[Hospitalization of discharged patients with acute myocardial infarction in the thrombolytic era].

The objective of the work is to assess in discharged patients with AIM data on the period of hospitalization in the intensive care unit and the total period of hospitalization and how these were influenced by stratification into patients with complicated and uncomplicated AIM and patients with a low, medium and high risk. Data on hospitalization were analyzed in 2,527 discharged patients with AIM. The median of hospitalization at intensive care units was 5 days and the mean period of hospitalization 6.

[The electrocardiogram and thrombolytic therapy in patients with acute myocardial infarct].

The objective of the submitted work is to analyze in patients with acute myocardial infarction (AIM) local priority data on ECG markers after admission to hospital, data on some associations of ECG and thrombolytic treatment and to assess in patients with the first AMI data on hospital mortality in connection with some ECG markers. The project was implemented as a prospective multicentre study. An independent audit and collection of data was done in 3123 patients with AIM in 66 departments between Sept.

Thrombolytic therapy for patients with acute myocardial infarction. Causes increasing the probability of not receiving thrombolytic therapy.

Intravenous thrombolysis is the most accessible and the most common form of reperfusion therapy. The aim of this study was to identify demographic, clinical and electrocardiographic factors, which based on published data and in patients included in the project Audit of diagnostic and therapeutic procedures in patients with acute myocardial infarction (AUDIT), increased the probability of not receiving thrombolytic therapy. In order to maximize the impact of thrombolytic therapy to reduce the case fatality rate associated with an acute myocardial infarction, we review, which a number of studies provide evidence on the usage of thrombolytic therapy in elder, women, patients with diabetes mellitus, bundle-branch block and after stroke.

[Effect of demographic, anamnestic and clinical factors on hospital mortality in patients with myocardial infarct].

The objective of the work was to analyze local priority data on the possible effect of demographic, anamnestic and clinical factors in a non-selected population of 3123 patients with acute myocardial infarction (AIM) on the hospital mortality (HM). 12.6% patients with AIM died in hospital.

[Early diagnosis and reasons for not administering thrombolytic therapy in acute myocardial infarct].

In Slovakia we are lacking data on early (before examination of serum markers of myocardial necrosis) pertaining to thrombolytic treatment (TLL) which is inevitable in case of acute myocardial infarction (AIM) as well as data on the reasons why TLL is not implemented. This why the authors analyze the results of completed comprehensive project Audit concerned with diagnostic and therapeutic procedures in patients with acute coronary syndromes during the pre-hospital and hospital stage (AUDIT). The investigation was a perspective multi-centre study.

[The prehospital phase in patients with acute myocardial infarct in Slovakia. A challenge].

Better management of patients with acute myocardial infarction during the prehospital phase is at present a challenge not only for health workers but for society as a whole. The authors pay attention to knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction which is a prerequisite for finding possible solutions for a favourable effect on their management. The authors analyzed 3,040 patients who were admitted to hospital alive within 96 hours after the development of complaints with suspicion of a first or repeated acute myocardial infarction.

[Epidemiology and prevention of cardiovascular diseases after 1989].

During the past 30 years the geographical distribution of cardiovascular diseases in Europe has substantially changed. The highest rates that were reported in the mid sixties in Finland occurred in 1990/91 occurred in central and eastern Europe. The reasons for such different development of cardiovascular mortality have not been explained yet.

[Pharmacotherapeutic profile of patients with acute myocardial infarct in the early hospitalization period].

Background: The early treatment efficacy of patients with acute myocardial infarction (AMI) with thrombolysis, antiplatelet drugs, betablockers and ACE inhibitors has been well documented in randomized mega trials. However, little is known about the fact to what extend the results of these mega trials have influenced the treatment practices. Moreover, in the view of a complete lack of data on management of patients with AMI in Slovak Republic a project of the Ministry of Health "Audit of diagnostic and therapeutic management in patients with acute coronary syndromes" (AUDIT) has been conducted.

[Minimizing the prehospital delay in patients with acute myocardial infarct].

Despite the known importance of early intervention, delays between symptoms onset and manifestation of acute myocardial infarction (AMI) in the hospital are common. Most of the prehospital delay consists of the interval between the onset of symptoms and the decision to seek medical help. The aim of this paper is to review the factors associated with the long duration of patient delay (patient time delay).

[Early diagnosis of acute myocardial infarct].

Inappropriately long patient time delay (PTD) is the main cause for undesirable pre-hospitalization delay, so called global pre-hospital time delay (GTD). The fact that patients treated for cardiovascular diseases have long GTD is alarming. General awareness of basic symptomatology and of the importance of time factor for further course of the disease may substantially influence the duration of AIM pre-hospitalization phase.

[Supraventricular arrhythmias and disorders of atrioventricular and intraventricular conduction in patients with acute myocardial infarct].

In addition to ventricular arrhythmias, various forms of supraventricular arrhythmias (SVA) and atrioventricular (AV) and intraventricular (IV) conduction disturbances occur also in acute myocardial infarction (AMI). In the setting of AMI, SVA may be caused by relevant atrial ischemia or infarction. SVA complicate the course especially that of inferior, posterior and lateral AMI.

[Reperfusion arrhythmias].

Reperfusion arrhythmias originate as a consequence of the complex of cellular and humoral reactions accompanying the opening of coronary artery. As the primary cause of their generation are considered the chemically defined substances that are produced and accumulated in myocardium during reperfusion. The key role is ascribed to free oxygen radicals but of importance are also other substances such as calcium, thrombin, platelet activating factor, inositol triphosphate, angiotensin II and others.

[Relation between insulin resistance and small, dense lipoproteins with low density and the development of atherosclerosis in type 2 diabetes mellitus].

Diabetes mellitus type 2 (DM type 2) is a common disease that is associated with high mortality and morbidity due to macrovascular and microvascular complications. CHD mortality and morbidity is 2-3 times higher in diabetic than in non-diabetic patients. There are many potentially atherogenic factors in diabetes these may underlie this problems.

[Informacia o niektorych vysledkoch z Pilotnej studie projektu Ministerstva zdravotnictva SR. AUDIT diagnostickeho a terapeutickeho postupu u chorych s akutnymi koronarnymi syndromami].

The basic analysis of the Pilot study fully confirms the possibilities of the realization of the project AUDIT ...

[Not Available].

In addition to ventricular arrhythmias, various forms of supraventricular arrhythmias (SVA) and atrioventricular (AV) and intraventricular (IV) conduction disturbances occur also in acute myocardial infarction (AMI). In the setting of AMI, SVA may be caused by relevant atrial ischemia or infarction. SVA complicate the course especially that of inferior, posterior and lateral AMI, SVA occur frequently also in the right ventricular myocardial infarction and in pericarditis.

[Not Available].

Reperfusion arrhythmias originate as a consequence of the complex of cellular and humoral reactions accompanying the opening of coronary artery. As the primary cause of their generation are considered the chemically defined substances that are produced and accumulated in myocardium during reperfusion. The key role id ascribed to free oxygen radicals but of importance are also other substances such as calcium, thrombin, platelet activating factor, inositol triphosphate, angiotensin II and others.

[Not Available].

Diabetes mellitus type 2 (DM type 2) is a common disease that is associated with high mortality and morbidity due to macrovascular and microvascular complications. CHD mortality and morbidity is 2--3 times higher in diabetic than in non-diabetic patients/. There are many potentially atherogenic factors in diabetes these may underlie this problems.

[Not Available].

Project Audit of diagnostic and therapeutic procedures in patients with acute coronary syndromes was approved by the Ministry of Health of the Slovak Republic on 13 May 1996. The essence of the project resides in a systematic and complex analysis of quality of provided medical care and the use of sources with the seeking for possibilities of improvement of the provided care aimed at prognosis and quality of life of patients with acute coronary syndrome (acute infarction, unstable angina pectoris, sudden cardiac death). The subsequent step will reside in the Project of Sudden Cardiac Death Prevention and the establishment of the myocardial infarction register.

[Non-pharmacologic prevention of sudden cardiac death].

Non-pharmacologic therapy has revolutionized the management of arrhythmias and prevention of sudden cardiac death (SCD). Of particular importance is the introduction of radiofrequent catheter ablation (RFCA) and implantable cardioverter-defibrillator (ICD). RFCA is effective and useful in the treatment and prevention of SCD, especially in supraventricular tachyarrhythmias related to dual or accessory atrioventricular pathways.

[Anti-arrhythmia agents in the prevention of sudden cardiac death after myocardial infarct].

Heart rhythm disturbances represent one of the most important causes of cardiovascular mortality and, in particular, sudden cardiac arrhythmic death. The persistent actuality of arrhythmias is currently characterized by: 1) better knowledge of pathogenetic mechanisms of arrhythmias and their modulating factors, 2) improved diagnostic possibilities of arrhythmias, 3) availability of a large number of effective antiarrhythmics, as well as of nonpharmacologic therapeutic approaches too. Despite the narrowing spectrum of indications to pharmacologic treatment, both chronic and prophylactic antiarrhythmic therapies have nor become less complicated, but on the contrary they are even more problematic.

[Ventricular arrhythmias and sudden cardiac death in acute myocardial infarct in the era of thrombolytics].

Sudden cardiac death (SCD) in the setting of acute myocardial infarction (AMI) remains an actual problem. There is a very close relationship between ventricular arrhythmias and SCD in AMI. Malignant ventricular arrhythmias, such as ventricular fibrillation and ventricular tachycardia are the major causes of SCD in coincidence with AMI.

[Occurrence of abnormal late ventricular potentials in myocardial ischemia and the determination of risk of sudden cardiac death in patients after myocardial infarct].

Background: The crucial step in prevention of sudden cardiac death (SCD) is a method of a precise and most accessible identification of those patients with ischaemic cardiac disease (ICD), especially after MI, who are highly presumptive candidates of malign ventricular arrhythmias. The selection of individuals exposed to risk, and individual judgment of the threat to patients after MI is a complex problem. Patients after MI are endangered by reinfarction, cardiac failure, heart wall rupture and primary ventricular tachyarrhythmia.

[Transthoracic echocardiography in the early phase of acute myocardial infarct].

The authors present an article reviewing the fundamental importance of transthoracic echocardiography in the early phase of acute myocardial infarction (AMI). They refer to its significance in the diagnostics and differential diagnostics statements of AMI and its complications, evaluation of left ventricular systolic and diastolic function. The authors emphasize its possibilities in risk stratification and prognostic evaluation of the patients after AMI.