Exercise capacity in patients 3 days after acute, uncomplicated myocardial infarction

Article Abstract:

A myocardial infarction (MI) is a potentially fatal condition resulting from a decrease in blood flow (ischemia) to the heart. The ischemia often results because of the presence of a blood clot or fatty plaque in the vessels that supply blood to the heart tissue. Past treatment of an MI involved complete bed rest, but current therapy focuses on the restoration of blood flow and the slow resumption of physical activity. Patients often undergo a treadmill test seven to ten days after their MI and prior to discharge to evaluate their progress. During an MI, suitable patients may be given drugs that dissolve the clot (thrombolytic), or may undergo a procedure in which a small inflatable balloon is inserted into the blocked vessel and inflated (PTCA); both treatments restore the blood flow to the heart and minimize damage. In thallium 201 scintigraphy, radioactive thallium is injected into the body and accumulates in certain body sites, including the heart. Emissions from the accumulated thallium can be used to make a picture of the tissue. A recent study of 507 MI patients evaluated early hospital discharge after MI; a thallium exercise test was performed after onset of the patient's MI. One hundred and seventy-nine of the patients had an uncomplicated MI that was not accompanied by chest pain, heart failure, or rhythm disturbances. One hundred and twenty six of these patients were tested three days after their MI, and 36 of these had ischemia of the heart. Ninety of the 126 patients who were tested three days after their MI had no symptoms of ischemia, and these patients had been treated with thrombolytic drugs or PTCA. These data indicate exercise testing with thallium imaging three days after an MI is as safe and accurate as a seven to ten day test. This type of testing is possible in patients who received thrombolytic or PTCA therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Testing, Treadmill exercise tests, Diagnostic imaging

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Myocardial infarction prognostic scoring system

Article Abstract:

The diagnosis of acute myocardial infarction (AMI, or heart attack) covers a wide range of clinical presentations and outcomes. Intensive care units (ICUs) are extremely expensive, and the effectiveness of the cardiac care unit (CCU) is questionable, having no impact on the mortality of low-risk patients, who make up half of those admitted. Patients with the largest infarctions are at greater risk, and are more likely to benefit from anti-clotting (thrombolytic) therapy. Careful monitoring may lead to earlier detection of complications. It is important to be able to classify patients according to risk, but no system of categorizing cardiac patients has proven practical. In order to be useful the score should be readily obtainable at the time of admission, not affected by therapy, be easily memorized, and rapidly applied. In order to develop such a system, 400 patients were investigated. The first 200 were used to develop the score, and the second 200 were used to validate it. The size of the infarction and the consequent degree of left ventricular dysfunction are the major prognostic indicators, and can be estimated by infarct location, maximal ST segment elevation (a measurement from an electrocardiogram), and hemodynamic (blood circulation) class. Extensive or limited anterior and right ventricular (inferior) infarcts are associated with the highest mortality. This scoring system may be useful in assessing heart attack patients upon admission to the hospital. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Prognosis

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Anxiety transmission in the patient with myocardial infarction

Article Abstract:

Patients suffering a heart attack, also called an acute myocardial infarction, are admitted to the coronary care unit for treatment and recovery. Studies indicate that their condition and prognosis can be affected by stress; any event causing the patient stress can inhibit their progress, including interpersonal interactions with family members. Because family members are often anxious and may convey this to the patient, methods are needed to prevent family to patient anxiety transmission. A recent study of 23 patients with myocardial infarction attempted to examine and document the transmission of anxiety between the patient's family and the nurse, and the patient's family and the patient. Conversations between the patient and the patient's family, and the patient's family and the coronary care nurse were recorded and analyzed. Family members did not transmit anxiety to the nurse, but they did transmit anxiety to the patient. It is concluded that family members may produce anxiety in a coronary care patient which may be detrimental to the patient's health. One solution may be to counsel the patient's family so they are aware of the impact they may have on the patient's recovery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Physiological aspects, Disease transmission, Family, Anxiety, Family health, Coronary care units

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