My o Genic Theory

8/12/2019 My o Genic Theory

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Stress: the triggering factor of cardiovasculardisease

The Myogenic Theory

of Myocardial Infarction

Fourth International Conference on

Advanced Cardiac Sciences

King of Organs, 2012Kingdom of Saudi Arabia

Carlos Monteiro

Infarct Combat Project

http://infarctcombat.org


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"The coronary patient does not die from coronary disease, he

dies from myocardial disease.*

!urch "# and col.$ Ischemic cardiom%opath%$ Am &eart '. ()*+ Mar,-0:12342


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Coronary Thrombosis: Cause or Consequence

of Myocardial Infarction?

It is important to note the coronar% thrombosis theor%$ introduced b% 'ames !r%an &erric5$ in ()(+$

remains suffering serious doubt on its cause and effect relationship.

6his has led Friedberg and &orn to suggest in ()) that the term coronar% thrombosis should be

abandoned in favor of the more generic one of acute m%ocardial infarction. In their paper the% sa%

that 7the clinical and electrocardiographic features of coronar% thrombosis ma% be observed in

patients in 8hom a coronar% arter% thrombus is subse9uentl% not found at necrops% as has been noted

b% ibman$ ;bendorfer$ !uchner$ &amburger and Saphir$ and &orn &. Acute m%ocardial infarction not due to coronar% arter% occlusion. '. Am Med Assoc

()),((+(*0:(?*43(?*)


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()1(0 &ermann and colleagues found the thrombotic occlusion could occur 8ithout infarction

8hen the collateral circulation appeared ade9uate and if an infarct has happened$ it could be

attributed to an occlusive thrombus at a critical location in the coronar% tree.

Angina Pectoris$ coronar% failure and acute m%ocardial infarction: 6he role of coronar% occlusions and

collateral circulation$ 'AMA ()1(,((?+0:)(3)*, Multiple fresh coronar% occlusions in patients 8ith

antecedent shoc5$ Arch Intern Med ()1(,?-+0:(-(3()-, #@perimental studies on the effect of temporar%

occlusion of coronar% arteries, 6he production of m%ocardial infarction$ American &eart 'ournal ()1( ++,I

3*13-)0

()4(0 Miller and colleagues pointed out that subendocardial infarcts 8ere rarel% associated 8ith

coronar% thrombi.

M%ocardial infarction 8ith and 8ithout acute coronar% occlusion: A pathologic stud%. AMA Arch Intern

Med ()4(,--40:4)*3?210


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()?20 Spain and !radess found complete coronar% obstruction of atherosclerotic

nature$ representing around of *4B of the cases and recent coronar% thrombosis

in just +4B of the autopsied cases. Also$ the% have observed crescent incidence

of coronar% thrombosis 8ith the crescent duration of survival after the

m%ocardial infarction. ess than a hour 8ith (?B of thrombosis$ bet8een ( and

+1 hours 8ith *B and in more than +1 hours 8ith 4+B of coronar%

thrombosis.

Spain$


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()*20 &ellstrom demonstrated e@perimentall% the coronar% thrombosis secondar% to

acute m%ocardial infarction caused b% ligature of the coronar% arter%.

&ellstrom$ &D. M%ocardial infarction as a cause of coronar% thrombosis. Circulation$ 1+$ Suppl.

III0, (?4$ ()*20

()*+0 Eilliam Doberts suggested that the coronar% arterial thrombi are conse9uences

rather than causes of acute m%ocardial infarction. In his stud% involving (2* patients

8ho 8ere submitted to necrops% he found that onl% 41B of those 8ith a transmural

infarction$ and onl% (2B of those 8ith subendocardial necrosis$ had a thrombus in the

infarct related arter%.

Fre9uenc% of coronar% thrombosis related to duration of survival from onset of acute fatalepisodes of m%ocardial ischemia$ Circulation$ ++:-(?$ ()?2, Doberts$ E.C.:, Coronar% arteries in

fatal acute m%ocardial infarction$ Circulation$1+:+(4$ ()*+$ Doberts E. C.0


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()-20


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+2240 "iorgio !aroldi and colleagues$ discussing the findings from


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+22(0 In a significant number of cases angioscopic e@amination continues to find thrombus

on the presumed culprit lesion$ at ? months after m%ocardial infarction.

Kasunori Jeda$ Masanori Asa5ura$ et al. +22(. 6he healing process of infarct3related pla9ue: Insights

from (- months of serial angioscopic follo83up. Am Coll Cardiol$ -:()(?3()++.0

())-0 Mura5ami and colleagues from 'apan using intracoronar% catheters to aspirate

occlusive tissues$ performed during the acute m%ocardial infarction$ have confirmed the

pathological findings that intracoronar% thrombus is absent in a substantial number of patientsindicating it contributes little to the pathogenesis of average acute m%ocardial infarction.

Mura5ami 6. Intracoronar% aspiration thrombectom% for acute m%ocardial infarction$ Am. ' Cardiolog%

())- ;ct (,-+*0:-)3110


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+2240 Dittersma and colleagues e@amined retrieved thrombus material aspirated using the

percutaneous thrombectom% catheter in +(( patients undergoing primar% percutaneous

coronar% intervention 8ithin si@ hours of s%mptom onset. 6he% then established$ b%

histological indicators$ the age of the aspirated thrombi. 6he researchers found thrombus in

()) of the +(( patients$ of 8hom fresh thrombus 8as identified in just under half. !% contrast$

4(B of patient samples contained thrombus that had l%tic or organiLed changes suggestingthat it had originated da%s or 8ee5s before the occlusive event. 6he% said that 7Stri5ingl%$

clinical characteristics did not differ bet8een the patients 8ith fresh thrombus and those 8ith

olderN thrombus$ although men 8ere more li5el% to have fresh thrombus than 8ere 8omen.=

Dittersma SO&$ van der Eal AC$ >och >6$ et al. Pla9ue instabilit% fre9uentl% occurs da%s or 8ee5sbefore occlusive coronar% thrombosis. A pathological thrombectom% stud% in primar% percutaneous

coronar% intervention. Circulation +224, (((:((?23((?4


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6he PASSI; trial$ recentl% published$ found that the use of thrombus aspiration in

adjunct to primar% percutaneous coronar% intervention PPCI0 did not affected rates

of major adverse cardiac events at + %ears follo83up$ as compared 8ith convencional

PPCI. So$ based in this stud%$ it is fair to sa% that thrombus aspiration do not prevent

the occurrence of the m%ocardial infarction.

Martin A in5$ Maurits 6


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Coronary Thrombosis: Cause or

Consequence of Myocardial Infarction?

M%ocardial infarction associated 8ith normal coronar% arteries is a 8ell 5no8n

condition. 6he overall prevalence rate of m%ocardial infarction 8ith normal

coronar% arteries is considered to be lo8$ var%ing from (B to (+B depending on

the definition of normal7 coronar% arteries.

egrand $


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())0 Arbustini and colleagues found in a series of (+ autopsies of hearts from

patients 8ho died of noncardiac causes$ that coronar% thrombi 8ere sho8n tooverla% the intima of a coronar% vessel independentl% of pla9ue t%pe and

severit%.

Arbustini #$ "rasso M$


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A recent 7State3of3the3Art= revie8 and commentar% published at the 'ournal of

the American College of Cardiolog% made the follo8ing conclusion:

7A large bod% of evidence conclusivel% suggests that coronar% arter% obstruction

is onl% ( element in a comple@ multifactorial pathoph%siological process that

leads to Ischemic &eart


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Prof. Dr. uintiliano !. de Mesquita"

#ra$ilian Cardiologist and Scientist

;ne of the major developments of


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Introduction and %undamentals

of the Myogenic Theory

6he coronar% atherosclerosis and slo8 coronar% flo8 in the normal e@tramural coronaries develop

m%ocardial ischemic process through the imbalance bet8een demand and blood suppl% to the

m%ocardial segments$ dependent on the right and left coronar% arteries. !asicall%$ the large e@tramural

coronar% arteries are responsible for nutrition of the segmental m%ocardium and mainl% b% the

contractile balance of each segment of the ventricular 8all.

#ver% time 8hen is developed a relative coronar% insufficienc% through ph%sical or ps%cho3emotional

stress results in an immediate loss of contractilit% of the ischemic area and simultaneous e@altation ofother unaffected contractile ventricular segments.

6he continuit% of such repetitive ischemic manifestations tend to contribute to the installation of

nons%nergic segments$ b% ischemia Q loss of contractilit% and overload imposed b% the remaining

intact ventricular segments$ during the ventricular ejection phase.

6hus$ the coronariopath% contributes to the deterioration of the ventricular segment$ constituting areas

of m%ocardiosclerosis or segmental m%ocardial disease$ possible future site of the m%ocardial

infarction.

!oo5 7M%ogenic 6heor% of M%ocardial Infarction=$ ()*).


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Myogenic Theory MechanismThe sequence of events

Coronary Atherosclerosis

Slo8 Coronar% Flo8

R

Stable Angina Pectoris Silent Coronariopath%

(3 Delative M%ocardial Ischemia

+3 Deciprocal Contractile oss

R

Ph%sical and Ps%cho3#motional Stress Factors

/ or Pharmacological Factors 3 egative Inotropic Agents

R

Segmental Myocardial Disease


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Myogenic Theory MechanismThe sequence of events

Segmental Myocardial Disease R

Jnstable Angina/ Intermediate S%ndrome

Infarcting Clinical Pictre

(3 Degional M%ocardial Insufficienc%

+3 Deciprocal M%ocardial Ischemia

R

Primar% M%ocardial ecrosis

!Infarction"

R Coronar% Stasis or Fragmentation and


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&''ro'riated terms to the myogenic

theory of myocardial infarction

6he term 7coronar%= has become s%non%mous 8ith ischemia and it is used todefine an atherosclerotic occlusive lesion that is believed to be responsible for

all clinical patterns.

So$ inside the sense of the m%ogenic theor% of m%ocardial infarction I 8ill ta5e

the libert% to use some terms more ade9uated to it li5e 7coronar%3

cardiom%opath%= or 7coronar%3m%ocardial disease= rather coronar% heart

disease$ coronar% arter% disease and= acute m%ocardial s%ndromes= rather acute

coronar% s%ndromes.


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Stress and acute myocardial syndromes

Several studies have sho8n a close connection bet8een catecholamine and

m%ocardial infarction. 6he h%peractivit% of the s%mpathetic nervous s%stem$ 8ith

an intense outflo8 of catecholamines adrenaline/epinephrine and

noradrenaline/norepinephrine0 also occur in unstable angina$ alternativel% called

preinfarction angina or intermediate s%ndrome$ being smaller and less long than in

acute m%ocardial infarction. 6a5otsubo cardiom%opath%$ also 5no8n as bro5en

heart s%ndrome$ a sudden temporar% 8ea5ening of the m%ocardium$ 8hich

simulates an evolving m%ocardial infarction clinical picture$ li5e8ise has am

intense outflo8 of catecholamines.

Increased cardiac s%mpathetic nervous activit% in patients 8ith unstable coronar% heart

disease$ McCance A'$ 6hompson PA$ Forfar 'C. #ur &eart ' ()) 'un,(1?0:*4(3* ,

S%mpathetic neural h%peractivit% and its normaliLation follo8ing unstable angina and acute

m%ocardial infarction$ "raham $ Smith PA et al. Clin Sci ond0 +221 'un,(2??0:?243((0


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Stress: The main ris( factor for &cute

Myocardial Syndromes

Acte stress !or stress o#erload"

!e%ond intense ph%sical activit%$ particularl% in sports competition$ or unusual

efforts$ surpassing the limits of his/her heart conditions$ or else the heav% use of

stimulant drugs$ there are man% ris5 factors for acute m%ocardial s%ndromes$based on recent severe stress situations or sudden emotional stress$ li5e:

Marital separation or divorce$ loss of 8or5 or retirement$ loss of revenue or

business failure$ important famil% conflicts$ important personal injur% or illness$

death or illness of a close famil% member$ shoc5 of a surprise part%$ armed

robber% or other 5ind of violence$ heated discussion$ threats or acts of 8ar$earth9ua5es$ to trac5 the team of preference in matches live football$ etc


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Cardiotonic: The com'atible drug )ith

the Myogenic Theory

6he recent discover% of endogenous cardiotonic hormones digitalis$ strophanthin$ proscillaridine$ etc..0$ isolated from

human tissues and bod% fluids$ ma% represent a strong ne8 argument for the m%ogenic theor% of m%ocardial infarction.

An elevated concentration of endogenous cardiotonics have been found under different conditions such as sodium

imbalance$ h%pertension$ cardiac arrh%thmias$ chronic renal failure$ congestive heart failure and acute m%ocardial infarction.

igorous ph%sical e@ercises as 8ell ph%siological stress situations ma% also elevate the concentration of endogenous

cardiotonics in the bod%.

Ee thin5 the cardiotonics found in nature ma% complement a deficient production of endogenous cardiotonic hormonesproduced b% the human bod% and thus support cardiac metabolism and protect the heart from the infarction$ as proposed in

M%ogenic 6heor%.

T#o uotes related to these findings%

The diseased heart is avid for cardiotonics

&uintiliano '. de Mesuita, ())

Cardiotonics are the insulin for cardiovascular disease

+arlos Monteiro, !


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The use of cardiotonics for coronary

heart disease during the *+th century

()(+0 'ames &erric5: Proclaimed the m%ocardial infarction MI0 as conse9uence

of coronar% thrombosis and cardiotonics digitalis and strophanthin0 as the best

therap%. &e declared: 6he timel% use of this remed% ma% occasionall% save

live.

()+?0 ouis &amman: Shared in same concepts and enthusiasm of &erric5

regarding the use of cardiotonics to treat the MI. &e said: 6he patient should be

promptl% and full% digitaliLed... not onl% is the digitaliLed heart better prepared

to 8ithstand the added burden of certain arrh%thmias should the% come on$ but it

is also stimulated to put forth its better efforts. &o8 desirable the best efforts

ma% be 8hen a large area of heart muscle is infarcted$ needs no further comment

'AMA$4): +2(4$ ()(+ , !ull 'ohns &op5ins &osp., -: +*$ ()+?0


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()10 #rnst #dens: After %ears using strophanthin b% intravenous 8a% in

angina pectoris and MI in more than (22 patients he declared: Subse9uentl% to

the recognition of the strophanthin as the best and safest medicine for the

m%ocardial infarction 8e donTt have the right to use it in a patient onl% for

scientific reasons and tests$ giving preference to other remedies losing precious

time for the cure. &e also told that 8ill come the moment in 8hich the omission

of the use of strophanthin 8ould be seen as a professional malpractice.

Munchener MediLinischen Eochenschrift, *$ ()10


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()420 Ferdinand D. Schemm: PreconiLed the use free from restraint of digitalis for MI treatment.

&e used digitalis in +?4 patients recording a mortalit% of (2B. In practice he noticed that instead

of an% m%ocardial damages$ the cardiotonic presented compatibilit% 8ith the acute m%ocardial

infarction$ reason of salutar% effects and lo8er mortalit%.

()4(0 'ohn Martin As5e%: Applied digitalis in 42 consecutive patients 8ith acute MI. Citing the

results achieved b% Schemm 8ith digitalis refers that the medical profession 8as unable to ta5e

full advantage of this valuable drug$ offering the &enr% 6horeau thought: It is never too late to

give up our prejudices. o 8a% of thin5ing ho8ever ancient$ can be trusted 8ithout proof. 6his

affirmation from As5e% 8as stated during the presentation about his results and to appreciate the

clinical and e@perimental proceedings realiLed at that time. i5e8ise he demonstrated a health%

apprehension in front of the accommodation and disinterest regarding so e@citing theme.

Postgrad Med., -4$ ()42, 'AMA, (1?: (22-$ ()4(0


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()440 orman &. !o%er: Mentioned that after an une@pected but fortunate e@perience

using digitalis b% intravenousl% 8a% ceased his fear about the use of digitalis appl%ing itstarting from this moment in a se9uence of 42 patients 8ith MI.

()*20 !erthold >ern: Erote that he used sublingual strophanthin in more than (4.222

cardiac patients during the period of ()1* till ()?- resulting in a ver% lo8 mortalit% rate

and fe8 m%ocardial infarctions.

e8 #ngland '. Med, +4+: 4?$ ()44,


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()*+0 Guintiliano &. de Mes9uita: Advocated that treatment 8ith cardiotonics should

be started the earliest possible in order to correct the regional m%ocardial collapse in

progress. &e also stated that cardiotonic administration protects the m%ocardial fibers

in collapse$ ischemic$ but viable to be 5ept from the necrosis 8hich 8ould certainl%

occur in case of non3use of this remed%. Surpassing the acute period$ the cardiotonicshould be used$ according him$ as a maintenance treatment$ 8hich blends 8ith the MI

proph%la@is$ in order to defend the ischemic m%ocardium in its functional side.


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()*10 Pritpal Puri have demonstrated that the intermediate h%pocontractile area

bet8een the infarction and normal m%ocardium responded to the cardiotonic

Strophanthin maintaining normal contractilit% starting from the the m%ocardial

ischemia and h%pocontractilit%.

()*40 !an5a and col$ confirmed the e@periments from Puri using


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()*40 PiLarello et al and Morrison et al in ()*? have sho8n the serial enL%matic

reactions using digitalis the infarction 8as halted and$ thus$ the cardiotonic might

be considered as able to rescue the viable m%ocardial fibers.

()-20 Morrison et al confirmed no change in serial creatinine M! isoenL%me in agroup of patients 8ith heart failure after m%ocardial infarction ta5ing digitalis$ in

contrast 8ith past observations made in animals follo8ing coronar% arter% ligation$

8hich have sho8n an e@tension of the area of infarction after digitalis

administration.

PiLarello D$ Deduto $ "eller >$ "ullota S$ Morrison ' Protection of the ischemic

m%ocardium in man b% digitalis. Circulation ()*4, 4(34+ suppl III0: -)4, Morrison '$

PiLarello D$ Deduto $ "ullota S #ffect of digitalis on predicted m%ocardial infarct siLe.

Circulation ()*?, 4341 Suppl II0: (2+, Morrison '$ Coromilas '$ Dobbins M et al


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()-20 Peter Schmidsberger$ medical journalist: Deport the results obtained b% Professor

Mes9uita in !raLil informing that Dolf


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())40 eor ' and colleagues found in patients recovering from m%ocardial

infarction that one %ear mortalit% 8as significantl% higher among patients treated

8ith a full dose \() of ((+ (*B0] than patients treated 8ith a lo8 dose ofdigo@in \( of 1( +B0]

eor '$ "oldbourt J et al.


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,ld citations about the use of digitalis in

heart disease

- #ish it #as as easy to #rite upon the Digitalis - despair of pleasing myself

or instructing others in a sub/ect so difficult. -t is much easier to #rite upon a

disease than upon a remedy. The former is in the hands of nature and a faithful

obser0er #ith an eye to tolerable /udgment can not fail to delineate a li1eness2the latter #ill e0er be sub/ect to the #hims, the inaccuracies and the blunders of

man1ind". 3illiam 3ithering, 4etter, Sep !), ($

Digitalis% A 5od6gi0en remedy7 by 8riedrich 4ud#ig Kreysig 9erlin, ($(:

Digitalis% The opium of the heart7 by ;ean 9aptiste 9ouillaud


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Dissociation bet)een the severity of

stenosis and the ris( of infarction

6he ris5 of a heart attac5 or other acute m%ocardial events is not proportional to the

severit% of coronar% stenosis. Several studies in 8hich more than one angiograph% 8as

performed in patients 8ho developed acute s%ndromes sho8ed that most of these

s%ndromes appear to be developed from lesions that on the first angiograph% caused

not significant stenosis. 6hese less severe stenotic lesions lead to m%ocardial infarctionbecause the% have not developed a sufficient collateral circulation around that 8ould

prevent or limit the e@tent of m%ocardial necrosis. 6his means that a 2B reduction in

arterial caliber ma% have an increased ris5 for a m%ocardial infarction than an

obstruction )2B.

Ambrose ' A$ 6annenbaum M A et al$ Angiographic progression of coronar% arter% disease and

the development of m%ocardial infarction$ ' Am Coll Cardiol ()--, (+:4?3?+, ittle E C et al$

Can coronar% angiograph% predict the site of a subse9uent m%ocardial infarction in patients 8ith

mild to moderate coronar% arter% disease^$ Circulation ()--, *-:((4*3??, 'ohn A Ambrose$

alentin Fuster$ 6he ris5 of coronar% occlusion is not proportional to the prior severit% of

coronar% stenoses$ #ditorial$ &eart ())-, *):310


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Collateral circulation and infarction


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Cardiotonic -ffects and Stress

In m% vie8$ in addition of positive inotropic effects over the heart muscle contractilit%$

cardiotonics ma% also have possible benefic effects for cardiovascular disease$

including in halting acute m%ocardial s%ndromes$ through the reduction of heightened

catecholamine levels in blood and in reduction of the resulting elevated lactateproduction and accumulation b% the cardiac muscle.

Schobel &P et al. ())(. Contrasting effects of digitalis and dobutamine on barorefle@

s%mpathetic control in normal humans$ Circulation -1$ (((-3((+),

M "heorgiade and < Ferguson$ ())(.


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The cardiotonic use in stable coronary

myocardial disease

6he m%ogenic theor% recommends the use of the cardiotonic Q coronar% dilator in

stable coronar% m%ocardiopath%$ 8ith or 8/out previous infarction in the long run$

complementing the beneficial and protective effects of collateral coronar%circulation in front of severe coronar% obstructions.

In short$ according the m%ogenic theor%$ cardiotonics are the anti3infarction

drugs.

#@cerpts from the paper from Mes9uita G&de et al #ffects of the Cardiotonic Q Coronar%


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myocardial disease


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myocardial disease

In a paper published in +22+$ Guintiliano Mes9uita and his assistant$ ClWudio

!aptista$ have prospectivel% anal%Led data from a period of +- %ears ()*+ 3

+2220 using cardiac gl%cosides at lo8 concentration lo8 dose0 in patients 8ith

stable coronar% arter% disease 8ith or 8ithout previous infarction . 6heir results

have sho8ed ver% lo8 rates in mortalit% and morbidit%. 6he patients 8eredivided in t8o groups...

Cardiotonic: Insuperable in preservation of m%ocardial stabilit%$ as preventive of acute

coronar% s%ndromes and responsible for a prolongued survival. Casuistr% of +- %ears ()*+3

+2220=$ Guintiliano &. de Mes9uita e ClWudio A S !aptista$ Ars Cvrandi +22+ maio0, 4: .

6e@t available at the follo8ing 8ebpage:

http://888.infarctcombat.org/+-%ears/digitalis.html


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The cardiotonic use in the stable

coronarymyocardial disease

The second gro$ inclded 1- $atients 'ith $rior infarction, $resenting in 2) yearsthe follo'ing mor*idity and mortality+

3 De3infarction: - cases 4.(B0

3 &eart failure: (* cases (2.-B0

3 &eart failure mortalit%: (* cases (2.-B0

3 Sudden


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myocardial disease

Permanent Thera$etic Maintenance

Cardiotonics em$loyed+

Proscillaridin3A 2.*43(.42mg/da%

Acetildigo@in 2.42mg/da%

anatoside3C 2.42mg/da%


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The cardiotonic use in the

unstable angina

6he m%ogenic theor% recommends the use of the cardiotonic Q coronar% dilator

in the treatment of unstable angina$ for correction of regional m%ocardial

insufficienc%$ presented as the determinant factor in the pathoph%siologicalmechanism of this alarming clinical s%ndrome$ usuall% characteriLing the pre3

infarction.

#@cerpts from the article of Mes9uita G&de et al 7#ffects of the Cardiotonic Q Coronar%


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unstable angina

.eslts

Perfect drug tolerance.

Immediate disappearance of spontaneous anginal episodes since the first injectionand in a short3term follo8ing the administration of the drug b% oral route.

Interruption of unstable angina in ()) pts,

;nl% ( case evolved to m%ocardial infarction in the eighth da%.

o deaths. #C" alterations 8ith rapid disappearance.

Arrh%thmic benign transitional manifestations +2.4B0.

Mild enL%matic changes in the first +1 hours.


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The cardiotonic in the

unstable angina

Thera$etic attac/ of nsta*le angina dring - days

Cardiotonics+

Strophanthin3> : 2.+432.1 mg/da%$ I

Strophanthin3" : 2.+432.42 mg/da%$ I

anatoside3C : 2.12 mg/da%$ I


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infarcting clinical 'icture

hy infarcting clinical $ictre

!ecause 8ith the use of cardiotonics the m%ocardial infarction can be halted as

occurred in ?.4B of the cases as sho8n in the studies b%


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.eslts

Absolute tolerance from the drug

Deduction in administration of analgesics and narcotics o8 incidence of cardiac arrh%thmias

o8 incidence of cardiac insufficienc%

o8 incidence of cardiogenic shoc5

Delative lo8ering of enL%matic reaction pea5s

o8 mortalit%

Clinical picture more calm and safe


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Thera$etic attac/ of the infarctioning clinical $ictre dring - days

Cardiotonics:

Strophanthin3> : 2.+432.1 mg/da%$ I

Strophanthin3" : 2.+432.42 mg/da%$ I

anatoside3C : 2.12 mg/da%$ I


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.eslts !Indices of clinical com$lications"+

entricular e@tras%stoles: +1.(B

3 Partial A bloc5: 4.-B

3 Complete A bloc5: 1.?B3 Atrial tach%cardia: (.*B

3 Flutter 3 Atrial fibrillation: 1.1B

3 6ach%cardia Q entricular Fibrilation: +.*B

3 As%stole: 1.4B

3 Cardiogenic shoc5: +B

3 Acute pulmonar% edema: (.B

3 &eart failure: (B

3 ;verall mortalit%: (+.+B

3 Mortalit% b% age: ).1B in patients under *2 %ears and +?.?B in patients over *2

%ears


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#oo( Myogenic Theory of Myocardial Infarction

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6his boo5 in Portuguese language ma% be do8nloaded free of charge. 6he summar% and conclusions in #nglish are at http://888.infarctcombat.org/ivro6M/parte-.htm


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/ideo and Po)er'oint 'resentations on the

Myogenic Theory of Myocardial Infarction

Kou can find recent videos and po8erpoint presentations as 8ell articles

and other information about the m%ogenic theor% at:

http://888.infarctcombat.org/M%ogenic6heor%.html

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My o Genic Theory