Finn Erland Nielsen

The relationship between ECG signs of atrial infarction and the development of supraventricular arrhythmias in patients with acute myocardial infarction

ECGs obtained on arrival at the hospital from 277 patients with acute myocardial infarction were analyzed retrospectively for PR displacements, which were classified as major or minor criteria for atrial infarction and related to the later occurrence of supraventricular arrhythmia in the hospital. Major criteria were (1) PR segment elevation greater than 0.5 mm in leads V5 and V6 with reciprocal PR segment depression in leads V1 and V2, (2) PR segment elevation greater than 0.5 mm in lead I with reciprocal PR segment depression in leads II and III, and (3) PR segment depression greater than 1.5 mm in precordial leads and greater than 1.2 mm in leads I, II, and III. Abnormal P waves were classified as minor criteria. Major and minor criteria were found in 15 (5.4%) and 19 (6.9%) patients, respectively. Eight (53.3%) patients with major and six (31.6%) with minor criteria had supraventricular arrhythmias, giving odds ratios of 9.9 and 3.7, respectively. Enzyme-estimated infarct size, the occurrence of heart failure, and mortality rates did not differ in patients with or without major criteria for atrial infarction. We conclude that the occurrence of PR segment displacements on the admission ECG may predict the risk of developing supraventricular arrhythmias during hospitalization for myocardial infarction.

Pain in Acute Myocardial Infarction

Pain is the most constant symptom in acute myocardial infarction (AMI) but there are considerable variations. It is possible that pain may indirectly cause extension of the infarct. The authors have, therefore, undertaken a retrospective investigation of 87 unselected patients admitted consecutively with the first episode of AMI. In these patients, the presence of any clinical and paraclinical parameters which could predict the employment of analgesics and the duration of pain while hospitalized were investigated. A significant connection was found between the presence of pulmonary stasis on administration to hospital and the total employment of analgesics during hospitalization. Patients with pulmonary stasis have frequently extensive infarcts and a significant connection was found between the enzyme-estimated extent of the infarct and the employment of analgesics and duration of pain. In contrast to previous investigations which were carried out on selected patient materials with exclusion of large infarcts, no significant connection was found between heart rate, systolic blood-pressure, electrocardiographic signs of AMI on admission and total amount of analgesics employed and the duration of pain.

Creatine kinase-MB activity after implantation of a cardiac pacemaker

Abstract Identification of creatine kinase (CK) isoenzyme CK-MB has made an excellent improvement of the diagnosis of myocardial infarction. 1 Cardiac muscle contains relatively large amounts of CK-MB. CK-MB is also present in skeletal muscle. Injury to skeletal muscle may therefore result in elevation of “non-cardiac” CK-MB and cause difficulties in the diagnosis of myocardial infarction. 2,3 Elevation of CK-MB may also be expected in direct cardiac muscle injury, but previous studies reflecting this relation have shown only a slight increase in CK-MB isoenzyme activity. 4 This study evaluates total CK and isoenzyme CK-MB activity in patients undergoing cardiac pacemaker implantation. In this procedure there is injury to cardiac and skeletal muscle.

The Value of Exercise Tests After Acute Myocardial Infarction

The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after 12 months in general practice. Six patients had died, and nine patients had suffered another MI. 23 patients were being treated for heart failure, 51 for angina pectoris, and 8 for arrhythmias. 14 patients received treatment for both heart failure and angina pectoris. Of the patients at work, 17.6% did not return to work because of the heart disease. 80 patients were in function groups I-II and 10 in function groups III-IV (New York Heart Associations Classification). Occurrence of ST-segment displacements was without prognostic value. Left ventricular function index (dRPP) and working capacity (W) were predictive with respect to mortality, heart failure, and angina pectoris requiring drug treatment. Exercise tests following acute myocardial infarction could not predict the chances of returning to work.

The Relationship between Serum Enzyme Activity, Infarct Site, and Cardiac Complications after a First Myocardial Infarction: A follow-up study in general practice

The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the site and size of infarct, estimated from standard enzyme measurements. One hundred and eight consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after 30 months in general practice. Twenty-six patients had died and 8 had had another infarction. Sixty-two of the surviving patients had received treatment for ischaemic heart disease, usually for angina pectoris and less often for heart failure and arrhythmias. No correlation was found between ischaemic heart disease requiring treatment and the enzyme-estimated size or the site of the infarct. With anterior infarcts there was, however, an overweight of arrhythmias requiring treatment. Of the patients at work, 31% had changed job or job status because of ischaemic heart disease. At the end of the 30 month period, 50 patients were in functional class 1 and 2, and 32 in functional class 3 and 4 (New York Heart Associations classification).

The effect of streptokinase on chest pain in acute myocardial infarction

&NA; Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76 patients not treated with streptokinase. All patients had acute myocardial infarction and less than 6 h of cardiac symptoms. Patients treated with streptokinase had a significantly lower need for nicomorphine (median 20 mg) than patients not treated with streptokinase (median 41 mg). Correspondingly, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain.

Reduced consumption of analgesics in patients with diabetes mellitus admitted to hospital for acute myocardial infarction

&NA; In a case‐control study, the consumption of analgesics was analysed in 39 patients with diabetes, admitted with acute myocardial infarction (MI). The control group comprised of non‐diabetics with MI was computer‐matched to the diabetic group with respect to age and sex as well as enzyme‐estimated size of the infarction. The median number of injections of opioid analgesics in the diabetes and non‐diabetes groups was 2 and 5, respectively (0.01 < P < 0.05), and the median consumption of morphine was 20 mg and 35 mg, respectively (0.01 < P < 0.05). There was no statistically significant trend for the duration of pain to be shorter in the diabetes group. There was no difference between the two groups with respect to number of patients with Q‐wave infarct, initial heart rate‐blood pressure product or body weight, all of which are possible confounders. We conclude that diabetics admitted with acute myocardial infarction have a lower consumption of analgesics than non‐diabetics.

Silent Ischemia and Severity of Pain in Acute Myocardial Infarction

An overall low tendency to complain of pain, due to a low perception of pain, has been suggested in the pathogenesis of silent ischemia, independent of the extent of the diseased coronaries and a history of previous acute myocardial infarction. This hypothesis has been tested indirectly in this retrospective study by comparison of the use of analgesics during admission for a first acute myocardial infarction with the occurrence of silent ischemia at exertion tests four weeks after discharge from hospital. The study did not show a lower use of analgesics in patients with silent ischemia, but this may be due to methodologic problems. Suggestions are given for another study design to overcome these problems.