Myocardial ischemia and myocardial function

Hippokratia 1997, 1(3):129-143

N. Lefkos

Abstract

Myocardial ischemia directly affects the diastolic initially and then the systolic cardiac function. The biochemical changes, in cellular level, during severe ischemia are summarized as follow: a) a rapid exhaustion of ATP and CP reserves, b) decomposition of AMP to adenosine which is rapidly converted to hypoxanthine, iosine and a small amount of xanthine, and c) intracellular increase of nonorganic phosphates, Mg++ and intracellular acidosis which in parallel, with the rapid exhaustion of the low reserves of glucagone, inhibits the initially activated anaerobic glycolysis. In about 15 minutes, the initially reversible phase of ischemic disturbances, in cellular level, converted to irreversible, because of the breakdown of the sarcolema of myocardial cells as a result of uncontrolled Ca++ increase, intracellular oedema and free-oxygen radicals production. Functional ischemic disorders of myocardial contractility are classified as reversible [stunning and hibernating myocardium] and permanent [necrosis of a myocardial region]. The chronic [permanent] ischemic disorders of myocardial function were attributed to: a) loss of extended regions of contracil myocardium and distortion of the pattern of left ventricle both contributed to chronic overload of surviving myocardium and b) inactivation of systemic or local neurohormonal systems who directly affect cardiac cells [myocardiac cells and inoblasts]. Finally, the cardioprotection against myocardial ischemia is obtained by: a) endogenous mechanisms [such as ischemic "preconditioning" and its second window, hypoxia, catecholamines, acetylcholine, tachycardia or rapid pacing], b) metabolic and c) pharmacologic agents [Ca++-antagonists, b-blockers, a-MEA, trimetazidine etc).

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Mental problems of cardiopathy patients. Coronary disease's (heart attack) psychosocial factors

Hippokratia 1997, 1(3):144-150

S. Giannitsi, A. Vidalis

Abstract

In this study were reviewed the psychosocial factors correlated with coronary disease, which continues to constitute one of the most common cause of death in Western societies. For this reason, the coronary disease and its relation with psychosocial factors have been a field of several multicentre researches in last 20 years. Type A personality, depression, anxiety, acute dysthymia within disturbing life events, a high degree of sympathetic responsiveness to environmental stimuli, so-ciocultural factors as well as interpersonal factors have been involved directly or indirectly in the origin and course of a number of cardiovascular problems. The psychiatric intervention, therefore may contribute decisively, to a certain degree tore formation of the above factors, intervening positively in prevention, course and prognosis of this disturbances.

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Treatment of hypercholesterolemia of renal allograft recipients with lovastatin

Hippokratia 1997, 1(3):151-158

G Vergoulas, Gr. Miserlis, F. Solonaki, A. Katsaveli, P. Pagidis, G. Imvrios, V. Papanikolaou, D. Takoudas, A. Antoniadis

Abstract

The aim of this study was to investigate the safety and efficacy of lovastatin in hyperlipidemic renal transplant patients. Fifteen hypercholesterolemic (total cholesterol >240 mg/dl) renal transplant recipients (7 men) with mean age 45 years (range 27-58 years), mean follow up 29.8 months (range 12-85 months), triple drug immunosuppression (cyclosporine A, azathioprine, methylprednizolone) stable renal function and weight in the normal range for sex, age and height, received 10 mg/d lovastatin for three months. Serum total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, phospholipids, apolipoproteins A, Apo ? were measured before and after treatment with lovastatin. Lipoprotein electrophoresis for chylomicrons, pro ?, ? and A lipoproteins was done at the same time. Also serum creatinine, K, Na, Ca, P, CPK, SGOT, SGPT and total protein were measured. Graft function remained stable during the study period, there were no elecrolyte disturbances and no change of CPK and transminase levels was noticed. HDL cholesterol, triglycerides and lipoprotein profile did not change but there was significant fall of total cholesterol and LDL cholesterol levels from 305 ? 55.5 mg/dl to 254.5 ? 29.87 mg/ dl (p = 0.004) and from 200.35 ? 46.17 mg/dl to 158.20 ? 36.28 mg/dl (p = 0.010) respectively. In conclusion low dose lovastatin treatment to hyperlipidemic renal allograft recipients under triple drug immunosuppression is safe and lowers significantly total and LDL cholesterol levels.

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The effect of thrombolytic treatment on the outcome of acute ischemic events following coronary angiography

Hippokratia 1997, 1(3):159-162

I. Kanonidis, A. Platis, G. Dadoush, K. Tsorbatzoglou, C. Papadopoulos

Abstract

The study evaluated the effect of thrombolysis in the treatment of patients who developed unstable angina or myocardial infarction following coronary angiography. Eighteen patients developed such symptoms within 48 hours following coronary angiography. These patients were treated with selective thrombolytic agents. The point of arterial puncture was enforced by the application of additional weight to avoid excessive bleeding. Thrombolytic treatment was clinically successful in 16 of the 18 patients. Local hematoma was noticed in 4 patients who were treated conservatively in all cases. Blood transfusion was carried out in one patient. It is concluded that thrombolytic treatment in combination with an additional weight application on the site of arterial puncture is an effective clinical approach for the treatment of acute ischemic events following coronary angiography and safe enough to prevent the development of severe local hematoma.

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Infertility in a patient with idiopathic unejaculation

Hippokratia 1997, 1(3):163-166

D. Panidis, A. Kourtis, S. Skiadopoulos, I. Pidonia, K. Pechlivanidis, M. Mamopoulos

Abstract

A case of a 28 years old male with unejaculation, who had normal libido and erection is described. Medical history, clinical examination and laboratory investigation showed idiopathic unejaculation. The etiology, the diagnostic approach and the therapy of this situation are discussed.

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