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S Cagán

Publications and source records attributed to S Cagán.

At least 19 recordsLinked to original sources
PubMed2002

[Early diagnosis and reasons for not administering thrombolytic therapy in acute myocardial infarct].

In Slovakia we are lacking data on early (before examination of serum markers of myocardial necrosis) pertaining to thrombolytic treatment (TLL) which is inevitable in case of acute myocardial infarction (AIM) as well as data on the reasons why TLL is not implemented. This why the authors analyze the results of completed comprehensive project Audit concerned with diagnostic and therapeutic procedures in patients with acute coronary syndromes during the pre-hospital and hospital stage (AUDIT). The investigation was a perspective multi-centre study. Data were collected from 3123 patients with AIM in 66 departments (in 64 health institutions) during Sept. 16 1997 till Sept. 15 1998. The group included patients admitted within 96 hours after the development of complaints with the diagnosis or suspicion of AIM and discharged with the diagnosis of a first/repeated AIM. Early diagnosis of AIM was made in 1736 (55.6%) patients. In the AUDIT study TLL was assessed in 1074 (34.6%) patients. A marked difference between the number of candidates for TLL and the number of patients with TLL where TLL was implemented requires that in analyses of TLL in patients with AIM attention should be paid also to reasons why it was not implemented. The most frequent cause why TLL was nor implemented was late admission of the patient to hospital (in patients who attended hospital < 6 hours, TLL was not implemented in 48.5%, after admission between 6 and 12 hours in 70% and in patients admitted > 12 hours in as many as 90.8% patients), equivocal indication of TLL (in 29.9% patients) and contraindications (in 16.1% patients). The presented results are priority data on the early diagnosis of AIM and reasons why TLL was not implemented. It is part of data essential needed for elaboration of a (national) programme of better care (management) of patients with AIM taking into account also economic factors.

Contraindications↗
PubMed2002

[Effect of demographic, anamnestic and clinical factors on hospital mortality in patients with myocardial infarct].

The objective of the work was to analyze local priority data on the possible effect of demographic, anamnestic and clinical factors in a non-selected population of 3123 patients with acute myocardial infarction (AIM) on the hospital mortality (HM). 12.6% patients with AIM died in hospital. The mean age of those who died was 71.92 years. There were more than 4 times more patients above 64 years than 64-year-old ones or younger ones who died. The mortality rate of 64-year-old patients and younger ones (5.2% is significantly lower than in patients above 64 years (19%). The mortality rate of patients above 74 years was 27.1%. Important correlations of the HM were moreover found--in women, patients living permanently in rural areas, in widowed subjects, in patients with elementary education, old age, pensioners and non-smokers. The HM was lower (< 10%) in patients with a history of complex ventricular arrhythmias, impaired lipid metabolism and those who had no other serious disease in the case-history. A higher HM (> 15%) was recorded in patients with a history of a cerebrovascular attack, with data on heart failure and in diabetic patients. The majority of patients (39.4% of all who died) died within 24 hours after admission. During the first three days 57% patients died. Analysis of the characteristic of AIM and HM revealed some clinically important data on the HM less than 30% (patients with complicated AIM, with elevated ST segments, with a left ventricular ejection fraction of less than 40% and with and concurrent heart failure). An adverse course of the disease with a high HM (> 30%) was found in patients with complications of AIM. It was highest, more than 60%, in patients after implemented cardiopulmonary resuscitation, in patients with a combination of three markers of imminent shock and patients in shock. The local priority findings on the HM assembled in Slovakia in a non-selected population of patients with AIM confirm that the high HM still persists in patients of advanced age and in women. It is adversely influenced also by some demographic data, educational level, some anamnestic and clinical factors. The HM of patients with AIM may be adversely influenced also by side-effects of protracted economic transformation which is under way. Data assembled in Slovakia are comparable with similar results assembled in other countries.

Aged↗
PubMed2002

[The electrocardiogram and thrombolytic therapy in patients with acute myocardial infarct].

The objective of the submitted work is to analyze in patients with acute myocardial infarction (AIM) local priority data on ECG markers after admission to hospital, data on some associations of ECG and thrombolytic treatment and to assess in patients with the first AMI data on hospital mortality in connection with some ECG markers. The project was implemented as a prospective multicentre study. An independent audit and collection of data was done in 3123 patients with AIM in 66 departments between Sept. 16 1997 and Sept. 15 1998. The group included patients admitted within 96 hours after development of complaints with the diagnosis or suspicion of AMI who were discharged with the diagnosis of a first/repeated AMI. Elevation of ST segments was recorded in 67.1%, a Q wave in 42.2% and left bundle branch block in 3.7% of the patients. Early diagnosis of AMI based on ECG and data on prolonged stenocardia was made in 55.6% patients. This is the maximal proportion of patients where thrombolytic treatment can be contemplated. Thrombolytic treatment was not administered to 54.9% patients with elevations of the ST segments and in as many as 81.2% patients with left bundle branch block. The hospital mortality in patients with a first AMI is significantly greater in patients with elevations of the ST segment, Q infarction, anterior wall infarction, combined infarction, right ventricular infarction and in patients with bundle branch and fascicular block. It was confirmed that in Slovakia in clinical practice thrombolytic treatment is not always administered consistent with criteria adopted from randomized studies. The result is underutilization or overutilization of thrombolytic treatment to patients with AIM in clinical practice. Underutilization of thrombolytic treatment is generally known. It was demonstrated that attention must be devoted also to overutilization of thrombolytic treatment. All patients where significantly higher hospital mortality was recorded must receive special care already on admission to hospital.

Aged↗
PubMed2001

[Hospitalization of discharged patients with acute myocardial infarction in the thrombolytic era].

The objective of the work is to assess in discharged patients with AIM data on the period of hospitalization in the intensive care unit and the total period of hospitalization and how these were influenced by stratification into patients with complicated and uncomplicated AIM and patients with a low, medium and high risk. Data on hospitalization were analyzed in 2,527 discharged patients with AIM. The median of hospitalization at intensive care units was 5 days and the mean period of hospitalization 6.35 days. The significantly longer hospitalization (p < 0.001) in patients with complicated AIM (median 6 days) as compared with patients with uncomplicated AIM (median 5 days) impliesonly a one-day longer hospitalization in patients with complicated AIM. The median of total hospitalization was 17 days and the mean period of hospitalization 17.95 days. In the majority of patients the period of hospitalization was 15 - 21 days. More than 20% are hospitalized for more than 21 days. A significant difference of the total period of hospitalization in high risk patients and patients with a medium and low risk expressed in medians is only 2 days. The majority of patients in all three sub-groups of patients with AIM is dicharged between the 15th to 21st day of hospitalization. In the period of hospitalization at intensive care units and total hospitalizatiob of different sub-groups there is no substantial difference in their health status, incl. the danger of sudden cardiac death. By reducing the total period of hospitalization in discharged patients without complications it would be possible to save a considerable percentage of costs of hospitalization. The period of hospitalization must be fixed individually in every patient. In early dicharges it is important to consider also the psychosocial impact of discharge on the patient and his relatives.

Aged↗
PubMed2000

[The prehospital phase in patients with acute myocardial infarct in Slovakia. A challenge].

Better management of patients with acute myocardial infarction during the prehospital phase is at present a challenge not only for health workers but for society as a whole. The authors pay attention to knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction which is a prerequisite for finding possible solutions for a favourable effect on their management. The authors analyzed 3,040 patients who were admitted to hospital alive within 96 hours after the development of complaints with suspicion of a first or repeated acute myocardial infarction. They focused attention in particular on prehospital time delay. They found that within a satisfactory time interval (within 2 hours) 29.8% patients were delivered and within a yet acceptable interval of 4 hours 51.6% patients (with respect to effectiveness of thrombolytic treatment). Similarly undesirable are also data on the patient time delay. Within the optimal first hour after development of complaints following the decision of the patient (subjects present) to ask for or seek medical assistance was the decision of 34% patients, during the first two hours 47.5% and within 4 hours 61.2% patients with acute myocardial infarction. The ratio of time delay of the patient in the total prehospital delay is 45.5% even in patients who were admitted during the first hour after development of acute myocardial infarction. In patients who were admitted 4 hours after development of complaints it is 79.5%. The patient is admitted to hospital most quickly if he calls the medical emergency service and latest when he decides to see a doctor. Physicians and other health workers contributed only in 16.4-20.9% patients with acute myocardial infarction to their early decision to seek medical assistance. Patients with an early decision (within one hour) call most frequently the medical emergency service and are taken to hospital by this service. The time delay due to transport is shortest in these patients. The late hospital admission of patients with acute myocardial infarction in Slovakia calls for reduction of the time interval from the development of complaints to hospital admission (total prehospital delay), in particular the time taken by the patient to make up his mind (patient time delay). Early calling of the emergency medical service and transport of the maximum possible number of patients with acute myocardial infarction to hospital by the emergency medical service will greatly improve the management of patients with acute myocardial infarction. Comprehensive implementation of the survival chain (24), the most comprehensive implementation of recommendations of the European Society of Cardiology and the European Resuscitation Council for in the management of patients with acute heart attacks during the prehospital phase (21) and early effective treatment which begins already in the prehospital phase has a favourable impact on the condition of patients with acute myocardial infarction and on their prognosis. Along with early and effective treatment of patients with acute myocardial infarction in hospital and their stratification these are the most important approaches to the development and control of sudden cardiac death. Knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction is the prerequisite for the elaboration of high standard prehospital management of patients with acute myocardial infarction.

Adult↗
PubMed1996

[Use of beta-blockers in the treatment of chronic heart failure].

Recently in the world literature with increasing frequency reports are found on clinical studies investigating the use of beta-blockers in the treatment of chronic heart failure. The authors present a review of the problem comprising pathophysiological mechanisms at a receptor level up to investigations of the effect of beta-blockers on haemodynamics, the functional state of the left ventricle and survival. Although this promising and frequently controversial treatment is not accepted universally so far, partial data in the mentioned investigations indicate that when a more accurate dosage pattern is established and indications are specified in more detail, the use of beta-blockers is one way how to approach - in addition to the use of diuretics, cardiotonics and angiotensin converting enzyme inhibitors - a comprehensive therapeutic control of chronic heart failure.

Adrenergic beta-Antagonists↗
PubMed1996

[Intracoronary pressure and its significance in the clinical evaluation of patients with ischemic heart disease].

Assessment of coronary artery disease is a highly relevant problem in current cardiology. Although, coronary angiography still remains the ultimate diagnostic test to prove the presence of coronary narrowings, it is increasingly becoming obvious that a refine understanding of the atherosclerosclerotic lesions and its consequences on perfusion of the underlying myocardium requires much more than just the silhouette of the arterial lumen provided by contrast angiography. This knowledge together with the current therapeutic invasive approaches has led to the introduction of new invasive methods to demonstrate the haemodynamic significance of a given lesion. In this brief review we describe the importance, feasibility and usefulness of transstenotic pressure gradient measurements. Furthermore, we provide the description of myocardial fractional flow reserve as a new functional index for the assessment of the coronary stenosis severity and its effects on maximal myocardial perfusion. This index, by interpreting the transstenotic pressure gradient in combination with mean aortic and central venous pressure offers a complex and easy assessment of coronary haemodynamics. On the basis of our recent experience we discuss the applications of the presented concept in daily clinical practice. (Tab. 3, Fig. 4, Ref. 25.).

Blood Pressure↗
PubMed1996

[Prevention and therapy of atherosclerosis].

Atherosclerosis is a complex progressive process with high morbidity and frequent dramatic mortality. The experience from the developed countries justifies the effectiveness of atherosclerosis prevention. The combination of nonpharmacologic, antiaggregatory and antihyperlipemic prevention reaches currently the effectiveness of surgical intervention, with the exception of sudden events. On the other hand the surgical intervention does not restore the process of atherosclerosis and requires the same secondary prevention if the long term prognosis is to be improved. The review presents the guidelines on nonpharmacologic, antihyperlipemic (up to the combination of statin with fibrates) and the antiaggregatory prevention with the initial dose of ASA being 200 mg and a long term dose being > or = 30 mg of ASA/d treatment. (Tab. 4, Fig. 3, Ref. 25.)

Arteriosclerosis↗
PubMed1996

[The electrocardiogram in acute myocardial infarct in the "thrombolytic era"].

Authors presented the basic criteria for indicating thrombolytic therapy in patients with acute myocardial infarction according to literature data and their own experience regarding the judgment of changes in initial standard electrocardiogram (without any changes after administration of nitroglycerine and/or chest pain resolution). They are: 1. ST segment elevation > or = 0.1 mV, in at least two contiguous leads, 2. new or a presumably new bundle branch block, 3. ST segment depression in thoracic leads V1-V3 in the presumptive presence of acute posterior myocardial infarction. It is appropriate to repeat the recording, to perform echocardiography (or coronary angiography) and to evaluate in complexity the general clinical status in case of nonspecific changes on the electrocardiogram. Authors include a review of literature data on evaluation of cases with successful thrombolysis based on standard electrocardiogram. They emphasized strongly the meaning of a fast and sustained decrease/normalisation of ST segment and/or presence of so called reperfusion arrhythmias (namely early, frequent, repetitive accelerated idioventricular rhythm). The authors presented also the changes of QRS complex, T wave and Q-T interval with thrombolytic therapy. The evaluation of ST segment re-elevation during and after thrombolytic therapy still requires to be studied into greater detail. (Tab. 5, Ref. 65.)

Electrocardiography↗
PubMed1996

[Specialized echocardiographic modalities in the early phases of acute myocardial infarct].

The authors present the clinical contribution of specialized echocardiographic methods in the early phase of acute myocardial infarction (AMI)--stress echocardiography, myocardial contrast echocardiography, transesophageal echocardiography, as well as some latest technologic modalities (tissue doppler imaging, automatic endocardial detection, digital image processing). These methods frequently render fundamental information about the patient after AMI, but with regard to the relatively short period of their clinical use, some unsolved problems remain to be answered. Meanwhile, there exists only limited experience with specialized echocardiographic modalities after AMI in Slovakia. (Fig. 2, Ref. 53.)

Echocardiography↗
PubMed1996

[Adjuvant therapy in patients with acute myocardial infarct].

Besides the thrombolytic therapy several adjuvant therapeutic measures were identified which significantly improve the prognosis of patients with acute myocardial infarction (AMI). These measures include the treatment by means of acetylsalicylic acid (ASA), beta-blockers and ACE inhibitors. Early administration of ASA and beta-blockers are indicated in all patients with AMI who have no contraindications for this therapy. They are especially the patients with manifest heart failure or asymptomatic left ventricular dysfunction who benefit from ACE inhibitors. The effectivity of routine administration of other medicaments such as anticoagulants, nitrates, calcium channel blockers and magnesium, have not been convincingly proved. However, some selected patients with AMI can benefit from these medicaments. Intravenous administration of heparin is unambiguously justified only in thrombolysis with t-PA. Thrombolyses with streptokinase, urokinase, and anistreplase are justified only at high risk of thromboembolic complications. Their prevention and therapy include also the necessity to restrict the administration of pelentan. The use of nitrates is indicated in patients with AMI in case of sustaining stenocardia, arterial hypertension and manifest heart left ventricular failure. Until the definitive standpoint is gained regarding the effect of magnesium in patients with AIM, its administration remains especially indicated in cases of arterial hypertension, tachycardiac disturbances of the heart rhythm and states of assumed or proved hypomagnesiemia. In AMI cases when magnesium is used in order to protect the patient from reperfusion lesion, it must be administered prior to the reperfusion therapy. An intensive research in the field of therapeutical measures in patients with AMI still continues. It is certain that it will soon bring further knowledge which will in turn improve the prognosis and quality of life of patients with AMI. (Tab. 4, Ref. 133.)

Humans↗
PubMed1996

[Transthoracic echocardiography in the early phase of acute myocardial infarct].

The authors present an article reviewing the fundamental importance of transthoracic echocardiography in the early phase of acute myocardial infarction (AMI). They refer to its significance in the diagnostics and differential diagnostics statements of AMI and its complications, evaluation of left ventricular systolic and diastolic function. The authors emphasize its possibilities in risk stratification and prognostic evaluation of the patients after AMI. Regarding the valuable possibilities of transthoracic echocardiography which in a decisive manner often determine the further diagnostic and therapeutic procedures, the authors postulate that this procedure should be performed in each patient with AMI already in early phase. They consider the inaccessibility of early bed-side transthoracic echocardiography as a management failure. (Fig. 2, Ref. 72.).

Diagnosis, Differential↗
PubMed1996

[Occurrence of abnormal late ventricular potentials in myocardial ischemia and the determination of risk of sudden cardiac death in patients after myocardial infarct].

BACKGROUND: The crucial step in prevention of sudden cardiac death (SCD) is a method of a precise and most accessible identification of those patients with ischaemic cardiac disease (ICD), especially after MI, who are highly presumptive candidates of malign ventricular arrhythmias. The selection of individuals exposed to risk, and individual judgment of the threat to patients after MI is a complex problem. Patients after MI are endangered by reinfarction, cardiac failure, heart wall rupture and primary ventricular tachyarrhythmia. Stratification of patients exposed to a presumably higher risk of probable new coronary event and malign ventricular arrhythmia with an early decision to intervene, gains practical clinical significance. Similarly, it is important to identify also the patients after MI exposed to lower risk, who need no interventional therapeutical procedure. The cardiologic practice utilizes several examinatory procedures and tests, prevailingly of non-invasive character. AIMS AND OBJECTIVES: The study reviews the latest information on pathophysiology and current level of clinical interpretation of non-invasive ecg procedure from the field of high-resolution electrocardiography including the late ventricular potentials (LVP). The study is aimed at: a) presentation of a review of available information from the field of electrophysiology and clinical electrocardiography and the mechanism of impact of myocardial ischaemia on the existence of high-frequency, but at the same time extremely low-amplitude potentials abnormalities in the course of QRS complex and S-T segment (LVP), b) presentation of a review on the informative value and clinical significance produced by non-invasively detected electrophysiological heterogeneity of myocardium during ischaemia, aiding the short-term and long-term prognosis judgments in patients with ICD, especially after undergoing its most serious form--myocardial infarction. Beside the group analysis the study is also aimed at individual non-invasive judgment of risk of the development of malign ventricular arrhythmias in patients with acute coronary syndromes. (Fig. 3, Ref. 41.)

Death, Sudden, Cardiac↗
PubMed1995

[Electrocardiographic Holter monitoring in patients with ventricular pre-excitation: possibilities of its uses and pitfalls].

Holter monitoring (HM) of the electrocardiogram (ECG) is used currently for the management of patients with ventricular preexcitation (PE). It makes it possible to detect inconstant PE which is considered a marker of a favourable clinical development. HM of ECG is not suitable for the detection of paroxysmal supraventricular tachycardias (PSVT) in patients with PE, as their presence is detected only exceptionally during HM. It can be used for the detection of other disorders of the cardiac rhythm than PSVT, in particular in supraventricular and ventricular extrasystoles (SVES and VES). Frequent SVES and VES detected during HM can as potential triggers of PSVT indicate a higher risk of these arrhythmias. HM is used for the objectivization of relatively frequent, sometimes quite polymorphous subjective complaints of patients with PE. Subjective data of these patients are very unreliable and from these data it is not possible to draw conclusions on the presence or absence of disorders of the cardiac rhythm. HM of ECG is not a suitable method for the evaluation of the effectiveness of medicamentous antiarrhythmic treatment of PSVT because of their considerable spontaneous variability. It may be, however, used partly for the evaluation of success of radiofrequency ablation treatment. Evaluation of long-term ambulatory ECG Holter tracings in patients with PE is more complicated and more time consuming than in subjects without PE. In any case it is essential that the record should be evaluated by an experienced physician with sufficient knowledge in arrhythmology.

Electrocardiography↗
PubMed1995

[Ventricular tachycardia in non-ischemic heart disease].

Ventricular tachycardia (VT) is found usually in patients with structural heart disease. Its symptomatology depends on haemodynamic manifestations. ECG criteria for the diagnosis of VT are known. For the classification of VT we use morphological criteria (monomorphous and polymorphous), duration of arrhythmia (non-and sustained VT) and the pathomechanism of VT (re-entry, increased automation and triggered activity). The clinical impact of VT and the therapeutic approach depend to a great extent on the basic disease. The therapeutic results and prognostic estimates assembled in ischaemic heart disease cannot be mechanically applied in non-ischaemic heart disease. The authors mention the prevalence of VT and the approach to its treatment in dilatative cardiomyopathy, in prolapse of the mitral valve, in hypertrophic cardiomyopathy, in arrhythmogenic right ventricular dysplasia and in patients with a "normal" heart. Only collection of the necessary data and their analysis will help us to achieve better therapeutic results. In the treatment authors focus attention first of all on the pharmacological approach. They emphasize the need of thorough and comprehensive examination of the patient, draw attention to proarrhythmia. In the prevention of relapses of VT most frequently beta-blockers and amiodarone are used (either alone or combined).

Cardiomyopathies↗
PubMed1995

[Free oxygen radicals in atherosclerosis and diabetes mellitus].

Recent research suggests that reactive oxygen species (including free radicals) may be involved in the initiation and development of vascular complication in diabetics. Free radicals meet many of the criteria required for a role in the pathogenesis of diabetic vascular disease: they are present in tissues affected by the diabetic process, they have a direct toxic effect on tissues, under certain condition glucose molecules can induce free radicals production. Diabetes mellitus represents a state of increased oxidative stress which is based on evidence of increased peroxidation, glycoxidation and reduced antioxidant reserve. Glycative stress can be modified by reducing glycemia, maintaining good diabetic control, and identifying the patients in whom diabetes or impaired glucose tolerance has not been diagnosed. Strategies for reducing the oxidative stress may include the supplementation of antioxidant micronutrients (vitamins E and C, beta-carotene). At present the most appropriate dose, form, method and site of administration of antioxidants are not known. One interesting therapeutic approach for the future will be to make apo-B particles more resistant to oxidative modification or to reduce the prooxidant activity in general.

Arteriosclerosis↗
PubMed1995

Paracrine modulation of coronary vasomotor tone and myocardial performance by vascular and endocardial endothelium.

Over the last years it has become evident that endothelium is one of the most active paracrine organs releasing a number of vasoactive substances. These mediators, by acting on subjacent vascular smooth muscle, play and important role in control of vasomotor tone and of platelets aggregation. The relations between vascular endothelium and cardiovascular risk factors are complex. Functional abnormalities of vascular endothelium are probably segmental and may differ in individual cases. Experimental and clinical study has demonstrated that all cardiac endothelial cells, coronary vascular and endocardial, modulate the performance of underlying myocardium. Modulation of the left ventricular function by endothelial cells constitutes an important autoregulation of muscle-pump performance of the heart by altering the duration of contraction and diastolic function. It is likely that cardiac endothelial cells take part in extrinsic and intrinsic cardiac compensatory mechanisms and, although there is still no direct evidence, they may be closely involved in pathophysiology of heart failure in humans.

Animals↗