Cases reported "Myocardial Infarction"

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1/15. Marked ST elevation after successful PTCA for acute myocardial infarction.

    Prompt reperfusion of acutely ischemic myocardium appears to be the rational way of reversing ischemic injury and limiting the extent of eventual necrosis. Recent advances in emergency coronary bypass surgery, percutaneous transluminal coronary angioplasty (PTCA) and thrombolytic therapy have provided methods for effective treatment of acute myocardial infarction. However, several observations indicate this issue is more complex. Although blood flow must be restored to ischemic myocardium if it is to survive, animal experiments suggest potential deleterious effects associated with this reperfusion. These deleterious effects may be associated with unstable ST segments reported early after acute infarct thrombolysis. Though recurrent coronary occlusion cannot be excluded, reperfusion injury in this setting of coronary artery patency must be considered. This case illustrates this proposed reperfusion injury reflected as "tombstone" ST segment elevation in a patient following successful acute infarct PTCA.
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2/15. Psychosocial influences on heart rhythm in the coronary-care unit.

    This report is an extension of previous studies which have shown that significant heart rate and rhythm changes can occur in coronary-care patients during a variety of socio-clinical interactions. Results of continuous day-long observations and concurrent monitoring of one such coronary-care patient disclosed that twice as many ectopic beats occurred during routine nursing interactions compared to resting periods, even though such interactions accounted for less than half of the total observation period. These results are similar to previous studies that have shown that the frequency of ectopic beats can be significantly altered in coronary-care patients by such routine interactions as pulse palpation. Combined with other clinical and animal studies, these data suggest that psycho-social interactions can have major effects on cardiac functioning.
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3/15. On the electrocardiographic diagnosis of biventricular infarctions.

    To diagnose posterior and anterior biventricular infarctions it is necessary to record from right and left thoracic and high abdominal unipolar leads. These supplementary leads are dependable, can be repeated as many times as needed and show the evolution from signs of myocardial injury to those of dead tissue (Q waves of 0.04 sec or more). This electrocardiographic evolution increases the diagnostic value of the electrical exploration, since the injury current can be observed also in other conditions. The diagnosis of right ventricular infarction can be established even in the presence of RBBB. Signs of a dead zone in the free right ventricular wall are more frequently observed in posterior biventricular infarctions than in anterior ones. In these cases, the signs of subepicardial injury are more accentuated in the right thoracic unipolar leads than in V3, indicating anterior right ventricular involvement. These signs are also observed in experimental studies made in animals. This electrocardiographic exploration opens a wide field for the diagnosis of myocardial infarction, particularly in biventricular involvement, including old myocardial scars, and in discarding signs of pericarditis manifested only by the upward displacement of the ST segment. A review of the medical literature concerning diagnosis of biventricular infarctions is presented.
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4/15. Percutaneous autologous myoblast transplantation in the treatment of post-infarction myocardial contractility impairment--report on two cases.

    Numerous animal experimental studies as well as the initial human experience have shown that autologous skeletal myoblast transplantation into area of post-infarction left ventricular injury results in an increase in segmental contractile performance related to contraction of cells differentiated from transplanted myoblasts. We have previously introduced skeletal myoblast transplantation performed at the time of coronary artery bypass grafting. Currently, we report the first two cases in poland of percutaneous autologous myoblast transplantation in the treatment of post-infarction heart failure. The procedures were performed using a catheter system enabling intra-myocardial injections from the lumen of cardiac veins under intravascular ultrasound guidance. Lack of major procedural complications and expected benefits from myocardial regeneration in patients with post-infarction heart failure justify initiation of phase one clinical trial to evaluate this method.
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5/15. acute coronary syndrome and crystal methamphetamine use: a case series.

    "ice" is a form of methamphetamine commonly used as a recreational drug in hawaii and the philippines, but seldom encountered in the continental united states. It differs in appearance from methamphetamine tablets, but otherwise has exactly the same molecules, only arranged in a crystalline structure. A sizeable body of in vitro, animal, and autopsy data suggest a linkage between methamphetamine use and myocardial pathology. In this report, we describe a series of eight patients who developed unstable angina or acute myocardial infarction in association with smoking crystal methamphetamine. The findings, to a large extent, resemble those with cocaine-associated acute coronary syndromes. Given the widespread abuse of methamphetamine among young age groups, the recognition and primary prevention of cardiovascular toxic effects is of mounting socioeconomic importance.
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6/15. ST segment alternans during coronary angioplasty.

    Four patients with severe proximal or mid-LAD stenosis were noted to have ST alternans during balloon angioplasty. Neither mechanical alternans nor increased ventricular ectopy were noted. In contrast to prior descriptions in animals or patients with variant angina, ST alternans did not occur following a premature ventricular contraction. Frequent use of calcium channel blockers during PTCA may interfere with the mechanism leading to electrical alternans and its consequences as seen in animal studies, accounting for the low frequency with which this phenomenon is noted during PTCA.
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7/15. Surgical treatment of ventricular arrhythmias using epicardial, transmural, and endocardial mapping.

    In 3 patients with ischemic coronary disease or primary myocardiopathy who were unresponsive to conventional and experimental antiarrhythmia therapy, surgical treatment of intractable ventricular tachycardia was performed using epicardial, transmural, and endocardial mapping techniques. An experimental canine model of acute and chronic myocardial ischemia with recurrent ventricular tachycardia was developed to refine the mapping technique for clinical use. In patients and animals alike, atrial overdrive pause pacing, premature ventricular pacing, or both were used to bring outa repeatable pattern of tachycardia. Mapping techniques distinguished the irritable focus so that surgical excision of the site of earliest activation could be performed. In addition, the mapping techniques were used in the validation following excision. The limitations of epicardial mapping alone in locating all areas of premature focus are discussed, and the need for mapping in ventricular aneurysm is demonstrated.
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8/15. Immune complex deposition and coronary vasculitis in systemic lupus erythematosus. Report of two cases.

    Extramural coronary arteries were examined in two patients with systemic lupus erythematosus (SLE). Coronary vasculitis was found in both patients. One patient with clinically and serologically inactive SLE had died suddenly and was found to have a myocardial infarction secondary to the coronary vasculitis. Immunopathologic studies demonstrated immune reactants in the walls of inflamed and noninflamed arterial segments in a pattern consistent with immune complex aggregates. Immunologic injury secondary to immune complex deposition may be responsible for the development of coronary disease in patients with SLE. This has been demonstrated in experimental animals but not in humans. Although this is an uncommon complication of SLE, it represents a cause of sudden death and a potentially treatable lesion in this patient population. Its occurrence may be related to the deposition of immune aggregates in the walls of coronary vessels.
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9/15. Future directions for clinical investigation in thrombolytic therapy.

    Experiments in animals have shown that coronary artery reperfusion limits the extent of myocardial damage and brings about late return of regional contraction and overall left ventricular function over a period of several weeks. Such studies provide a basis for optimism that similar effects can be demonstrated after thrombolytic treatment in man, and such functional contractile recovery should provide an important end point in clinical investigations. However, before the initiation of a large-scale clinical trial, adequate methods for determining salvage of myocardium must be identified, and since changes in such measures may be small, the use of mortality as an end point should also be considered. In addition, the possibility of having two treatment groups to compare intracoronary and intravenous modes of therapy should be examined. Based on the growing number of uncontrolled clinical reports concerned with the success of intracoronary thrombolysis in restoring vessel patency and preliminary data on morbidity, mortality and potential improvement in left ventricular function with this procedure, planning for a randomized clinical trial sponsored by the National Institutes of health is warranted.
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10/15. Isolated left posterior fascicular block associated with acquired ventricular septal defect.

    Isolated left posterior fascicular block in the absence of associated right bundle-branch block is a rare electrocardiographic finding. In view of its anatomy and the fact that it receives a dual blood supply, the posterior fascicle of the left bundle branch appears to be less vulnerable than the anterior fascicle or the right bundle. Mechanical disruption of the posterior fascicle can produce isolated left posterior fascicular block. This has been demonstrated in animal models. However, such occurrence has not been noted in humans. We present two cases of inferior wall myocardial infarction, complicated by rupture of the inferior septum, resulting in isolated left posterior fascicular block. The development of isolated left posterior fascicular block complicating myocardial infarction may, therefore, serve to alert to the possible underlying septal rupture.
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