Cardiology Update 1999

Overview

In autumn 1999 results of two well-controlled studies were published that are consistent with a frequent associationbetween Helicobacter pylori seropositivity and coronary heart disease (CHD). Concerning the therapy of CHD,attention is mainly focused on new thrombolytic agents, bypass grafting (CABG) and balloon angioplasty (PTCA).In patients with intractable angina where aggressive medical therapy was exhausted and who were no longercandidates for CABG or PTCA, transmural laser revascularisation (TMLR), enhanced external counterpulsation(EECP) and spinal cord stimulation can be considered. TMLR was shown to improve symptoms but not myocardialperfusion; the preoperative mortality accounts for 10-20 %. In hypertrophic obstructive cardiomyopathy, alcohol-induced trasmural septal myocardial ablation (PTSMA) reduces both the symptoms and the left ventricular outflowtract gradient. Although the prevalence of hypertension emergencies has dramatically diminished, the number ofhypertensive patients with heart failure and end-stage renal disease is increasing. It is important to detect and treatmild hypertensives in early stages, especially diabetics and younger women with additional risk factors and/orproteinuria. The choice and dosage of drugs is to be individualised. In chronic heart failure (CHF), the protectiveeffect of ACE inhibitors, metoprolol and carvedilol has been repeatedly shown in CHF stage NYHA II and III. Themerit of ACE inhibitor and b-blockers in high doses remains questionable in old patients and those with severe CHF(NYHA IV). In the latter indication, spirolactone was successfully reintroduced. Eplerenone (epoxymexrenone) isa new aldosterone antagonist with little affinity to other steroid receptors and has therefore less undesirable effectsthan spirolactone. The body of knowledge in therapeutic and technical progress in medicine of the 20th century aresummarised and their positive and negative consequences briefly discussed.

Key words:
Helicobacter pylori, coronary heart disease, transmural laser revascularisation, enhanced external