Non-Q Myocardial Infarction (NQMI) is considered to be an unstable condition with increased risk of recurrent infarction. Thus aggressive approaches in management have been recommended. However, there is no firm evidence that this strategy influences the course of NQMI patients favourably. To determine the experience at Groote Schuur Hospital all patients admitted to CCU from 1990 to 1993 with NQMI were analysed retrospectively especially with regard to management and outcome. One-hundred and eighty-one patients were admitted with NQMI. Seventy-eight percent (141) remained cardiovascularly stable in the early period after the index event; 51% (93) underwent cardiac catheterisation during that hospital admission and revascularization was performed in 29% (52). There were 2 deaths during the initial hospital admission, both after surgical revascularisation. At one year the cardiac mortality was 7%. There were 23 cardiac deaths in all. Early readmission for symptomatic recurrence of ischaemia was identified as a risk factor (p=0.004). By one year 51% of patients had developed recurrence of symptomatic ischaemia, the majority (62%) in the first 3 months after the primary admission. There was a significantly reduced recurrence in those patients managed actively (i.e. cardiac catheterisation with/without revascularization) as compared to those treated conservatively (p=0.001).

Background. Recently rodent and porcine bone marrow stromal cells (MSCs) have been reported to be uniquely immune tolerant. In order to confirm these findings in human cells, we tested the hypothesis that human MSCs are also immune tolerant, such that they can be useful as "universal donor cells" for myocardial regenerative therapy. / Methods. Immunocompetent female rats underwent left coronary ligations (n=90). They were randomized into 3 groups. In Group I, lac-Z labeled male human MSCs were implanted into the peri-infarcted area. In Group II and III isogenic rat MSCs or culture medium were injected respectively. Echocardiography was carried out to assess cardiac function, and the specimens were examined serially for up to 8 weeks with immunohistochemistry, FISH and PCR to examine MSCs survival and differentiation. / Results. Human MSCs were found to survive within the rat myocardium without immunosuppression. This was confirmed by PCR and FISH test. No cellular infiltration characteristic of immune rejection was noted. Some of these cells appeared to express cardiomyocyte-specific markers such as troponin-Ic and connexin-43. Furthermore, the implanted MSCs significantly contributed to the improvement in ventricular function and attenuated LV remodeling. / Conclusions. Human MSC survived within this xenogeneic environment, and contributed to the improvement in cardiac function. Our findings support the feasibility of using these cells as "universal donor cells" for xeno- or allo-geneic cell therapy, as they can be tested, prepared and stored well in advance for urgent use. Allogeneic MSCs from healthy donors may be particularly useful for severely ill or elderly patients whose own MSCs could be dysfunctional. / Plusieurs études ont récemment démontré la tolérance immunologiquedes cellules souches stromales (CSS) issues de rongeurs et de porcinés. Pour confirmer cesrésultats chez les cellules humaines, l'étude actuelle évalue l'effet des CSS humaines sur larégénération du myocarde chez des rats immunocompétents et étudie la possibilité d'utiliserces CSS comme « donatrices universelles» à la suite d'un infarctus.

No description available.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the degree of Master of Science in Medicine, 2014 / The earliest possible initiation of reperfusion therapy is necessary to reduce morbidity and mortality from acute STEMI. Therefore improving the time to thrombolysis where percutaneous coronary interventional facilities are limited or do not exist is critical. The most effective system would integrate three key components to deliver continuous patient care, including: 1) from time of call for help through to emergency response; 2) transportation to and admission to hospital; 3) assessment and initiation of thrombolytic therapy. The purpose of this prospective study is: to develop a chest pain awareness education programme appropriate for the South African context; to assess safe initiation of thrombolytic therapy by emergency care practitioners for STEMI; and to compare the performance of emergency care practitioner thrombolysis with historical control data.

The advent of intravenous thrombolytic agents has revolutiontzed the management of patients with acute myocardial infarction and has dramatically altered the morbidity and mortality associated with this condition. The aims of this study in patients presenting with acute myocardial infarction and treated with thrombolytic agents are: 1. To evaluate the efficacy of thrombolytic agents used at Groote Schuur Hospital in terms of (a) patency of the infarct related artery; ( b) short and long-term mortality. 2. To assess the feasibility and safety of combining intravenous beta-adrenergic blockade with intravenous thrombolytic therapy in patients presenting with acute nyocardial infarction. 3. To assess the need for coronary angiography in all patients treated with thrombolytic agents for acute myocardial infarction. 4. To assess the effect on mortality of offering coronary angioplasty or coronary artery bypass grafting only to those patients manifesting spontaneous or inducible ischaemia post infarction.