Lege Artis Medicinae

[ARRHYTHMIAS IN ACUTE MYOCARDIAL INFARCTION]

TOMCSÁNYI János

NOVEMBER 30, 2005

Lege Artis Medicinae - 2006;16(01 klsz)

[Arrhythmias ranging from a premature beat to sustained tachycardias are common in acute myocardial infarction. This paper discusses the diagnosis, prognosis and treatment of the most frequent and important arrhythmias that may accompany myocardial infarction.]

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Lege Artis Medicinae

[PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROME]

ANDRÁSSY Péter

[Recently the indications of percutaneous coronary intervention have changed both in the ST elevation and in the non-ST elevation, unstable angina group of acute coronary syndrome. Current indications in these groups are briefly reviewed and the outcomes and indications of primary interventions or those following successful or unsuccessful thrombolysis are discussed based on the most recent guidelines. Of the technical aspects, experience of the person performing the intervention, the issue of stent implantation or balloon expansion, and protection against embolism are mentioned.]

Lege Artis Medicinae

[AMBULANCE CARE OF ACUTE CORONARY SYNDROME]

BURÁNY Béla

[In Hungary, the advanced life support and mobile intensive care units of the National Ambulance Service are responsible for the effective praehospital care of patients with acute coronary syndrome. At the onset of chest pain, patients are supposed to call the ambulance service without delay. The dispatcher is to direct the most adequate unit to each patient. On-site treatment and optimization of medical care pathways are supported by existing algorithms. For early onset ST-elevation myocardial infarcts, praehospital fibrinolysis can provide the most benefit. Emergency secondary transports may lead to significant delays; therefore, this pathway should be limited to carefully selected cases.]

Lege Artis Medicinae

[LIPID LOWERING IN ACUTE CORONARY SYNDROME]

MÁRK László

[A large number of studies have proved that in acute coronary syndrome the administration of statins improves clinical outcome by their lipid lowering effect, and also by stabilizing the plaque as part of their pleiotropic effects. An important question regarding statin therapy is when it should be introduced after the onset of symptoms. Studies on this issue agree that statin therapy should be initiated right after the onset of acute symptoms. If the patient is already receiving statin, we must make sure it is not abandoned. According to current Hungarian guidelines, for patients with acute coronary syndrome the target level of the low density lipoprotein cholesterol is 1.8 mmol/l.]

Lege Artis Medicinae

[REHABILITATION AFTER ACUTE CORONARY SYNDROME]

SÁNDORI Klára

[Changes that have occurred in the treatment of acute coronary syndrome have also had an impact on rehabilitation. Unfortunately, current international and national professional guidelines barely take this into account. At present, most patients after acute coronary intervention are certainly not directed to take part in rehabilitation programmes. Thus those very patients miss these programmes who would gain the most benefit from a multi-disciplinary approach to rehabilitation. It would be necessary to develop standard guidelines for the selection of patients. The outcome of the interventions is highly affected by the patients' personality and psychosocial status. It has become obvious that in addition to physical exercise, which is useful but not a cure-all, psychosocial intervention is a key component of successful rehabilitation. This, however, is possible only by increasing the number of rehabilitation professionals and also by the fundamental improvement of financing.]

Lege Artis Medicinae

[LOWERING BLOOD PRESSURE IN ACUTE CORONARY SYNDROME]

BECKER Dávid

[Early monitoring and management of patients with acute coronary syndrome takes place in coronary units. Hypertension is one of the main risk factors of the syndrome. Many patients have high blood pressure in the acute situation, and it may be further increased by the acute stress effect. To ensure controllability of blood pressure, intravenously administered nitroglycerine, beta receptor blockers, angiotensin-converting enzyme inhibitors, and centrally acting drugs are the medications of choice in the management of acute coronary syndrome.]

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Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

Aim - To evaluate P-wave dispersion before and after antiepileptic drug (AED) treatment as well as to investigate the risk of ventricular repolarization using the Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio in patients with epileptic disorder. Methods - A total of 63 patients receiving AED therapy and 35 healthy adults were included. ECG recordings were obtained before and 3 months after anti-epileptic treatment among patients with epilepsy. For both groups, Tp-e and Tp-e/QT ratio were measured using a 12-lead ECG device. Results - Tp-e interval, Tpe/QT and Tp-e/QTc ratios were found to be higher in the patient group than in the control group (p<0.05, for all), while QTmax ratio was significantly lower in the patient group. After 3 months of AED therapy, significant increases in QT max, QTc max, QTcd, Tp-e, Tp-e/QT, and Tp-e/QTc were found among the patients (p<0.05). When the arrhythmic effects of the drugs before and after treatment were compared, especially in the valproic acid group, there were significant increases in Tp-e interval, Tp-e/QT and Tp-e/QTc values after three months of treatment (p<0.05). Carbamazepine and levetiracetam groups were not statistically significant in terms of pre- and post-treatment values. Conclusions - It was concluded that an arrhythmogenic environment may be associated with the disease, and patients who received AED monotherapy may need to be followed up more closely for arrhythmia.

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[POST-INFARCTION CARDIAC FAILURE]

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[Recent advances in the care of acute myocardial infarction have resulted in more patients surviving myocardial infarction than earlier. However, heart failure is a common complication in these patients, which in turn is associated with substantial mortality, primarily due to a remodelling of the left ventricle that already starts in an early stage of the myocardial infarction. The aim of this review article is to present the pathomechanism of this remodelling and to discuss related therapeutic options. Current guidelines recommend the use of an angiotensin- converting enzyme inhibitor combined with or followed by an angiotensin receptor blocker, a beta-blocker, and an aldosterone antagonist in post-infarction patients with concomitant heart failure.]

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VARRÓ András

[Sudden cardiac death of athletes is very rare (1/50 000 to 1/100 000 annually) but it is still 2 to 4 times more frequent than that of the agematched normal population. In addition, it attracts peculiar media attention. Sudden cardiac death in athletes is supposed to not primarily have an ischemic origin but most likely relates to repolarization abnormalities. These may be caused by several independent and/or dependent factors such as benign cardiac hypertrophy developing normally in athletes (athlete’s heart), hypertrophic cardiomyopathy, increased sympathetic activity, genetic defects, seemingly harmless drugs, doping agents, food, and dietary supplements. These factors together can increase inhomogeneities in myocardial repolarization (“substrate”). In this case, an otherwise harmless extrasystole (“trigger”) occurring with unlucky timing may - although very seldomly - elicit fatal arrhythmias. Thus, effective prevention of sudden cardiac death may include new types of cost-effective cardiac electrophysiological screening methods (ECG or echocardiography) and, in case of a high level of suspicion, more costly genetic tests can be considered.]

Lege Artis Medicinae

[ANTITHROMBOTIC MEDICAL TREATMENT IN ACUTE CORONARY SYNDROME]

KISS Róbert Gábor

[Treatment of acute coronary syndrome has extensively changed during the last two to three decades. Improvement of medical care resulted in a strikingly lower hospital mortality, at least for acute coronary syndrome with ST-segment elevation. Currently, invasive revascularisation procedures have stepped into the limelight of medical activities. The success of this instrumental intervention has been due the development of aggressive adjuvant antithrombotic therapy. In our country, management of patients with acute coronary syndrome has also changed fundamentally, restructuring care system. This has at the same time resulted in better adherence to professional guidelines.]

Journal of Nursing Theory and Practice

Use of Imogene King’s Nursing Model in the Care for a Patient with Heart Arrhythmias

CLOUBOVÁ Ivana, BULAVA Alan

Objectives: To discover the benefits of implementation of Imogene King’s nursing model into nursing care in a patient with arrhythmias. To find out how these patients are limited in saturation of their own needs and what are the most severe limitations for patients with arrhythmias. Material and methods: Qualitative research using semi-structured interviews. The interview with patients with arrhythmia was conducted in accordance with the structure of King’s nursing model. Results: The research group consisted of 20 respondents; 13 men and seven women. All respondents expressed satisfaction with their cooperation with staff. The respondents described a change in the subjectively perceived state, the psychic state, and emotions. Conclusions: Assessment of the subjectively perceived quality of life of patients with arrhythmias using the King’s interaction model allows nurses to see the patient from the holistic point of view and plan and provide individualized care.