Coronary arteriographic findings in cocaine abuse-induced myocardial infarction.

A 31-year-old black man was admitted with an acute anterior myocardial infarction 20 minutes after IV cocaine abuse. Cardiac catheterization showed a totally occluded left anterior descending artery. Intracoronary and intravenous streptokinase resulted in thrombolysis: repeat angiography showed a normal anterior descending.

Exercise thallium 201 scintigraphy in evaluating aortocoronary bypass surgery.

Thirty patients with recurrent symptoms after aortocoronary bypass graft surgery underwent angiography as well as exercise thallium 201 imaging. Exercise imaging has been shown to be highly specific (100 percent in our study) in evaluating patients after bypass surgery. Patients with complete revascularization have normal thallium 201 images.

Exercise thallium 201 imaging. Clinical implications of normal exercise images.

To determine whether normal exercise images can reduce the need for coronary arteriography, we analyzed our data on 102 patients with normal thallium 201 exercise images who underwent coronary arteriographic studies. Eight-two patients had normal or insignificant coronary artery disease; 20 patients had significant coronary artery disease. Eight patients had disease limited to one of the secondary branches of the left system; seven patients had disease limited to one of the major coronary arteries; two patients had disease involving the right coronary artery and a secondary branch; two patients had disease involving two secondary branches; and one patient had disease involving the three major vessels.

Ruptured sinus of Valsalva aneurysm: diagnosis by echocardiography.

Fluttering of the right side of the interventricular septum noted on M-mode echocardiography in association with a bulging of the right sinus of Valsalva detected by two-dimensional echocardiography were present in a patient. These two echocardiographic findings should alert the clinician to a diagnosis of a ruptured sinus of Valsalva aneurysm.

Two dimensional echocardiographic recognition of the descending thoracic aorta: value in differentiating pericardial from pleural effusions.

The course of the descending thoracic aorta has recently been visualized with two dimensional echocardiography and its presence confirmed with contrast studies. In the parasternal short axis view, we used the location of the descending thoracic aorta to differentiate pericardial from pleural effusions in 40 patients. Sixteen patients, each with an isolated pericardial effusion, had an echo-free space between the descending thoracic aorta and left ventricular posterior wall.