Przydatność monitorowania EKG metodą Holtera do oceny ryzyka pacjentów z chorobami układu krążenia

Ambulatoryjne monitorowanie EKG metodą Holtera jest nieinwazyjnym badaniem o potwierdzonej przydatności w diagnostyce schorzeń układu krążenia. W ostatnich latach, dzięki wprowadzeniu nowych analiz możliwych do zastosowania w czasie badania holterowskiego, metoda ta stała się przydatna również w ocenie rokowania, zwłaszcza pacjentów z chorobą niedokrwienną serca. W niniejszej pracy, na podstawie danych z piśmiennictwa i własnych obserwacji, opisano przydatność monitorowania EKG metodą Holtera w przewidywaniu ryzyka u pacjentów z chorobami układu sercowo-naczyniowego

The influence of physical rehabilitation on arterial compliance in patients after myocardial infarction

Background: The aim of this study was to determine the effect of 6-week physical training on the mechanical properties of the arteries, in patients (pts) after acute myocardial infarction (MI). Methods: The group under investigation consisted 119 pts after their first acute MI qualified for the second stage of post-hospital training. Only 64 pts (Group 1) underwent the training program. The remaining 55 pts (Group 2) could not participate in it. All the pts underwent an initial exercise test, an ultrasound cardiac scan and a pulse wave velocity (PWV) measurement by means of the COMPLIOR system. Group 1 underwent cardiac rehabilitation program according to Model A or B, depending on exercise tolerance at baseline. Then, both groups had another exercise test and another PWV measurement. Additional PWV measurements were taken in both groups after 6 months. Results: Both groups were comparable with respect to demographic data, the site of MI, the method of treatment, left ventricular function, mean exercise time, the workload attained and mean PWV values at baseline (12.8 ± 1.6 m/s vs. 12.2 ± 2.7 m/s). In group 1 a significant increase in exercise capacity was observed: from 6.46 ± 2.7 to 8.95 ± 2.16 MET, and the PWV values were significantly lowered from 12.8 ± 1.6 to 8.7 ± 1.8 m/s. Group 2 showed only a slight lowering of PWV from 12.2 ± 2.7 to 10.8 ± 2.3 m/s. Conclusions: Controlled physical training after MI significantly improves systemic arterial compliance, probably through improving the endothelial function. (Cardiol J 2007; 14: 366-371

Myocardial infarction in young people

An estimated 6 to 10% of myocardial infarctions occur in patients under the age of 45. Usually this applies to men, but an increasing prevalence is being observed among women. Atherosclerosis, often one vessel disease, is the main cause. The presence of classic risk factors affects the dynamics of coronary artery disease: the strongest risk factor is smoking, regardless of gender. Environmental influence is also possible. No atherosclerosis is found in 20% of young patients. In such cases, the most frequent mechanisms of ischemia are: coronary artery embolism (5%), thrombosis (5%), anomalies (4%) and inflammation or spasm of the vessel. Age is an independent prognostic factor. Thus the clinical outcome after myocardial infarction is better in younger than in older patients