The aim of the present study was to investigate the prevalence of left ventricular (LV) thrombus formation and important determinants in patients with acute ST elevation myocardial infarction localized to the anterior wall treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy. One hundred selected patients with ST elevation myocardial infarctions revascularized with PCI in the left anterior descending coronary artery were included. The patients participated in the Autologous Stem Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial. All were treated with aspirin 75 mg/day and clopidogrel 75 mg/day and underwent serial echocardiography and magnetic resonance imaging during the first 3 months after PCI. After 4 to 5 days, the ejection fraction and infarct size in percentage of the left anterior descending coronary artery area were assessed using single photon-emission computed tomography in addition to the ejection fraction by echocardiography. LV thrombi were detected in 15 patients during the first 3 months, 2/3 of them within the first week. No differences in baseline characteristics between the groups with and without LV thrombi were shown. However, in the thrombus group, significantly higher peak creatine kinase levels (6,128 vs 2,197 U/L, p <0.01), larger infarct sizes (82.5% vs 63.8%, p <0.01), and lower ejection fractions on single photon-emission computed tomography (35.5% vs 40.0%, p ‫؍‬ 0.03) and on echocardiography (43.0% vs 46.0%, p ‫؍‬ 0.03) were found compared to patients without LV thrombi. In conclusion, LV thrombus formation is a frequent finding in patients with anterior wall ST elevation myocardial infarction treated acutely with PCI and dualantiplatelet therapy and should be assessed by echocardiography within the first week.

e Abstract-Objective: The aim of this study was to determine the prevalence of anxiety and depressive disorders in patients presenting with chest pain to the Emergency Department (ED) and determine if there is a relationship between these and cardiac vs. non-cardiac chest pain. Methods: This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale. Results: A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 ؎ 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p ‫؍‬ 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p ‫؍‬ 0.965). Conclusion: Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.

To determine, among patients who present to the emergency department with symptoms suggestive of acute coronary syndrome (ACS), predictors of short-term revascularization. A prospective descriptive trial was performed. Potential predictors for revascularization were measured by means of a questionnaire of providers, serum for cardiac biomarkers, and an initial ECG. The primary outcome of revascularization (coronary bypass graft or percutaneous intervention) was determined through a medical record review. Potential predictors of revascularization were entered into a family of logistic regressions. 341 eligible subjects were enrolled, of whom 14% underwent revascularization. The predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization. In a single site study, among emergency department patients with symptoms suggestive of ACS, ST elevation on initial ECG and an elevation in troponin I, CK-MB, and myoglobin upon presentation all predicted short -term revascularization. Among the three biomarkers, elevation in troponin I was the strongest predictor. ABBREVIATED ABSTRACT: We conducted a prospective descriptive trial to identify predictors of short-term revascularization among 341 emergency department patients who presented with symptoms suggestive of ACS. Fourteen percent of the study population received revascularization. Predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0.), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization.

for acute myocardial infarction (AMI) demonstrate the potential to limit infarct size and decrease mortality by coronary reperfusion and arrhythmia control. The effectiveness of these treatments is dependent on time and access to acute medical care. Coronary reperfusion requires early administration of thrombolytic agents or angioplasty. 1-3 Defibrillation and other methods to control cardiac arrhythmias require trained personnel and equipment in an appropriate clinical setting. 4,5 Although the need for timely receipt of these therapeutic strategies is well recognized, rapid access to emergency medical care re-).

Introduction: The treatment and outcome of acute myocardial infarction (AMI) has evolved greatly over the past few decades. We compared the mortality and complication rates of patients with AMI admitted to the Coronary Care Unit (CCU) in 2002 to previously reported data. Materials and Methods: All data for AMI patients admitted to National Heart Centre CCU in 2002 were collected through the Singapore Cardiac Data Bank, including demographics, inhospital complications and mortality. These were compared to previous reports from the same institution in 1988, 1975 and 1967. Results: A total of 516 cases with AMI were identified. A higher proportion of patients were aged ≥ ≥ ≥ ≥ ≥70 years in 2002 (31.8%) compared to 1988 (25%), 1975 (11%) and 1967 (5.6%). Acute percutaneous transluminal coronary angioplasty (PTCA) was performed in 250 of 516 (48%) patients in 2002. The overall in-patient and age-standardised mortality was 14.7% and 10% respectively, compared to 20.6% and 17% respectively in 1988 (P = 0.06). For the 250 patients who underwent acute PTCA, overall mortality was 5.2% compared to 24% in those who did not (P <0.001). Common in-hospital complications included heart failure (38%), non-sustained ventricular tachycardia (8%), atrial fibrillation (8%) and complete heart block (6%). Age, heart failure, bundle branch block and sustained ventricular tachycardia were associated with higher mortality by univariate analysis. On multivariate analysis, older age, heart failure and the absence of percutaneous intervention were independently associated with higher mortality. Conclusion: In-hospital mortality for AMI patients admitted to the CCU declined from 1988 to 2002 despite a higher proportion of elderly patients.

The demonstration in animals that recombinant tissue-type plasminogen activator produces prolonged thrombolysis after its clearance from the circulation has prompted a few pilot studies of bolus administration in patients. Alteplase (bolus dose of 70 mg) resulted in the highest recanalixation rate in our previous pilot study comparing bolus doses of 50,60 and 70 mg of alteplase in patients with acute myocardial infarction. The aim of the present trial was to assess the efficacy and safety of the same bolus dose in a larger number of patients. A further objective was to study the anglographic reocclusion rate at 12 to 24 hours in patients who had a recanaliied infarct-related coronary artery at 90 minutes and were randomized at that time to a bolus dose or an infusion for 3 hours of 30 mg of alteplase.

Background and purpose: Some types of radiation therapy have been associated with an increased risk of cardiac mortality and morbidity in patients with early-stage breast cancer. A relationship has been observed between cardiac radiation dose-volume and the level of excess risk of cardiac mortality. However, relatively few data are available on the morbidity from myocardial infarction associated with adjuvant radiotherapy.

Background: Cardiovascular and cancer problem is increasing day by day and causing untimely deaths worldwide. A continuous research is going on to develop new cardioprotective and anticancer drugs which are safe, economical and effective. Doxorubicin is a potent anticancer drug with restricted use due to cardio toxicity that it causes as side effect. Thus, any drug which will reduce its toxicity will be a boon for cancer patient. Herbal drugs are emerging as potent targets for research because they are cheap, locally available; having least reported side effects and generally being the part of our food culture. In view of this we have tried to evaluate the cardioprotective potential of resveratrol and black tea extract alone and in combination on the doxorubicin-induced myocardial infarction in rats.  Methods: Thirty rats of Wistar albino strain were taken and divided into Control, Doxorubicin (DOX), Black Tea + DOX, Resveratrol + DOX, Black Tea + Resveratrol and Black Tea + Resveratrol + DOX treated groups. Various biochemical parameters were assessed to evaluate their antioxidant property and myocardial membrane integrity. Effect of these neutraceuticals on cellular architecture was also assessed by histopathological studies. Results and Discussions: Biochemical and histopathological investigations clearly showed the reversal of all the parameters  towards  normal indicating improvement in antioxidant status and reduction in cardiac damage. Conclusion:  All the test drugs administered groups ; black tea-treated, resveratrol-treated and their combination-treated groups, showed cardio protection but the combination-treated group proved to be a better cardioprotective agent than the two drugs alone.

on behalf of the GISSI-3 Investigators* Left ventricular (LV) thrombosis can be found in patients with acute myocardial infarction (AMI). No wide multicenter trial on AMI has provided information about LV thrombosis until now. The protocol of the GISSI-3 study included the search for the presence of LV thrombosis in patients from 200 coronary care units that did not specifically focus on LV thrombosis. We examined the GISSI-3 database results related to 8,326 patients at low to medium risk for LV thrombi in which a predischarge echocardiogram (9 ؎ 5 days) was available. LV thrombosis was found in 427 patients (5.1%): 292 of 2,544 patients (11.5%) with anterior AMI and in 135 of 5,782 patients (2.3%) with AMI in other sites (p <0.0001). The incidence of LV thrombosis was higher in patients with ejection fraction <40% (151 of 1,432 [10.5%] vs 276 of 6,894 [4%]; p <0.0001) both in the total population and in the subgroup with anterior AMI (106 of 597 [17.8%] vs 186 of 1,947 [9.6%]; p <0.0001). Multivariate analysis showed that only the Killip class >I and early intravenous ␤-blocker administration were independently associated with higher LV thrombosis risk in the subgroup of patients with anterior AMI (odds ratio 1.75, 95% confidence interval 1.28 to 2.39; odds ratio 1.32, 95% confidence interval 1.02 to 1.72, respectively). In patients with anterior AMI, oral ␤-blocker therapy given or not given after early intravenous ␤-blocker administration does not influence the occurrence of LV thrombosis. The rate of LV thrombosis was similar in patients treated or not treated with nitrates and lisinopril both in the total population and in patients with anterior and nonanterior AMI. In conclusion, in the GISSI-3 population at low to medium risk for LV thrombi, the highest rate of occurrence of LV thrombosis was found among patients with anterior AMI and an ejection fraction <40%. Killip class >I and the early intravenous ␤-blocker administration were the only variables independently associated with a higher predischarge incidence of LV thrombosis after anterior AMI. ᮊ1998 by Excerpta Medica, Inc.

Background: Myocardial infarction is one of the most common life threatening diagnoses in emergency hospital admissions. Most of the complications occur during the first few hours while the patients are likely to be in the hospital. Although the mortality rate after admission for myocardial infarction has declined significantly over the last two decades but it still remains high. Survival is markedly influenced by age of the patient, presence of different risk factors and complications that patients develop after myocardial infarction. We conducted a study at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) to document the predictors of mortality in patients with acute myocardial infarction. Methods: Patients with first acute myocardial infarction admitted to the hospital from Feb. 2007 to June 2007 were included in the study. It was a descriptive case series study and data was collected on a pre-designed proforma with convenient sampling technique. Patients were assessed clinically with special emphasis on history of typical chest pain and physical examination. Relevant investigations were carried out to establish the diagnosis. Results: Two hundred and fifty cases were assessed. Mean age was 57.94±14.00 years. Males were 74.4% and Females were 25.6%. Overall in-hospital mortality was 9.2%. Females had a higher mortality (14.06%) as compared to males (7.52%). Mortality was also related with age of the patient and Diabetes Mellitus. Other features adversely affecting the in-hospital mortality included higher Killip class, anterior wall myocardial infarction and higher peak Creatine Kinase (CK) levels. Mortality was also higher in patients who did not receive thrombolytic therapy for different reasons. Conclusion: Patients with certain risk factors are more prone to develop complications and have a higher mortality rate. Identification of some of these risk factors and timely management of complications may reduce mortality.

In patients with acute myocardial infarction (AMI), little is known about the correlation between prognostic variables and aspects of ruptured plaque at the coronary angiography. Five hundred patients with acute myocardial infarction were studied in a consecutive and prospective manner; of these, 264 patients were excluded mainly because of the presence of an occluded culprit coronary artery. The remaining 236 patients were divided according to the presence (113, 52%) or absence (126, 48%) of angiographic aspects suggestive of ruptured plaque, and correlated with 49 clinical, electrocardiographic, in-hospital complications, procedures, and other angiographic prognostic variables. The variables that correlated significantly and independently with angiographic aspects of ruptured plaque were: presence of thrombi and higher degree of residual stenosis at the culprit coronary artery, as well as white ethnic group.

Carbon monoxide (CO) is known as a silent killer because it is an odorless, colorless and nonirritating gas. The clinical findings of CO poisoning are highly variable, but neurologic and cardiovascular complications are common . Myocardial infarction related to CO poisoning has been frequently reported in the literature; however, ST elevation myocardial infarction due to coronary occlusion is a very rare presentation. Here, we report a rare case of acute CO poisoning complicated with acute anterior ST elevation myocardial infarction.

Acute mitral regurgitation is a heterogeneous and life-threatening pathology, with severe hemodynamic consequences and extremely adverse outcomes. Traditionally, the definitive treatment is prompt surgical intervention after hemodynamic stabilization. Nowadays, however, percutaneous repair of mitral valve with MitraClip device has emerged as a safe and effective therapeutic option. Evidences in this field are still scarce. Hereby, we report the case of an 82-year-old woman with lateral ST-elevation myocardial infarction determining severe acute mitral regurgitation (MR) with an asymmetric leaflet tethering mechanism. Due to prohibitive operative risk and unstable hemodynamic status, the patient underwent a successful urgent MitraClip procedure with optimal reduction of MR and immediate hemodynamic improvement. Moreover, we provide a review of the available literature regarding the echocardiographic assessment of acute MR, results of published cases and possible management of this complex pathology.

Human heart-type fatty acid-binding protein (FABP) is suggested as an early plasma marker of acute myocardial infarction (AMI), and several studies have proved that, for early diagnosis of AMI, FABP performs better than myoglobin, which is a more often used early marker protein. Because serial measurement of biochemical markers in plasma is now universally accepted as an important determinant in AMI diagnosis, a rapid and continuous measuring method for FABP would be desirable. The aim of the present study was to develop an immunoassay based on the principle of displacement and using a column for rapid and continuous measurement of FABP in plasma. Glass columns filled with Sepharose-bound FABP were loaded with a horseradish peroxidase (HRP)-labeled antibody (Ab) and equilibrated with human plasma. After reaching a stable baseline, human plasma spiked with FABP or plasma from AMI patients was added. The Ab-HRP complex dissociated due to the presence of FABP in the plasma and was subsequently quantified. For plasma from AMI patients (n=5), the Ab-HRP level thus measured correlated with the corresponding plasma FABP concentration (R=0.96). The results of this study show the feasibility of a sensor for continuous monitoring of FABP in plasma. D 2004 Published by Elsevier B.V.

This study investigates the impact of tbrombol sis on infarct expansion and subsequent left ventricu ar (LV) r remodeling in patients with anterior wall acute myocardial infarction (AMI). We evaluated 51 consecutive patients (24 treated with thrombolysis) with anterior wall AMI by 2-dimensional echocardiography in the following s 6 weeks, an 7 uence: days 1, 2, 3, and 7, after 3 and after 3,6, and 12 months. LV end-diastolic and end-systolic volume indexes were determined from apical 2-and 4-chamber views using Simpson's biplane formula. Infarct and -total LV perimeters were determined in the same views and their ratio expressed as infarct percentage. Infarct expansion was defined as: (1) an increase in infarct percentage and total perimeter *5% on days 2 to 3 in either of the views, or (2) initial infarct percentage ~50% with an increase in total perimeter ~5% on days 2 to 3. Corona angiography was performed in 43 patients bef a:h ore ISC arge, and patency of the infarct-related artery was assessed using Thrombolysis in Myocardial Infarction trial criteria. Infarct expansion was deteck ed in 23 patients. Infarct perimeter steadi 'r decreased in patients with versus without thrombo sis and in patients with patent versus occluded in arckrelated r arteries. Furthermore, by logistic regression, thrombolysis (p = 0.007) and patency of the infarct-related artery (p = 0.02) were strong negative 'predictors of expansion, whereas initial infarct perimeter (p = 0.009) was directly associated with subsequent expansion. End-systolic volume index was higher in patients with expansion from day 1 (p = 0.003) through the end of the study (p = O.OZl), and end-diastolic volume index was higher in these patients from da 2 ( tR = 0.012) throu 9

In a randomized, double-blind, controlled trial, the effects of oral treatment with coenzyme Q10 (CoQ10, 120 mg/day), a bioenergetic and antioxidant cytoprotective agent, were compared for 1 year, on the risk factors of atherosclerosis, in 73 (CoQ, group A) and 71 (B vitamin group B) patients after acute myocardial infarction (AMI). After 1 year, total cardiac events (24.6 vs. 45.0%, p < 0.02) including non-fatal infarction (13.7 vs. 25.3%, p < 0.05) and cardiac deaths were significantly lower in the intervention group compared to control group. The extent of cardiac disease, elevation in cardiac enzymes, left ventricular enlargement, previous coronary artery disease and elapsed time from symptom onset to infarction at entry to study showed no significant differences between the two groups. Plasma level of vitamin E (32.4 ± 4.3 vs. 22.1 ± 3.6 umol/L) and high density lipoprotein cholesterol (1.26 ± 0.43 vs. 1.12 ± 0.32 mmol/L) showed significant (p < 0.05) increase whereas thiobarbituric acid reactive substances, malondialdehyde (1.9 + 0.31 vs. 3.1 + 0.32 pmol/L) and diene conjugates showed significant reduction respectively in the CoQ group compared to control group. Approximately half of the patients in each group (n = 36 vs. 31) were receiving lovastatin (10 mg/day) and both groups had a significant reduction in total and low density lipoprotein cholesterol compared to baseline levels. It is possible that treatment with CoQ10 in patients with recent MI may be beneficial in patients with high risk of atherothrombosis, despite optimal lipid lowering therapy during a follow-up of 1 year. Adverse effect of treatments showed that fatigue (40.8 vs. 6.8%, p < 0.01) was more common in the control group than CoQ group.

Tako-tsubo cardiomyopathy is a cardiac syndrome precipitated by profound emotional stress and anxiety, particularly in middle-aged women. It presents as a mimic of acute myocardial infarction, but coronary angiography shows normal coronary arteries and a characteristic left ventriculogram resembling an &quot;octopus pot&quot;. The condition seems to have a favourable prognosis. Initially described in Japan, and with many names in the literature, it is being increasingly recognised in the West owing to early coronary angiography and primary coronary intervention, accounting for up to 1 in 30 primary cases of angioplasty in some institutions. A typical case is described, and the clinical features, pathophysiology and management reviewed.

The decision to administer thrombolytic therapy for limitation of acute myocardial infarction (AMI) size must occur when only the history, physical examination and 12-lead electrocardiogram of a patient are available. A method that could quickly assess the amount of jeopardized myocardium would greatly aid the physician. This study developed formulas from 66 anterior and 60 inferior AMI patients using the extent of initial ST-segment deviation (STA) to predict the final AMI size estimated by the Selvester QRS score in a population not receiving reperfusion therapy. Inclusion required: initial anterior or inferior AMI; admission electrocardiograpm 16 hours after the onset of symptoms with evidence of epicardial injury; elevated creatine kinase-MB; a predischarge electrocardiogram taken 272 hours after admission; and no AMI extension before the predischarge

Inhalation of hydrogen (H 2 ) gas has been demonstrated to limit the infarct volume of brain and liver by reducing ischemia-reperfusion injury in rodents. When translated into clinical practice, this therapy must be most frequently applied in the treatment of patients with acute myocardial infarction, since angioplastic recanalization of infarct-related occluded coronary artery is routinely performed. Therefore, we investigate whether H 2 gas confers cardioprotection against ischemia-reperfusion injury in rats. In isolated perfused hearts, H 2 gas enhances the recovery of left ventricular function following anoxiareoxygenation. Inhaled H 2 gas is rapidly transported and can reach 'at risk' ischemic myocardium before coronary blood flow of the occluded infarct-related artery is reestablished. Inhalation of H 2 gas at incombustible levels during ischemia and reperfusion reduces infarct size without altering hemodynamic parameters, thereby preventing deleterious left ventricular remodeling. Thus, inhalation of H 2 gas is promising strategy to alleviate ischemia-reperfusion injury coincident with recanalization of coronary artery.

The aims of this study were to assess the safety of drug-eluting stent (DES) use and to compare the incidence of in-stent restenosis (ISR) and neointimal hyperplasia formation according to the type of stent implanted (DES vs bare-metal stents [BMS]) in patients who underwent intracoronary bone marrow mononuclear cell transplantation after acute ST elevation myocardial infarction. Fifty-nine patients with successfully revascularized ST elevation myocardial infarction (37 using BMS and 22 using DES) underwent paired angiographic examinations at baseline and 6 to 9 months after the intracoronary injection of 91 million ؎ 56 million autologous bone marrow mononuclear cells. A subgroup of 30 patients also underwent serial intravascular ultrasound examinations. Off-line angiographic assessment showed 4 cases of binary ISR, primarily in BMS (3 cases), and no major adverse cardiac events were associated with stent type (mean follow-up period 41 ؎ 10 months). At follow-up, angiographic late luminal loss was significantly lower in patients with DES than in those patients with BMS (0.35 ؎ 0.66 vs 0.71 ؎ 0.38 mm, p ‫؍‬ 0.011). Multivariate analysis identified the use of DES (␤ ‫؍‬ ؊0.32, 95% confidence interval [CI] ؊0.57 to ؊0.26, p ‫؍‬ 0.03) and a smaller baseline reference vessel diameter (␤ ‫؍‬ 0.29, 95% CI 0.04 to 0.54, p ‫؍‬ 0.02) as independent predictors of lower late loss. Moreover, intravascular ultrasound showed a significant reduction of in-stent neointimal hyperplasia formation related to DES use compared with BMS use (⌬ neointimal hyperplasia volume 5.4 mm 3 [95% CI 2.7 to 28.1] vs 35.9 mm 3 [95% CI 22.0 to 43.6], p ‫؍‬ 0.035). In conclusion, these findings suggest that the use of DES is safe and may prevent ISR and neointimal hyperplasia formation in patients who undergo intracoronary bone marrow mononuclear cell transplantation after a successfully revascularized ST elevation myocardial infarction.

The medical management of acute coronary syndrome (ACS) follows the recommendations of international medical societies. The call to the emergency services by the patient triggers a race against the clock in pre-hospital care. It is essential to reduce the duration of the inadequate perfusion of the heart in order to limit its consequences. An effective reperfusion strategy must be planned in advance taking into account the logistical constraints. It is crucial that the general public is educated to recognise the signs of ACS and to call the emergency services immediately (such as (15,112, 991).
La prise en charge médicale du syndrome coronarien aigu (SCA) est cadrée par les recommandations des sociétés savantes internationales. L’appel au centre 15 par le patient déclenche une course contre la montre en préhospitalier. Il faut réduire le délai de mauvaise perfusion du cœur et en limiter les conséquences. Une stratégie de reperfusion efficace doit être anticipée avec des contraintes logistiques. L’éducation des populations est primordiale dans la reconnaissance des signes de SCA, avec un appel précoce au centre 15, 112 ou 911.

Background: Trandolapril is a newer angiotensin-converting enzyme (ACE) inhibitor that is approved by the US Food and Drug Administration for the treatment of hypertension and for use in stable patients who have evidence of left ventricular (LV) systolic dysfunction or symptoms of chronic heart failure within the first 2 days after an acute myocardial infarction (AMI). The fixed-dose combination of trandolapril and verapamil extended release (ER) is approved for the treatment of hypertension only. Objective: The purpose of this article was to review the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of trandolapril as monotherapy and in fixed-dose combination with verapamil ER. Methods: Relevant studies were identified through a MEDLINE/PubMed search of the English-language literature published between January 1983 and August 2002 and a review of the bibliographies of identified articles. Results: Trandolapril has a sufficient duration of inhibition of plasma ACE activity to allow once-daily dosing. It is converted by esterases to the active trandolaprilat metabolite, with mean terminal disposition half-lives of <1 and-75 hours for the prodrug and metabolite, respectively. In comparative trials in the management of hypertension, trandolapril 1 to 4 mg/d was statistically indistinguishable from or superior to captopril 100 mg/d, enalapril 10 or 20 mg/d, hydrochlorothiazide (HCTZ) 25 mg/d, nifedipine ER 30 or 40 mg/d, nitrendipine 20 mg/d, perindopril 4 mg/d, and verapamil ER 120 to 240 mg/d. In the Trandolapril Cardiac Evaluation, trandolapril also significantly reduced all-cause mortality, cardiovascular mortality, sudden death, and progression to severe chronic heart failure in patients with evidence of LV systolic dysfunction after AMI. In

The American College of Cardiology (ACC) and European Society of Cardiology (ESC) recently proposed criteria for acute ST elevation myocardial infarction (STEMI). These criteria were based on STj Ͼ0.1 mV in limbs leads and V4 -V6, or STj Ͼ0.2 mV in V1 to V3 with criteria being met in two contiguous leads. The criteria were neither age nor sex dependent and the aim of the present study was to evaluate whether or not improved STEMI criteria that were age and gender dependent could be developed. A training set of 789 ECGs from patients presenting with chest pain due to cardiac and other causes was available for study. Revised criteria for STEMI were developed using these data as well as ECGs from a normal adult population of 859 males and 637 females. A test set of ECGs was available in the form of 1220 ECGs recorded from a separate hospital from patients presenting with chest pain. 248 patients had an acute myocardial infarction on the basis of conventional clinical criteria while 972 did not. There was an improvement in sensitivity using the new criteria compared to the old criteria from 41.5% to 46.7% while specificity improved from 96.0% to 98.5%. Specificity in normals improved from 92.6% to 99.8%. The conclusion drawn is that while the ACC/ESC criteria are simple to apply, they are not particularly specific and can be improved by being supplemented by other ECG measures and optimized for age and sex.

on behalf of the GISSI-Prevenzione Investigators* Background-The relation between coffee consumption and cardiovascular disease has been studied extensively, but results are still debated. In addition, little evidence is available on patients with established coronary heart disease. Methods and Results-Prospectively ascertained information among 11 231 Italian patients (9584 males and 1647 females) with recent (Յ3 months) myocardial infarction enrolled in the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevenzione trial was used. Usual dietary habits were assessed at baseline and updated at 0.5 and 1.5 years. Coffee consumption was categorized as never/almost never, Ͻ2 cups per day, 2 to 4 cups per day, and Ͼ4 cups per day. Medication use and fasting glucose were assessed at 0.5, 1, 1.5, 2.5, and 3.5 years. Risk was evaluated with Cox proportional hazards with time-varying covariates. The main outcome measure was the cumulative incidence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke). A total of 1167 cardiovascular events occurred during 36 961 person-years of follow-up. After multivariable adjustment for potential confounders in the time-dependent analysis, the relative risk of cardiovascular events across categories of coffee consumption was 1.02 (95% CI 0.87 to 1.20) for Ͻ2 cups per day, 0.91 (95% CI 0.75 to 1.09) for 2 to 4 cups per day, and 0.88 (95% CI 0.64 to 1.20) for Ͼ4 cups per day compared with abstainers (P for trendϭ0.18). Ultimately, coffee consumption did not change the risk of coronary heart disease events, stroke, and sudden death. Conclusions-No association between moderate coffee intake and cardiovascular events was observed in post-myocardial infarction patients.

This review summarizes the nature of ambient air pollutants, which are either gaseous or particulate of various sizes, the latter determining their penetration into the body, the smallest even translocating from the lung into the systemic circulation. It presents the epidemiological evidence linking air pollution to overall mortality, cardiovascular mortality and myocardial infarction, making the distinction between acute and chronic exposure to the pollutants. It reviews mechanistic investigations that have evaluated the links among exposure to pollutants, thrombosis, pulmonary inflammation, arterial vasoconstriction and heart rate variability. It concludes by attempting to integrate current epidemiological and mechanistic observations into a pathophysiological framework that links ambient air pollution to acute myocardial infarction and cardiovascular mortality.

We compared a rapid, point-of-care multimarker protocol with a single and serial troponin I (TnI)-only protocol in 5,244 patients admitted to the emergency department with chest pain. The diagnosis of acute myocardial infarction (AMI) was based on a doubling myoglobin level accompanied by at least a 50% increase in the creatine kinase (CK)-MB level with no detectable TnI; a doubling of myoglobin level together with any detectable TnI; or a TnI level of 0.4 ng/mL (0.4 µg/L) or more, irrespective of myoglobin or CK-MB results. By using these new criteria, 145 of 148 cases were positive for AMI (positive predictive value [PPV], 92.4%) and 3 were negative, which were also negative by the core laboratory TnI assay. Twelve confirmed non-AMI cases were positive by the new protocol, with 10 of 12 confirmed by the core laboratory as positive for TnI. The negative predictive value (NPV) was 99.9%; the overall diagnostic accuracy was 99.7%. The TnI-only protocol had a sensitivity of 68.2% with an NPV of 99.1%. With lower TnI-only cutoffs, 4 patients had false-negative results, and a PPV of 36.4% was observed. Our rapid multimarker protocol seems superior to a TnI-only approach for rapidly triaging patients with chest pain or AMI.

Human saliva plays a pivotal role in digesting food and maintaining oral hygiene. The presence of electrolytes, mucus, glycoproteins, enzymes, antibacterial compounds, and gingival crevicular fluid in saliva ensures the optimum condition of oral cavity and general health condition. Saliva collection has been proven non-invasive, convenient, and inexpensive compared to conventional venipuncture procedure. These distinctive advantages provide a promising potential of saliva as a diagnostic fluid. Through comprehensive analysis, an array of salivary proteins and peptides may be beneficial as biomarkers in oral and systemic diseases. In this review, we discuss the utility of human salivary proteomes and tabulate the recent salivary biomarkers found in subjects with acute myocardial infarction as well as respective methods employed. In a clinical setting, since acute myocardial infarction contributes to large cases of mortality worldwide, an early intervention using these biomarkers will provide an effective solution to reduce global heart attack incidence particularly among its high-risk group of type-2 diabetes mellitus patients. The utility of salivary biomarkers will make the prediction of this cardiac event possible due to its reliability hence improve the quality of life of the patients. Current challenges in saliva collection are also addressed to improve the quality of saliva samples and produce robust biomarkers for future use in clinical applications.

. Chest pain is one of the most important reasons of Emergency Department arrivals 5% of total . As it is not possible to rule-in all patients claiming chest pain, it has been proposed to create new departments to monitor these patients during some Ž . hours, in order to exclude or confirm an acute coronary syndrome. These departments are named Chest Pain Units CPUs . The Chest Pain Unit has been created since June 1998 in Alessandria Hospital ASS. Antonio e Biagio e C. ArrigoB. Chest Pain Unit patients presenting in Emergency Department with an unclear defined chest pain are submitted to a continuous ECG monitoring of S-T trend for 24 h. Moreover, cardiac markers such as myoglobin, mass CK-MB and Troponin-I are tested at arrival and Troponin-I is tested again serially 3, 6, 9, 18 h after the first sampling. It is really important to be able to measure these markers of myocardial damage with robust and quick methods. A point-of-care analyzer is available in our chest pain unit and enables our department to obtain results in a very short time at low cost and with quality similar to that of clinical chemistry laboratories' instruments. This easy-to-use analyzer can be run by nurses without interfering in their normal activities. The presentation of our experience will be completed by describing all patients admitted in our Chest Pain

ABSTRACT Heart fatty-acid binding protein (h-FABP) is a small cytosolic protein (15 kDa) that is abundant in the heart. Its concentration in the plasma of healthy persons is relatively low (&amp;lt;6 μg/L). The h-FABP is rapidly released into the circulation from damaged myocardium and is cleared from the circulation by the kidney with a plasma half-time of 20 min. Analysis of the release kinetics of h-FABP revealed that levels were elevated above the cutoff level within 2 h after the onset of acute myocardial infarction, peaked at 4 h, and were complete within 20 h. Several studies indicate its usefulness in cardiology: exclusion of acute myocardial infarction, detection of reperfusion, prognostic value… Additional studies are needed to confirm these data and to specify its diagnostic and prognostic usefulness in patients with acute coronary syndromes (ACS). The use of this biological test seems to be most interesting in the prehospital phase than in the hospital phase.

This paper reviews the history of the contribution of the laboratory medicine to clinical cardiology and discusses the most important steps in this field. Until 20 years ago, the clinical laboratory only placed at the cardiologist's disposal a few assays for the retrospective detection of cardiac tissue necrosis, such as enzymatic methods for creatine kinase and lactate dehydrogenase activities. However, in the latter part of the 20th century, highly sensitive and specific assays, such as cardiac troponins, as well as assays for markers of myocardial function, such as cardiac natriuretic peptides, rapidly changed the scenario of clinical management of patients with cardiac diseases, assigning to the laboratory a pivotal role in the overall diagnostic flow. This is witnessed by the recent incorporation of these markers into international guidelines and in the redefinition of myocardial infarction. For the foreseeable future, new serum markers of myocardial ischemic, i.e. reversible, injury or related to coronary plaque instability and disruption are expected.

A~traet--With the advent of thrombolytic therapy and other coronary reperfusion strategies, rapid identification and treatment of acute myocardial infarction greatly reduces mortality. Unfortunately, many patients delay seeking medical care and miss the benefits afforded by recent advances in treatment. Studies have shown that the median time from onset of symptoms to seeking care ranges from 2 to 61/2 hours, while optimal benefit is derived during the first hour from symptom onset. The phenomenon of delay by AMI patients and those around them needs to be understood prior to the design of education and counseling strategies to reduce delay. In this article the literature is reviewed and variables that increase patient delay are identified. A theoretical model based on the health belief model, a self regulation model of illness cognition, and interactionist role theory is proposed to explain the response of an individual to the signs and symptoms of acute myocardial infarction. Finally, recommendations are made for future research.

ABSTRACT
Acute myocardial infarction (AMI) is on the raise even in young adults in India. Though there plenty of reports from
various parts of our country since 1978, the risk factors were still less known and different from that in adults. The
study was conducted in SVS Medical College Hospital Mahabubnagar during 2007 – 2011 for a period of 5 years.
The youngest patient was 22, males dominated with 32: 8. A total number of 1886 CAD cases admitted to ICCU of
SVS Medical College Mahabubnagar. Male sex(32), smoking(24),sedentary working (6),positive family history (6),
dyslipidemias (5), diabetes mellitus (2), overweight (2), were the routine risk factors. An alarmingly high 24 cases
were alcohol abusers, 11 cases had anaemia.Our study emphasizes the alcohol as one of the main risk factors,
followed by anemia anti-psychotic medications. Other factors like SLE, hysterectomy, nephrotic syndrome are
occasionally associated with AMI. Two patients did not had any of the known risk factors. The results were
reviewed with that in available literature.
Key words: AMI, Young adults, risk factors

In this descriptive study, the self-care limitations of persons who had experienced their first myocardial infarction were identified during the first 3 months of their convalescent period. The five most frequently occurring limitations identified were patterns of personal and family living that interfere with self-care; intense emotional states, likes or dislikes, overriding interests and concerns; perceptions, meanings, and appraisals not in accord with reality; inability to attend to self with respect to changing conditions; and new, unrecognized requirements for self-care associated with changed health. Assessment of limitation is a framework that nurses might use to evaluate the needs of post myocardial infarction patients.

Myocardial infarction is the leading cause of death and disability worldwide. Bulgaria has increased the incidence of this disease and the average age is about 50 years old and suffers mostly males. The latest data [4, 8, 9, 10] rehabilitation of these patients reflects favorably on the quality of life. Numerous studies have shown that early conducting of cardiorehabilitation recovery, prevent future vascular incident, improved control of risk factors and improves the quality of life for patients with cardiovascular diseases [1, 5, 6]. It is generally accepted that the basis of the rehabilitation program in patients with AMI and held the PCI are dosed exercise. It includes training, control of risk factors, psychological and social assistance and exercise of low and moderate intensity [2, 3, 7]. Aim of the study is study the effect of the application of a comprehensive program for physical therapy in patients with acute myocardial infarction treated with thrombolysis. Hospital rehabilitation program has duration 3-5 days in uncomplicated heart attacks. During hospital rehabilitation, optimal number of classes is up to two times per day for the duration 5-20 min. The appropriate intensity applied exercise is determined based