Biomedical subjects
Publications and source records attributed to M Dłuzniewski.
In 30 patients after myocardial infarctum with actual silent ischemia (no pain during last 12 months) mononitrate (Olicard 40) was administered and red blood cell deformability was determined. Clinical improvement and decrease of aforementioned deformability were observed after mononitrate therapy.
To determine the efficacy of mononitrate retard therapy in congestive heart failure 54 pts (42 males and 12 females, aged 67.2 +/- 8.7 yrs.) with NYHA functional class 1-3 and left ventricular ejection fraction less than 40% were investigated. Clinical examination, exercise treadmill test (ETT), ecg holter monitoring and echocardiography (echo-2D) were performed before and after 4 weeks of therapy with Olicard 40 mg Retard. 4 weeks treatment with mononitrate improved clinical parameters. The shift to lower functional NYHA class was observed in 12 cases (p < 0.01). Number of anginal pains per week was reduced from average 3.15 to 1.55 (p < 0.01). Mononitrate therapy improved exercise tolerance during ETT. Exercise time increased from 424 +/- 168 to 568 +/- 143 sec. (p < 0.001) as well as total workload in METS (3.6 +/- 1.4 vs. 4.9 +/- 1.9, p < 0.001). The time to 0.1 mV ischemic ST segment depression was extended from 215 +/- 149 to 357 +/- 173 sec. (p < 0.01). Holter monitoring revealed moderate increase in heart rate and significant reduction of ventricular arrhythmia (p < 0.05). No changes in systolic and diastolic echo-2D parameters were observed.
In order to compare the effectiveness of magnesium with that of proajmaline in preventing of recurrences of paroxysmal tachyarrhythmias. 60 consecutive patients were studied who had been previously treated for paroxysmal arterial fibrillation (PAF) or paroxysmal supraventricular tachycardia (PSVT). For the studies the patients were qualified who had been effectively treated during acute phase with intravenous magnesium (magnesium sulphate) and ajmaline (gilurytmal). The patients were randomly divided into three groups of 20 persons in each, every group received different oral treatment: in the first group--magnesium (magnesium carbonate) 3 x 0.6, in the second--proajmaline (neogilurytmal) in dose 3 x 20 mg, and in the third--neogilurytmal 2 x 20 mg and magnesium 2 x 0.6. During three months of observation the effectiveness of treatment and incidence of adverse effects were assessed. The following was found: neogilurytmal showed higher effectiveness (60%) than magnesium (30%), while the combined treatment demonstrated similar effectiveness (65%) as neogilurytmal alone with lower drug doses and lower incidence of bad tolerance manifestations (10% vs 20%).
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Relationship between duration of myocardial infarction pain (MIP) and homeostatic disturbances as well as degree of myocardial injury was investigated. Thirty patients admitted to the Coronary Care Unit during the pain due to progressive myocardial infarction were studied. Patients were divided into two groups according to the duration of pain. First one consisted of subject with pain lasting up to four hours, second group included those whose pain exceeded 4 hours. Following parameters were measured: 24 hours urine catecholamines excretion, serum triiodothyronine and creatinine phosphokinase activity estimated every 6 hours during consecutive two days. We concluded that patients with longer MIP displayed lager thyro-adrenergic and myocardial injury.
We investigated the relationship between platelet aggregability and occurrence of complex arrhythmias in 72 males in the third or fourth week after the onset of myocardial infarction. The patients who displayed complex arrhythmias (n = 31), as opposed to those with stable rhythm (n = 41) showed higher platelet aggregability (48 +/- 27% vs 37 +/- 22%, mean +/- standard deviation, respectively, P less than 0.01). No differences were found with respect to plasma free fatty acids and excretion of catecholamines. It is suggested that, after myocardial infarction, increased platelet aggregability may contribute to the development of complex arrhythmias.
The relationship between left ventricular (LV) wall motion disturbances (2D Echo) and latent complex ventricular arrhythmias (24-hr Holter ECG, Lown classification) in the late hospital phase of MI was investigated. A positive correlation was found between the extent of LV damage and the occurrence of complex arrhythmias expressed as the highest Lown class. Echocardiographic indices predictive of latent complex arrhythmias were derived. The most specific and predictive indices are: presence of dyskinesia, Heger index greater than 9, Heger index greater than 6 with LV enlargement, and number of hypo-, a- and dyskinetic LV segments greater than 4 with LV enlargement. Echocardiographic estimation of LV wall motion disturbances can be used as a method to identify patients threatened with major arrhythmias.
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Late potentials occurring at the end of or after the QRS complex were recorded from the body surface by means of a high-gain ECG and the signal-averaging technique in 75 patients, within 24 h from the onset of symptoms of acute myocardial infarction. Late potentials were found in 20 patients (26.7%). Out of this group, eight (40%) developed ventricular fibrillation. There was only one incident of ventricular fibrillation among 55 patients without late potentials (1.8%, P less than 0.001). The three-month mortality after myocardial infarction was slightly higher in individuals with late potentials: 15% vs. 11.5%, but this difference was not statistically significant. We conclude that the presence of late potentials recorded in the acute phase of myocardial infarction indicates a risk of ventricular fibrillation, but this was not associated with an increased mortality rate during the three-month follow-up.
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