The therapy of acute myocardial infarction: current state of the art.

For decades management of acute myocardial infarction (AMI) consisted of bed rest, oxygen, prevention for thromboembolic complications, and treatment of arrhythmias and heart failure. In the last years a more aggressive treatment of AMI has been developed, based on the following three basic principles: (1) Mortality of patients with AMI is determined by the infarct size and the degree of left ventricular dysfunction. (2) The time interval between the onset of coronary occlusion and any intervention to limit infarct size is brief and takes usually not more than three to four hours.

Evaluation of three methods for quantifying valvular regurgitation using gated equilibrium radionuclide ventriculography.

The non-invasive quantification of mitral and aortic regurgitation using the left-to-right stroke count ratio (SCR) calculated with gated equilibrium radionuclide ventriculography (RNV), is affected by the overlap of atria and ventricles and the consequent difficult definition of the ventricular regions of interest (ROI). Various solutions of the problem have been proposed. In this study we evaluated the results obtained with a technique based on visual inspection of the RNV images (variable ROI method--VRI) and those of two approaches which utilize functional images (stroke volume image method--SVI--and Fourier amplitude ratio--FAR), by comparing them with the invasive quantification of valvular regurgitation according to Sandler et al.

Changes in left ventricular diastolic function during exercise in patients with coronary artery disease.

In 10 controls and 43 patients with coronary artery disease (CAD) left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurement at rest and during bicycle exercise. During exercise ventriculography 20 patients had angina pectoris, and 16 patients were asymptomatic. At rest there were no akinetic segments in 28 patients, and at least one akinetic segment was found in 15 patients.

Fatty acid metabolism in symptomatic patients with mitral valve prolapse but without coronary artery disease--comparison with 201Tl myocardial perfusion scintigraphy.

Using 123I-omega-heptadecanoic acid (HDA) and 201Tl, respectively, myocardial fatty acid metabolism and perfusion were studied in 51 symptomatic patients with mitral valve prolapse (MVP) as diagnosed by ventriculography, and no evidence of coronary artery disease. Twelve subjects with normal coronary arteries and normal ventriculogram served as a control group for the evaluation of elimination kinetics of HDA. In the control group, the mean elimination half-life was 26.

[Right ventricular stroke volume--comparison of various methods of angiography and equilibrium radionuclide ventriculography].

In 21 patients with various heart diseases RVEF was measured angiographically and by radionuclide ventriculography. Using biplane angiocardiography evaluation was performed by 7 different methods (Simpson's rule, Dogde, Arcilla, Ferlinz, Duebel). Using equilibrium RNV, evaluation was performed by 9 modifications of analysis.

A prospective placebo-controlled double-blind multicenter trial of intravenous streptokinase in acute myocardial infarction (ISAM): long-term mortality and morbidity.

Long-term mortality and morbidity of 1,741 patients with acute myocardial infarction, treated with intravenous streptokinase (1.5 million IU/h) or placebo, was assessed in a double-blind placebo-controlled trial (ISAM). At the 7 month follow-up, 94 (10.

Fatal outcome of aortocoronary bypass grafting in a 62-year-old man with unsuspected coronary arteritis.

A 62-year-old man was admitted to our hospital with unstable angina. The coronary arteriography showed the occlusion of the left anterior descending artery and other stenotic lesions. The patient underwent an aortocoronary bypass operation, but unfortunately he did not survive.

Fibrinolytic activity in renal venous blood in man.

In 50 patients without renal insufficiency, fibrinolytic activity, as reflected by euglobulin lysis time, was determined in blood obtained from the renal veins, the renal artery and a peripheral vein. Fibrinolytic activity was found to be significantly higher in the renal veins than in the renal artery and the peripheral vein. Other coagulation and fibrinolysis parameters did not show such differences.

[Occlusion of the common trunk of the left coronary artery. Physiopathological features and clinical findings].

The total occlusion of the left main coronary artery is rarely observed (approximately 0.05% of coronary angiographic studies). We have tried to draw the clinical and pathophysiological outline of this condition, starting from our experience and reviewing the published reports.

[Acute coronary angiography in therapy-refractory angina pectoris].

Unlabelled: Emergency coronary angiography was performed in 188 patients with treatment-resistant unstable angina. Criteria analysed were: duration of angina less than 72 h; angina despite heparin and nitroglycerin infusion; no significant S-T segment elevation in the ECG; creatine-kinase rise up to 150 U/l. Coronary heart disease (CHD) was found in 130 patients (group A).

Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities.

Patients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). We performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ventriculography (99mtechnetium), and perfusion scintigrams (201thallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams.

[Valvuloplasty and peripheral angioplasty with coronary dilatation catheters].

The further development of coronary balloon catheters has encouraged their use for dilating small vessels of other organs and stenoses in larger vessels not passable by conventional catheters. The technique was used successfully as a primary intervention in two stenoses of the external carotid artery preparatory to extra-intracranial anastomosis, in four anastomotic stenoses in three patients with Blalock-Taussig anastomosis, and in a subtotal anastomosis of a Cimino shunt. After failed dilatation attempts with a standard dilatation catheter in three patients with four renal artery stenoses and two with subclavian artery stenosis, coronary angioplasty catheters successfully dilated the stenoses.

[Follow-up of patients with anterior wall aneurysms using radionuclide ventriculography].

32 patients with a large anterolateral aneurysm were studied by using biplane ventricular angiography and rest and exercise radionuclide ventriculography (gated-blood-pool method). The correlation coefficient of biplane ejection fraction by angiography and radionuclide ventriculography was poor (r = 0.65), but repeated investigations and interobserver comparison showed nearly identical values, therefore we used the gated-blood-pool method (GBP) for follow-up investigations in patients with an aneurysm of the anterolateral wall.

Underestimation of left-ventricular ejection fraction by radionuclide ventriculography in patients with aneurysm.

The left-ventricular ejection fraction (LVEF) of 72 patients with aneurysm of the anterior wall was measured by multiple gated blood pool acquisition (MUGA) in the anterior and left anterior oblique (LAO) positions, and by cineangiography (CA) in right anterior oblique (RAO) and LAO projections of 30 degrees and 60 degrees, respectively. The LVEF was overestimated by CA in the LAO projection and by MUGA in the anterior position, but underestimated by CA in the RAO projection (6.1 percentage points) and by MUGA in the LAO position (6.

[Slow flow in the coronary system and ST elevation in the ECG in left atrium catheterization].

A complication of transseptal left atrial catheterization is a transient ST-elevation in the ECG with unknown cause. In this case simultaneous angiography showed a so-called "slow flow" of dye dilution in the coronary artery. A coronary spasm or an embolic occlusion of the coronary artery could be excluded.

[Occlusion of the right coronary artery with acute right heart infarct and cardiogenic shock].

In a 42-year-old patient with an acute inferior infarction the right coronary artery was recanalised by intracoronary streptokinase 4 hours after the onset of symptoms. In spite of early reperfusion the patient developed an extensive myocardial infarction and died three days later from cardiogenic shock. Autopsy revealed an almost complete necrosis of the right ventricle including the inferior interventricular septum and the adjacent left ventricular wall.

Analysis of left ventricular regional motility: a comparison of different methods.

Multiple gated blood pool (MUGA) and contrast ventriculographic studies were performed within 24 h in 80 patients, 20 with 120 normokinetic wall segments and 60 with wall motion abnormalities in 239 of 360 wall segments. Three methods of evaluation of the radionuclide ventriculograms were compared with the results of the biplane contrast ventriculography which served as a standard: (1) qualitative analysis of the cine mode, (2) analysis of parametric scans (amplitude and phase images) and the phase histogram obtained by Fourier analysis, (3) quantitative determination of regional ejection fraction. Normal values were obtained from 20 patients with normal wall motion in the contrast angiogram.

[Prognostic value of thallium scintigraphy in diagnostic problem cases].

Quantitative myocardial scintigraphy was performed in 40 patients with a medium prevalence of coronary artery disease (CAD), i.e. in cases with diagnostic difficulties.

[ECG changes and angina pectoris due to direct current from a defective cardiac pacemaker].

The case of a 73-year-old patient whose external cardiac pacemaker produced a constant direct current is reported. The patient had severe angina pectoris, and the ECG showed marked QT prolongation and deformation both of the QRS complex and of the ST-T segments. Both angina and ECG changes disappeared when the defective pacemaker was replaced.