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M Jereczek

Publications and source records attributed to M Jereczek.

9 recordsLinked to original sources
PubMed1994

Early assessment of outcome by ST-segment analysis after thrombolytic therapy in acute myocardial infarction.

As an early marker of outcome, the sum of ST-segment elevation resolution between the electrocardiogram before and 3 hours after initiation of thrombolysis was investigated in 77 patients with acute myocardial infarction. Prospectively, three groups were defined according to complete (> or = 70%, n = 34), partial (< 70% to > or = 30%, n = 26), or no (< 30%, n = 17) ST resolution. There were considerable differences in the enzyme-determined infarct size (alpha-hydroxybutyrate dehydrogenase release for complete, partial, and no ST resolution: 529 +/- 397 IU/L, 689 +/- 484 IU/L, and 1293 +/- 742 IU/L, respectively; p = 0.0001) and the angiographic left ventricular function 1 week later (ejection fraction 58% +/- 10%, 53% +/- 13%, and 43% +/- 12%, respectively, p < 0.01; regional dyssynergic area 24 +/- 19, 39 +/- 23, and 50 +/- 21 U2, respectively, p < 0.01). Early reperfusion as assessed by creatine kinase release measured in 15-minute intervals was 90%, 65%, and 18%, respectively (p = 0.0001). Differences in degrees of ST-elevation resolution at 3 hours may help facilitate timely screening of patients for appropriate therapeutic intervention. Patients with complete ST resolution may be considered for early discharge, and patients with no ST resolution may be candidates for an early invasive approach or additional thrombolytic therapy.

Cardiac Catheterization↗
PubMed1994

[Recurrent ST segment elevations in continuous ECG analysis in the acute phase of myocardial infarct treated with thrombolytic therapy].

Early fluctuations of the ST-segment elevation indicating intermittent opening and reocclusion of the infarct artery has been well documented by angiographic monitoring in individual acute myocardial infarction patients undergoing thrombolytic therapy. However, the frequency of such episodes has not been studied in a consecutive patient group. Furthermore, it is not known what impact this finding has on the reinfarction risk during hospitalization and on left ventricular healing. The present investigation included 79 patients with acute myocardial infarction (pain < or = 6 h). Continuous Holter monitoring of the infarct-related ST elevation was initiated before or directly after starting thrombolytic therapy. During the 24-h observation period, 34 patients (43%) showed episodes of recurrent ST elevation after an initial resolution (group 1). Among those without episodes, ST elevation resolved within 4 h in 34 (43%, group 2) and persisted > or = 4 h in 11 (14%, group 3). Episodes of re-elevation were more frequent during the first 4 h (0.25 episodes per hour) than in the late part of the observation period (0.04 episodes per hour). Most episodes were transient and short lasting; only nine patients showed persistent re-elevations longer than 60 min. During hospitalization, group 1 patients had a higher incidence of reinfarctions and severe ischemic events than those without episodes (group 1 12/34 (35%) vs. group 2 4/34 (12%) vs. group 3 1/11 (9%), p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction.

Exercise testing is generally accepted for prognostic assessment of patients after infarction, but the prognostic value of transient myocardial ischemia during ambulatory electrocardiographic monitoring remains controversial. Of 281 consecutive postinfarction patients, 173 patients (132 men, 41 women) were prospectively studied with 24-hour Holter monitoring 14 +/- 5 days after acute myocardial infarction, and with submaximal exercise testing after 15 +/- 7 days. Patients with either conduction disturbances or pacemaker rhythm and 71 patients with digitalis medication were excluded. Myocardial ischemia was defined as horizontal or descending ST depressions or transient ST elevations > or = 0.1 mV with or without angina pectoris. The follow-up period was 1 year. Myocardial ischemia was observed in 40 patients (23%) during Holter monitoring, and 96% of the episodes were asymptomatic. Ischemia occurred during exercise testing in 46 patients (27%), two thirds of whom had no symptoms. Ischemia was detected by both methods (group A) in 19 patients (11%), with exercise testing only (group B) in 27 patients (16%), and with Holter monitoring only (group C) in 21 patients (12%). In 106 patients (61%), ischemia could not be ascertained at all. The 4 groups were comparable with regard to sex and age distribution, coronary risk factors, and medication. During follow-up, 50 patients (29%) experienced clinical cardiac events: 6 patients died, 7 had recurrent myocardial infarction, 14 developed unstable angina pectoris and required immediate revascularization, and 23 patients had recurrent but stable angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Transient ST segment depression during Holter monitoring: how to avoid false positive findings.

To increase the specificity of 24-hour Holter monitoring in detecting transient myocardial ischemia, we separated genuine ST deviations from those dependent on artifacts by adding a detailed shape analysis of real-time printouts to the usual criteria of significant ST segment depression. We screened 116 apparently healthy subjects; 31 had to be excluded, because of pathologic findings in preliminary examinations. The remaining 85 (49 women and 36 men; mean age, 43.1 years) underwent Holter monitoring for assessment of the extent, frequency, and duration of episodes of horizontal and descending ST segment depression of at least 0.1 mV that persisted for at least 60 msec after the J point and that were at least 1 minute apart. On the basis of these criteria, six subjects (7.1%) showed 24 episodes of horizontal or descending ST segment depression with a mean of 0.2 mV (range, 0.15 to 0.25 mV), a frequency of four episodes per 24 hours (one to nine), and a duration of 12.2 minutes (range 3-range 41 minutes). Supplementary criteria--e.g., sudden onset of ST segment depression, identical orientation of PQ and ST segments, or simultaneous increase in R and P wave amplitude--made it possible to identify ST changes caused by artifacts in four volunteers. In only two subjects (2.4%) could true silent ischemia not be differentiated from false positive results. Thus consideration of only the extent, frequency, and duration of episodes does not permit a differentiation between true silent ischemia and false positive results. A supplementary shape analysis increases the specificity of ST segment analysis in detecting transient myocardial ischemia during 24-hour Holter monitoring.

Adult↗
PubMed1992

[Unexpected malposition of a ventricular pacemaker electrode].

Ten years after mitral-valve replacement, a 69-year-old patient underwent VVI pacemaker implantation because of symptomatic bradyarrhythmia. Postoperatively, the electrocardiogram showed a right bundle branch pattern under ventricular stimulation while the threshold was optimal. Under fluoroscopy, we suspected a malposition of the electrode outside the right ventricle in the LAO and lateral view. This could not be verified by echocardiography, whereas contrast angiography of the right ventricle proved the extracavitary position of the electrode under the inferior wall of the left ventricle, probably in the middle cardiac vein. The electrode position was operatively corrected without complications. We discuss different ways of malposition and their detection by considering electrocardiographic configuration and fluoroscopy in LAO and lateral view.

Aged↗
PubMed1989

Accuracy of the ambulatory ECG monitoring system Cardio-Data Mk4 in detecting exercise-induced myocardial ischaemia.

The accuracy of ST-segment analysis in a direct-recording ambulatory ECG monitoring (AEGG) system (CardioData Mk 4 with recorder CardioData PR3) was compared with that obtained in a standard ECG recorder. Twenty two patients with coronary heart disease and a positive exercise test were submitted to a second bicycle exercise test with concomitant AECG monitoring. Application of a junction box made it possible to record the two bipolar AECG leads simultaneously on both standard ECG (leads ECG 1 and 2) and AECG (leads 1 and 2). We determined the time of the beginning, end and maximum and the magnitude of the ST-segment depression in bipolar leads AECG 1 and 2, and ECG 1 and 2. AECG monitoring was just as accurate as standard ECG: time intervals between the different leads showed good alignment. The degree of maximum ST-segment depression in ECG 1 (mean +/- SD: 0.22 +/- 0.11 mV) was identical to that in AECG 1 (0.22 +/- 0.13 mV). Maximum extent of ST-segment depression was lower in ECG 2 and AECG 2 but also comparable (ECG 2: 0.13 +/- 0.14 mV, AECG 2: 0.15 +/- 0.17 mV). Thus, ST-segment depressions found with a standard ECG recorder can also be reliably detected with a direct recording AECG monitoring system.

Aged↗
PubMed1988

[Diagnosis of stress-induced myocardial ischemia: accuracy of a direct recording long-term ECG system in comparison to standard ECG equipment].

The accuracy of ST-segment analysis with a direct-recording long-term ECG system (CardioData Mk 4) with a good low-frequency response was compared to that obtained by a standard ECG-recorder. Twenty-two patients with coronary heart disease and a positive exercise test were submitted to a second bicycle exercise test with concomitant long-term ECG registration. Application of a special switch device made it possible to record not only extremity and chest leads but also the two bipolar long-term ECG leads simultaneously on both the standard-ECG (leads ECG 1 and 2), and the long-term ECG (leads LEG 1 and 2). We determined the time of the beginning, end, maximum, and the magnitude of the ST-segment depression in bipolar leads LEG 1/2 and ECG 1/2, as well as in the unipolar leads V5/V6 of the exercise ECG. The long-term ECG was just as accurate as the standard ECG: the time intervals between the different leads showed good agreement. The degree of maximum ST-segment depression in ECG 1 (MW +/- SD = 2.2 +/- 1.1 mm) was identical to that in LEG 1 (2.2 +/- 1.3 mm). The maximum extent of ST-segment depression was lower in ECG 2 and LEG 2 but also comparable (ECG 2: 1.4 +/- 1.4 mm, LEG 2: 1.5 +/- 1.7 mm). Comparison of the unipolar leads V5/V6 of standard ECG with the bipolar lead LEG 1 of the long-term ECG yielded nearly identical results: V5/V6 2.0 +/- 0.7 mm; LEG 1: 2.2 +/- 1.3 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗