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Eleven percent of 905 consecutive patients with acute myocardial infarction admitted to the coronary care unit at Duke University Medical Center experienced cardiac arrest. Subgroups of patients at high and low risk for cardiac arrest were identified. Cardiac arrest was experienced by 17 percent of patients with signs of heart failure on admission but by only 3 percent of patients without diabetes mellitus, prior myocardial infarction or heart failure by history or on admission. Only 59 percent of patients with cardiac arrest survived hospitalization compared with 88 percent of those without cardiac arrest. Long-term survival for the 765 hospital survivors was significantly greater in the group without than in the group with arrest at each yearly interval from 1 through 5 years; the 2 year survival rate was 50 and 77 percent, respectively, in these two groups. Many of the deaths among the hospital survivors occurred in patients with signs of heart failure during hospitalization. Among 668 hospital survivors who had mild or no heart failure during hospitalization, cardiac arrest continued to be a significant predictor of mortality. The mode of death among hospital survivors did not differ in the groups with and without cardiac arrest; for example, the incidence rate of sudden death in the two groups was 44 and 37 per cent, respectively. In light of recent reports suggesting that the prophylactic use of antiarrhythmic agents can virtually eliminate virtually fibrillation during the hospital phase of acute myocardial infarction, we contend that such use may substantially reduce both long-term and hospital mortality after acute myocardial infarction.
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PMID:Cardiac arrest complicating acute myocardial infarction: predictability and prognosis. 83 30

In order to study the relationship between the fatty acid composition of adipose tissue and coronary heart disease (CHD), 34 consecutive male patients with acute myocardial infarction and 33 hospitalized men free of CHD were compared. Patients with diabetes mellitus, endocrine disorders, liver and kidney diseases, recent changes in body weight and deviations from the "normal", customary diet were exlcuded. A statistically significant difference between the two groups was observed only in stearic acid, its proportion being lower in CHD patients (3.25% vs. 4.13%). Using multivariate discriminant analysis, age discriminated best between the groups, followed by stearic acid. The signs observed were positive for the former and negative for the latter. All other acids, relative body weight, and skinfold measurements did not significantly contribute to the discrimination. Age did not correlate with the proportion of stearic acid. Blood lipids from samples taken within 24 h of admission did not significantly differ between the groups. Three months later they had risen considerably in the infarct patients. The metabolic basis of the relationship between CHD and stearic acid is not clear at present. Additional studies are necessary to substantiate the importance of this acid as an indicator of CHD.
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PMID:Fatty acid composition of adipose tissue in patients with coronary heart disease. 83 46

1463 patients with acute myocardial infarction were treated in 26 hospitals in Northern Germany from June 1972 till August 1973. The time elapsed between onset of symptoms and admission to the regional hospital was similar in rural patients and those living in cities. 39% were admitted later than 12 hours after onset of symptoms. Having survived the prehospital phase the age of infarction did not influence the mortality. The treatment in the different hospitals was in no way standardized, except the treatment with streptokinase. Regarding this procedure, the following results can be presented. The overall mortality was 25.8%. Mortality was higher in cases of high age, preexisting myocardial failure, diabetes mellitus and in cases of shock and/or arrhythmia. Anterior wall infarction showed a higher mortality than posterior wall infarction. In this study the average results of treating 1463 patients with acute myocardial infarction treated in Northern Germany were presented.
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PMID:[Investigations of the clinical course of acute myocardial infarction. II. Epidemiological facts (author's transl)]. 84 Jan 18

The standard test for sensitivity of insulin was conducted in 20 patients with acute large-focal myocardial infarction, and in 9 of them it was repeated 3 weeks later. The study includes only those patients who had no diabetes mellitus symptoms prior to the admission to the clinic, and whose immediate relatives were free of this disease. The test was conducted in the morning on an empty stomach, insulin was administered intravenously by infusion of 5 U/l m2 of body surface. Blood sugar measurements were made in samples procured 10, 20, 30, 45, 60, 90 and 120 min. following insulin administration. The blood sugar level was determined by the orthotoluidine method. In patients with acute myocardial infarction less distinct and slower deceleration of the reduction of the blood sugar level was noted in response to the intravenous insulin injection than during the repeated examination on the 22nd-24th day of the disease, which indicates a decreased sensitivity of insulin during the acute period of myocardial infarction. Reduction of insulin sensitivity seems to be one of the causes of frequent carbohydrates metabolism disorders in patients with acute myocardial infarction.
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PMID:[Sensitivity to insulin in acute myocardial infarct]. 85 71

Fifty patients who suffered from an acute myocardial infarction at age 40 or below and underwent coronary arteriography, were studied from 8 to 184 months after the infarction (mean follow-up 56 months). Hyperlipidaemia (60%) and cigarette-smoking (82%) were the most common risk factors, while hypertension and diabetes mellitus were found in 10% of all patients. Thirty-seven patients had two or more risk factors. Preinfarction angina was present in 7 subjects. Death rate was 14% within five years and was related to the severity of symptoms. Out of the patients with normal coronary arteriogram (6 patients) or with a single vessel disease 21 were free of angina and 30 did not suffer a reinfarction. Out of 17 patients with two or more coronary vessel disease, angina was present in 14 and reinfarction was seen in 5.
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PMID:[Myocardial infarction in the young: evolution and clinico-coronarographic correlation (author's transl)]. 87 96

Ventricular ectopic beats (VEB) were studied in 100 consecutive patients prior to discharge after an acute myocardial infarction and again after 1 yr, on 6-h recordings. VEB were found in 71 patients prior to discharge. Reinfarction and sudden death taken together were significantly more common in the 35 patients who had severe VEB, i.e. multiform, paired, R-on-T or ventricular tachycardia (P less than 0.05). Reinvestigation after 1 yr of 73 survivors who had not reinfarcted revealed a nonsignificant overall increase in patients with VEB from 67 to 78% together with an increase in degree of severity. The intraindividual pattern, however, differed considerably. Several clinical findings including angina pectoris, heart fialure, hypertension, diabetes mellitus, hyperlipidemia, antiarrhythmic therapy, and smoking, failed to differentiate patients with increasing VEB severity from the remainder.
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PMID:Ventricular arrhythmias prior to discharge and one year after acute myocardial infarction. 89 82

50 non-diabetic patients, less then 70 y.o. and with fasting blood sugar (FBS) subsequently proved to be normal, consecutively admitted to the Coronary Care Unit by the 10th hour of acute myocardial infarction (AMI), have been studied. Blood sugar (BS) and white blood cell count (WBC) on admission and serum CPK every four hour until the 36th hour, have been determined. Oral glucose tolerance test (OGTT) has been performed at least one week later, when FBS has been determined. In 16 patients with normal OGTT the test has been repeated twice, 4 to 15 months later, before and after a cortisone load. Data have been statistically computed. Mean blood sugar on admission was significantly higher then mean FBS. No correlation was found between BS and WBC neither between BS and maximal CPK. No significant difference has been found between the mean BS on admission among 25 patients with normal OGTT and the one among the remaining 25 patients with abnormal OGTT. The OGTT was confirmed to be normal in the 16 patients belonging to the former group, who had the test repeated, with a single exception as far as the cortisone-OGTT is concerned. The above results are consistent with the opinion that the hyperglycemia usually observed during the first hours of AMI, is related to the acute medical stress and in no way indicates subclinical and/or latent diabetes.
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PMID:[Hyperglycemia in acute myocardial infarction (author's transl)]. 92 58

The relation between mode of therapy and mortality rate and incidence of primary ventricular fibrillation was studied in 265 patients with diabetes mellitus and acute myocardial infarction. Sixty patients were being treated with diet only, 54 were receiving insulin and 151 were taking oral hypoglycemic agents. Fourteen patients (5.3 percent) had primary ventricular fibrillation, and all but one died. No statistically significant association was found between the incidence of primary ventricular fibrillation and the type of treatment for diabetes mellitus. Sixty-four (24.2 percent) of the 265 patients died during hospitalization. Mortality was greater among diabetic patients receiving oral therapy. However, after adjusting for age and sex, the difference among these three treatment regimens did not reach the P less than 0.05 level of significance.
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PMID:Diabetic treatment and primary ventricular fibrillation in acute myocardial infarction. 93 81

A series of 597 consecutive patients with acute myocardial infarction (AMI) have been screened for diabetes mellitus (DM). Six per cent of the series had DM, which is exactly the frequency of DM in an age-matched population. This finding corresponds with results of other investigators, indicating that treated diabetics do not have an increased risk of AMI. Diabetics suffering from AMI do not have an increased mortality, nor do patients treated with oral antidiabetics have a higher mortality than those treated with insulin.
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PMID:Diabetes mellitus and acute myocardial infarction. 97 Feb 22

The various aspects of the sexual life of 100 female patients aged 40-60 with acute myocardial infarction were compared with those of a control group of 100 female patients of the same age, hospitalized for other diseases. Sexual frigidity and dissatisfaction were found among 65% of the coronary patients as compared with 24% of the controls. The commonest cause for sexual dissatisfaction was premature ejaculation or impotence in the husband. The incidence of premarital sexual relations was greater among the frigid patients when compared with those who achieved orgasm. The coronary patients had an earlier menopausal age than the controls. The number of coronary patients who underwent artificial abortions in the past was lower than in the control group. All these findings were statistically significant at a level of P less than 0.05. No connection was found between extramarital relations and sexual frigidity. There was no relation found between sexual frigidity and diabetes, essential hypertension, marital status, pathological gynecological findings, or localization of the infarction. Until now, sexual frigidity and dissatisfaction appear to have been a neglected aspect in the female coronary patient.
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PMID:Sexual life and sexual frigidity among women developing acute myocardial infarction. 100 33


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