations of serum thyroid hormones, cytokines and cortisol levels in 30 patients with a first episode of AMI 4, 24, 48h and 10 days (240h) after the onset of the chest pain and we investigated the possible relationship of these alterations with the severity of AMI. RESULTS: Fifteen patients had left ventricular ejection fraction (LVEF) </=50% (group I) and 15 patients had LVEF >50% (group II). A transient decrease of total tri-iodothyronine (T(3)), more prominent in group I (P<0.05, t-test) with a concomitant rise of reverse T(3 )(rT(3)) occurred at 24h. Total thyroxine (T(4)), free T(4) (FT(4)) and free T(4) index did not change significantly, but tended to be higher in group I patients, whereas TSH significantly increased in group II at 48h. Interleukin-6 (IL-6) increased significantly at 24h only in group I and declined thereafter (24 vs 240h, P<0.001) and this temporal change of IL-6 was associated with similar changes of creatine phosphokinase and creatine kinase isoenzyme MB (CK-MB). Tumor necrosis factor-alpha and IL-1beta remained low in both groups. Cortisol was higher at 4h and in 12 patients was above the normal values. Negative correlation was found between LVEF and IL-6 (P<0. 001), whereas T(3), T(4) or cortisol levels were not correlated with the LVEF. CONCLUSIONS: Our data indicate that NTIS, in association with increase of IL-6, occurs in the early post-infarction period. In the NTIS following AMI the high level of IL-6 is the best predictor, among several parameters, of the severity of AMI as assessed by the LVEF and the rise of CK-MB.

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MOTERŲ MIOKARDO INFARKTO KLINIKINĖS SIMPTOMATIKOS IR BAIGČIŲ YPATUMAI

Sveikatos mokslai ◽

10.5200/sm-hs.2015.007 ◽

2015 ◽

Vol 25 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Žaneta Petrulionienė ◽

Pranas Šerpytis ◽

Dovilė Jančauskaitė ◽

Urtė Gargalskaitė ◽

Brigita Brazauskaitė ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Heart Rhythm ◽

Type I ◽

Type Ii ◽

Group I ◽

Primary Arterial Hypertension ◽

St Elevation ◽

Atrial Fibrilation ◽

Group Ii

Objective. The aim of the present study was to compare differences of symptoms, comorbidities, risk factors and outcomes in younger (up to 55 years-old) and older (over 55 years-old) women with acute myocardial infarction. Materials and methods. In this retrospective study we analised 473 cases of women with acute myocardial infarction treated in 2012. Patients were divided into two groups according to their age: group I (up to 55 years) and group II (older than 55 years). The first group included 37 patients while the second group - 436 patients. Results. The average age of patients was 72,3 ± 11,07 m. Myocardial infarction with ST elevation were diagnosed to 54,3%, of wich Q+ 70,4%, Q- 29,6% (p 0,001), non-ST elevation 45,7%, of wich Q+ 6,5%, Q- 93,5% (p 0,001), no statistically significant difference was observed between the groups. 73% women in group I had primary arterial hypertension (I grade 2,7%, II 59,5%, III 10,8%), in the second group - 92,7% (I grade 0,7%, II 86%, III 6%), (p 0,001). Moreover, 13,5% patients in group I had diabetes (5,4% of type I, 8,1% of type II), in the group II 23,9% (0,3% of type I, 23,6% of type II), (p 0,001). Heart rhythm disorders were more often in women over 55 years-old (32,8%), (p=0,006). Among these patients, persistent atrial fibrilation were identified in 27,2%, permanent atrial fibrilation in 18,4%, ventricular fibrilation in 4,1% patients (all p 0,001). 5,4% women in younger group had previously experienced myocardial infarction while in older group - 20% (p=0,03). The spread of the pain to left hand was more common in the group of younger patients (27%) (p=0,047). Futhermore, in group I 18,9% felt weakness, while in group II - 38,5% (p=0,018). Fatal outcomes were observed in 6,8% patients, all of them were older than 55 years. Among patients with fatal outcomes Killip IV were found to 78,1% patients (p 0,001). Conclusions. Older women (≥ 55 years-old) treated for acute myocardial infarction more often had the grade II of primary arterial hypertension, heart rhythm disorder, previously experienced mycardial infarction and felt weakness. Younger patients (below 55 years old) had type I diabetes more often and were characterized by pain spreading to the left arm. Determined Killip IV leaded to increased lethality.

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P749 Echocardiographic risk factors of functional ischemic mitral regurgitation in patients with first acute myocardial infarction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.414 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

J Kochanowski ◽

R Piatkowski ◽

P Scislo ◽

M Budnik ◽

M Marchel ◽

...

Keyword(s):

Myocardial Infarction ◽

Mitral Regurgitation ◽

Left Ventricular ◽

Group Iv ◽

Ischemic Mitral Regurgitation ◽

Mean Values ◽

St Segment Elevation ◽

Group Iii ◽

Group I ◽

Group Ii

Abstract Purpose The aim of this study was to assess the correlation between the size of acute functional ischemic mitral regurgitation (FIMR) and selected left ventricle echocardiography measurements in patients (pts) with first ST-segment elevation myocardial infarction (STEMI) treated with effective primary angioplasty (PCI). Methods We analyzed 1578 consecutive hospitalized pts with STEMI (M-914; 66,4 ± 10,2 years) treated with PCI. The echocardiographic examination was performed at up to 3 days after admission. We assessed the frequency and size of FIMR, left ventricular end diastolic diameter (LVEDd), ejection fraction (EF), wall motion score index (WMSI) and systolic sphericity index (Sls). Effective regurgitation orifice area (EROA) was used for quantitative FIMR assessment (mild: <10 mm², moderate: ≥10 and < 20 mm², severe: ≥ 20mm²). The study population was divided into four groups depending on the size of FIMR. Correlation coefficient was used to determine correlations between data sets. Results We observed mild FIMR in 550 pts (34,9%) - group I, moderate in 356 pts (22,5%) - group II, severe in 57 pts (3,6%) - group III, no FIMR in 615 pts (39%) – group IV. Mean values of selected echocardiographic parameters in each analyzed group are shown in table 1. The positive good correlations between SIs and size of FIMR were found (r = 0,68) as well as weak correlations between LVEDd, WMSI and FIMR (ro = 0,25, ro = 0,34, respectively). The negative weak correlation between EF and size of IMR was present (ro = - 0,34). Conclusions 1. FIMR is a common complication in pts with STEMI treated with PCI. 2. We found a statistically significant correlation between SIs and FIMR severity. Table 1 Group I Group II Group III Group IV p LVEDd (cm) 5,22 ± 0,64 5,42 ± 0,56 5,72 ± 0,64 4,98 ± 0,58 NS EF (%) 48 ± 6 42 ± 8 35 ± 8 51 ± 8 NS WMSI 1,34 ± 0,28 1,42 ± 0,24 1,68 ± 0,32 1,32 ± 0,22 NS SIs 0,22 ± 0,1 0,32 ± 0,1 0,68 ± 0,1 0,18 ± 0,1 0,01 NS - non-significant

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INTRAVENOUS THROMBOLYTIC THERAPY WITH SINGLE-CHAIN UROKINASE-TYPE PLASMINOGEN ACTIVATOR IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

10.1055/s-0038-1643574 ◽

1987 ◽

Author(s):

C Bode ◽

F Schwarz ◽

G Schuler ◽

R Zimmermann ◽

W Kubler

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Plasminogen Activator ◽

Intravenous Infusion ◽

Human Kidney ◽

Single Chain ◽

Group I ◽

Type Plasminogen Activator ◽

Urokinase Type Plasminogen Activator ◽

Group Ii

Seventeen patients with acute myocardial infarction were treated with heparin combined with intravenous single-chain urokinase-type plasminogen activator (scu-PA),obtained from transformed human kidney cells. 4 patients in group I and 13 patients in group II received a bolus of 4 mg and 7-5 mg followed by an infusion of 11 mg and 40.5 mg over 60 minutes, respectively. Thrombolysis was achieved in no patient of group I during intravenous infusion of scu-PA, however, upon subsequent intracoronary infusion of 250000 IE streptokinase, reperfusion could be established in two out of three patients. In group II seven patients were successfully treated with intravenous infusion of scu-PA. In 2 of the 6 patients unsuccessfully treated with intravenous scu-PA,intracoronary streptokinase was subsequently administered. In both cases recanalization could not be achieved. The effects on the hemostatic system are summarized below. In all patients a severe residual stenosis persisted after thrombolytic treatment and 13 patients underwent PTCA.Group Reperfusion Fibrinogen Plasminogen AntiplasminThere was no difference between sucessfully and unsuccessfully treated patients in group II with respect to the effect of treatment on serum parameters.It is concluded that intravenous infusion of scu-PA at a dose of 15 mg over 60 minutes is ineffective treatment for patients with acute myocardial infarction. However,at a dose of 48 mg over 60 minutes this form therapy is effective, save and specific.

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Effect of Statin Therapy In Ventricular Arrhythmias In Patient With Acute Anterior Myocardial Infarction

Cardiovascular Journal ◽

10.3329/cardio.v6i1.16113 ◽

2013 ◽

Vol 6 (1) ◽

pp. 37-42

Author(s):

Syeda Masuma Kawsar ◽

AAS Majumder ◽

MA Ali ◽

M Ullah ◽

AKMM Islam

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Statin Therapy ◽

Ventricular Arrhythmias ◽

Left Ventricular Ejection ◽

High Dose ◽

Anterior Myocardial Infarction ◽

Group I ◽

Atorvastatin Therapy ◽

Group Ii

Background: Though statins are widely used in acute coronary syndrome (ACS), there is a paucity of information on the efficacy of high dose statin therapy in reducing the incidence of ventricular arrhythmias after acute myocardial infarction. Arrhythmias are relatively common in acute myocardial infarction (AMI) anterior, and sometimes progress to cardiac arrest. This study was planned to evaluate the role of high dose atorvastatin therapy in prevention of ventricular arrhythmias after acute anterior myocardial infarction. Methods: This study was conducted in NICVD from December 2010 to October 2011. Total 200 patients with newly diagnosed acute anterior myocardial infarction who received thrombolytic therapy were included in the study. They were divided into two groups. Group I (n=100) was selected for high dose atorvastatin therapy and group II (n=100) was selected for conventional doses of atorvastatin therapy. 24 hours Holter monitoring was performed 48 hours after hospital admission to evaluate arrhythmia. Results: Majority of the patients belonged to age range of 40 to 59 years with a male predominance. Patient characteristics regarding age, sex, drug use, risk factors for ventricular arrhythmia, body mass index, left ventricular ejection fraction were similar in two study groups. There was no electrolyte imbalance or renal impairment in any patient in either group. A significant difference in frequency of ventricular arrhythmias was found between the two groups. Ventricular premature beats were found in 66% patients in group I and 97% patients in group II (p=0.001) whereas non sustained ventricular tachycardia were observed in 0% and 4% in group I and group II respectively. Conclusion: High dose atorvastatin therapy is associated with lower frequency of ventricular arrhythmias after acute anterior myocardial infarction. Cardiovascular Journal Volume 6, No. 1, 2013, Page 37-42 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16113

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