Clinical Picture
and Tactics of Treatment of Non Q-Myocardial Infarction in a Specialized Hospital
Matoušková J., Aschermann O., Formánek P., Henyš P., Stárek A., Niederle P.
Kardiologické oddělení Nemocnice Na Homolce, Praha, přednosta doc. MUDr. P. Niederle, DrSc. |
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Summary:
The authors present an analysis of all patients treated at the cardiological department of the
hospital Na Homolce in Prague on account of the diagnosis „non Q-myocardial infarction“ during
the last two years and the period from the beginning of 1999 till Dec. 8, 2000 resp.
During this period a total of 294 patients were hospitalized with the diagnosis of acute
myocardial infarction. Among them an unequivocal „primary“ non Q-infarction was diagnosed
in 44 patients (= 14.9% of the total number of infarction treated in the department) who were
also included in this review.
The authors investigated the time from the onset of complaints to admission to hospital and
subsequently the onset of invasive examinations, site of the infarction, ECG, ECHO and
laboratory findings, as well as intervention and conservative treatment and the incidence of
complications.
As to sites non Q-myocardial infarction of the anterior wall predominated with only slightly
impaired kinetics (hypokinesia) in the affected area and only with a mildly reduced left
ventricular function. The course of hospitalization was in most instances not complicated, the
patients were discharged on the third to fifth day. Invasive examination was made in 75%
patients incl. 55% who were catheterized within six hours after admission. As to intervention,
angioplasty of one or two arteries predominated (64% patients). The mortality was 2.2%.
Pharmacological treatment involved above all administration of low-molecular heparin, aspirin, possibly nitrates and beta-blockers. 77% patients had hypolipidaemic treatment where
statin administration predominated.
In the discussion the authors analyze the approach to patients with this diagnosis. The authors
recommend invasive examination in the maximum number of patients after non-Q-myocardial
infarction along with thorough prevention. The most suitable period of catheterization has not
been firmly established, it depends on the clinical condition of the patient and his reaction to
initial conservative treatment. The authors consider catheterization by the third day of
admission as optimal.
Key words:
Q-myocardial infarction - primary treatment - angioplasty.
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