Biomedical subjects

Jan Eritsland

Publications and source records attributed to Jan Eritsland.

8 recordsLinked to original sources

PubMed2006

[Impaired glucose tolerance in patients with acute myocardial infarction].

BACKGROUND: Diabetes and impaired glucose tolerance are associated with increased mortality in patients with acute myocardial infarction. We have used standardised oral glucose tolerance tests shortly after a myocardial infarction. METHODS: 109 patients admitted with acute myocardial infarction were prospectively enrolled in the study. An oral glucose tolerance test was performed the first morning the patients were stable, without pain, nausea or hyperglycaemia. The patients were classified into normal glucose tolerance, impaired glucose tolerance or diabetes, according to the results of the oral glucose tolerance test and fasting plasma glucose levels. RESULTS: 109 patients (25 women) were included. Eight patients were previously diagnosed with diabetes type 2. Oral glucose tolerance was tested for 90 patients, usually the day after admission. The test was positive in 47 patients; 32 of them had 2-h plasma glucose levels between 7.8 and 11.0 mmol/L and were classified as having impaired glucose tolerance, and 15 had 2-h plasma glucose > or = 11.1 mmol/L and were classified as newly diagnosed diabetes patients. Similar body mass indexes and lipid values were found in patients with different glycometabolic states. Smoking was associated with a positive oral glucose tolerance test. INTERPRETATION: More than half of the patients with acute myocardial infarction had undiagnosed impaired glucose tolerance or diabetes type 2, as determined by an oral glucose tolerance test. The test could easily be performed shortly after a myocardial infarction in most of the patients. Oral glucose tolerance testing should be considered in all patients with coronary heart disease without a history of diagnosed diabetes.

Adult↗

PubMed2005

[Primary angioplasty in acute ST elevation myocardial infarction in the elderly].

BACKGROUND: Based on data from the literature, it has been suggested that elderly patients with acute myocardial infarction will benefit more from primary angioplasty than from thrombolysis. MATERIAL AND METHODS: Data for 100 consecutive patients, age 75 years or more, presenting with an acute ST elevation myocardial infarction (STEMI) without cardiogenic shock and treated with primary angioplasty were analysed retrospectively. Some variables were compared with previously published data on a group of 100 younger patients (mean age 59) with STEMI. RESULTS: Angiographically, the success rate of revascularization was similar between the elderly (mean age 80) and the younger STEMI patients. Mortality, both at 30 days and at 1 year, was higher among the elderly patients compared with the younger (15% vs. 1% and 21% vs. 3% respectively, both p < 0.001). In the same time period, primary angioplasty was performed in seven patients > or = 75 years who presented with cardiogenic shock at admission. All of these died during hospitalization. INTERPRETATION: Technically, the success rate of primary angioplasty in elderly patients with STEMI was similar to that in younger STEMI patients. Mortality after 30 days was significantly higher among the elderly patients, but the mortality rate from 30 days to 1 year after the infarction was similar to that of the same age group in the general population. Patients > or = 75 years presenting with STEMI and cardiogenic shock had no benefit of angioplasty; all died during hospitalization.

Aged↗

PubMed2005

[Is there a difference between low-molecular-weight heparins?].

Low-molecular-weight heparins share many properties and are commonly referred to as a group, but structurally and pharmacologically they are dissimilar. The size spectrum of the heparin molecules varies between the different products and as assessed in vitro, their anticoagulant properties differ. In particular, the ratio anti-factor Xa : anti-factor IIa activities varies. The clinical consequences of these differences are unknown. The efficacy and safety of two different low-molecular-weight heparins have been compared in only a few clinical studies; no significant differences in outcome were shown. However, low-molecular-weight heparins should be used according to the approved indication for each product and in doses shown effective and safe in clinical studies. A change from one low-molecular-weight heparin to another in the same patient should be avoided. Fondaparinux is a synthetic penta-saccharide which may be regarded as an extreme low-molecular-weight heparin with a ratio of anti-factor Xa : anti-factor IIa activity as 1 : 0, and with a promising efficacy/safety profile. So far, the approved clinical indication for its use is limited to prophylaxis in orthopaedic surgery.

Anticoagulants↗

PubMed2005

[Cardiogenic shock-- new therapeutic strategies].

BACKGROUND: Cardiogenic shock is a condition associated with high mortality. The evidence base for choice of treatment is insufficient, but new therapeutic options and new understanding have lead to some improvement in the prognosis. A new class of heart failure medication is now approved in Norway (calcium sensitizers). METHODS: We present a case history that illustrates new options in the treatment of cardiogenic shock complicating acute myocardial infarction. We have searched available literature and give a review of the treatment of cardiogenic shock with special emphasis on the role of inotropic drug therapy. RESULTS AND INTERPRETATION: A 46-year-old man with cardiogenic shock complicating myocardial infarction because of occlusion of the left-main coronary artery was treated with acute revascularization, intra-aortic balloon counterpulsation (IABP) and levosimendan. Early revascularization is a key factor in the treatment of cardiogenic shock; rapid transfer of patients to a revascularization centre is recommended. IABP should be considered after successful revascularization because of post-ischaemic dysfunction that persists despite restoration of epicardial blood flow. Beta-adrenergic stimulation of the heart should, if possible, be avoided, because of increased myocardial oxygen requirement, calcium overload of the cardiomyocytes, and increased mortality. Drug therapy using calcium sensitizers is promising, but more controlled clinical trials are needed.

Cardiotonic Agents↗

PubMed2004

[Reduction of myocardial infarction size after primary percutaneous coronary intervention].

BACKGROUND: Achieving reperfusion as soon as possible is essential in order to reduce myocardial infarction size and thus improve prognosis. An increasing number of patients with myocardial infarction are treated with primary percutaneous coronary intervention (PCI). Technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) is a valid test for assessing myocardium at risk and final infarct size expressed by a hypoperfusion index (HPI) of the left ventricular mass. MATERIAL AND METHODS: 20 patients with acute ST-elevation myocardial infarction were treated with primary percutaneous coronary intervention within six hours of onset of symptoms. Myocardium at risk and final infarct size were assessed by Technetium 99m-tetrofosmin immediately before and a few hours, one week and six weeks after. RESULTS: The hypoperfusion index immediately before percutaneous coronary intervention was 31%, four to six hours after PCI 25%, one week later 16% and six weeks later 12%, i.e. a relative reduction of 60% (p < 0.01). Anterior wall infarctions had a higher level of myocardium at risk before primary PCI compared to inferior wall infarctions (36% vs. 24%), but anterior wall infarctions had a higher salvage index compared to inferior wall infarctions. INTERPRETATION: This non-controlled study shows a marked reduction in final infarction size in patients with acute ST-elevation myocardial infarction treated with primary PCI.

Adult↗

PubMed2004

[Secondary prophylaxis after myocardial infarction, bypass surgery and percutaneous coronary intervention].

Patients who have sustained a myocardial infarction as well as patients treated with percutaneous coronary intervention or coronary bypass surgery have atherosclerotic coronary artery disease. They will need aggressive secondary prophylaxis, including modification of lifestyle risk factors. Most of these patients should be treated with statins. As clinical events often are manifestations of thrombotic complications, this patient group should be treated with platelet inhibition, anticoagulation, or both. After a myocardial infarction patients should be considered for anticoagulant treatment, for acetylsalicylic acid, or both. After coronary revascularisation acetylsalicylic acid should be considered primarily. If acetylsalicylic acid is contraindicated, clopidogrel is an alternative. After coronary stenting acetylsalicylic acid and clopidogrel should be prescribed combined, for up to one year afterwards. If indicated, anticoagulant treatment can be added to platelet inhibition. After bypass surgery, anticoagulation is equally effective as acetylsalicylic acid against graft occlusion and can be given alone if indicated. International Normalized Ratio can be aimed at 3.0 when anticoagulation is given alone, at 2.0-2.5 when combined with platelet inhibition. After a myocardial infarction patients should be given a beta-blocker if this is not strongly contraindicated and they also should be considered for ACE inhibitor treatment. These patients also seem to profit from a moderate supplement of n-3 polyunsaturated fatty acids.

Adrenergic beta-Antagonists↗

PubMed2003

[Aortic dissection--a differential diagnosis in patients with chest pain and ECG changes].

BACKGROUND: The effect of thrombolytic therapy in patients with myocardial infarction is well documented. In patients presenting with chest pain it may, however, be difficult to discriminate between myocardial infarction and aortic dissection only on the basis of clinical manifestations. Moreover, patients with type A dissection may have ECG changes caused by affection of the coronary flow. MATERIAL AND METHODS: We retrospectively investigated all patients admitted to our hospital with type A dissection of the aorta over the period 1999 to March 2001. RESULTS: Fourteen patients were identified. Only two patients had normal ECG, six had ST elevation. Two patients had received antithrombotic or thrombolytic therapy. INTERPRETATION: In patients with chest pain and ST elevation, aortic dissection must be considered as a differential diagnosis before thrombolytic therapy.

Adult↗

PubMed2002

[Left ventricular function and infarction size after primary angioplasty for acute myocardial infarction].

BACKGROUND: There is little information available on long-term changes in left ventricular function and infarct size after acute myocardial infarction treated with primary angioplasty. MATERIAL AND METHODS: From 1996 to 1998, 100 consecutive patients were treated with primary angioplasty for acute ST-elevation myocardial infarction. Left ventricular ejection fraction was determined by radionuclide ventriculography before discharge, after six weeks and after a mean follow-up time of 20 months (range 11-37). Infarct size was assessed by technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) at rest, performed at the same time intervals. RESULTS: Mean ejection fraction was 56% at discharge, 55% after six weeks and 57% after 20 months of follow-up. A mean perfusion defect of 19% was measured by SPECT after one week. After six weeks and 20 months of follow-up, the mean perfusion defects were reduced to 14% (p < 0.001) and 15%, respectively. INTERPRETATION: Left ventricular function was well preserved and infarct sizes small to moderate 20 months (range 11-37) after primary angioplasty for acute myocardial infarction, demonstrating that the initial successful effect of the treatment was maintained.

Aged↗