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J Senges

Publications and source records attributed to J Senges.

At least 109 records · Page 6Linked to original sources
PubMed1997

Primary angioplasty versus thrombolysis in the treatment of acute myocardial infarction. ALKK Study Group.

This study investigates the hypothesis if primary angioplasty is superior to intravenous thrombolysis in the treatment of acute myocardial infarction (AMI). Small prospective randomized studies did not demonstrate a significant benefit regarding total mortality. A total of 14,980 patients with AMI were registered by "The 60-Minutes Myocardial Infarction Project," a prospective multicenter observational study: 210 of these patients were treated with primary angioplasty. A matched pair analysis comparing 1 primary angioplasty patient with 3 intravenous thrombolysis patients could be performed in 156 primary angioplasty patients. Criteria for matching were age, sex, location of AMI, systolic blood pressure, previous AMI, and prehospital delay. Patients with a bundle branch block or requiring resuscitation were excluded from analysis. Because of matching, both groups showed similar baseline characteristics. Patients with primary angioplasty had more relative contraindications for thrombolysis (ulcers: 10.3% vs 2.3%, recent intramuscular injections: 6.4% vs 1.6%, recent surgical interventions: 5.1% vs 1.1%, central punctures: 9% vs 3.9%). There was a tendency toward less combined adverse events in the primary angioplasty group (3.2% vs 5.7%, odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.21 to 1.44). In-hospital mortality rates in the primary angioplasty group and thrombolysis group were 4.3% and 10.3%, respectively (OR = 0.39, 95% CI = 0.17 to 0.92). The difference in mortality could already be demonstrated within the first 48 hours with 1.9% versus 5.3% deaths (OR = 0.35, 95% CI = 0.11 to 1.14). Thus this study indicates a superiority of primary angioplasty in comparison to intravenous thrombolysis in AMI even in a clinical routine setting, with a reduction of hospital mortality of about 60%.

Aged↗
PubMed1997

Pseudoaneurysm after cardiac catheterization: therapeutic interventions and their sequelae: experience in 86 patients.

After diagnostic cardiac catheterization in 8,715 patients, a pseudoaneurysm was diagnosed in 86 (1%) patients. Primary conservative management by repeated compression bandages (CB) or ultrasound guided compression (UGC) was attempted in all patients. Occlusion of the pseudoaneurysm was achieved significantly more often by UGC (41/47; 87%) than by CB (22/39; 56%; P = 0.016). Of 86 patients, 23 (27%) required surgical treatment. Major clinical acute complications occurred after surgery in 8/23 cases (35%) versus 4/63 (6%; P = 0.0004) following successful CB or UGC. However, intention-to-treat analysis showed no difference in the rate of acute complications in the CB or UGC group (15.4% versus 12.8%, P = 0.7272), because of a trend towards a higher complication rate following secondary surgery in the UGC (4/6 = 66.7%), as compared to the CB group (4/17 = 23.5%, P = 0.1589). During follow up, 22/64 (34%) patients reported persistent inguinal complaints, 9/15 (60%) after surgery and 13/49 (27%) after successful CB or UGC (P = 0.0169). However, according to the intention-to-treat analysis, there was no significant difference between the initial groups (CB: 26.1% versus UGC: 39.0%, P = 0.2958). Despite a higher effectiveness of UGC to achieve occlusion of a pseudoaneurysm compared to CB (87% vs. 56%), UGC is not superior to CB because of a higher rate of acute complications as well as long-term complaints in those patients requiring secondary surgery in the UCG group as compared to the CB group.

Adult↗
PubMed1997

[Direct dilatation and emergency bypass operation of main branch occlusion in acute anterior wall infarct and cardiogenic shock].

Occlusion of the left main coronary artery (LMCA) is the cause of myocardial infarction in about 0.04%. Those patients who do not die during the acute phase often do have a dominant right coronary artery with extensive collaterals to the left coronary artery. Because this is a very rare situation there are only some cases reports dealing with the management of these patients. A 60 years old woman was admitted to our hospital with the signs of an acute Q-wave anterior myocardial infarction. Within a few minutes after the arrival she developed a cardiogenic shock. Coronary angiography was performed immediately. The left main coronary artery was occluded and a big right coronary artery showed a significant stenosis. There were many collaterals from the right coronary artery supplying the left coronary artery. After information of the cardiac surgeons, primary angioplasty of the LMCA was performed in order to achieve hemodynamic stabilisation and to relieve symptoms. Reperfusion of the left anterior descendent coronary artery (LAD) could be achieved within 30 minutes. This led to hemodynamic stabilisation of the patient. But a significant residual stenosis of the LMCA remained and the circumflex artery was still occluded. In the meanwhile cardiac surgery was able to be performed and so the patient was transferred to surgery without further dilatation or stent implantation. Four venous grafts (LAD, first diagonal branch, circumflex artery and right coronary artery) were inserted. After 4 weeks the patient was in a good shape and could be discharged at home. Primary angioplasty seems to be an effective treatment in patients with acute myocardial infarction and an occlusion of the LMCA. But coronary bypass surgery is nearly almost necessary during the following period in order to achieve complete revascularisation and to improve survival.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Problems in carrying out baroreflex sensitivity measurements in clinical routine practice: practicability and complications].

Measurement of baroreflex sensitivity is a new method to identify patients after myocardial infarction with a high risk for sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In this retrospective study the baroreflex sensitivity was obtained noninvasively by measuring the systolic blood pressure blood pressure with a FINAPRES-device and correlating this with the R-R intervals of the ECG after raising blood pressure with an intravenous dose of Norfenefrin-hydrochloride (Novadral). According to other investigators a correlation of > 0.7 with a significance of p < 0.05 was recommended for evaluable results with a baroreflex sensitivity < 3 ms/mm Hg being judged as decreased. We investigated 302 patients (mean age 59 +/- 17 years, 224 males, 78 females). 75% of the investigations showed acceptable results. In 77 cases (25%) reasonable results could not be achieved. We found premature ventricular beats to be responsible in 18 investigations (6% of all investigations). 41 (13.1%) of all investigations were not evaluable because of bad correlation for unknown reason. When we looked closely at these nonevaluable results, we found a significantly higher number of patients with impaired left ventricular ejection fraction (< 40%), diabetes or inducible sustained ventricular tachyarrhythmia in the electrophysiologic study in this group. During all investigations no severe side effects were observed. We conclude that the noninvasive measuring of the baroreflex sensitivity is a save method and leads to reasonable results in 75% of the investigations. In 13.1% it is not possible for unknown reason to achieve sufficiently correlating values. These measurements cannot be evaluated from nowadays' standards and have to be further investigated as they may indicate a population at high risk.

Adult↗
PubMed1997

[High frequency catheter ablation as therapy of symptomatic ventricular extrasystole].

Ventricular ectopic activity is commonly encountered in clinical practice. Usually it is not associated with life-threatening consequences in the absence of significant structural heart disease. However, frequent ventricular ectopic beats can be highly symptomatic and even incapacitating in some patients. Currently, reassurance and pharmacological therapy are the mainstays of treatment. This study assesses the useful role of catheter ablation in eliminating drug refractory monomorphic ventricular ectopic beats in severely symptomatic patients. Eight patients were included, five patients had no heart disease and in three patients a structural heart disease was present (coronary artery disease in 1, hypertensive heart disease in 1, mitral valve prolaps in 1). The ejection fraction was higher than 40% in all patients (mean EF 56 +/- 14%). Mean number of ventricular ectopic activity was 29,295 +/- 10,650 VPB/24 h (1209 +/- 457 VPB/h) before ablation. No other spontaneous or induced arrhythmias were documented. The site of origin of ventricular ectopic activity was accurately mapped by using earliest endocardial activation time during ectopic activity or pace mapping, or both. The ectopic focus was located in the right ventricular outflow tract in five patients and in the left ventricle in three patients (posteroseptal 2, anterolateral 1). Frequent ventricular ectopic beats were successfully eliminated by catheter ablation in all patients. Early recurrence occurred in one patient after 10 min and 30 min after the procedure. In another patient a recurrence occurred 6 days after the procedure. In a second session he was successfully ablated and remained free of recurrence since 2 months. After ablation the mean number of ventricular premature beats was 211 +/- 159 VPB/24 h (9 +/- 7 VPB/h). The mean number of radiofrequency applications was 8 +/- 7 (range 2-22). Mean radiation time was 12 +/- 8 min. No complications were observed. During a mean follow-up of 6 months there were no further recurrences in the remaining six patients. Radiofrequency catheter ablation can be successfully used to eliminate monomorphic ventricular ectopic activity. It may therefore be a reasonable alternative for the treatment of severely symptomatic, drug resistant monomorphic ventricular ectopic activity.

Adult↗
PubMed1997

[Early treatment of acute myocardial infarct: implementation of therapy guidelines in routine clinical practice, MITRA pilot phase].

The prognostic value of thrombolytics, aspirin, beta-blockers and ACE-inhibitors has been well documented in large clinical trials, but the application of these drugs in clinical practice is not known. MITRA is a multicenter study of 54 hospitals in a defined region in southwest Germany. The aim is to document actual clinical practice (pilot phase) and to establish an individually optimised prognostic therapy for acute myocardial infarction, considering only the absolute contraindications for each drug. In the pilot phase, 1303 consecutive patients with acute transmural myocardial infarction were enrolled. The median age was 66 years, the prehospital time was 2.7 hours. 47% had an anterior infarction. In the subgroup of patients without absolute contraindications, only 53.4% were treated with thrombolytics, 87.6% with aspirin, 37.1% with beta-blocker, and 17.4% with ACE-inhibitor. Out of these, patients were classified as "optimally treated" if they received thrombolysis, aspirin as well as beta-blocker. Patients were also included if any of these medications was withheld in the presence of absolute contraindications. Treatment was defined suboptimal, if the patients did not receive any of these three medications despite the absence of absolute contraindications. Only 29% (n = 383) received an optimal post-infarction therapy and 71% (n = 775) a suboptimal treatment. The univariate analysis revealed 10 variables influencing optimal therapy. In this subgroup patients were younger, they more often had clear ECG-findings or left bundle branch block, an anterior infarction, acute cardiac failure, AV-block, bradycardia, recent trauma or surgery (less then 2 weeks) and a severe chronic obstructive lung disease. The prehospital time was more often available. Early mortality after 2 days was 5.0% versus 9.3% in the suboptimal treated patients (OR: 0.5, CI: 0.30-0.86) the total inhospital mortality was 10.9% in the optimal versus 17.7% in the suboptimal group (OR: 0.6, CI: 0.38-0.84). In a multivariate analysis the parameter "optimal treatment" was found to be an independent predictor of the early (OR = 0.4; CI: 0.20-0.69) and the inhospital mortality (OR = 0.4; CI: 0.25-0.64). The following in-hospital events occurred: stroke 2.8%, reinfarction 12.9%, cardiac failure 21.5%, cardiogenic shock 10.4% and in-hospital mortality 18.1% (2-days mortality 9.5%). Pharmacological therapy for acute myocardial infarction is inconsistent with the recommendations suggested in recent clinical trials and needs to be individually optimised. Optimal treatment is an independent predictor of early and inhospital mortality.

Adrenergic beta-Antagonists↗
PubMed1997

[Balloon dilatation in acute myocardial infarct in routine clinical practice: results of the register of the Working Society of Leading Cardiologic Hospital Physicians in 4,625 patients].

Balloon angioplasty as the treatment of first choice in the setting of an acute myocardial infarction (AMI) is gaining widespread acceptance because of favourable results from specialised centres concerning high patency rates and low mortality. This study reports the results of angioplasty for AMI at large community hospitals during 1992-1995. 4625 procedures were performed at 68 centres of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK). The age of the patients was 60.8 +/- 11.3 years, with 75.1% men. The infarct related artery was the left anterior descendent in 43%, the right coronary artery in 37%, the circumflex artery in 16%, a bypass graft in 2.3% and the left main stem in 1.4% of patients. The success rate (residual stenosis < 50%) of the intervention was 86%. There was a wide range of procedures per centre, with a median of 40 AMI angioplasties per year and centre. The amount of angioplasties for AMI in relation to all angioplasties performed during this period rose from 5.2% in 1992 to 5.9% in 1995 (p = 0.01). Local complications at the puncture site occurred in 3.2%, with the need for a surgical intervention in 1.1% of patients. In 273 (5.9%) of the patients a second angioplasty was performed during the hospital stay. Aortocoronary bypass surgery was performed in 3% of the patients. Hospital mortality was 9.5% (438/4625 patients). The mortality rate remained constant during the years investigated (1992: 10.6%; 1993: 8.6%; 1994: 9.7%; 1995: 9.8%; p = ns). Higher mortality was observed in older patients, patients with multiple vessel disease, the left anterior descending artery or a bypass graft as infarct related artery as well as in patients with failed reperfusion (residual stenoses > 50%). Hospitals with a case load of more than 40 angioplasties for AMI per year showed a lower mortality as compared to the others. In clinical practice at large community hospitals results of angioplasty for AMI concerning mortality, complications and technical success rate are comparable to those of highly specialised centres. The absolute numbers of angioplasties for AMI increased constantly over the years.

Aged↗
PubMed1997

The 60 minutes myocardial infarction project. Treatment and clinical outcome of patients with acute myocardial infarction in Germany.

AIMS: To describe patient characteristics, pre-hospital delay, treatment, complications and outcome in patients with acute myocardial infarction admitted to hospitals in Germany. METHODS AND RESULTS: The study was of prospective observational multicentre design. Those involved were consecutive patients with acute Q-wave myocardial infarction admitted within 96 h of onset of symptoms to 136 German hospitals between July 1992 and September 1994 (n = 14980, median age 66 (quartiles 57, 74) years, 68% male, 48% anterior wall infarction). Median pre-hospital delay was 170 (90, 475) min, with 17% arriving within the first hour and 61% within 4 h of onset of symptoms. The following patient groups had a short pre-hospital delay: males, those aged less than 65 years, those admitted at night or the weekend, those with a previous myocardial infarction, those in need of cardiopulmonary resuscitation, and those with a diagnostic first ECG. The first ECG was diagnostic in 67.6% of cases. Reperfusion therapy was used in 53%, with thrombolytic therapy in 51.6%. Median time from admission to initiation of treatment was 30 (20, 55) min. Respective rates of treatment with aspirin, nitrates, and beta-blockers were 81%, 83%, and 16%. Major complications were cerebral bleeding (0.4%), bleeding requiring transfusions (0.9%), left ventricular rupture (0.6%) and anaphylactic shock (0.1%). Median hospital stay was 20 (13, 26) days. In-hospital death rate was 17.2%. Increased hospital mortality was observed with female gender, an unknown or long pre-hospital delay, a diagnostic first ECG, anterior wall infarction, trauma or major operation within the last 14 days, renal insufficiency and malignoma. CONCLUSIONS: 'Real-life' hospital mortality is much higher than previously reported in clinical trials. To reduce hospital mortality, the efficacy of thrombolysis should be increased by shortening the pre-hospital delay, and the use of concomitant therapy, especially beta-blockers, should be increased.

Aged↗
PubMed1997

Local venous thrombosis after cardiac catheterization.

Pulmonary embolism is a rare but life-threatening complication of cardiac catheterization. Underlying deep venous thrombosis (DVT) is often not detectable clinically. To determine the true incidence of DVT the authors prospectively studied 450 consecutive patients (29% women, 71% men, mean age: fifty-eight years) undergoing a diagnostic cardiac catheterization. Patients were examined clinically and by duplex sonography with a high-resolution (5 or 7.5 MHz) transducer before and twenty-four hours after catheterization before mobilization. Duplex sonography excluded complete proximal DVT in all patients. Only partial occluding thrombi (pDVT) were detected in 11 (2.4%) patients. The thrombi were always localized at the puncture site. In 2 patients a difference was found in the circumferences of the legs, but no other clinical signs of DVT were seen. With use of continuous wave (cw) Doppler sonography, only 3 of these 11 patients (27%) showed a spontaneous (s) sound. Phlebography was performed in 4/11 patients (36%). In 2 patients the diagnosis was confirmed; in 1 patient extravenous compression was assumed, and the other demonstrated a normal-appearing phlebography at the time of investigation. Logistic regression analysis yielded a 3.5 times higher risk for developing a pDVT if a venous puncture was performed in addition to arterial puncture. Furthermore a 9.8 times higher risk was found if more than one venous puncture was necessary. During the follow-up no patient developed clinical signs of pulmonary embolism. The results of this study demonstrate that DVT is a rare complication of cardiac catheterization (0/450 patients), but pDVT occurred in 2.4%. Risk factors for pDVT are the venous puncture itself and multiple puncture attempts. Clinical relevance of pDVT remains to be determined.

Cardiac Catheterization↗
PubMed1996

Postinfarction stress testing and one year outcome of stable patients after myocardial infarction treated with thrombolytics.

OBJECTIVE: The purpose of our study was to evaluate the predictive power of early postinfarction stress testing in survivors of uncomplicated MI treated with thrombolytics. METHODS: The study population consisted of 102 consecutive, thrombolyzed survivors (56 +/- 11 years) of acute, transmural myocardial infarction with uncomplicated postinfarction course. All patients were clinically stable in the postinfarction period and underwent cycle ergometry, 99mTc perfusion scintigraphy and dobutamine stress-echocardiography within three weeks after the acute event. Coronary angiography was used to determine the extent of CAD, LV ejection fraction (LVEF), TIMI grade and residual stenosis of the infarct-related coronary artery. A follow up questionnaire was performed one year after hospital discharge to determine the relation to the occurrence of cardiac events (unstable angina, reinfarction, PTCA, bypass surgery and death). RESULTS: 30 patients developed 34 cardiac events. Four patients died. Two thirds of the 'cardiac events' in the year of follow-up were revascularization procedures mostly selected by evidence of ischemia on 99mTc perfusion scintigraphy and/or stress-echocardiography. These two methods were significantly associated with the development of new cardiac events (stress-echocardiography: p < 0.01; 99mTc perfusion scintigraphy: p < 0.006). Parameters of bicycle ergometry and variables of coronary angiography were not related to an increased risk of future cardiac events. The number of 'hard cardiac events'--death or nonfatal AMI--was too small (8%) in these patients who are able to exercise to make statistical comparisons. CONCLUSIONS: The study underlines the necessity of early noninvasive risk assessment to identify patients at a greater risk among survivors of uncomplicated AMI treated with thrombolytics who are clinically stable in the early postinfarction period. PTCA and coronary bypass surgery is performed in one third of these patients selected mostly by evidence of ischemia on 99mTc perfusion scintigraphy and/or stress-echocardiography. Results of bicycle ergometry are of limited value in these patients within the first year after acute myocardial infarction.

Coronary Angiography↗
PubMed1996

Intraindividual comparison of three stress tests during the early postinfarction period in stable patients with thrombolysis.

The intention of the study was to intraindividually compare the ischemic yield of three stress tests early after acute myocardial infarction. At a large community hospital 107 stable patients who survived acute transmural myocardial infarction after thrombolytic therapy followed by an individual optimized medical treatment, were prospectively investigated by three noninvasive stress tests. All patients received bicycle ergometry, 99mTc perfusion scintigraphy and stress-echocardiography within three weeks after the acute event. Each patient underwent diagnostic cardiac catheterization for determination of angiographic data. 99mTc perfusion scintigraphy had the highest rate of positive test results (61%), as compared to bicycle ergometry (32%), stress echocardiography (34%) and stress induced angina in any of the stress tests performed (40%). In 79% of the patients studied, at least one of four ischemic parameters was positive. The combination of bicycle ergometry, stress induced angina and 99mTc perfusion scintigraphy detected myocardial ischemia in 78% of the patients studied. Concordance of at least three positive parameters was seen in only 27%. Intraindividual comparison between positive and negative test results was inconclusive. Only stress-echocardiography versus stress-induced angina showed a moderate agreement (kappa = 0.44). Stress-induced angina was the only ischemic parameter which corresponded to the grade of the residual stenosis of the infarct related coronary artery (p < 0.01) and reduced left ventricular function (p < 0.005). These findings show, that concordance of three common stress tests in detecting myocardial ischemia anywhere in patients after acute transmural myocardial infarction and thrombolytic therapy is poor. Stress-echocardiography and stress inducible angina show a moderate agreement. Follow-up studies of these patients are currently performed to clarify prognostic significance and therapeutic consequences of positive test results in these patients.

Angina Pectoris↗
PubMed1996

[Feasibility and safety of dobutamine stress echocardiography: experiences with 1,000 studies].

The use of dobutamine stress echocardiography for the evaluation of coronary artery disease is rapidly expanding. Despite its widespread use, the feasibility and safety of dobutamine stress echocardiography has not been sufficiently documented. Between November 1992 and June 1995, we performed 1000 dobutamine stress echocardiographies. There were 744 men and 256 women with a mean age of 59 +/- 11 years. Anti anginal medication was not routinely withdrawn before the test. The mean maximal dobutamine dose was 41,4 +/- 10 mu g/kg center dot min(-1). Atropine was given additionally in 440 patients, with a mean dose of 0.5 mg. In patients receiving beta-blockers additional atropine was more often necessary as compared to those not receiving beta-blockers (278/457 = 61% versus 162/543 = 30 %, p < 0.0001). Reasons for discontinuing dobutamine infusion were achievement of target heart rate (64 % of cases) and maximal dose (12 % of cases). In 791 (79,1 %) patients no side-effects of dobutamine stress echocardiography were noticed. Termination of the study because of adverse side-effects occurred in 6.6 %. A total of 103 (10,3 %) noncardiac side-effects were observed: dizziness or nausea 6.4 %, headache 1.7 %. In one patient a focal cerebral seizure occurred. 156 cardiac side-effects occurred: blood pressure decrease of more than 20 mm Hg in 25 patients, extreme palpitations in 16 patients and pulmonary edema in one case. Most common cardiac side-effects consisted of arrhythmias (11.4 %): 9.1 % ventricular and 2.3 % supraventricular arrhythmias. Most ventricular arrhythmias were less severe (uniform and multiform premature ventricular beats, ventricular bigeminy or couplets in 71 patients). Nonsustained ventricular tachycardia, with a maximum duration of 20 s, occurred in 18 patients. In one patient sustained ventricular tachycardia developed and progressed towards ventricular fibrillation. This patient could be successfully defibrillated. Supraventricular arrhythmias presented as new atrial fibrillation in 10 patients, supraventricular tachycardia in three patients, junctional rhythm with a short decline in heart rate in nine patients and a second-degree AV block in another case. Dobutamine stress echocardiography has proven to be a safe and feasible method in the diagnosis of coronary heart disease. Minor side-effects are common and sometimes unpleasant for the patient, but do not often require termination of the study. Severe side-effects are seldom (< 1 %), but nevertheless, adequate medical and technical (defibrillator) support should be rapidly available.

Adult↗
PubMed1996

Do 5-F-catheters reduce the incidence of a pseudoaneurysm?

Femoral artery pseudoaneurysm is a major problem in patients undergoing cardiac catheterization. This study describes our experience with 5 French (5 F) and 7 French (7 F) introduction sheaths and 7 investigators at our institution regarding the incidence of pseudoaneurysms. During 54 months (1/1990-6/1994) 8715 consecutive patients after diagnostic cardiac catheterization were first clinically checked for pseudoaneurysm and in case of suspicion a duplex sonography was performed. In 86 (1%) patients, 44 (52%) women and 42 (48%) men, mean age 63 +/- 9.7 years we observed this complication by duplex ultrasound. 54 (62%) patients had arterial hypertension, 18 (20%) diabetes and only 3 (3.6%) had peripheral arteriosclerosis. An antithrombotic medication was used in 60% (52 patients). As compared to a control group of 450 consecutive patients a pseudoaneurysm was significantly more likely to occur in patients with a history of hypertension (63% vs 25%, p < 0.0001). Women are also at higher risk representing 51% of all pseudoaneurysms as compared to 29% in the control group (p < 0.0001). Using 7-F catheters more pseudoaneurysms occurred (82/7183; 1%) than using 5 F (4/1532; 0.2%) introduction sheaths (p = 0.0005). There were also significantly more pseudoaneurysms caused by investigator 1 (21/787; 2.7%) as compared to the other investigators (65/7829; 0.8%), (p = 0.0002). Investigator 1 had a more distal puncture technique than the others. Pseudoaneurysms complicating cardiac catheterization occur 5-times more frequent using 7 F (1%) as compared to 5 F catheters (0.2%). Moreover distal puncture site is associated with a higher frequency of pseudoaneurysms.

Aneurysm, False↗
PubMed1996

[Renaissance of beta blocker therapy in myocardial infarct].

Beta-adrenergic blocking drugs have been evaluated for the treatment of arrhythmias and for the prevention of sudden cardia death, particularly in post-myocardial infarction patients. Betablockers have been demonstrated to reduce mortality, reinfarction, ventricular fibrillation and cardiac rupture in acute infarction. Therefore, in patients with suspected myocardial infarction and without contraindications, treatment with betablockers should be initiated early and continued for at least 2 years. Side-effects are mild and occur in approximately 10% of patients. Patients who have contraindications for betablockers use early in myocardial infarction should be reevaluated before discharge from the hospital and considered for such therapy. Because betablockers prevent some of the adverse arrhythmogenic mechanisms seen in chronic heart failure, it may be reasonable to expect that these drugs could have a role in preventing sudden cardiac death in these patients. Analysis of some of the betablocker post-infarction trials indicate that betablockers reduced the risk of sudden death in patients with heart failure at baseline. Some studies demonstrated also the symptomatic improvement following therapy with betablockers in patients with heart failure. But the currently available data are too limited to provide conclusive information.

Adrenergic beta-Antagonists↗