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We describe a case of a 59-year-old male with permanent VT in the course of an acute coronary syndrome. Coronary angiography revealed acute occlusion of the right coronary artery. Although the underlying condition was treated by implantation of 4 stents with excellent haemodynamic effect (TIMI 3), the tachycardia continued, being refractory to drugs (amiodarone). The attempts to restore sinus rhythm by DC electrical cardioversion or transvenous pacing were unsuccessful. The patient was referred to the EP lab. A critical isthmus localised at the paraseptal region of the LV and parallel to the mitral annulus was identified. The isthmus was closed by linear RF application, resulting in VT termination. Due to impaired LV ejection fraction (<30%) the patient was scheduled for ICD implantation. During 6-week follow-up the patient remained free of arrhythmia.

Background: Mortality in acute myocardial infarction (MI) complicated by cardiogenic shock approaches 90%, regardless of the type of pharmacological treatment., Aim: To assess in-hospital and mid-term results of invasive treatment of patients with acute MI with ST segment elevation (STEMI) complicated by cardiogenic shock., Methods: From a prospective registry of all patients admitted to our institution for urgent coronary angiography due to acute coronary syndrome between February 2001 and June 2002, patients with STEMI, symptom duration up to 12 hours and cardiogenic shock diagnosed on admission were identified. The in-hospital and mid-term outcome of 37 patients (mean age 65 years, range 54-77, 68% of males) treated with primary percutaneous coronary intervention (PCI) was analysed., Results: Of the 41 patients with STEMI and cardiogenic shock, total occlusion or critical stenosis of a coronary artery were found in 38 patients. One patient with the occlusion of three main coronary arteries underwent urgent surgical revascularisation and remains alive after an 18-month follow-up. In the remaining 37 patients primary PCI of an infarct-related artery was performed (stent implantation in 70%, abciximab administration in 54%) which restored normal blood flow (TIMI grade 3 flow) in 54% of subjects. In patients with TIMI grade 3 flow the in-hospital mortality was 25%. Of the whole PCI-treated group, 18 (48.6%) patients died during stay in our institution, an additional two - after transfer to another hospital, and one - during a 19-month follow-up period. The remaining 16 patients remain alive (median follow-up of 8 months)., Conclusions: Invasive treatment of patients with STEMI complicated by cardiogenic shock significantly reduces mortality in this high-risk population. The mid-term results in patients discharged from hospital are good. Invasive treatment of acute MI should be accessible for all patients with extensive acute MI.

Background: Short-acting calcium channel blockers (Ca-blockers) have been shown in some studies to increase the risk of myocardial infarction (MI) and post-MI complications. Data from large, international, randomised studies such as the INJECT trial may bring new important information on the effects of medication used before MI, on the course of MI and post-MI complications., Aim: To assess the effects of beta-blocker and Ca-blocker therapy administered prior to MI on the early and late outcome after MI., Methods: The study group consisted of 6001 patients with acute MI treated according to the INJECT protocol. The patients were divided into four groups according to the type of treatment before the index MI: Group I (n=580) - patients treated with beta-blockers; Group II (n=831) - patients treated with Ca-blockers; Group III (n=277) - patients treated with both beta-blockers and Ca-blockers; and Group IV (n=4313) - no beta-blocker or Ca-blocker treatment. The analysed end-points were 35- and 180-day mortality as well as angina recurrences, occurrence of heart failure, atrial fibrillation/flutter and asystole., Results: During hospital stay, supraventricular arrhythmias, asystole, recurrent ischaemia and heart failure occurred more frequently in patients from groups II and III than in other groups. Early mortality was significantly higher in group II (p<0.001) and group III (p<0.002) than in group IV. Late mortality was the lowest in group IV, followed by group I. Cox proportional hazards multivariable analysis revealed that hypotension, Killip class IV (p<0.001), previous Ca-blocker (p<0.01) or Ca- and beta-blocker treatment (p<0.01) as well as previous MI (p<0.05) were the independent predictors of death., Conclusions: Compared with beta-blocker therapy or no treatment, previous use of Ca-blockers increases both early and long-term complication rates in patients with MI.

This article presents a case of 45-year-old man with polycythemia vera non diagnosed before. The first symptom of polycythemia vera was acute congestive heart failure which suggested diagnosis of myocarditis. Polycythemia vera was confirmed by raised hematocrit, significantly increased platelet count, normal oxygen saturation, score for leukocyte alkaline phosphatase (LAP)-130 and splemomegaly. Echocardiography revealed left ventricular histological. Coronary arteriography showed normal coronary arteries. Finding of histological examination of the endomyocardial biopsy were described as necrosis of myocytes and abnormal blood flow in very small coronary vessels. It was the main reason of dilated cardiomyopathy caused by microinfarcts in polycythemia vera. Hematological parameters were reduced to normal levels after hydroxyurea treatment. Digitalis and ACE-inhibitor therapy quickly improved cardiovascular status from III to II NYHA class.

There was presented the case of a bronchial asthma attack in 29 years old patient with congestive heart failure and a history of atopic bronchial asthma in 30th minute after 12.5 mg of captopril administration.