Differential classification of acute myocardial infarction into ST- and non-ST segment elevation is not valid or rational.

Background: The distinction between ST elevation and nonST elevation infarcts is widely accepted and is employed as a guide to management.

Aim: This is review of the world literature to assess the basis for this distinction, since the two studies on which it is based are seriously flawed in method and conclusions.

Method: Pathologic and clinical studies were reviewed from the world literature.

Initial therapy for acute myocardial infarction: socioeconomic implications and limitations.

Background: The optimal therapeutic approach for acute myocardial infarction (AMI) is still evolving; however, many would consider one of two basic options: "medical"-only thrombolysis or reperfusion, or an early (invasive), percutaneous coronary intervention (PCI). The decision about which is most appropriate depends (perhaps unfortunately) on more than just medical factors. That is, the choice for some patients is also limited by payor source and the technical capabilities at the site of the initial treatment.

Q-wave versus non-Q wave myocardial infarction: a meaningless distinction.

The whole subject can thus be summed up in two statements. 1. Every appropriately designed study comparing first Q and NQMI's has found no difference in post-MI course of the two categories and no foundation for the common notion that the NQMI is a uniquely "unstable" entity, to be classed with unstable angina in terms of prognosis and management.

Torsade de pointes and low-dose oral haloperidol.

Haloperidol, used to treat patients with psychoses, is considered minimally cardiotoxic. Several cases of torsade de pointes have been reported in association with the use of oral haloperidol. In each of those cases, a prolonged QTc preceded the torsade de pointes episode and thus may be considered a predictor for ventricular arrhythmias in elderly women treated with haloperidol.

One heart, two bodies: insight from the transplanted heart and its new electrocardiogram.

Cardiac transplantation provides a unique opportunity to record the electric field generated by a human heart in a new somatic environment. By examining pre- and posttransplantation electrocardiograms (ECGs), it is possible to address questions on the effect of rotation of the heart on its long axis on the surface ECG, the effect of thoracic anatomy on ECG voltage and predisposing factors for conduction defects observed after transplant surgery. To examine these questions, we reviewed a series of 35 matched donor and recipient ECGs.

Experience of a Wyoming county streptococcal control project.

Figures from Natrona County, Wyoming, during the period 1957-1959 and from the Papago Indian Health Service in Arizona during the years 1970-1982 indicate that a vigorous control program targeted to school children that used throat culturing to detect group A streptococci and to recommend adequate treatment effectively lowered the incidence of first attacks of rheumatic fever. Statistics from the Wyoming Department of Public Health for the years 1972-1983 recorded a consistently lower rate of rheumatic fever in Natrona County, where such a control program was maintained, than for the rest of the state, although the national decline in rheumatic fever incidence makes these figures more difficult to assess. Experience gained in these programs may be valuable for third world countries where rheumatic heart disease is still a major cause of death and disability.

Vectorcardiographic and blood pressure correlates of obstructive pulmonary diseases in a community population.

Vectorcardiography was performed on 2,449 subjects, aged six years and older, in the Tucson (Ariz) Epidemiological Study of Airway Obstructive Diseases (AOD), 95 percent of the white non-Mexican Americans in the stratified cluster population sample. The objectives were to confirm previous relationships and to determine if hypothesized changes in the vectorcardiogram (VCG) could predict AOD. Trained nurse technicians performed the VCGs, which were read and interpreted by a cardiologist.

Indications for pacing in the treatment of bradyarrhythmias. Report of an independent study group.

Indications for permanent pacing in the bradyarrhythmias are summarized. In the absence of symptoms, pacing is justified only when Mobitz type II block or complete atrioventricular (AV) block is localized in the bundle-branch system. All other abnormalities of impulse generation or conduction (incomplete AV block of any type, atrial fibrillation with slow ventricular response, or sinus node dysfunction) must be shown to be stable and intrinsic and to cause CNS symptoms or hemodynamic compromise to justify pacing.