Radionuclide imaging of the myocardium with technetium-99m-labelled pyrophosphate (PYP) is a sensitive method for the diagnosis of a recent (2 - 7 days old) myocardial infarct. Although the sensitivity of planar imaging with PYP is more than 95% for recent transmural infarcts, it varies between 30% and 95% in non-transmural infarcts. It has, however, been shown that single photon emission computed tomography (SPECT) considerably enhances the sensitivity of this technique in patients with proven non-transmural infarcts. In the present study SPECT is evaluated in patients with a doubtful diagnosis of a recent myocardial infarct.
The level of plasma fibrinogen, a risk factor for stroke and coronary heart disease, is reported to increase with age. It is not known whether this increase is an 'eugeriatric' process, influenced by time only, or whether' underlying chronic disease in the elderly is responsible. In this study, plasma fibrinogen levels of 113 'healthy', well-nourished elderly white subjects (mean age 71,5 ï¿½ 5,4 years in men and 72,5 ï¿½ 5,5 years in women) were compared with that of 20 - 30, 31 - 45 and 46 - 64-year-old men (N = 279) and women (N = 172) of the same ethnic and socio-economic background. Mean levels of the elderly men (2,50 ï¿½ 0,71 g/l) and women (2,24 ï¿½ 0,49 g/l) were not higher than levels of the younger subjects. The results suggest that reported raised fibrinogen levels in the elderly may be because of underlying chronic disease and not because of the ageing process per se.
At least 6 prospective epidemiological studies have provided evidence that a raised plasma fibrinogen level is a major and independent risk factor for coronary heart disease, myocardial infarction and stroke. The plasma concentrations of fibrinogen are reviewed. Smoking habit, hyperlipidaemia, use of oral contraceptives, job stress and insulin resistant states, such as obesity and diabetes mellitus, are all associated with raised levels. Measurement of plasma fibrinogen could possibly improve the ability to predict future cardiovascular events in individuals. Treatment of raised levels through changes in lifestyle, such as stopping smoking and losing weight, may lead to better primary and secondary prevention of cardiovascular disease in high-risk individuals. However, standardisation of methodology, establishment of normal ranges, and more research on lifestyle factors and therapeutic measures that influence levels are urgently needed.
New data on the inheritance of progressive familial heart block type 1 (PFHB1) does not favour the theory that the original immigrant (founder of PFHB1 families) introduced the genetic abnormality into South Africa and suggests that a new mutation in family member b6 (Fig. 1) was possibly responsible for the origin of the disease. If the mutation occurred in family member b6, this would reduce the number of affected family members from a previously estimated 9 000 to a mere 860 with a revised prevalence of 1:5 000 South Africans of European descent.
Protection against myocardial infarction (MI) has always been an important goal in cardiology, since the cell damage is irreversible, and the morbidity and mortality in patients who suffer MI correlate directly with the size of the infarct. Numerous strategies have been shown to protect the heart against ischaemia in experimental animals, such as use of calcium blockers and anti-oxidants, but clinical trials have not been able to prove any such beneficial effects.