Left ventricular non-compaction (LVNC) is a rare cardiomyopathy, which is today, due to modern ultrasound technology more frequently detected in clinical practice. It is caused by the failure of ...normal embryonic development of the myocardium from loosely arranged muscle fibers to the mature compacted form of myocardium. Morphologic presentation consists of unique two-layered structure, a thick noncompacted endocardial and a thin compact epicardial layer, in infero-lateral and apical segments. The endocardial layer contains loosely arranged muscle fibers, prominent trabeculations and deep perfused intertrabecular recesses. It could be diagnosed both as an infantile or adult type, appearing sporadically or among families where it is transferred x-linked or autosomal dominant. The recognition of the disease is mandatory because of its high mortality and morbidity due to the progressive heart failure, thromboembolic events and lethal arrhythmias. Echocardiography is the procedure of choice to confirm the diagnosis and in the follow-up of patients with LVNC. A literature review about LVNC pathogenesis, diagnostis, and treatment was discussed.
Approximately half of the patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (LVEF>50%). Diastolic dysfunction is an abnormality in left ...ventricular myocardial relaxation and/or compliance that alters the ease with which blood is accepted into the left ventricle during diastole. Elevated pressures in the left atrium are compensatory, ensuring adequate filling. All patients with systolic dysfunction have concomitant diastolic dysfunction. Indeed, in patients with CHF and reduced systolic function the level of diastolic dysfunction influences the severity of symptoms. It is now clear that hypertension, coronary artery disease and other diseases and conditions commonly produce diastolic dysfunction in the absence of significant systolic dysfunction. Accurate noninvasive Doppler-echocardiographic assessment of the presence and severity of diastolic impairment is crucial to the broad application and understanding of this common condition. This review discusses the clinical impact of classic and recent echocardiographic contributions to the field of diastology.
BACKGROUND: There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjust*ing for age and other prognostic factors. Therefore, we ...investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI. METHODS: The data were obtained from a chart review of 3382 consec*utive patients, 1184 (35%) women (69.7±10.9 years) and 2198 (65%) men (63.5±11.8 years) with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression. RESULTS: Unadjusted in-hospital mortality was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other base-line differences (hypertension, diabetes mellitus, hy*percholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy) decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortal*ity after the first AMI. Women were dying more often because of me*chanical complications--refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycar*dia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01). CONCLUSION: Our results demonstrate significant differences in mech*anisms of in-hospital death after the first AMI in women and men, sug*gesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-re*lated differences in susceptibility to cardiac arrhythmias following acute coronary events.
Nekompaktna lijeva klijetka (NLK) rijetka je kardiomiopatija, koja se danas znatno češće otkriva u kliničkoj praksi zahvaljujući suvremenoj ultrazvučnoj dijagnostici. Bolest je uzrokovana zastojem ...normalne embrionalne pretvorbe endomiokarda iz mreže isprepletenih mišićnih vlakana u zreli kompaktni miokard. Morfološki se manifestira jedinstvenom dvoslojnom strukturom miokarda, koju čine unutarnji hipertrofični nekompaktni i subepikardijalni tanki kompaktni sloj, najčešće u inferiolateralnim i apikalnim segmentima lijeve klijetke. Unutarnji sloj tvori isprepletena masa mišićnih niti i trabekula s protočnim intertrabekularnim recesusima. Dijagnosticira se u infantilnom i adultnom obliku, koji se javljaju sporadično ili u obitelji, spolno vezano, odnosno autosomno dominantno. Prepoznavanje ove bolesti bitno je zbog visokog pobola i smrtnosti uzrokovanih progresivnim zatajivanjem srca, tromboembolijskim incidentima i malignim aritmijama. Ehokardiografija je metoda izbora u dijagnozi i praćenju bolesnika s NLK. U radu su sažeti najnoviji literaturni podatci o patogenezi, dijagnostičkim postupcima i liječenju ove bolesti.
ln 1976-1997, the breeding biology of the Dipper was studied in the Zasavje region (central Slovenia). 238 nests were found, each of them built in the immediate vicinity of a watercourse, in most ...cases under a bridge (40% of the nests). Nests are built by females from mid-February to the end of Mareh. They are completed in a week and their average size is 25 by 23 cm. Clutches consist of 3 to 6 eggs (4.7 on average), which measure 26.3 by 18.8 mm on average and weigh 4.6 g. The Dippers breeding in Slovenia have one to two clutches per year. The peak as far as egg-laying for the first clutch is concerned is reached in the second half of Mareh. The eggs are laid only two weeks after the young from the first clutch are fledged, which means that the peak of egg laying in the second nest is reached in the first two thirds of May. The egg-laying procedure (performed only by the female) lasts for 14-15 days. 4.1 young hatch on average and after 3 weeks 4.0 young are fledged. Just hatched young weigh 4 g, just fledged ones some 5.5 g. The growth rate is the highest between their fifth and eleventh days (4.5 g per day). In case of danger the nest is left up to five days earlier. The Dipper is today most endangered by the anthropogenic changes in watercourses and along them.
The aim of this study was to determine the pattern of myocardial infarction (MI) incidence regarding the age, gender, infarction site and the most important risk factors. Between 1989 and 1997 there ...were 3454 patients hospitalized in coronary care units of Clinical Hospital Split. In the three-year period preceding the war, from 1989-1991, 1024 patients were hospitalized because of MI. During the three years of full was activities, from 1992-1994, there were 1257 patients (significantly more, p < 0.05), and in the three-year period after the was, from 1995-1997, there were 1173 patients. In the war period there were 12% (151) patients under the 45 years of age (p < 0.05); of that number, 95% (143) were men (significantly more than in other two periods, p < 0.05), and 5% (8) were women. In the period preceding the was there were 6.5% (66) patients under the 45 years; 91% (60) men and 9% (6) women, whereas in the period after the war there were 7.5% (88), 92% (81) and 8% (7), respectively. The patients under 45 (305) more often had MI of inferior than anterior site (49 vs. 28%, p < 0.001), whereas there was no difference in patients over 45 (36 vs. 37%, p > 0.05). The patients over 45 had significantly higher hospital mortality (21 vs. 4%, p < 0.001), and were more likely to have hypertension (51 vs. 15%, p < 0.001) as well as hypercholesterolemia (54 vs. 14%, p < 0.001). Smokers were more prevalent among those under the 45 (75 vs. 51%, p < 0.001). The number of hospitalized patients with MI was the greatest during the war period. It included significant increase in incidence in men under 45 (12 vs. 7%, p < 0.05), with smoking as the most important risk factor, especially for infarctions of inferior site.
We have studied the incidence of possible triggers of the myocardial infarction regarding its site in 750 patients with anterior and 731 patients with inferior infarction. Infarctions occurred most ...frequently without recalling any triggering activity, especially in patients with anterior infarction (67 vs. 44%). Physical effort as the possible precipitator was also more frequent in anterior infarctions (22 vs. 16%). However, the onset of inferior infarction was more frequent during meteorological stress (9 vs. 2%), emotional stress (10 vs. 3%), after overeating (13 vs. 3%) and nicotine abuse (6 vs. 1.5%). These triggers were independent and highly significant (
P<0.02 in each case) discriminators of the site of myocardial infarction. Bimodal circadian rhythm, with primary peak between 6 and 9 h a.m. and the secondary peak between 3 and 6 p.m. was observed in patients which did not recall any triggering activity, and this was more pronounced in patients with inferior infarction. These results support the hypothesis that the influence of the vegetative tone is most pronounced in the onset of myocardial infarction of inferior wall.
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