In the frame of the attendance to patients with specific myocardial diseases differences are found in contrast to groups of patients, in particular of older age. The complex diagnostic clarification, including myocardial biopsy, is recommended. Convalescent treatment is of priority. Because of the bad prognosis of patients with impaired left-ventricular function, in particular patients with normal or slightly impaired left-ventricular ejection fraction should be mobilised using complex rehabilitative measures (psychologist, welfare worker) only after some longer convalescent treatment. Decisions as to sanatorium treatment or on further special therapeutic principles have to be made individually.
The authors examined the heart rate regulation by means of rhythmography during and after dynamic exercise in 90 normal subjects aged between 20 and 89 years and in 15 older man who went in for endurance training. It was shown that the quality of the regulation of the cardiac rhythm deteriorates in the course of aging. This is associated with the impairment of the vegetative influences on the sino-atrial node on aging. Physical endurance training contributes to the regulation of the cardiac rhythm in persons at older age.
The thromboticgenesis and the close time dependence of the development of the acute myocardial infarction (AMI) are decisive findings of the dynamic development in the past ten years. Therapy started in time including the elimination of the thrombotic coronary occlusion as soon as possible leads to the reperfusion of the vessel affected by the infarction and thus to the limitation of the size of the myocardial infarction. Because of the temporally limited tolerance of ischaemia of the myocardium, an efficient thrombolytic therapy (TT) with an objectifiable improvement of the left-ventricular function (ejection fraction global-EFg) is possible up to the 4th ApS hour. The median value of the maximum creatine kinase activity (CKmax) time was 11.8 h with effective TT; with ineffective TT 21.5 h (p less than 0.001). There is no significant difference of the CKmax-t between the age groups (less than 60 and greater than 60 years). CKmax significantly differentiates between the deceased and ineffective/effective TT (p less than 0.001). Monitoring the EFg shows significant differences in the deceased (16.3), ineffective TT (34.0), and effective TT (42.5%) both in the acute phase and in the first weeks after AMI by the dynamism of the EFg. So, - EFg was verified to be 6% with effective TT to - EFg to be 1.6% (absolute) with ineffective TT. The percentage of cases of death was restricted also for patients greater than 60 years. After effective TT less patients are found in the high and medium risk group after AMI. 70% of the patients had an effective TT.(ABSTRACT TRUNCATED AT 250 WORDS)
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